%0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63644 %T Leveraging Cognitive and Speech Ecological Momentary Assessment in Individuals With Phenylketonuria: Development and Usability Study of Cognitive Fluctuations in a Rare Disease Population %A Singh,Shifali %A Kluen,Lisa %A Curtis,Katelin %A Norel,Raquel %A Agurto,Carla %A Grinspoon,Elizabeth %A Hawks,Zoe %A Christ,Shawn %A Waisbren,Susan %A Cecchi,Guillermo %A Germine,Laura %+ McLean Hospital, Harvard Medical School, 115 Mill Street, South Belknap, Belmont, MA, 02478, United States, 1 6178552675, ssingh@mclean.harvard.edu %K neuropsychology %K ecological momentary assessment %K rare diseases %K metabolism %K cognition %K phenylketonuria %K PKU %K hereditary %K phenylalanine hydroxylase deficiency %K phenylalanine %D 2025 %7 3.6.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Phenylketonuria (PKU) is a rare, hereditary disease that causes disruption in phenylalanine (Phe) metabolism. Despite early intervention, individuals with PKU may have difficulty in several different cognitive domains, including verbal fluency, processing speed, and executive functioning. Objective: The overarching goal of this study is to characterize the relationships among cognition, speech, mood, and blood-based biomarkers (Phe, tyrosine) in individuals with early treated PKU. We describe our initial optimization pilot results that are guiding this study while establishing the feasibility and reliability of using ecological momentary assessment (EMA) in this clinical population. Methods: In total, 20 adults with PKU were enrolled in this study between December 2022 and March 2023 through the National PKU Alliance. Of the total, 18 participants completed an extended baseline assessment followed by 6 EMAs over 1 month. The EMAs included digital cognitive tests measuring processing speed, sustained attention, and executive functioning, as well as speech (semantic fluency) and mood measures. Participants had 60 minutes to complete the assessment. Results: Completion rates of EMAs were above 70% (on average 4.78 out of 6 EMAs), with stable performances across baseline measures and EMAs. Between-person reliability (BPR) of the EMAs, representing the variance due to differences between individuals versus within individuals, is satisfactory with values close to (semantic fluency BPR: 0.7, sustained attention BPR: 0.72) or exceeding (processing speed: 0.93, executive functioning: 0.88) data collected from a large normative database (n=5039-10,703), as well as slightly below or matching a previous study using a clinical group (n=18). As applicable, within-person reliability was also computed; we demonstrated strong reliability for processing speed (0.87). A control analysis ensured that time of day (ie, morning, afternoon, and evening) did not impact performance; performance on tasks did not decrease if tested earlier versus later in the day (all P values >.09). Similarly, to assess variability in task performance over the course of all EMAs, the coefficient of variability was computed; 28% for the task measuring sustained attention, 37% for semantic fluency, 15.8% for the task measuring executive functioning, and 17.6% for processing speed. Performance appears more stable in tasks measuring processing speed and executive functioning than on tasks of sustained attention and semantic fluency. Conclusions: Preliminary results of this study demonstrate strong reliability of cognitive EMA, indicating that EMA is a promising tool for evaluating fluctuations in cognitive status in this population. Future work should refine and expand the utility of these digital tools, determine how variable EMA frequencies might better characterize changes in functioning as they relate to blood-based biomarkers, and validate a singular battery that could be rapidly administered at scale and in clinical trials to determine the progression of disease. %M 40072884 %R 10.2196/63644 %U https://formative.jmir.org/2025/1/e63644 %U https://doi.org/10.2196/63644 %U http://www.ncbi.nlm.nih.gov/pubmed/40072884 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e72573 %T The Potential to Leverage Real-World Data for Pediatric Clinical Trials: A Proof-of-Concept Study %A Declerck,Jens %A Lee,Joanne %A Sen,Anando %A Palmeri,Avril %A Oostenbrink,Rianne %A Giannuzzi,Viviana %A Woodworth,Simon %A Malik,Salma %A Mahler,Fenna %A Aurich,Beate %A Leary,Rebecca %A Kalra,Dipak %A Straub,Volker %+ John Walton Muscular Dystrophy Research Centre, Translational and Clinical Research Institute, Newcastle University and Newcastle Hospitals NHS Foundation Trust, Central Parkway, Newcastle upon Tyne, NE1 4EP, United Kingdom, 44 01912086707, Becca.Leary@newcastle.ac.uk %K electronic health records %K observational research %K safety studies %K data interoperability %K rare diseases %K data collection %D 2025 %7 30.5.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Pediatric clinical research, especially in rare diseases, faces persistent challenges including the identification and recruitment of eligible patients, assessing protocol feasibility, and ensuring efficient trial execution. These issues are compounded by small, age-stratified populations and fragmented clinical data. Real-world data (RWD), especially when drawn from electronic health records (EHRs), present an opportunity to support innovative trial designs, such as real-world comparator arms and postmarketing surveillance. However, realizing this potential depends on the routine availability of structured, reusable clinical data. Objective: This proof-of-concept study aimed to assess the availability and structure of routine clinical data in European pediatric hospitals, focusing on data elements relevant for use in comparator arms and postmarketing surveillance studies. The study focused on 2 disease areas—neurofibromatosis (NF) and atopic dermatitis (AD)—as examples of rare and common conditions in children, respectively. Methods: An inventory of 113 high-value clinical data items was developed based on expert analysis of clinical protocols for NF, AD, and safety studies. These items were included in a structured web-based survey disseminated through the connect4children (c4c) National Hub network, reaching sites across. Europe. Respondents were asked to indicate how each data item is collected and stored: in structured/coded EHR fields, as free text, in external systems, or on paper. Results: Survey responses from 24 hospitals across 11 European countries revealed considerable variability in how data are captured and stored. While many general clinical and drug safety data elements—such as demographics, vital signs, and medication use—were often collected in structured formats, disease-specific and contextual variables were frequently captured as free text or not documented in a standardized way. For example, structured data capture was more prevalent for basic demographic and safety-related variables, whereas only a minority of sites recorded key disease-specific clinical details in a structured form. Lifestyle and family history data were among the least consistently documented. These gaps in structured data entry reduce the immediate reusability of EHR data for secondary research purposes. Conclusions: This study highlights gaps in the structured documentation of pediatric clinical data across European sites. While the routine collection of many variables is promising, the lack of structured and coded formats poses a barrier to reusing these data for observational studies or comparator arms. As a first step toward the broader integration of RWD into pediatric research, this study demonstrates the feasibility of assessing EHR data availability and sets the stage for future scaling across more diseases and sites. %M 40446289 %R 10.2196/72573 %U https://www.jmir.org/2025/1/e72573 %U https://doi.org/10.2196/72573 %U http://www.ncbi.nlm.nih.gov/pubmed/40446289 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e52123 %T A Mixed Method Survey of Characteristics of HIV Care Facilities: Medical Monitoring Project Facility Survey Project %A Williams,Dustin %A Weiser,John %A McManus,Timothy %A Demeke,Hanna B %A Creel,Darryl %A Craw,Jason %A Cahoon,Milton %A Beer,Linda %+ RTI International, 3040 East Cornwallis Road, Durham, NC, 27709, United States, 1 8432241561, dwilliams@rti.org %K multimode surveys %K establishment surveys %K imputation %K weighting %K nonresponse medical monitoring %K HIV care %K people with HIV %K data collection %K United States %K Medical Monitoring Project %K physicians %K clinician %K web surveys method %K methods %K HIV medical facilities %K Americans %K support %K HIV epidemic %K centers %K mobile phone %D 2025 %7 29.5.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Measuring the capacity of HIV medical facilities to deliver quality treatment and prevention care to people with HIV is essential to the over 1 million Americans living with HIV and supports federal efforts to end the HIV epidemic. To fill this gap and complement the ongoing Medical Monitoring Project—which conducts annual surveys of people with HIV and periodic surveys of HIV care providers—the US Centers for Disease Control and Prevention (CDC) and RTI (Research Triangle Institute) International conducted the Medical Monitoring Project Facility Survey (MMPFS). Objective: We aimed to describe the survey methods designed to achieve a high response rate from the 1022 facilities providing care to people with HIV as part of the Medical Monitoring Project—including frame development, survey instrument development, facility recruitment, and postsurvey data processing. Methods: For the MMPFS, the CDC and RTI developed a sequential multimode data collection approach (paper, web, and phone), including an abbreviated nonresponse follow-up (NRFU) instrument and the collection of administrative data for all facilities. Data were then processed to produce raw, imputed, and weighted datasets. Analyses included comparisons of responses to the full survey and NRFU survey. Results: The full MMPFS survey yielded 455 complete survey respondents and the NRFU survey yielded 59 complete survey responses, a combined response rate of 50.3% (514/1022). A nonresponse bias analysis comparing the 2 surveys found a significant difference in the raw datasets for 4 (12%) of the 34 categorical variables that were identical between the 2 surveys (all P>.0014). Weighted and imputed datasets were then generated and compared. There was no significant difference between the 2 datasets for any variable (all P>.05). Conclusions: The CDC and RTI’s MMPFS methodology proved to be a valuable means of collecting data from HIV care providers and providing estimates for facility characteristics related to the provision of health care for people with HIV. The combined response rate allowed the CDC and RTI to generate facility-level estimates and an imputed dataset that can be linked to MMPFS patient data. The methods may be applied to other facility survey studies. %M 40441694 %R 10.2196/52123 %U https://formative.jmir.org/2025/1/e52123 %U https://doi.org/10.2196/52123 %U http://www.ncbi.nlm.nih.gov/pubmed/40441694 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 9 %N %P e66436 %T Augmenting Engagement in Decentralized Clinical Trials for Atrial Fibrillation: Development and Implementation of a Programmatic Architecture %A Omole,Toluwa Daniel %A Mrkva,Andrew %A Ferry,Danielle %A Shepherd,Erin %A Caratelli,Jessica %A Davis,Noah %A Akatue,Richmond %A Bickmore,Timothy %A Paasche-Orlow,Michael K %A Magnani,Jared W %K atrial fibrillation %K rurality %K diversity %K mobile health intervention %K mobile health %K mhealth %K chronic cardiovascular condition %K cardiovascular %K cardio %K heart %K vascular %K medication %K self-monitoring %K digital health %K programmatic architecture %K effectiveness %K smartphone-based %K smartphone %K telehealth %K telemedicine %K digital technology %K application %K digital literacy %K clinical trial %K cardiovascular trials %D 2025 %7 12.5.2025 %9 %J JMIR Cardio %G English %X Background: Atrial fibrillation (AF) is a chronic cardiovascular condition that requires long-term adherence to medications and self-monitoring. Clinical trials for AF have had limited diversity by sex, race and ethnicity, and rural residence, thereby compromising the integrity and generalizability of trial findings. Digital technology coupled with remote strategies has the potential to increase recruitment of individuals from underrepresented demographic and geographic populations, resulting in increased trial diversity, and improvement in the generalizability of interventions for complex diseases such as AF. Objective: This study aimed to summarize the architecture of a research program using remote methods to enhance geographic and demographic diversity in mobile health trials to improve medication adherence. Methods: We developed a programmatic architecture to conduct remote recruitment and assessments of individuals with AF in 2 complementary randomized clinical trials, funded by the National Institutes of Health, to test the effectiveness of a smartphone-based relational agent on adherence to oral anticoagulation. The study team engaged individuals with either rural or metropolitan residences receiving care for AF at health care settings who then provided consent, and underwent baseline assessments and randomization during a remotely conducted telephone visit. Participants were randomized to receive the relational agent intervention or control and subsequently received a study smartphone with installed apps by mail. Participants received a telephone-based training session on device and app usage accompanied by a booklet with pictures and instructions accessible for any level of health or digital literacy. The program included remote methods by mail and telephone to promote retention at 4-, 8-, and 12-month visits and incentivized return of the smartphone following study participation. The program demonstrated excellent participant engagement and retention throughout the duration of the clinical trials. Results: The trials enrolled 513 participants, surpassing recruitment goals for the rural (n=270; target n=264) and metropolitan (n=243; target n=240) studies. A total of 62% (319/513) were women; 31% (75/243) of participants in the metropolitan study were African American, Asian, American Indian or Alaskan native or other races or ethnicities, in contrast to 5% (12/270) in the rural study. Among all participants, 56% (286/513) had less than an associate’s degree and 44% (225/513) were characterized as having limited health literacy. Intervention recipients receiving the relational agent used the agent median of 95‐98 (IQR, 56‐109) days across both studies. Retention exceeded 89% (457/513) at 12 months with study phones used for median 3.3 (IQR, 1‐5) participants. Conclusions: We report here the development and implementation of a programmatic architecture for the remote conduct of clinical trials. Our program successfully enhanced trial diversity and composition while providing an innovative mobile health intervention for medication adherence in AF. Our methods provide a model for enhanced recruitment and engagement of diverse participants in cardiovascular trials. Trial Registration: Clinicaltrials.gov NCT04076020; https://clinicaltrials.gov/study/NCT04076020 and Clinicaltrials.gov NCT04075994; https://clinicaltrials.gov/study/NCT04075994 %R 10.2196/66436 %U https://cardio.jmir.org/2025/1/e66436 %U https://doi.org/10.2196/66436 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e56028 %T Online Health Information–Seeking Behaviors Among the Chongqing Population: Cross-Sectional Questionnaire Study %A Rong,Honghui %A Lu,Lu %A He,Miao %A Guo,Tian %A Li,Xian %A Tao,Qingliu %A Li,Yixin %A Zheng,Chuanfen %A Zhang,Ling %A Li,Fengju %A Yi,Dali %A Lei,Enyu %A Luo,Ting %A Yang,Qinghua %A Chen,Ji-an %K online health information seeking %K health behavior %K Chongqing %K China %K Internet %D 2025 %7 5.5.2025 %9 %J JMIR Form Res %G English %X Background: With the rapid development of the internet and its widespread use, online health information–seeking (OHIS) has become a popular and important research topic. Various benefits of OHIS are well recognized. However, OHIS seems to be a mixed blessing. Research on OHIS has been reported in Western countries and in high-income regions in eastern China. Studies on the population in the western region of China, such as Chongqing, are still limited. Objective: The aim of the study was to identify the prevalence, common topics, and common methods of health information–seeking and the factors influencing these behaviors among the Chongqing population. Methods: This cross-sectional questionnaire study was conducted from September to October 2021. A web-based questionnaire was sent to users aged 15 years and older in Chongqing using a Chinese web-based survey hosting site (N=14,466). Data on demographics, web-based health information resources, and health topics were collected. Factors that may influence health literacy were assessed using the chi-square test and multivariate logistic regression models. Results: A total of 67.1% (9704/14,466) of the participants displayed OHIS behaviors. Participants who were younger, had a higher educational level, and worked as medical staff or teachers were more likely to engage in OHIS, while those living in rural areas, ethnic minorities, and farmers were less likely to seek health information on the web (P<.01). Among the Chongqing population, the most common topic searched on the internet was health behavior and literacy (87.4%, 8483/9704), and the most popular method of seeking health information on the web was through WeChat (77.0%, 7468/9704). Conclusions: OHIS is prevalent in Chongqing. Further research could be performed based on the influencing factors identified herein and high-priority, effective ways of improving the OHIS behaviors of the Chongqing population. %R 10.2196/56028 %U https://formative.jmir.org/2025/1/e56028 %U https://doi.org/10.2196/56028 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65879 %T Characterizing Patient-Reported Fatigue Using Electronic Diaries in Neurodegenerative and Immune-Mediated Inflammatory Diseases: Observational Study %A Bennetot,Adrien %A Zia Ur Rehman,Rana %A Romijnders,Robbin %A Li,Zhi %A Macrae,Victoria %A Davies,Kristen %A Ng,Wan-Fai %A Maetzler,Walter %A Kudelka,Jennifer %A Hildesheim,Hanna %A Emmert,Kirsten %A Paulides,Emma %A van der Woude,C Janneke %A Reilmann,Ralf %A Aufenberg,Svenja %A Chatterjee,Meenakshi %A Manyakov,Nikolay V %A Pinaud,Clémence %A Avey,Stefan %K chronic disease %K fatigue %K neurodegenerative diseases %K immune-mediated inflammatory diseases %K diary, patient-reported outcomes %K electronic diaries %K digital technologies %K digital health %K eHealth %K mobile phone %D 2025 %7 5.5.2025 %9 %J JMIR Form Res %G English %X Background: Fatigue is a prevalent and debilitating symptom in many chronic conditions, including immune-mediated inflammatory diseases (IMIDs) and neurodegenerative diseases (NDDs). Fatigue often fluctuates significantly within and between days, yet traditional patient-reported outcomes (PROs) typically rely on recall periods of a week or more, potentially missing these short-term variations. The development of digital tools, such as electronic diaries (eDiaries), offers a unique opportunity to collect granular, real-time data. However, the feasibility, adherence, and comparability of eDiary-based assessments to established PROs require further investigation. Objective: This study aimed to evaluate the feasibility and acceptability of using a high-frequency eDiary to capture intraday variability in fatigue and to compare eDiary data with scores obtained from the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), a validated weekly recall PRO. Methods: Data were collected from 159 participants enrolled in the IDEA-FAST (Identifying Digital Endpoints to Assess Fatigue, Sleep and Activities in Daily Living in Neurodegenerative Disorders and Immune-Mediated Inflammatory Diseases) feasibility study; a 4-week prospective observational study conducted at 4 European centers. Participants included individuals with NDDs (n=39), IMIDs (n=78), and healthy volunteers (n=42). Participants used an eDiary to report their physical and mental fatigue levels up to 4 times daily on a 7-point Likert scale (0=low and 6=high). Adherence was calculated as the proportion of completed eDiary entries relative to the total expected entries. Correlations between averaged eDiary scores and weekly FACIT-F scores were analyzed. Results: Adherence to the eDiary protocol was 5505/8880 (61.99%) overall, varying by cohort, with the highest adherence (1117/1200, 93.07%) observed in the primary Sjögren syndrome cohort and the lowest adherence in the Parkinson disease (410/960, 42.7%) and Huntington disease (320/720, 44.4%) cohorts. The average adherence was 430/1680 (43.45%) in the NDD cohorts and 3367/4560 (73.84%) in the IMID cohorts. Fatigue levels showed clear diurnal variation, with significantly higher fatigue reported in the evening compared to the morning (P<.001). A moderate correlation (Spearman=0.46, P<.001) was observed between eDiary fatigue scores and FACIT-F scores, with stronger cohort-specific associations for certain FACIT-F items. These results indicate that eDiaries provide complementary insights to weekly PROs by capturing intraday fluctuations in fatigue. Conclusions: This study demonstrates the feasibility, acceptability, and validity of using high-frequency eDiaries to assess fatigue in chronic conditions. By effectively detecting intra- and interday fatigue variations, eDiaries complement traditional PROs such as FACIT-F, offering a more nuanced understanding of fatigue patterns. Future research should explore optimized eDiary protocols to balance participant burden with data granularity. %R 10.2196/65879 %U https://formative.jmir.org/2025/1/e65879 %U https://doi.org/10.2196/65879 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63639 %T Electronic Implementation of Patient-Reported Outcome Measures in Primary Health Care: Mixed Methods Systematic Review %A Sasseville,Maxime %A Supper,Wilfried %A Gartner,Jean-Baptiste %A Layani,Géraldine %A Amil,Samira %A Sheffield,Peter %A Gagnon,Marie-Pierre %A Hudon,Catherine %A Lambert,Sylvie %A Attisso,Eugène %A Ouellet,Steven %A Breton,Mylaine %A Poitras,Marie-Eve %A Roux-Lévy,Pierre-Henri %A Plaisimond,James %A Bergeron,Frédéric %A Ashcroft,Rachelle %A Wong,Sabrina T. %A Groulx,Antoine %A Paquette,Jean-Sébastien %A D'Anjou,Natasha %A Langlois,Sylviane %A LeBlanc,Annie %+ Faculty of Medicine, Université Laval, Quebec City, QC, Canada, 1 877 785 2825, maxime.sasseville@fsi.ulaval.ca %K patient-reported outcomes measures %K digital health %K implementation science %K systematic review %K PRISMA %D 2025 %7 5.5.2025 %9 Review %J J Med Internet Res %G English %X Background: Managing chronic diseases remains a critical challenge in primary health care (PHC) across the Organization for Economic Co-operation and Development countries. Electronic patient-reported outcome measures (ePROMs) are emerging as valuable tools for enhancing patient engagement, facilitating clinical decision-making, and improving health outcomes. However, their implementation in PHC remains limited, with significant variability in effectiveness and adoption. Objective: This systematic review aimed to assess the implementation and effectiveness of ePROMs in chronic disease management within PHC settings and to identify key barriers and facilitators influencing their integration. Methods: A mixed methods systematic review was conducted following the Cochrane Methods and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included studies that implemented ePROMs among adults for chronic disease management in PHC. The extracted data included patient health outcomes, provider workflow implications, implementation factors, and cost considerations. The reach, effectiveness, adoption, implementation, and maintenance framework was used. Results: Our search yielded 12,525 references, from which 22 (0.18%) studies were included after screening and exclusions. These studies, primarily conducted in the United States (n=9, 41%) and Canada (n=8, 36%), covered various chronic diseases and used diverse ePROM tools, predominantly mobile apps (n=9, 41%). While some studies (n=10, 45%) reported improvements in patient health outcomes and self-management, others (n=12, 55%) indicated no significant change. Key barriers included digital literacy gaps, integration challenges within clinical workflows, and increased provider workload. Facilitators included strong patient-provider relationships, personalized interventions, and technical support for users. While some studies (n=10, 45%) demonstrated improved patient engagement and self-management, long-term cost-effectiveness and sustainability remain uncertain. Conclusions: Success in implementing ePROMs in PHC appears to hinge on addressing digital literacy, ensuring personalization and meaningful patient-provider interactions, carefully integrating technology into clinical workflows, and conducting thorough research on their long-term impacts and cost-effectiveness. Future efforts should focus on these areas to fully realize the benefits of digital health technologies for patients, providers, and health care systems. Trial Registration: PROSPERO CRD42022333513; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022333513 International Registered Report Identifier (IRRID): RR2-10.2196/48155 %M 40324173 %R 10.2196/63639 %U https://www.jmir.org/2025/1/e63639 %U https://doi.org/10.2196/63639 %U http://www.ncbi.nlm.nih.gov/pubmed/40324173 %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 e63687 %T Challenging the Continued Usefulness of Social Media Recruitment for Surveys of Hidden Populations of People Who Use Opioids %A Nesoff,Elizabeth D %A Palamar,Joseph J %A Li,Qingyue %A Li,Wenqian %A Martins,Silvia S %+ Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, 423 Guardian Dr, Philadelphia, PA, 19104, United States, 1 215 662 2560, elizabeth.nesoff@pennmedicine.upenn.edu %K opioids %K substance use %K survey methods %K social media %K recruitment %K survey %K drug overdose %K substance use disorder %K online recruitment %K online survey %K mental health %K addiction %K data collection %D 2025 %7 30.4.2025 %9 Viewpoint %J J Med Internet Res %G English %X Historically, recruiting research participants through social media facilitated access to people who use opioids, capturing a range of drug use behaviors. The current rapidly changing online landscape, however, casts doubt on social media’s continued usefulness for study recruitment. In this viewpoint paper, we assessed social media recruitment for people who use opioids and described challenges and potential solutions for effective recruitment. As part of a study on barriers to harm reduction health services, we recruited people who use opioids in New York City to complete a REDCap (Research Electronic Data Capture; Vanderbilt University) internet-based survey using Meta (Facebook and Instagram), X (formerly known as Twitter), Reddit, and Discord. Eligible participants must have reported using opioids (heroin, prescription opioids, or fentanyl) for nonprescription purposes in the past 90 days and live or work in New York City. Data collection took place from August 2023 to November 2023. Including study purpose, compensation, and inclusion criteria caused Meta’s social media platforms and X to flag our ads as “discriminatory” and “spreading false information.” Listing incentives increased bot traffic across all platforms despite bot prevention activities (eg, reCAPTCHA and counting items in an image). We instituted a rigorous post hoc data cleaning protocol (eg, investigating duplicate IP addresses, participants reporting use of a fictitious drug, invalid ZIP codes, and improbable drug use behaviors) to identify bot submissions and repeat participants. Participants received a US $20 gift card if still deemed eligible after post hoc data inspection. There were 2560 submissions, 93.2% (n=2387) of which were determined to be from bots or malicious responders. Of these, 23.9% (n=571) showed evidence of a duplicate IP or email address, 45.9% (n=1095) reported consuming a fictitious drug, 15.8% (n=378) provided an invalid ZIP code, and 9.4% (n=225) reported improbable drug use behaviors. The majority of responses deemed legitimate (n=173) were collected from Meta (n=79, 45.7%) and Reddit (n=48, 27.8%). X’s ads were the most expensive (US $1.96/click) and yielded the fewest participants (3 completed surveys). Social media recruitment of hidden populations is challenging but not impossible. Rigorous data collection protocols and post hoc data inspection are necessary to ensure the validity of findings. These methods may counter previous best practices for researching stigmatized behaviors. %M 40306644 %R 10.2196/63687 %U https://www.jmir.org/2025/1/e63687 %U https://doi.org/10.2196/63687 %U http://www.ncbi.nlm.nih.gov/pubmed/40306644 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e56329 %T Using Social Media to Recruit a Diverse Sample of Participants for a Mobile Health (mHealth) Intervention to Increase Physical Activity: Exploratory Study %A Pathak,Laura %A Hernandez-Ramos,Rosa %A Rosales,Karina %A Miramontes-Gomez,Jose %A Garcia,Faviola %A Yip,Vivian %A Sudarshan,Suchitra %A Cemballi,Anupama Gunshekar %A Lyles,Courtney %A Aguilera,Adrian %K mHealth %K social media %K research subject recruitment %K Spanish speakers %K Spanish %K physical activity %K clinical research %K social media platform %K smartphone %K text messaging %K machine learning %K diabetes %K depression %K Facebook %K depressive symptoms %K screening survey %K online platform %K cost-effectiveness %K mobile health %D 2025 %7 28.4.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Recruitment of demographically diverse samples in clinical research is often challenging and even more so during the COVID-19 pandemic when traditional in-person recruitment methods could not be implemented. Social media platforms offer an alternative approach for recruiting diverse samples of participants for clinical trials, including those testing digital health interventions. This approach allowed for a quicker recruitment process without the physical constraints associated with traditional in-person methods. Objective: This study aimed to detail the online and social media campaigns used to recruit participants for “Diabetes and Mental Health Adaptive Notification Tracking and Evaluation” (DIAMANTE), a randomized controlled trial testing a smartphone-based intervention (a text messaging system that uses machine learning to personalize content) to increase physical activity for patients with diabetes and depression. In describing the recruitment process, we seek to offer insights to the research community on recruitment through online and social media advertisements for diverse communities. Methods: This study sought to recruit demographically diverse individuals in the United States through social media, including paid advertisements on Craigslist and Facebook (Meta). For the DIAMANTE project recruitment, we created 18 personas that mapped into the population’s target demographics using a user-centered design methodology. We deployed targeted English and Spanish ads on Craigslist and Facebook in 78 cities based on county-level demographics and diabetes prevalence data to target diverse individuals aged 18‐75 years old, who had been diagnosed with diabetes and had documented depressive symptoms. Results: A total of 1379 individuals completed the study’s initial screening survey. Of those, 71 respondents on Facebook and 508 on Craigslist were interested in enrolling in our study. In total, 26 out of 58 (45%) eligible respondents from Facebook and 50 out of 235 (21.3%) eligible respondents from Craigslist were eventually recruited in the randomized controlled trial. In all, both platforms showed poor performance in recruiting Spanish speakers, with Facebook advertisements accounting for 0 and Craigslist for 4 (5.3%) of such participants. When it came to English speakers, Craigslist proved to be the better performing platform compared to Facebook, both in terms of reach (579 vs 71) and cost-effectiveness (US $67.61 in average cost per recruited participant vs US $80.16). While Craigslist ads reached more people, resulting in more completed screening surveys than Facebook ads, there was a higher number of ineligible and incomplete enrollment from Craigslist compared with Facebook, leading to a relatively lower conversion rate (9.4% vs 36.6%). Importantly, participants recruited through Craigslist were more ethnically and racially diverse than those recruited from Facebook. Conclusions: Results from this study revealed that it is possible to recruit diverse sample sets using social media and online advertisements. However, despite targeted recruitment efforts, social media recruitment of Spanish speakers proved especially challenging and costly. Further research is needed to determine systematic, online methods for recruiting marginalized communities. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-034723 %R 10.2196/56329 %U https://mhealth.jmir.org/2025/1/e56329 %U https://doi.org/10.2196/56329 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64007 %T Uncovering Social States in Healthy and Clinical Populations Using Digital Phenotyping and Hidden Markov Models: Observational Study %A Leaning,Imogen E %A Costanzo,Andrea %A Jagesar,Raj %A Reus,Lianne M %A Visser,Pieter Jelle %A Kas,Martien J H %A Beckmann,Christian F %A Ruhé,Henricus G %A Marquand,Andre F %+ Donders Institute for Brain, Cognition and Behaviour, Radboud University Nijmegen, Trigon Building, Kapittelweg 29, Nijmegen, 6525 EN, The Netherlands, 31 24 361 42 44, imogen.leaning@donders.ru.nl %K passive monitoring %K mobile health %K mHealth %K smartphone %K mobile phone %K digital phenotyping %K hidden Markov model %K social behavior %K Alzheimer disease %K cognitive impairment %K schizophrenia %D 2025 %7 28.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Brain-related disorders are characterized by observable behavioral symptoms, for example, social withdrawal. Smartphones can passively collect behavioral data reflecting digital activities such as communication app usage and calls. These data are collected objectively in real time, avoiding recall bias, and may, therefore, be a useful tool for measuring behaviors related to social functioning. Despite promising clinical utility, analyzing smartphone data is challenging as datasets often include a range of temporal features prone to missingness. Objective: Hidden Markov models (HMMs) provide interpretable, lower-dimensional temporal representations of data, allowing for missingness. This study aimed to investigate the HMM as a method for modeling smartphone time series data. Methods: We applied an HMM to an aggregate dataset of smartphone measures designed to assess phone-related social functioning in healthy controls (HCs) and participants with schizophrenia, Alzheimer disease (AD), and memory complaints. We trained the HMM on a subset of HCs (91/348, 26.1%) and selected a model with socially active and inactive states. Then, we generated hidden state sequences per participant and calculated their “total dwell time,” that is, the percentage of time spent in the socially active state. Linear regression models were used to compare the total dwell time to social and clinical measures in a subset of participants with available measures, and logistic regression was used to compare total dwell times between diagnostic groups and HCs. We primarily reported results from a 2-state HMM but also verified results in HMMs with more hidden states and trained on the whole participant dataset. Results: We identified lower total dwell times in participants with AD (26/257, 10.1%) versus withheld HCs (156/257, 60.7%; odds ratio 0.95, 95% CI 0.92-0.97; false discovery rate [FDR]–corrected P<.001), as well as in participants with memory complaints (57/257, 22.2%; odds ratio 0.97, 95% CI 0.96-0.99; FDR-corrected P=.004). The result in the AD group was very robust across HMM variations, whereas the result in the memory complaints group was less robust. We also observed an interaction between the AD group and total dwell time when predicting social functioning (FDR-corrected P=.02). No significant relationships regarding total dwell time were identified for participants with schizophrenia (18/257, 7%; P>.99). Conclusions: We found the HMM to be a practical, interpretable method for digital phenotyping analysis, providing an objective phenotype that is a possible indicator of social functioning. %M 40294408 %R 10.2196/64007 %U https://www.jmir.org/2025/1/e64007 %U https://doi.org/10.2196/64007 %U http://www.ncbi.nlm.nih.gov/pubmed/40294408 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67451 %T Ecological Momentary Assessment of Parental Well-Being and Time Use: Mixed Methods Compliance and Feasibility Study %A Altweck,Laura %A Tomczyk,Samuel %+ Department Health and Prevention, Institute of Psychology, Universität Greifswald, Robert-Blum-Str. 13, Greifswald, 17487, Germany, 49 3834 420 ext 3813, laura.altweck@uni-greifswald.de %K ecological momentary assessment %K parents %K feasibility %K compliance %K time use %K well-being %K stress %K EMA %K mixed methods %K daily life %K parents %K online questionnaires %K questionnaires %K surveys %K quantitative %K qualitative %K sociodemographic %K mobile phone %D 2025 %7 23.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Parents often juggle multiple conflicting responsibilities, including work, childcare, and the household, making them a particularly burdened group. However, the impact of daily routines and associated (poor) well-being among parents has received relatively little attention. Ecological Momentary Assessment (EMA) is increasingly being used to capture real-time data and can help address this research gap. Objective: This study aims to examine compliance rates and the feasibility of EMA for measuring daily well-being and time use among parents. Methods: An exploratory mixed-methods study was conducted with 74 German parents (57/74, 77% women, (age: mean 37.6, SD 5.9 years). Participants completed a baseline questionnaire, followed by 4 daily EMA surveys (at 7:30 AM, 12 PM, 16:30 PM, and 21:30 PM) over a 1-week period, and a follow-up questionnaire. A subset of parents was also subsequently interviewed. Sociodemographic background and expected feasibility (open-ended questions) were surveyed at baseline, and feasibility was assessed at follow-up (closed- and open-ended questions) and in the interviews. State well-being (affective and cognitive), state stress, state as well as retrospective time-use were measured in the EMA surveys. Compliance and feasibility were examined using a combination of quantitative (descriptive analyses) and qualitative methodologies. Results: Participants completed an average of 83% (SD 13%) of the daily surveys. Compliance varied by gender and age, where men (90% vs 80%) and older parents showed higher rates. Participants generally found the survey frequency and length manageable, though some suggested adjustments to the study period depending on their individual routines. The 7:30 AM survey was reported as the most challenging due to childcare drop-offs (40%-49%), followed by the 16:30 PM survey for similar reasons (7%-17%). The qualitative analysis further revealed additional points for improvement, for instance, the need for personalization (eg, individual adjustment of the survey timings and intervals), technical support, and the incorporation of gamification elements. Most interviewees (46% vs 23%) found the used measurement of well-being and stress to be appropriate. Regarding time use, they felt that the predefined activity groups (eg, personal care, working) were suitable (46%) but noted challenges assigning less frequent activities (eg, medical appointments) (5%-54%). Reporting the timings of time-use via consecutive questions (ie, specifying the duration or start and end times of an activity) was perceived as confusing (9%-69%), with participants expressing a preference for a visual overview, such as a Gantt chart. Conclusions: The study demonstrates that, when accounting for certain sociodemographic and study design factors, EMA can be a feasible method for data collection regarding daily well-being and time use, even in highly time-constrained populations like parents. This shows great potential for future research, such as exploring work-family conflict or performative gender roles and complementing established methods (eg, retrospective daily diaries). Trial Registration: OSF Registries osf.io/8qj3d; https://osf.io/8qj3d International Registered Report Identifier (IRRID): RR2-10.2196/54728 %M 40267468 %R 10.2196/67451 %U https://formative.jmir.org/2025/1/e67451 %U https://doi.org/10.2196/67451 %U http://www.ncbi.nlm.nih.gov/pubmed/40267468 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e59511 %T Italian Medical Professionals' Practices, Attitudes, and Knowledge in Travel Medicine: Protocol for a National Survey %A Baglivo,Francesco %A De Angelis,Luigi %A Vannini,Federico %A Agostini,Antonello %A Todaro,Antonio %A Torri,Eleonora %A Gianolio Lopez,Giulio Alberto %A Fui,Margherita %A Tomasi,Alberto %A Rizzo,Caterina %+ , Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35, Pisa, 56123, Italy, 39 3288348649, francesco.baglivo@phd.unipi.it %K travel medicine %K Italy %K cross-sectional %K survey %K KAP %K medical professional %K medical professionals %K Italian %K global health %K epidemiology %K scoping review %K power analysis %K dissemination %K healthcare service %K healthcare services %K survey protocol %K awareness %K assessment %D 2025 %7 21.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The evolving global health landscape highlights the importance of travel medicine, making it necessary for health care professionals to understand the epidemiologic profiles among varied traveler populations and keep themselves updated in this rapidly changing field. However, in Italy, travel medicine clinics have significant gaps in resource allocation, staff training, and infrastructure. Objective: This protocol of a cross-sectional study aims to create and validate a questionnaire to assess the knowledge, attitudes, and practices of health care professionals in travel medicine in Italy. The final goal is to provide a tool to evaluate the state of travel medicine, guide training initiatives, and be able to monitor trends over time. Methods: The study population consists of health care professionals who practice travel medicine in Italy. The questionnaire will be developed by adapting an existing English survey and conducting a scoping review to align the questionnaire with contemporary scientific discourse. The validation process includes face validity, content validity, and expert evaluation. The sample size, determined through power analysis, ranges from 218 to 278 participants. The questionnaire will undergo a pilot test on a smaller sample size (10% of the total) to identify and address any issues. Statistical analysis will include central tendency and dispersion measures, categorical summaries, group comparisons, and regressions. This research received ethical approval, and informed consent will be obtained from all participants. Results: As of July 2024, we completed the questionnaire validation involving 9 experts. The validated version of the questionnaire includes 86 items. Furthermore, we conducted a pilot test on 53 individuals during the SIMVIM (Italian Society of Travel Medicine and Migrations) course on travel medicine held in Lucca, Italy, on June 14, 2024. Conclusions: This cross-sectional study will guide strategic planning and targeting training and awareness activities in areas deemed most critical or lacking. The study’s structured approach and periodic assessments will facilitate the identification of educational gaps, the dissemination of best practices, and the overall improvement of health care services for travelers in Italy. International Registered Report Identifier (IRRID): DERR1-10.2196/59511 %M 40258265 %R 10.2196/59511 %U https://www.researchprotocols.org/2025/1/e59511 %U https://doi.org/10.2196/59511 %U http://www.ncbi.nlm.nih.gov/pubmed/40258265 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68093 %T Using Social Media to Engage and Enroll Underrepresented Populations: Longitudinal Digital Health Research %A Harry,Christiana %A Goodday,Sarah %A Chapman,Carol %A Karlin,Emma %A Damian,April Joy %A Brooks,Alexa %A Boch,Adrien %A Lugo,Nelly %A McMillan,Rebecca %A Tempero,Jonell %A Swanson,Ella %A Peabody,Shannon %A McKenzie,Diane %A Friend,Stephen %+ 4YouandMe, 185 Great Neck Rd Ste 447, Great Neck, NY, 11021, United States, 1 206 861 3655, christianacharry@gmail.com %K digital health research %K digital health technology %K recruitment %K research subject %K participant %K pregnancy %K maternal health %K underrepresented populations %K health equity %K diversity %K marginalized %K advertisement %K social media %K retention %K attrition %K dropout %D 2025 %7 15.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Emerging digital health research poses roadblocks to the inclusion of historically marginalized populations in research. Exclusion of underresourced communities in digital health research is a result of multiple factors (eg, limited technology access, decreased digital literacy, language barriers, and historical mistrust of research and research institutions). Alternative methods of access and engagement may aid in achieving long-term sustainability of diversified participation in digital health research, ensuring that developed technologies and research outcomes are effective and equitable. Objective: This study aims to (1) characterize socioeconomic and demographic differences in individuals who enrolled and engaged with different remote, digital, and traditional recruitment methods in a digital health pregnancy study and (2) determine whether social media outreach is an efficient way of recruiting and retaining specific underrepresented populations (URPs) in digital health research. Methods: The Better Understanding the Metamorphosis of Pregnancy (BUMP) study was used as a case example. This is a prospective, observational, cohort study using digital health technology to increase understanding of pregnancy among 524 women, aged 18-40 years, in the United States. The study used different recruitment strategies: patient portal for genetic testing results, paid/unpaid social media ads, and a community health organization providing care to pregnant women (Moses/Weitzman Health System). Results: Social media as a recruitment tool to engage URPs in a digital health study was overall effective, with a 23.6% (140/594) enrollment rate of those completing study interest forms across 25 weeks. Community-based partnerships were less successful, however, resulting in 53.3% (57/107) engagement with recruitment material and only 8.8% (5/57) ultimately enrolling in the study. Paid social media ads provided access to and enrollment of a diverse potential participant pool of race- or ethnicity-based URPs in comparison to other digital recruitment channels. Of those that engaged with study materials, paid recruitment had the highest percentage of non-White (non-Hispanic) respondents (85/321, 26.5%), in comparison to unpaid ads (Facebook and Reddit; 37/167, 22.2%). Of the enrolled participants, paid ads also had the highest percentage of non-White (non-Hispanic) participants (14/70, 20%), compared to unpaid ads (8/52, 15.4%) and genetic testing service subscribers (72/384, 18.8%). Recruitment completed via paid ads (Instagram) had the highest study retention rate (52/70, 74.3%) across outreach methods, whereas recruitment via community-based partnerships had the lowest (2/5, 40%). Retention of non-White (non-Hispanic) participants was low across recruitment methods: paid (8/52, 15.4%), unpaid (3/35, 14.3%), and genetic testing service subscribers (50/281, 17.8%). Conclusions: Social media recruitment (paid/unpaid) provides access to URPs and facilitates sustained retention similar to other methods, but with varying strengths and weaknesses. URPs showed lower retention rates than their White counterparts across outreach methods. Community-based recruitment showed lower engagement, enrollment, and retention. These findings highlight social media’s potential for URP engagement and enrollment, illuminate potential roadblocks of traditional methods, and underscore the need for tailored research to improve URP enrollment and retention. %M 40233355 %R 10.2196/68093 %U https://formative.jmir.org/2025/1/e68093 %U https://doi.org/10.2196/68093 %U http://www.ncbi.nlm.nih.gov/pubmed/40233355 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70852 %T Approach to Design and Evaluate Digital Tools to Enhance Young Adult Participation in Clinical Trials: Co-Design and Controlled Intercept Study %A Mackey,Tim %A Cuomo,Raphael E %A Xu,Qing %A McMann,Tiana J %A Li,Zhuoran %A Cai,Mingxiang %A Wenzel,Christine %A Yang,Joshua S %+ Global Health Program, Department of Anthropology, University of California San Diego, 9500 Gilman Drive, MC: 0505, La Jolla, CA, 9209, United States, 1 951 491 4161, tmackey@ucsd.edu %K health %K clinical trials %K COVID-19 %K digital health %K coronavirus disease %D 2025 %7 11.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Certain populations are underrepresented in clinical trials, limiting the generalizability of new treatments and their efficacy and uptake in these populations. It is essential to identify and understand effective strategies for enrolling young adults in clinical trials, as they represent a vital and key demographic for future clinical trial participation. Objective: This study aimed to develop, test, and evaluate digital tools designed to encourage the participation of young adults in the clinical trial process. An interdisciplinary approach, incorporating social listening, qualitative focus groups, and co-design workshops, was used to achieve this goal. Methods: Digital tools were designed and evaluated using a 4-phase approach that included: (1) social listening to characterize lived experiences with COVID-19 trials as self-reported by online users, (2) qualitative focus groups with young adults to explore specific lived attitudes and experiences related to COVID-19 clinical research hesitancy and engagement, (3) a series of cocreation and co-design workshops to build digital tools aimed at encouraging clinical trial participation, and (4) a controlled intercept study to assess the usability and specific outcome measures of the co-designed digital tools among young adults. Results: A significantly higher change in the likelihood of participating in a clinical trial post exposure was observed among study participants when exposed to prototypes of a mobile app (Δ=0.74 on a 10-point scale, P<.01) and website (Δ=0.93, P<.01) compared to those exposed to a Facebook ad (Δ=0.21) but not a digital flyer (Δ=0.58). Furthermore, those exposed to the mobile app (x̅=5.76, P=.04) and electronic flier (x̅=5.72, P=.04), but not the website (x̅=5.55), exhibited significantly higher postexposure interest in learning about clinical trials when compared to participants exposed to the Facebook (Meta) ad (x̅=5.06). Participants in the intercept study were more likely to consider joining a clinical trial after seeing a mobile app (Δ=0.74, P<.01) or website (Δ=0.93, P<.001) compared to a Facebook ad (Δ=0.21), but the digital flyer (Δ=0.58) did not show a significant difference. In addition, those who saw the mobile app (x̅=5.76, P=.04) or the digital flyer (x̅=5.72, P=.04) showed more interest in learning about clinical trials than those who saw the Facebook ad (x̅=5.06), though the website (x̅= 5.55) did not significantly impact interest. Conclusions: Mobile apps and web pages co-designed with young diverse adults may represent effective digital tools to advance shared goals of encouraging inclusive clinical trials. %M 40215482 %R 10.2196/70852 %U https://www.jmir.org/2025/1/e70852 %U https://doi.org/10.2196/70852 %U http://www.ncbi.nlm.nih.gov/pubmed/40215482 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e59405 %T Development of Digital Strategies for Reducing Sedentary Behavior in a Hybrid Office Environment: Modified Delphi Study %A Parés-Salomón,Iris %A Vaqué-Crusellas,Cristina %A Coffey,Alan %A Loef,Bette %A Proper,Karin I %A Señé-Mir,Anna M %A Puig-Ribera,Anna %A Dowd,Kieran P %A Bort-Roig,Judit %+ Faculty of Health Sciences and Welfare, University of Vic – Central University of Catalonia (UVic-UCC), C Sagrada Família, 7, Vic, 08500, Spain, 34 938 815 50, iris.pares@uvic.cat %K sedentary behavior %K office work %K home office %K hybrid work %K technology %K Delphi %D 2025 %7 8.4.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Hybrid work is the new modus operandi for many office workers, leading to more sedentary behavior than office-only working. Given the potential of digital interventions to reduce sedentary behavior and the current lack of studies evaluating these interventions for home office settings, it is crucial to develop digital interventions for such contexts involving all stakeholders. Objective: This study aimed to reach expert consensus on the most feasible work strategies and the most usable digital elements as a delivery method to reduce sedentary behavior in the home office context. Methods: A modified Delphi study including 3 survey rounds and focus groups was conducted to achieve consensus. The first Delphi round consisted of two 9-point Likert scales for assessing the feasibility of work strategies and the potential usefulness of digital elements to deliver the strategies. The work strategies were identified and selected from a scoping review, a systematic review, and 2 qualitative studies involving managers and employees. The median and mean absolute deviation from the median for each item are reported. The second round involved 2 ranking lists with the highly feasible strategies and highly useful digital elements based on round 1 responses to order the list according to experts’ preferences. The weighted average ranking for each item was calculated to determine the most highly ranked work strategies and digital elements. The third round encompassed work strategies with a weight above the median from round 2 to be matched with the most useful digital elements to implement each strategy. In total, 4 focus groups were additionally conducted to gain a greater understanding of the findings from the Delphi phase. Focus groups were analyzed using the principles of reflexive thematic analysis. Results: A total of 27 international experts in the field of occupational health participated in the first round, with response rates of 86% (25/29) and 66% (19/29) in rounds 2 and 3, respectively, and 52% (15/29) in the focus groups. Consensus was achieved on 18 work strategies and 16 digital elements. Feedback on activity progress and goal achievement; creating an action plan; and standing while reading, answering phone calls, or conducting videoconferences were the most feasible work strategies, whereas wrist-based activity trackers, a combination of media, and app interfaces in smartphones were the most useful digital elements. Moreover, experts highlighted the requirement of combining multiple levels of strategies, such as social support, physical environment, and individual strategies, to enhance their implementation and effectiveness in reducing sedentary behavior when working from home. Conclusions: This expert consensus provided a foundation for developing digital interventions for sedentary behavior in home office workers. Ongoing interventions should enable the evaluation of feasible strategies delivered via useful digital elements in home office or hybrid contexts. %M 40198908 %R 10.2196/59405 %U https://humanfactors.jmir.org/2025/1/e59405 %U https://doi.org/10.2196/59405 %U http://www.ncbi.nlm.nih.gov/pubmed/40198908 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e67294 %T Detecting Sleep/Wake Rhythm Disruption Related to Cognition in Older Adults With and Without Mild Cognitive Impairment Using the myRhythmWatch Platform: Feasibility and Correlation Study %A Jones,Caleb D %A Wasilko,Rachel %A Zhang,Gehui %A Stone,Katie L %A Gujral,Swathi %A Rodakowski,Juleen %A Smagula,Stephen F %K sleep %K sleep/wake %K circadian %K activity pattern %K dementia %K cognition %K mobile sensing %K actigraphy %K accelerometer %D 2025 %7 7.4.2025 %9 %J JMIR Aging %G English %X Background: Consumer wearable devices could, in theory, provide sufficient accelerometer data for measuring the 24-hour sleep/wake risk factors for dementia that have been identified in prior research. To our knowledge, no prior study in older adults has demonstrated the feasibility and acceptability of accessing sufficient consumer wearable accelerometer data to compute 24-hour sleep/wake rhythm measures. Objective: We aimed to establish the feasibility of characterizing 24-hour sleep/wake rhythm measures using accelerometer data gathered from the Apple Watch in older adults with and without mild cognitive impairment (MCI), and to examine correlations of these sleep/wake rhythm measures with neuropsychological test performance. Methods: Of the 40 adults enrolled (mean [SD] age 67.2 [8.4] years; 72.5% female), 19 had MCI and 21 had no cognitive disorder (NCD). Participants were provided devices, oriented to the study software (myRhythmWatch or myRW), and asked to use the system for a week. The primary feasibility outcome was whether participants collected enough data to assess 24-hour sleep/wake rhythm measures (ie, ≥3 valid continuous days). We extracted standard nonparametric and extended-cosine based sleep/wake rhythm metrics. Neuropsychological tests gauged immediate and delayed memory (Hopkins Verbal Learning Test) as well as processing speed and set-shifting (Oral Trails Parts A and B). Results: All participants meet the primary feasibility outcome of providing sufficient data (≥3 valid days) for sleep/wake rhythm measures. The mean (SD) recording length was somewhat shorter in the MCI group at 6.6 (1.2) days compared with the NCD group at 7.2 (0.6) days. Later activity onset times were associated with worse delayed memory performance (β=−.28). More fragmented rhythms were associated with worse processing speed (β=.40). Conclusions: Using the Apple Watch-based myRW system to gather raw accelerometer data is feasible in older adults with and without MCI. Sleep/wake rhythms variables generated from this system correlated with cognitive function, suggesting future studies can use this approach to evaluate novel, scalable, risk factor characterization and targeted therapy approaches. %R 10.2196/67294 %U https://aging.jmir.org/2025/1/e67294 %U https://doi.org/10.2196/67294 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e65668 %T Participant Adherence in Repeated-Dose Clinical Studies Using Video-Based Observation: Retrospective Data Analysis %A Han,Seunghoon %A Song,Jihong %A Han,Sungpil %A Choi,Suein %A Lim,Jonghyuk %A Oh,Byeong Yeob %A Shin,Dongoh %+ Department of Clinical Pharmacology and Therapeutics, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea, 82 10 9484 2415, waystolove@catholic.ac.kr %K adherence %K mobile health %K self-administration %K repeated-dose clinical trials %K video-based monitoring %K mobile phone %D 2025 %7 7.4.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Maintaining accurate medication records in clinical trials is essential to ensure data validity. Traditional methods such as direct observation, self-reporting, and pill counts have shown limitations that make them inaccurate or impractical. Video-based monitoring systems, available as commercial or proprietary mobile applications for smartphones and tablets, offer a promising solution to these traditional limitations. In Korea, a system applicable to the clinical trial context has been developed and used. Objective: This study aimed to evaluate the usefulness of an asynchronous video-based self-administration of the investigational medicinal product (SAI) monitoring system (VSMS) in ensuring accurate dosing and validating participant adherence to planned dosing times in repeated-dose clinical trials. Methods: A retrospective analysis was conducted using data from 17,619 SAI events in repeated-dose clinical trials using the VSMS between February 2020 and March 2023. The SAI events were classified into four categories: (1) Verified on-time dosing, (2) Verified deviated dosing, (3) Unverified dosing, and (4) Missed dosing. Analysis methods included calculating the success rate for verified SAI events and analyzing trends in difference between planned and actual dosing times (PADEV) over the dosing period and by push notification type. The mean PADEV for each subsequent dosing period was compared with the initial period using either a paired t test or a Wilcoxon signed-rank test to assess any differences. Results: A comprehensive analysis of 17,619 scheduled SAI events across 14 cohorts demonstrated a high success rate of 97% (17,151/17,619), with only 3% (468/17,619) unsuccessful due to issues like unclear video recordings or technical difficulties. Of the successful events, 99% (16,975/17,151) were verified as on-time dosing, confirming that the dosing occurred within the designated SAI time window with appropriate recorded behavior. In addition, over 90% (367/407) of participants consistently reported dosing videos on all analyzed SAI days, with most days showing over 90% objective dosing data, underscoring the system’s effectiveness in supporting accurate SAI. There were cohort differences in the tendency to dose earlier or later, but no associated cohort characteristics were identified. The initial SAI behaviors were generally sustained during the whole period of participation, with only 16% (13/79) of study days showing significant shifts in actual dosing times. Earlier deviations in SAI times were observed when only dosing notifications were used, compared with using reminders together or no notifications. Conclusions: VSMS has proven to be an effective tool for obtaining dosing information with accuracy comparable to direct observation, even in remote settings. The use of various alarm features and appropriate intervention by the investigator or observer was identified as a way to minimize adherence deterioration. It is expected that the usage and usefulness of VSMS will be continuously improved through the accumulation of experience in various medical fields. %M 40194283 %R 10.2196/65668 %U https://mhealth.jmir.org/2025/1/e65668 %U https://doi.org/10.2196/65668 %U http://www.ncbi.nlm.nih.gov/pubmed/40194283 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e70149 %T Digital Health Platform for Maternal Health: Design, Recruitment Strategies, and Lessons Learned From the PowerMom Observational Cohort Study %A Ajayi,Toluwalase %A Kueper,Jacqueline %A Ariniello,Lauren %A Ho,Diana %A Delgado,Felipe %A Beal,Matthew %A Waalen,Jill %A Baca Motes,Katie %A Ramos,Edward %+ Jacobs Center for Health Innovation, Department of Medicine and Pediatrics, University of California, San Diego, 9300 Campus Point Drive, MC 7196, La Jolla, CA, 92037, United States, 1 785 218 1643, tajayi@health.ucsd.edu %K maternal health research %K digital health platforms %K pregnancy monitoring %K decentralized clinical trials %K participant engagement %K health disparities %D 2025 %7 7.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Maternal health research faces challenges in participant recruitment, retention, and data collection, particularly among underrepresented populations. Digital health platforms like PowerMom (Scripps Research) offer scalable solutions, enabling decentralized, real-world data collection. Using innovative recruitment and multimodal techniques, PowerMom engages diverse cohorts to gather longitudinal and episodic data during pregnancy and post partum. Objective: This study aimed to evaluate the design, implementation, and outcomes of the PowerMom research platform, with a focus on participant recruitment, engagement, and data collection across diverse populations. Secondary objectives included identifying challenges encountered during implementation and deriving lessons to inform future digital maternal health studies. Methods: Participants were recruited via digital advertisements, pregnancy apps, and the PowerMom Consortium of more than 15 local and national organizations. Data collection included self-reported surveys, wearable devices, and electronic health records. Anomaly detection measures were implemented to address fraudulent enrollment activity. Recruitment trends and descriptive statistics from survey data were analyzed to summarize participant characteristics, assess engagement metrics, and quantify missing data to identify gaps. Results: Overall, 5617 participants were enrolled from 2021 to 2024, with 69.8% (n=3922) providing demographic data. Of these, 48.5% (2723/5617) were younger than 35 years, 14% (788/5617) identified as Hispanic or Latina, and 13.7% (770/5617) identified as Black or African American. Geographic representation spanned all 50 US states, Puerto Rico, and Guam, with 58.3% (3276/5617) residing in areas with moderate access to maternity care and 16.4% (919/5617) in highly disadvantaged neighborhoods based on the Area Deprivation Index. Enrollment rates increased substantially over the study period, from 55 participants in late 2021 to 3310 in 2024, averaging 99.4 enrollments per week in 2024. Participants completed a total of 17,123 surveys, with 71.8% (4033/5617) completing the Intake Survey and 12.4% (697/5617) completing the Postpartum Survey. Wearable device data were shared by 1168 participants, providing more than 378,000 daily biometric measurements, including activity levels, sleep, and heart rate. Additionally, 96 participants connected their electronic health records, contributing 276 data points such as diagnoses, medications, and laboratory results. Among pregnancy-related characteristics, 28.1% (1578/5617) enrolled during the first trimester, while 15.1% (849/5617) reported information about the completion of their pregnancies during the study period. Among the 913 participants who shared delivery information, 56.1% (n=512) had spontaneous vaginal deliveries and 17.9% (n=163) underwent unplanned cesarean sections. Conclusions: The PowerMom platform demonstrates the feasibility of using digital tools to recruit and engage diverse populations in maternal health research. Its ability to integrate multimodal data sources showcases its potential to provide comprehensive maternal-fetal health insights. Challenges with data completeness and survey attrition underscore the need for sustained participant engagement strategies. These findings offer valuable lessons for scaling digital health platforms and addressing disparities in maternal health research. Trial Registration: ClinicalTrials.gov NCT03085875; https://clinicaltrials.gov/study/NCT03085875 %M 40194282 %R 10.2196/70149 %U https://formative.jmir.org/2025/1/e70149 %U https://doi.org/10.2196/70149 %U http://www.ncbi.nlm.nih.gov/pubmed/40194282 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e68560 %T Online Health Information–Seeking in the Era of Large Language Models: Cross-Sectional Web-Based Survey Study %A Yun,Hye Sun %A Bickmore,Timothy %+ Khoury College of Computer Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, United States, 1 6173732000, yun.hy@northeastern.edu %K online health information–seeking %K large language models %K eHealth %K internet %K consumer health information %D 2025 %7 31.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: As large language model (LLM)–based chatbots such as ChatGPT (OpenAI) grow in popularity, it is essential to understand their role in delivering online health information compared to other resources. These chatbots often generate inaccurate content, posing potential safety risks. This motivates the need to examine how users perceive and act on health information provided by LLM-based chatbots. Objective: This study investigates the patterns, perceptions, and actions of users seeking health information online, including LLM-based chatbots. The relationships between online health information–seeking behaviors and important sociodemographic characteristics are examined as well. Methods: A web-based survey of crowd workers was conducted via Prolific. The questionnaire covered sociodemographic information, trust in health care providers, eHealth literacy, artificial intelligence (AI) attitudes, chronic health condition status, online health information source types, perceptions, and actions, such as cross-checking or adherence. Quantitative and qualitative analyses were applied. Results: Most participants consulted search engines (291/297, 98%) and health-related websites (203/297, 68.4%) for their health information, while 21.2% (63/297) used LLM-based chatbots, with ChatGPT and Microsoft Copilot being the most popular. Most participants (268/297, 90.2%) sought information on health conditions, with fewer seeking advice on medication (179/297, 60.3%), treatments (137/297, 46.1%), and self-diagnosis (62/297, 23.2%). Perceived information quality and trust varied little across source types. The preferred source for validating information from the internet was consulting health care professionals (40/132, 30.3%), while only a very small percentage of participants (5/214, 2.3%) consulted AI tools to cross-check information from search engines and health-related websites. For information obtained from LLM-based chatbots, 19.4% (12/63) of participants cross-checked the information, while 48.4% (30/63) of participants followed the advice. Both of these rates were lower than information from search engines, health-related websites, forums, or social media. Furthermore, use of LLM-based chatbots for health information was negatively correlated with age (ρ=–0.16, P=.006). In contrast, attitudes surrounding AI for medicine had significant positive correlations with the number of source types consulted for health advice (ρ=0.14, P=.01), use of LLM-based chatbots for health information (ρ=0.31, P<.001), and number of health topics searched (ρ=0.19, P<.001). Conclusions: Although traditional online sources remain dominant, LLM-based chatbots are emerging as a resource for health information for some users, specifically those who are younger and have a higher trust in AI. The perceived quality and trustworthiness of health information varied little across source types. However, the adherence to health information from LLM-based chatbots seemed more cautious compared to search engines or health-related websites. As LLMs continue to evolve, enhancing their accuracy and transparency will be essential in mitigating any potential risks by supporting responsible information-seeking while maximizing the potential of AI in health contexts. %M 40163112 %R 10.2196/68560 %U https://www.jmir.org/2025/1/e68560 %U https://doi.org/10.2196/68560 %U http://www.ncbi.nlm.nih.gov/pubmed/40163112 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 17 %N %P e50225 %T Impact of Platform Design and Usability on Adherence and Retention: Randomized Web- and Mobile-Based Longitudinal Study %A Jiang,Xinrui %A Timmons,Michelle %A Boroda,Elias %A Onakomaiya,Marie %K behavioral science %K electronic patient-reported outcomes %K ePROs %K retention %K adherence %K patient engagement %K clinical trials %K mobile phone %D 2025 %7 27.3.2025 %9 %J J Particip Med %G English %X Background: Low retention and adherence increase clinical trial costs and timelines. Burdens associated with participating in a clinical trial contribute to early study termination. Electronic patient-reported outcome (ePRO) tools reduce participant burden by allowing remote participation, and facilitate communication between researchers and participants. The Datacubed Health (DCH) mobile app is unique among ePRO platforms in its application of behavioral science principles (reward, motivation, identity, etc) in clinical trials to promote engagement, adherence, and retention. Objective: We evaluated the impact of platform design and usability on adherence and retention with a longitudinal study involving repeated patient-facing study instruments. We expected participants assigned to complete instruments in the DCH mobile app to stay in this study longer (increased retention) and complete more surveys while in this study (increased adherence) due to the enhanced motivational elements unique to the participant experience in the DCH app group, and this group’s overall lower burden of participation. Methods: A total of 284 adult participants completed 24 weekly surveys via 1 of 4 modalities (DCH app vs DCH website vs third-party website vs paper) in a web-based and mobile longitudinal study. Participants were recruited from open access websites (eg, Craigslist or Facebook [Meta]), and a closed web-based user group. All participation occurred remotely. Study staff deliberately limited communications with participants to directly assess the main effects of survey administration modality; enrollment and study administration were largely automated. Participants assigned to the DCH app group experienced behavioral science–driven motivational elements related to reward and identity formation throughout their study journey. There was no homolog to this feature in any other tested platform. Participants assigned to the DCH app group accessed study measures using passcodes or smartphone biometrics (face or touch ID). Participants in the DCH website group logged into a website using a username and password. Participants in the third-party website group accessed web-based surveys via personalized emailed links with no need for password authentication. Paper arm participants received paper surveys in the mail. Results: Mode of survey administration (DCH app vs DCH website vs third-party website vs paper) predicted study retention (F9,255=4.22, P<.001) and adherence (F9,162=5.5, P<.001). The DCH app group had greater retention than the paper arm (t=−3.80, P<.001), and comparable retention to the DCH website group. The DCH app group had greater adherence than all other arms (DCH web: t=−2.42, P=.02; third-party web: t=−3.56, P<.001; and paper arm: t=−4.53, P<.001). Conclusions: Using an ePRO platform in a longitudinal study increased retention and adherence in comparison to paper instruments. Incorporating behavioral science design in an ePRO platform resulted in further increase in adherence in a longitudinal study. %R 10.2196/50225 %U https://jopm.jmir.org/2025/1/e50225 %U https://doi.org/10.2196/50225 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 17 %N %P e57084 %T Real-World Data on Alcohol Consumption Behavior Among Smartphone Health Care App Users in Japan: Retrospective Study %A Eguchi,Kana %A Kubota,Takeaki %A Koyanagi,Tomoyoshi %A Muto,Manabu %+ Department of Informatics, Graduate School of Informatics, Kyoto University, Yoshida-Hommachi, Sakyo-ku,, Kyoto, 606-8501, Japan, 81 75 753 3369, kana.eguchi@ieee.org %K alcohol consumption %K individual behavior %K mobile health %K mobile health app %K mobile health care app log-based survey %K real-world data %K RWD %K RWD analysis %K smartphone health care app %K surveillance system %K health care app %D 2025 %7 25.3.2025 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Although many studies have used smartphone apps to examine alcohol consumption, none have clearly delineated long-term (>1 year) consumption among the general population. Objective: The objective of our study is to elucidate in detail the alcohol consumption behavior of alcohol drinkers in Japan using individual real-world data. During the state of emergency associated with the COVID-19 outbreak, the government requested that people restrict social gatherings and stay at home, so we hypothesize that alcohol consumption among Japanese working people decreased during this period due to the decrease in occasions for alcohol consumption. This analysis was only possible with individual real-world data. We also aimed to clarify the effects of digital interventions based on notifications about daily alcohol consumption. Methods: We conducted a retrospective study targeting 5-year log data from January 1, 2018, to December 31, 2022, obtained from a commercial smartphone health care app (CALO mama Plus). First, to investigate the possible size of the real-world data, we investigated the rate of active users of this commercial smartphone app. Second, to validate the individual real-world data recorded in the app, we compared individual real-world data from 9991 randomly selected users with government-provided open data on the number of daily confirmed COVID-19 cases in Japan and with nationwide alcohol consumption data. To clarify the effects of digital interventions, we investigated the relationship between 2 types of notification records (ie, “good” and “bad”) and a 3-day daily alcohol consumption log following the notification. The protocol of this retrospective study was approved by the Ethics Committee of the Kyoto University Graduate School and Faculty of Medicine (R4699). %M 40131328 %R 10.2196/57084 %U https://ojphi.jmir.org/2025/1/e57084 %U https://doi.org/10.2196/57084 %U http://www.ncbi.nlm.nih.gov/pubmed/40131328 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59209 %T Embedding a Choice Experiment in an Online Decision Aid or Tool: Scoping Review %A Wickramasekera,Nyantara %A Shackley,Phil %A Rowen,Donna %+ , Sheffield Centre for Health and Related Research (SCHARR), The University of Sheffield, 30 Regent St, Sheffield, S14DA, United Kingdom, 44 01142224348, N.Wickramasekera@sheffield.ac.uk %K decision aid %K decision tool %K discrete choice experiment %K conjoint analysis %K value clarification %K scoping review %K choice experiment %K database %K study %K article %K data charting %K narrative synthesis %D 2025 %7 21.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Decision aids empower patients to understand how treatment options match their preferences. Choice experiments, a method to clarify values used within decision aids, present patients with hypothetical scenarios to reveal their preferences for treatment characteristics. Given the rise in research embedding choice experiments in decision tools and the emergence of novel developments in embedding methodology, a scoping review is warranted. Objective: This scoping review examines how choice experiments are embedded into decision tools and how these tools are evaluated, to identify best practices. Methods: This scoping review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Searches were conducted on MEDLINE, PsycInfo, and Web of Science. The methodology, development and evaluation details of decision aids were extracted and summarized using narrative synthesis. Results: Overall, 33 papers reporting 22 tools were included in the scoping review. These tools were developed for various health conditions, including musculoskeletal (7/22, 32%), oncological (8/22, 36%), and chronic conditions (7/22, 32%). Most decision tools (17/22, 77%) were developed in the United States, with the remaining tools originating in the Netherlands, United Kingdom, Canada, and Australia. The number of publications increased, with 73% (16/22) published since 2015, peaking at 4 publications in 2019. The primary purpose of these tools (20/22, 91%) was to help patients compare or choose treatments. Adaptive conjoint analysis was the most frequently used design type (10/22, 45%), followed by conjoint analysis and discrete choice experiments (DCEs; both 4/22, 18%), modified adaptive conjoint analysis (3/22, 14%), and adaptive best-worst conjoint analysis (1/22, 5%). The number of tasks varied depending on the design (6-12 for DCEs and adaptive conjoint vs 16-20 for conjoint analysis designs). Sawtooth software was commonly used (14/22, 64%) to embed choice tasks. Four proof-of-concept embedding methods were identified: scenario analysis, known preference phenotypes, Bayesian collaborative filtering, and penalized multinomial logit model. After completing the choice tasks patients received tailored information, 73% (16/22) of tools provided attribute importance scores, and 23% (5/22) presented a “best match” treatment ranking. To convey probabilistic attributes, most tools (13/22, 59%) used a combination of approaches, including percentages, natural frequencies, icon arrays, narratives, and videos. The tools were evaluated across diverse study designs (randomized controlled trials, mixed methods, and cohort studies), with sample sizes ranging from 23 to 743 participants. Over 40 different outcomes were included in the evaluations, with the decisional conflict scale being the most frequently used in 6 tools. Conclusions: This scoping review provides an overview of how choice experiments are embedded into decision tools. It highlights the lack of established best practices for embedding methods, with only 4 proof-of-concept methods identified. Furthermore, the review reveals a lack of consensus on outcome measures, emphasizing the need for standardized outcome selection for future evaluations. %M 40117570 %R 10.2196/59209 %U https://www.jmir.org/2025/1/e59209 %U https://doi.org/10.2196/59209 %U http://www.ncbi.nlm.nih.gov/pubmed/40117570 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63252 %T Introducing Novel Methods to Identify Fraudulent Responses (Sampling With Sisyphus): Web-Based LGBTQ2S+ Mixed-Methods Study %A MacKinnon,Kinnon Ross %A Khan,Naail %A Newman,Katherine M %A Gould,Wren Ariel %A Marshall,Gin %A Salway,Travis %A Pullen Sansfaçon,Annie %A Kia,Hannah %A Lam,June SH %+ School of Social Work, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100, kinnonmk@yorku.ca %K sampling %K bots %K transgender %K nonbinary %K detransition %K lesbian, gay, bisexual, and transgender %K mobile phone %D 2025 %7 17.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The myth of Sisyphus teaches about resilience in the face of life challenges. Detransition after an initial gender transition is an emerging experience that requires sensitive and community-driven research. However, there are significant complexities and costs that researchers must confront to collect reliable data to better understand this phenomenon, including the lack of a uniform definition and challenges with recruitment. Objective: This paper presents the sampling and recruitment methods of a new study on detransition-related phenomena among lesbian, gay, bisexual, transgender, queer, and 2-spirit (LGBTQ2S+) populations. It introduces a novel protocol for identifying and removing bot, scam, and ineligible responses from survey datasets and presents preliminary descriptive sociodemographic results of the sample. This analysis does not present gender-affirming health care outcomes. Methods: To attract a large and heterogeneous sample, 3 different study flyers were created in English, French, and Spanish. Between December 1, 2023, and May 1, 2024, these flyers were distributed to >615 sexual and gender minority organizations and gender care providers in the United States and Canada, and paid advertisements totaling >CAD $7400 (US $5551) were promoted on 5 different social media platforms. Although many social media promotions were rejected or removed, the advertisements reached >7.7 million accounts. Study website visitors were directed from 35 different traffic sources, with the top 5 being Facebook (3,577,520/7,777,218, 46%), direct link (2,255,393/7,777,218, 29%), Reddit (1,011,038/7,777,218, 13%), Instagram (466,633/7,777,218, 6%), and X (formerly known as Twitter; 233,317/7,777,218, 3%). A systematic protocol was developed to identify scam, nonsense, and ineligible responses and to conduct web-based Zoom video platform screening with select participants. Results: Of the 1377 completed survey responses, 957 (69.5%) were deemed eligible and included in the analytic dataset after applying the exclusion protocol and conducting 113 virtual screenings. The mean age of the sample was 25.87 (SD 7.77; median 24, IQR 21-29 years). A majority of the participants were White (Canadian, American, or of European descent; 748/950, 78.7%), living in the United States (704/957, 73.6%), and assigned female at birth (754/953, 79.1%). Many participants reported having a sexual minority identity, with more than half the sample (543/955, 56.8%) indicating plurisexual orientations, such as bisexual or pansexual identities. A minority of participants (108/955, 11.3%) identified as straight or heterosexual. When asked about their gender-diverse identities after stopping or reversing gender transition, 33.2% (318/957) reported being nonbinary, 43.2% (413/957) transgender, and 40.5% (388/957) identified as detransitioned. Conclusions: Despite challenges encountered during the study promotion and data collection phases, a heterogeneous sample of >950 eligible participants was obtained, presenting opportunities for future analyses to better understand these LGBTQ2S+ experiences. This study is among the first to introduce an innovative strategy to sample a hard-to-reach and equity-deserving group, and to present an approach to remove fraudulent responses. %M 40096683 %R 10.2196/63252 %U https://www.jmir.org/2025/1/e63252 %U https://doi.org/10.2196/63252 %U http://www.ncbi.nlm.nih.gov/pubmed/40096683 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64965 %T Investigating the Magnitude and Persistence of COVID-19–Related Impacts on Affect and GPS-Derived Daily Mobility Patterns in Adolescence and Emerging Adulthood: Insights From a Smartphone-Based Intensive Longitudinal Study of Colorado-Based Youths From June 2016 to April 2022 %A Alexander,Jordan D %A Duffy,Kelly A %A Freis,Samantha M %A Chow,Sy-Miin %A Friedman,Naomi P %A Vrieze,Scott I %+ Department of Psychology, University of Minnesota, 75 East River Parkway, Minneapolis, MN, 55455, United States, 1 6126252818, alexa877@umn.edu %K adolescence %K emerging adulthood %K intensive longitudinal assessment %K COVID-19 %K affect %K GPS %K mobility patterns %K smartphone data %K respiratory %K infectious %K pulmonary %K pandemic %K adolescents %K teens %K teenagers %K mobility %K apps %K smartphones %K intensive longitudinal panel studies %K emotional well-being %K well-being %K daily routines %K affect survey %D 2025 %7 17.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The onset of the COVID-19 pandemic in early 2020 introduced unprecedented disruptions impacting the emotional well-being and daily routines of US youths. However, the patterns and persistence of these impacts over the pandemic’s multiyear course remain less well understood. Objective: This study examined longitudinal changes in affect and daily mobility patterns observed in adolescence and young adulthood from June 2016 to April 2022. The study aimed to quantify changes in youths’ mood and daily routines following the pandemic’s onset and in response to local COVID-19 case rates as well as the persistence of these effects over the pandemic’s multiyear course. Methods: Colorado-based adolescent and young adult twins (N=887; n=479, 54% female; meanage 19.2, SDage 1.5 years on January 01, 2020) participating in the CoTwins study between June 2016 and April 2022 were followed via a smartphone app, which recorded persistent GPS location data and, beginning in February 2019, administered an abbreviated Positive and Negative Affect Schedule every 2 weeks. Nonlinear trajectories in affect and daily mobility over time and in response to local COVID-19 counts were modeled via generalized additive mixed models, while the magnitude and persistence of pandemic-related changes were quantified via linear mixed effects regressions. Results: Between January and April 2020, participants experienced a 28.6% decline in daily locations visited (from 3.5 to 2.5; SD 0.9) and a 60% reduction in daily travel distance (from 20.0 to 8.0 km; SD 9.4). Mean positive affect similarly declined by 0.3 SD (from 3.0 to 2.79; SD 0.6), while, correspondingly, mean negative affect increased by 0.3 SD (from 1.85 to 2.10; SD 0.6). Though mobility levels partially recovered beginning in the summer of 2020, daily locations visited remained slightly below 2019 levels through the study’s conclusion in April 2022 (standardized β=–0.10; P<.001). Average positive affect similarly remained slightly below (standardized β=–0.20; P<.001) and negative affect slightly above (standardized β=0.14; P=.04) 2019 levels through April 2022. Weekly county-level COVID-19 transmission rates were negatively associated with mobility and positive affect and positively with negative affect, though these effects were greatly weakened later in the pandemic (eg, early 2022) or when transmission rates were high (eg, >200 new cases per 100,000 people per week). Conclusions: Findings demonstrate large initial declines in daily mobility, a moderate decline in positive affect, and a moderate increase in negative affect following the pandemic’s onset in 2020. Though most effects attenuated over time, affect and mobility levels had not recovered to prepandemic levels by April 2022. Findings support theories of hedonic adaptation and resiliency while also identifying lingering emotional and behavioral consequences. The study highlights both youth’s resiliency in adapting to major stressors while also underscoring the need for continued support for youth mental health and psychosocial functioning in the pandemic’s aftermath. %M 40096681 %R 10.2196/64965 %U https://www.jmir.org/2025/1/e64965 %U https://doi.org/10.2196/64965 %U http://www.ncbi.nlm.nih.gov/pubmed/40096681 %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 %@ 2561-326X %I JMIR Publications %V 9 %N %P e59955 %T Assessment of Fraud Deterrence and Detection Procedures Used in a Web-Based Survey Study With Adult Black Cisgender Women: Description of Lessons Learned and Recommendations %A Sophus,Amber I %A Mitchell,Jason W %+ Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, 11200 S.W. 8th Street, Miami, FL, 33199, United States, asophus@fiu.edu %K Black women %K HIV %K fraud deterrence %K fraud detection %K web-based research %K online research %K data integrity %K data collection %K survey %D 2025 %7 12.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Online research studies enable engagement with more Black cisgender women in health-related research. However, fraudulent data collection responses in online studies raise important concerns about data integrity, particularly when incentives are involved. Objective: The purpose of this study was to assess the strengths and limitations of fraud deterrence and detection procedures implemented in an incentivized, cross-sectional, online study about HIV prevention and sexual health with Black cisgender women living in Texas. Methods: Data for this study came from a cross-sectional web-based survey that examined factors associated with potential pre-exposure prophylaxis use among a convenience sample of adult Black cisgender women from 3 metropolitan areas in Texas. Each eligibility screener and associated survey entry was evaluated using 4 fraud deterrence features and 7 fraud detection benchmarks with corresponding decision rules. Results: A total of 5862 respondents provided consent and initiated the eligibility screener, of whom 2150 (36.68%) were ineligible for not meeting the inclusion criteria, and 131 (2.23%) completed less than 80% of the survey and were removed from further consideration. Other entries were removed for not passing level 1 fraud deterrent safeguards: duplicate entries with the same IP address (388/5862, 6.62%), same telephone number (69/5862, 1.18%), same email address (114/5862, 1.94%), and same telephone number and email address (17/5862, 0.29%). Of the remaining 2993 entries, 1652 entries were removed for not passing the first 2 items of the level 2 fraud detection benchmarks: screeners and surveys with latitude and longitude coordinates outside of the United States (347/2993, 11.59%) and survey completion time of less than 10 minutes (1305/2993, 43.6%). Of the remaining 1341 entries, 130 (9.69%) passed all 5 of the remaining level 2 data validation benchmarks, and 763 (56.89%) entries were removed due to passing less than 3. An additional 33.4% (423/1341) entries were removed after passing 4 of the 5 remaining validation benchmarks, being contacted to verify survey information, and not providing legitimate contact information or being unable to confirm personal information. The final enrolled sample in this online study consisted of 155 respondents who provided consent, were deemed eligible, and passed fraud deterrence features and fraud detection benchmarks. In this paper, we discuss the lessons learned and provide recommendations for leveraging available features in survey software programs to help deter bots and enhance fraud detection procedures beyond relying on survey software options. Conclusions: Effectively identifying fraudulent responses in online surveys is an ongoing challenge. The data validation approach used in this study establishes a robust protocol for identifying genuine participants, thereby contributing to the removal of false data from study findings. By sharing experiences and implementing thorough fraud deterrence and detection protocols, researchers can maintain data validity and contribute to best practices in web-based research. %M 40073396 %R 10.2196/59955 %U https://formative.jmir.org/2025/1/e59955 %U https://doi.org/10.2196/59955 %U http://www.ncbi.nlm.nih.gov/pubmed/40073396 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67488 %T Accuracy of Large Language Models for Literature Screening in Thoracic Surgery: Diagnostic Study %A Dai,Zhang-Yi %A Wang,Fu-Qiang %A Shen,Cheng %A Ji,Yan-Li %A Li,Zhi-Yang %A Wang,Yun %A Pu,Qiang %+ Department of Thoracic Surgery, West China Hospital of Sichuan University, No.37, Guoxue Alley, Chengdu, 610041, China, 86 18980606738, puqiang100@163.com %K accuracy %K large language models %K meta-analysis %K literature screening %K thoracic surgery %D 2025 %7 11.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Systematic reviews and meta-analyses rely on labor-intensive literature screening. While machine learning offers potential automation, its accuracy remains suboptimal. This raises the question of whether emerging large language models (LLMs) can provide a more accurate and efficient approach. Objective: This paper evaluates the sensitivity, specificity, and summary receiver operating characteristic (SROC) curve of LLM-assisted literature screening. Methods: We conducted a diagnostic study comparing the accuracy of LLM-assisted screening versus manual literature screening across 6 thoracic surgery meta-analyses. Manual screening by 2 investigators served as the reference standard. LLM-assisted screening was performed using ChatGPT-4o (OpenAI) and Claude-3.5 (Anthropic) sonnet, with discrepancies resolved by Gemini-1.5 pro (Google). In addition, 2 open-source, machine learning–based screening tools, ASReview (Utrecht University) and Abstrackr (Center for Evidence Synthesis in Health, Brown University School of Public Health), were also evaluated. We calculated sensitivity, specificity, and 95% CIs for the title and abstract, as well as full-text screening, generating pooled estimates and SROC curves. LLM prompts were revised based on a post hoc error analysis. Results: LLM-assisted full-text screening demonstrated high pooled sensitivity (0.87, 95% CI 0.77-0.99) and specificity (0.96, 95% CI 0.91-0.98), with the area under the curve (AUC) of 0.96 (95% CI 0.94-0.97). Title and abstract screening achieved a pooled sensitivity of 0.73 (95% CI 0.57-0.85) and specificity of 0.99 (95% CI 0.97-0.99), with an AUC of 0.97 (95% CI 0.96-0.99). Post hoc revisions improved sensitivity to 0.98 (95% CI 0.74-1.00) while maintaining high specificity (0.98, 95% CI 0.94-0.99). In comparison, the pooled sensitivity and specificity of ASReview tool-assisted screening were 0.58 (95% CI 0.53-0.64) and 0.97 (95% CI 0.91-0.99), respectively, with an AUC of 0.66 (95% CI 0.62-0.70). The pooled sensitivity and specificity of Abstrackr tool-assisted screening were 0.48 (95% CI 0.35-0.62) and 0.96 (95% CI 0.88-0.99), respectively, with an AUC of 0.78 (95% CI 0.74-0.82). A post hoc meta-analysis revealed comparable effect sizes between LLM-assisted and conventional screening. Conclusions: LLMs hold significant potential for streamlining literature screening in systematic reviews, reducing workload without sacrificing quality. Importantly, LLMs outperformed traditional machine learning-based tools (ASReview and Abstrackr) in both sensitivity and AUC values, suggesting that LLMs offer a more accurate and efficient approach to literature screening. %M 40068152 %R 10.2196/67488 %U https://www.jmir.org/2025/1/e67488 %U https://doi.org/10.2196/67488 %U http://www.ncbi.nlm.nih.gov/pubmed/40068152 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67188 %T Monitoring Sleep Quality Through Low α-Band Activity in the Prefrontal Cortex Using a Portable Electroencephalogram Device: Longitudinal Study %A Han,Chuanliang %A Zhang,Zhizhen %A Lin,Yuchen %A Huang,Shaojia %A Mao,Jidong %A Xiang,Weiwen %A Wang,Fang %A Liang,Yuping %A Chen,Wufang %A Zhao,Xixi %+ National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, No. 5 Ankang Hutong, Xicheng District, Beijing, 100088, China, 86 15501193896, zhaoxixi@ccmu.edu.cn %K EEG %K electroencephalogram %K alpha oscillation %K prefrontal cortex %K sleep %K portable device %D 2025 %7 10.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The pursuit of sleep quality has become an important aspect of people’s global quest for overall health. However, the objective neurobiological features corresponding to subjective perceptions of sleep quality remain poorly understood. Although previous studies have investigated the relationship between electroencephalogram (EEG) and sleep, the lack of longitudinal follow-up studies raises doubts about the reproducibility of their findings. Objective: Currently, there is a gap in research regarding the stable associations between EEG data and sleep quality assessed through multiple data collection sessions, which could help identify potential neurobiological targets related to sleep quality. Methods: In this study, we used a portable EEG device to collect resting-state prefrontal cortex EEG data over a 3-month follow-up period from 42 participants (27 in the first month, 25 in the second month, and 40 in the third month). Each month, participants’ sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI) to estimate their recent sleep quality. Results: We found that there is a significant and consistent positive correlation between low α band activity in the prefrontal cortex and PSQI scores (r=0.45, P<.001). More importantly, this correlation remained consistent across all 3-month follow-up recordings (P<.05), regardless of whether we considered the same cohort or expanded the sample size. Furthermore, we discovered that the periodic component of the low α band primarily contributed to this significant association with PSQI. Conclusions: These findings represent the first identification of a stable and reliable neurobiological target related to sleep quality through multiple follow-up sessions. Our results provide a solid foundation for future applications of portable EEG devices in monitoring sleep quality and screening for sleep disorders in a broad population. %M 40063935 %R 10.2196/67188 %U https://www.jmir.org/2025/1/e67188 %U https://doi.org/10.2196/67188 %U http://www.ncbi.nlm.nih.gov/pubmed/40063935 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65343 %T Association of Screen Content With Early Development Among Preschoolers in Shanghai: 7-Day Monitoring Study With Auto Intelligent Technology %A Chen,Hao %A Sun,Yi %A Luo,Sha %A Ma,Yingyan %A Li,Chenshu %A Xiao,Yingcheng %A Zhang,Yimeng %A Lin,Senlin %A Jia,Yingnan %+ Preventive Medicine and Health Education Department, School of Public Health, Fudan University, No 138 Yixueyuan Road, Shanghai, 200032, China, 86 13764665540, jyn@fudan.edu.cn %K types of screen content %K screen time %K intelligent technology %K early development %K preschool %D 2025 %7 5.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: It is unclear how exposure to different types of screen content is associated with early development among preschool children. Objective: This study aims to precisely evaluate the screen exposure time across different content types and to explore the associations with the Ages and Stages Questionnaire, Third Edition (ASQ-3) score and 5 capacity domains in children aged 34.5-66 months. Methods: This monitoring study used intelligent technology to collect data on the 7-day screen time and the time spent viewing each content type. The participants were 2 groups of Shanghai kindergarten kids. The data were collected between March 2023 and July 2023. Screen exposure data (total daily time and time for each type of content) were collected from children aged between 34.5 and 66 months. A self-designed questionnaire and the Healthy Screen Viewing for Children intelligent technology app were used to assess screen exposure to all media and tablets. The ASQ-3 was used to assess early development in children aged 34.5-66 months. Results: In the 535-child sample, the results of linear regression analysis indicated that both screen time of more than 60 minutes and exposure to smartphones and tablets were negatively associated with ASQ-3 score. Among 365 participants with data collected by the Healthy Screen Viewing for Children app, median regression showed that the median total ASQ-3 score was negatively associated with screen time for noneducational content (β=–.055; 95% CI –0.148 to –0.006; P=.03), screen time for both educational and noneducational content (β=–.042; 95% CI –0.081 to –0.007; P=.001), and fast-paced content (β=–.034; 95% CI –0.062 to –0.011; P=.049). The median gross motor score was negatively associated with screen time for parental guidance-13–rated content (β=–.015; 95% CI –0.022 to 0.009; P=.03), educational and noneducational content (β=–.018, 95% CI –0.038 to –0.001; P=.02), static content (β=–.022; 95% CI –0.050 to 0.007; P=.02). This study also revealed that the median fine motor score was negatively associated with screen time for guidance–rated content (β=–.032, 95% CI –0.057 to –0.003; P=.006), parental guidance (PG) rated content (β=–.020; 95% CI –0.036 to –0.007; P=.004), noneducational content (β=–.026; 95% CI –0.067 to –0.003; P=.01), both educational and noneducational content (β=–.020; 95% CI –0.034 to –0.001; P<.001), fast-paced content (β=–.022; 95% CI –0.033 to –0.014; P<.001), static content (β=–.034; 95% CI –0.050 to 0.018; P<.001), animated content (β=–.038; 95% CI –0.069 to –0.001; P=.004), and screen use during the daytime (β=–.026; 95% CI –0.043 to 0.005; P=.005). Conclusions: The results indicated that the time spent viewing noneducational, static, fast-paced, and animated content was negatively associated with early development among preschool children. Limiting screen time in relevant aspects is recommended. %M 40053802 %R 10.2196/65343 %U https://www.jmir.org/2025/1/e65343 %U https://doi.org/10.2196/65343 %U http://www.ncbi.nlm.nih.gov/pubmed/40053802 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59954 %T Supplementing Consent for a Prospective Longitudinal Cohort Study of Infants With Antenatal Opioid Exposure: Development and Assessment of a Digital Tool %A Newman,Jamie E %A Clarke,Leslie %A Athimuthu,Pranav %A Dhawan,Megan %A Owen,Sharon %A Beiersdorfer,Traci %A Parlberg,Lindsay M %A Bangdiwala,Ananta %A McMillan,Taya %A DeMauro,Sara B %A Lorch,Scott %A Peralta-Carcelen,Myriam %A Wilson-Costello,Deanne %A Ambalavanan,Namasivayam %A Merhar,Stephanie L %A Poindexter,Brenda %A Limperopoulos,Catherine %A Davis,Jonathan M %A Walsh,Michele %A Bann,Carla M %K informed consent digital tool %K avatars %K video-assisted consent %K MRI %K antenatal opioid exposure %K infant %K antenatal %K opioid exposure %K caregiver %K survey %K magnetic resonance imaging %K Outcomes of Babies With Opioid Exposure %D 2025 %7 4.3.2025 %9 %J JMIR Form Res %G English %X Background: The Outcomes of Babies With Opioid Exposure (OBOE) study is an observational cohort study examining the impact of antenatal opioid exposure on outcomes from birth to 2 years of age. COVID-19 social distancing measures presented challenges to research coordinators discussing the study at length with potential participants during the birth hospitalization, which impacted recruitment, particularly among caregivers of unexposed (control) infants. In response, the OBOE study developed a digital tool (consenter video) to supplement the informed consent process, make it more engaging, and foster greater identification with the research procedures among potential participants. Objective: We aim to examine knowledge of the study, experiences with the consent process, and perceptions of the consenter video among potential participants of the OBOE study. Methods: Analyses included 129 caregivers who were given the option to view the consenter video as a supplement to the consent process. Participants selected from 3 racially and ethnically diverse avatars to guide them through the 11-minute video with recorded voice-overs. After viewing the consenter video, participants completed a short survey to assess their knowledge of the study, experiences with the consent process, and perceptions of the tool, regardless of their decision to enroll in the main study. Chi-square tests were used to assess differences between caregivers of opioid-exposed and unexposed infants in survey responses and whether caregivers who selected avatars consistent with their racial or ethnic background were more likely to enroll in the study than those who selected avatars that were not consistent with their background. Results: Participants demonstrated good understanding of the information presented, with 95% (n=123) correctly identifying the study purpose and 88% (n=112) correctly indicating that their infant would not be exposed to radiation during the magnetic resonance imaging. Nearly all indicated they were provided “just the right amount of information” (n=123, 98%) and that they understood the consent information well enough to decide whether to enroll (n=125, 97%). Survey responses were similar between caregivers of opioid-exposed infants and unexposed infants on all items except the decision to enroll. Those in the opioid-exposed group were more likely to enroll in the main study compared to the unexposed group (n=49, 89% vs n=38, 51%; P<.001). Of 81 caregivers with known race or ethnicity, 35 (43%) chose avatars to guide them through the video that matched their background. Caregivers selecting avatars consistent with their racial or ethnic background were more likely to enroll in the main study (n=29, 83% vs n=43, 57%; P=.01). Conclusions: This interactive digital tool was helpful in informing prospective participants about the study. The consenter tool enhanced the informed consent process, reinforced why caregivers of unexposed infants were being approached, and was particularly helpful as a resource for families to understand magnetic resonance imaging procedures. Trial Registration: ClinicalTrials.gov NCT04149509; https://clinicaltrials.gov/study/NCT04149509 %R 10.2196/59954 %U https://formative.jmir.org/2025/1/e59954 %U https://doi.org/10.2196/59954 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e58797 %T Recent Use of Novel Data Streams During Foodborne Illness Cluster Investigations by the United States Food and Drug Administration: Qualitative Review %A Bazaco,Michael C %A Carstens,Christina K %A Greenlee,Tiffany %A Blessington,Tyann %A Pereira,Evelyn %A Seelman,Sharon %A Ivory,Stranjae %A Jemaneh,Temesgen %A Kirchner,Margaret %A Crosby,Alvin %A Viazis,Stelios %A van Twuyver,Sheila %A Gwathmey,Michael %A Malais,Tanya %A Ou,Oliver %A Kenez,Stephanie %A Nolan,Nichole %A Karasick,Andrew %A Punzalan,Cecile %A Schwensohn,Colin %A Gieraltowski,Laura %A Chen Parker,Cary %A Jenkins,Erin %A Harris,Stic %K foodborne illness surveillance %K novel data streams %K outbreak investigations %K novel data %K foodborne illness %K foodborne %K illness %K United States %K public health %K prevention %K outbreaks %K social media %K product review %K cluster %K product information %K surveillance %K epidemiology %D 2025 %7 28.2.2025 %9 %J JMIR Public Health Surveill %G English %X Foodborne illness is a continuous public health risk. The recognition of signals indicating a cluster of foodborne illness is key to the detection, mitigation, and prevention of foodborne adverse event incidents and outbreaks. With increased internet availability and access, novel data streams (NDSs) for foodborne illness reports initiated by users outside of the traditional public health framework have emerged. These include, but are not limited to, social media websites, web-based product reviews posted to retailer websites, and private companies that host public-generated notices of foodborne illnesses. Information gathered by these platforms can help identify early signals of foodborne illness clusters or help inform ongoing public health investigations. Here we present an overview of NDSs and 3 investigations of foodborne illness incidents by the US Food and Drug Administration that included the use of NDSs at various stages. Each example demonstrates how these data were collected, integrated into traditional data sources, and used to inform the investigation. NDSs present a unique opportunity for public health agencies to identify clusters that may not have been identified otherwise, due to new or unique etiologies, as shown in the 3 examples. Clusters may also be identified earlier than they would have been through traditional sources. NDSs can further provide investigators supplemental information that may help confirm or rule out a source of illness. However, data collected from NDSs are often incomplete and lack critical details for investigators, such as product information (eg, lot numbers), clinical or medical details (eg, laboratory results of affected individuals), and contact information for report follow-up. In the future, public health agencies may wish to standardize an approach to maximize the potential of NDSs to catalyze and supplement adverse event investigations. Additionally, the collection of essential data elements by NDS platforms and data-sharing processes with public health agencies may aid in the investigation of foodborne illness clusters and inform subsequent public health and regulatory actions. %R 10.2196/58797 %U https://publichealth.jmir.org/2025/1/e58797 %U https://doi.org/10.2196/58797 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e67981 %T Increasing Participation and Completion Rates in Questionnaire Surveys of Primary Care Patients: Cluster-Randomized Study %A Sebo,Paul %A Tudrej,Benoit %A Bernard,Augustin %A Delaunay,Bruno %A Dupuy,Alexandra %A Malavergne,Claire %A Maisonneuve,Hubert %+ , University Institute for Primary Care (IuMFE), University of Geneva, Rue Michel-Servet 1, Geneva, 1211, Switzerland, 41 22 379 50 61, paulsebo@hotmail.com %K completion rate %K missing data %K mixed mode %K web-based %K participation rate %K primary care %K questionnaire %K QR code %K tablet %K survey %K primary care patients %K randomized study %D 2025 %7 25.2.2025 %9 Original Paper %J Interact J Med Res %G English %X Background: Participation and completion rates in questionnaire-based surveys are often low. Objective: This study aims to assess participation and completion rates for a survey using paper and mixed mode questionnaires with patients recruited by research assistants in primary care waiting rooms. Methods: This cluster-randomized study, conducted in 2023 in France, involved 974 patients from 39 practices randomized into 4 groups: “paper with incentive” (n=251), “paper without incentive” (n=368), “mixed mode with tablet” (n=187), and “mixed mode with QR code” (n=168). Analyses compared the combined paper group with the 2 mixed mode groups and the “paper with incentive” and “paper without incentive” groups. Logistic regressions were used to analyze participation and completion rates. Results: Of the 974 patients recruited, 822 (women: 536/821, 65.3%; median age 52, IQR 37-68 years) agreed to participate (participation rate=84.4%), with no significant differences between groups. Overall, 806 patients (98.1%) answered all 48 questions. Completion rates were highest in the combined paper group (99.8%) compared to mixed mode groups (96.8% for paper or tablet, 93.3% for paper or QR code; P<.001). There was no significant difference in completion rates between the “paper with incentive” and “paper without incentive” groups (100% vs 99.7%). Conclusions: Recruiting patients in waiting rooms with research assistants resulted in high participation and completion rates across all groups. Mixed mode options did not enhance participation or completion rates but may offer logistical advantages. Future research should explore incentives and mixed-mode strategies in diverse settings. %M 39999441 %R 10.2196/67981 %U https://www.i-jmr.org/2025/1/e67981 %U https://doi.org/10.2196/67981 %U http://www.ncbi.nlm.nih.gov/pubmed/39999441 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e63466 %T Identifying Patient-Reported Care Experiences in Free-Text Survey Comments: Topic Modeling Study %A Steele,Brian %A Fairie,Paul %A Kemp,Kyle %A D'Souza,Adam G %A Wilms,Matthias %A Santana,Maria Jose %K natural language processing %K patient-reported experience %K topic models %K inpatient %K artificial intelligence %K AI %K patient reported %K feedback %K survey %K patient experiences %K bidirectional encoder representations from transformers %K BERT %K sentiment analysis %K pediatric caregivers %K patient safety %K safety %D 2025 %7 24.2.2025 %9 %J JMIR Med Inform %G English %X Background: Patient-reported experience surveys allow administrators, clinicians, and researchers to quantify and improve health care by receiving feedback directly from patients. Existing research has focused primarily on quantitative analysis of survey items, but these measures may collect optional free-text comments. These comments can provide insights for health systems but may not be analyzed due to limited resources and the complexity of traditional textual analysis. However, advances in machine learning–based natural language processing provide opportunities to learn from this traditionally underused data source. Objective: This study aimed to apply natural language processing to model topics found in free-text comments of patient-reported experience surveys. Methods: Consumer Assessment of Healthcare Providers and Systems–derived patient experience surveys were collected and linked to administrative inpatient records by the provincial health services organization responsible for inpatient care. Unsupervised topic modeling with automated labeling was performed with BERTopic. Sentiment analysis was performed to further assist in topic description. Results: Between April 2016 and February 2020, 43.4% (43,522/100,272) adult patients and 46.9% (3501/7464) pediatric caregivers included free-text responses on completed patient experience surveys. Topic models identified 86 topics among adult survey responses and 35 topics among pediatric responses that included elements of care not currently surveyed by existing questionnaires. Frequent topics were generally positive. Conclusions: We found that with limited tuning, BERTopic identified care experience topics with interpretable automated labeling. Results are discussed in the context of person-centered care, patient safety, and health care quality improvement. Furthermore, we note the opportunity for the identification of temporal and site-specific trends as a method to identify patient care and safety concerns. As the use of patient experience measurement increases in health care, we discuss how machine learning can be leveraged to provide additional insight on patient experiences. %R 10.2196/63466 %U https://medinform.jmir.org/2025/1/e63466 %U https://doi.org/10.2196/63466 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66718 %T Improving the User Interface and Guiding the Development of Effective Training Material for a Clinical Research Recruitment and Retention Dashboard: Usability Testing Study %A Gardner,Leah Leslie %A Raeisian Parvari,Pezhman %A Seidman,Mark %A Holden,Richard J %A Fowler,Nicole R %A Zarzaur,Ben L %A Summanwar,Diana %A Barboi,Cristina %A Boustani,Malaz %K recruitment strategies %K clinical research %K research subject recruitment %K agile science %K agile implementation %K human-computer interaction %D 2025 %7 24.2.2025 %9 %J JMIR Form Res %G English %X Background: Participant recruitment and retention are critical to the success of clinical trials, yet challenges such as low enrollment rates and high attrition remain ongoing obstacles. RecruitGPS is a scalable dashboard with integrated control charts to address these issues by providing real-time data monitoring and analysis, enabling researchers to better track and improve recruitment and retention. Objective: This study aims to identify the challenges and inefficiencies users encounter when interacting with the RecruitGPS dashboard. By identifying these issues, the study aims to inform strategies for improving the dashboard’s user interface and create targeted, effective instructional materials that address user needs. Methods: Twelve clinical researchers from the Midwest region of the United States provided feedback through a 10-minute, video-recorded usability test session, during which participants were instructed to explore the various tabs of the dashboard, identify challenges, and note features that worked well while thinking aloud. Following the video session, participants took a survey on which they answered System Usability Scale (SUS) questions, ease of navigation questions, and a Net Promoter Score (NPS) question. Results: A quantitative analysis of survey responses revealed an average SUS score of 61.46 (SD 23.80; median 66.25) points, indicating a need for improvement in the user interface. The NPS was 8, with 4 of 12 (33%) respondents classified as promoters and 3 of 12 (25%) as detractors, indicating a slightly positive satisfaction. When participants compared RecruitGPS to other recruitment and study management tools they had used, 8 of 12 (67%) of participants rated RecruitGPS as better or much better. Only 1 of 12 (8%) participants rated RecruitGPS as worse but not much worse. A qualitative analysis of participants’ interactions with the dashboard diagnosed a confusing part of the dashboard that could be eliminated or made optional and provided valuable insight for the development of instructional videos and documentation. Participants liked the dashboard’s data visualization capabilities, including intuitive graphs and trend tracking; progress indicators, such as color-coded status indicators and comparison metrics; and the overall dashboard’s layout and design, which consolidated relevant data on a single page. Users also valued the accuracy and real-time updates of data, especially the integration with external sources like Research Electronic Data Capture (REDCap). Conclusions: RecruitGPS demonstrates significant potential to improve the efficiency of clinical trials by providing researchers with real-time insights into participant recruitment and retention. This study offers valuable recommendations for targeted refinements to enhance the user experience and maximize the dashboard’s effectiveness. Additionally, it highlights navigation challenges that can be addressed through the development of clear and focused instructional videos. %R 10.2196/66718 %U https://formative.jmir.org/2025/1/e66718 %U https://doi.org/10.2196/66718 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e64111 %T Screening Workers for Occupational Exposure to Respirable Crystalline Silica: Development and Usability of an Electronic Data Capture Tool %A Hore-Lacy,Fiona %A Dimitriadis,Christina %A Hoy,Ryan F %A Jimenez-Martin,Javier %A Sim,Malcolm R %A Fisher,Jane %A Glass,Deborah C %A Walker-Bone,Karen %K silicosis %K occupational history %K electronic data capture tool (EDCT) %K REDCap %K occupational respiratory screening %K occupational hazard %K exposure %K silica %K fibrotic lung disease %K lung disease %K respirable crystalline silica %K mining %K construction %K workers %K occupational lung disease %K occupational %K Australia %K screening %D 2025 %7 24.2.2025 %9 %J JMIR Hum Factors %G English %X Background: Cases of the occupational lung disease silicosis have been identified in workers processing artificial stone in the stone benchtop industry (SBI). In the Australian state of Victoria, the Regulator commissioned a screening program for all workers in this industry. Objective: To facilitate systematic data collection, including high-quality exposure assessment, an electronic data capture tool (EDCT) was developed. Methods: A multidisciplinary team developed an EDCT using Research Electronic Data Capture (REDCap; Vanderbilt University). The needs of the EDCT were (1) data entry by multiple clinicians and the workers attending for screening and (2) systematic collection of data for clinical and research purposes. The comprehensibility and utility of the tool were investigated with a sample of workers, and the EDCT was subsequently refined. Results: The EDCT was used in clinical practice, with capacity for data extraction for research. Testing of comprehension and utility was undertaken with 15 workers, and the refined version of the Occupational Silica Exposure Assessment Tool (OSEAT) was subsequently developed. Conclusions: The refined OSEAT has been determined to be comprehensible to workers and capable of collecting exposure data suitable for assessment of risk of silicosis. It was developed for workers in the SBI in Australia and is adaptable, including translation into other languages. It can also be modified for SBI workers in other countries and for use by workers from other industries (mining, construction) at risk of silica exposure, including in lower-income settings. %R 10.2196/64111 %U https://humanfactors.jmir.org/2025/1/e64111 %U https://doi.org/10.2196/64111 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e60754 %T Promises and Pitfalls of Internet Search Data in Mental Health: Critical Review %A Loch,Alexandre Andrade %A Kotov,Roman %K privacy %K stigma %K online %K prevention %K internet %K search data %K mental health %K health care %K clinical information %K World Health Organization %K WHO %K digital health %K mental illness %K digital technologies %K social network %K mobile health %K mHealth %D 2025 %7 18.2.2025 %9 %J JMIR Ment Health %G English %X The internet is now integral to everyday life, and users’ web-based search data could be of strategic importance in mental health care. As shown by previous studies, internet searches may provide valuable insights into an individual’s mental state and could be of great value in early identification and helping in pathways to care. Internet search data can potentially provide real-time identification (eg, alert mechanisms for timely interventions). In this paper, we discuss the various problems related to the use of these data in research and clinical practice, including privacy concerns, integration with clinical information, and technical limitations. We also propose solutions to address these issues and provide possible future directions. %R 10.2196/60754 %U https://mental.jmir.org/2025/1/e60754 %U https://doi.org/10.2196/60754 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59015 %T A New Computer-Based Cognitive Measure for Early Detection of Dementia Risk (Japan Cognitive Function Test): Validation Study %A Shimada,Hiroyuki %A Doi,Takehiko %A Tsutsumimoto,Kota %A Makino,Keitaro %A Harada,Kenji %A Tomida,Kouki %A Morikawa,Masanori %A Makizako,Hyuma %+ Department of Preventive Gerontology, Centre for Gerontology and Social Science, National Center for Geriatrics and Gerontology, 7-430, Morioka-cho, Ōbu, 474-8511, Japan, 81 0562 46 2311, shimada@ncgg.go.jp %K cognition %K neurocognitive test %K dementia %K Alzheimer disease %K aged %K MMSE %K cognitive impairment %K Mini-Mental State Examination %K monitoring %K eHealth %D 2025 %7 14.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The emergence of disease-modifying treatment options for Alzheimer disease is creating a paradigm shift in strategies to identify patients with mild symptoms in primary care settings. Systematic reviews on digital cognitive tests reported that most showed diagnostic performance comparable with that of paper-and-pencil tests for mild cognitive impairment and dementia. However, most studies have small sample sizes, with fewer than 100 individuals, and are based on case-control or cross-sectional designs. Objective: This study aimed to examine the predictive validity of the Japanese Cognitive Function Test (J-Cog), a new computerized cognitive battery test, for dementia development. Methods: We randomly assigned 2520 older adults (average age 72.7, SD 6.7 years) to derivation and validation groups to determine and validate cutoff points for the onset of dementia. The Mini-Mental State Examination (MMSE) was used for comparison purposes. The J-Cog consists of 12 tasks that assess orientation, designation, attention and calculation, mental rotation, verbal fluency, sentence completion, working memory, logical reasoning, attention, common knowledge, word memory recall, and episodic memory recall. The onset of dementia was monitored for 60 months. In the derivation group, receiver operating characteristic curves were plotted to determine the MMSE and J-Cog cutoff points that best discriminated between the groups with and without dementia. In the validation group, Cox proportional regression models were developed to predict the associations of the group classified using the cutoff points of the J-Cog or MMSE with dementia incidence. Harrell C-statistic was estimated to summarize how well a predicted risk score described an observed sequence of events. The Akaike information criterion was calculated for relative goodness of fit, where lower absolute values indicate a better model fit. Results: Significant hazard ratios (HRs) for dementia incidence were found using the MMSE cutoff between 23 and 24 point (HR 1.93, 95% CI 1.13-3.27) and the J-Cog cutoff between 43 and 44 points (HR 2.42, 95% CI 1.50-3.93). In the total validation group, the C-statistic was above 0.8 for all cutoff points. Akaike information criterion with MMSE cutoff between 23 and 24 points as a reference showed a poor fit for MMSE cutoff between 28 and 29 points, and a good fit for the J-Cog cutoff between 43 and 44 points. Conclusions: The J-Cog has higher accuracy in predicting the development of dementia than the MMSE and has advantages for use in the community as a test of cognitive function, which can be administered by nonprofessionals. %M 39951718 %R 10.2196/59015 %U https://www.jmir.org/2025/1/e59015 %U https://doi.org/10.2196/59015 %U http://www.ncbi.nlm.nih.gov/pubmed/39951718 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67452 %T Using an Interactive Voice Response Survey to Assess Patient Satisfaction in Ethiopia: Development and Feasibility Study %A Shamebo,Dessalegn %A Derseh Mebratie,Anagaw %A Arsenault,Catherine %+ Department of Global Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Avenue, Washington, DC, 20052, United States, 1 2029941011, catherine.arsenault@gwu.edu %K mobile phone surveys %K patient satisfaction %K interactive voice response %K global health %K surveys %K Ethiopia %K IVR %K Africa %D 2025 %7 13.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient satisfaction surveys can offer crucial information on the quality of care but are rarely conducted in low-income settings. In contrast with in-person exit interviews, phone-based interactive voice response (IVR) surveys may offer benefits including standardization, patient privacy, reduced social desirability bias, and cost and time efficiency. IVR surveys have rarely been tested in low-income settings, particularly for patient satisfaction surveys. Objective: In this study, we tested the feasibility of using an IVR system to assess patient satisfaction with primary care services in Addis Ababa, Ethiopia. We described the methodology, response rates, and survey costs and identified factors associated with survey participation, completion, and duration. Methods: Patients were recruited in person from 18 public and private health facilities in Addis Ababa. Patients’ sex, age, education, reasons for seeking care, and mobile phone numbers were collected. The survey included 15 questions that respondents answered using their phone keypad. We used a Heckman probit regression model to identify factors influencing the likelihood of IVR survey participation (picking up and answering at least 1 question) and completion (answering all survey questions) and a Weibull regression model to identify factors influencing the survey completion time. Results: A total of 3403 individuals were approached across 18 health facilities. Nearly all eligible patients approached (2985/3167, 94.3%) had a functioning mobile phone, and 89.9% (2415/2685) of those eligible agreed to be enrolled in the study. Overall, 92.6% (2236/2415) picked up the call, 65.6% (1584/2415) answered at least 1 survey question, and 42.9% (1037/2415) completed the full survey. The average survey completion time was 8.1 (SD 1.7) minutes for 15 Likert-scale questions. We found that those aged 40-49 years and those aged 50+ years were substantially less likely to participate in (odds ratio 0.63, 95% CI 0.53-0.74) and complete the IVR survey (odds ratio 0.77, 95% CI 0.65-0.90) compared to those aged 18-30 years. Higher education levels were also strongly associated with survey participation and completion. In adjusted models, those enrolled in private facilities were less likely to participate and complete the survey compared to those in public health centers. Being male, younger, speaking Amharic, using a private hospital, and being called after 8 PM were associated with a shorter survey duration. The average survey costs were US $7.90 per completed survey. Conclusions: Our findings reveal that an IVR survey is a feasible, low-cost, and rapid solution to assess patient satisfaction in an urban context in Ethiopia. However, survey implementation must be carefully planned and tailored to local challenges. Governments and health facilities should consider IVR to routinely collect patient satisfaction data to inform quality improvement strategies. %R 10.2196/67452 %U https://formative.jmir.org/2025/1/e67452 %U https://doi.org/10.2196/67452 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58451 %T A 4-Site Public Deliberation Project on the Acceptability of Youth Self-Consent in Biomedical HIV Prevention Trials: Assessment of Facilitator Fidelity to Key Principles %A Draucker,Claire Burke %A Carrión,Andrés %A Ott,Mary A %A Hicks,Ariel I %A Knopf,Amelia %+ Indiana University, 111 Middle Drive, Indianapolis, IN, 46202, United States, 1 317 274 4139, cdraucke@iu.edu %K public deliberation %K deliberative democracy %K bioethics %K ethical conflict %K biomedical %K HIV prevention %K HIV research %K group facilitation %K fidelity assessment %K content analysis %D 2025 %7 13.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Public deliberation is an approach used to engage persons with diverse perspectives in discussions and decision-making about issues affecting the public that are controversial or value laden. Because experts have identified the need to evaluate facilitator performance, our research team developed a framework to assess the fidelity of facilitator remarks to key principles of public deliberation. Objective: This report describes how the framework was used to assess facilitator fidelity in a 4-site public deliberation project on the acceptability of minor self-consent in biomedical HIV prevention research. Methods: A total of 88 individuals participated in 4 deliberation sessions held in 4 cities throughout the United States. The sessions, facilitated by 18 team members, were recorded and transcribed verbatim. Facilitator remarks were highlighted, and predetermined coding rules were used to code the remarks to 1 of 6 principles of quality deliberations. A variety of display tables were used to organize the codes and calculate the number of facilitator remarks that were consistent or inconsistent with each principle during each session across all sites. A content analysis was conducted on the remarks to describe how facilitator remarks aligned or failed to align with each principle. Results: In total, 735 remarks were coded to one of the principles; 516 (70.2%) were coded as consistent with a principle, and 219 (29.8%) were coded as inconsistent. A total of 185 remarks were coded to the principle of equal participation (n=138, 74.6% as consistent; n=185, 25.4% as inconsistent), 158 were coded to expression of diverse opinions (n=110, 69.6% as consistent; n=48, 30.4% as inconsistent), 27 were coded to respect for others (n=27, 100% as consistent), 24 were coded to adoption of a societal perspective (n=11, 46% as consistent; n=13, 54% as inconsistent), 99 were coded to reasoned justification of ideas (n=81, 82% as consistent; n=18, 18% as inconsistent), and 242 were coded to compromise or movement toward consensus (n=149, 61.6% as consistent; n=93, 38.4% as inconsistent). Therefore, the counts provided affirmation that most of the facilitator remarks were aligned with the principles of deliberation, suggesting good facilitator fidelity. By considering how the remarks aligned or failed to align with the principles, areas where facilitator fidelity can be strengthened were identified. The results indicated that facilitators should focus more on encouraging quieter members to participate, refraining from expressing personal opinions, promoting the adoption of a societal perspective and reasoned justification of opinions, and inviting deliberants to articulate their areas of common ground. Conclusions: The results provide an example of how a framework for assessing facilitator fidelity was used in a 4-site deliberation project. The framework will be refined to better address issues related to balancing personal and public perspectives, managing plurality, and mitigating social inequalities. %M 39946717 %R 10.2196/58451 %U https://formative.jmir.org/2025/1/e58451 %U https://doi.org/10.2196/58451 %U http://www.ncbi.nlm.nih.gov/pubmed/39946717 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60630 %T Impact of Mobile Phone Usage on Sleep Quality Among Medical Students Across Latin America: Multicenter Cross-Sectional Study %A Izquierdo-Condoy,Juan S %A Paz,Clara %A Nati-Castillo,H A %A Gollini-Mihalopoulos,Ricardo %A Aveiro-Róbalo,Telmo Raul %A Valeriano Paucar,Jhino Renson %A Laura Mamami,Sandra Erika %A Caicedo,Juan Felipe %A Loaiza-Guevara,Valentina %A Mejía,Diana Camila %A Salazar-Santoliva,Camila %A Villavicencio-Gomezjurado,Melissa %A Hall,Cougar %A Ortiz-Prado,Esteban %+ One Health Research Group, Universidad de las Américas, Calle de los Colimes, Quito, 170137, Ecuador, 593 0995760693, e.ortizprado@gmail.com %K mobile phone %K addiction behavior %K sleep quality %K medical students %K Latin America %D 2025 %7 10.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The ubiquitous use of mobile phones among medical students has been linked to potential health consequences, including poor sleep quality. Objective: This study investigates the prevalence of mobile phone addiction and its association with sleep quality among medical students across 6 Latin American countries. Methods: A descriptive, cross-sectional, multicenter study was conducted between December 2023 and March 2024 using a self-administered online survey. The survey incorporated the Mobile Phone Addiction Scale and the Pittsburgh Sleep Quality Index to evaluate mobile phone addiction and sleep quality among 1677 medical students. A multiple regression model was applied to analyze the relationship between mobile phone addiction and poor sleep quality, adjusting for sex, age, and educational level to ensure robust results. Results: Mobile phone addiction was identified in 32.5% (545/1677) of participants, with significant differences across countries. The overall mean Pittsburgh Sleep Quality Index score was 7.26, indicating poor sleep quality. Multiple regression analysis revealed a strong association between mobile phone addiction and poor sleep, controlled for demographic variables (β=1.4, 95% CI 1.05-1.74). Conclusions: This study underscores a significant prevalence of mobile phone addiction among medical students and its detrimental association with sleep quality in Latin America. The findings advocate for the need to address mobile phone usage to mitigate its negative implications on student health and academic performance. Strategies to enhance digital literacy and promote healthier usage habits could benefit medical education and student well-being. %M 39928921 %R 10.2196/60630 %U https://www.jmir.org/2025/1/e60630 %U https://doi.org/10.2196/60630 %U http://www.ncbi.nlm.nih.gov/pubmed/39928921 %0 Journal Article %@ 2817-1705 %I JMIR Publications %V 4 %N %P e57319 %T Investigating the Classification of Living Kidney Donation Experiences on Reddit and Understanding the Sensitivity of ChatGPT to Prompt Engineering: Content Analysis %A Nielsen,Joshua %A Chen,Xiaoyu %A Davis,LaShara %A Waterman,Amy %A Gentili,Monica %+ Department of Industrial Engineering, JB Speed School of Engineering, University of Louisville, 220 Eastern Parkway, Louisville, KY, 40292, United States, 1 5024891335, joshua.nielsen@louisville.edu %K prompt engineering %K generative artificial intelligence %K kidney donation %K transplant %K living donor %D 2025 %7 7.2.2025 %9 Original Paper %J JMIR AI %G English %X Background: Living kidney donation (LKD), where individuals donate one kidney while alive, plays a critical role in increasing the number of kidneys available for those experiencing kidney failure. Previous studies show that many generous people are interested in becoming living donors; however, a huge gap exists between the number of patients on the waiting list and the number of living donors yearly. Objective: To bridge this gap, we aimed to investigate how to identify potential living donors from discussions on public social media forums so that educational interventions could later be directed to them. Methods: Using Reddit forums as an example, this study described the classification of Reddit content shared about LKD into three classes: (1) present (presently dealing with LKD personally), (2) past (dealt with LKD personally in the past), and (3) other (LKD general comments). An evaluation was conducted comparing a fine-tuned distilled version of the Bidirectional Encoder Representations from Transformers (BERT) model with inference using GPT-3.5 (ChatGPT). To systematically evaluate ChatGPT’s sensitivity to distinguishing between the 3 prompt categories, we used a comprehensive prompt engineering strategy encompassing a full factorial analysis in 48 runs. A novel prompt engineering approach, dialogue until classification consensus, was introduced to simulate a deliberation between 2 domain experts until a consensus on classification was achieved. Results: BERT and GPT-3.5 exhibited classification accuracies of approximately 75% and 78%, respectively. Recognizing the inherent ambiguity between classes, a post hoc analysis of incorrect predictions revealed sensible reasoning and acceptable errors in the predictive models. Considering these acceptable mismatched predictions, the accuracy improved to 89.3% for BERT and 90.7% for GPT-3.5. Conclusions: Large language models, such as GPT-3.5, are highly capable of detecting and categorizing LKD-targeted content on social media forums. They are sensitive to instructions, and the introduced dialogue until classification consensus method exhibited superior performance over stand-alone reasoning, highlighting the merit in advancing prompt engineering methodologies. The models can produce appropriate contextual reasoning, even when final conclusions differ from their human counterparts. %M 39918869 %R 10.2196/57319 %U https://ai.jmir.org/2025/1/e57319 %U https://doi.org/10.2196/57319 %U http://www.ncbi.nlm.nih.gov/pubmed/39918869 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e64722 %T Electronic Health Record Use Patterns Among Well-Being Survey Responders and Nonresponders: Longitudinal Observational Study %A Tawfik,Daniel %A Shanafelt,Tait D %A Bayati,Mohsen %A Profit,Jochen %K electronic health record metadata %K electronic health record %K EHR %K electronic medical record %K patient record %K health records %K personal health record %K use %K response bias %K well-being %K burnout %K physicians %K experiences %K surveys %K longitudinal studies %K observational studies %D 2025 %7 4.2.2025 %9 %J JMIR Med Inform %G English %X Background: Physician surveys provide indispensable insights into physician experience, but the question of whether responders are representative can limit confidence in conclusions. Ubiquitously collected electronic health record (EHR) use data may improve understanding of the experiences of survey nonresponders in relation to responders, providing clues regarding their well-being. Objective: The aim of the study was to identify EHR use measures corresponding with physician survey responses and examine methods to estimate population-level survey results among physicians. Methods: This longitudinal observational study was conducted from 2019 through 2020 among academic and community primary care physicians. We quantified EHR use using vendor-derived and investigator-derived measures, quantified burnout symptoms using emotional exhaustion and interpersonal disengagement subscales of the Stanford Professional Fulfillment Index, and used an ensemble of response propensity-weighted penalized linear regressions to develop a burnout symptom prediction model. Results: Among 697 surveys from 477 physicians with a response rate of 80.5% (697/866), always responders were similar to nonresponders in gender (204/340, 60% vs 38/66, 58% women; P=.78) and age (median 50, IQR 40‐60 years vs median 50, IQR 37.5‐57.5 years; P=.88) but with higher clinical workload (median 121.5, IQR 58.5‐184 vs median 34.5, IQR 0‐115 appointments; P<.001), efficiency (median 5.2, IQR 4.0-6.2 vs median 4.3, IQR 0‐5.6; P<.001), and proficiency (median 7.0, IQR 5.4‐8.5 vs median 3.1, IQR 0‐6.3; P<.001). Survey response status prediction showed an out-of-sample area under the receiver operating characteristics curve of 0.88 (95% CI 0.77-0.91). Burnout symptom prediction showed an out-of-sample area under the receiver operating characteristics curve of 0.63 (95% CI 0.57-0.70). The predicted burnout prevalence among nonresponders was 52%, higher than the observed prevalence of 28% among responders, resulting in an estimated population burnout prevalence of 31%. Conclusions: EHR use measures showed limited utility for predicting burnout symptoms but allowed discrimination between responders and nonresponders. These measures may enable qualitative interpretations of the effects of nonresponders and may inform survey response maximization efforts. %R 10.2196/64722 %U https://medinform.jmir.org/2025/1/e64722 %U https://doi.org/10.2196/64722 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e59159 %T Using a Consumer Wearable Activity Monitoring Device to Study Physical Activity and Sleep Among Adolescents in Project Viva: Cohort Study %A Zhang,Yutong %A Bornkamp,Nicole %A Hivert,Marie-France %A Oken,Emily %A James,Peter %K wearable device %K Fitbit %K physical activity %K sleep %K adolescents %K behavior risk %K mobile phone %D 2025 %7 4.2.2025 %9 %J JMIR Pediatr Parent %G English %X Background: The increasing prevalence of physical inactivity and insufficient sleep in adolescents likely contribute to worsening cardiometabolic and mental health. However, obtaining accurate behavioral measures is a challenge. Consumer wearable devices offer a user-friendly method to assess physical activity and sleep. Objective: This study aimed to describe the process and the preliminary results of physical activity and sleep collected using a consumer wearable Fitbit device in an adolescent cohort. Methods: We provided Fitbit Charge 2 or Charge 3 wrist-worn activity monitors to adolescent participants in Project Viva, a Boston, Massachusetts area cohort, from 2017 to 2022. We invited participants to wear the devices for ≥7 days for 24 hours a day to measure their physical activity, heart rate, and sleep, and allowed them to keep the device as a participation incentive. Results: We collected over 7 million minutes of physical activity, heart rate, and sleep data from 677 participants, 53% (356/677) of whom were female. The mean (SD) age of participants was 17.7 (0.7) years. Among the 677 participants, 65% (n=439) were non-Hispanic White, 14% (n=947) were non-Hispanic Black, 10% (n=69) were Hispanic, 3.2% (n=22) were non-Hispanic Asian, and 7.8% (n=53) belonged to other races. Participants demonstrated a high adherence to the research protocol, with the mean (SD) wear duration of 7.5 (1.1) days, and 90% of participants (612/677) had 5 or more days wearing the device for >600 minutes/day. The mean (SD) number of steps was 8883 (3455) steps/day and the mean (SD) awake sedentary time was 564 (138) minutes/day. Male participants were more often engaged in very active (27 minutes/day) and moderately active physical activity (29 minutes/day) compared with female participants (15 and 17 minutes/day, respectively). Over 87% (588/677) of participants had sleep data available for 5 or more days, among whom the average nightly sleep duration was 7.9 (SD 0.9) hours. Conclusions: This study demonstrated the feasibility of using consumer wearable devices to measure physical activity and sleep in a cohort of US adolescents. The high compliance rates provide valuable insights into adolescent behavior patterns and their influence on chronic disease development and mental health outcomes. %R 10.2196/59159 %U https://pediatrics.jmir.org/2025/1/e59159 %U https://doi.org/10.2196/59159 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e60438 %T Collecting Real-World Data via an In-Home Smart Medication Dispenser: Longitudinal Observational Study of Survey Panel Persistency, Response Rates, and Psychometric Properties %A Ogorek,Benjamin %A Rhoads,Thomas %A Smith,Erica %K real-world data %K real-world evidence %K patient-reported outcomes %K longitudinal studies %K survey methods %D 2025 %7 3.2.2025 %9 %J JMIR Hum Factors %G English %X Background: A smart medication dispenser called “spencer” is a novel generator of longitudinal survey data. The patients dispensing medication act as a survey panel and respond to questions about quality of life and patient-reported outcomes. Objectives: Our goal was to evaluate panel persistency, survey response rates, reliability, and validity of surveys administered via spencer to 4138 polychronic patients residing in the United States and Canada. Methods: Patients in a Canadian health care provider’s program were included if they were dispensing via spencer in the June 2021 to February 2024 time frame and consented to have their data used for research. Panel persistency was estimated via discrete survival methods for 2 years and survey response rates were computed for 1 year. Patients were grouped by mean response rates in the 12th month (<90% vs ≥90%) to observe differential response rate trends. For reliability and validity, we used a spencer question about recent falls with ternary responses value-coded −1, 0, and 1. For reliability, we computed Pearson correlation between mean scores over 2 years of survey responses, and transitions between mean score intervals of [0, 0.5), [−0.5, 0.5), and [0.5, 1]. For validity, we measured the association between the falls question and known factors influencing fall risk: age, biological sex, quality of life, physical and emotional health, and use of selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors, using repeated-measures regression for covariates and Kendall τ for concomitant spencer questions. Results: From 4138 patients, dispenser persistency was 68.3% (95% CI 66.8%‐69.8%) at 1 year and 51% (95% CI 49%‐53%) at 2 years. Within the cohort observed beyond 1 year, 82.3% (1508/1832) kept surveys enabled through the 12th month with a mean response rate of 84.1% (SD 26.4%). The large SD was apparent in the subgroup analysis, where a responder versus nonresponder dichotomy was observed. For 234 patients with ≥5 fall risk responses in each of the first 2 years, the Pearson correlation estimate between yearly mean scores was 0.723 (95% CI 0.630‐0.798). For mean score intervals [0, 0.5), [−0.5, 0.5), and [0.5, 1], self-transitions were the most common, with 59.8% (140/234) of patients starting and staying in [0.5, 1]. Fall risk responses were not significantly associated with sex (P=.66) or age (P=.76) but significantly related to selective serotonin reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor usage, quality of life, depressive symptoms, physical health, disability, and trips to the emergency room (P<.001). Conclusions: A smart medication dispenser, spencer, generated years of longitudinal survey data from patients in their homes. Panel attrition was low, and patients continued to respond at high rates. A fall risk measure derived from the survey data showed evidence of reliability and validity. An alternative to web-based panels, spencer is a promising tool for generating patient real-world data. %R 10.2196/60438 %U https://humanfactors.jmir.org/2025/1/e60438 %U https://doi.org/10.2196/60438 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54147 %T Effectiveness of Electronic Quality Improvement Activities to Reduce Cardiovascular Disease Risk in People With Chronic Kidney Disease in General Practice: Cluster Randomized Trial With Active Control %A Manski-Nankervis,Jo-Anne %A Hunter,Barbara %A Lumsden,Natalie %A Laughlin,Adrian %A McMorrow,Rita %A Boyle,Douglas %A Chondros,Patty %A Jesudason,Shilpanjali %A Radford,Jan %A Prictor,Megan %A Emery,Jon %A Amores,Paul %A Tran-Duy,An %A Nelson,Craig %+ Primary Care and Family Medicine, Lee Kong Chian School of Medicine, 11 Mandalay Road, Singapore, 308232, Singapore, 65 65138572, joanne.mn@ntu.edu.sg %K primary care %K general practice %K clinical decision support %K chronic kidney disease %K cardiovascular disease %K cardiovascular %K clinical decision %K decision support %K support %K kidney %K kidney disease %K electronic medical record %K risk %K risk reduction %K pharmacological %K pharmacological therapy %K medical records %K logistic model %D 2025 %7 3.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Future Health Today (FHT) is a program integrated with electronic medical record (EMR) systems in general practice and comprises (1) a practice dashboard to identify people at risk of, or with, chronic disease who may benefit from intervention; (2) active clinical decision support (CDS) at the point of care; and (3) quality improvement activities. One module within FHT aims to facilitate cardiovascular disease (CVD) risk reduction in people with chronic kidney disease (CKD) through the recommendation of angiotensin-converting enzyme inhibitor inhibitors (ACEI), angiotensin receptor blockers (ARB), or statins according to Australian guidelines (defined as appropriate pharmacological therapy). Objective: This study aimed to determine if the FHT program increases the proportion of general practice patients with CKD receiving appropriate pharmacological therapy (statins alone, ACEI or ARB alone, or both) to reduce CVD risk at 12 months postrandomization compared with active control (primary outcome). Methods: General practices recruited through practice-based research networks in Victoria and Tasmania were randomly allocated 1:1 to the FHT CKD module or active control. The intervention was delivered to practices between October 4, 2021, and September 30, 2022. Data extracted from EMRs for eligible patients identified at baseline were used to evaluate the trial outcomes at the completion of the intervention period. The primary analysis used an intention-to-treat approach. The intervention effect for the primary outcome was estimated with a marginal logistic model using generalized estimating equations with robust SE. Results: Overall, of the 734 eligible patients from 19 intervention practices and 715 from 21 control practices, 82 (11.2%) and 70 (9.8%), respectively, had received appropriate pharmacological therapy (statins alone, ACEI or ARB alone, or both) at 12 months postintervention to reduce CVD risk, with an estimated between-trial group difference (Diff) of 2.0% (95% CI –1.6% to 5.7%) and odds ratio of 1.24 (95% CI 0.85 to 1.81; P=.26). Of the 470 intervention patients and 425 control patients that received a recommendation for statins, 61 (13%) and 38 (9%) were prescribed statins at follow-up (Diff 4.3%, 95% CI 0 to 8.6%; odds ratio 1.55, 95% CI 1.02 to 2.35; P=.04). There was no statistical evidence to support between-group differences in other secondary outcomes and general practice health care use. Conclusions: FHT harnesses the data stored within EMRs to translate guidelines into practice through quality improvement activities and active clinical decision support. In this instance, it did not result in a difference in prescribing or clinical outcomes except for small changes in statin prescribing. This may relate to COVID-19–related disruptions, technical implementation challenges, and recruiting higher performing practices to the trial. A separate process evaluation will further explore factors impacting implementation and engagement with FHT. Trial Registration: ACTRN12620000993998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380119 %M 39899838 %R 10.2196/54147 %U https://formative.jmir.org/2025/1/e54147 %U https://doi.org/10.2196/54147 %U http://www.ncbi.nlm.nih.gov/pubmed/39899838 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54167 %T Summer Research Internship Curriculum to Promote Self-Efficacy, Researcher Identity, and Peer-to-Peer Learning: Retrospective Cohort Study %A Levites Strekalova,Yulia A %A Liu-Galvin,Rachel %A Border,Samuel %A Midence,Sara %A Khan,Mishal %A VanZanten,Maya %A Tomaszewski,John %A Jain,Sanjay %A Sarder,Pinaki %K artificial intelligence %K biomedical research %K curriculum %K training programs %K workforce %D 2025 %7 3.2.2025 %9 %J JMIR Form Res %G English %X Background: Common barriers to students’ persistence in research include experiencing feelings of exclusion and a lack of belonging, difficulties developing a robust researcher identity, perceptions of racial and social stigma directed toward them, and perceived gaps in research skills, which are particularly pronounced among trainees from groups traditionally underrepresented in research. To address these known barriers, summer research programs have been shown to increase the participation and retention of undergraduate students in research. However, previous programs have focused predominantly on technical knowledge and skills, without integrating an academic enrichment curriculum that promotes professional development by improving students’ academic and research communication skills. Objective: This retrospective pre-then-post study aimed to evaluate changes in self-reported ratings of research abilities among a cohort of undergraduate students who participated in a summer research program. Methods: The Human BioMolecular Atlas Program (HuBMAP) piloted the implementation of a web-based academic enrichment curriculum for the Summer 2023 Research Internship cohort, which was comprised of students from groups underrepresented in biomedical artificial intelligence research. HuBMAP, a 400-member research consortium funded by the Common Fund at the National Institutes of Health, offered a 10-week summer research internship that included an academic enrichment curriculum delivered synchronously via the web to all students across multiple sites. The curriculum is intended to support intern self-efficacy, researcher identity development, and peer-to-peer learning. At the end of the internship, students were invited to participate in a web-based survey in which they were asked to rate their academic and research abilities before the internship and as a result of the internship using a modified Entering Research Learning Assessment instrument. Wilcoxon matched-pairs signed rank test was performed to assess the difference in the mean scores per respondent before and after participating in the internship. Results: A total of 14 of the 22 undergraduate students who participated in the internship responded to the survey. The results of the retrospective pre-then-post survey indicated that there was a significant increase in students’ self-rated research abilities, evidenced by a significant improvement in the mean scores of the respondents when comparing reported skills self-assessment before and after the internship (improvement: median 1.09, IQR 0.88-1.65; W=52.5, P<.001). After participating in the HuBMAP web-based academic enrichment curriculum, students’ self-reported research abilities, including their confidence, their communication and collaboration skills, their self-efficacy in research, and their abilities to set research career goals, increased. Conclusions: Summer internship programs can incorporate an academic enrichment curriculum with small-group peer learning in addition to a laboratory-based experience to facilitate increased student engagement, self-efficacy, and a sense of belonging in the research community. Future research should investigate the impact of academic enrichment curricula and peer mentoring on the long-term retention of students in biomedical research careers, particularly retention of students underrepresented in biomedical fields. %R 10.2196/54167 %U https://formative.jmir.org/2025/1/e54167 %U https://doi.org/10.2196/54167 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63114 %T Adolescent Youth Survey on HIV Prevention and Sexual Health Education in Alabama: Protocol for a Web-Based Survey With Fraud Protection Study %A Budhwani,Henna %A Yigit,Ibrahim %A Bruce,Josh %A Bond,Christyenne Lily %A Johnson,Andrea %+ , Institute on Digital Health and Innovation, College of Nursing, Florida State University, Innovation Park, Research Building B, 2010 Levy Ave, RM B3400, Tallahassee, FL, 32310, United States, 1 8506443296, hbudhwani@fsu.edu %K HIV knowledge %K PrEP %K pre-exposure prophylaxis %K adolescents %K teenagers %K transgender %K MSM %K men who have sex with men %K south %K bot protection %K bots %K fraud protection %K survey protocol %D 2025 %7 29.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Alabama, the undiagnosed HIV rate is over 20%; youth and young adults, particularly those who identify as sexual and gender minority individuals, are at elevated risk for HIV acquisition and are the only demographic group in the United States with rising rates of new infections. Adolescence is a period marked by exploration, risk taking, and learning, making comprehensive sexual health education a high-priority prevention strategy for HIV and sexually transmitted infections. However, in Alabama, school-based sexual health and HIV prevention education is strictly regulated and does not address the unique needs of sexual and gender minority teenagers. Objective: To understand knowledge gaps related to sexual health, HIV prevention, and pre-exposure prophylaxis (PrEP), we conducted the Alabama Youth Survey with individuals aged 14-17 years. In the survey, we also evaluated young sexual and gender minority individuals’ preferences related to prevention modalities and trusted sources of health information. Methods: Between September 2023 and March 2024, we conducted a web-based survey with 14- to 17-year-olds who are assigned male at birth, are sexually attracted to male youth, and lived in Alabama. Half of the study’s participants were recruited through community partners, the Magic City Acceptance Academy and Magic City Acceptance Center. The other half were recruited on the web via social media. A 7-step fraud and bot detection protocol was implemented and applied to web-based recruitment to reduce the likelihood of collecting false information. Once data are ready, we will compute frequencies for each measure and construct summary scores of scales, such as HIV and PrEP knowledge, to determine internal consistency. Using multivariable logistic regression, we will examine associations between personal characteristics of survey respondents and key constructs using SPSS 29 (IBM Corp) or SAS 9.4 (SAS Institute). Results: Analyses are ongoing (N=206) and will conclude in June 2025. Preliminary results include a sample mean age of 16.21 (SD 0.88) years; about a quarter identified as transgender or gender nonconforming, with 6% stating their gender as a transgender woman. A total of 30% self-reported their race as African American or Black; 12% were Hispanic or Latinx. More than half reported being sexually active in the past 6 months. Primary data analyses will be completed in mid-2025. If findings are promising, results will be used as preliminary data to support the development of an intervention to address knowledge gaps and prevention preferences. Conclusions: If the study is successful, it will yield information on HIV knowledge, PrEP awareness, PrEP preferences, and related outcomes among sexual and gender minority teenagers in Alabama, an underserved, hard-to-reach, but also high-priority population for public health efforts to Ending the HIV Epidemic. International Registered Report Identifier (IRRID): DERR1-10.2196/63114 %M 39880394 %R 10.2196/63114 %U https://www.researchprotocols.org/2025/1/e63114 %U https://doi.org/10.2196/63114 %U http://www.ncbi.nlm.nih.gov/pubmed/39880394 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54531 %T Identifying Digital Markers of Attention-Deficit/Hyperactivity Disorder (ADHD) in a Remote Monitoring Setting: Prospective Observational Study %A Sankesara,Heet %A Denyer,Hayley %A Sun,Shaoxiong %A Deng,Qigang %A Ranjan,Yatharth %A Conde,Pauline %A Rashid,Zulqarnain %A Asherson,Philip %A Bilbow,Andrea %A Groom,Madeleine J %A Hollis,Chris %A Dobson,Richard J B %A Folarin,Amos %A Kuntsi,Jonna %K ADHD %K smartphones %K wearable devices %K mobile health %K mHealth %K remote monitoring %K surveillance %K digital markers %K attention-deficit/hyperactivity disorder %K behavioral data %K real world %K adult %K adolescent %K participants %K digital signals %K restlessness %K severity %K predicting outcomes %D 2025 %7 29.1.2025 %9 %J JMIR Form Res %G English %X Background: The symptoms and associated characteristics of attention-deficit/hyperactivity disorder (ADHD) are typically assessed in person at a clinic or in a research lab. Mobile health offers a new approach to obtaining additional passively and continuously measured real-world behavioral data. Using our new ADHD remote technology (ART) system, based on the Remote Assessment of Disease and Relapses (RADAR)–base platform, we explore novel digital markers for their potential to identify behavioral patterns associated with ADHD. The RADAR-base Passive App and wearable device collect sensor data in the background, while the Active App involves participants completing clinical symptom questionnaires. Objective: The main aim of this study was to investigate whether adults and adolescents with ADHD differ from individuals without ADHD on 10 digital signals that we hypothesize capture lapses in attention, restlessness, or impulsive behaviors. Methods: We collected data over 10 weeks from 20 individuals with ADHD and 20 comparison participants without ADHD between the ages of 16 and 39 years. We focus on features derived from (1) Active App (mean and SD of questionnaire notification response latency and of the time interval between questionnaires), (2) Passive App (daily mean and SD of response time to social and communication app notifications, the SD in ambient light during phone use, total phone use time, and total number of new apps added), and (3) a wearable device (Fitbit) (daily steps taken while active on the phone). Linear mixed models and t tests were employed to assess the group differences for repeatedly measured and time-aggregated variables, respectively. Effect sizes (d) convey the magnitude of differences. Results: Group differences were significant for 5 of the 10 variables. The participants with ADHD were (1) slower (P=.047, d=1.05) and more variable (P=.01, d=0.84) in their speed of responding to the notifications to complete the questionnaires, (2) had a higher SD in the time interval between questionnaires (P=.04, d=1.13), (3) had higher daily mean response time to social and communication app notifications (P=.03, d=0.7), and (4) had a greater change in ambient (background) light when they were actively using the smartphone (P=.008, d=0.86). Moderate to high effect sizes with nonsignificant P values were additionally observed for the mean of time intervals between questionnaires (P=.06, d=0.82), daily SD in responding to social and communication app notifications (P=.05, d=0.64), and steps taken while active on the phone (P=.09, d=0.61). The groups did not differ in the total phone use time (P=.11, d=0.54) and the number of new apps downloaded (P=.24, d=0.18). Conclusions: In a novel exploration of digital markers of ADHD, we identified candidate digital signals of restlessness, inconsistent attention, and difficulties completing tasks. Larger future studies are needed to replicate these findings and to assess the potential of such objective digital signals for tracking ADHD severity or predicting outcomes. %R 10.2196/54531 %U https://formative.jmir.org/2025/1/e54531 %U https://doi.org/10.2196/54531 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58628 %T Technological Adjuncts to Streamline Patient Recruitment, Informed Consent, and Data Management Processes in Clinical Research: Observational Study %A Koh,Jodie %A Caron,Stacey %A Watters,Amber N %A Vaidyanathan,Mahesh %A Melnick,David %A Santi,Alyssa %A Hudson,Kenneth %A Arguelles,Catherine %A Mathur,Priyanka %A Etemadi,Mozziyar %+ Kellogg School of Management, Northwestern University, 2211 Campus Drive, Evanston, IL, 60208, United States, 1 847 491 3300, jodie.koh@kellogg.northwestern.edu %K digital health %K patient recruitment %K consent %K technological adjuncts %K data management %K clinical research processes %K automation %K digital platforms %K data warehouse %K patient data %K imaging data %K pregnancy %K clinical research methods %D 2025 %7 29.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient recruitment and data management are laborious, resource-intensive aspects of clinical research that often dictate whether the successful completion of studies is possible. Technological advances present opportunities for streamlining these processes, thus improving completion rates for clinical research studies. Objective: This paper aims to demonstrate how technological adjuncts can enhance clinical research processes via automation and digital integration. Methods: Using one clinical research study as an example, we highlighted the use of technological adjuncts to automate and streamline research processes across various digital platforms, including a centralized database of electronic medical records (enterprise data warehouse [EDW]); a clinical research data management tool (REDCap [Research Electronic Data Capture]); and a locally managed, Health Insurance Portability and Accountability Act–compliant server. Eligible participants were identified through automated queries in the EDW, after which they received personalized email invitations with digital consent forms. After digital consent, patient data were transferred to a single Health Insurance Portability and Accountability Act–compliant server where each participant was assigned a unique QR code to facilitate data collection and integration. After the research study visit, data obtained were associated with existing electronic medical record data for each participant via a QR code system that collated participant consent, imaging data, and associated clinical data according to a unique examination ID. Results: Over a 19-month period, automated EDW queries identified 20,988 eligible patients, and 10,582 patients received personalized email invitations. In total, 1000 (9.45%) patients signed consents to participate in the study. Of the consented patients, 549 unique patients completed 779 study visits; some patients consented to the study at more than 1 time period during their pregnancy. Conclusions: Technological adjuncts in clinical research decrease human labor while increasing participant reach and minimizing disruptions to clinic operations. Automating portions of the clinical research process benefits clinical research efforts by expanding and optimizing participant reach while reducing the limitations of labor and time in completing research studies. %M 39879093 %R 10.2196/58628 %U https://formative.jmir.org/2025/1/e58628 %U https://doi.org/10.2196/58628 %U http://www.ncbi.nlm.nih.gov/pubmed/39879093 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66384 %T Detecting Deception and Ensuring Data Integrity in a Nationwide mHealth Randomized Controlled Trial: Factorial Design Survey Study %A Kezbers,Krista M %A Robertson,Michael C %A Hébert,Emily T %A Montgomery,Audrey %A Businelle,Michael S %+ Tobacco Settlement Endowment Trust Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 4052718001 ext 45042, krista-kezbers@ouhsc.edu %K ecological momentary assessment %K enrollment %K fraud %K mHealth %K randomized controlled trial %K recruitment %K deception %K data integrity %K behavior %K social %K RCT %K factorial design %K mobile phone %D 2025 %7 28.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Social behavioral research studies have increasingly shifted to remote recruitment and enrollment procedures. This shifting landscape necessitates evolving best practices to help mitigate the negative impacts of deceptive attempts (eg, fake profiles and bots) at enrolling in behavioral research. Objective: This study aimed to develop and implement robust deception detection procedures during the enrollment period of a remotely conducted randomized controlled trial. Methods: A 32-group (2×2×2×2×2) factorial design study was conducted from November 2021 to September 2022 to identify mobile health (mHealth) survey design features associated with the highest completion rates of smartphone-based ecological momentary assessments (n=485). Participants were required to be at least 18 years old, live in the United States, and own an Android smartphone that was compatible with the Insight app that was used in the study. Recruitment was conducted remotely through Facebook advertisements, a 5-minute REDCap (Research Electronic Data Capture) prescreener, and a screening and enrollment phone call. The research team created and implemented a 12-step checklist (eg, address verification and texting a copy of picture identification) to identify and prevent potentially deceptive attempts to enroll in the study. Descriptive statistics were calculated to understand the prevalence of various types of deceptive attempts at study enrollment. Results: Facebook advertisements resulted in 5236 initiations of the REDCap prescreener. A digital deception detection procedure was implemented for those who were deemed pre-eligible (n=1928). This procedure resulted in 26% (501/1928) of prescreeners being flagged as potentially deceptive. Completing multiple prescreeners (301/501, 60.1%) and providing invalid addresses (156/501, 31.1%) were the most common reasons prescreeners were flagged. An additional 1% (18/1928) of prescreeners were flagged as potentially deceptive during the subsequent study screening and enrollment phone call. Reasons for exclusion at the screening and enrollment phone call level included having an invalid phone type (6/18, 33.3%), completing multiple prescreeners (6/18, 33.3%), and providing an invalid address (5/18, 27.7%). This resulted in 1409 individuals being eligible after all deception checks were completed. Postenrollment social security number checks revealed that 3 (0.6%) fully enrolled participants out of 485 provided erroneous social security numbers during the screening process. Conclusions: Implementation of a deception detection procedure in a remotely conducted randomized controlled trial resulted in a substantial proportion of cases being flagged as potentially engaging in deceptive attempts at study enrollment. The results of the deception detection procedures in this study confirmed the need for vigilance in conducting remote behavioral research in order to maintain data integrity. Implementing systematic deception detection procedures may support study administration, data quality, and participant safety in remotely conducted behavioral research. Trial Registration: ClinicalTrials.gov NCT05194228; https://clinicaltrials.gov/study/NCT05194228 %M 39874573 %R 10.2196/66384 %U https://www.jmir.org/2025/1/e66384 %U https://doi.org/10.2196/66384 %U http://www.ncbi.nlm.nih.gov/pubmed/39874573 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63634 %T Health and Experiences During the COVID-19 Pandemic Among Children and Young People: Analysis of Free-Text Responses From the Children and Young People With Long COVID Study %A Rojas,Natalia K %A Martin,Sam %A Cortina-Borja,Mario %A Shafran,Roz %A Fox-Smith,Lana %A Stephenson,Terence %A Ching,Brian C F %A d'Oelsnitz,Anaïs %A Norris,Tom %A Xu,Yue %A McOwat,Kelsey %A Dalrymple,Emma %A Heyman,Isobel %A Ford,Tamsin %A Chalder,Trudie %A Simmons,Ruth %A , %A Pinto Pereira,Snehal M %+ Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, 43-45 Foley St, W1W 7TY, London, United Kingdom, 44 (0) 20 7679 200, n.rojas@ucl.ac.uk %K children and young people %K text mining %K free-text responses %K experiences %K COVID-19 %K long COVID %K InfraNodus %K sentiment analysis %K discourse analysis %K AI %K artificial intelligence %D 2025 %7 28.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The literature is equivocal as to whether the predicted negative mental health impact of the COVID-19 pandemic came to fruition. Some quantitative studies report increased emotional problems and depression; others report improved mental health and well-being. Qualitative explorations reveal heterogeneity, with themes ranging from feelings of loss to growth and development. Objective: This study aims to analyze free-text responses from children and young people participating in the Children and Young People With Long COVID study to get a clearer understanding of how young people were feeling during the pandemic. Methods: A total of 8224 free-text responses from children and young people were analyzed using InfraNodus, an artificial intelligence–powered text network analysis tool, to determine the most prevalent topics. A random subsample of 411 (5%) of the 8224 responses underwent a manual sentiment analysis; this was reweighted to represent the general population of children and young people in England. Results: Experiences fell into 6 main overlapping topical clusters: school, examination stress, mental health, emotional impact of the pandemic, social and family support, and physical health (including COVID-19 symptoms). Sentiment analysis showed that statements were largely negative (314/411, 76.4%), with a small proportion being positive (57/411, 13.9%). Those reporting negative sentiment were mostly female (227/314, 72.3%), while those reporting positive sentiment were mostly older (170/314, 54.1%). There were significant observed associations between sentiment and COVID-19 status as well as sex (P=.001 and P<.001, respectively) such that the majority of the responses, regardless of COVID-19 status or sex, were negative; for example, 84.1% (227/270) of the responses from female individuals and 61.7% (87/141) of those from male individuals were negative. There were no observed associations between sentiment and all other examined demographics. The results were broadly similar when reweighted to the general population of children and young people in England: 78.52% (negative), 13.23% (positive), and 8.24% (neutral). Conclusions: We used InfraNodus to analyze free-text responses from a large sample of children and young people. The majority of responses (314/411, 76.4%) were negative, and many of the children and young people reported experiencing distress across a range of domains related to school, social situations, and mental health. Our findings add to the literature, highlighting the importance of specific considerations for children and young people when responding to national emergencies. %M 39874576 %R 10.2196/63634 %U https://www.jmir.org/2025/1/e63634 %U https://doi.org/10.2196/63634 %U http://www.ncbi.nlm.nih.gov/pubmed/39874576 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e59916 %T The Application of Machine Learning Algorithms to Predict HIV Testing in Repeated Adult Population–Based Surveys in South Africa: Protocol for a Multiwave Cross-Sectional Analysis %A Jaiteh,Musa %A Phalane,Edith %A Shiferaw,Yegnanew A %A Phaswana-Mafuya,Refilwe Nancy %+ South African Medical Research Council/University of Johannesburg Pan African Centre for Epidemics Research Extramural Unit, Faculty of Health Sciences, University of Johannesburg, 40 Bunting Road, Auckland Park, Johannesburg, 2092, South Africa, 27 791850627, mjaiteh1993@gmail.com %K predictive modelling %K testing %K support vector machines %K random forest %K supervised machine learning %K decision trees %K adult %K population-based %K South Africa %K protocol %K HIV/AIDS %K HIV testing %K retrospective analysis %K cross-sectional survey %K chi-square test %K logistic regression %K public health %K epidemiology %K infectious disease %D 2025 %7 27.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: HIV testing is the cornerstone of HIV prevention and a pivotal step in realizing the Joint United Nations Program on HIV/AIDS (UNAIDS) goal of ending AIDS by 2030. Despite the availability of relevant survey data, there exists a research gap in using machine learning (ML) to analyze and predict HIV testing among adults in South Africa. Further investigation is needed to bridge this knowledge gap and inform evidence-based interventions to improve HIV testing. Objective: This study aims to determine consistent predictors of HIV testing by applying supervised ML algorithms in repeated adult population-based surveys in South Africa. Methods: A retrospective analysis of multiwave cross-sectional survey data will be conducted to determine the predictors of HIV testing among South African adults aged 18 years and older. A supervised ML technique will be applied across the five cycles of the South African National HIV Prevalence, Incidence, Behavior, and Communication Survey (SABSSM) surveys. The Human Science Research Council (HSRC) conducted the SABSSM surveys in 2002, 2005, 2008, 2012, and 2017. The available SABSSM datasets will be imported to RStudio (version 4.3.2; Posit Software, PBC) to clean and remove outliers. A chi-square test will be conducted to select important predictors of HIV testing. Each dataset will be split into 80% training and 20% test samples. Logistic regression, support vector machines, random forests, and decision trees will be used. A cross-validation technique will be used to divide the training sample into k-folds, including a validation set, and models will be trained on each fold. The models’ performance will be evaluated on the validation set using evaluation metrics such as accuracy, precision, recall, F1-score, area under curve-receiver operating characteristics, and confusion matrix. Results: The SABSSM datasets are open access datasets available on the HSRC database. Ethics approval for this study was obtained from the University of Johannesburg Research and Ethics Committee on April 23, 2024 (REC-2725-2024). The authors were given access to all five SABSSM datasets by the HSRC on August 20, 2024. The datasets were explored to identify the independent variables likely influencing HIV testing uptake. The findings of this study will determine consistent variables predicting HIV testing uptake among the South African adult population over the course of 20 years. Furthermore, this study will evaluate and compare the performance metrics of the 4 different ML algorithms, and the best model will be used to develop an HIV testing predictive model. Conclusions: This study will contribute to existing knowledge and deepen understanding of factors linked to HIV testing beyond traditional methods. Consequently, the findings would inform evidence-based policy recommendations that can guide policy makers to formulate more effective and targeted public health approaches toward strengthening HIV testing. International Registered Report Identifier (IRRID): DERR1-10.2196/59916 %M 39870368 %R 10.2196/59916 %U https://www.researchprotocols.org/2025/1/e59916 %U https://doi.org/10.2196/59916 %U http://www.ncbi.nlm.nih.gov/pubmed/39870368 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e52043 %T Parental Mental Health and Child Maltreatment in the COVID-19 Pandemic: Importance of Sampling in a Quantitative Statistical Study %A Engelke,Lara %A Calvano,Claudia %A Pohl,Steffi %A Winter,Sibylle Maria %A Renneberg,Babette %+ Clinical Psychology and Psychotherapy, Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, Berlin, 14195, Germany, 49 30 838 76522, engelke.l@fu-berlin.de %K COVID-19 %K parental stress %K parental mental health %K child maltreatment %K data collection methods %K web-based surveys %K convenience sample %K sampling methods %D 2025 %7 24.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Results on parental burden during the COVID-19 pandemic are predominantly available from nonrepresentative samples. Although sample selection can significantly influence results, the effects of sampling strategies have been largely underexplored. Objective: This study aimed to investigate how sampling strategy may impact study results. Specifically, we aimed to (1) investigate if outcomes on parental health and child maltreatment during the COVID-19 pandemic from a convenience sample differ from those of a specific representative sample and (2) investigate reasons for differences in the results. Methods: In 2020, we simultaneously conducted 2 studies: (1) a web-based survey using a convenience sample of 4967 parents of underage children, primarily recruited via social media, and (2) a study using a quota sample representative of the German adult population with underage children (N=1024), recruited through a combination of telephone interviews and computer-assisted web interviews. In both studies, the same questionnaire was used. To evaluate the impact of sampling, we compared the results on outcomes (parental stress, subjective health, parental mental health, general stress, pandemic-related stress, and the occurrence of child maltreatment) between the 2 samples. To explain differences in the results between the 2 studies, we controlled for sociodemographic data, parent-related risk factors, and COVID-19–related experiences. Results: Compared to parents from the quota sample, parents from the convenience sample reported significantly more parental stress (η2=0.024); decreased subjective health (η2=0.016); more anxiety and depression symptoms (η2=0.055); more general stress (η2=0.044); more occurrences of verbal emotional abuse (VEA; φ=0.12), witnessing domestic violence (WDV; φ=0.13), nonverbal emotional abuse (NEA; φ=0.03), physical abuse (φ=0.10), and emotional neglect (φ=0.06); and an increase of child maltreatment (VEA: exp(B)=2.95; WDV: exp(B)=3.19; NEA: exp(B)=1.65). Sociodemographic data, parent-related risk factors, and COVID-19–related experiences explained the differences in parental stress (remaining difference between samples after controlling for covariates: η2=0.002) and subjective health (remaining difference between samples after controlling for covariates: η2=0.004) and partially explained differences in parental mental health (remaining: η2=0.016), general stress (remaining: η2=0.014), and child maltreatment (remaining: VEA: exp(B)=2.05 and WDV: exp(B)=2.02) between the 2 samples. The covariates could not explain the difference in NEA (exp(B)=1.70). We discuss further factors that may explain the unexplained differences. Conclusions: Results of studies can be heavily impacted by the sampling strategy. Scientists are advised to collect relevant explaining variables (covariates) that are possibly related to sample selection and the outcome under investigation. This approach enables us to identify the individuals to whom the results apply and to combine findings from different studies. Furthermore, if data on the distribution of these explanatory variables in the population are available, it becomes possible to adjust for sample selection bias. %M 39854726 %R 10.2196/52043 %U https://www.jmir.org/2025/1/e52043 %U https://doi.org/10.2196/52043 %U http://www.ncbi.nlm.nih.gov/pubmed/39854726 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63349 %T Factors Influencing Informed Consent Preferences in Digital Health Research: Survey Study of Prospective Participants %A McInnis,Brian J %A Pindus,Ramona %A Kareem,Daniah %A Vital,Daniela G %A Hekler,Eric B %A Nebeker,Camille %+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Dr MC 0811, La Jolla, CA, 92093-0811, United States, 1 6195182875, nebeker@health.ucsd.edu %K digital health %K research ethics %K informed consent %K readability %K health literacy %K human-centered approach %K consent communication %K text snippet %K qualitative analysis %K effectiveness %K health information %K health informatics %D 2025 %7 23.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Readability is important to consider when developing informed consent communications for prospective research participants, but not the most important consideration. Other factors to consider relate to learning preferences and literacy needs of people recruited to participate in research, as these factors can influence understanding of consent communications. To promote understanding among prospective participants, researchers should take a human-centered approach to develop consent communications. Objective: This study aims to explore how factors related to readability, topic, and participant demographic characteristics play into preferences for digital health research consent material. These factors are important to consider as not attending to some details that matter to a specific subgroup of prospective participants may systematically exclude people from research. Methods: People eligible to participate in a digital health study were recruited to review 31 paragraph length sections of a consent form, referred to as “text snippets,” for an existing institutional review board–approved digital health study. Participants (N=79) were surveyed and asked to choose between 2 variations of the text snippets, either indicating a preference for the institutional review board–approved original or a version that was modified to improve readability. Results: A slim majority of participants provided feedback about the snippets (n=44; 55%). Our qualitative analysis of the feedback found that participants preferred shorter snippets, in general, but the snippets also elicited new questions not addressed by the original consent material. This observation is supported by our quantitative analysis, which found that when the character length of the original was longer, participants were less likely to prefer the original (P<.001) and more likely to prefer the modified text by a factor of 1.20 times (P=.04), and particularly for snippets explaining study risks (P=.03). Our analysis also found significant differences in participant demographic characteristics. For example, older participants tended to prefer the original more than younger participants, by a factor of 1.95 times (P=.004). The results present illustrative examples of how factors related to sex, age, physical activity, and ethnicity all play into preference for consent communication. Conclusions: The findings point toward new ways of evaluating informed consent communication: (1) for responsiveness to specific prospective participant populations, and (2) effectiveness at eliciting informed questions from people considering participation. We discuss how creating partnerships with prospective participants to prototype informed consent materials, specifically study procedures and risks, can be a way to identify those details before launching a study. Furthermore, future research should go beyond “readability” to explore alternate measures of evaluating consent materials, such as the likelihood that the consent material and communication procedures will elicit “informed questions” for the research team. %M 39847412 %R 10.2196/63349 %U https://www.jmir.org/2025/1/e63349 %U https://doi.org/10.2196/63349 %U http://www.ncbi.nlm.nih.gov/pubmed/39847412 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58128 %T Testing an Electronic Patient-Reported Outcome Platform in the Context of Traumatic Brain Injury: PRiORiTy Usability Study %A McMullan,Christel %A Turner,Grace %A Retzer,Ameeta %A Belli,Antonio %A Davies,Elin Haf %A Nice,Laura %A Flavell,Luke %A Flavell,Jackie %A Calvert,Melanie %K usability study %K usability %K patient reported outcome %K PRO %K electronic patient reported outcome %K ePRO %K traumatic brain injury %K TBI %K think aloud %K cognitive interviews %K early warning %K early detection %K mobile phone %D 2025 %7 23.1.2025 %9 %J JMIR Form Res %G English %X Background: Traumatic brain injury (TBI) is a significant public health issue and a leading cause of death and disability globally. Advances in clinical care have improved survival rates, leading to a growing population living with long-term effects of TBI, which can impact physical, cognitive, and emotional health. These effects often require continuous management and individualized care. Traditional paper-based assessments can be cumbersome, potentially impeding regular monitoring of patient-reported outcomes (PROs). Electronic PROs (ePROs) offer a promising alternative by enabling real-time symptom tracking, which can facilitate early identification of issues, support shared decision-making, and improve outcomes for patients with TBI. Objective: This study evaluates the usability of an ePRO platform—Atom5—for individuals with TBI. By analyzing how patients use the system to report their symptoms, the study aims to identify usability issues, assess user satisfaction, and determine the potential of Atom5 to support ongoing patient-centered care. Methods: Atom5 was customized to enable individuals with TBI to report their symptoms. Usability testing was conducted through one-on-one sessions with participants recruited from Headway UK—an organization supporting brain injury survivors. Each participant took part in cognitive interviews using with the “Think Aloud” method, encouraging them to verbalize their thoughts and experiences while using the platform. This approach provided qualitative insights into areas of difficulty, usability strengths, and accessibility barriers. User satisfaction was quantitatively assessed with a brief 4-item questionnaire based on the System Usability Scale. Usability outcomes were analyzed for critical and noncritical errors, focusing on user experience and overall satisfaction. Results: In total, 9 participants completed a single usability testing session using Atom5, including 4 men, 4 women, and 1 nonbinary individual; 4 participants were under 55 years old, and 6 had their TBI <10 years ago. Finally, 8 participants used an Android device. The platform included measures for anxiety (Generalized Anxiety Disorder-2 item), depression (Patient Health Questionnaire-2), posttraumatic stress disorder (Posttraumatic Stress Disorder checklist 2), and TBI-specific quality of life (Traumatic Brain Injury – Quality of Life Short form) and a total of 26 questions. Overall, all participants were satisfied with the system, noting that it was easy to navigate and accessible despite difficulties in understanding some questions. Further, 6 participants encountered no errors, while 1 participant reported one critical error and 2 others reported one noncritical error each. The participants rated their overall satisfaction with the platform at an average score of 3.9 (SD 0.49) out of 5. Conclusions: This usability study suggests that individuals living with TBI can effectively report symptoms using the Atom5 ePRO platform, with generally high satisfaction and few usability issues, thereby enabling continuous monitoring and proactive symptom management. Future ePRO development should focus on inclusivity and adaptability to address the diverse needs of patients with TBI, ensuring these tools can effectively support a wide range of users. %R 10.2196/58128 %U https://formative.jmir.org/2025/1/e58128 %U https://doi.org/10.2196/58128 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58450 %T Identifying Fraudulent Responses in a Study Exploring Delivery Options for Pregnancies Impacted by Gestational Diabetes: Lessons Learned From a Web-Based Survey %A Ruby,Emma %A Ramlawi,Serine %A Bowie,Alexa Clare %A Boyd,Stephanie %A Dingwall-Harvey,Alysha %A Rennicks White,Ruth %A El-Chaâr,Darine %A Walker,Mark %+ , Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Centre for Practice Changing Research, Box 241, Ottawa, ON, K1H8L6, Canada, 1 613 737 8899 ext 73840, mwalker@toh.ca %K research fraud %K anonymous online research %K data integrity %K fraudulent responses %K web-based survey %K internet research %K perinatal health %K social media %K patient participation %K provider participation %K fraudulent %K fraud %K pregnancy %K gestational diabetes %K diabetes %K data analysis %K survey %K diabetes mellitus %K patient %K evidence-based %D 2025 %7 20.1.2025 %9 Viewpoint %J J Med Internet Res %G English %X Current literature is unclear on the safety and optimal timing of delivery for pregnant individuals with gestational diabetes mellitus, which inspired our study team to conduct a web-based survey study exploring patient and provider opinions on delivery options. However, an incident of fraudulent activity with survey responses prompted a shift in the focus of the research project. Unfortunately, despite the significant rise of web-based surveys used in medical research, there remains very limited evidence on the implications of and optimal methods to handle fraudulent web-based survey responses. Therefore, the objective of this viewpoint paper was to highlight our approach to identifying fraudulent responses in a web-based survey study, in the context of clinical perinatal research exploring patient and provider opinions on delivery options for pregnancies with gestational diabetes mellitus. Initially, we conducted cross-sectional web-based surveys across Canada with pregnant patients and perinatal health care providers. Surveys were available through Research Electronic Data Capture, and recruitment took place between March and October 2023. A change to recruitment introduced a US $5 gift card incentive to increase survey engagement. In mid-October 2023, an incident of fraudulent activity was reported, after which the surveys were deactivated. Systematic guidelines were developed by the study team in consultation with information technology services and the research ethics board to filter fraudulent from true responses. Between October 14 and 16, 2023, an influx of almost 2500 responses (393 patients and 2047 providers) was recorded in our web-based survey. Systematic filtering flagged numerous fraudulent responses. We identified fraudulent responses based on criteria including, but not limited to, identical timestamps and responses, responses with slight variations in wording and similar timestamps, and fraudulent email addresses. Therefore, the incident described in this viewpoint paper highlights the importance of preserving research integrity by using methodologically sound practices to extract true data for research findings. These fraudulent events continue to threaten the credibility of research findings and future evidence-based practices. %M 39832359 %R 10.2196/58450 %U https://www.jmir.org/2025/1/e58450 %U https://doi.org/10.2196/58450 %U http://www.ncbi.nlm.nih.gov/pubmed/39832359 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 9 %N %P e64893 %T Estimating Trends in Cardiovascular Disease Risk for the EXPOSE (Explaining Population Trends in Cardiovascular Risk: A Comparative Analysis of Health Transitions in South Africa and England) Study: Repeated Cross-Sectional Study %A Scholes,Shaun %A Mindell,Jennifer S %A Toomse-Smith,Mari %A Cois,Annibale %A Adjaye-Gbewonyo,Kafui %+ Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, United Kingdom, 44 01207 679 1727, s.scholes@ucl.ac.uk %K data harmonization %K cardiovascular disease %K CVD %K CVD risk scores %K trends %K cross-country comparisons %K public health %K England %K South Africa %D 2025 %7 20.1.2025 %9 Original Paper %J JMIR Cardio %G English %X Background: Cardiovascular diseases (CVDs) are the leading cause of death globally. Demographic, behavioral, socioeconomic, health care, and psychosocial variables considered risk factors for CVD are routinely measured in population health surveys, providing opportunities to examine health transitions. Studying the drivers of health transitions in countries where multiple burdens of disease persist (eg, South Africa), compared with countries regarded as models of “epidemiologic transition” (eg, England), can provide knowledge on where best to intervene and direct resources to reduce the disease burden. Objective: The EXPOSE (Explaining Population Trends in Cardiovascular Risk: A Comparative Analysis of Health Transitions in South Africa and England) study analyzes microlevel data collected from multiple nationally representative population health surveys conducted in these 2 countries between 1998 and 2017. Creating a harmonized dataset by pooling repeated cross-sectional surveys to model trends in CVD risk is challenging due to changes in aspects such as survey content, question wording, inclusion of boost samples, weighting, measuring equipment, and guidelines for data protection. This study aimed to create a harmonized dataset based on the annual Health Surveys for England to estimate trends in mean predicted 10-year CVD risk (primary outcome) and its individual risk components (secondary outcome). Methods: We compiled a harmonized dataset to estimate trends between 1998 and 2017 in the English adult population, including the primary and secondary outcomes, and potential drivers of those trends. Laboratory- and non–laboratory-based World Health Organization (WHO) and Globorisk algorithms were used to calculate the predicted 10-year total (fatal and nonfatal) CVD risk. Sex-specific estimates of the mean 10-year CVD risk and its components by survey year were calculated, accounting for the complex survey design. Results: Laboratory- and non–laboratory-based 10-year CVD risk scores were calculated for 33,628 and 61,629 participants aged 40 to 74 years, respectively. The absolute predicted 10-year risk of CVD declined significantly on average over the last 2 decades in both sexes (for linear trend; all P<.001). In men, the mean of the laboratory-based WHO risk score was 10.1% (SE 0.2%) and 8.4% (SE 0.2%) in 1998 and 2017, respectively; corresponding figures in women were 5.6% (SE 0.1%) and 4.5% (SE 0.1%). In men, the mean of the non–laboratory-based WHO risk score was 9.6% (SE 0.1%) and 8.9% (SE 0.2%) in 1998 and 2017, respectively; corresponding figures in women were 5.8% (SE 0.1%) and 4.8% (SE 0.1%). Predicted CVD risk using the Globorisk algorithms was lower on average in absolute terms, but the pattern of change was very similar. Trends in the individual risk components showed a complex pattern. Conclusions: Harmonized data from repeated cross-sectional health surveys can be used to quantify the drivers of recent changes in CVD risk at the population level. %M 39832161 %R 10.2196/64893 %U https://cardio.jmir.org/2025/1/e64893 %U https://doi.org/10.2196/64893 %U http://www.ncbi.nlm.nih.gov/pubmed/39832161 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60189 %T Building a Digital Health Research Platform to Enable Recruitment, Enrollment, Data Collection, and Follow-Up for a Highly Diverse Longitudinal US Cohort of 1 Million People in the All of Us Research Program: Design and Implementation Study %A Klein,Dave %A Montgomery,Aisha %A Begale,Mark %A Sutherland,Scott %A Sawyer,Sherilyn %A McCauley,Jacob L %A Husbands,Letheshia %A Joshi,Deepti %A Ashbeck,Alan %A Palmer,Marcy %A Jain,Praduman %+ Vibrent Health, Inc, 4114 Legato Rd #900, Fairfax, VA, 22033, United States, 1 6784686545, aisha.montgomery@gmail.com %K longitudinal studies %K cohort studies %K health disparities %K minority populations %K vulnerable populations %K precision medicine %K biomedical research %K decentralization %K digital health technology %K database management system %D 2025 %7 15.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Longitudinal cohort studies have traditionally relied on clinic-based recruitment models, which limit cohort diversity and the generalizability of research outcomes. Digital research platforms can be used to increase participant access, improve study engagement, streamline data collection, and increase data quality; however, the efficacy and sustainability of digitally enabled studies rely heavily on the design, implementation, and management of the digital platform being used. Objective: We sought to design and build a secure, privacy-preserving, validated, participant-centric digital health research platform (DHRP) to recruit and enroll participants, collect multimodal data, and engage participants from diverse backgrounds in the National Institutes of Health’s (NIH) All of Us Research Program (AOU). AOU is an ongoing national, multiyear study aimed to build a research cohort of 1 million participants that reflects the diversity of the United States, including minority, health-disparate, and other populations underrepresented in biomedical research (UBR). Methods: We collaborated with community members, health care provider organizations (HPOs), and NIH leadership to design, build, and validate a secure, feature-rich digital platform to facilitate multisite, hybrid, and remote study participation and multimodal data collection in AOU. Participants were recruited by in-person, print, and online digital campaigns. Participants securely accessed the DHRP via web and mobile apps, either independently or with research staff support. The participant-facing tool facilitated electronic informed consent (eConsent), multisource data collection (eg, surveys, genomic results, wearables, and electronic health records [EHRs]), and ongoing participant engagement. We also built tools for research staff to conduct remote participant support, study workflow management, participant tracking, data analytics, data harmonization, and data management. Results: We built a secure, participant-centric DHRP with engaging functionality used to recruit, engage, and collect data from 705,719 diverse participants throughout the United States. As of April 2024, 87% (n=613,976) of the participants enrolled via the platform were from UBR groups, including racial and ethnic minorities (n=282,429, 46%), rural dwelling individuals (n=49,118, 8%), those over the age of 65 years (n=190,333, 31%), and individuals with low socioeconomic status (n=122,795, 20%). Conclusions: We built a participant-centric digital platform with tools to enable engagement with individuals from different racial, ethnic, and socioeconomic backgrounds and other UBR groups. This DHRP demonstrated successful use among diverse participants. These findings could be used as best practices for the effective use of digital platforms to build and sustain cohorts of various study designs and increase engagement with diverse populations in health research. %M 39813673 %R 10.2196/60189 %U https://www.jmir.org/2025/1/e60189 %U https://doi.org/10.2196/60189 %U http://www.ncbi.nlm.nih.gov/pubmed/39813673 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60413 %T Recruiting Young People for Digital Mental Health Research: Lessons From an AI-Driven Adaptive Trial %A Zheng,Wu Yi %A Shvetcov,Artur %A Slade,Aimy %A Jenkins,Zoe %A Hoon,Leonard %A Whitton,Alexis %A Logothetis,Rena %A Ravindra,Smrithi %A Kurniawan,Stefanus %A Gupta,Sunil %A Huckvale,Kit %A Stech,Eileen %A Agarwal,Akash %A Funke Kupper,Joost %A Cameron,Stuart %A Rosenberg,Jodie %A Manoglou,Nicholas %A Senadeera,Manisha %A Venkatesh,Svetha %A Mouzakis,Kon %A Vasa,Rajesh %A Christensen,Helen %A Newby,Jill M %+ Black Dog Institute, University of New South Wales, Hospital Road, Randwick, Sydney, 2031, Australia, 61 0422510718, wuyi.zheng@blackdog.org.au %K recruitment %K Facebook %K retention, COVID-19 %K artificial intelligence %D 2025 %7 14.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: With increasing adoption of remote clinical trials in digital mental health, identifying cost-effective and time-efficient recruitment methodologies is crucial for the success of such trials. Evidence on whether web-based recruitment methods are more effective than traditional methods such as newspapers, media, or flyers is inconsistent. Here we present insights from our experience recruiting tertiary education students for a digital mental health artificial intelligence–driven adaptive trial—Vibe Up. Objective: We evaluated the effectiveness of recruitment via Facebook and Instagram compared to traditional methods for a treatment trial and compared different recruitment methods’ retention rates. With recruitment coinciding with COVID-19 lockdowns across Australia, we also compared the cost-effectiveness of social media recruitment during and after lockdowns. Methods: Recruitment was completed for 2 pilot trials and 6 minitrials from June 2021 to May 2022. To recruit participants, paid social media advertising on Facebook and Instagram was used, alongside mailing lists of university networks and student organizations or services, media releases, announcements during classes and events, study posters or flyers on university campuses, and health professional networks. Recruitment data, including engagement metrics collected by Meta (Facebook and Instagram), advertising costs, and Qualtrics data on recruitment methods and survey completion rates, were analyzed using RStudio with R (version 3.6.3; R Foundation for Statistical Computing). Results: In total, 1314 eligible participants (aged 22.79, SD 4.71 years; 1079, 82.1% female) were recruited to 2 pilot trials and 6 minitrials. The vast majority were recruited via Facebook and Instagram advertising (n=1203; 92%). Pairwise comparisons revealed that the lead institution’s website was more effective in recruiting eligible participants than Facebook (z=3.47; P=.003) and Instagram (z=4.23; P<.001). No differences were found between recruitment methods in retaining participants at baseline, at midpoint, and at study completion. Wilcoxon tests found significant differences between lockdown (pilot 1 and pilot 2) and postlockdown (minitrials 1-6) on costs incurred per link click (lockdown: median Aus $0.35 [US $0.22], IQR Aus $0.27-$0.47 [US $0.17-$0.29]; postlockdown: median Aus $1.00 [US $0.62], IQR Aus $0.70-$1.47 [US $0.44-$0.92]; W=9087; P<.001) and the amount spent per hour to reach the target sample size (lockdown: median Aus $4.75 [US $2.95], IQR Aus $1.94-6.34 [US $1.22-$3.97]; postlockdown: median Aus $13.29 [US $8.26], IQR Aus $4.70-25.31 [US $2.95-$15.87]; W=16044; P<.001). Conclusions: Social media advertising via Facebook and Instagram was the most successful strategy for recruiting distressed tertiary students into this artificial intelligence–driven adaptive trial, providing evidence for the use of this recruitment method for this type of trial in digital mental health research. No recruitment method stood out in terms of participant retention. Perhaps a reflection of the added distress experienced by young people, social media recruitment during the COVID-19 lockdown period was more cost-effective. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001092886; https://tinyurl.com/39f2pdmd; Australian New Zealand Clinical Trials Registry ACTRN12621001223820; https://tinyurl.com/bdhkvucv %M 39808785 %R 10.2196/60413 %U https://www.jmir.org/2025/1/e60413 %U https://doi.org/10.2196/60413 %U http://www.ncbi.nlm.nih.gov/pubmed/39808785 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59937 %T Unified Mobile App for Streamlining Verbal Autopsy and Cause of Death Assignment in India: Design and Development Study %A Kaur,Harleen %A Tripathi,Stuti %A Chalga,Manjeet Singh %A Benara,Sudhir K %A Dhiman,Amit %A Gupta,Shefali %A Nair,Saritha %A Menon,Geetha %A Gulati,B K %A Sharma,Sandeep %A Sharma,Saurabh %K verbal autopsy %K cause of death %K mortality %K mHealth %K public health %K India %K mobile health %D 2025 %7 10.1.2025 %9 %J JMIR Form Res %G English %X Background: Verbal autopsy (VA) has been a crucial tool in ascertaining population-level cause of death (COD) estimates, specifically in countries where medical certification of COD is relatively limited. The World Health Organization has released an updated instrument (Verbal Autopsy Instrument 2022) that supports electronic data collection methods along with analytical software for assigning COD. This questionnaire encompasses the primary signs and symptoms associated with prevalent diseases across all age groups. Traditional methods have primarily involved paper-based questionnaires and physician-coded approaches for COD assignment, which is time-consuming and resource-intensive. Although computer-coded algorithms have advanced the COD assignment process, data collection in densely populated countries like India remains a logistical challenge. Objective: This study aimed to develop an Android-based mobile app specifically tailored for streamlining VA data collection by leveraging the existing Indian public health workforce. The app has been designed to integrate real-time data collection by frontline health workers and seamless data transmission and digital reporting of COD by physicians. This process aimed to enhance the efficiency and accuracy of COD assignment through VA. Methods: The app was developed using Android Studio, the primary integrated development environment for developing Android apps using Java. The front-end interface was developed using XML, while SQLite and MySQL were employed to streamline complete data storage on the local and server databases, respectively. The communication between the app and the server was facilitated through a PHP application programming interface to synchronize data from the local to the server database. The complete prototype was specifically built to reduce manual intervention and automate VA data collection. Results: The app was developed to align with the current Indian public health system for district-level COD estimation. By leveraging this mobile app, the average duration required for VA data collection to ascertainment of COD, which typically ranges from 6 to 8 months, is expected to decrease by approximately 80%, reducing it to about 1‐2 months. Based on annual caseload projections, the smallest administrative public health unit, health and wellness centers, is anticipated to handle 35‐40 VA cases annually, while medical officers at primary health centers are projected to manage 150‐200 physician-certified VAs each year. The app’s data collection and transmission efficiency were further improved based on feedback from user and subject area experts. Conclusions: The development of a unified mobile app could streamline the VA process, enabling the generation of accurate national and subnational COD estimates. This mobile app can be further piloted and scaled to different regions to integrate the automated VA model into the existing public health system for generating comprehensive mortality statistics in India. %R 10.2196/59937 %U https://formative.jmir.org/2025/1/e59937 %U https://doi.org/10.2196/59937 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e58531 %T Methodology for the Positive Voices 2022 Survey of People With HIV Accessing Care in England, Wales, and Scotland: Cross-Sectional Questionnaire Study %A Sewell,Janey %A Kelly,Carole %A Aghaizu,Adamma %A Kitt,Hannah %A Pelchen-Matthews,Annegret %A Martin,Veronique %A Farah,Amal %A Smith,Colette %A Brown,Alison %A Humphreys,Clare %A Sparrowhawk,Alex %A Delpech,Valerie %A Rodger,Alison %A Lampe,Fiona %A Kall,Meaghan %+ Department for Infection and Population Health, University College London, Institute for Global Health, Royal Free Hospital, Pond Street, London, NW3 2QG, United Kingdom, 44 7792096376, j.sewell@ucl.ac.uk %K HIV care %K national survey %K quality of life %K Positive Voices %K transgender population %K gender-diverse population %K health disparities %K health services research %K living with HIV %K HIV stigma %K social determinants of health %K longitudinal cohort %K access to care %K welfare services %K health policy %K preventive care %D 2025 %7 10.1.2025 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Due to advances in treatment, HIV is now a chronic condition with near-normal life expectancy. However, people with HIV continue to have a higher burden of mental and physical health conditions and are impacted by wider socioeconomic issues. Positive Voices is a nationally representative series of surveys of people with HIV in the United Kingdom. It monitors the physical, mental, and social health, well-being, and needs of this population so that they can be addressed. Objective: This paper aimed to describe the methodology, recruitment strategies, and key demographic features of participants recruited for the second national round of Positive Voices (PV2022). Methods: PV2022 was a national, cross-sectional questionnaire study that included people attending HIV care at 101 of the 178 clinics in the United Kingdom between April 2022 and March 2023. Data from the HIV and AIDS reporting system (HARS), a national surveillance database of people with HIV and attending care that is held at the UK Health Security Agency (UKHSA), was used as a sampling frame. The information collected in PV2022 included demographic and socioeconomic factors, HIV diagnoses and treatment, mental and physical health, health service use and satisfaction, social care and support, met and unmet needs, stigma and discrimination, quality of life, lifestyle factors, and additional challenges experienced due to the COVID-19 pandemic. Data linkage to HARS enabled the extraction of clinical information on antiretroviral therapy (ART), HIV viral load, and CD4 lymphocyte counts. Probabilistic sampling was used to provide a randomly selected, representative sample of people attending HIV care who could be invited to complete a paper or online questionnaire. At the start of 2023, due to under-recruitment mainly due to the impact of the monkeypox (Mpox) outbreak, a separate sequential recruitment strategy was initiated in 14 of the largest clinics to increase participant numbers. Results: Of the 4622 participants who completed the questionnaire, 3692 were recruited through probabilistic recruitment and 930 through sequential recruitment. The overall response rate (measured as the number of people who completed a questionnaire of those who either accepted or declined) was 50%. Survey respondents represented approximately 1 in 20 people diagnosed with HIV in England, Wales, and Scotland. The median age of participants was 52 years, 3428 of participants were men, 2991 were White, and 1121 were Black. Conclusions: PV2022 is currently the largest survey of people with HIV in the United Kingdom (as of September 2024). The PV2022 findings will be used to explore the health and well-being of the HIV population and examine associations with demographic, socioeconomic, lifestyle, and other HIV-related factors. International Registered Report Identifier (IRRID): RR1-10.2196/58531 %R 10.2196/58531 %U https://www.researchprotocols.org/2025/1/e58531 %U https://doi.org/10.2196/58531 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e58630 %T Population Size Estimation of Men Who Have Sex With Men in Low- and Middle-Income Countries: Google Trends Analysis %A Malburg,Carly M %A Gutreuter,Steve %A Ruiseñor-Escudero,Horacio %A Abdul-Quader,Abu %A Hladik,Wolfgang %K population size estimation %K men who have sex with men %K MSM %K PSE %K google trends %K HIV %K AIDS %K programming and policy %K internet %K porn %K gay porn %K male adult %K geriatric %K linear regression %K homosexuality %K sensitivity analysis %K World Health Organization %K WHO %K epidemiology %D 2025 %7 9.1.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Population size estimation (PSE) for key populations is needed to inform HIV programming and policy. Objective: This study aimed to examine the utility of applying a recently proposed method using Google Trend (GT) internet search data to generate PSE (Google Trends Population Size Estimate [GTPSE]) for men who have sex with men (MSM) in 54 countries in Africa, Asia, the Americas, and Europe. Methods: We examined GT relative search volumes (representing the relative internet search frequency of specific search terms) for “porn” and, as a comparator term, “gay porn” for the year 2020. We assumed “porn” represents “men” (denominator) while “gay porn” represents a subset of “MSM” (numerator) in each county, resulting in a proportional size estimate for MSM. We multiplied the proportional GTPSE values with the countries’ male adult population (15‐49 years) to obtain absolute size estimates. Separately, we produced subnational MSM PSE limited to countries’ (commercial) capitals. Using linear regression analysis, we examined the effect of countries’ levels of urbanization, internet penetration, criminalization of homosexuality, and stigma on national GTPSE results. We conducted a sensitivity analysis in a subset of countries (n=14) examining the effect of alternative English search terms, different language search terms (Spanish, French, and Swahili), and alternative search years (2019 and 2021). Results: One country was excluded from our analysis as no GT data could be obtained. Of the remaining 53 countries, all national GTPSE values exceeded the World Health Organization’s recommended minimum PSE threshold of 1% (range 1.2%‐7.5%). For 44 out of 49 (89.8%) of the countries, GTPSE results were higher than Joint United Nations Programme on HIV/AIDS (UNAIDS) Key Population Atlas values but largely consistent with the regional UNAIDS Global AIDS Monitoring results. Substantial heterogeneity across same-region countries was evident in GTPSE although smaller than those based on Key Population Atlas data. Subnational GTPSE values were obtained in 51 out of 53 (96%) countries; all subnational GTPSE values exceeded 1% but often did not match or exceed the corresponding countries’ national estimates. None of the covariates examined had a substantial effect on the GTPSE values (R2 values 0.01‐0.28). Alternative (English) search terms in 12 out of 14 (85%) countries produced GTPSE>1%. Using non-English language terms often produced markedly lower same-country GTPSE values compared with English with 10 out of 14 (71%) countries showing national GTPSE exceeding 1%. GTPSE used search data from 2019 and 2021, yielding results similar to those of the reference year 2020. Due to a lack of absolute search volume data, credibility intervals could not be computed. The validity of key assumptions, especially who (males and females) searches for porn and gay porn, could not be assessed. Conclusions: GTPSE for MSM provides a simple, fast, essentially cost-free method. Limitations that impact the certainty of our estimates include a lack of validation of key assumptions and an inability to assign credibility intervals. GTPSE for MSM may provide an additional data source, especially for estimating national-level PSE. %R 10.2196/58630 %U https://publichealth.jmir.org/2025/1/e58630 %U https://doi.org/10.2196/58630 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65684 %T Older Adults’ Experiences With an Online Survey %A Weir,Kristie Rebecca %A Maitah,Yehya %A Vordenberg,Sarah E %+ Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, City Road, Sydney, NSW 2006, Australia, 61 293512222, kristie.weir@sydney.edu.au %K older adults %K gerontology %K geriatric %K older %K aging %K online %K internet %K survey %K questionnaire %K research engagement %K engagement %K study subject %K participant %K medication decisions %D 2025 %7 8.1.2025 %9 Research Letter %J JMIR Hum Factors %G English %X The study explored older adults' perceptions after participating in an online survey about medication decisions, finding that approximately 80% of participants provided positive feedback about the research methodology and their experience. %M 39773887 %R 10.2196/65684 %U https://humanfactors.jmir.org/2025/1/e65684 %U https://doi.org/10.2196/65684 %U http://www.ncbi.nlm.nih.gov/pubmed/39773887 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62768 %T The Willingness of Doctors to Adopt Artificial Intelligence–Driven Clinical Decision Support Systems at Different Hospitals in China: Fuzzy Set Qualitative Comparative Analysis of Survey Data %A Yu,Zhongguang %A Hu,Ning %A Zhao,Qiuyi %A Hu,Xiang %A Jia,Cunbo %A Zhang,Chunyu %A Liu,Bing %A Li,Yanping %+ Economics and Management School, Wuhan University, 299 Bayi Road, Wuchang District, Wuhan, 430072, China, 86 68753084, ypli@whu.edu.cn %K artificial intelligence %K clinical decision support systems %K willingness %K technology adoption %K fuzzy set qualitative comparative analysis %K fsQCA %K pathways %D 2025 %7 7.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Artificial intelligence–driven clinical decision support systems (AI-CDSSs) are pivotal tools for doctors to improve diagnostic and treatment processes, as well as improve the efficiency and quality of health care services. However, not all doctors trust artificial intelligence (AI) technology, and many remain skeptical and unwilling to adopt these systems. Objective: This study aimed to explore in depth the factors influencing doctors’ willingness to adopt AI-CDSSs and assess the causal relationships among these factors to gain a better understanding for promoting the clinical application and widespread implementation of these systems. Methods: Based on the unified theory of acceptance and use of technology (UTAUT) and the technology-organization-environment (TOE) framework, we have proposed and designed a framework for doctors’ willingness to adopt AI-CDSSs. We conducted a nationwide questionnaire survey in China and performed fuzzy set qualitative comparative analysis to explore the willingness of doctors to adopt AI-CDSSs in different types of medical institutions and assess the factors influencing their willingness. Results: The survey was administered to doctors working in tertiary hospitals and primary/secondary hospitals across China. We received 450 valid responses out of 578 questionnaires distributed, indicating a robust response rate of 77.9%. Our analysis of the influencing factors and adoption pathways revealed that doctors in tertiary hospitals exhibited 6 distinct pathways for AI-CDSS adoption, which were centered on technology-driven pathways, individual-driven pathways, and technology-individual dual-driven pathways. Doctors in primary/secondary hospitals demonstrated 3 adoption pathways, which were centered on technology-individual and organization-individual dual-driven pathways. There were commonalities in the factors influencing adoption across different medical institutions, such as the positive perception of AI technology’s utility and individual readiness to try new technologies. There were also variations in the influence of facilitating conditions among doctors at different medical institutions, especially primary/secondary hospitals. Conclusions: From the perspective of the 6 pathways for doctors at tertiary hospitals and the 3 pathways for doctors at primary/secondary hospitals, performance expectancy and personal innovativeness were 2 indispensable and core conditions in the pathways to achieving favorable willingness to adopt AI-CDSSs. %M 39773696 %R 10.2196/62768 %U https://www.jmir.org/2025/1/e62768 %U https://doi.org/10.2196/62768 %U http://www.ncbi.nlm.nih.gov/pubmed/39773696 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60446 %T Topic Modeling of Nursing Issues in the Media During 4 Emerging Infectious Disease Epidemics in South Korea: Descriptive Analysis %A Kim,Jungok %A Yun,Eun Kyoung %+ , College of Nursing Science, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea, 82 2 961 2348, ekyun@khu.ac.kr %K topic modeling %K news articles %K nursing issues %K text analysis %K emerging infectious disease %D 2025 %7 6.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Emerging infectious disease disasters receive extensive media coverage and public attention. Nurse burnout and attrition peak during health crises such as pandemics. However, there is limited research on nursing issues related to repeated emerging infectious disease crises over time. Objective: The purpose of this study was to analyze and draw implications from changes in key nursing issues reported by the news media during the outbreaks of severe acute respiratory syndrome (SARS; 2003), influenza A (2009), Middle East respiratory syndrome (MERS; 2015), and COVID-19 (2020) in Korea using topic modeling. Methods: A total of 51,489 news articles were extracted by searching for the keywords “nursing” or “nurse” in the title or body of articles published from April 2003 to May 2021 (during new infectious disease outbreaks) in the open integrated database. The selected news articles were preprocessed then analyzed for text and structure using a 3-step keyword analysis method, latent Dirichlet allocation topic modeling, and keyword network analysis. Results: Among the 51,489 news articles collected with the search terms “nursing” and “nurse,” 17,285 (33.6%) were selected based on the eligibility criteria and used in the final analysis. Using topic modeling, we derived 5 topics each for SARS, influenza A, and MERS and 6 topics for COVID-19. The themes commonly identified through topic modeling and keyword network analysis across the 4 epidemics were “response to emerging infectious diseases in Korea,” “demand for nurses,” “vulnerability in the work environment,” and “roles and responsibilities of nurses.” Although the topic names were the same, the meanings implied by the comprehensive keywords for each epidemic varied depending on the epidemic and the times. Conclusions: Analysis of the identified themes and associated keyword network revealed that issues related to nurse shortages, working conditions, and poor treatment were not unique to the COVID-19 pandemic but rather recurring themes from previous epidemics. Our findings can be used to inform strategies to improve the professional roles, work environment, and treatment of nurses during health crises. Suggestions for future nursing-related policy impact and change research are also provided. %M 39761557 %R 10.2196/60446 %U https://www.jmir.org/2025/1/e60446 %U https://doi.org/10.2196/60446 %U http://www.ncbi.nlm.nih.gov/pubmed/39761557 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e65099 %T Research Participants’ Engagement and Retention in Digital Health Interventions Research: Protocol for Mixed Methods Systematic Review %A Terceiro,Luciana %A Mustafa,Mudassir Imran %A Hägglund,Maria %A Kharko,Anna %+ Department of Women's and Children's Health, CIRCLE - Complex Intervention Research in Health and Care, Uppsala University, Dag Hammarskjölds väg 14B, 1tr, Uppsala, 75237, Sweden, 46 0702564467, luciana.terceiro@uu.se %K clinical research informatics %K participant engagement %K participant retention %K clinical research %K mobile application %K digital platforms %K mobile phone %D 2025 %7 3.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital health interventions have become increasingly popular in recent years, expanding the possibilities for treatment for various patient groups. In clinical research, while the design of the intervention receives close attention, challenges with research participant engagement and retention persist. This may be partially due to the use of digital health platforms, which may lack adequacy for participants. Objective: This systematic literature review aims to investigate the relationship between digital health platforms and participant engagement and retention in clinical research. It will map and analyze key definitions of engagement and retention, as well as identify design characteristics that influence them. Methods: We will carry out a mixed methods systematic literature review, analyzing qualitative and quantitative studies. The search strategy includes the electronic databases PubMed, IEEE Xplore, CINAHL, Scopus, Web of Science, APA PsycINFO, and the ACM Digital Library. The review will encompass studies published between January 2018 and June 2024. Criteria for inclusion will be the presence of digital health care interventions conducted through digital health platforms like websites, web and mobile apps used by patients, and informal caregivers as research participants. The main outcome will be a narrative analysis with key findings on the definitions of participant engagement and retention and critical factors that affect them. Quality assessment and appraisal will be done through the Mixed-Methods Assessment Tool. Data analysis and synthesis will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 flow diagram. Quantitative data will be qualified and integrated into qualitative data, which will be analyzed using thematic analysis and synthesis. Results: The study expects to map and summarize critical definitions of participant engagement and retention, and the characteristics of digital health platforms that influence them. The systematic review is expected to be completed in June 2025. Conclusions: This systematic review will contribute to the growing discussion on how the design of digital health intervention platforms can promote participant engagement and retention in clinical research. Trial Registration: PROSPERO CRD42024561650; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=561650 International Registered Report Identifier (IRRID): PRR1-10.2196/65099 %M 39752662 %R 10.2196/65099 %U https://www.researchprotocols.org/2025/1/e65099 %U https://doi.org/10.2196/65099 %U http://www.ncbi.nlm.nih.gov/pubmed/39752662 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e64636 %T Baseline Smartphone App Survey Return in the Electronic Framingham Heart Study Offspring and Omni 1 Study: eCohort Study %A Rong,Jian %A Pathiravasan,Chathurangi H %A Zhang,Yuankai %A Faro,Jamie M %A Wang,Xuzhi %A Schramm,Eric %A Borrelli,Belinda %A Benjamin,Emelia J %A Liu,Chunyu %A Murabito,Joanne M %K mHealth %K mobile health %K mobile application %K smartphone %K digital health %K digital technology %K digital intervention %K gerontology %K geriatric %K older adult %K aging %K eFHS %K eCohort %K smartphone app %K baseline app surveys %K Framingham Heart Study %K health information %K information collection %K mobile phone %D 2024 %7 31.12.2024 %9 %J JMIR Aging %G English %X Background: Smartphone apps can be used to monitor chronic conditions and offer opportunities for self-assessment conveniently at home. However, few digital studies include older adults. Objective: We aim to describe a new electronic cohort of older adults embedded in the Framingham Heart Study including baseline smartphone survey return rates and survey completion rates by smartphone type (iPhone [Apple Inc] and Android [Google LLC] users). We also aim to report survey results for selected baseline surveys and participant experience with this study’s app. Methods: Framingham Heart Study Offspring and Omni (multiethnic cohort) participants who owned a smartphone were invited to download this study’s app that contained a range of survey types to report on different aspects of health including self-reported measures from the Patient-Reported Outcomes Measurement Information System (PROMIS). iPhone users also completed 4 tasks including 2 cognitive and 2 physical function testing tasks. Baseline survey return and completion rates were calculated for 12 surveys and compared between iPhone and Android users. We calculated standardized scores for the PROMIS surveys. The Mobile App Rating Scale (MARS) was deployed 30 days after enrollment to obtain participant feedback on app functionality and aesthetics. Results: We enrolled 611 smartphone users (average age 73.6, SD 6.3 y; n=346, 56.6% women; n=88, 14.4% Omni participants; 478, 78.2% iPhone users) and 596 (97.5%) returned at least 1 baseline survey. iPhone users had higher app survey return rates than Android users for each survey (range 85.5% to 98.3% vs 73.8% to 95.2%, respectively), but survey completion rates did not differ in the 2 smartphone groups. The return rate for the 4 iPhone tasks ranged from 80.9% (380/470) for the gait task to 88.9% (418/470) for the Trail Making Test task. The Electronic Framingham Heart Study participants had better standardized t scores in 6 of 7 PROMIS surveys compared to the general population mean (t score=50) including higher cognitive function (n=55.6) and lower fatigue (n=45.5). Among 469 participants who returned the MARS survey, app functionality and aesthetics was rated high (total MARS score=8.6 on a 1‐10 scale). Conclusions: We effectively engaged community-dwelling older adults to use a smartphone app designed to collect health information relevant to older adults. High app survey return rates and very high app survey completion rates were observed along with high participant rating of this study’s app. %R 10.2196/64636 %U https://aging.jmir.org/2024/1/e64636 %U https://doi.org/10.2196/64636 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51786 %T Challenges and Lessons Learned in Managing Web-Based Survey Fraud for the Garnering Effective Outreach and Research in Georgia for Impact Alliance–Community Engagement Alliance Survey Administrations %A Craig,Leslie S %A Evans,Christina L %A Taylor,Brittany D %A Patterson,Jace %A Whitfield,Kaleb %A Hill,Mekhi %A Nwagwu,Michelle %A Mubasher,Mohamed %A Bednarczyk,Robert A %A McCray,Gail G %A Gaddis,Cheryl L R %A Taylor,Natasha %A Thompson,Emily %A Douglas,Ursula %A Latimer,Saundra K %A Spivey,Sedessie G %A Henry Akintobi,Tabia %A Quarells,Rakale Collins %K web-based survey research %K data quality %K data integrity %K COVID-19 %K Georgia %K data collection %K scientists %K integrity %K transparency %K public health %K deception %K disinformation %K survey fraud %K legitimate data %D 2024 %7 24.12.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Convenience, privacy, and cost-effectiveness associated with web-based data collection have facilitated the recent expansion of web-based survey research. Importantly, however, practical benefits of web-based survey research, to scientists and participants alike, are being overshadowed by the dramatic rise in suspicious and fraudulent survey submissions. Misinformation associated with survey fraud compromises data quality and data integrity with important implications for scientific conclusions, clinical practice, and social benefit. Transparency in reporting on methods used to prevent and manage suspicious and fraudulent submissions is key to protecting the veracity of web-based survey data; yet, there is limited discussion on the use of antideception strategies during all phases of survey research to detect and eliminate low-quality and fraudulent responses. Objective: This study aims to contribute to an evolving evidence base on data integrity threats associated with web-based survey research by describing study design strategies and antideception tools used during the web-based administration of the Garnering Effective Outreach and Research in Georgia for Impact Alliance–Community Engagement Alliance (GEORGIA CEAL) Against COVID-19 Disparities project surveys. Methods: GEORGIA CEAL was established in response to the COVID-19 pandemic and the need for rapid, yet, valid, community-informed, and community-owned research to guide targeted responses to a dynamic, public health crisis. GEORGIA CEAL Surveys I (April 2021 to June 2021) and II (November 2021 to January 2022) received institutional review board approval from the Morehouse School of Medicine and adhered to the CHERRIES (Checklist for Reporting Results of Internet E-Surveys). Results: A total of 4934 and 4905 submissions were received for Surveys I and II, respectively. A small proportion of surveys (Survey I: n=1336, 27.1% and Survey II: n=1024, 20.9%) were excluded due to participant ineligibility, while larger proportions (Survey I: n=1516, 42.1%; Survey II: n=1423, 36.7%) were flagged and removed due to suspicious activity; 2082 (42.2%) and 2458 (50.1%) of GEORGIA CEAL Surveys I and II, respectively, were retained for analysis. Conclusions: Suspicious activity during GEORGIA CEAL Survey I administration prompted the inclusion of additional security tools during Survey II design and administration (eg, hidden questions, Completely Automated Public Turing Test to Tell Computers and Humans Apart verification, and security questions), which proved useful in managing and detecting fraud and resulted in a higher retention rate across survey waves. By thorough discussion of experiences, lessons learned, and future directions for web-based survey research, this study outlines challenges and best practices for designing and implementing a robust defense against survey fraud. Finally, we argue that, in addition to greater transparency and discussion, community stakeholders need to be intentionally and mindfully engaged, via approaches grounded in community-based participatory research, around the potential for research to enable scientific discoveries in order to accelerate investment in quality, legitimate survey data. %R 10.2196/51786 %U https://publichealth.jmir.org/2024/1/e51786 %U https://doi.org/10.2196/51786 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e65957 %T Medical Marijuana Documentation Practices in Patient Electronic Health Records: Retrospective Observational Study Using Smart Data Elements and a Review of Medical Records %A Beiler,Donielle %A Chopra,Aanya %A Gregor,Christina M %A Tusing,Lorraine D %A Pradhan,Apoorva M %A Romagnoli,Katrina M %A Kraus,Chadd K %A Piper,Brian J %A Wright,Eric A %A Troiani,Vanessa %K cannabis %K learning health system %K Epic %K prescription drug monitoring program %K medical marijuana %K electronic health records %K physician %K cannabis use %K drug use %K data sharing %K patient care %K legalization %K dosage %K chart review protocol %K human data extraction %K data collection %D 2024 %7 23.12.2024 %9 %J JMIR Form Res %G English %X Background: Medical marijuana (MMJ) is available in Pennsylvania, and participation in the state-regulated program requires patient registration and receiving certification by an approved physician. Currently, no integration of MMJ certification data with health records exists in Pennsylvania that would allow clinicians to rapidly identify patients using MMJ, as exists with other scheduled drugs. This absence of a formal data sharing structure necessitates tools aiding in consistent documentation practices to enable comprehensive patient care. Customized smart data elements (SDEs) were made available to clinicians at an integrated health system, Geisinger, following MMJ legalization in Pennsylvania. Objective: The purpose of this project was to examine and contextualize the use of MMJ SDEs in the Geisinger population. We accomplished this goal by developing a systematic protocol for review of medical records and creating a tool that resulted in consistent human data extraction. Methods: We developed a protocol for reviewing medical records for extracting MMJ-related information. The protocol was developed between August and December of 2022 and focused on a patient group that received one of several MMJ SDEs between January 25, 2019, and May 26, 2022. Characteristics were first identified on a pilot sample (n=5), which were then iteratively reviewed to optimize for consistency. Following the pilot, 2 reviewers were assigned 200 randomly selected patients’ medical records, with a third reviewer examining a subsample (n=30) to determine reliability. We then summarized the clinician- and patient-level features from 156 medical records with a table-format SDE that best captured MMJ information. Results: We found the review protocol for medical records was feasible for those with minimal medical background to complete, with high interrater reliability (κ=0.966; P<.001; odds ratio 0.97, 95% CI 0.954-0.978). MMJ certification was largely documented by nurses and medical assistants (n=138, 88.5%) and typically within primary care settings (n=107, 68.6%). The SDE has 6 preset field prompts with heterogeneous documentation completion rates, including certifying conditions (n=146, 93.6%), product (n=145, 92.9%), authorized dispensary (n=137, 87.8%), active ingredient (n=130, 83.3%), certifying provider (n=96, 61.5%), and dosage (n=48, 30.8%). We found preset fields were overall well-recorded (mean 76.6%, SD 23.7% across all fields). Primary diagnostic codes recorded at documentation encounters varied, with the most frequent being routine examinations and testing (n=34, 21.8%), musculoskeletal or nervous conditions, and signs and symptoms not classified elsewhere (n=21, 13.5%). Conclusions: This method of reviewing medical records yields high-quality data extraction that can serve as a model for other health record inquiries. Our evaluation showed relatively high completeness of SDE fields, primarily by clinical staff responsible for rooming patients, with an overview of conditions under which MMJ is documented. Improving the adoption and fidelity of SDE data collection may present a valuable data source for future research on patient MMJ use, treatment efficacy, and outcomes. %R 10.2196/65957 %U https://formative.jmir.org/2024/1/e65957 %U https://doi.org/10.2196/65957 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e65882 %T Identifying the Relative Importance of Factors Influencing Medication Compliance in General Patients Using Regularized Logistic Regression and LightGBM: Web-Based Survey Analysis %A Iino,Haru %A Kizaki,Hayato %A Imai,Shungo %A Hori,Satoko %+ Division of Drug Informatics, Faculty of Pharmacy and Graduate School of Pharmaceutical Sciences, Keio University, 1-5-30 Shibakoen Minato-ku, Tokyo, 105-8512, Japan, 81 354002650, satokoh@keio.jp %K medication adherence %K pharmacological management %K medication compliance %K Japan %K drugs %K dose %K psychological %K questionnaire survey %K LightGBM %K logistic regression model %K regularization %K machine learning %K AI %K artificial intelligence %D 2024 %7 23.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Medication compliance, which refers to the extent to which patients correctly adhere to prescribed regimens, is influenced by various psychological, behavioral, and demographic factors. When analyzing these factors, challenges such as multicollinearity and variable selection often arise, complicating the interpretation of results. To address the issue of multicollinearity and better analyze the importance of each factor, machine learning methods are considered to be useful. Objective: This study aimed to identify key factors influencing medication compliance by applying regularized logistic regression and LightGBM. Methods: A questionnaire survey was conducted among 638 adult patients in Japan who had been continuously taking medications for at least 3 months. The survey collected data on demographics, medication habits, psychological adherence factors, and compliance. Logistic regression with regularization was used to handle multicollinearity, while LightGBM was used to calculate feature importance. Results: The regularized logistic regression model identified significant predictors, including “using the drug at approximately the same time each day” (coefficient 0.479; P=.02), “taking meals at approximately the same time each day” (coefficient 0.407; P=.02), and “I would like to have my medication reduced” (coefficient –0.410; P=.01). The top 5 variables with the highest feature importance scores in the LightGBM results were “Age” (feature importance 179.1), “Using the drug at approximately the same time each day” (feature importance 148.4), “Taking meals at approximately the same time each day” (feature importance 109.0), “I would like to have my medication reduced” (feature importance 77.48), and “I think I want to take my medicine” (feature importance 70.85). Additionally, the feature importance scores for the groups of medication adherence–related factors were 77.92 for lifestyle-related items, 52.04 for awareness of medication, 20.30 for relationships with health care professionals, and 5.05 for others. Conclusions: The most significant factors for medication compliance were the consistency of medication and meal timing (mean of feature importance), followed by the number of medications and patient attitudes toward their treatment. This study is the first to use a machine learning model to calculate and compare the relative importance of factors affecting medication adherence. Our findings demonstrate that, in terms of relative importance, lifestyle habits are the most significant contributors to medication compliance among the general patient population. The findings suggest that regularization and machine learning methods, such as LightGBM, are useful for better understanding the numerous adherence factors affected by multicollinearity. %M 39715551 %R 10.2196/65882 %U https://formative.jmir.org/2024/1/e65882 %U https://doi.org/10.2196/65882 %U http://www.ncbi.nlm.nih.gov/pubmed/39715551 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51994 %T Tracking Upper Limb Motion via Wearable Solutions: Systematic Review of Research From 2011 to 2023 %A Karoulla,Eirini %A Matsangidou,Maria %A Frangoudes,Fotos %A Paspalides,Panayiotis %A Neokleous,Kleanthis %A Pattichis,Constantinos S %+ CYENS - Centre of Excellence, Lellou Demetriades, Plateia Dimarchou 1, Nicosia, 1016, Cyprus, 357 22747575, m.matsangidou@cyens.org.cy %K motion tracking %K motion sensing %K posture monitoring %K wearable devices %K upper limb rehabilitation %K interactive feedback %K real-time feedback %K wearble technology %K upper limb motion %D 2024 %7 23.12.2024 %9 Review %J J Med Internet Res %G English %X Background: The development of wearable solutions for tracking upper limb motion has gained research interest over the past decade. This paper provides a systematic review of related research on the type, feasibility, signal processing techniques, and feedback of wearable systems for tracking upper limb motion, mostly in rehabilitation applications, to understand and monitor human movement. Objective: The aim of this article is to investigate how wearables are used to capture upper limb functions, especially related to clinical and rehabilitation applications. Methods: A systematic literature search identified 27 relevant studies published in English from 2011 to 2023, across 4 databases: ACM Digital Library, IEEE Xplore, PubMed, and ScienceDirect. We included papers focusing on motion or posture tracking for the upper limbs, wearable devices, feedback given to end users, and systems having clinical or rehabilitation purposes. We excluded papers focusing on exoskeletons, robotics, prosthetics, orthoses, or activity recognition systems; reviews; and books. Results: The results from this research focus on wearable devices that are designed to monitor upper limb movement. More specifically, studies were divided into 2 distinct categories: clinical motion tracking (15/27, 56%) and rehabilitation (12/27, 44%), involving healthy individuals and patients, with a total of 439 participants. Among the 27 studies, the majority (19/27) used inertial measurement units to track upper limb movement or smart textiles embedded with sensors. These devices were attached to the body with straps (mostly Velcro), providing flexibility and stability. The developed wearable devices positively influenced user motivation through the provided feedback, with visual feedback being the most common owing to the high level of independence provided. Moreover, a variety of signal processing techniques, such as Kalman and Butterworth filters, were applied to ensure data accuracy. However, limitations persist and include sensor positioning, calibration, and battery life, as well as a lack of clinical data on the effectiveness of these systems. The sampling rate of the data collection ranged from 50 Hz to 2000 Hz, which notably affected data quality and battery life. In addition, several findings were inconclusive, and thus, further future research is needed to understand and improve upper limb posture to develop progressive wearable systems. Conclusions: This paper offers a comprehensive overview of wearable monitoring systems, with a focus on upper limb motion tracking and rehabilitation. It emphasizes the various types of available solutions; their efficacy, wearability, and feasibility; and proposed processing techniques. Finally, it presents robust findings regarding feedback accuracy derived from experiments and outlines potential future research directions. %M 39714084 %R 10.2196/51994 %U https://www.jmir.org/2024/1/e51994 %U https://doi.org/10.2196/51994 %U http://www.ncbi.nlm.nih.gov/pubmed/39714084 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60944 %T Call for Decision Support for Electrocardiographic Alarm Administration Among Neonatal Intensive Care Unit Staff: Multicenter, Cross-Sectional Survey %A Tang,Xiaoli %A Yang,Xiaochen %A Yuan,Jiajun %A Yang,Jie %A Jin,Qian %A Zhang,Hanting %A Zhao,Liebin %A Guo,Weiwei %+ Shanghai Engineering Research Center of Intelligence Pediatrics, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, 1678 Dongfang Road, Pudong New Area, Shanghai, 200127, China, 86 18930830578, guoweiwei@scmc.com.cn %K ECG alarm %K electrocardiographic %K perception %K practice %K decision-making %K neonatal intensive care unit %K health care providers %K cross-sectional survey %K nationwide %D 2024 %7 20.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous studies have shown that electrocardiographic (ECG) alarms have high sensitivity and low specificity, have underreported adverse events, and may cause neonatal intensive care unit (NICU) staff fatigue or alarm ignoring. Moreover, prolonged noise stimuli in hospitalized neonates can disrupt neonatal development. Objective: The aim of the study is to conduct a nationwide, multicenter, large-sample cross-sectional survey to identify current practices and investigate the decision-making requirements of health care providers regarding ECG alarms. Methods: We conducted a nationwide, cross-sectional survey of NICU staff working in grade III level A hospitals in 27 Chinese provinces to investigate current clinical practices, perceptions, decision-making processes, and decision-support requirements for clinical ECG alarms. A comparative analysis was conducted on the results using the chi-square, Kruskal-Wallis, or Mann-Whitney U tests. Results: In total, 1019 respondents participated in this study. NICU staff reported experiencing a significant number of nuisance alarms and negative perceptions as well as practices regarding ECG alarms. Compared to nurses, physicians had more negative perceptions. Individuals with higher education levels and job titles had more negative perceptions of alarm systems than those with lower education levels and job titles. The mean difficulty score for decision-making about ECG alarms was 2.96 (SD 0.27) of 5. A total of 62.32% (n=635) respondents reported difficulty in resetting or modifying alarm parameters. Intelligent module–assisted decision support systems were perceived as the most popular form of decision support. Conclusions: This study highlights the negative perceptions and strong decision-making requirements of NICU staff related to ECG alarm handling. Health care policy makers must draw attention to the decision-making requirements and provide adequate decision support in different forms. %M 39705688 %R 10.2196/60944 %U https://www.jmir.org/2024/1/e60944 %U https://doi.org/10.2196/60944 %U http://www.ncbi.nlm.nih.gov/pubmed/39705688 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60493 %T Resting Heart Rate and Associations With Clinical Measures From the Project Baseline Health Study: Observational Study %A Feng,Kent Y %A Short,Sarah A %A Saeb,Sohrab %A Carroll,Megan K %A Olivier,Christoph B %A Simard,Edgar P %A Swope,Susan %A Williams,Donna %A Eckstrand,Julie %A Pagidipati,Neha %A Shah,Svati H %A Hernandez,Adrian F %A Mahaffey,Kenneth W %+ Verily Life Sciences, 269 E Grand Ave, South San Francisco, CA, 94080, United States, 1 650 495 7100, sarahshort@verily.com %K resting heart rate %K wearable devices %K remote monitoring %K physiology %K PBHS %K Project Baseline Health Study %K Verily Study Watch %K heart rate %K observational study %K cohort study %K wearables %K electrocardiogram %K regression analyses %K socioeconomic status %K medical condition %K vital signs %K laboratory assessments %K physical function %K electronic health %K eHealth %D 2024 %7 20.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Though widely used, resting heart rate (RHR), as measured by a wearable device, has not been previously evaluated in a large cohort against a variety of important baseline characteristics. Objective: This study aimed to assess the validity of the RHR measured by a wearable device compared against the gold standard of ECG (electrocardiography), and assess the relationships between device-measured RHR and a broad range of clinical characteristics. Methods: The Project Baseline Health Study (PHBS) captured detailed demographic, occupational, social, lifestyle, and clinical data to generate a deeply phenotyped cohort. We selected an analysis cohort within it, which included participants who had RHR determined by both ECG and the Verily Study Watch (VSW). We examined the correlation between these simultaneous RHR measures and assessed the relationship between VSW RHR and a range of baseline characteristics, including demographic, clinical, laboratory, and functional assessments. Results: From the overall PBHS cohort (N=2502), 875 (35%) participants entered the analysis cohort (mean age 50.9, SD 16.5 years; n=519, 59% female and n=356, 41% male). The mean and SD of VSW RHR was 66.6 (SD 11.2) beats per minute (bpm) for female participants and 64.4 (SD 12.3) bpm for male participants. There was excellent reliability between the two measures of RHR (ECG and VSW) with an intraclass correlation coefficient of 0.946. On univariate analyses, female and male participants had similar baseline characteristics that trended with higher VSW RHR: lack of health care insurance (both P<.05), higher BMI (both P<.001), higher C-reactive protein (both P<.001), presence of type 2 diabetes mellitus (both P<.001) and higher World Health Organization Disability Assessment Schedule (WHODAS) 2.0 score (both P<.001) were associated with higher RHR. On regression analyses, within each domain of baseline characteristics (demographics and socioeconomic status, medical conditions, vitals, physical function, laboratory assessments, and patient-reported outcomes), different characteristics were associated with VSW RHR in female and male participants. Conclusions: RHR determined by the VSW had an excellent correlation with that determined by ECG. Participants with higher VSW RHR had similar trends in socioeconomic status, medical conditions, vitals, laboratory assessments, physical function, and patient-reported outcomes irrespective of sex. However, within each domain of baseline characteristics, different characteristics were most associated with VSW RHR in female and male participants. Trial Registration: ClinicalTrials.gov NCT03154346; https://clinicaltrials.gov/study/NCT03154346 %M 39705694 %R 10.2196/60493 %U https://www.jmir.org/2024/1/e60493 %U https://doi.org/10.2196/60493 %U http://www.ncbi.nlm.nih.gov/pubmed/39705694 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59521 %T Accuracy of the Huawei GT2 Smartwatch for Measuring Physical Activity and Sleep Among Adults During Daily Life: Instrument Validation Study %A Mei,Longfei %A He,Ziwei %A Hu,Liang %K smartwatch %K accelerometry %K free-living %K physical activity %K sleep %K validity %D 2024 %7 20.12.2024 %9 %J JMIR Form Res %G English %X Background: Smartwatches are increasingly popular for physical activity and health promotion. However, ongoing validation studies on commercial smartwatches are still needed to ensure their accuracy in assessing daily activity levels, which is important for both promoting activity-related health behaviors and serving research purposes. Objective: This study aimed to evaluate the accuracy of a popular smartwatch, the Huawei Watch GT2, in measuring step count (SC), total daily activity energy expenditure (TDAEE), and total sleep time (TST) during daily activities among Chinese adults, and test whether there are population differences. Methods: A total of 102 individuals were recruited and divided into 2 age groups: young adults (YAs) and middle-aged and older (MAAO) adults. Participants’ daily activity data were collected for 1 week by wearing the Huawei Watch GT2 on their nondominant wrist and the Actigraph GT3X+ (ActiGraph) on their right hip as the reference measure. The accuracy of the GT2 was examined using the intraclass correlation coefficient (ICC), Pearson product-moment correlation coefficient (PPMCC), Bland-Altman analysis, mean percentage error, and mean absolute percentage error (MAPE). Results: The GT2 demonstrated reasonable agreement with the Actigraph, as evidenced by a consistency test ICC of 0.88 (P<.001) and an MAPE of 25.77% for step measurement, an ICC of 0.75 (P<.001) and an MAPE of 33.79% for activity energy expenditure estimation, and an ICC of 0.25 (P<.001) and an MAPE of 23.29% for sleep time assessment. Bland-Altman analysis revealed that the GT2 overestimated SC and underestimated TDAEE and TST. The GT2 was better at measuring SC and TDAEE among YAs than among MAAO adults, and there was no significant difference between these 2 groups in measuring TST (P=.12). Conclusions: The Huawei Watch GT2 demonstrates good accuracy in step counting. However, its accuracy in assessing activity energy expenditure and sleep time measurement needs further examination. The GT2 demonstrated higher accuracy in measuring SC and TDAEE in the YA group than in the MAAO group. However, the measurement errors for TST did not differ significantly between the 2 age groups. Therefore, the watch may be suitable for monitoring several key parameters (eg, SC) of daily activity, yet caution is advised for its use in research studies that require high accuracy. %R 10.2196/59521 %U https://formative.jmir.org/2024/1/e59521 %U https://doi.org/10.2196/59521 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e63155 %T Heuristics Identified in Health Data–Sharing Preferences of Patients With Cancer: Qualitative Focus Group Study %A Hermansen,Anna %A Pollard,Samantha %A McGrail,Kimberlyn %A Bansback,Nick %A Regier,Dean A %+ BC Cancer Research Institute, 675 W 10th Ave, Vancouver, BC, V5Z 1L3, Canada, 1 (604) 822 2772, ajhermansen@gmail.com %K heuristics %K health data sharing %K cancer patients %K decision-making %K real-world data %K altruism %K trust %K control %K data sharing %K focus group %K precision medicine %K clinical data %K exploratory study %K qualitative %K Canada %K thematic analysis %K informed consent %K patient education %K information technology %K healthcare %K medical informatics %D 2024 %7 17.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Evaluating precision oncology outcomes requires access to real-world and clinical trial data. Access is based on consent, and consent is based on patients’ informed preferences when deciding to share their data. Decision-making is often modeled using utility theory, but a complex decision context calls for a consideration of how heuristic, intuitive thought processes interact with rational utility maximization. Data-sharing decision-making has been studied using heuristic theory, but almost no heuristic research exists in the health data context. This study explores this evidence gap, applying a qualitative approach to probe for evidence of heuristic mechanisms behind the health data-sharing preferences of those who have experienced cancer. Exploring qualitative decision-making reveals the types of heuristics used and how they are related to the process of decision-making to better understand whether consent mechanisms should consider nonrational processes to better serve patient decision-making. Objective: This study aimed to explore how patients with cancer use heuristics when deciding whether to share their data for research. Methods: The researchers conducted a focus group study of Canadians who have experienced cancer. We recruited participants through an online advertisement, screening individuals based on their ability to increase demographic diversity in the sample. We reviewed the literature on data-sharing platforms to develop a semistructured topic guide on concerns about data sharing, incentives to share, and consent and control. Focus group facilitators led the open-ended discussions about data-sharing preferences that revealed underlying heuristics. Two qualitative analysts coded transcripts using a heuristic framework developed from a review of the literature. Transcripts were analyzed for heuristic instances which were grouped according to sociocultural categories. Using thematic analysis, the analysts generated reflexive themes through norming sessions and consultations. Results: A total of 3 focus groups were held with 19 participants in total. The analysis identified 12 heuristics underlying intentions to share data. From the thematic analysis, we identified how the heuristics of social norms and community building were expressed through altruism; the recognition, reputation, and authority heuristics led to (dis)trust in certain institutions; the need for security prompted the illusion of control and transparency heuristics; and the availability and affect heuristics influenced attitudes around risk and benefit. These thematic relationships all had impacts on the participants’ intentions to share their health data. Conclusions: The findings provide a novel qualitative understanding of how health data–sharing decisions and preferences may be based on heuristic processing. As patients consider the extent of risks and benefits, heuristic processes influence their assessment of anticipated outcomes, which may not result in rational, truly informed consent. This study shows how considering heuristic processing when designing current consent mechanisms opens up the opportunity for more meaningful and realistic interactions with the complex decision-making context. %M 39689309 %R 10.2196/63155 %U https://www.jmir.org/2024/1/e63155 %U https://doi.org/10.2196/63155 %U http://www.ncbi.nlm.nih.gov/pubmed/39689309 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60184 %T From Doubt to Confidence—Overcoming Fraudulent Submissions by Bots and Other Takers of a Web-Based Survey %A Hardesty,Jeffrey J %A Crespi,Elizabeth %A Sinamo,Joshua K %A Nian,Qinghua %A Breland,Alison %A Eissenberg,Thomas %A Kennedy,Ryan David %A Cohen,Joanna E %+ Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins University, Fourth Floor, 2213 McElderry St, Baltimore, MD, 21205, United States, 1 410 641 4537, jhardesty@jhu.edu %K fake data %K recruitment %K online survey %K internet survey %K challenges %K data integrity %K data quality %K e-cigs %K tobacco control %K longitudinal survey %K web-based survey %K e-cigarette %K vaping %K smoking %K smoke %K cessation %K prevalence %K data collection %K United States %K US %K adult %K VAPER %K Vaping and Patterns of E-cigarette Use Research %D 2024 %7 16.12.2024 %9 Viewpoint %J J Med Internet Res %G English %X In 2019, we launched a web-based longitudinal survey of adults who frequently use e-cigarettes, called the Vaping and Patterns of E-cigarette Use Research (VAPER) Study. The initial attempt to collect survey data failed due to fraudulent survey submissions, likely submitted by survey bots and other survey takers. This paper chronicles the journey from that setback to the successful completion of 5 waves of data collection. The section “Naïve Beginnings” examines the study preparation phase, identifying the events, decisions, and assumptions that contributed to the failure (eg, allowing anonymous survey takers to submit surveys and overreliance on a third-party’s proprietary fraud detection tool to identify participants attempting to submit multiple surveys). “A 5-Alarm Fire and Subsequent Investigation” summarizes the warning signs that suggested fraudulent survey submissions had compromised the data integrity after the initial survey launched (eg, an unanticipated acceleration in recruitment and a voicemail alleging fraudulent receipt of multiple gift codes). This section also covers the investigation process, along with conclusions regarding how the methodology was exploited (eg, clearing cookies and using virtual private networks) and the extent of the issue (ie, only 363/1624, 22.4% of the survey completions were likely valid). “Building More Resilient Methodology” details the vulnerabilities and threats that likely compromised the initial survey attempt (eg, anonymity and survey bots); the corresponding mitigation strategies and their benefits and limitations (eg, personal record verification platforms, IP address matching, virtual private network detection services, and CAPTCHA [Completely Automated Public Turing test to tell Computers and Humans Apart]); and the array of strategies that were implemented in future survey attempts. “Staying Vigilant” recounts the identification and management of an additional threat that emerged despite the implementation of an array of mitigation strategies, underscoring the need for ongoing vigilance and adaptability. While the precise nature of the threat remains unknown, the evidence suggested multiple fraudulent surveys were submitted by a single or connected entities, who likely did not possess e-cigarettes. To mitigate the chance of reoccurrence, participants were required to submit an authentic photo of their most used e-cigarette. Finally, in “Reflection 4 Years Later,” we share insights after completing 5 waves of data collection without additional threats or vulnerabilities uncovered that necessitated the application of further mitigation strategies. Reflections include reasons for confidence in the data’s integrity, the scalability and cost-effectiveness of the study protocols, and the potential introduction of sampling bias through recruitment and mitigation strategies. By sharing our journey, we aim to provide valuable insights for researchers facing similar challenges with web-based surveys and those seeking to minimize such challenges a priori. Our experiences highlight the importance of proactive measures, continuous monitoring, and adaptive problem-solving to ensure the integrity of data collected from participants recruited from web-based platforms. %M 39680887 %R 10.2196/60184 %U https://www.jmir.org/2024/1/e60184 %U https://doi.org/10.2196/60184 %U http://www.ncbi.nlm.nih.gov/pubmed/39680887 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e50449 %T Dermatologic Data From the Global Burden of Disease Study 2019 and the PatientsLikeMe Online Support Community: Comparative Analysis %A Szeto,Mindy D %A Alhanshali,Lina %A Rundle,Chandler W %A Adelman,Madeline %A Hook Sobotka,Michelle %A Woolhiser,Emily %A Wu,Jieying %A Presley,Colby L %A Maghfour,Jalal %A Meisenheimer,John %A Anderson,Jaclyn B %A Dellavalle,Robert P %K Global Burden of Disease %K GBD %K PatientsLikeMe %K PLM %K online support communities %K forums %K users %K social media %K internet %K demographics %K lived experience %K disability-adjusted life year %K DALY %K prevalence %K dermatology %K comparative analysis %D 2024 %7 11.12.2024 %9 %J JMIR Dermatol %G English %X The Global Burden of Disease (GBD) study aims to characterize the worldwide prevalence and morbidity of major diseases, while PatientsLikeMe (PLM) is an online community providing patient-generated insights into lived experiences; for dermatologic conditions, quantitative comparisons of GBD and PLM data revealed expected demographic differences but also notable correlations, highlighting their potential as complementary data sources elucidating unmet patient needs and priorities. %R 10.2196/50449 %U https://derma.jmir.org/2024/1/e50449 %U https://doi.org/10.2196/50449 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e50754 %T Weight and Lifestyle Behavior Changes in Chinese Health Care Workers During the COVID-19 Pandemic: 3-Year Retrospective Survey %A Guo,Xinyue %A Gong,Shaoqing %A Chen,Ying %A Hou,Xiaohui %A Sun,Tong %A Wen,Jianqiang %A Wang,Zhiyao %A He,Jingyang %A Sun,Xuezhu %A Wang,Sufang %A Chen,Zhixin %A Feng,Xue %A Tian,Xiangyang %+ Chinese Center for Health Education, Building 12, District 1, Anhua Xili, outside Andingmen, Beijing, Beijing, China, 1 01064263018, healthtian@163.com %K COVID-19 %K healthcare workers %K lifestyle behavior %K overweight %K obesity %K physical activity %K mental health %K stress %K anxiety,depression %K pandemic %D 2024 %7 10.12.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Health care workers (HCWs) played a key role in preventing and controlling COVID-19. Higher infection risks and intensive work led to occupational burnout for many HCWs, which may affect their lifestyle behaviors and weight. Objective: This study aimed to assess HCWs’ self-rated health status, overweight and obesity rates, lifestyle behaviors, and psychoemotional changes from 2019 to 2022 across China and to analyze the factors associated with changes from underweight or normal weight in 2019 to overweight or obese in 2022. Methods: In this retrospective study, 100 health care institutions were randomly selected from 5 provinces or regions in China. All HCWs who worked in the institutions for at ≥3 years were invited to complete the electronic questionnaire and participate in the online survey from August 1, 2022, to August 31, 2022. Collected data included changes in lifestyle behaviors (dietary habits, physical activity, sleep quality, smoking, alcohol consumption), psychoemotional conditions (persistent stress or recurrent anxiety or depressed mood), health status, and chronic disease control from December 2019 to August 2022. Height and weight in 2019 and 2022 were retrieved from annual physical examination records. Overweight and obesity were defined as 24.0 kg/m2≤BMI<28.0 kg/m2 (overweight) and BMI≥28.0 kg/m2 (obesity). Chi square tests and ANOVAs were used to assess the associations between groups. Logistic regression models were used to analyze the factors associated with HCWs becoming overweight or obese from 2019 to 2022. Results: The questionnaire was submitted by 23,234 HCWs. Of the underweight or normal weight HCWs in 2019, 12.67% (1486/23,234) became overweight or obese in 2022; this change was associated with the following factors: 34-43 years old (OR 0.843, 95% CI 0.740-0.960), 44-53 years old (OR 0.738, 95% CI 0.635-0.960), and 54-63 years old (OR 0.503, 95% CI 0.368-0.685; reference: 24-33 years old), reduction in or never or rarely engaging in physical activity (OR 1.201, 95% CI 1.055-1.368; reference: increase in physical activity; P=.006), increased appetite (OR 2.043, 95% CI 1.788-2.034; reference: reduction or no change in appetite; P<.001). From 2019 to 2022, 51.29% (11,917/23,234) of the respondents experienced increased persistent stress or recurrent anxiety or depressed mood; 44.38% (10,311/23,234) stayed up late more often. Increased persistent stress or recurrent anxiety or depressed mood was associated with physical activity (OR 0.421, 95% CI 0.398-0.447; P<.001) and appetite (OR 1.601, 95% CI 1.483-1.728; P<.001). Conclusions: The pandemic was associated with overweight and obesity for HCWs due to changes in lifestyle behaviors, especially reduced physical activity and increased appetite related to increased persistent stress or recurrent anxiety or depressed mood caused by excessive workload. An integrated approach is needed to address overweight and obesity and lifestyle changes among HCWs by releasing negative psychoemotional conditions through workload reduction in future stressful events. %M 39657182 %R 10.2196/50754 %U https://www.i-jmr.org/2024/1/e50754 %U https://doi.org/10.2196/50754 %U http://www.ncbi.nlm.nih.gov/pubmed/39657182 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56788 %T Data Verification and Respondent Validity for a Web-Based Sexual Health Survey: Tutorial %A Parker,Jayelin N %A Rager,Theresa L %A Burns,Jade %A Mmeje,Okeoma %K sexually transmitted infections %K adolescent and young adults %K sexual health %K recruitment %K survey design %K social media %K data verification %K web-based surveys %K data integrity %K social media advertisements %K online advertisements %K STI %K STD %K sexual health survey %K sexually transmitted disease %D 2024 %7 9.12.2024 %9 %J JMIR Form Res %G English %X Background: As technology continues to shape the landscape of health research, the utilization of web-based surveys for collecting sexual health information among adolescents and young adults has become increasingly prevalent. However, this shift toward digital platforms brings forth a new set of challenges, particularly the infiltration of automated bots that can compromise data integrity and the reliability of survey results. Objective: We aimed to outline the data verification process used in our study design, which employed survey programming and data cleaning protocols. Methods: A 26-item survey was developed and programmed with several data integrity functions, including reCAPTCHA scores, RelevantID fraud and duplicate scores, verification of IP addresses, and honeypot questions. Participants aged 15‐24 years were recruited via social media advertisements over 7 weeks and received a US $15 incentive after survey completion. Data verification occurred through a 2-part cleaning process, which removed responses that were incomplete, flagged as spam by Qualtrics, or from duplicate IP addresses, or those that did not meet the inclusion criteria. Final comparisons of reported age with date of birth and reported state with state inclusion criteria were performed. Participants who completed the study survey were linked to a second survey to receive their incentive. Responses without first and last names and full addresses were removed, as were those with duplicate IP addresses or the exact same longitude and latitude coordinates. Finally, IP addresses used to complete both surveys were compared, and consistent responses were eligible for an incentive. Results: Over 7 weeks, online advertisements for a web-based survey reached 1.4 million social media users. Of the 20,585 survey responses received, 4589 (22.3%) were verified. Incentives were sent to 462 participants; of these, 14 responses were duplicates and 3 contained discrepancies, resulting in a final sample of 445 responses. Conclusions: Confidential web-based surveys are an appealing method for reaching populations—particularly adolescents and young adults, who may be reluctant to disclose sensitive information to family, friends, or clinical providers. Web-based surveys are a useful tool for researchers targeting hard-to-reach populations due to the difficulty in obtaining a representative sample. However, researchers face the ongoing threat of bots and fraudulent participants in a technology-driven world, necessitating the adoption of evolving bot detection software and tailored protocols for data collection in unique contexts. %R 10.2196/56788 %U https://formative.jmir.org/2024/1/e56788 %U https://doi.org/10.2196/56788 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e58076 %T Web-Based Respondent-Driven Sampling to Assess Biobehavioral Factors Among Men Who Have Sex With Men in Thailand: Cross-Sectional Study %A Srinor,Watcharapol %A Tanpradech,Suvimon %A Thiengtham,Panupit %A Karuchit,Samart %A Naksuk,Charif %A Yingyong,Thitipong %A Naiwatanakul,Thananda %A Northbrook,Sanny %A Hladik,Wolfgang %K online respondent-driven sampling %K HIV %K men who have sex with men %K MSM %K Bangkok %K health clinic %K public health %K testing %K stigma %K online testing %K HIV prevention %K research data collection %D 2024 %7 6.12.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Respondent-driven sampling (RDS) is the current standard for sampling key populations at risk for HIV infections but is usually limited to local implementation in single towns or cities. Web-based sampling eliminates this spatial constraint but often relies on self-selected convenience samples. We piloted a web-based RDS survey with biomarker collection among men who have sex with men (MSM) in Thailand. Objective: This study aimed to evaluate and demonstrate the feasibility of implementing a web-based RDS survey as a routine surveillance system in Thailand. The goal was to enhance surveillance efforts targeting hard-to-reach populations in the country. Methods: We developed a website to fully function like a conventional RDS survey office, including coupon verification, eligibility screening, consenting, interviewing (self-administered), peer recruitment training, coupon issuance, compensation, and recruitment tracking. All functions were automated; data managers monitored recruitment, data collection, and payment and could be contacted by recruits as needed. Eligible participants were male, older than 15 years, resided in Thailand, and had anal sex with a man in the past 6 months. Recruits who resided in Bangkok were additionally invited to physically attend a participating health clinic of their choice for an HIV-related blood draw. Data were weighted to account for the complex sampling design. Results: The survey was implemented from February to June 2022; seeds (21 at start, 14 added later) were identified mostly through targeted web-based banner ads; coupon uptake was 45.1%. Of 2578 candidate recruits screened for eligibility, 2151 (83.4%) were eligible and 2142 (83.1%) enrolled. Almost all (2067/2578, 80.2%) completed the questionnaire; however, 318 survey records were removed from analysis as fraudulent enrollments. The final sample size was 1749, the maximum number of waves achieved was 191, and sampling covered all 6 geographic regions and 75 of 77 (97.4%) provinces; convergence was reached for several salient variables. The mean age was 20.5 (SD 4.0) years, and most (69.8%) had never tested for HIV before, with fear of stigma as the biggest reason (97.1%) for not having tested. Most (76.9%) had visited gay-focused physical venues several times a week. A condom was used in 97.6% of the last sex acts, 11.0% had purchased sex from other men (past 12 mo), 4.5% had sold sex to men (past 12 mo), and 95.3% had 3+ male sex partners (last 3 mo). No participant in Bangkok presented for a blood draw. Conclusions: We successfully conducted a web-based RDS survey among MSM in Thailand, covering nearly the entire country, although, as in physical RDS surveys, sampling was dominated by younger MSM. The survey also failed to collect biomarkers in Bangkok. Public health interventions should aim at increasing testing and addressing (the perception of) stigma. %R 10.2196/58076 %U https://publichealth.jmir.org/2024/1/e58076 %U https://doi.org/10.2196/58076 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e57718 %T Google Trends Assessment of Keywords Related to Smoking and Smoking Cessation During the COVID-19 Pandemic in 4 European Countries: Retrospective Analysis %A Jagomast,Tobias %A Finck,Jule %A Tangemann-Münstedt,Imke %A Auth,Katharina %A Drömann,Daniel %A Franzen,Klaas F %+ Airway Research Center North, Deutsches Zentrum für Lungenforschung, Wöhrendamm 80, Großhansdorf, 22927, Germany, 49 45150075562, klaas.franzen@uni-luebeck.de %K internet %K coronavirus %K COVID-19 %K SARS-CoV-2 %K pandemics %K public health %K smoking cessation %K tobacco products %K Google Trends %K relative search volume %K Europe %K online %K search %K smoking %K addiction %K quit %K cessation %K trend %K cluster %K public interest %K lockdown %K vaccination %K spread %K incidence %D 2024 %7 3.12.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Smoking is a modifiable risk factor for SARS-CoV-2 infection. Evidence of smoking behavior during the pandemic is ambiguous. Most investigations report an increase in smoking. In this context, Google Trends data monitor real-time public information–seeking behavior and are therefore useful to characterize smoking-related interest over the trajectory of the pandemic. Objective: This study aimed to use Google Trends data to evaluate the effect of the pandemic on public interest in smoking-related topics with a focus on lockdowns, vaccination campaigns, and incidence. Methods: The weekly relative search volume was retrieved from Google Trends for England, Germany, Italy, and Spain from December 31, 2017, to April 18, 2021. Data were collected for keywords concerning consumption, cessation, and treatment. The relative search volume before and during the pandemic was compared, and general trends were evaluated using the Wilcoxon rank-sum test. Short-term changes and hereby temporal clusters linked to lockdowns or vaccination campaigns were addressed by the flexible spatial scan statistics proposed by Takahashi and colleagues. Subsequently, the numbers of clusters after the onset of the pandemic were compared by chi-square test. Results: Country-wise minor differences were observed while 3 overarching trends prevailed. First, regarding cessation, the statistical comparison revealed a significant decline in interest for 58% (7/12) of related keywords, and fewer clusters were present during the pandemic. Second, concerning consumption, significantly reduced relative search volume was observed for 58% (7/12) of keywords, while treatment-related keywords exhibited heterogeneous trends. Third, substantial clusters of increased interest were sparsely linked to lockdowns, vaccination campaigns, or incidence. Conclusions: This study reports a substantial decline in overall relative search volume and clusters for cessation interest. These results underline the importance of intensifying cessation aid during times of crisis. Lockdowns, vaccination, and incidence had less impact on information-seeking behavior. Other public measures that positively affect smoking behavior remain to be determined. %M 39626237 %R 10.2196/57718 %U https://ojphi.jmir.org/2024/1/e57718 %U https://doi.org/10.2196/57718 %U http://www.ncbi.nlm.nih.gov/pubmed/39626237 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56874 %T Predicting and Monitoring Symptoms in Patients Diagnosed With Depression Using Smartphone Data: Observational Study %A Ikäheimonen,Arsi %A Luong,Nguyen %A Baryshnikov,Ilya %A Darst,Richard %A Heikkilä,Roope %A Holmen,Joel %A Martikkala,Annasofia %A Riihimäki,Kirsi %A Saleva,Outi %A Isometsä,Erkki %A Aledavood,Talayeh %+ Department of Computer Science, Aalto University, Konemiehentie 2, Espoo, 02150, Finland, 358 449750110, arsi.ikaheimonen@aalto.fi %K data analysis %K digital phenotyping %K digital behavioral data %K depression symptoms %K depression monitoring %K mHealth %K mobile health %K smartphone %K mobile phone %D 2024 %7 3.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinical diagnostic assessments and the outcome monitoring of patients with depression rely predominantly on interviews by professionals and the use of self-report questionnaires. The ubiquity of smartphones and other personal consumer devices has prompted research into the potential of data collected via these devices to serve as digital behavioral markers for indicating the presence and monitoring of the outcome of depression. Objective: This paper explores the potential of using behavioral data collected with smartphones to detect and monitor depression symptoms in patients diagnosed with depression. Specifically, it investigates whether this data can accurately classify the presence of depression, as well as monitor the changes in depressive states over time. Methods: In a prospective cohort study, we collected smartphone behavioral data for up to 1 year. The study consists of observations from 164 participants, including healthy controls (n=31) and patients diagnosed with various depressive disorders: major depressive disorder (MDD; n=85), MDD with comorbid borderline personality disorder (n=27), and major depressive episodes with bipolar disorder (n=21). Data were labeled based on depression severity using 9-item Patient Health Questionnaire (PHQ-9) scores. We performed statistical analysis and used supervised machine learning on the data to classify the severity of depression and observe changes in the depression state over time. Results: Our correlation analysis revealed 32 behavioral markers associated with the changes in depressive state. Our analysis classified patients who are depressed with an accuracy of 82% (95% CI 80%-84%) and change in the presence of depression with an accuracy of 75% (95% CI 72%-76%). Notably, the most important smartphone features for classifying depression states were screen-off events, battery charge levels, communication patterns, app usage, and location data. Similarly, for predicting changes in depression state, the most important features were related to location, battery level, screen, and accelerometer data patterns. Conclusions: The use of smartphone digital behavioral markers to supplement clinical evaluations may aid in detecting the presence and changes in severity of symptoms of depression, particularly if combined with intermittent use of self-report of symptoms. %M 39626241 %R 10.2196/56874 %U https://www.jmir.org/2024/1/e56874 %U https://doi.org/10.2196/56874 %U http://www.ncbi.nlm.nih.gov/pubmed/39626241 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51877 %T Challenges and Approaches to Recruitment for and Retention in a Dyad-Focused eHealth Intervention During COVID-19: Randomized Controlled Trial %A Ma,Chunxuan %A Adler,Rachel H %A Neidre,Daria B %A Chen,Ronald C %A Northouse,Laurel L %A Rini,Christine %A Tan,Xianming %A Song,Lixin %+ School of Nursing, Mays Cancer Center, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, United States, 1 210 450 8561, songl2@uthscsa.edu %K randomized controlled trials %K RCT %K prostate cancer %K accrual %K retention %K COVID-19 pandemic %K family-based research %D 2024 %7 3.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Family-based randomized controlled trials (RCTs) encounter recruitment and retention challenges. Cancer-focused RCTs typically recruit convenience samples from local cancer centers and hospitals. Objective: This study aimed to examine the recruitment and retention of a population-based, patient-partner dyad cohort in an RCT testing a dyadic eHealth intervention to improve the quality of life in patients with prostate cancer and their partners. Methods: In this 2-arm, parallel-group RCT, men who recently completed treatment for localized prostate cancer statewide were recruited through North Carolina Central Cancer Registry rapid case ascertainment between April 2018 and April 2021, coinciding with the COVID-19 pandemic. Patient-partner dyads underwent baseline assessments and were randomly assigned to either the intervention or control groups. Follow-up surveys were conducted at 4, 8, and 12 months after baseline. Descriptive and logistic regression analyses were used to achieve the study’s aims. Results: Of the 3078 patients referred from rapid case ascertainment, 2899 were screened. A total of 357 partners were approached after obtaining the eligible patients’ permission, 280 dyads completed baseline assessments and were randomized (dyad enrollment rate: 85.11%, 95% CI 81.3%-88.9%), and 221 dyads completed the 12-month follow-up (retention rate: 78.93%, 95% CI 74.2%-83.7%). Regarding the factors associated with retention, compared with White participants, people self-reporting as “other races” (including American Indian, Asian, and multiracial) were more likely to drop out of the study (odds ratio 2.78, 95% CI 1.10-7.04), and older participants were less likely to withdraw (odds ratio 0.96, 95% CI 0.92-0.99). Conclusions: Despite the negative impact of the pandemic, we successfully recruited enough patient-partner dyads to test our RCT hypotheses. Our recruitment and retention rates were equivalent to or higher than those in most dyadic intervention studies. A well-functioning research team and specific strategies (eg, eHealth intervention, internet phone, and online surveys) facilitated the recruitment and retention of patients with prostate cancer and their partners during the unprecedented pandemic. Trial Registration: ClinicalTrials.gov NCT03489057; https://clinicaltrials.gov/study/NCT03489057 International Registered Report Identifier (IRRID): RR2-https://doi.org/10.1186/s13063-021-05948-5 %M 39625741 %R 10.2196/51877 %U https://www.jmir.org/2024/1/e51877 %U https://doi.org/10.2196/51877 %U http://www.ncbi.nlm.nih.gov/pubmed/39625741 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e63032 %T Comparing Health Survey Data Cost and Quality Between Amazon’s Mechanical Turk and Ipsos’ KnowledgePanel: Observational Study %A Herman,Patricia M %A Slaughter,Mary E %A Qureshi,Nabeel %A Azzam,Tarek %A Cella,David %A Coulter,Ian D %A DiGuiseppi,Graham %A Edelen,Maria Orlando %A Kapteyn,Arie %A Rodriguez,Anthony %A Rubinstein,Max %A Hays,Ron D %+ RAND, 1776 Main Street, Santa Monica, CA, 90407, United States, 1 3103930411 ext 7129, pherman@rand.org %K data collection %K probability panel %K convenience sample %K data quality %K weighting %K back pain %K misrepresentation %K Amazon %K Mechanical Turk %K MTurk %K convenience panel %K KnowledgePanel %D 2024 %7 29.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Researchers have many options for web-based survey data collection, ranging from access to curated probability-based panels, where individuals are selectively invited to join based on their membership in a representative population, to convenience panels, which are open for anyone to join. The mix of respondents available also varies greatly regarding representation of a population of interest and in motivation to provide thoughtful and accurate responses. Despite the additional dataset-building labor required of the researcher, convenience panels are much less expensive than probability-based panels. However, it is important to understand what may be given up regarding data quality for those cost savings. Objective: This study examined the relative costs and data quality of fielding equivalent surveys on Amazon’s Mechanical Turk (MTurk), a convenience panel, and KnowledgePanel, a nationally representative probability-based panel. Methods: We administered the same survey measures to MTurk (in 2021) and KnowledgePanel (in 2022) members. We applied several recommended quality assurance steps to enhance the data quality achieved using MTurk. Ipsos, the owner of KnowledgePanel, followed their usual (industry standard) protocols. The survey was designed to support psychometric analyses and included >60 items from the Patient-Reported Outcomes Measurement Information System (PROMIS), demographics, and a list of health conditions. We used 2 fake conditions (“syndomitis” and “chekalism”) to identify those more likely to be honest respondents. We examined the quality of each platform’s data using several recommended metrics (eg, consistency, reliability, representativeness, missing data, and correlations) including and excluding those respondents who had endorsed a fake condition and examined the impact of weighting on representativeness. Results: We found that prescreening in the MTurk sample (removing those who endorsed a fake health condition) improved data quality but KnowledgePanel data quality generally remained superior. While MTurk’s unweighted point estimates for demographics exhibited the usual mismatch with national averages (younger, better educated, and lower income), weighted MTurk data matched national estimates. KnowledgePanel’s point estimates better matched national benchmarks even before poststratification weighting. Correlations between PROMIS measures and age and income were similar in MTurk and KnowledgePanel; the mean absolute value of the difference between each platform’s 137 correlations was 0.06, and 92% were <0.15. However, correlations between PROMIS measures and educational level were dramatically different; the mean absolute value of the difference across these 17 correlation pairs was 0.15, the largest difference was 0.29, and the direction of more than half of these relationships in the MTurk sample was the opposite from that expected from theory. Therefore, caution is needed if using MTurk for studies where educational level is a key variable. Conclusions: The data quality of our MTurk sample was often inferior to that of the KnowledgePanel sample but possibly not so much as to negate the benefits of its cost savings for some uses. International Registered Report Identifier (IRRID): RR2-10.1186/s12891-020-03696-2 %M 39612505 %R 10.2196/63032 %U https://www.jmir.org/2024/1/e63032 %U https://doi.org/10.2196/63032 %U http://www.ncbi.nlm.nih.gov/pubmed/39612505 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60878 %T Population Characteristics in Justice Health Research Based on PubMed Abstracts From 1963 to 2023: Text Mining Study %A Lukmanjaya,Wilson %A Butler,Tony %A Taflan,Patricia %A Simpson,Paul %A Ginnivan,Natasha %A Buchan,Iain %A Nenadic,Goran %A Karystianis,George %+ School of Population Health, University of New South Wales, Samuels Building, F25, Samuel Terry Ave, Kensington NSW, Sydney, 2052, Australia, 61 2 9385 3136, w.lukmanjaya@unsw.edu.au %K epidemiology %K PubMed %K criminology %K text mining %K justice health %K offending and incarcerated populations %K population characteristics %K open research %K health research %K text mining study %K epidemiological criminology %K public health %K justice systems %K bias %K population %K men %K women %K prison %K prisoner %K researcher %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The field of epidemiological criminology (or justice health research) has emerged in the past decade, studying the intersection between the public health and justice systems. To ensure research efforts are focused and equitable, it is important to reflect on the outputs in this area and address knowledge gaps. Objective: This study aimed to examine the characteristics of populations researched in a large sample of published outputs and identify research gaps and biases. Methods: A rule-based, text mining method was applied to 34,481 PubMed abstracts published from 1963 to 2023 to identify 4 population characteristics (sex, age, offender type, and nationality). Results: We evaluated our method in a random sample of 100 PubMed abstracts. Microprecision was 94.3%, with microrecall at 85.9% and micro–F1-score at 89.9% across the 4 characteristics. Half (n=17,039, 49.4%) of the 34,481 abstracts did not have any characteristic mentions and only 1.3% (n=443) reported sex, age, offender type, and nationality. From the 5170 (14.9%) abstracts that reported age, 3581 (69.3%) mentioned young people (younger than 18 years) and 3037 (58.7%) mentioned adults. Since 1990, studies reporting female-only populations increased, and in 2023, these accounted for almost half (105/216, 48.6%) of the research outputs, as opposed to 33.3% (72/216) for male-only populations. Nordic countries (Sweden, Norway, Finland, and Denmark) had the highest number of abstracts proportional to their incarcerated populations. Offenders with mental illness were the most common group of interest (840/4814, 17.4%), with an increase from 1990 onward. Conclusions: Research reporting on female populations increased, surpassing that involving male individuals, despite female individuals representing 5% of the incarcerated population; this suggests that male prisoners are underresearched. Although calls have been made for the justice health area to focus more on young people, our results showed that among the abstracts reporting age, most mentioned a population aged <18 years, reflecting a rise of youth involvement in the youth justice system. Those convicted of sex offenses and crimes relating to children were not as researched as the existing literature suggests, with a focus instead on populations with mental illness, whose rates rose steadily in the last 30 years. After adjusting for the size of the incarcerated population, Nordic countries have conducted proportionately the most research. Our findings highlight that despite the presence of several research reporting guidelines, justice health abstracts still do not adequately describe the investigated populations. Our study offers new insights in the field of justice health with implications for promoting diversity in the selection of research participants. %M 39576975 %R 10.2196/60878 %U https://formative.jmir.org/2024/1/e60878 %U https://doi.org/10.2196/60878 %U http://www.ncbi.nlm.nih.gov/pubmed/39576975 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57747 %T Short-Form Video Informed Consent Compared With Written Consent for Adolescents and Young Adults: Randomized Experiment %A Afolabi,Aliyyat %A Cheung,Elaine %A Lyu,Joanne Chen %A Ling,Pamela M %+ Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366, San Francisco, CA, 94143-1390, United States, 1 4155148627, Pamela.Ling@ucsf.edu %K health communication %K video informed consent %K randomized experiment %K informed consent %K adolescent %K video %K consent %K e-cigarette %K vaping %K health research %K social media %K vaping cessation %K smoking cessation %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents and young adults have the highest prevalence of e-cigarette use (“vaping”), but they are difficult to enroll in health research studies. Previous studies have found that video consent can improve comprehension and make informed consent procedures more accessible, but the videos in previous studies are much longer than videos on contemporary social media platforms that are popular among young people. Objective: This study aimed to examine the effectiveness of a short-form (90-second) video consent compared with a standard written consent for a vaping cessation study for adolescents and young adults. Methods: We conducted a web-based experiment with 435 adolescents and young adults (aged 13-24 years) recruited by a web-based survey research provider. Each participant was randomly assigned to view either a short-form video consent or a written consent form describing a behavioral study of a social media–based vaping cessation program. Participants completed a postexposure survey measuring three outcomes: (1) comprehension of the consent information, (2) satisfaction with the consent process, and (3) willingness to participate in the described study. Independent sample 2-tailed t tests and chi-square tests were conducted to compare the outcomes between the 2 groups. Results: In total, 435 cases comprised the final analytic sample (video: n=215, 49.4%; written: n=220, 50.6%). There was no significant difference in characteristics between the 2 groups (all P>.05). Participants who watched the short-form video completed the consent review and postconsent survey process in less time (average 4.5 minutes) than those in the written consent group (5.1 minutes). A total of 83.2% (179/215) of the participants in the video consent condition reported satisfaction with the overall consent process compared with 76.3% (168/220) in the written consent condition (P=.047). There was no difference in the ability to complete consent unassisted and satisfaction with the amount of time between study conditions. There was no difference in the composite measure of overall comprehension, although in individual measures, participants who watched the short-form video consent performed better in 4 measures of comprehension about risk, privacy, and procedures, while participants who read the written document consent had better comprehension of 2 measures of study procedures. There was no difference between the groups in willingness to participate in the described study. Conclusions: Short-form informed consent videos had similar comprehension and satisfaction with the consent procedure among adolescents and young adults. Short-form informed consent videos may be a feasible and acceptable alternative to the standard written consent process, although video and written consent forms have different strengths with respect to comprehension. Because they match how young people consume media, short-form videos may be particularly well suited for adolescents and young adults participating in research. %M 39576682 %R 10.2196/57747 %U https://formative.jmir.org/2024/1/e57747 %U https://doi.org/10.2196/57747 %U http://www.ncbi.nlm.nih.gov/pubmed/39576682 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56166 %T Online Depression Communities as a Complementary Approach to Improving the Attitudes of Patients With Depression Toward Medication Adherence: Cross-Sectional Survey Study %A Chen,Runnan %A Fu,Xiaorong %A Liu,Mochi %A Liao,Ke %A Bai,Lifei %+ Department of Marketing, School of Business Administration, Southwestern University of Finance and Economics, 555 Liutai Road, Chengdu, 611130, China, 86 13981916682, fuxr@swufe.edu.cn %K online depression communities %K attitudes %K institution-generated content %K user-generated content %K perceived social support %K antidepressants %K hopelessness %K cross-sectional study %K China %K health care system %K online health community %K depression %K medication adherence %K social support %K health care practitioner %K peer support %D 2024 %7 19.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Lack of adherence to prescribed medication is common among patients with depression in China, posing serious challenges to the health care system. Online health communities have been found to be effective in enhancing patient compliance. However, empirical evidence supporting this effect in the context of depression treatment is absent, and the influence of online health community content on patients’ attitudes toward medication adherence is also underexplored. Objective: This study aims to explore whether online depression communities (ODCs) can help ameliorate the problem of poor medication taking among patients with depression. Drawing on the stimulus-organism-response and feelings-as-information theories, we established a research model to examine the influence of useful institution-generated content (IGC) and positive user-generated content (UGC) on attitudes toward medication adherence when combined with the mediating role of perceived social support, perceived value of antidepressants, and the moderating role of hopelessness. Methods: A cross-sectional questionnaire survey method was used in this research. Participants were recruited from various Chinese ODCs, generating data for a main study and 2 robustness checks. Hierarchical multiple regression analyses and bootstrapping analyses were adopted as the primary methods to test the hypotheses. Results: We received 1515 valid responses in total, contributing to 5 different datasets: model IGC (n=353, 23.3%), model UGC (n=358, 23.63%), model IGC+UGC (n=270, 17.82%), model IGC-B (n=266, 17.56%), and model UGC-B (n=268, 17.69%). Models IGC and UGC were used for the main study. Model IGC+UGC was used for robustness check A. Models IGC-B and UGC-B were used for robustness check B. Useful IGC and positive UGC were proven to have positive impact on the attitudes of patients with depression toward medication adherence through the mediations of perceived social support and perceived value of antidepressants. The findings corroborated the role of hopelessness in weakening or even negating the positive effects of ODC content on the attitudes of patients with depression toward medication adherence. Conclusions: This study provides the first empirical evidence demonstrating the relationship between ODC content and attitudes toward medication adherence, through which we offer a novel solution to the problem of poor medication adherence among patients with depression in China. Our findings also provide suggestions about how to optimize this new approach—health care practitioners should generate online content that precisely matches the informational needs of patients with depression, and ODC service providers should endeavor to regulate the community atmosphere. Nonetheless, we warn that ODC interventions cannot be used as the only approach to addressing the problem of poor medication taking among patients with severe depressive symptoms. %M 39561355 %R 10.2196/56166 %U https://www.jmir.org/2024/1/e56166 %U https://doi.org/10.2196/56166 %U http://www.ncbi.nlm.nih.gov/pubmed/39561355 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55137 %T Leveraging Implementation Science at the Early-Stage Development of a Novel Telehealth-Delivered Fear of Exercise Program to Understand Intervention Feasibility and Implementation Potential: Feasibility Behavioral Intervention Study %A Duran,Andrea T %A Cumella,Robin M %A Mendieta,Miguel %A Keener-Denoia,Adrianna %A López Veneros,David %A Farris,Samantha G %A Moise,Nathalie %A Kronish,Ian M %+ Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY, 10032, United States, 1 212 342 4491, atd2127@cumc.columbia.edu %K behavioral intervention development %K implementation science %K acute coronary syndrome %K exercise sensitivity %K interoceptive exposure %K digital health %K mobile phone %D 2024 %7 12.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To increase real-world adoption of effective telehealth-delivered behavioral health interventions among midlife and older adults with cardiovascular disease, incorporating implementation science (IS) methods at earlier stages of intervention development may be needed. Objective: This study aims to describe how IS can be incorporated into the design and interpretation of a study assessing the feasibility and implementation potential of a technology-delivered behavioral health intervention. Methods: We assessed the feasibility and implementation potential of a 2-session, remotely delivered, home-based behavioral intervention composed of psychoeducation, interoceptive exposure through low-to-moderate intensity walking, interoceptive counseling, and homework (Reducing Exercise Sensitivity with Exposure Training; RESET) among patients with recent acute coronary syndrome (ACS) and some fear of exercise. To assess intervention feasibility, we measured patient protocol adherence, intervention delivery fidelity, and completion of intervention outcome assessments using direct observations, fidelity checklists, surveys, and device-measured physical activity. To assess implementation potential, we measured implementation outcomes (feasibility, acceptability, and appropriateness) using 4-item measures, each rated from the patient perspective on a 1 to 5 Likert scale (1=completely disagree and 5=completely agree; criteria: ≥4=agree or completely agree), and patient-perceived implementation determinants and design feedback using survey and interview data. Interview data underwent thematic analysis to identify implementation determinant themes, which were then categorized into Consolidated Framework for Implementation Research (CFIR) domains and constructs. Results: Of 31 patients approached during recruitment, 3 (10%) were eligible, enrolled, and completed the study (mean age 46.3, SD 14.0 y; 2/3, 67% male; 1/3, 33% Black; and 1/3, 33% Asian). The intervention was delivered with fidelity for all participants, and all participants completed the entire intervention protocol and outcome assessments. On average, participants agreed that the RESET intervention was feasible and acceptable, while appropriateness ratings did not meet implementation criteria (feasibility: mean 4.2, SD 0.4; acceptability: mean 4.3, SD 0.7; and appropriateness: mean 3.7, SD 0.4). Key patient-perceived implementation determinants were related to constructs in the innovation (design, adaptability, and complexity), inner setting (available resources [physical space, funding, materials, and equipment] and access to knowledge and information), and innovation recipient characteristics (motivation, capability, opportunity, and need) domains of the CFIR, with key barriers related to innovation design. Design feedback indicated that the areas requiring the most revisions were the interoceptive exposure design and the virtual delivery modality, and reasons why included low dose and poor usability. Conclusions: The RESET intervention was feasible but not implementable in a small sample of patients with ACS. Our theory-informed, mixed methods approach aided our understanding of what, how, and why RESET was not perceived as implementable; this information will guide intervention refinement. This study demonstrated how integrating IS methods early in intervention development can guide decisions regarding readiness to advance interventions along the translational research pipeline. %M 39531636 %R 10.2196/55137 %U https://formative.jmir.org/2024/1/e55137 %U https://doi.org/10.2196/55137 %U http://www.ncbi.nlm.nih.gov/pubmed/39531636 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57664 %T A Personalized Data Dashboard to Improve Compliance with Ecological Momentary Assessments in College Students: Protocol for a Microrandomized Trial %A Lanza,Stephanie T %A Linden-Carmichael,Ashley N %A Wang,Danny %A Bhandari,Sandesh %A Stull,Samuel W %+ Department of Biobehavioral Health, Pennsylvania State University, 129 Biobehavioral Health Building, University Park, PA, 16802, United States, 1 814 865 7095, SLanza@psu.edu %K ecological momentary assessments %K data dashboard %K study compliance %K microrandomized trial %K intensive longitudinal data %K EMA %K adolescents %K substance use %K wearables %D 2024 %7 11.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Ecological momentary assessments (EMA) are ideal for capturing the dynamic nature of young adult substance use behavior in daily life and identifying contextual risk factors that signal higher-risk episodes. These methods could provide a signal to trigger real-time intervention delivery. Study compliance and engagement are common barriers to participation but may be improved by personalizing messages. This study compares compliance outcomes between one group of young adults receiving standard (generic) prompts at each assessment and another group that received additional personalization and an updated data dashboard (DD) showing study progress to date at 1 randomly selected prompt per day. Objective: The primary objectives are to (1) develop a real-time DD for giving participants personalized updates on their progress in the study and (2) examine its preliminary overall effects on study compliance and experiences. Secondary objectives are to identify person-, day-, and moment-level characteristics associated with study compliance and person-level characteristics associated with perceived usefulness of the DD. Methods: This is a protocol for Project ENGAGE, a 2-arm randomized controlled trial. Arm 1 (EMA group) is engaged in a standard EMA protocol, and arm 2 (EMA+DD group) is engaged in the same study but with additional personalization and feedback. Inclusion criteria are (1) previous participation in a recent college student survey about health behavior and mental health who indicated willingness to participate in future research studies and (2) indicated past-month alcohol use; lifetime marijuana, hashish, or Delta-8-tetrahydrocannabinol (THC) use; or some combination of these on that survey. All participants in this study completed a baseline survey; EMA at 11 AM, 2 PM, 5 PM, and 8 PM each day for 21 days; and an exit survey. Participants in arm 2 engaged in a microrandomized trial, receiving a personalized DD at 1 randomly selected prompt per day. Primary outcomes include whether a survey was completed, time to complete a survey, and subjective experiences in the study. Primary analyses will compare groups on overall study compliance and, for arm 2, use marginal models to assess the momentary effect of receiving 1 updated DD per day. Results: Approval was granted by the university’s institutional review board on February 8, 2023. Recruitment via direct email occurred on March 30 and April 6, 2023; data collection was completed by April 29, 2023. A total of 91 individuals participated in the study. Results have been accepted for publication in JMIR Formative Research. Conclusions: Results from the evaluation of this study will indicate whether providing (at randomly selected prompts) real-time, personalized feedback on a participant’s progress in an EMA study improves study compliance. Overall, this study will inform whether a simple, automated DD presenting study compliance and incentives earned to date may improve young adults’ compliance and engagement in intensive longitudinal studies. International Registered Report Identifier (IRRID): DERR1-10.2196/57664 %M 39527809 %R 10.2196/57664 %U https://www.researchprotocols.org/2024/1/e57664 %U https://doi.org/10.2196/57664 %U http://www.ncbi.nlm.nih.gov/pubmed/39527809 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e58771 %T Dropout in a Longitudinal Survey of Amazon Mechanical Turk Workers With Low Back Pain: Observational Study %A Qureshi,Nabeel %A Hays,Ron D %A Herman,Patricia M %+ RAND Health Care, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, United States, 1 3103930411 ext 6054, nqureshi@rand.org %K chronic low back pain %K Mechanical Turk %K MTurk %K survey attrition %K survey weights %K Amazon %K occupational health %K manual labor %D 2024 %7 11.11.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Surveys of internet panels such as Amazon’s Mechanical Turk (MTurk) are common in health research. Nonresponse in longitudinal studies can limit inferences about change over time. Objective: This study aimed to (1) describe the patterns of survey responses and nonresponse among MTurk members with back pain, (2) identify factors associated with survey response over time, (3) assess the impact of nonresponse on sample characteristics, and (4) assess how well inverse probability weighting can account for differences in sample composition. Methods: We surveyed adult MTurk workers who identified as having back pain. We report participation trends over 3 survey waves and use stepwise logistic regression to identify factors related to survey participation in successive waves. Results: A total of 1678 adults participated in wave 1. Of those, 983 (59%) participated in wave 2 and 703 (42%) in wave 3. Participants who did not drop out took less time to complete previous surveys (30 min vs 35 min in wave 1, P<.001; 24 min vs 26 min in wave 2, P=.02) and reported having fewer health conditions (5.88 vs 6.6, P<.001). In multivariate models predicting responding at wave 2, lower odds of participation were associated with more time to complete the baseline survey (odds ratio [OR] 0.98, 95% CI 0.97-0.99), being Hispanic (compared with non-Hispanic, OR 0.69, 95% CI 0.49-0.96), having a bachelor’s degree as their terminal degree (compared with all other levels of education, OR 0.58, 95% CI 0.46-0.73), having more pain interference and intensity (OR 0.75, 95% CI 0.64-0.89), and having more health conditions. In contrast, older respondents (older than 45 years age compared with 18-24 years age) were more likely to respond to the wave 2 survey (OR 2.63 and 3.79, respectively) and those whose marital status was divorced (OR 1.81) and separated (OR 1.77) were also more likely to respond to the wave 2 survey. Weighted analysis showed slight differences in sample demographics and conditions and larger differences in pain assessments, particularly for those who responded to wave 2. Conclusions: Longitudinal studies on MTurk have large, differential dropouts between waves. This study provided information about the individuals more likely to drop out over time, which can help researchers prepare for future surveys. %M 39527103 %R 10.2196/58771 %U https://www.i-jmr.org/2024/1/e58771 %U https://doi.org/10.2196/58771 %U http://www.ncbi.nlm.nih.gov/pubmed/39527103 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e54415 %T Enhancing Clinical History Taking Through the Implementation of a Streamlined Electronic Questionnaire System at a Pediatric Headache Clinic: Development and Evaluation Study %A Cho,Jaeso %A Han,Ji Yeon %A Cho,Anna %A Yoo,Sooyoung %A Lee,Ho-Young %A Kim,Hunmin %K electronic questionnaire system %K electronic questionnaire %K history taking %K medical history %K headache %K migraine %K neuralgia %K pediatric %K paediatric %K infant %K neonatal %K toddler %K child %K youth %K adolescent %D 2024 %7 8.11.2024 %9 %J JMIR Med Inform %G English %X Background: Accurate history taking is essential for diagnosis, treatment, and patient care, yet miscommunications and time constraints often lead to incomplete information. Consequently, there has been a pressing need to establish a system whereby the questionnaire is duly completed before the medical appointment, entered into the electronic health record (EHR), and stored in a structured format within a database. Objective: This study aimed to develop and evaluate a streamlined electronic questionnaire system, BEST-Survey (Bundang Hospital Electronic System for Total Care-Survey), integrated with the EHR, to enhance history taking and data management for patients with pediatric headaches. Methods: An electronic questionnaire system was developed at Seoul National University Bundang Hospital, allowing patients to complete previsit questionnaires on a tablet PC. The information is automatically integrated into the EHR and stored in a structured database for further analysis. A retrospective analysis compared clinical information acquired from patients aged <18 years visiting the pediatric neurology outpatient clinic for headaches, before and after implementing the BEST-Survey system. The study included 365 patients before and 452 patients after system implementation. Answer rates and positive rates of key headache characteristics were compared between the 2 groups to evaluate the system’s clinical utility. Results: Implementation of the BEST-Survey system significantly increased the mean data acquisition rate from 54.6% to 99.3% (P<.001). Essential clinical features such as onset, location, duration, severity, nature, and frequency were obtained in over 98.7% (>446/452) of patients after implementation, compared to from 53.7% (196/365) to 85.2% (311/365) before. The electronic system facilitated comprehensive data collection, enabling detailed analysis of headache characteristics in the patient population. Most patients (280/452, 61.9%) reported headache onset less than 1 year prior, with the temporal region being the most common pain location (261/703, 37.1%). Over half (232/452, 51.3%) experienced headaches lasting less than 2 hours, with nausea and vomiting as the most commonly associated symptoms (231/1036, 22.3%). Conclusions: The BEST-Survey system markedly improved the completeness and accuracy of essential history items for patients with pediatric headaches. The system also streamlined data extraction and analysis for clinical and research purposes. While the electronic questionnaire cannot replace physician-led history taking, it serves as a valuable adjunctive tool to enhance patient care. %R 10.2196/54415 %U https://medinform.jmir.org/2024/1/e54415 %U https://doi.org/10.2196/54415 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60673 %T Sensor-Derived Measures of Motor and Cognitive Functions in People With Multiple Sclerosis Using Unsupervised Smartphone-Based Assessments: Proof-of-Concept Study %A Scaramozza,Matthew %A Ruet,Aurélie %A Chiesa,Patrizia A %A Ahamada,Laïtissia %A Bartholomé,Emmanuel %A Carment,Loïc %A Charre-Morin,Julie %A Cosne,Gautier %A Diouf,Léa %A Guo,Christine C %A Juraver,Adrien %A Kanzler,Christoph M %A Karatsidis,Angelos %A Mazzà,Claudia %A Penalver-Andres,Joaquin %A Ruiz,Marta %A Saubusse,Aurore %A Simoneau,Gabrielle %A Scotland,Alf %A Sun,Zhaonan %A Tang,Minao %A van Beek,Johan %A Zajac,Lauren %A Belachew,Shibeshih %A Brochet,Bruno %A Campbell,Nolan %+ Biogen, 225 Binney St, Cambridge, MA, 02142, United States, 1 781 464 2000, matt.scaramozza@biogen.com %K multiple sclerosis %K sensor-derived measure %K smartphone %K cognitive function %K motor function %K digital biomarkers %K mobile phone %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphones and wearables are revolutionizing the assessment of cognitive and motor function in neurological disorders, allowing for objective, frequent, and remote data collection. However, these assessments typically provide a plethora of sensor-derived measures (SDMs), and selecting the most suitable measure for a given context of use is a challenging, often overlooked problem. Objective: This analysis aims to develop and apply an SDM selection framework, including automated data quality checks and the evaluation of statistical properties, to identify robust SDMs that describe the cognitive and motor function of people with multiple sclerosis (MS). Methods: The proposed framework was applied to data from a cross-sectional study involving 85 people with MS and 68 healthy participants who underwent in-clinic supervised and remote unsupervised smartphone-based assessments. The assessment provided high-quality recordings from cognitive, manual dexterity, and mobility tests, from which 47 SDMs, based on established literature, were extracted using previously developed and publicly available algorithms. These SDMs were first separately and then jointly screened for bias and normality by 2 expert assessors. Selected SDMs were then analyzed to establish their reliability, using an intraclass correlation coefficient and minimal detectable change at 95% CI. The convergence of selected SDMs with in-clinic MS functional measures and patient-reported outcomes was also evaluated. Results: A total of 16 (34%) of the 47 SDMs passed the selection framework. All selected SDMs demonstrated moderate-to-good reliability in remote settings (intraclass correlation coefficient 0.5-0.85; minimal detectable change at 95% CI 19%-35%). Selected SDMs extracted from the smartphone-based cognitive test demonstrated good-to-excellent correlation (Spearman correlation coefficient, |ρ|>0.75) with the in-clinic Symbol Digit Modalities Test and fair correlation with Expanded Disability Status Scale (EDSS) scores (0.25≤|ρ|<0.5). SDMs extracted from the manual dexterity tests showed either fair correlation (0.25≤|ρ|<0.5) or were not correlated (|ρ|<0.25) with the in-clinic 9-hole peg test and EDSS scores. Most selected SDMs from mobility tests showed fair correlation with the in-clinic timed 25-foot walk test and fair to moderate-to-good correlation (0.5<|ρ|≤0.75) with EDSS scores. SDM correlations with relevant patient-reported outcomes varied by functional domain, ranging from not correlated (cognitive test SDMs) to good-to-excellent correlation (|ρ|>0.75) for mobility test SDMs. Overall, correlations were similar when smartphone-based tests were performed in a clinic or remotely. Conclusions: Reported results highlight that smartphone-based assessments are suitable tools to remotely obtain high-quality SDMs of cognitive and motor function in people with MS. The presented SDM selection framework promises to increase the interpretability and standardization of smartphone-based SDMs in people with MS, paving the way for their future use in interventional trials. %M 39515815 %R 10.2196/60673 %U https://formative.jmir.org/2024/1/e60673 %U https://doi.org/10.2196/60673 %U http://www.ncbi.nlm.nih.gov/pubmed/39515815 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59155 %T Collecting Real-Time Patient-Reported Outcome Data During Latent Labor: Feasibility Study of the MyCap Mobile App in Prospective Person-Centered Research %A Kissler,Katherine %A Phillippi,Julia C %A Erickson,Elise %A Holmes,Leah %A Tilden,Ellen %+ College of Nursing, Anschutz Medical Campus, University of Colorado, 13120 E 19th Ave., Mailstop C288, Aurora, CO, 80045, United States, 1 3037244769, katherine.kissler@cuanschutz.edu %K patient-reported outcomes %K survey methods %K smartphone %K labor onset %K prodromal symptoms %K prospective studies %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The growing emphasis on patient experience in medical research has increased the focus on patient-reported outcomes and symptom measures. However, patient-reported outcomes data are subject to recall bias, limiting reliability. Patient-reported data are most valid when reported by patients in real time; however, this type of data is difficult to collect from patients experiencing acute health events such as labor. Mobile technologies such as the MyCap app, integrated with the REDCap (Research Electronic Data Capture) platform, have emerged as tools for collecting patient-generated health data in real time offering potential improvements in data quality and relevance. Objective: This study aimed to evaluate the feasibility of using MyCap for real-time, patient-reported data collection during latent labor. The objective was to assess the usability of MyCap in characterizing patient experiences during this acute health event and to identify any challenges in data collection that could inform future research. Methods: In this descriptive cohort study, we quantified and characterized data collected prospectively through MyCap and the extent to which participants engaged with the app as a research tool for collecting patient-reported data in real time. Longitudinal quantitative and qualitative surveys were sent to (N=18) enrolled patients with term pregnancies planning vaginal birth at Oregon Health Sciences University. Participants were trained in app use prenatally. Then participants were invited to initiate the research survey on their personal smartphone via MyCap when they experienced labor symptoms and were asked to return to MyCap every 3 hours to provide additional longitudinal symptom data. Results: Out of 18 enrolled participants, 17 completed the study. During latent labor, 13 (76.5%) participants (all those who labored at home and two-thirds of those who were induced) recorded at least 1 symptom report during latent labor. A total of 191 quantitative symptom reports (mean of 10 per participant) were recorded. The most commonly reported symptoms were fatigue, contractions, and pain, with nausea and diarrhea being less frequent but more intense. Four participants recorded qualitative data during labor and 14 responded to qualitative prompts in the postpartum period. The study demonstrated that MyCap could effectively capture real-time patient-reported data during latent labor, although qualitative data collection during active symptoms was less robust. Conclusions: MyCap is a feasible tool for collecting prospective data on patient-reported symptoms during latent labor. Participants engaged actively with quantitative symptom reporting, though qualitative data collection was more challenging. The use of MyCap appears to reduce recall bias and facilitate more accurate data collection for patient-reported symptoms during acute health events outside of health care settings. Future research should explore strategies to enhance qualitative data collection and assess the tool’s usability across more diverse populations and disease states. %M 39515816 %R 10.2196/59155 %U https://formative.jmir.org/2024/1/e59155 %U https://doi.org/10.2196/59155 %U http://www.ncbi.nlm.nih.gov/pubmed/39515816 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49708 %T Designing and Validating a Survey for National-Level Data During the COVID-19 Pandemic in Sri Lanka: Cross-Sectional Mobile Phone Surveys %A Phadnis,Rachael %A Perera,Udara %A Lea,Veronica %A Davlin,Stacy %A Lee,Juliette %A Siesel,Casey %A Abeygunathilaka,Dhanushka %A Wickramasinghe,S C %+ Centers for Disease Control and Prevention Foundation, 600 Peachtree St NE, #1000, Atlanta, GA, 30308, United States, 1 320 248 7430, rachaelphadnis@gmail.com %K pilot study %K mobile phone survey %K survey methodology %K COVID-19 %K data collection %K national survey %K pandemic %K population-based study %K Sri Lanka %K middle-income countries %K low-income countries %K vaccine acceptability %K vaccine %K COVID-19 vaccination %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has generated a demand for timely data, resulting in a surge of mobile phone surveys for tracking the impacts of and responses to the pandemic. Mobile phone surveys have become a preferred mode of data collection across low- and middle-income countries. Objective: This study piloted 2 population-based, cross-sectional mobile phone surveys among Sri Lankan residents in 2020 and 2021 during the COVID-19 pandemic. The surveys aimed to gather data on knowledge, attitudes, and practices, vaccine acceptability, availability, and barriers to COVID-19 testing, and use of a medicine distribution service. Methods: The study used Surveda, an open-source survey tool developed by the NCD (noncommunicable disease) Mobile Phone Survey Data 4 Health Initiative, for data collection and management. The surveys were conducted through interactive voice response using automated, prerecorded messages in Sinhala, Tamil, and English. The sample design involved random sampling of mobile phone numbers, stratified by sex, proportional to the general population. Eligibility criteria varied between surveys, targeting adults aged 35 years and older with any noncommunicable disease for the first survey and all adults for the second survey. The data were adjusted to population estimates, and statistical analysis was conducted using SAS (SAS Institute) and R software (R Core Team). Descriptive statistics, Rao-Scott chi-square tests, and z tests were used to analyze the data. Response rates, cooperation rates, and productivity of the sampling approach were calculated. Results: In the first survey, n=5001, the overall response rate was 7.5%, with a completion rate of 85.6%. In the second survey, n=1250, the overall response rate was 10.9%, with a completion rate of 61.9%. Approximately 3 out of 4 adults reported that they avoided public places (888/1175, 75.6%), more than two-thirds avoided public transportation (808/1173, 68.9%), and 9 out of 10 practiced physical distancing (1046/1167, 89.7%). Approximately 1 out of 10 Sri Lankan persons reported being tested for COVID-19, and the majority of those received a polymerase chain reaction test (112/161, 70%). Significantly more males than females reported being tested for COVID-19 (98/554, 17.8% vs 61/578, 10.6%, respectively; P<.001). Finally, the majority of adult Sri Lankan people reported that they definitely or probably would get the COVID-19 vaccination (781/1190, 65.7%). Conclusions: The surveys revealed that, overall, the adult Sri Lankan population adhered to COVID-19 mitigation strategies. These findings underscore the use of mobile phone surveys in swiftly and easily providing essential data to inform a country’s response during the COVID-19 pandemic, obviating the need for face-to-face data collection. %M 39514850 %R 10.2196/49708 %U https://formative.jmir.org/2024/1/e49708 %U https://doi.org/10.2196/49708 %U http://www.ncbi.nlm.nih.gov/pubmed/39514850 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55140 %T Service Quality and Patient Satisfaction of Internet Hospitals in China: Cross-Sectional Evaluation With the Service Quality Questionnaire %A Han,Tao %A Wei,Qinpeng %A Wang,Ruike %A Cai,Yijin %A Zhu,Hongyi %A Chen,Jiani %A Zhang,Zhiruo %A Li,Sisi %+ School of Public Health, Shanghai Jiao Tong University School of Medicine, 227 Chongqing South Road, Shanghai, 200025, China, 86 02163846590 ext 776145, lisi8318@gmail.com %K service quality %K SERVQUAL %K Service Quality Questionnaire %K internet hospital %K e-hospital %K digital medical care %K health care professionals %K Chinese digital health care %D 2024 %7 8.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet hospitals, which refer to service platforms that integrate consultation, prescription, payment, and drug delivery based on hospital entities, have been developing at a rapid pace in China since 2014. However, assessments regarding their service quality and patient satisfaction have not been well developed. There is an urgent need to comprehensively evaluate and improve the service quality of internet hospitals. Objective: This study aims to investigate the current status of patients’ use of internet hospitals, as well as familiarity and willingness to use internet hospitals, to evaluate patients’ expected and perceived service qualities of internet hospitals using the Chinese version of the Service Quality Questionnaire (SERVQUAL-C) with a national representative sample, and to explore the association between service quality of internet hospitals and patients’ overall satisfaction toward associated medical platforms. Methods: This cross-sectional survey was conducted through face-to-face or digital interviews from June to September 2022. A total of 1481 outpatient participants (635 men and 846 women; mean age 33.22, SD 13.22). Participants reported their use of internet hospitals, and then rated their expectations and perceptions of service quality toward internet hospitals via the SERVQUAL-C, along with their demographic information. Results: Among the surveyed participants, 51.2% (n=758) of participants had used internet hospital service or services. Use varied across age, education level, and annual income. Although the majority of them (n=826, 55.8%) did not know internet hospital services well, 68.1% (n=1009) of participants expressed the willingness to adopt this service. Service quality evaluation revealed that the perceived service quality did not match with the expectation, especially the responsiveness dimension. Important-performance analysis results further alerted that reliable diagnosis, prompt response, clear feedback pathway, and active feedback handling were typically the services awaiting substantial improvement. More importantly, multiple linear regressions revealed that familiarity and willingness to use internet hospital services were significant predictors of satisfaction, above and over tangibles, reliability, and empathy service perspectives, and demographic characteristics such as gender, age, education level, and annual income. Conclusions: In the future, internet hospitals should focus more on how to narrow the gaps between the expected and perceived service quality. Promotion of internet hospitals should also be facilitated to increase patients’ familiarity with and willingness to use these services. %M 39514849 %R 10.2196/55140 %U https://www.jmir.org/2024/1/e55140 %U https://doi.org/10.2196/55140 %U http://www.ncbi.nlm.nih.gov/pubmed/39514849 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58116 %T Combating Antimicrobial Resistance Through a Data-Driven Approach to Optimize Antibiotic Use and Improve Patient Outcomes: Protocol for a Mixed Methods Study %A Mayito,Jonathan %A Tumwine,Conrad %A Galiwango,Ronald %A Nuwamanya,Elly %A Nakasendwa,Suzan %A Hope,Mackline %A Kiggundu,Reuben %A Byonanebye,Dathan M %A Dhikusooka,Flavia %A Twemanye,Vivian %A Kambugu,Andrew %A Kakooza,Francis %+ Infectious Diseases Institute, College of Health Sciences, Makerere University, IDI-McKinnell Knowledge Centre, P.O. Box 22418, Kampala, 10208, Uganda, 256 0704976874, tconrad@idi.co.ug %K antimicrobial resistance %K AMR database %K AMR %K machine learning %K antimicrobial use %K artificial intelligence %K antimicrobial %K data-driven %K mixed-method %K patient outcome %K drug-resistant infections %K drug resistant %K surveillance data %K economic %K antibiotic %D 2024 %7 8.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: It is projected that drug-resistant infections will lead to 10 million deaths annually by 2050 if left unabated. Despite this threat, surveillance data from resource-limited settings are scarce and often lack antimicrobial resistance (AMR)–related clinical outcomes and economic burden. We aim to build an AMR and antimicrobial use (AMU) data warehouse, describe the trends of resistance and antibiotic use, determine the economic burden of AMR in Uganda, and develop a machine learning algorithm to predict AMR-related clinical outcomes. Objective: The overall objective of the study is to use data-driven approaches to optimize antibiotic use and combat antimicrobial-resistant infections in Uganda. We aim to (1) build a dynamic AMR and antimicrobial use and consumption (AMUC) data warehouse to support research in AMR and AMUC to inform AMR-related interventions and public health policy, (2) evaluate the trends in AMR and antibiotic use based on annual antibiotic and point prevalence survey data collected at 9 regional referral hospitals over a 5-year period, (3) develop a machine learning model to predict the clinical outcomes of patients with bacterial infectious syndromes due to drug-resistant pathogens, and (4) estimate the annual economic burden of AMR in Uganda using the cost-of-illness approach. Methods: We will conduct a study involving data curation, machine learning–based modeling, and cost-of-illness analysis using AMR and AMU data abstracted from procurement, human resources, and clinical records of patients with bacterial infectious syndromes at 9 regional referral hospitals in Uganda collected between 2018 and 2026. We will use data curation procedures, FLAIR (Findable, Linkable, Accessible, Interactable and Repeatable) principles, and role-based access control to build a robust and dynamic AMR and AMU data warehouse. We will also apply machine learning algorithms to model AMR-related clinical outcomes, advanced statistical analysis to study AMR and AMU trends, and cost-of-illness analysis to determine the AMR-related economic burden. Results: The study received funding from the Wellcome Trust through the Centers for Antimicrobial Optimisation Network (CAMO-Net) in April 2023. As of October 28, 2024, we completed data warehouse development, which is now under testing; completed data curation of the historical Fleming Fund surveillance data (2020-2023); and collected retrospective AMR records for 599 patients that contained clinical outcomes and cost-of-illness economic burden data across 9 surveillance sites for objectives 3 and 4, respectively. Conclusions: The data warehouse will promote access to rich and interlinked AMR and AMU data sets to answer AMR program and research questions using a wide evidence base. The AMR-related clinical outcomes model and cost data will facilitate improvement in the clinical management of AMR patients and guide resource allocation to support AMR surveillance and interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/58116 %M 39514268 %R 10.2196/58116 %U https://www.researchprotocols.org/2024/1/e58116 %U https://doi.org/10.2196/58116 %U http://www.ncbi.nlm.nih.gov/pubmed/39514268 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e63814 %T Examining Whether Patient Portal and Video Visit Use Differs by Race and Ethnicity Among Older Adults in a US Integrated Health Care Delivery System: Cross-Sectional Electronic Health Record and Survey-Based Study %A Gordon,Nancy P %A Yin,Chelsea %A Lo,Joan C %+ Kaiser Permanente Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Drive, Pleasanton, CA, 94588, United States, 1 5109107992, nancypgordon@yahoo.com %K patient portal use %K video visit use %K older adults %K racial and ethnic differences %K telehealth %K mobile phone %D 2024 %7 7.11.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Health care systems are increasingly encouraging patients to use patient portals and participate in video visits. However, there is limited information about how portal use differs among older adults. Objective: This study aimed to understand how patient portal and video visit use differed by age, race, and ethnicity among older adult patients with access to the same digital health resources. Methods: This cross-sectional study used electronic health record and survey data for adults aged 65 to 85 years who were members of a large Northern California health care delivery system throughout 2019 and 2020. The electronic health record cohort (N=471,152) included 320,686 White, 35,892 Black, 44,922 Latino, 20,786 Chinese, 28,732 Filipino, 8473 South Asian, 6716 Japanese, 2930 Vietnamese, and 2015 Korean adults. Racial and ethnic group and age group (65 to 75 years vs 76 to 85 years) differences in having a patient portal account by December 2020, the performance of 2 portal activities (sending ≥1 message to a clinician in 2019 or 2020 and viewing ≥1 laboratory test result in 2020), and having ≥1 video visit during 2020 were examined. Modified log-Poisson regression was used to examine prevalence ratios for portal and video visit use, comparing racial and ethnic groups to White adults and Asian ethnic groups to Chinese adults after adjusting for sex and age. Data from a 2020 member survey were used to compare internet use factors among 2867 White, 306 Black, 343 Latino, 225 Chinese, and 242 Filipino adults. Results: Black, Latino, and Filipino adults were less likely to have a patient portal account than White adults, and Filipino adults were less likely to have a patient portal account than Chinese adults. Black, Latino, Filipino, Korean, Vietnamese, and South Asian adults were less likely to have sent messages and viewed test results than White adults, while Chinese and Japanese adults’ use of these features was similar to that of White adults. Filipino, Vietnamese, and Korean adults were less likely to have performed the aforementioned activities than Chinese adults. Video visit use was lower among Black and Latino adults and higher among Chinese and South Asian adults compared with White adults (aged 76 to 85 years) and lower among Filipino, Korean, and Vietnamese adults compared to Chinese adults. Survey data suggested that underlying differences in internet use may partially explain the lower use of messaging by Black, Latino, and Filipino adults compared with White and Chinese adults. Conclusions: Patient portal and video visit use differed by race, ethnicity, and age group among older adult patients with access to the same patient portal. Internet use factors may contribute to these differences. Differences in patient portal and video visit use across Asian subgroups underscore the importance of disaggregating use data by Asian ethnicity. %M 39509698 %R 10.2196/63814 %U https://aging.jmir.org/2024/1/e63814 %U https://doi.org/10.2196/63814 %U http://www.ncbi.nlm.nih.gov/pubmed/39509698 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55086 %T Racial and Demographic Disparities in Susceptibility to Health Misinformation on Social Media: National Survey-Based Analysis %A Chandrasekaran,Ranganathan %A Sadiq T,Muhammed %A Moustakas,Evangelos %+ University of Illinois at Chicago, 601 S Morgan Street, Chicago, IL, 60607, United States, 1 3129962847, ranga@uic.edu %K health misinformation %K digital divide %K racial disparities %K social media %K national survey-based analysis %K health information %K interventions %D 2024 %7 6.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media platforms have transformed the dissemination of health information, allowing for rapid and widespread sharing of content. However, alongside valuable medical knowledge, these platforms have also become channels for the spread of health misinformation, including false claims and misleading advice, which can lead to significant public health risks. Susceptibility to health misinformation varies and is influenced by individuals’ cultural, social, and personal backgrounds, further complicating efforts to combat its spread. Objective: This study aimed to examine the extent to which individuals report encountering health-related misinformation on social media and to assess how racial, ethnic, and sociodemographic factors influence susceptibility to such misinformation. Methods: Data from the Health Information National Trends Survey (HINTS; Cycle 6), conducted by the National Cancer Institute with 5041 US adults between March and November 2022, was used to explore associations between racial and sociodemographic factors (age, gender, race/ethnicity, annual household income, marital status, and location) and susceptibility variables, including encounters with misleading health information on social media, difficulty in assessing information truthfulness, discussions with health providers, and making health decisions based on such information. Results: Over 35.61% (1740/4959) of respondents reported encountering “a lot” of misleading health information on social media, with an additional 45% (2256/4959) reporting seeing “some” amount of health misinformation. Racial disparities were evident in comparison with Whites, with non-Hispanic Black (odds ratio [OR] 0.45, 95% CI 0.33-0.6, P<.01) and Hispanic (OR 0.54, 95% CI 0.41-0.71, P<.01) individuals reporting lower odds of finding deceptive information, while Hispanic (OR 1.68, 95% CI 1.48-1.98, P<.05) and non-Hispanic Asian (OR 1.96, 95% CI 1.21-3.18, P<.01) individuals exhibited higher odds in having difficulties in assessing the veracity of health information found on social media. Hispanic and Asian individuals were more likely to discuss with providers and make health decisions based on social media information. Older adults aged ≥75 years exhibited challenges in assessing health information on social media (OR 0.63, 95% CI 0.43-0.93, P<.01), while younger adults (18-34) showed increased vulnerability to health misinformation. In addition, income levels were linked to higher exposure to health misinformation on social media: individuals with annual household incomes between US $50,000 and US $75,000 (OR 1.74, 95% CI 1.14-2.68, P<.01), and greater than US $75,000 (OR 1.78, 95% CI 1.20-2.66, P<.01) exhibited greater odds, revealing complexities in decision-making and information access. Conclusions: This study highlights the pervasive presence of health misinformation on social media, revealing vulnerabilities across racial, age, and income groups, underscoring the need for tailored interventions. %M 39504121 %R 10.2196/55086 %U https://www.jmir.org/2024/1/e55086 %U https://doi.org/10.2196/55086 %U http://www.ncbi.nlm.nih.gov/pubmed/39504121 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50461 %T Lessons From 3 Longitudinal Sensor-Based Human Behavior Assessment Field Studies and an Approach to Support Stakeholder Management: Content Analysis %A Kallio,Johanna %A Kinnula,Atte %A Mäkelä,Satu-Marja %A Järvinen,Sari %A Räsänen,Pauli %A Hosio,Simo %A Bordallo López,Miguel %+ VTT Technical Research Centre of Finland Ltd, Kaitoväylä 1, Oulu, 90571, Finland, 358 50 527 0180, johanna.kallio@vtt.fi %K field trial %K behavioral research %K sensor data %K machine learning %K pervasive technology %K stakeholder engagement %K qualitative coding %K mobile phone %D 2024 %7 31.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Pervasive technologies are used to investigate various phenomena outside the laboratory setting, providing valuable insights into real-world human behavior and interaction with the environment. However, conducting longitudinal field trials in natural settings remains challenging due to factors such as low recruitment success and high dropout rates due to participation burden or data quality issues with wireless sensing in changing environments. Objective: This study gathers insights and lessons from 3 real-world longitudinal field studies assessing human behavior and derives factors that impacted their research success. We aim to categorize challenges, observe how they were managed, and offer recommendations for designing and conducting studies involving human participants and pervasive technology in natural settings. Methods: We developed a qualitative coding framework to categorize and address the unique challenges encountered in real-life studies related to influential factor identification, stakeholder management, data harvesting and management, and analysis and interpretation. We applied inductive reasoning to identify issues and related mitigation actions in 3 separate field studies carried out between 2018 and 2022. These 3 field studies relied on gathering annotated sensor data. The topics involved stress and environmental assessment in an office and a school, collecting self-reports and wrist device and environmental sensor data from 27 participants for 3.5 to 7 months; work activity recognition at a construction site, collecting observations and wearable sensor data from 15 participants for 3 months; and stress recognition in location-independent knowledge work, collecting self-reports and computer use data from 57 participants for 2 to 5 months. Our key extension for the coding framework used a stakeholder identification method to identify the type and role of the involved stakeholder groups, evaluating the nature and degree of their involvement and influence on the field trial success. Results: Our analysis identifies 17 key lessons related to planning, implementing, and managing a longitudinal, sensor-based field study on human behavior. The findings highlight the importance of recognizing different stakeholder groups, including those not directly involved but whose areas of responsibility are impacted by the study and therefore have the power to influence it. In general, customizing communication strategies to engage stakeholders on their terms and addressing their concerns and expectations is essential, while planning for dropouts, offering incentives for participants, conducting field tests to identify problems, and using tools for quality assurance are relevant for successful outcomes. Conclusions: Our findings suggest that field trial implementation should include additional effort to clarify the expectations of stakeholders and to communicate with them throughout the process. Our framework provides a structured approach that can be adopted by other researchers in the field, facilitating robust and comparable studies across different contexts. Constantly managing the possible challenges will lead to better success in longitudinal field trials and developing future technology-based solutions. %M 39481098 %R 10.2196/50461 %U https://www.jmir.org/2024/1/e50461 %U https://doi.org/10.2196/50461 %U http://www.ncbi.nlm.nih.gov/pubmed/39481098 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e56943 %T Determinants of Citizens’ Intention to Participate in Self-Led Contact Tracing: Cross-Sectional Online Questionnaire Study %A Helms,Yannick Bernd %A van der Meer,Akke %A Crutzen,Rik %A Ferreira,José António %A Kretzschmar,Mirjam E E %A Timen,Aura %A Hamdiui,Nora %A Stein,Mart L %+ Centre for Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, Netherlands, 31 629637782, akke.van.der.meer@rivm.nl %K contact tracing %K telemedicine %K health services research %K intention %K public health surveillance %K machine learning %K cross-sectional study %K online questionnaire %K disease outbreaks %K task shifting %D 2024 %7 30.10.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Contact tracing (CT) is a key intervention to contain outbreaks of communicable diseases. During large-scale outbreaks, public health services may lack the resources required to perform CT effectively. One way of mitigating this issue is to shift some of the tasks in CT normally performed by public health services to cases and their contacts, supported by digital tools. We refer to this as “self-led CT.” However, while the effectiveness of the self-led CT inherently depends on the willingness and skills of citizens to participate, the determinants of citizens’ intention to participate in self-led CT are not yet fully understood. Objective: We aimed to identify determinants of Dutch citizens’ intention to participate in self-led CT and assess their potential for behavioral change, so as to identify “behavior change targets,” which may be used in the development and implementation of self-led CT to increase citizens’ intention to participate. Methods: In March 2022, we performed an online cross-sectional questionnaire study. The questionnaire was developed based on findings from a previous exploratory semistructured interview study and distributed among a Dutch consumer panel. Using all questionnaire items as potential predictors, we performed a random forest analysis to identify determinants of citizens’ intention to participate in self-led CT. We then performed an Agglomerative Hierarchical Cluster Analysis to identify groups of related determinants that may be considered overarching behavior change targets. Finally, we used Confidence Interval-Based Estimation of Relevance and calculated the Potential for Change Indices to compare the potential for behavioral change of the selected individual determinants and determinant clusters. Results: The questionnaire was completed by 3019 respondents. Our sample is representative of the Dutch population in terms of age, gender, educational level, and area of residence. Out of 3019 respondents, 2295 (76%) had a positive intention to participate in self-led CT. We identified 20 determinants of citizens’ intention that we grouped into 9 clusters. In general, increasing citizens’ trust in the digital tools developed for self-led CT has the highest potential to increase citizens’ intention, followed by increasing the belief that using digital tools makes participating in self-led CT easier, reducing privacy-related concerns, and increasing citizens’ willingness—and sense of responsibility—to cooperate in CT in general. Conclusions: Overall, Dutch citizens are positive toward participating in self-led CT. Our results provide directions for the development and implementation of self-led CT, which may be particularly useful in preparing for future, large-scale outbreaks. %M 39476390 %R 10.2196/56943 %U https://publichealth.jmir.org/2024/1/e56943 %U https://doi.org/10.2196/56943 %U http://www.ncbi.nlm.nih.gov/pubmed/39476390 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59623 %T Development and Initial Evaluation of a Digital Phenotype Collection System for Adolescents: Proof-of-Concept Study %A Cho,Minseo %A Park,Doeun %A Choo,Myounglee %A Kim,Jinwoo %A Han,Doug Hyun %+ College of Medicine, Chung-Ang University, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Republic of Korea, 82 1050430876, hduk70@gmail.com %K adolescents %K adolescent mental health %K smartphone apps %K self-monitoring %K qualitative research %K phenotypes %K proof of concept %K digital phenotyping %K phenotype data %K ecological momentary assessment %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The growing concern on adolescent mental health calls for proactive early detection and intervention strategies. There is a recognition of the link between digital phenotypes and mental health, drawing attention to their potential use. However, the process of collecting digital phenotype data presents challenges despite its promising prospects. Objective: This study aims to develop and validate system concepts for collecting adolescent digital phenotypes that effectively manage inherent challenges in the process. Methods: In a formative investigation (N=34), we observed adolescent self-recording behaviors and conducted interviews to develop design goals. These goals were then translated into system concepts, which included planners resembling interfaces, simplified data input with tags, visual reports on behaviors and moods, and supportive ecological momentary assessment (EMA) prompts. A proof-of-concept study was conducted over 2 weeks (n=16), using tools that simulated the concepts to record daily activities and complete EMA surveys. The effectiveness of the system was evaluated through semistructured interviews, supplemented by an analysis of the frequency of records and responses. Results: The interview findings revealed overall satisfaction with the system concepts, emphasizing strong support for self-recording. Participants consistently maintained daily records throughout the study period, with no missing data. They particularly valued the recording procedures that aligned well with their self-recording goal of time management, facilitated by the interface design and simplified recording procedures. Visualizations during recording and subsequent report viewing further enhanced engagement by identifying missing data and encouraging deeper self-reflection. The average EMA compliance reached 72%, attributed to a design that faithfully reflected adolescents’ lives, with surveys scheduled at convenient times and supportive messages tailored to their daily routines. The high compliance rates observed and positive feedback from participants underscore the potential of our approach in addressing the challenges of collecting digital phenotypes among adolescents. Conclusions: Integrating observations of adolescents’ recording behavior into the design process proved to be beneficial for developing an effective and highly compliant digital phenotype collection system. %M 39446465 %R 10.2196/59623 %U https://formative.jmir.org/2024/1/e59623 %U https://doi.org/10.2196/59623 %U http://www.ncbi.nlm.nih.gov/pubmed/39446465 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59950 %T Evaluating the Psychometric Properties of a Physical Activity and Sedentary Behavior Identity Scale: Survey Study With Two Independent Samples of Adults in the United States %A Wen,Cheng K Fred %A Schneider,Stefan %A Junghaenel,Doerte U %A Toledo,Meynard John L %A Lee,Pey-Jiuan %A Smyth,Joshua M %A Stone,Arthur A %+ Dornsife Center for Self-Report Science, University of Southern California, 635 Downey Way, Los Angeles, CA, 90089-3332, United States, 1 213 821 1850, chengkuw@usc.edu %K physical activity %K sedentary behavior %K geriatrics %K exercise %K lifestyle %K physical health %K mental health %K social-cognitive approach %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Emerging evidence suggests a positive association between relevant aspects of one’s psychological identity and physical activity engagement, but the current understanding of this relationship is primarily based on scales designed to assess identity as a person who exercises, leaving out essential aspects of physical activities (eg, incidental and occupational physical activity) and sedentary behavior. Objective: The goal of this study is to evaluate the validity of a new physical activity and sedentary behavior (PA/SB) identity scale using 2 independent samples of US adults. Methods: In study 1, participants answered 21 candidate items for the PA/SB identity scale and completed the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Study 2 participants completed the same PA/SB identity items twice over a 1-week interval and completed the IPAQ-SF at the end. We performed factor analyses to evaluate the structure of the PA/SB identity scale, evaluated convergent validity and test-retest reliability (in study 2) of the final scale scores, and examined their discriminant validity using tests for differences in dependent correlations. Results: The final PA/SB identity measure was comprised of 3 scales: physical activity role identity (F1), physical activity belief (F2), and sedentary behavior role identity (F3). The scales had high test-retest reliability (Pearson correlation coefficient: F1, r=0.87; F2, r=0.75; F3, r=0.84; intraclass correlation coefficient [ICC]: F1: ICC=0.85; F2: ICC=0.75; F3: ICC=0.84). F1 and F2 were positively correlated with each other (study 1, r=0.76; study 2, r=0.69), while both were negatively correlated with F3 (Pearson correlation coefficient between F1 and F3: r=–0.58 for study 1 and r=–0.73 for study 2; F2 and F3: r=–0.46 for studies 1 and 2). Data from both studies also demonstrated adequate discriminant validity of the scale developed. Significantly larger correlations with time in vigorous and moderate activities and time walking and sitting assessed by IPAQ-SF with F1, compared with F2, were observed. Significantly larger correlations with time in vigorous and moderate activities with F1, compared with F3, were also observed. Similarly, a larger correlation with time in vigorous activities and a smaller correlation with time walking were observed with F2, compared with F3. Conclusions: This study provided initial empirical evidence from 2 independent studies on the reliability and validity of the PA/SB identity scales for adults. %M 39446463 %R 10.2196/59950 %U https://formative.jmir.org/2024/1/e59950 %U https://doi.org/10.2196/59950 %U http://www.ncbi.nlm.nih.gov/pubmed/39446463 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50184 %T Mobile Phone Syndromic Surveillance for Respiratory Conditions in an Emergency (COVID-19) Context in Colombia: Representative Survey Design %A Vecino-Ortiz,Andres I %A Guzman-Tordecilla,Deivis Nicolas %A Maniar,Vidhi %A Agudelo-Londoño,Sandra %A Franco-Suarez,Oscar %A Aya Pastrana,Nathaly %A Rodríguez-Patarroyo,Mariana %A Mejía-Rocha,Marino %A Cardona,Jaime %A Chavez Chamorro,Mariangela %A Gibson,Dustin %+ Health Systems Program, International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, United States, 1 410 955 3934, andres.vecino@gmail.com %K mobile phone surveys %K syndromic surveillance %K COVID-19 %K public health surveillance %K IVR %K interactive voice response %K survey %K surveys %K voice response %K syndromic %K surveillance %K respiratory %K pandemic %K SARS-CoV-2 %K feasibility %K data collection %K public health %K emergency %K outbreak %K mobile phone %D 2024 %7 17.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Syndromic surveillance for respiratory infections such as COVID-19 is a crucial part of the public health surveillance toolkit as it allows decision makers to detect and prepare for new waves of the disease in advance. However, it is labor-intensive, costly, and increases exposure to survey personnel. This study assesses the feasibility of conducting a mobile phone–based respiratory syndromic surveillance program in a middle-income country during a public health emergency, providing data to support the inclusion of this method in the standard infection control protocols at the population level. Objective: This study aims to assess the feasibility of a national active syndromic surveillance system for COVID-19 disease in Colombia. Methods: In total, 2 pilots of syndromic mobile phone surveys (MPSs) were deployed using interactive voice response technology in Colombia (367 complete surveys in March 2022 and 451 complete surveys in April and May 2022). Respondents aged 18 years and older were sampled using random digit dialing, and after obtaining consent, they were sent a 10-minute survey with modules on sociodemographic status, respiratory symptoms, past exposure to COVID-19 infection and vaccination status, preferences about COVID-19 vaccination, and information source for COVID-19. Pilot 1 used a nationally representative sample while pilot 2 used quota sampling to yield representative results at the regional level. In this work, we assessed the performance characteristics of the survey pilots and compared the demographic information collected with a nationally representative household survey. Results: For both pilots, contact rates were between 1% and 2%, while participation rates were above 80%. The results revealed that younger, female, and higher educated participants were more likely to participate in the syndromic survey. Survey rates as well as demographics, COVID-19 vaccination status, and prevalence of respiratory symptoms are reported for both pilots. We found that respondents of the MPSs are more likely to be younger and female. Conclusions: In a COVID-19 pandemic setting, using an interactive voice response MPS to conduct syndromic surveillance may be a transformational, low-risk, and feasible method to detect outbreaks. This evaluation expects to provide a path forward to the inclusion of MPSs as a traditional surveillance method. %M 39418077 %R 10.2196/50184 %U https://www.jmir.org/2024/1/e50184 %U https://doi.org/10.2196/50184 %U http://www.ncbi.nlm.nih.gov/pubmed/39418077 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58203 %T The Rutgers Omnibus Study: Protocol for Quarterly Web-Based Surveys to Promote Rapid Tobacco Research %A Bover Manderski,Michelle T %A Young,William J %A Ganz,Ollie %A Delnevo,Cristine D %+ Institute for Nicotine and Tobacco Studies, Rutgers Biomedical and Health Sciences (Rutgers Health), Rutgers, The State University of New Jersey, 303 George Street, Suite 405, New Brunswick, NJ, 08901, United States, 1 732 235 9727, bovermi@ints.rutgers.edu %K survey %K tobacco %K nicotine %K young adults %K adults %K protocol %K Rutgers Omnibus Study %K Amazon Mechanical Turk %K MTurk %D 2024 %7 16.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Rapid and flexible data collection efforts are necessary for effective monitoring and research on tobacco and nicotine product use in a constantly evolving marketplace. The Rutgers Omnibus Survey (1) provides timely data on awareness and use of new and emerging tobacco products among adults in a rapid manner, (2) provides a platform for measurement experiments to help develop and refine measures of tobacco use that reflect the current marketplace, and (3) generates pilot data for grant applications and scientific manuscripts. Objective: This study aims to document the first 2 years of the Rutgers Omnibus Study through the reporting of methodology, fielding summaries, and sample characteristics. Methods: Launched in February 2022 and fielded quarterly thereafter, we survey convenience samples of 2000 to 3000 US adults aged 18-45 years recruited from Amazon Mechanical Turk (MTurk) using the MTurk Toolkit by CloudResearch. The questionnaire includes core and rotating modules and is designed to take approximately 10 minutes to complete through Qualtrics. The fielding duration is approximately 10 days per wave. Each wave includes both unique and repeating participants, and responses can be linked across waves by an anonymous ID. Results: Sample sizes ranged from 2082 (wave 8, December 2023) to 2989 (wave 1, February 2022), and the 8-wave longitudinal dataset included 10,334 participants, of whom 2477 had 3 or more data points. The cost per complete at each wave was low, ranging from US $2.46 to US $3.27 across waves. Key demographics were consistent across waves and similar to that of the general population, while tobacco product trial and past–30-day use were generally higher. Conclusions: The Rutgers Omnibus Study is a quarterly survey that is effective for rapidly assessing the use of emerging tobacco and nicotine products and can also be leveraged to conduct survey experiments, generate pilot data, and address both cross-sectional and longitudinal research questions. International Registered Report Identifier (IRRID): RR1-10.2196/58203 %M 39413372 %R 10.2196/58203 %U https://www.researchprotocols.org/2024/1/e58203 %U https://doi.org/10.2196/58203 %U http://www.ncbi.nlm.nih.gov/pubmed/39413372 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e50585 %T Temperature Measurement Timings and the Fever Detection Rate After Gastrointestinal Surgery: Retrospective Cross-Sectional Study %A Wang,Shiqi %A Ji,Gang %A Feng,Xiangying %A Huang,Luguang %A Luo,Jialin %A Yu,Pengfei %A Zheng,Jiyang %A Yang,Bin %A Wang,Xiangjie %A Zhao,Qingchuan %+ Xijing Hospital of Digestive Diseases, Xijing Hospital, Fourth Military Medical University, 127 Changlexi Street, Xi'an, 710032, China, 86 2984771533, wsqfmmu@126.com %K fever %K gastrointestinal surgery %K temperature measurement %K temperature %K detection %K gastrointestinal %K cross-sectional study %D 2024 %7 9.10.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Postoperative fever frequently indicates surgical complications and is commonly used to evaluate the efficacy of interventions against surgical stress. However, the presence of circadian rhythms in body temperature may compromise the accurate detection of fever. Objective: This study aimed to investigate the detection rate of fever under intermittent measurement. Methods: We retrospectively reviewed the clinical records of patients who underwent nonemergency gastrointestinal surgery between November 2020 and April 2021. Patients’ temperature data were continuously collected every 4 seconds using a wireless axillary thermometer, and fever was defined as a temperature exceeding 38 °C within a day. To simulate intermittent measurement in clinical practice, the body temperature at each hour was selected from the continuously collected temperature dataset. Considering that temperatures are measured multiple times per day, all possible measurement plans using intermittent measurement were composed by combining 1-24 time points from the 24-hour daily cycle. Fever was clinically diagnosed based on the temperature readings at the selected time points per day. The fever detection rates for each plan, with varying measurement times, were listed and ranked. Results: Based on the temperature data continuously collected by the thermometer, fever occurred in 60 (40.8%) of the 147 included patients within 3 days after surgery. Of the measurement plans that included 1-24 measurements daily, the fever detection rates ranged from 3.3% (2/60) to 85% (51/60). The highest detection rates and corresponding timings for measurement plans with 1, 2, 3, and 4 measurements daily were 38.3% (23/60; at 8 PM), 56.7% (34/60; at 3 AM and 7 or 8 PM), 65% (39/60; at 3 AM, 8 PM, and 10 or 11 PM), and 70% (42/60; at 12 AM, 3 AM, 8 PM, and 11 PM), respectively; and the lowest detection rates were 3.3% (2/60), 6.7% (4/60), 6.7% (4/60), and 8.3% (5/60), respectively. Although fever within 3 days after surgery was not correlated with an increased incidence of postoperative complications (5/60, 8.3% vs 6/87, 6.9%; P=.76), it was correlated with a longer hospital stay (median 7, IQR 6-9 days vs median 6, IQR 5-7 days; P<.001). Conclusions: The fever detection rate of the intermittent approach is determined by the timing and frequency of measurement. Measuring at randomly selected time points can miss many fever events after gastrointestinal surgery. However, we can improve the fever detection rate by optimizing the timing and frequency of measurement. %M 39383527 %R 10.2196/50585 %U https://www.i-jmr.org/2024/1/e50585 %U https://doi.org/10.2196/50585 %U http://www.ncbi.nlm.nih.gov/pubmed/39383527 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53557 %T User-Centered Design for Designing and Evaluating a Prototype of a Data Collection Tool to Submit Information About Incidents of Violence Against Sex Workers: Multiple Methods Approach %A Ditmore,Melissa H %A Florez-Arango,Jose Fernando %K mobile health %K sex worker %K user-centered design methods %K usability %K heuristic analysis %K cognitive walkthrough %K aggression %K abuse %K occupational health %K reporting %K prototype %K heuristics %K human-centered design %K implementation %K barriers %K enablers %K data collection %K digital health %K underreporting %D 2024 %7 9.10.2024 %9 %J JMIR Hum Factors %G English %X Background: Sex workers face an epidemic of violence in the United States. However, violence against sex workers in the United States is underreported. Sex workers hesitate to report it to the police because they are frequently punished themselves; therefore, an alternative for reporting is needed. Objective: We aim to apply human-centered design methods to create and evaluate the usability of the prototype interface for ReportVASW (violence against sex worker, VASW) and identify opportunities for improvement. Methods: This study explores ways to improve the prototype of ReportVASW, with particular attention to ways to improve the data collection tool. Evaluation methods included cognitive walkthrough, system usability scale, and heuristic evaluation. Results: End users were enthusiastic about the idea of a website to document violence against sex workers. ReportVASW scored 90 on the system usability scale. The tool scored neutral on consistency, and all other responses were positive toward the app, with most being strong. Conclusions: Many opportunities to improve the interface were identified. Multiple methods identified multiple issues to address. Most changes are not overly complex, and the majority were aesthetic or minor. Further development of the ReportVASW data collection tool is worth pursuing. %R 10.2196/53557 %U https://humanfactors.jmir.org/2024/1/e53557 %U https://doi.org/10.2196/53557 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56851 %T Development and Validation of a Computed Tomography–Based Model for Noninvasive Prediction of the T Stage in Gastric Cancer: Multicenter Retrospective Study %A Tao,Jin %A Liu,Dan %A Hu,Fu-Bi %A Zhang,Xiao %A Yin,Hongkun %A Zhang,Huiling %A Zhang,Kai %A Huang,Zixing %A Yang,Kun %+ Department of General Surgery and Laboratory of Gastric Cancer, State Key Laboratory of Biotherapy/Collaborative Innovation Center of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Guo Xue street, Chengdu, 610041, China, 86 18980606729, yangkun068@163.com %K gastric cancer %K computed tomography %K radiomics %K T stage %K deep learning %K cancer %K multicenter study %K accuracy %K binary classification %K tumor %K hybrid model %K performance %K pathological stage %D 2024 %7 9.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: As part of the TNM (tumor-node-metastasis) staging system, T staging based on tumor depth is crucial for developing treatment plans. Previous studies have constructed a deep learning model based on computed tomographic (CT) radiomic signatures to predict the number of lymph node metastases and survival in patients with resected gastric cancer (GC). However, few studies have reported the combination of deep learning and radiomics in predicting T staging in GC. Objective: This study aimed to develop a CT-based model for automatic prediction of the T stage of GC via radiomics and deep learning. Methods: A total of 771 GC patients from 3 centers were retrospectively enrolled and divided into training, validation, and testing cohorts. Patients with GC were classified into mild (stage T1 and T2), moderate (stage T3), and severe (stage T4) groups. Three predictive models based on the labeled CT images were constructed using the radiomics features (radiomics model), deep features (deep learning model), and a combination of both (hybrid model). Results: The overall classification accuracy of the radiomics model was 64.3% in the internal testing data set. The deep learning model and hybrid model showed better performance than the radiomics model, with overall classification accuracies of 75.7% (P=.04) and 81.4% (P=.001), respectively. On the subtasks of binary classification of tumor severity, the areas under the curve of the radiomics, deep learning, and hybrid models were 0.875, 0.866, and 0.886 in the internal testing data set and 0.820, 0.818, and 0.972 in the external testing data set, respectively, for differentiating mild (stage T1~T2) from nonmild (stage T3~T4) patients, and were 0.815, 0.892, and 0.894 in the internal testing data set and 0.685, 0.808, and 0.897 in the external testing data set, respectively, for differentiating nonsevere (stage T1~T3) from severe (stage T4) patients. Conclusions: The hybrid model integrating radiomics features and deep features showed favorable performance in diagnosing the pathological stage of GC. %M 39382960 %R 10.2196/56851 %U https://www.jmir.org/2024/1/e56851 %U https://doi.org/10.2196/56851 %U http://www.ncbi.nlm.nih.gov/pubmed/39382960 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58110 %T Ability of Heart Rate Recovery and Gait Kinetics in a Single Wearable to Predict Frailty: Quasiexperimental Pilot Study %A Merchant,Reshma Aziz %A Loke,Bernard %A Chan,Yiong Huak %+ Division of Geriatric Medicine, Department of Medicine, National University Hospital, 1E Kent Ridge Road, Singapore, 119228, Singapore, 65 +6567795555, mdcram@nus.edu.sg %K falls %K fall prevention %K wearables %K older adult %K community dwelling older adults %K gait %K gait kinetics %K gait analysis %K biomechanics %K sensors %K gerontology %D 2024 %7 3.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Aging is a risk factor for falls, frailty, and disability. The utility of wearables to screen for physical performance and frailty at the population level is an emerging research area. To date, there is a limited number of devices that can measure frailty and physical performance simultaneously. Objective: The aim of this study is to evaluate the accuracy and validity of a continuous digital monitoring wearable device incorporating gait mechanics and heart rate recovery measurements for detecting frailty, poor physical performance, and falls risk in older adults at risk of falls. Methods: This is a substudy of 156 community-dwelling older adults ≥60 years old with falls or near falls in the past 12 months who were recruited for a fall prevention intervention study. Of the original participants, 22 participants agreed to wear wearables on their ankles. An interview questionnaire involving demographics, cognition, frailty (FRAIL), and physical function questions as well as the Falls Risk for Older People in the Community (FROP-Com) was administered. Physical performance comprised gait speed, timed up and go (TUG), and the Short Physical Performance Battery (SPPB) test. A gait analyzer was used to measure gait mechanics and steps (FRAIL-functional: fatigue, resistance, and aerobic), and a heart rate analyzer was used to measure heart rate recovery (FRAIL-nonfunctional: weight loss and chronic illness). Results: The participants’ mean age was 74.6 years. Of the 22 participants, 9 (41%) were robust, 10 (46%) were prefrail, and 3 (14%) were frail. In addition, 8 of 22 (36%) had at least one fall in the past year. Participants had a mean gait speed of 0.8 m/s, a mean SPPB score of 8.9, and mean TUG time of 13.8 seconds. The sensitivity, specificity, and area under the curve (AUC) for the gait analyzer against the functional domains were 1.00, 0.84, and 0.92, respectively, for SPPB (balance and gait); 0.38, 0.89, and 0.64, respectively, for FRAIL-functional; 0.45, 0.91, and 0.68, respectively, for FROP-Com; 0.60, 1.00, and 0.80, respectively, for gait speed; and 1.00, 0.94, and 0.97, respectively, for TUG. The heart rate analyzer demonstrated superior validity for the nonfunctional components of frailty, with a sensitivity of 1.00, specificity of 0.73, and AUC of 0.83. Conclusions: Agreement between the gait and heart rate analyzers and the functional components of the FRAIL scale, gait speed, and FROP-Com was significant. In addition, there was significant agreement between the heart rate analyzer and the nonfunctional components of the FRAIL scale. The gait and heart rate analyzers could be used in a screening test for frailty and falls in community-dwelling older adults but require further improvement and validation at the population level. %M 39361400 %R 10.2196/58110 %U https://formative.jmir.org/2024/1/e58110 %U https://doi.org/10.2196/58110 %U http://www.ncbi.nlm.nih.gov/pubmed/39361400 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54304 %T Assessing the Response Results of an mHealth-Based Patient Experience Survey Among People Receiving HIV Care in Lusaka, Zambia: Cohort Study %A Mutale,Jacob %A Sikombe,Kombatende %A Mwale,Boroma %A Lumpa,Mwansa %A Simbeza,Sandra %A Bukankala,Chama %A Mukamba,Njekwa %A Mody,Aaloke %A Beres,Laura K %A Holmes,Charles B %A Bolton Moore,Carolyn %A Geng,Elvin H %A Sikazwe,Izukanji %A Pry,Jake M %+ School of Medicine, University of California, Davis, 4610 X Street, Sacramento, CA, 95817, United States, 1 916 734 4800, jmpry@ucdavis.edu %K mHealth %K mobile health %K survey %K incentives %K HIV %K Zambia %K airtime %K USSD %K unstructured supplementary service data %K HIV care %K pilot study %K mobile phone %K public health service %K mobile health %K urban %K rural %K regression model %K longitudinal %K mobile %K patient feedback %D 2024 %7 30.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: This pilot study evaluates the effectiveness of mobile talk-time incentives in maintaining participation in a longitudinal mobile health (mHealth) data collection program among people living with HIV in Lusaka, Zambia. While mHealth tools, such as mobile phone surveys, provide vital health feedback, optimal incentive strategies to ensure long-term engagement remain limited. This study explores how different incentive levels affect response rates in multiple survey rounds, providing insights into effective methods for encouraging ongoing participation, especially in the context of Zambia’s prepaid mobile system and multi-SIM usage, a common practice in sub-Saharan Africa. Objective: This study aimed to assess the response rate success across multiple invitations to participate in a care experience survey using a mobile phone short codes and unstructured supplementary service data (USSD) model among individuals in an HIV care setting in the Lusaka, Zambia. Methods: Participants were recruited from 2 study clinics–1 in a periurban setting and 1 in an urban setting. A total of 2 rounds of survey invitations were sent to study participants on a 3-month interval between November 1, 2018, and September 23, 2019. Overall, 3 incentive levels were randomly assigned by participant and survey round: (1) no incentive, (2) 2 Zambian Kwacha (ZMW; US $0.16), and (3) 5 ZMW (US $0.42). Survey response rates were analyzed using mixed-effects Poisson regression, adjusting for individual- and facility-level factors. Probability plots for survey completion were generated based on language, incentive level, and survey round. We projected the cost per additional response for different incentive levels. Results: A total of 1006 participants were enrolled, with 72.3% (727/1006) from the urban HIV care facility and 62.4% (628/1006) requesting the survey in English. We sent a total of 1992 survey invitations for both rounds. Overall, survey completion across both surveys was 32.1% (637/1992), with significantly different survey completion between the first (40.5%, 95% CI 37.4-43.6%) and second (23.7%, 95% CI 21.1-26.4) invitations. Implementing a 5 ZMW (US $0.42) incentive significantly increased the adjusted prevalence ratio (aPR) for survey completion compared with those that received no incentive (aPR 1.35, 95% CI 1.11-1.63). The cost per additional response was highest at 5 ZMW, equivalent to US $0.42 (72.8 ZMW [US $5.82] per 1% increase in response). Conclusions: We observed a sharp decline of almost 50% in survey completion success from the initial invitation to follow-up survey administered 3 months later. This substantial decrease suggests that longitudinal data collection potential for a care experience survey may be limited without additional sensitization and, potentially, added survey reminders. Implementing a moderate incentive increased response rates to our health care experience survey. Tailoring survey strategies to accommodate language preferences and providing moderate incentives can optimize response rates in Zambia. Trial Registration: Pan African Clinical Trial Registry PACTR202101847907585; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=14613 %M 39348170 %R 10.2196/54304 %U https://www.jmir.org/2024/1/e54304 %U https://doi.org/10.2196/54304 %U http://www.ncbi.nlm.nih.gov/pubmed/39348170 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e54427 %T Impact of Health Informatics Analyst Education on Job Role, Career Transition, and Skill Development: Survey Study %A Lee,Kye Hwa %A Lee,Jae Ho %A Lee,Yura %A Lee,Hyunna %A Lee,Ji Sung %A Jang,Hye Jeon %A Lee,Kun Hee %A Han,Jeong Hyun %A Jang,SuJung %K health informatics %K health informatics training %K informatics training %K professional development %K training program %K digital health technology %K informatics workforce %K informatics competencies %K competencies %K job skills %K continuing education %K data science %D 2024 %7 25.9.2024 %9 %J JMIR Med Educ %G English %X Background: Professionals with expertise in health informatics play a crucial role in the digital health sector. Despite efforts to train experts in this field, the specific impact of such training, especially for individuals from diverse academic backgrounds, remains undetermined. Objective: This study therefore aims to evaluate the effectiveness of an intensive health informatics training program on graduates with respect to their job roles, transitions, and competencies and to provide insights for curriculum design and future research. Methods: A survey was conducted among 206 students who completed the Advanced Health Informatics Analyst program between 2018 and 2022. The questionnaire comprised four categories: (1) general information about the respondent, (2) changes before and after program completion, (3) the impact of the program on professional practice, and (4) continuing education requirements. Results: The study received 161 (78.2%) responses from the 206 students. Graduates of the program had diverse academic backgrounds and consequently undertook various informatics tasks after their training. Most graduates (117/161, 72.7%) are now involved in tasks such as data preprocessing, visualizing results for better understanding, and report writing for data processing and analysis. Program participation significantly improved job performance (P=.03), especially for those with a master’s degree or higher (odds ratio 2.74, 95% CI 1.08‐6.95) and those from regions other than Seoul or Gyeonggi-do (odds ratio 10.95, 95% CI 1.08‐6.95). A substantial number of respondents indicated that the training had a substantial influence on their career transitions, primarily by providing a better understanding of job roles and generating intrinsic interest in the field. Conclusions: The integrated practical education program was effective in addressing the diverse needs of trainees from various fields, enhancing their capabilities, and preparing them for the evolving industry demands. This study emphasizes the value of providing specialized training in health informatics for graduates regardless of their discipline. %R 10.2196/54427 %U https://mededu.jmir.org/2024/1/e54427 %U https://doi.org/10.2196/54427 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60129 %T A Digital Intervention for Capturing the Real-Time Health Data Needed for Epilepsy Seizure Forecasting: Protocol for a Formative Co-Design and Usability Study (The ATMOSPHERE Study) %A Quilter,Emily E V %A Downes,Samuel %A Deighan,Mairi Therese %A Stuart,Liz %A Charles,Rosie %A Tittensor,Phil %A Junges,Leandro %A Kissack,Peter %A Qureshi,Yasser %A Kamaraj,Aravind Kumar %A Brigden,Amberly %+ School of Engineering Mathematics and Technology, University of Bristol, 1 Cathedral Square, Bristol, BS1 5DD, United Kingdom, 44 01174282343, amberly.brigden@bristol.ac.uk %K epilepsy %K seizure forecasting %K data science %K artificial intelligence %K machine learning %K wearable technology %K mobile phone %D 2024 %7 19.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Epilepsy is a chronic neurological disorder affecting individuals globally, marked by recurrent and apparently unpredictable seizures that pose significant challenges, including increased mortality, injuries, and diminished quality of life. Despite advancements in treatments, a significant proportion of people with epilepsy continue to experience uncontrolled seizures. The apparent unpredictability of these events has been identified as a major concern for people with epilepsy, highlighting the need for innovative seizure forecasting technologies. Objective: The ATMOSPHERE study aimed to develop and evaluate a digital intervention, using wearable technology and data science, that provides real-time, individualized seizure forecasting for individuals living with epilepsy. This paper reports the protocol for one of the workstreams focusing on the design and testing of a prototype to capture real-time input data needed for predictive modeling. The first aim was to collaboratively design the prototype (work completed). The second aim is to conduct an “in-the-wild” study to assess usability and refine the prototype (planned research). Methods: This study uses a person-based approach to design and test the usability of a prototype for real-time seizure precipitant data capture. Phase 1 (work completed) involved co-design with individuals living with epilepsy and health care professionals. Sessions explored users’ requirements for the prototype, followed by iterative design of low-fidelity, static prototypes. Phase 2 (planned research) will be an “in-the-wild” usability study involving the deployment of a mid-fidelity, functional prototype for 4 weeks, with the collection of mixed methods usability data to assess the prototype’s real-world application, feasibility, acceptability, and engagement. This phase involves primary participants (adults diagnosed with epilepsy) and, optionally, their nominated significant other. The usability study will run in 3 rounds of deployment and data collection, aiming to recruit 5 participants per round, with prototype refinement between rounds. Results: The phase-1 co-design study engaged 22 individuals, resulting in the development of a mid-fidelity, functional prototype based on identified requirements, including the tracking of evidence-based and personalized seizure precipitants. The upcoming phase-2 usability study is expected to provide insights into the prototype’s real-world usability, identify areas for improvement, and refine the technology for future development. The estimated completion date of phase 2 is the last quarter of 2024. Conclusions: The ATMOSPHERE study aims to make a significant step forward in epilepsy management, focusing on the development of a user-centered, noninvasive wearable device for seizure forecasting. Through a collaborative design process and comprehensive usability testing, this research aims to address the critical need for predictive seizure forecasting technologies, offering a promising approach to improving the lives of individuals with epilepsy. By leveraging predictive analytics and personalized machine learning models, this technology seeks to offer a novel approach to managing epilepsy, potentially improving clinical outcomes, including quality of life, through increased predictability and seizure management. International Registered Report Identifier (IRRID): DERR1-10.2196/60129 %M 39298757 %R 10.2196/60129 %U https://www.researchprotocols.org/2024/1/e60129 %U https://doi.org/10.2196/60129 %U http://www.ncbi.nlm.nih.gov/pubmed/39298757 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56591 %T Acceptance of Electronic Labeling for Medicinal Product Information Among Malaysian Hospital Patients: Cross-Sectional Study %A Loh,Xin Yee %A Woo,Ai Ling %A Haris,Azwa %A Pereira,Cheryl Shajini %A Tan,Bee Kim %+ School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, 1 Jalan Taylors, Subang Jaya, 47500, Malaysia, 60 3 5629 5000, beekim.tan@taylors.edu.my %K electronic labeling %K e-labeling %K electronic medication information %K patient preference %K acceptance %K hospital ambulatory care patient %D 2024 %7 18.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: While perceptions of electronic labeling (e-labeling) in developed countries have been generally positive, existing data primarily come from studies involving hospital pharmacists, community pharmacy customers who may not be frequent medication users, and individuals receiving COVID-19 vaccines. Objective: This study aims to assess e-labeling acceptance, perceptions of its benefits, challenges with its implementation, and preferences among hospital ambulatory care patients in Malaysia. Additionally, the study investigates the factors influencing patients’ acceptance of e-labeling. Methods: A cross-sectional study using a 28-item questionnaire was conducted at the outpatient pharmacy department of a quaternary hospital in Kuala Lumpur, Malaysia, from May to June 2023. The questionnaire was developed based on a review of published literature related to e-labeling and was guided by the Unified Theory of Acceptance and Use of Technology, second version (UTAUT2). Patients aged 18 years and above were recruited using a stratified sampling method to ensure representative age-related medication usage. A mobile tablet was provided to patients for self-completion of the e-survey in their preferred language (English, Malay, or Mandarin). Categorical data on e-labeling acceptance, perceptions, and preferences were analyzed using descriptive statistics. Qualitative content analysis was performed to characterize participants’ responses to open-ended questions. Univariate and multivariate binomial logistic regression analyses were conducted to identify predictors of e-labeling acceptance. Results: Out of 462 patients approached, 387 (83.8%) participated in the survey, with 283 (73.1%) accepting e-labeling. Most participants perceived the electronic version of the package insert as beneficial, particularly for understanding their medication better through the choice of language (352/387, 91.0%). However, around half of the participants (197/387, 50.9%) expressed concerns about the potential risks of obtaining illegal medication information via e-labeling. Most participants (302/387, 78.0%) preferred to access electronic leaflets through government websites. However, 221/387 (57.1%) still wanted the option to request printed leaflets. Significant predictors of e-labeling acceptance included perceived benefits such as better understanding of medication (adjusted odds ratio [AOR] 8.02, 95% CI 2.80-22.97, P<.001), environmental protection (AOR 7.24, 95% CI 3.00-17.51, P<.001), and flexibility in information retrieval (AOR 2.66, 95% CI 1.11-6.35, P=.03). Conversely, being of Chinese ethnicity compared with Malay (AOR 0.28, 95% CI 0.13-0.60, P=.005) and perceived lack of self-efficacy in browsing electronic leaflets (AOR 0.25, 95% CI 0.11-0.56, P<.001) were associated with lower acceptance. Conclusions: The acceptance rate for e-labeling among hospital ambulatory care patients was moderately high and was significantly influenced by ethnicity as well as patients’ perceived benefits and challenges related to its implementation. Future strategies to enhance e-labeling uptake should address patient concerns regarding the challenges of using the digital platform and emphasize the benefits of e-labeling. %M 39293048 %R 10.2196/56591 %U https://www.jmir.org/2024/1/e56591 %U https://doi.org/10.2196/56591 %U http://www.ncbi.nlm.nih.gov/pubmed/39293048 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e58432 %T Data Integrity Issues With Web-Based Studies: An Institutional Example of a Widespread Challenge %A French,Blandine %A Babbage,Camilla %A Bird,Katherine %A Marsh,Lauren %A Pelton,Mirabel %A Patel,Shireen %A Cassidy,Sarah %A Rennick-Egglestone,Stefan %+ School of Psychology, University of Nottingham, University Park Campus, Psychology, Pharmacy, Life Sciences, East Dr, Nottingham, NG7 2RD, United Kingdom, 44 0115 748 6970, blandine.french@nottingham.ac.uk %K web-based research %K web-based studies %K qualitative studies %K surveys %K mental health %K data integrity, misrepresentation %D 2024 %7 16.9.2024 %9 Viewpoint %J JMIR Ment Health %G English %X This paper reports on the growing issues experienced when conducting web-based–based research. Nongenuine participants, repeat responders, and misrepresentation are common issues in health research posing significant challenges to data integrity. A summary of existing data on the topic and the different impacts on studies is presented. Seven case studies experienced by different teams within our institutions are then reported, primarily focused on mental health research. Finally, strategies to combat these challenges are presented, including protocol development, transparent recruitment practices, and continuous data monitoring. These strategies and challenges impact the entire research cycle and need to be considered prior to, during, and post data collection. With a lack of current clear guidelines on this topic, this report attempts to highlight considerations to be taken to minimize the impact of such challenges on researchers, studies, and wider research. Researchers conducting web-based research must put mitigating strategies in place, and reporting on mitigation efforts should be mandatory in grant applications and publications to uphold the credibility of web-based research. %R 10.2196/58432 %U https://mental.jmir.org/2024/1/e58432 %U https://doi.org/10.2196/58432 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e60039 %T Use of Web-Based Surveys to Collect Long-Term Pediatric Outcomes in Patients With Twin-Twin Transfusion Syndrome Treated With Fetoscopic Laser Photocoagulation: Observational Study %A Bergh,Eric %A Rennie,Kimberly %A Espinoza,Jimmy %A Johnson,Anthony %A Papanna,Ramesha %K automation %K REDCap %K data collection %K reporting %K response rate %K response rates %K survey %K surveys %K questionnaire %K questionnaires %K fetal medicine %K pediatric outcomes %K long-term outcomes %K photocoagulation %K twin %K twins %K blood %K pregnant %K pregnancy %K pediatric %K pediatrics %K infant %K infants %K infancy %K baby %K babies %K neonate %K neonates %K neonatal %K newborn %K newborns %K maternal %K in utero %K TTTS %K fetus %K fetal %K twin-twin transfusion syndrome %D 2024 %7 11.9.2024 %9 %J JMIR Pediatr Parent %G English %X Background: In the United States, patients with monochorionic diamniotic twins who undergo in utero fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome (TTTS) may travel great distances for care. After delivery, many parents cannot return to study sites for formal pediatric evaluation due to geographic location and cost. Objective: The aim of this study was to collect long-term pediatric outcomes in patients who underwent FLP for TTTS. Methods: We assessed the feasibility of using a web-based survey designed in REDCap (Research Electronic Data Capture; Vanderbilt University) to collect parent-reported outcomes in children treated for TTTS at a single center during 2011‐2019. Patients with ≥1 neonatal survivor were invited via email to complete 5 possible questionnaires: the child status questionnaire (CSQ); fetal center questionnaire (FCQ); Ages & Stages Questionnaires, Third Edition (ASQ-3); Modified Checklist for Autism in Toddlers, Revised With Follow-Up (M-CHAT-R/F); and thank you questionnaire (TYQ). The R programming language (R Foundation for Statistical Computing) was used to automate survey distribution, scoring, and creation of customized reports. The survey was performed in 2019 and repeated after 12 months in the same study population in 2020. Results: A total of 389 patients in 26 different states and 2 international locations had an email address on file and received an invitation in 2019 to complete the survey (median pediatric age 48.9, IQR 1.0‐93.6 months). Among surveyed mothers in 2019, the overall response rate was 37.3% (145/389), and the questionnaire completion rate was 98% (145/148), 87.8% (130/148), 71.1% (81/100), 86.4% (19/22), and 74.3% (110/148) for the CSQ, FCQ, ASQ-3, M-CHAT-R/F, and TYQ, respectively. In 2020, the overall response rate was 57.8% (56/97), and the questionnaire completion rate was 96.4% (54/56), 91.1% (51/56), 86.1% (31/36), 91.7% (11/12), and 80.4% (45/56) for the CSQ, FCQ, ASQ-3, M-CHAT-R/F, and TYQ, respectively. Conclusions: This is the first study to use both REDCap and computer automation to aid in the dissemination, collection, and reporting of surveys to collect long-term pediatric outcomes in the field of fetal medicine. %R 10.2196/60039 %U https://pediatrics.jmir.org/2024/1/e60039 %U https://doi.org/10.2196/60039 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e56044 %T Identifying Population Segments by Differing Levels of COVID-19 Vaccine Confidence and Evaluating Subsequent Uptake of COVID-19 Prevention Behaviors: Web-Based, Longitudinal, Probability-Based Panel Survey %A Luchman,Joseph %A Bennett,Morgane %A Kranzler,Elissa %A Tuskeviciute,Rugile %A Vega,Ronald %A Denison,Benjamin %A Trigger,Sarah %A Nighbor,Tyler %A Vines,Monica %A Hoffman,Leah %+ Fors Marsh, 4250 N. Fairfax Drive, Ste 520, Arlington, VA, 22201, United States, 1 5718583800, jluchman@forsmarsh.com %K COVID-19 %K COVID-19 vaccination %K vaccine %K United States %K segmentation %K latent class cluster analysis %K vaccines %K vaccination %K segmentation analysis %K estimation %K validation %K attitude %K attitudes %K belief %K beliefs %K behavior %K behaviors %K sociodemographic %K nonintender %K nonintenders %K waiter %K waiters %K confident %K confidents %K social distancing %K bivariate %K regression analysis %K survey %K respondent %K respondents %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic prompted the launch of the US Department of Health and Human Services’ COVID-19 Public Education Campaign to boost vaccine confidence and uptake among adults, as vaccines are key to preventing severe illness and death. Objective: Past segmentation research relevant to COVID-19 behavior has found important differences in attitudes, sociodemographics, and subsequent COVID-19 prevention behaviors across population segments. This study extends prior work by incorporating a more comprehensive set of attitudes, behaviors, and sociodemographic variables to identify population segments by differing levels of COVID-19 vaccine confidence and evaluate differences in their subsequent uptake of COVID-19 prevention behaviors. Methods: Data were obtained from 5 waves (January 2021 to June 2022) of a web-based longitudinal, probability-based panel survey of US adults (N=4398) administered in English and in Spanish. Participants were recruited from NORC at the University of Chicago’s national AmeriSpeak panel and were invited to participate across multiple waves. Latent class cluster analysis estimated segments of respondents based on over 40 COVID-19 attitudes, beliefs, behaviors, and sociodemographics as reported in wave 1. Survey-weighted cross-tabulations and bivariate regression analyses assessed differences in COVID-19 vaccine uptake, booster uptake, mask use, and social distancing in all segments across all 5 survey waves. Results: A total of 6 segments (hardline nonintenders, prevention-compliant nonintenders, burned-out waiters, anxious waiters, skeptical confidents, and ready confidents) were identified, which differed by their COVID-19 vaccine confidence, prevention-related attitudes and behaviors, and sociodemographics. Cross-tabulations and regression results indicated significant segment membership differences in COVID-19 vaccine and booster timing, mask use, and social distancing. Results from survey-weighted cross-tabulations comparing COVID-19 vaccine and booster uptake across segments indicate statistically significant differences in these outcomes across the 6 segments (P<.001). Results were statistically significant for each segment (P<.01 for booster uptake among burned-out waiters; P<.001 for all other coefficients), indicating that, on average, respondents in segments with lower intentions to vaccinate reported later receipt of COVID-19 vaccines and boosters relative to the timing of vaccine and booster uptake among ready confidents. Conclusions: Results extend previous research by showing that initial beliefs and behaviors relevant to COVID-19 vaccination, mask use, and social distancing are important for understanding differences in subsequent compliance with recommended COVID-19 prevention measures. Specifically, we found that across respondent segments, the probability of vaccine and booster uptake corresponded with both COVID-19 vaccine confidence and mask use and social distancing compliance; more compliant segments were more likely to get vaccinated or boosted than less compliant segments given similar levels of vaccine confidence. These findings help identify appropriate audiences for campaigns. Results highlight the use of a comprehensive list of attitudes, behaviors, and other individual-level characteristics that can serve as a basis for future segmentation efforts relevant to COVID-19 and other infectious diseases. %M 39255032 %R 10.2196/56044 %U https://publichealth.jmir.org/2024/1/e56044 %U https://doi.org/10.2196/56044 %U http://www.ncbi.nlm.nih.gov/pubmed/39255032 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55354 %T Using Text Messaging Surveys in General Practice Research to Engage With People From Low-Income Groups: Multi-Methods Study %A Sturgiss,Elizabeth %A Advocat,Jenny %A Barton,Christopher %A Walker,Emma N %A Nielsen,Suzanne %A Wright,Annemarie %A Lam,Tina %A Gunatillaka,Nilakshi %A Oad,Symrin %A Wood,Christopher %+ School of Primary and Allied Health Care, Monash University, Peninsula Campus, Moorooduc Highway, Frankston, 3199, Australia, 61 412233119, liz.sturgiss@monash.edu %K SMS %K data collection %K research methods %K disadvantaged population %K priority populations %K message %K messages %K messaging %K disadvantaged %K underserved %K survey %K surveys %K digital divide %K marginalized %K access %K accessibility %K barrier %K barriers %K smartphone %K smartphones %K digital health %K underrepresented %K data collection %K mobile phone %K short message service %D 2024 %7 5.9.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: SMS text messages through mobile phones are a common means of interpersonal communication. SMS text message surveys are gaining traction in health care and research due to their feasibility and patient acceptability. However, challenges arise in implementing SMS text message surveys, especially when targeting marginalized populations, because of barriers to accessing phones and data as well as communication difficulties. In primary care, traditional surveys (paper-based and online) often face low response rates that are particularly pronounced among disadvantaged groups due to financial limitations, language barriers, and time constraints. Objective: This study aimed to investigate the potential of SMS text message–based patient recruitment and surveys within general practices situated in lower socioeconomic areas. This study was nested within the Reducing Alcohol-Harm in General Practice project that aimed to reduce alcohol-related harm through screening in Australian general practice. Methods: This study follows a 2-step SMS text message data collection process. An initial SMS text message with an online survey link was sent to patients, followed by subsequent surveys every 3 months for consenting participants. Interviews were conducted with the local primary health network organization staff, the participating practice staff, and the clinicians. The qualitative data were analyzed using constructs from the Consolidated Framework for Implementation Research. Results: Out of 6 general practices, 4 were able to send SMS text messages to their patients. The initial SMS text message was sent to 8333 patients and 702 responses (8.2%) were received, most of which were not from a low-income group. This low initial response was in contrast to the improved response rate to the ongoing 3-month SMS text message surveys (55/107, 51.4% at 3 months; 29/67, 43.3% at 6 months; and 44/102, 43.1% at 9 months). We interviewed 4 general practitioners, 4 nurses, and 4 administrative staff from 5 of the different practices. Qualitative data uncovered barriers to engaging marginalized groups including limited smartphone access, limited financial capacity (telephone, internet, and Wi-Fi credit), language barriers, literacy issues, mental health conditions, and physical limitations such as manual dexterity and vision issues. Practice managers and clinicians suggested strategies to overcome these barriers, including using paper-based surveys in trusted spaces, offering assistance during survey completion, and offering honoraria to support participation. Conclusions: While SMS text message surveys for primary care research may be useful for the broader population, additional efforts are required to ensure the representation and involvement of marginalized groups. More intensive methods such as in-person data collection may be more appropriate to capture the voice of low-income groups in primary care research. International Registered Report Identifier (IRRID): RR2-10.3399/BJGPO.2021.0037 %M 39235843 %R 10.2196/55354 %U https://mhealth.jmir.org/2024/1/e55354 %U https://doi.org/10.2196/55354 %U http://www.ncbi.nlm.nih.gov/pubmed/39235843 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47882 %T The Digital Platform and Its Emerging Role in Decentralized Clinical Trials %A Copland,Rachel R %A Hanke,Sten %A Rogers,Amy %A Mpaltadoros,Lampros %A Lazarou,Ioulietta %A Zeltsi,Alexandra %A Nikolopoulos,Spiros %A MacDonald,Thomas M %A Mackenzie,Isla S %+ MEMO Research, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, United Kingdom, 44 1382388380, rcopland001@dundee.ac.uk %K decentralized clinical trials %K digital platform %K digitalization %K clinical trials %K mobile phone %D 2024 %7 3.9.2024 %9 Viewpoint %J J Med Internet Res %G English %X Decentralized clinical trials (DCTs) are becoming increasingly popular. Digital clinical trial platforms are software environments where users complete designated clinical trial tasks, providing investigators and trial participants with efficient tools to support trial activities and streamline trial processes. In particular, digital platforms with a modular architecture lend themselves to DCTs, where individual trial activities can correspond to specific platform modules. While design features can allow users to customize their platform experience, the real strengths of digital platforms for DCTs are enabling centralized data capture and remote monitoring of trial participants and in using digital technologies to streamline workflows and improve trial management. When selecting a platform for use in a DCT, sponsors and investigators must consider the specific trial requirements. All digital platforms are limited in their functionality and technical capabilities. Integrating additional functional modules into a central platform may solve these challenges, but few commercial platforms are open to integrating third-party components. The lack of common data standardization protocols for clinical trials will likely limit the development of one-size-fits-all digital platforms for DCTs. This viewpoint summarizes the current role of digital platforms in supporting decentralized trial activities, including a discussion of the potential benefits and challenges of digital platforms for investigators and participants. We will highlight the role of the digital platform in the development of DCTs and emphasize where existing technology is functionally limiting. Finally, we will discuss the concept of the ideal fully integrated and unified DCT and the obstacles developers must address before it can be realized. %M 39226549 %R 10.2196/47882 %U https://www.jmir.org/2024/1/e47882 %U https://doi.org/10.2196/47882 %U http://www.ncbi.nlm.nih.gov/pubmed/39226549 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54450 %T Strategies for Identifying and Recruiting Women at High Risk for Breast Cancer for Research Outside of Clinical Settings: Observational Study %A Conley,Claire C %A Rodriguez,Jennifer D %A McIntyre,McKenzie %A Niell,Bethany L %A O'Neill,Suzanne C %A Vadaparampil,Susan T %+ Department of Oncology, Georgetown University, 2115 Wisconsin Ave NW, Suite 300, Washington, DC, 20007, United States, 1 2026875086, claire.conley@georgetown.edu %K breast cancer %K high-risk populations %K risk management %K recruitment %K woman %K women %K high risk %K observational study %K cross-sectional %K Facebook %K Twitter %K flyer %K flyers %K community events %K community event %K genetic mutation %D 2024 %7 2.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Research is needed to understand and address barriers to risk management for women at high (≥20% lifetime) risk for breast cancer, but recruiting this population for research studies is challenging. Objective: This paper compares a variety of recruitment strategies used for a cross-sectional, observational study of high-risk women. Methods: Eligible participants were assigned female at birth, aged 25-85 years, English-speaking, living in the United States, and at high risk for breast cancer as defined by the American College of Radiology. Individuals were excluded if they had a personal history of breast cancer, prior bilateral mastectomy, medical contraindications for magnetic resonance imaging, or were not up-to-date on screening mammography per American College of Radiology guidelines. Participants were recruited from August 2020 to January 2021 using the following mechanisms: targeted Facebook advertisements, Twitter posts, ResearchMatch (a web-based research recruitment database), community partner promotions, paper flyers, and community outreach events. Interested individuals were directed to a secure website with eligibility screening questions. Participants self-reported method of recruitment during the eligibility screening. For each recruitment strategy, we calculated the rate of eligible respondents and completed surveys, costs per eligible participant, and participant demographics. Results: We received 1566 unique responses to the eligibility screener. Participants most often reported recruitment via Facebook advertisements (724/1566, 46%) and ResearchMatch (646/1566, 41%). Community partner promotions resulted in the highest proportion of eligible respondents (24/46, 52%), while ResearchMatch had the lowest proportion of eligible respondents (73/646, 11%). Word of mouth was the most cost-effective recruitment strategy (US $4.66 per completed survey response) and paper flyers were the least cost-effective (US $1448.13 per completed survey response). The demographic characteristics of eligible respondents varied by recruitment strategy: Twitter posts and community outreach events resulted in the highest proportion of Hispanic or Latina women (1/4, 25% and 2/6, 33%, respectively), and community partner promotions resulted in the highest proportion of non-Hispanic Black women (4/24, 17%). Conclusions: Although recruitment strategies varied in their yield of study participants, results overall support the feasibility of identifying and recruiting women at high risk for breast cancer outside of clinical settings. Researchers must balance the associated costs and participant yield of various recruitment strategies in planning future studies focused on high-risk women. %M 39222344 %R 10.2196/54450 %U https://www.jmir.org/2024/1/e54450 %U https://doi.org/10.2196/54450 %U http://www.ncbi.nlm.nih.gov/pubmed/39222344 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56957 %T Feasibility and Acceptability Study of a Culturally Adapted Web-Based Intervention to Reduce Suicidal Ideation for Syrian Asylum Seekers and Refugees in the United Kingdom: Protocol for a Mixed Methods Study %A Beuthin,Oliver %A Shahid,Sadiya %A Yu,Ly-Mee %A Bhui,Kamaldeep %+ Department of Psychiatry, University of Oxford, Linacre College, St Cross Road, Oxford, OX1 3JA, United Kingdom, 44 1865 618200, oliver.beuthin@linacre.ox.ac.uk %K cultural adaptation %K digital mental health %K suicidal ideation %K refugee mental health %K Syrian refugee %K experience-based co-design %K mental health %K suicide %K suicidal %K refugee %K immigrant %K ethnic minority %K asylum %K user experience %K cultural %K Syria %K Syrian %K refugees %K feasibility %K acceptability %K depression %K anxiety %K posttraumatic stress disorder %K United Kingdom %K Arabic-speaking %D 2024 %7 2.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The war in Syria has displaced over 6.8 million people, more than any other conflict since the Second World War. As a result, Syrian asylum seekers and refugees have experienced several life-changing events, resulting in high rates of anxiety, depression, posttraumatic stress disorder, and suicidal ideation (SI). To address the treatment gap and reduce the burden of help-seeking, a web-based intervention to reduce SI developed for general populations was culturally adapted for and with Syrian asylum seekers and refugees in the United Kingdom. The study revealed the importance of understanding their lived experience with migration and the acculturative process in providing treatment for SI. This study will now assess the feasibility and acceptability of the culturally adapted intervention for this population. Objective: The first phase of the study will include recruiting participants and delivering the web-based intervention (1) to assess the feasibility of meeting recruitment goals and recruitment rates and (2) to assess the feasibility of outcome measures. The second phase of the study will include one-to-one semistructured interviews (1) to assess the suitability of the culturally adapted intervention in terms of recruitment and adherence rates and barriers and facilitators to engagement and (2) to assess the acceptability of the intervention in terms of its cultural relevance and appropriateness. Methods: This is a protocol for a single-group, noncontrolled, mixed methods feasibility and acceptability study of a culturally adapted web-based intervention to reduce SI for Syrian asylum seekers and refugees in the United Kingdom. The study will assess the feasibility of recruitment goals, recruitment rates, adherence rates, and outcome measures using individual participant tracking forms, which will be analyzed quantitatively. The suitability and acceptability of the intervention will be assessed using one-to-one semistructured interviews with 12 participants who completed the intervention, which will be analyzed qualitatively. Results: Recruitment began in February 2024 and will run until 30 participants are recruited to the study or until the end of July 2024. Thus far, 19 participants have provided informed consent, 16 were eligible and enrolled, and 12 have completed a postintervention interview. No data have been analyzed. The study, including the write-up period, is expected to end in December 2024. Conclusions: Despite experiencing several stressors related to forced displacement and high rates of mental health issues, access to treatment is still limited for Syrian asylum seekers and refugees in the United Kingdom. To address the treatment gap and reduce the burden of help-seeking, a web-based intervention to reduce SI was culturally adapted in collaboration with Syrian asylum seekers and refugees in the United Kingdom. This study will now assess the feasibility and acceptability of the intervention and culturally appropriate recruitment strategies. Trial Registration: ISRCTN ISRCTN11417025; https://www.isrctn.com/ISRCTN11417025 International Registered Report Identifier (IRRID): PRR1-10.2196/56957 %M 39222345 %R 10.2196/56957 %U https://www.researchprotocols.org/2024/1/e56957 %U https://doi.org/10.2196/56957 %U http://www.ncbi.nlm.nih.gov/pubmed/39222345 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57309 %T Contextual Acceptance of COVID-19 Mitigation Mobile Apps in the United States: Mixed Methods Survey Study on Postpandemic Data Privacy %A Feng,Yuanyuan %A Stenger,Brad %A Zhang,Shikun %+ Department of Computer Science, University of Vermont, 85 South Prospect Street, Burlington, VT, 05405, United States, 1 802 656 3475, yuanyuan.feng@uvm.edu %K data privacy %K health privacy %K COVID-19 %K mobile apps %K contextual integrity %K respiratory %K infectious %K pulmonary %K pandemic %K mobile app %K app %K apps %K digital health %K digital technology %K digital intervention %K digital interventions %K smartphone %K smartphones %K mobile phone %D 2024 %7 29.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic gave rise to countless user-facing mobile apps to help fight the pandemic (“COVID-19 mitigation apps”). These apps have been at the center of data privacy discussions because they collect, use, and even retain sensitive personal data from their users (eg, medical records and location data). The US government ended its COVID-19 emergency declaration in May 2023, marking a unique time to comprehensively investigate how data privacy impacted people’s acceptance of various COVID-19 mitigation apps deployed throughout the pandemic. Objective: This research aims to provide insights into health data privacy regarding COVID-19 mitigation apps and policy recommendations for future deployment of public health mobile apps through the lens of data privacy. This research explores people’s contextual acceptance of different types of COVID-19 mitigation apps by applying the privacy framework of contextual integrity. Specifically, this research seeks to identify the factors that impact people’s acceptance of data sharing and data retention practices in various social contexts. Methods: A mixed methods web-based survey study was conducted by recruiting a simple US representative sample (N=674) on Prolific in February 2023. The survey includes a total of 60 vignette scenarios representing realistic social contexts that COVID-19 mitigation apps could be used. Each survey respondent answered questions about their acceptance of 10 randomly selected scenarios. Three contextual integrity parameters (attribute, recipient, and transmission principle) and respondents’ basic demographics are controlled as independent variables. Regression analysis was performed to determine the factors impacting people’s acceptance of initial data sharing and data retention practices via these apps. Qualitative data from the survey were analyzed to support the statistical results. Results: Many contextual integrity parameter values, pairwise combinations of contextual integrity parameter values, and some demographic features of respondents have a significant impact on their acceptance of using COVID-19 mitigation apps in various social contexts. Respondents’ acceptance of data retention practices diverged from their acceptance of initial data sharing practices in some scenarios. Conclusions: This study showed that people’s acceptance of using various COVID-19 mitigation apps depends on specific social contexts, including the type of data (attribute), the recipients of the data (recipient), and the purpose of data use (transmission principle). Such acceptance may differ between the initial data sharing and data retention practices, even in the same context. Study findings generated rich implications for future pandemic mitigation apps and the broader public health mobile apps regarding data privacy and deployment considerations. %M 39207832 %R 10.2196/57309 %U https://www.jmir.org/2024/1/e57309 %U https://doi.org/10.2196/57309 %U http://www.ncbi.nlm.nih.gov/pubmed/39207832 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55841 %T Implementation of Patient-Reported Outcomes in a Medical Oncology Setting (the iPROMOS Study): Type II Hybrid Implementation Study %A Roberts,Natasha Anne %A Pelecanos,Anita %A Alexander,Kimberly %A Wyld,David %A Janda,Monika %+ The University of Queensland Centre for Clinical Research, Herston Road, Herston, 4029, Australia, 61 7 36468100, natasha.roberts@uq.edu.au %K implementation science %K iPARIHS %K clinical practice %K intervention %K implementation %K facilitator %K facilitation %K patient-reported outcomes, patient-reported outcome measures %K oncology %K symptom %K symptoms %K detection %K investigate %K service %K services %K clinic %K clinics %K Australia %K binary logistic models %K regression model %K regression models %K patient %K patients %K supportive care %D 2024 %7 27.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinical trials have demonstrated that patient-reported outcome measures (PROMs) can improve mortality and morbidity outcomes when used in clinical practice. Objective: This study aimed to prospectively investigate the implementation of PROMs in routine oncology. Outcomes measured included improved symptom detection, clinical response to symptom information, and health service outcomes. Methods: Two of 12 eligible clinics were randomized to implement symptom PROMs in a medical oncology outpatient department in Australia. Randomization was carried out at the clinic level. Patients in control clinics continued with usual care; those in intervention clinics completed a symptom PROM at presentation. This was a pilot study investigating symptom detection, using binary logistic models, and clinical response to PROMs investigated using multiple regression models. Results: A total of 461 patient encounters were included, consisting of 242 encounters in the control and 222 in the intervention condition. Patients in these clinics most commonly had head and neck, lung, prostate, breast, or colorectal cancer and were seen in the clinic for surveillance and oral or systemic treatments for curative, metastatic, or palliative cancer care pathways. Compared with control encounters, the proportion of symptoms detected increased in intervention encounters (odds ratio 1.05, 95% CI 0.99-1.11; P=.08). The odds of receiving supportive care, demonstrated by nonroutine allied health review, increased in the intervention compared with control encounters (odds ratio 3.54, 95% CI 1.26-9.90; P=.02). Conclusions: Implementation of PROMs in routine care did not significantly improve symptom detection but increased the likelihood of nonroutine allied health reviews for supportive care. Larger studies are needed to investigate health service outcomes. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000398202; https://tinyurl.com/3cxbemy4 %M 39190468 %R 10.2196/55841 %U https://www.jmir.org/2024/1/e55841 %U https://doi.org/10.2196/55841 %U http://www.ncbi.nlm.nih.gov/pubmed/39190468 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e38189 %T Recruitment in Appalachian, Rural and Older Adult Populations in an Artificial Intelligence World: Study Using Human-Mediated Follow-Up %A Milliken,Tabitha %A Beiler,Donielle %A Hoffman,Samantha %A Olenginski,Ashlee %A Troiani,Vanessa %+ Research Institute, Geisinger, 100 N. Academy Ave, Danville, PA, 17821, United States, 1 215 681 1733, vtroiani@geisinger.edu %K telecommunication %K enrollment rate %K Northern Appalachia %K web-based %K aging %K recruitment %K rural %D 2024 %7 22.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Participant recruitment in rural and hard-to-reach (HTR) populations can present unique challenges. These challenges are further exacerbated by the need for low-cost recruiting, which often leads to use of web-based recruitment methods (eg, email, social media). Despite these challenges, recruitment strategy statistics that support effective enrollment strategies for underserved and HTR populations are underreported. This study highlights how a recruitment strategy that uses email in combination with follow-up, mostly phone calls and email reminders, produced a higher-than-expected enrollment rate that includes a diversity of participants from rural, Appalachian populations in older age brackets and reports recruitment and demographic statistics within a subset of HTR populations. Objective: This study aims to provide evidence that a recruitment strategy that uses a combination of email, telephonic, and follow-up recruitment strategies increases recruitment rates in various HTR populations, specifically in rural, older, and Appalachian populations. Methods: We evaluated the overall enrollment rate of 1 recruitment arm of a larger study that aims to understand the relationship between genetics and substance use disorders. We evaluated the enrolled population’s characteristics to determine recruitment success of a combined email and follow-up recruitment strategy, and the enrollment rate of HTR populations. These characteristics included (1) enrollment rate before versus after follow-up; (2) zip code and county of enrollee to determine rural or urban and Appalachian status; (3) age to verify recruitment in all eligible age brackets; and (4) sex distribution among age brackets and rural or urban status. Results: The email and follow-up arm of the study had a 17.4% enrollment rate. Of the enrolled participants, 76.3% (4602/6030) lived in rural counties and 23.7% (1428/6030) lived in urban counties in Pennsylvania. In addition, of patients enrolled, 98.7% (5956/6030) were from Appalachian counties and 1.3% (76/6030) were from non-Appalachian counties. Patients from rural Appalachia made up 76.2% (4603/6030) of the total rural population. Enrolled patients represented all eligible age brackets from ages 20 to 75 years, with the 60-70 years age bracket having the most enrollees. Females made up 72.5% (4371/6030) of the enrolled population and males made up 27.5% (1659/6030) of the population. Conclusions: Results indicate that a web-based recruitment method with participant follow-up, such as a phone call and email follow-up, increases enrollment numbers more than web-based methods alone for rural, Appalachian, and older populations. Adding a humanizing component, such as a live person phone call, may be a key element needed to establish trust and encourage patients from underserved and rural areas to enroll in studies via web-based recruitment methods. Supporting statistics on this recruitment strategy should help researchers identify whether this strategy may be useful in future studies and HTR populations. %M 39173153 %R 10.2196/38189 %U https://formative.jmir.org/2024/1/e38189 %U https://doi.org/10.2196/38189 %U http://www.ncbi.nlm.nih.gov/pubmed/39173153 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55403 %T Quality Assessment of TikTok as a Source of Information About Mitral Valve Regurgitation in China: Cross-Sectional Study %A Cui,Nannan %A Lu,Yuting %A Cao,Yelin %A Chen,Xiaofan %A Fu,Shuiqiao %A Su,Qun %+ Department of Surgical Intensive Care Unit, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, 310003, China, 86 13588045704, sqicu@zju.edu.cn %K mitral valve regurgitation %K video quality %K TikTok %K Journal of American Medical Association %K JAMA %K Global Quality Score %K GQS %K PEMAT- A/V %K Spearman correlation analysis %K Poisson regression analysis %D 2024 %7 20.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In China, mitral valve regurgitation (MR) is the most common cardiovascular valve disease. However, patients in China typically experience a high incidence of this condition, coupled with a low level of health knowledge and a relatively low rate of surgical treatment. TikTok hosts a vast amount of content related to diseases and health knowledge, providing viewers with access to relevant information. However, there has been no investigation or evaluation of the quality of videos specifically addressing MR. Objective: This study aims to assess the quality of videos about MR on TikTok in China. Methods: A cross-sectional study was conducted on the Chinese version of TikTok on September 9, 2023. The top 100 videos on MR were included and evaluated using quantitative scoring tools such as the modified DISCERN (mDISCERN), the Journal of the American Medical Association (JAMA) benchmark criteria, the Global Quality Score (GQS), and the Patient Education Materials Assessment Tool for Audio-Visual Content (PEMAT-A/V). Correlation and stepwise regression analyses were performed to examine the relationships between video quality and various characteristics. Results: We obtained 88 valid video files, of which most (n=81, 92%) were uploaded by certified physicians, primarily cardiac surgeons, and cardiologists. News agencies/organizations and physicians had higher GQS scores compared with individuals (news agencies/organizations vs individuals, P=.001; physicians vs individuals, P=.03). Additionally, news agencies/organizations had higher PEMAT understandability scores than individuals (P=.01). Videos focused on disease knowledge scored higher in GQS (P<.001), PEMAT understandability (P<.001), and PEMAT actionability (P<.001) compared with videos covering surgical cases. PEMAT actionability scores were higher for outpatient cases compared with surgical cases (P<.001). Additionally, videos focused on surgical techniques had lower PEMAT actionability scores than those about disease knowledge (P=.04). The strongest correlations observed were between thumbs up and comments (r=0.92, P<.001), thumbs up and favorites (r=0.89, P<.001), thumbs up and shares (r=0.87, P<.001), comments and favorites (r=0.81, P<.001), comments and shares (r=0.87, P<.001), and favorites and shares (r=0.83, P<.001). Stepwise regression analysis identified “length (P<.001),” “content (P<.001),” and “physicians (P=.004)” as significant predictors of GQS. The final model (model 3) explained 50.1% of the variance in GQSs. The predictive equation for GQS is as follows: GQS = 3.230 − 0.294 × content − 0.274 × physicians + 0.005 × length. This model was statistically significant (P=.004) and showed no issues with multicollinearity or autocorrelation. Conclusions: Our study reveals that while most MR-related videos on TikTok were uploaded by certified physicians, ensuring professional and scientific content, the overall quality scores were suboptimal. Despite the educational value of these videos, the guidance provided was often insufficient. The predictive equation for GQS developed from our analysis offers valuable insights but should be applied with caution beyond the study context. It suggests that creators should focus on improving both the content and presentation of their videos to enhance the quality of health information shared on social media. %M 39163110 %R 10.2196/55403 %U https://www.jmir.org/2024/1/e55403 %U https://doi.org/10.2196/55403 %U http://www.ncbi.nlm.nih.gov/pubmed/39163110 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58802 %T Degenerative Cervical Myelopathy Awareness in Primary Care: UK National Cross-Sectional Survey of General Practitioners %A Rufus-Toye,Remi M %A Rafati Fard,Amir %A Mowforth,Oliver D %A McCarron,Luke V %A Chan,Kayen %A Hirayama,Yuri %A Smith,Emma K %A Veremu,Munashe %A Davies,Benjamin M %A Brannigan,Jamie F M %+ Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, United Kingdom, 44 7825545404, Jamie.brannigan@medsci.ox.ac.uk %K cervical spine %K degeneration %K general practice %K myelopathy %K neurology %K neurosurgery %K medical education %K cervical myelopathy %K primary care %K misdiagnosis %D 2024 %7 19.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Degenerative cervical myelopathy (DCM) is a progressive neurological condition, characterized by spinal cord injury secondary to degenerative changes in the spine. Misdiagnosis in primary care forms part of a complex picture leading to an average diagnostic delay of 2 years. This leads to potentially preventable and permanent disability. A lack of awareness secondary to deficits in postgraduate education may contribute to these delays. Objective: This study aims to assess the awareness of DCM in the setting of general practice. Methods: General practitioners completed a quantitative web-based cross-sectional questionnaire. The 17-item questionnaire captured data regarding demographics, subjective awareness, and objective knowledge. The questionnaire was disseminated via professional networks, including via practice managers and senior practice partners. Incentivization was provided via a bespoke DCM fact sheet for those that completed the survey. Results: A total of 54 general practitioners representing all 4 UK nations responded to the survey. General practitioners most commonly self-assessed that they had “limited awareness” of DCM (n=24, 51%). General practitioners felt most commonly “moderately able” to recognize a case of DCM (n=21, 46%). In total, 13% (n=6) of respondents reported that they would not be at all able to recognize a patient with DCM. Respondents most commonly reported that they were “moderately confident” in their ability to triage a patient with DCM (n=19, 41%). A quarter of respondents reported no prior introduction to DCM throughout their medical training (n=13, 25%). The mean score for knowledge-based questions was 42.6% (SD 3.96%) with the lowest performance observed in patient demographic and clinical recognition items. Conclusions: General practitioners lack confidence in the recognition and management of DCM. These findings are consistent with the diagnostic delays previously described in the literature at the primary care level. Further work to develop and implement educational interventions to general practitioner practices is a crucial step to improving patient outcomes in DCM. %M 39158957 %R 10.2196/58802 %U https://formative.jmir.org/2024/1/e58802 %U https://doi.org/10.2196/58802 %U http://www.ncbi.nlm.nih.gov/pubmed/39158957 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50275 %T Investigating Best Practices for Ecological Momentary Assessment: Nationwide Factorial Experiment %A Businelle,Michael S %A Hébert,Emily T %A Shi,Dingjing %A Benson,Lizbeth %A Kezbers,Krista M %A Tonkin,Sarah %A Piper,Megan E %A Qian,Tianchen %+ TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 405 271 8001 ext 50460, michael-businelle@ouhsc.edu %K ecological momentary assessment %K mobile health %K smartphone %K compliance %K ambulatory assessment %K adherence %K experience sampling %K mobile phone %K mHealth %K real-time data %K behavior %K dynamic behavioral processes %K self-report %K factorial design %D 2024 %7 12.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Ecological momentary assessment (EMA) is a measurement methodology that involves the repeated collection of real-time data on participants’ behavior and experience in their natural environment. While EMA allows researchers to gain valuable insights into dynamic behavioral processes, the need for frequent self-reporting can be burdensome and disruptive. Compliance with EMA protocols is important for accurate, unbiased sampling; yet, there is no “gold standard” for EMA study design to promote compliance. Objective: The purpose of this study was to use a factorial design to identify optimal study design factors, or combinations of factors, for achieving the highest completion rates for smartphone-based EMAs. Methods: Participants recruited from across the United States were randomized to 1 of 2 levels on each of 5 design factors in a 2×2×2×2×2 design (32 conditions): factor 1—number of questions per EMA survey (15 vs 25); factor 2—number of EMAs per day (2 vs 4); factor 3—EMA prompting schedule (random vs fixed times); factor 4—payment type (US $1 paid per EMA vs payment based on the percentage of EMAs completed); and factor 5—EMA response scale type (ie, slider-type response scale vs Likert-type response scale; this is the only within-person factor; each participant was randomized to complete slider- or Likert-type questions for the first 14 days or second 14 days of the study period). All participants were asked to complete prompted EMAs for 28 days. The effect of each factor on EMA completion was examined, as well as the effects of factor interactions on EMA completion. Finally, relations between demographic and socioenvironmental factors and EMA completion were examined. Results: Participants (N=411) were aged 48.4 (SD 12.1) years; 75.7% (311/411) were female, 72.5% (298/411) were White, 18.0% (74/411) were Black or African American, 2.7% (11/411) were Asian, 1.5% (6/411) were American Indian or Alaska Native, 5.4% (22/411) belonged to more than one race, and 9.6% (38/396) were Hispanic/Latino. On average, participants completed 83.8% (28,948/34,552) of scheduled EMAs, and 96.6% (397/411) of participants completed the follow-up survey. Results indicated that there were no significant main effects of the design factors on compliance and no significant interactions. Analyses also indicated that older adults, those without a history of substance use problems, and those without current depression tended to complete more EMAs than their counterparts. No other demographic or socioenvironmental factors were related to EMA completion rates. Finally, the app was well liked (ie, system usability scale score=82.7), and there was a statistically significant positive association between liking the app and EMA compliance. Conclusions: Study results have broad implications for developing best practices guidelines for future studies that use EMA methodologies. Trial Registration: ClinicalTrials.gov number NCT05194228; https://clinicaltrials.gov/study/NCT05194228 %M 39133915 %R 10.2196/50275 %U https://www.jmir.org/2024/1/e50275 %U https://doi.org/10.2196/50275 %U http://www.ncbi.nlm.nih.gov/pubmed/39133915 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e52257 %T Understanding the Use of Mobility Data in Disasters: Exploratory Qualitative Study of COVID-19 User Feedback %A Chan,Jennifer Lisa %A Tsay,Sarah %A Sambara,Sraavya %A Welch,Sarah B %+ Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, 211 E. Ontario Street312-694-7000, Chicago, IL, 60611, United States, 1 312 694 7000, jennifer-chan@northwestern.edu %K mobility data %K disasters %K surveillance %K COVID-19 %K qualitative %K user feedback %K policy making %K emergency %K pandemic %K disaster response %K data usage %K situational awareness %K data translation %K big data %D 2024 %7 1.8.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Human mobility data have been used as a potential novel data source to guide policies and response planning during the COVID-19 global pandemic. The COVID-19 Mobility Data Network (CMDN) facilitated the use of human mobility data around the world. Both researchers and policy makers assumed that mobility data would provide insights to help policy makers and response planners. However, evidence that human mobility data were operationally useful and provided added value for public health response planners remains largely unknown. Objective: This exploratory study focuses on advancing the understanding of the use of human mobility data during the early phase of the COVID-19 pandemic. The study explored how researchers and practitioners around the world used these data in response planning and policy making, focusing on processing data and human factors enabling or hindering use of the data. Methods: Our project was based on phenomenology and used an inductive approach to thematic analysis. Transcripts were open-coded to create the codebook that was then applied by 2 team members who blind-coded all transcripts. Consensus coding was used for coding discrepancies. Results: Interviews were conducted with 45 individuals during the early period of the COVID-19 pandemic. Although some teams used mobility data for response planning, few were able to describe their uses in policy making, and there were no standardized ways that teams used mobility data. Mobility data played a larger role in providing situational awareness for government partners, helping to understand where people were moving in relation to the spread of COVID-19 variants and reactions to stay-at-home orders. Interviewees who felt they were more successful using mobility data often cited an individual who was able to answer general questions about mobility data; provide interactive feedback on results; and enable a 2-way communication exchange about data, meaning, value, and potential use. Conclusions: Human mobility data were used as a novel data source in the COVID-19 pandemic by a network of academic researchers and practitioners using privacy-preserving and anonymized mobility data. This study reflects the processes in analyzing and communicating human mobility data, as well as how these data were used in response planning and how the data were intended for use in policy making. The study reveals several valuable use cases. Ultimately, the role of a data translator was crucial in understanding the complexities of this novel data source. With this role, teams were able to adapt workflows, visualizations, and reports to align with end users and decision makers while communicating this information meaningfully to address the goals of responders and policy makers. %M 39088256 %R 10.2196/52257 %U https://humanfactors.jmir.org/2024/1/e52257 %U https://doi.org/10.2196/52257 %U http://www.ncbi.nlm.nih.gov/pubmed/39088256 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e48516 %T Measuring Relationship Influences on Romantic Couples’ Cancer-Related Behaviors During the COVID-19 Pandemic: Protocol for a Longitudinal Online Study of Dyads and Cancer Survivors %A Bowers,Jennifer M %A Huelsnitz,Chloe O %A Dwyer,Laura A %A Gibson,Laurel P %A Agurs-Collins,Tanya %A Ferrer,Rebecca A %A Acevedo,Amanda M %+ Behavioral Research Program, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD, 20850, United States, 1 2402765478, amanda.acevedo@nih.gov %K cancer prevention %K COVID-19 %K risk perceptions %K dyads %K romantic relationships %K cancer %K oncology %K survivor %K survivors %K dyad %K spouse %K spousal %K partner %K health behavior %K health behaviors %K cohabiting %K cohabit %K study design %K recruit %K recruitment %K methodology %K methods %K enrol %K enrolment %K enroll %K enrollment %D 2024 %7 31.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Research has established the effects of romantic relationships on individuals’ morbidity and mortality. However, the interplay between relationship functioning, affective processes, and health behaviors has been relatively understudied. During the COVID-19 pandemic, relational processes may influence novel health behaviors such as social distancing and masking. Objective: We describe the design, recruitment, and methods of the relationships, risk perceptions, and cancer-related behaviors during the COVID-19 pandemic study. This study was developed to understand how relational and affective processes influence romantic partners’ engagement in cancer prevention behaviors as well as health behaviors introduced or exacerbated by the COVID-19 pandemic. Methods: The relationships, risk perceptions, and cancer-related behaviors during the COVID-19 pandemic study used online survey methods to recruit and enroll 2 cohorts of individuals involved in cohabiting romantic relationships, including 1 cohort of dyads (n=223) and 1 cohort of cancer survivors (n=443). Survey assessments were completed over 2 time points that were 5.57 (SD 3.14) weeks apart on average. Health behaviors assessed included COVID-19 vaccination and social distancing, physical activity, diet, sleep, alcohol use, and smoking behavior. We also examined relationship factors, psychological distress, and household chaos. Results: Data collection occurred between October 2021 and August 2022. During that time, a total of 926 participants were enrolled, of which about two-thirds were from the United Kingdom (n=622, 67.8%) and one-third were from the United States (n=296, 32.2%); about two-thirds were married (n=608, 66.2%) and one-third were members of unmarried couples (n=294, 32%). In cohorts 1 and 2, the mean age was about 34 and 50, respectively. Out of 478 participants in cohort 1, 19 (4%) identified as Hispanic or Latino/a, 79 (17%) as non-Hispanic Asian, 40 (9%) as non-Hispanic Black or African American, and 306 (64%) as non-Hispanic White; 62 (13%) participants identified their sexual orientation as bisexual or pansexual, 359 (75.1%) as heterosexual or straight, and 53 (11%) as gay or lesbian. In cohort 2, out of 440 participants, 13 (3%) identified as Hispanic or Latino/a, 8 (2%) as non-Hispanic Asian, 5 (1%) as non-Hispanic Black or African American, and 398 (90.5%) as non-Hispanic White; 41 (9%) participants identified their sexual orientation as bisexual or pansexual, 384 (87.3%) as heterosexual or straight, and 13 (3%) as gay or lesbian. The overall enrollment rate for individuals was 66.14% and the overall completion rate was 80.08%. Conclusions: We discuss best practices for collecting online survey data for studies examining relationships and health, challenges related to the COVID-19 pandemic, recruitment of underrepresented populations, and enrollment of dyads. Recommendations include conducting pilot studies, allowing for extra time in the data collection timeline for marginalized or underserved populations, surplus screening to account for expected attrition within dyads, as well as planning dyad-specific data quality checks. International Registered Report Identifier (IRRID): DERR1-10.2196/48516 %M 39083795 %R 10.2196/48516 %U https://www.researchprotocols.org/2024/1/e48516 %U https://doi.org/10.2196/48516 %U http://www.ncbi.nlm.nih.gov/pubmed/39083795 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45780 %T Cerebral Microbleeds in Different Brain Regions and Their Associations With the Digital Clock-Drawing Test: Secondary Analysis of the Framingham Heart Study %A Akhter-Khan,Samia C %A Tao,Qiushan %A Ang,Ting Fang Alvin %A Karjadi,Cody %A Itchapurapu,Indira Swetha %A Libon,David J %A Alosco,Michael %A Mez,Jesse %A Qiu,Wei Qiao %A Au,Rhoda %+ Framingham Heart Study, Boston University School of Medicine, 72 East Concord Street, R-623D, Boston, MA, 02118, United States, 1 6176384336, wqiu67@bu.edu %K cerebral microbleeds %K CMB %K digital clock-drawing test %K DCT %K Alzheimer disease %K dementia %K early screening %K Boston Process Approach %K cerebral microbleed %K neuroimaging %K cerebrovascular diseases %K aging %K MRI %K magnetic resonance imaging %K clock-drawing test %K cognitive function %D 2024 %7 29.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Cerebral microbleeds (CMB) increase the risk for Alzheimer disease. Current neuroimaging methods that are used to detect CMB are costly and not always accessible. Objective: This study aimed to explore whether the digital clock-drawing test (DCT) may provide a behavioral indicator of CMB. Methods: In this study, we analyzed data from participants in the Framingham Heart Study offspring cohort who underwent both brain magnetic resonance imaging scans (Siemens 1.5T, Siemens Healthcare Private Limited; T2*-GRE weighted sequences) for CMB diagnosis and the DCT as a predictor. Additionally, paper-based clock-drawing tests were also collected during the DCT. Individuals with a history of dementia or stroke were excluded. Robust multivariable linear regression models were used to examine the association between DCT facet scores with CMB prevalence, adjusting for relevant covariates. Receiver operating characteristic (ROC) curve analyses were used to evaluate DCT facet scores as predictors of CMB prevalence. Sensitivity analyses were conducted by further including participants with stroke and dementia. Results: The study sample consisted of 1020 (n=585, 57.35% female) individuals aged 45 years and older (mean 72, SD 7.9 years). Among them, 64 (6.27%) participants exhibited CMB, comprising 46 with lobar-only, 11 with deep-only, and 7 with mixed (lobar+deep) CMB. Individuals with CMB tended to be older and had a higher prevalence of mild cognitive impairment and higher white matter hyperintensities compared to those without CMB (P<.05). While CMB were not associated with the paper-based clock-drawing test, participants with CMB had a lower overall DCT score (CMB: mean 68, SD 23 vs non-CMB: mean 76, SD 20; P=.009) in the univariate comparison. In the robust multiple regression model adjusted for covariates, deep CMB were significantly associated with lower scores on the drawing efficiency (β=–0.65, 95% CI –1.15 to –0.15; P=.01) and simple motor (β=–0.86, 95% CI –1.43 to –0.30; P=.003) domains of the command DCT. In the ROC curve analysis, DCT facets discriminated between no CMB and the CMB subtypes. The area under the ROC curve was 0.76 (95% CI 0.69-0.83) for lobar CMB, 0.88 (95% CI 0.78-0.98) for deep CMB, and 0.98 (95% CI 0.96-1.00) for mixed CMB, where the area under the ROC curve value nearing 1 indicated an accurate model. Conclusions: The study indicates a significant association between CMB, especially deep and mixed types, and reduced performance in drawing efficiency and motor skills as assessed by the DCT. This highlights the potential of the DCT for early detection of CMB and their subtypes, providing a reliable alternative for cognitive assessment and making it a valuable tool for primary care screening before neuroimaging referral. %M 39073857 %R 10.2196/45780 %U https://www.jmir.org/2024/1/e45780 %U https://doi.org/10.2196/45780 %U http://www.ncbi.nlm.nih.gov/pubmed/39073857 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e54137 %T Roles and Responsibilities of the Global Specialist Digital Health Workforce: Analysis of Global Census Data %A Butler-Henderson,Kerryn %A Gray,Kathleen %A Arabi,Salma %K workforce %K functions %K digital health %K census %K census data %K workforce survey %K survey %K support %K development %K use %K management %K health data %K health information %K health knowledge %K health technology %K Australia %K New Zealand %K online content %K digital data %D 2024 %7 25.7.2024 %9 %J JMIR Med Educ %G English %X Background: The Global Specialist Digital Health Workforce Census is the largest workforce survey of the specialist roles that support the development, use, management, and governance of health data, health information, health knowledge, and health technology. Objective: This paper aims to present an analysis of the roles and functions reported by respondents in the 2023 census. Methods: The 2023 census was deployed using Qualtrics and was open from July 1 to August 13, 2023. A broad definition was provided to guide respondents about who is in the specialist digital health workforce. Anyone who self-identifies as being part of this workforce could undertake the survey. The data was analyzed using descriptive statistical analysis and thematic analysis of the functions respondents reported in their roles. Results: A total of 1103 respondents completed the census, with data reported about their demographic information and their roles. The majority of respondents lived in Australia (n=870, 78.9%) or New Zealand (n=130, 11.8%), with most (n=620, 56.3%) aged 35‐54 years and identifying as female (n=720, 65.3%). The top four occupational specialties were health informatics (n=179, 20.2%), health information management (n=175, 19.8%), health information technology (n=128, 14.4%), and health librarianship (n=104, 11.7%). Nearly all (n=797, 90%) participants identified as a manager or professional. Less than half (430/1019, 42.2%) had a formal qualification in a specialist digital health area, and only one-quarter (244/938, 26%) held a credential in a digital health area. While two-thirds (502/763, 65.7%) reported undertaking professional development in the last year, most were self-directed activities, such as seeking information or consuming online content. Work undertaken by specialist digital health workers could be classified as either leadership, functional, occupational, or technological. Conclusions: Future specialist digital health workforce capability frameworks should include the aspects of leadership, function, occupation, and technology. This largely unqualified workforce is undertaking little formal professional development to upskill them to continue to support the safe delivery and management of health and care through the use of digital data and technology. %R 10.2196/54137 %U https://mededu.jmir.org/2024/1/e54137 %U https://doi.org/10.2196/54137 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e57574 %T Investigating Users’ Attitudes Toward Automated Smartwatch Cardiac Arrest Detection: Cross-Sectional Survey Study %A van den Beuken,Wisse M F %A van Schuppen,Hans %A Demirtas,Derya %A van Halm,Vokko P %A van der Geest,Patrick %A Loer,Stephan A %A Schwarte,Lothar A %A Schober,Patrick %K out-of-hospital cardiac arrest %K wearables %K wearable %K digital health %K smartwatch %K automated cardiac arrest detection %K emergency medicine %K emergency %K cardiology %K heart %K cardiac %K cross sectional %K survey %K surveys %K questionnaire %K questionnaires %K experience %K experiences %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K acceptance %K adoption %K willingness %K intent %K intention %D 2024 %7 25.7.2024 %9 %J JMIR Hum Factors %G English %X Background: Out-of-hospital cardiac arrest (OHCA) is a leading cause of mortality in the developed world. Timely detection of cardiac arrest and prompt activation of emergency medical services (EMS) are essential, yet challenging. Automated cardiac arrest detection using sensor signals from smartwatches has the potential to shorten the interval between cardiac arrest and activation of EMS, thereby increasing the likelihood of survival. Objective: This cross-sectional survey study aims to investigate users’ perspectives on aspects of continuous monitoring such as privacy and data protection, as well as other implications, and to collect insights into their attitudes toward the technology. Methods: We conducted a cross-sectional web-based survey in the Netherlands among 2 groups of potential users of automated cardiac arrest technology: consumers who already own a smartwatch and patients at risk of cardiac arrest. Surveys primarily consisted of closed-ended questions with some additional open-ended questions to provide supplementary insight. The quantitative data were analyzed descriptively, and a content analysis of the open-ended questions was conducted. Results: In the consumer group (n=1005), 90.2% (n=906; 95% CI 88.1%-91.9%) of participants expressed an interest in the technology, and 89% (n=1196; 95% CI 87.3%-90.7%) of the patient group (n=1344) showed interest. More than 75% (consumer group: n= 756; patient group: n=1004) of the participants in both groups indicated they were willing to use the technology. The main concerns raised by participants regarding the technology included privacy, data protection, reliability, and accessibility. Conclusions: The vast majority of potential users expressed a strong interest in and positive attitude toward automated cardiac arrest detection using smartwatch technology. However, a number of concerns were identified, which should be addressed in the development and implementation process to optimize acceptance and effectiveness of the technology. %R 10.2196/57574 %U https://humanfactors.jmir.org/2024/1/e57574 %U https://doi.org/10.2196/57574 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52101 %T Equivalence of Alcohol Use Disorder Symptom Assessments in Routine Clinical Care When Completed Remotely via Online Patient Portals Versus In Clinic via Paper Questionnaires: Psychometric Evaluation %A Matson,Theresa E %A Lee,Amy K %A Oliver,Malia %A Bradley,Katharine A %A Hallgren,Kevin A %+ Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1360, Seattle, WA, 98101, United States, 1 2062872699, tessa.e.matson@kp.org %K alcohol %K alcohol use disorder %K assessment %K symptom checklist %K electronic health record %K patient portal %K item response theory %K differential item functioning %K alcohol use %K patient portals %K in-clinic %K psychometric evaluation %K alcoholism %K cross-sectional %K United States %D 2024 %7 22.7.2024 %9 Short Paper %J J Med Internet Res %G English %X Background: The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends the paper-based or computerized Alcohol Symptom Checklist to assess alcohol use disorder (AUD) symptoms in routine care when patients report high-risk drinking. However, it is unknown whether Alcohol Symptom Checklist response characteristics differ when it is administered online (eg, remotely via an online electronic health record [EHR] patient portal before an appointment) versus in clinic (eg, on paper after appointment check-in). Objective: This study evaluated the psychometric performance of the Alcohol Symptom Checklist when completed online versus in clinic during routine clinical care. Methods: This cross-sectional, psychometric study obtained EHR data from the Alcohol Symptom Checklist completed by adult patients from an integrated health system in Washington state. The sample included patients who had a primary care visit in 2021 at 1 of 32 primary care practices, were due for annual behavioral health screening, and reported high-risk drinking on the behavioral health screen (Alcohol Use Disorder Identification Test–Consumption score ≥7). After screening, patients with high-risk drinking were typically asked to complete the Alcohol Symptom Checklist—an 11-item questionnaire on which patients self-report whether they had experienced each of the 11 AUD criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) over a past-year timeframe. Patients could complete the Alcohol Symptom Checklist online (eg, on a computer, smartphone, or tablet from any location) or in clinic (eg, on paper as part of the rooming process at clinical appointments). We examined sample and measurement characteristics and conducted differential item functioning analyses using item response theory to examine measurement consistency across these 2 assessment modalities. Results: Among 3243 patients meeting eligibility criteria for this secondary analysis (2313/3243, 71% male; 2271/3243, 70% White; and 2014/3243, 62% non-Hispanic), 1640 (51%) completed the Alcohol Symptom Checklist online while 1603 (49%) completed it in clinic. Approximately 46% (752/1640) and 48% (764/1603) reported ≥2 AUD criteria (the threshold for AUD diagnosis) online and in clinic (P=.37), respectively. A small degree of differential item functioning was observed for 4 of 11 items. This differential item functioning produced only minimal impact on total scores used clinically to assess AUD severity, affecting total criteria count by a maximum of 0.13 criteria (on a scale ranging from 0 to 11). Conclusions: Completing the Alcohol Symptom Checklist online, typically prior to patient check-in, performed similarly to an in-clinic modality typically administered on paper by a medical assistant at the time of the appointment. Findings have implications for using online AUD symptom assessments to streamline workflows, reduce staff burden, reduce stigma, and potentially assess patients who do not receive in-person care. Whether modality of DSM-5 assessment of AUD differentially impacts treatment is unknown. %M 39038284 %R 10.2196/52101 %U https://www.jmir.org/2024/1/e52101 %U https://doi.org/10.2196/52101 %U http://www.ncbi.nlm.nih.gov/pubmed/39038284 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e53831 %T Patterns of Skin Picking in Skin Picking Disorder: Ecological Momentary Assessment Study %A Gallinat,Christina %A Moessner,Markus %A Wilhelm,Maximilian %A Keuthen,Nancy %A Bauer,Stephanie %+ Center for Psychotherapy Research, University Hospital Heidelberg, Bergheimer Straße 54, Heidelberg, 69115, Germany, 49 6221567876, christina.gallinat@med.uni-heidelberg.de %K skin picking disorder %K ecological momentary assessment %K EMA %K body-focused repetitive behavior %K obsessive-compulsive spectrum %K skin %K dermatology %K mental health %K assessment %K mobile phone %D 2024 %7 18.7.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Skin picking disorder (SPD) is an understudied mental illness that is classified as a body-focused repetitive behavior disorder. Literature suggests that pathological skin picking is strongly integrated into the daily lives of affected individuals and may involve a high degree of variability in terms of episode characteristics, frequency, and intensity. However, existing data on the phenomenology of SPD are limited and typically involve retrospective assessments, which may fail to accurately capture the behavior’s variability. Objective: This study aimed to investigate skin picking in the daily lives of individuals with SPD by using ecological momentary assessment (EMA). The first aim focused on the description of skin picking patterns (eg, characteristics, intensity, and distribution of episodes and urges), and the second aim explored differences in characteristics and patterns between automatic and focused skin picking. Methods: Participants were recruited online and underwent a web-based screening, a diagnostic telephone interview, and a comprehensive online self-report questionnaire before participating in an EMA protocol. The latter included 10 consecutive days with 7 pseudorandom, time-contingent assessments per day between 8 AM and 10 PM. The EMA questionnaire assessed the current skin picking urge, the occurrence of the behavior, and a detailed assessment of the episodes’ characteristics (eg, length, intensity, and consciousness) if applicable. Results: The final sample consisted of 57 participants, who completed at least 70% of the scheduled assessments (n=54, 94.7% female: mean age 29.3, SD 6.77 years). They completed 3758 EMAs and reported 1467 skin picking episodes. Skin picking occurred frequently (mean 2.57, SD 1.12 episodes per day and person) in relatively short episodes (10-30 min; 10 min: nepisodes=642, 43.8%; 20 min: nepisodes=312, 21.3%; 30 min: nepisodes=217, 14.8%), and it was distributed quite evenly throughout the day and across different days of the week. Focused and automatic episodes were relatively balanced across all reported episodes (focused: nepisodes=806, 54.9%) and over the course of the day. The analyses showed statistically significant differences between self-reported triggers for the different styles. Visual or tactile cues and the desire to pick the skin were more important for the focused style (visual or tactile cues: mean focused style [Mf]=4.01, SD 0.69 vs mean automatic style [Ma]=3.47, SD 0.99; P<.001; SMD=0.64; desire to pick: Mf=2.61, SD 1.06 vs Ma=1.94, SD 1.03; P<.001; SMD=0.82), while boredom and concentration problems were more prominent in automatic skin picking (boredom: Mf=1.69, SD 0.89 vs Ma=1.84, SD 0.89; P=.03; SMD=–0.31; concentration problems: Mf=2.06, SD 0.87 vs Ma=2.31, SD 1.06; P=.006; SMD=–0.41). Conclusions: These results contribute to an enhanced understanding of the phenomenology of SPD using a more rigorous assessment methodology. Our findings underscore that picking can impact affected persons multiple times throughout their daily lives. Trial Registration: German Clinical Trials Register DRKS00025168; https://tinyurl.com/mr35pdwh %M 39024568 %R 10.2196/53831 %U https://www.i-jmr.org/2024/1/e53831 %U https://doi.org/10.2196/53831 %U http://www.ncbi.nlm.nih.gov/pubmed/39024568 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54867 %T Comparison of the Response to an Electronic Versus a Traditional Informed Consent Procedure in Terms of Clinical Patient Characteristics: Observational Study %A Zondag,Anna G M %A Hollestelle,Marieke J %A van der Graaf,Rieke %A Nathoe,Hendrik M %A van Solinge,Wouter W %A Bots,Michiel L %A Vernooij,Robin W M %A Haitjema,Saskia %A , %+ Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands, 31 631117922, a.g.m.zondag@umcutrecht.nl %K informed consent %K learning health care system %K e-consent %K cardiovascular risk management %K digital health %K research ethics %D 2024 %7 11.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic informed consent (eIC) is increasingly used in clinical research due to several benefits including increased enrollment and improved efficiency. Within a learning health care system, a pilot was conducted with an eIC for linking data from electronic health records with national registries, general practitioners, and other hospitals. Objective: We evaluated the eIC pilot by comparing the response to the eIC with the former traditional paper-based informed consent (IC). We assessed whether the use of eIC resulted in a different study population by comparing the clinical patient characteristics between the response categories of the eIC and former face-to-face IC procedure. Methods: All patients with increased cardiovascular risk visiting the University Medical Center Utrecht, the Netherlands, were eligible for the learning health care system. From November 2021 to August 2022, an eIC was piloted at the cardiology outpatient clinic. Prior to the pilot, a traditional face-to-face paper-based IC approach was used. Responses (ie, consent, no consent, or nonresponse) were assessed and compared between the eIC and face-to-face IC cohorts. Clinical characteristics of consenting and nonresponding patients were compared between and within the eIC and the face-to-face cohorts using multivariable regression analyses. Results: A total of 2254 patients were included in the face-to-face IC cohort and 885 patients in the eIC cohort. Full consent was more often obtained in the eIC than in the face-to-face cohort (415/885, 46.9% vs 876/2254, 38.9%, respectively). Apart from lower mean hemoglobin in the full consent group of the eIC cohort (8.5 vs 8.8; P=.0021), the characteristics of the full consenting patients did not differ between the eIC and face-to-face IC cohorts. In the eIC cohort, only age differed between the full consent and the nonresponse group (median 60 vs 56; P=.0002, respectively), whereas in the face-to-face IC cohort, the full consent group seemed healthier (ie, higher hemoglobin, lower glycated hemoglobin [HbA1c], lower C-reactive protein levels) than the nonresponse group. Conclusions: More patients provided full consent using an eIC. In addition, the study population remained broadly similar. The face-to-face IC approach seemed to result in a healthier study population (ie, full consenting patients) than the patients without IC, while in the eIC cohort, the characteristics between consent groups were comparable. Thus, an eIC may lead to a better representation of the target population, increasing the generalizability of results. %M 38990640 %R 10.2196/54867 %U https://www.jmir.org/2024/1/e54867 %U https://doi.org/10.2196/54867 %U http://www.ncbi.nlm.nih.gov/pubmed/38990640 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52998 %T Determining an Appropriate Sample Size for Qualitative Interviews to Achieve True and Near Code Saturation: Secondary Analysis of Data %A Squire,Claudia M %A Giombi,Kristen C %A Rupert,Douglas J %A Amoozegar,Jacqueline %A Williams,Peyton %+ RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709-2194, United States, 1 9195416613, cms@rti.org %K saturation %K sample size %K web-based data collection %K semistructured interviews %K qualitative %K research methods %K research methodology %K data collection %K coding %K interviews %K interviewing %K in-depth %D 2024 %7 9.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In-depth interviews are a common method of qualitative data collection, providing rich data on individuals’ perceptions and behaviors that would be challenging to collect with quantitative methods. Researchers typically need to decide on sample size a priori. Although studies have assessed when saturation has been achieved, there is no agreement on the minimum number of interviews needed to achieve saturation. To date, most research on saturation has been based on in-person data collection. During the COVID-19 pandemic, web-based data collection became increasingly common, as traditional in-person data collection was possible. Researchers continue to use web-based data collection methods post the COVID-19 emergency, making it important to assess whether findings around saturation differ for in-person versus web-based interviews. Objective: We aimed to identify the number of web-based interviews needed to achieve true code saturation or near code saturation. Methods: The analyses for this study were based on data from 5 Food and Drug Administration–funded studies conducted through web-based platforms with patients with underlying medical conditions or with health care providers who provide primary or specialty care to patients. We extracted code- and interview-specific data and examined the data summaries to determine when true saturation or near saturation was reached. Results: The sample size used in the 5 studies ranged from 30 to 70 interviews. True saturation was reached after 91% to 100% (n=30-67) of planned interviews, whereas near saturation was reached after 33% to 60% (n=15-23) of planned interviews. Studies that relied heavily on deductive coding and studies that had a more structured interview guide reached both true saturation and near saturation sooner. We also examined the types of codes applied after near saturation had been reached. In 4 of the 5 studies, most of these codes represented previously established core concepts or themes. Codes representing newly identified concepts, other or miscellaneous responses (eg, “in general”), uncertainty or confusion (eg, “don’t know”), or categorization for analysis (eg, correct as compared with incorrect) were less commonly applied after near saturation had been reached. Conclusions: This study provides support that near saturation may be a sufficient measure to target and that conducting additional interviews after that point may result in diminishing returns. Factors to consider in determining how many interviews to conduct include the structure and type of questions included in the interview guide, the coding structure, and the population under study. Studies with less structured interview guides, studies that rely heavily on inductive coding and analytic techniques, and studies that include populations that may be less knowledgeable about the topics discussed may require a larger sample size to reach an acceptable level of saturation. Our findings also build on previous studies looking at saturation for in-person data collection conducted at a small number of sites. %M 38980711 %R 10.2196/52998 %U https://www.jmir.org/2024/1/e52998 %U https://doi.org/10.2196/52998 %U http://www.ncbi.nlm.nih.gov/pubmed/38980711 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56716 %T Patient and Provider Satisfaction With a Geomapping Tool for Finding Community Family Physicians in Ontario, Canada: Cross-Sectional Online Survey Study %A Belanger,Christopher %A Peixoto,Cayden %A Francoeur,Sara %A Bjerre,Lise M %+ Institut du Savoir Montfort, 713 Montréal Rd, Ottawa, ON, K1K 0T2, Canada, 1 613 746 4621, lbjerre@uottawa.ca %K primary care %K language-concordant care %K web-based maps %K maps %K physicians %K experience %K language %K access %K accessibility %D 2024 %7 9.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Language-concordant health care, or health care in a patient’s language of choice, is an important element of health accessibility that improves patient safety and comfort and facilitates an increased quality of care. However, prior research has found that linguistic minorities often face higher travel burdens to access language-concordant care compared to the general population. Objective: This study intended to assess patient experiences and satisfaction with an online interactive physician map that allows patients to find family physicians who speak their preferred language in and around Ottawa, Ontario, Canada, as a means of identifying areas of improvement. Methods: This study used an online survey with questions related to user satisfaction. Responses to Likert-scale questions were compiled as summary statistics and short-answer responses underwent thematic analysis. The study setting was Ottawa and Renfrew County, Ontario, and the surrounding region, including the province of Quebec. Results: A total of 93 respondents completed the survey and self-identified as living in Ontario or Quebec. Overall, 57 (61%) respondents were “very satisfied” or “somewhat satisfied” with the map, 16 (17%) were “neither satisfied nor dissatisfied,” and 20 (22%) were “very dissatisfied” or “somewhat dissatisfied.” We found no significant differences in satisfaction by preferred language, age group, physician attachment, or intended beneficiary. A total of 56 respondents provided short-answer responses to an open-ended question about map improvements. The most common specific suggestion was to show which physicians are accepting new patients (n=20). Other suggestions included data refreshes (n=6), user interface adjustments (n=23), and additional languages (n=2). Some participants also provided positive feedback (n=5) or expressed concern with their inability to find a family physician (n=5). Several comments included multiple suggestions. Conclusions: While most patients were satisfied with the online map, a significant minority expressed dissatisfaction that the map did not show which family physicians were accepting new patients. This suggests that there may be public interest in an accessible database of which family physicians in Ontario are currently accepting new patients. %M 38980717 %R 10.2196/56716 %U https://formative.jmir.org/2024/1/e56716 %U https://doi.org/10.2196/56716 %U http://www.ncbi.nlm.nih.gov/pubmed/38980717 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50240 %T The Impact of Incentives on Data Collection for Online Surveys: Social Media Recruitment Study %A Sobolewski,Jessica %A Rothschild,Allie %A Freeman,Andrew %+ RTI International, 3040 E Cornwallis Road, Research Triangle Park, NC, 27709, United States, 1 203 770 3115, jsobolewski@rti.org %K social media %K online survey recruitment %K incentive %K experiment %K online surveys %K Facebook %K Instagram %K data collection %K users %K cost %K social media recruitment %K survey %D 2024 %7 4.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of targeted advertisements on social media platforms (eg, Facebook and Instagram) has become increasingly popular for recruiting participants for online survey research. Many of these surveys offer monetary incentives for survey completion in the form of gift cards; however, little is known about whether the incentive amount impacts the cost, speed, and quality of data collection. Objective: This experiment addresses this gap in the literature by examining how different incentives in paid advertising campaigns on Instagram for completing a 10-minute online survey influence the response rate, recruitment advertising cost, data quality, and length of data collection. Methods: This experiment tested three incentive conditions using three Instagram campaigns that were each allocated a US $1400 budget to spend over a maximum of 4 days; ads targeted users aged 15-24 years in three nonadjacent designated market areas of similar size to avoid overlapping audiences. Four ad creatives were designed for each campaign; all ads featured the same images and text, but the incentive amount varied: no incentive, US $5 gift card, and US $15 gift card. All ads had a clickable link that directed users to an eligibility screener and a 10-minute online survey, if eligible. Each campaign ran for either the full allotted time (4 days) or until there were 150 total survey completes, prior to data quality checks for fraud. Results: The US $15 incentive condition resulted in the quickest and cheapest data collection, requiring 17 hours and ad spending of US $338.64 to achieve 142 survey completes. The US $5 condition took more than twice as long (39 hours) and cost US $864.33 in ad spending to achieve 148 survey completes. The no-incentive condition ran for 60 hours, spending nearly the full budget (US $1398.23), and achieved only 24 survey completes. The US $15 and US $5 incentive conditions had similar levels of fraudulent respondents, whereas the no-incentive condition had no fraudulent respondents. The completion rate for the US $15 and US $5 incentive conditions were 93.4% (155/166) and 89.8% (149/166), respectively, while the completion rate for the no-incentive condition was 43.6% (24/55). Conclusions: Overall, we found that a higher incentive resulted in quicker data collection, less money spent on ads, and higher response rates, despite some fraudulent cases that had to be dropped from the sample. However, when considering the total incentive amounts in addition to the ad spending, a US $5 incentive appeared to be the most cost-effective data collection option. Other costs associated with running a campaign for a longer period should also be considered. A longer experiment is warranted to determine whether fraud varies over time across conditions. %M 38963924 %R 10.2196/50240 %U https://formative.jmir.org/2024/1/e50240 %U https://doi.org/10.2196/50240 %U http://www.ncbi.nlm.nih.gov/pubmed/38963924 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e58058 %T Inferring Population HIV Viral Load From a Single HIV Clinic’s Electronic Health Record: Simulation Study With a Real-World Example %A Goldstein,Neal D %A Jones,Justin %A Kahal,Deborah %A Burstyn,Igor %+ Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market St., Philadelphia, PA, 19104, United States, 1 267 359 6207, ng338@drexel.edu %K HIV %K human immunodeficiency virus %K viral load %K population viral load %K electronic health record %K EHR %K electronic health records %K EHRs %K electric medical record %K EMR %K electric medical records %K EMRs %K patient record %K patient record %K health record %K health records %K personal health record %K PHR %K selection weights %K sampling %K sampling bias %K Bayes %D 2024 %7 3.7.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Population viral load (VL), the most comprehensive measure of the HIV transmission potential, cannot be directly measured due to lack of complete sampling of all people with HIV. Objective: A given HIV clinic’s electronic health record (EHR), a biased sample of this population, may be used to attempt to impute this measure. Methods: We simulated a population of 10,000 individuals with VL calibrated to surveillance data with a geometric mean of 4449 copies/mL. We sampled 3 hypothetical EHRs from (A) the source population, (B) those diagnosed, and (C) those retained in care. Our analysis imputed population VL from each EHR using sampling weights followed by Bayesian adjustment. These methods were then tested using EHR data from an HIV clinic in Delaware. Results: Following weighting, the estimates moved in the direction of the population value with correspondingly wider 95% intervals as follows: clinic A: 4364 (95% interval 1963-11,132) copies/mL; clinic B: 4420 (95% interval 1913-10,199) copies/mL; and clinic C: 242 (95% interval 113-563) copies/mL. Bayesian-adjusted weighting further improved the estimate. Conclusions: These findings suggest that methodological adjustments are ineffective for estimating population VL from a single clinic’s EHR without the resource-intensive elucidation of an informative prior. %M 38959056 %R 10.2196/58058 %U https://ojphi.jmir.org/2024/1/e58058 %U https://doi.org/10.2196/58058 %U http://www.ncbi.nlm.nih.gov/pubmed/38959056 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52992 %T Impact Analysis of COVID-19 Pandemic on Hospital Reviews on Dianping Website in Shanghai, China: Empirical Study %A Huo,Weixue %A He,Mengwei %A Zeng,Zhaoxiang %A Bao,Xianhao %A Lu,Ye %A Tian,Wen %A Feng,Jiaxuan %A Feng,Rui %+ Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, 650 New Song Jiang Road, Songjiang District, Shanghai, 201600, China, 86 19174227674, rui.feng@shgh.cn %K patient satisfaction %K physician-patient relationship %K ChatGPT %K patient concern %K COVID-19 %D 2024 %7 2.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In the era of the internet, individuals have increasingly accustomed themselves to gathering necessary information and expressing their opinions on public web-based platforms. The health care sector is no exception, as these comments, to a certain extent, influence people’s health care decisions. During the onset of the COVID-19 pandemic, how the medical experience of Chinese patients and their evaluations of hospitals have changed remains to be studied. Therefore, we plan to collect patient medical visit data from the internet to reflect the current status of medical relationships under specific circumstances. Objective: This study aims to explore the differences in patient comments across various stages (during, before, and after) of the COVID-19 pandemic, as well as among different types of hospitals (children’s hospitals, maternity hospitals, and tumor hospitals). Additionally, by leveraging ChatGPT (OpenAI), the study categorizes the elements of negative hospital evaluations. An analysis is conducted on the acquired data, and potential solutions that could improve patient satisfaction are proposed. This study is intended to assist hospital managers in providing a better experience for patients who are seeking care amid an emergent public health crisis. Methods: Selecting the top 50 comprehensive hospitals nationwide and the top specialized hospitals (children’s hospitals, tumor hospitals, and maternity hospitals), we collected patient reviews from these hospitals on the Dianping website. Using ChatGPT, we classified the content of negative reviews. Additionally, we conducted statistical analysis using SPSS (IBM Corp) to examine the scoring and composition of negative evaluations. Results: A total of 30,317 pieces of effective comment information were collected from January 1, 2018, to August 15, 2023, including 7696 pieces of negative comment information. Manual inspection results indicated that ChatGPT had an accuracy rate of 92.05%. The F1-score was 0.914. The analysis of this data revealed a significant correlation between the comments and ratings received by hospitals during the pandemic. Overall, there was a significant increase in average comment scores during the outbreak (P<.001). Furthermore, there were notable differences in the composition of negative comments among different types of hospitals (P<.001). Children’s hospitals received sensitive feedback regarding waiting times and treatment effectiveness, while patients at maternity hospitals showed a greater concern for the attitude of health care providers. Patients at tumor hospitals expressed a desire for timely examinations and treatments, especially during the pandemic period. Conclusions: The COVID-19 pandemic had some association with patient comment scores. There were variations in the scores and content of comments among different types of specialized hospitals. Using ChatGPT to analyze patient comment content represents an innovative approach for statistically assessing factors contributing to patient dissatisfaction. The findings of this study could provide valuable insights for hospital administrators to foster more harmonious physician-patient relationships and enhance hospital performance during public health emergencies. %M 38954461 %R 10.2196/52992 %U https://www.jmir.org/2024/1/e52992 %U https://doi.org/10.2196/52992 %U http://www.ncbi.nlm.nih.gov/pubmed/38954461 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55013 %T Nonrepresentativeness of Human Mobility Data and its Impact on Modeling Dynamics of the COVID-19 Pandemic: Systematic Evaluation %A Liu,Chuchu %A Holme,Petter %A Lehmann,Sune %A Yang,Wenchuan %A Lu,Xin %+ College of Systems Engineering, National University of Defense Technology, No 137 Yanwachi Street, Changsha, 410073, China, 86 18627561577, xin.lu.lab@outlook.com %K human mobility %K data representativeness %K population composition %K COVID-19 %K epidemiological modeling %D 2024 %7 28.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, a range of novel smartphone-derived data streams about human mobility have become available on a near–real-time basis. These data have been used, for example, to perform traffic forecasting and epidemic modeling. During the COVID-19 pandemic in particular, human travel behavior has been considered a key component of epidemiological modeling to provide more reliable estimates about the volumes of the pandemic’s importation and transmission routes, or to identify hot spots. However, nearly universally in the literature, the representativeness of these data, how they relate to the underlying real-world human mobility, has been overlooked. This disconnect between data and reality is especially relevant in the case of socially disadvantaged minorities. Objective: The objective of this study is to illustrate the nonrepresentativeness of data on human mobility and the impact of this nonrepresentativeness on modeling dynamics of the epidemic. This study systematically evaluates how real-world travel flows differ from census-based estimations, especially in the case of socially disadvantaged minorities, such as older adults and women, and further measures biases introduced by this difference in epidemiological studies. Methods: To understand the demographic composition of population movements, a nationwide mobility data set from 318 million mobile phone users in China from January 1 to February 29, 2020, was curated. Specifically, we quantified the disparity in the population composition between actual migrations and resident composition according to census data, and shows how this nonrepresentativeness impacts epidemiological modeling by constructing an age-structured SEIR (Susceptible-Exposed-Infected- Recovered) model of COVID-19 transmission. Results: We found a significant difference in the demographic composition between those who travel and the overall population. In the population flows, 59% (n=20,067,526) of travelers are young and 36% (n=12,210,565) of them are middle-aged (P<.001), which is completely different from the overall adult population composition of China (where 36% of individuals are young and 40% of them are middle-aged). This difference would introduce a striking bias in epidemiological studies: the estimation of maximum daily infections differs nearly 3 times, and the peak time has a large gap of 46 days. Conclusions: The difference between actual migrations and resident composition strongly impacts outcomes of epidemiological forecasts, which typically assume that flows represent underlying demographics. Our findings imply that it is necessary to measure and quantify the inherent biases related to nonrepresentativeness for accurate epidemiological surveillance and forecasting. %M 38941609 %R 10.2196/55013 %U https://formative.jmir.org/2024/1/e55013 %U https://doi.org/10.2196/55013 %U http://www.ncbi.nlm.nih.gov/pubmed/38941609 %0 Journal Article %@ 2291-9694 %I %V 12 %N %P e52934 %T Data Flow Construction and Quality Evaluation of Electronic Source Data in Clinical Trials: Pilot Study Based on Hospital Electronic Medical Records in China %A Yuan,Yannan %A Mei,Yun %A Zhao,Shuhua %A Dai,Shenglong %A Liu,Xiaohong %A Sun,Xiaojing %A Fu,Zhiying %A Zhou,Liheng %A Ai,Jie %A Ma,Liheng %A Jiang,Min %K clinical trials %K electronic source data %K EHRs %K electronic data capture systems %K data quality %K electronic health records %D 2024 %7 27.6.2024 %9 %J JMIR Med Inform %G English %X Background: The traditional clinical trial data collection process requires a clinical research coordinator who is authorized by the investigators to read from the hospital’s electronic medical record. Using electronic source data opens a new path to extract patients’ data from electronic health records (EHRs) and transfer them directly to an electronic data capture (EDC) system; this method is often referred to as eSource. eSource technology in a clinical trial data flow can improve data quality without compromising timeliness. At the same time, improved data collection efficiency reduces clinical trial costs. Objective: This study aims to explore how to extract clinical trial–related data from hospital EHR systems, transform the data into a format required by the EDC system, and transfer it into sponsors’ environments, and to evaluate the transferred data sets to validate the availability, completeness, and accuracy of building an eSource dataflow. Methods: A prospective clinical trial study registered on the Drug Clinical Trial Registration and Information Disclosure Platform was selected, and the following data modules were extracted from the structured data of 4 case report forms: demographics, vital signs, local laboratory data, and concomitant medications. The extracted data was mapped and transformed, deidentified, and transferred to the sponsor’s environment. Data validation was performed based on availability, completeness, and accuracy. Results: In a secure and controlled data environment, clinical trial data was successfully transferred from a hospital EHR to the sponsor’s environment with 100% transcriptional accuracy, but the availability and completeness of the data could be improved. Conclusions: Data availability was low due to some required fields in the EDC system not being available directly in the EHR. Some data is also still in an unstructured or paper-based format. The top-level design of the eSource technology and the construction of hospital electronic data standards should help lay a foundation for a full electronic data flow from EHRs to EDC systems in the future. %R 10.2196/52934 %U https://medinform.jmir.org/2024/1/e52934 %U https://doi.org/10.2196/52934 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e45840 %T Pandemic Fatigue and Preferences for COVID-19 Public Health and Social Measures in China: Nationwide Discrete Choice Experiment %A Yang,Meng %A He,Zonglin %A Zhang,Yin %A Liu,Taoran %A Ming,Wai-kit %+ Department of Infectious Diseases and Public Health, City University of Hong Kong, Room 1A-503, 5/F, Block 1, To Yuen Building, 31 To Yuen Street, Hong Kong, China (Hong Kong), 852 34426956, wkming2@cityu.edu.hk %K pandemic fatigue %K preference %K public health and social measures %K discrete choice experiment %K COVID-19 %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Information on the public’s preferences for current public health and social measures (PHSMs) and people’s mental health under PHSMs is insufficient. Objective: This study aimed to quantify the public’s preferences for varied PHSMs and measure the level of pandemic fatigue in the COVID-19 normalization stage in China. Methods: A nationwide cross-sectional study with a discrete choice experiment and psychometric scales was conducted to assess public preferences for and attitudes toward PHSMs, using the quota sampling method. The COVID-19 Pandemic Fatigue Scale (CPFS) was used to screen fatigue levels among respondents. The multinomial logit model, latent class model, and Mann-Whitney test were used for statistical analysis. We also conducted subgroup analysis based on sex, age, monthly income, mental health status, and pandemic fatigue status. Results: A total of 689 respondents across China completed the survey. The discrete choice experiment revealed that respondents attached the greatest importance to the risk of COVID-19 infection within 3 months (45.53%), followed by loss of income within 3 months (30.69%). Vulnerable populations (low-income populations and elderly people) were more sensitive to the risk of infection, while younger respondents were more sensitive to income loss and preferred nonsuspension of social places and transportation. Migrants and those with pandemic fatigue had less acceptance of the mandatory booster vaccination and suspension of transportation. Additionally, a higher pandemic fatigue level was observed in female respondents, younger respondents, migrants, and relatively lower-income respondents (CPFS correlation with age: r=–0.274, P<.001; correlation with monthly income: r=–0.25, P<.001). Mandatory booster COVID-19 vaccination was also not preferred by respondents with a higher level of pandemic fatigue, while universal COVID-19 booster vaccination was preferred by respondents with a lower level of pandemic fatigue. Conclusions: Pandemic fatigue is widely prevalent in respondents across China, and respondents desired the resumption of normal social life while being confronted with the fear of COVID-19 infection in the normalization stage of COVID-19 in China. During future pandemics, the mental burden and adherence of residents should be considered for the proper implementation of PHSMs. %M 38935420 %R 10.2196/45840 %U https://publichealth.jmir.org/2024/1/e45840 %U https://doi.org/10.2196/45840 %U http://www.ncbi.nlm.nih.gov/pubmed/38935420 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e49785 %T User Preferences and Needs for Health Data Collection Using Research Electronic Data Capture: Survey Study %A Soni,Hiral %A Ivanova,Julia %A Wilczewski,Hattie %A Ong,Triton %A Ross,J Nalubega %A Bailey,Alexandra %A Cummins,Mollie %A Barrera,Janelle %A Bunnell,Brian %A Welch,Brandon %+ Doxy.me Research, Doxy.me Inc, 18 Broad Street, 3rd Floor, Suite 6 and 7, Charleston, SC, 29401, United States, 1 8444369963, sonihiralc@gmail.com %K Research Electronic Data Capture %K REDCap %K user experience %K electronic data collection %K health data %K personal health information %K clinical research %K mobile phone %D 2024 %7 25.6.2024 %9 Original Paper %J JMIR Med Inform %G English %X Background: Self-administered web-based questionnaires are widely used to collect health data from patients and clinical research participants. REDCap (Research Electronic Data Capture; Vanderbilt University) is a global, secure web application for building and managing electronic data capture. Unfortunately, stakeholder needs and preferences of electronic data collection via REDCap have rarely been studied. Objective: This study aims to survey REDCap researchers and administrators to assess their experience with REDCap, especially their perspectives on the advantages, challenges, and suggestions for the enhancement of REDCap as a data collection tool. Methods: We conducted a web-based survey with representatives of REDCap member organizations in the United States. The survey captured information on respondent demographics, quality of patient-reported data collected via REDCap, patient experience of data collection with REDCap, and open-ended questions focusing on the advantages, challenges, and suggestions to enhance REDCap’s data collection experience. Descriptive and inferential analysis measures were used to analyze quantitative data. Thematic analysis was used to analyze open-ended responses focusing on the advantages, disadvantages, and enhancements in data collection experience. Results: A total of 207 respondents completed the survey. Respondents strongly agreed or agreed that the data collected via REDCap are accurate (188/207, 90.8%), reliable (182/207, 87.9%), and complete (166/207, 80.2%). More than half of respondents strongly agreed or agreed that patients find REDCap easy to use (165/207, 79.7%), could successfully complete tasks without help (151/207, 72.9%), and could do so in a timely manner (163/207, 78.7%). Thematic analysis of open-ended responses yielded 8 major themes: survey development, user experience, survey distribution, survey results, training and support, technology, security, and platform features. The user experience category included more than half of the advantage codes (307/594, 51.7% of codes); meanwhile, respondents reported higher challenges in survey development (169/516, 32.8% of codes), also suggesting the highest enhancement suggestions for the category (162/439, 36.9% of codes). Conclusions: Respondents indicated that REDCap is a valued, low-cost, secure resource for clinical research data collection. REDCap’s data collection experience was generally positive among clinical research and care staff members and patients. However, with the advancements in data collection technologies and the availability of modern, intuitive, and mobile-friendly data collection interfaces, there is a critical opportunity to enhance the REDCap experience to meet the needs of researchers and patients. %M 38917448 %R 10.2196/49785 %U https://medinform.jmir.org/2024/1/e49785 %U https://doi.org/10.2196/49785 %U http://www.ncbi.nlm.nih.gov/pubmed/38917448 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55443 %T Provider Adoption of mHealth in Rural Patient Care: Web-Based Survey Study %A Weichelt,Bryan P %A Burke,Rick %A Kieke,Burney %A Pilz,Matt %A Shimpi,Neel %+ National Farm Medicine Center, Marshfield Clinic Research Institute, 1000 N Oak Ave, Marshfield, WI, 54449, United States, 1 715 221 7276, weichelt.bryan@marshfieldresearch.org %K mHealth %K clinician %K physician %K rural %K patient %K mobile %K health care %K adoption %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K acceptance %K mobile health %K app %K apps %K provider %K providers %K physicians %K survey %K surveys %K barrier %K barriers %K digital health %D 2024 %7 24.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Physicians and patient-facing caregivers have increasingly used mobile health (mHealth) technologies in the past several years, accelerating during the COVID-19 pandemic. However, barriers and feedback surrounding adoption remain relatively understudied and varied across health systems, particularly in rural areas. Objective: This study aims to identify provider adoption, attitudes, and barriers toward mHealth in a large, multisite, rural US health care system. We investigated (1) mHealth apps that providers use for their own benefit and (2) mHealth apps that a provider uses in conjunction with a patient. Methods: We surveyed all patient-seeing providers within the Marshfield Clinic Health System with a brief, 16-item, web-based survey assessing attitudes toward mHealth, adoption of these technologies, and perceived barriers faced by providers, their peers, and the institution. Survey results were summarized via descriptive statistics, with log-binomial regression and accompanying pairwise analyses, using Kruskal-Wallis and Jonckheere-Terpstra tests for significance, respectively. Respondents were grouped by reported clinical role and specialty. Results: We received a 38% (n/N=916/2410) response rate, with 60.7% (n=556) of those sufficiently complete for analyses. Roughly 54.1% (n=301) of respondents reported mHealth use, primarily around decision-making and supplemental information, with use differing based on provider role and years of experience. Self-reported barriers to using mHealth included a lack of knowledge and time to study mHealth technologies. Providers also reported concerns about patients’ internet access and the complexity of mHealth apps to adequately use mHealth technologies. Providers believed the health system’s barriers were largely privacy, confidentiality, and legal review concerns. Conclusions: These findings echo similar studies in other health systems, surrounding providers’ lack of time and concerns over privacy and confidentiality of patient data. Providers emphasized concerns over the complexity of these technologies for their patients and concerns over patients’ internet access to fully use mHealth in their delivery of care. %M 38913992 %R 10.2196/55443 %U https://humanfactors.jmir.org/2024/1/e55443 %U https://doi.org/10.2196/55443 %U http://www.ncbi.nlm.nih.gov/pubmed/38913992 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55548 %T Remote Inclusion of Vulnerable Users in mHealth Intervention Design: Retrospective Case Analysis %A Straand,Ingjerd J %A Baxter,Kimberley A %A Følstad,Asbjørn %+ Department of Social Work, University of Stavanger, Kjell Arholms hus, Stavanger, 4021, Norway, 47 93222289, ingjerd.j.straand@uis.no %K user testing %K user participation in research %K COVID-19 %K remote testing %K intervention design %K mobile phone %D 2024 %7 14.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) interventions that promote healthy behaviors or mindsets are a promising avenue to reach vulnerable or at-risk groups. In designing such mHealth interventions, authentic representation of intended participants is essential. The COVID-19 pandemic served as a catalyst for innovation in remote user-centered research methods. The capability of such research methods to effectively engage with vulnerable participants requires inquiry into practice to determine the suitability and appropriateness of these methods. Objective: In this study, we aimed to explore opportunities and considerations that emerged from involving vulnerable user groups remotely when designing mHealth interventions. Implications and recommendations are presented for researchers and practitioners conducting remote user-centered research with vulnerable populations. Methods: Remote user-centered research practices from 2 projects involving vulnerable populations in Norway and Australia were examined retrospectively using visual mapping and a reflection-on-action approach. The projects engaged low-income and unemployed groups during the COVID-19 pandemic in user-based evaluation and testing of interactive, web-based mHealth interventions. Results: Opportunities and considerations were identified as (1) reduced barriers to research inclusion; (2) digital literacy transition; (3) contextualized insights: a window into people’s lives; (4) seamless enactment of roles; and (5) increased flexibility for researchers and participants. Conclusions: Our findings support the capability and suitability of remote user methods to engage with users from vulnerable groups. Remote methods facilitate recruitment, ease the burden of research participation, level out power imbalances, and provide a rich and relevant environment for user-centered evaluation of mHealth interventions. There is a potential for a much more agile research practice. Future research should consider the privacy impacts of increased access to participants’ environment via webcams and screen share and how technology mediates participants’ action in terms of privacy. The development of support procedures and tools for remote testing of mHealth apps with user participants will be crucial to capitalize on efficiency gains and better protect participants’ privacy. %M 38875700 %R 10.2196/55548 %U https://mhealth.jmir.org/2024/1/e55548 %U https://doi.org/10.2196/55548 %U http://www.ncbi.nlm.nih.gov/pubmed/38875700 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e56906 %T Examining HIV Testing Coverage and Factors Influencing First-Time Testing Among Men Who Have Sex With Men in Zhejiang Province, China: Cross-Sectional Study Based on a Large Internet Survey %A He,Lin %A Jiang,Tingting %A Chen,Wanjun %A Jiang,Shaoqiang %A Zheng,Jinlei %A Chen,Weiyong %A Wang,Hui %A Ma,Qiaoqin %A Chai,Chengliang %+ Zhejiang Provincial Center for Disease Control and Prevention, 3399 Bin Sheng Road, Binjiang District, Hangzhou, 310051, China, 86 57187115193, chlchai@cdc.zj.cn %K HIV %K testing %K men who have sex with men %K MSM %K internet %K pre-exposure prophylaxis %K China %K mobile phone %D 2024 %7 14.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Men who have sex with men (MSM) constitute a significant population of patients infected with HIV. In recent years, several efforts have been made to promote HIV testing among MSM in China. Objective: This study aimed to assess HIV testing coverage and factors associated with first-time HIV testing among MSM to provide a scientific basis for achieving the goal of diagnosing 95% of patients infected with HIV by 2030. Methods: This cross-sectional study was conducted between July 2023 and December 2023. MSM were recruited from the “Sunshine Test,” an internet platform that uses location-based services to offer free HIV testing services to MSM by visiting the WeChat official account in Zhejiang Province, China. Participants were required to complete a questionnaire on their demographic characteristics, sexual behaviors, substance use, and HIV testing history. A logistic regression model was used to analyze first-time HIV testing and its associated factors. Results: A total of 7629 MSM participated in the study, with 87.1% (6647) having undergone HIV testing before and 12.9% (982) undergoing HIV testing for the first time. Multivariate logistic regression analysis revealed that first-time HIV testing was associated with younger age (adjusted odds ratio [aOR] 2.55, 95% CI 1.91-3.42), lower education (aOR 1.39, 95% CI 1.03-1.88), student status (aOR 1.35, 95% CI 1.04-1.75), low income (aOR 1.55, 95% CI 1.16-2.08), insertive anal sex role (aOR 1.28, 95% CI 1.05-1.56), bisexuality (aOR 1.69, 95% CI 1.40-2.03), fewer sex partners (aOR 1.44, 95% CI 1.13-1.83), use of rush poppers (aOR 2.06, 95% CI 1.70-2.49), unknown HIV status of sex partners (aOR 1.40, 95% CI 1.17-1.69), lack of awareness of HIV pre-exposure prophylaxis (aOR 1.39, 95% CI 1.03-1.88), and offline HIV testing uptake (aOR 2.08, 95% CI 1.80-2.41). Conclusions: A notable 12.9% (982/7629) of MSM had never undergone HIV testing before this large internet survey. We recommend enhancing HIV intervention and testing through internet-based platforms and gay apps to promote testing among MSM and achieve the target of diagnosing 95% of patients infected with HIV by 2030. %M 38875001 %R 10.2196/56906 %U https://publichealth.jmir.org/2024/1/e56906 %U https://doi.org/10.2196/56906 %U http://www.ncbi.nlm.nih.gov/pubmed/38875001 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50557 %T Web-Based Tool Designed to Encourage Supplemental Nutrition Assistance Program Use in Urban College Students: Usability Testing Study %A Li,Catherine Yan Hei %A Platkin,Charles %A Chin,Jonathan %A Khan,Asia %A Bennett,Jaleel %A Speck,Anna %A Nielsen,Annette %A Leung,May May %+ Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, United States, 1 617 636 3676, maymay.leung@tufts.edu %K SNAP %K SNAP eligibility screening %K food insecurity %K college students %K web-based tool %K think-aloud %K system usability %K user experience %K student %K college %K chronic health %K stress %K anxiety %K barrier %K technology %K tool %K Supplemental Nutrition Assistance Program %K usability %D 2024 %7 13.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Food insecurity continues to be a risk for college students in the United States. It is associated with numerous problems, such as chronic health conditions, increased stress and anxiety, and a lower grade point average. After COVID-19, the Supplemental Nutrition Assistance Program (SNAP) benefits were extended to college-aged students; however, there were some barriers to participation, which persisted such as lack of perceived food insecurity risk, lack of knowledge regarding the SNAP application process, the complexity of determining eligibility, and stigma associated with needing social assistance. A technology-enhanced tool was developed to address these barriers to SNAP enrollment and encourage at-risk college students to apply for SNAP. Objective: The purpose of this study was to test the usability and acceptability of a web-based SNAP screening tool designed for college-aged students. Methods: College students aged 18-25 years were recruited to participate in 2 rounds of usability testing during fall 2022. Participants tested the prototype of a web-based SNAP screener tool using a standardized think-aloud method. The usability and acceptability of the tool were assessed using a semistructured interview and a 10-item validated System Usability Scale questionnaire. Audio recordings and field notes were systematically reviewed by extracting and sorting feedback as positive or negative comments. System Usability Scale questionnaire data were analyzed using the Wilcoxon signed rank test and sign test. Results: A total of 12 students (mean age 21.8, SD 2.8 years; n=6, 50% undergraduate; n=11, 92% female; n=7, 58% Hispanic or Black or African American; n=9, 78% low or very low food security) participated in both rounds of user testing. Round 1 testing highlighted overall positive experiences with the tool, with most participants (10/12) stating that the website fulfills its primary objective as a support tool to encourage college students to apply for SNAP. However, issues related to user interface design, navigation, and wording of some questions in the screening tool were noted. Key changes after round 1 reflected these concerns, including improved design of response buttons and tool logo and improved clarity of screening questions. The overall system usability showed slight, but not statistically significant, improvement between round 1 and round 2 (91.25 vs 92.50; P=.10, respectively). Conclusions: Overall usability findings suggest that this web-based tool was highly usable and acceptable to urban college students and could be an effective and appealing approach as a support tool to introduce college students to the SNAP application process. The findings from this study will inform further development of the tool, which could eventually be disseminated publicly among various college campuses. %M 38869926 %R 10.2196/50557 %U https://formative.jmir.org/2024/1/e50557 %U https://doi.org/10.2196/50557 %U http://www.ncbi.nlm.nih.gov/pubmed/38869926 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52281 %T Combating Fraudulent Participation in Urban American Indian and Alaska Native Virtual Health Research: Protocol for Increasing Data Integrity in Online Research (PRIOR) %A Reed,Nicole D %A Bull,Sheana %A Shrestha,Umit %A Sarche,Michelle %A Kaufman,Carol E %+ Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Mail Stop F800, 13055 East 17th Ave, Aurora, CO, 80045, United States, 1 3037240177, nicole.d.reed@cuanschutz.edu %K fraudulent survey participation %K online survey research %K American Indian and Alaska Native %K data integrity %K health research %K research trust %K online survey %K case study %K randomized control trial %K RCT %K social media %K recruitment %K young women %K women %K American Indian %K Native Americans %K Native American %K fraudulent %K data privacy %D 2024 %7 13.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: While the advantages of using the internet and social media for research recruitment are well documented, the evolving online environment also enhances motivations for misrepresentation to receive incentives or to “troll” research studies. Such fraudulent assaults can compromise data integrity, with substantial losses in project time; money; and especially for vulnerable populations, research trust. With the rapid advent of new technology and ever-evolving social media platforms, it has become easier for misrepresentation to occur within online data collection. This perpetuation can occur by bots or individuals with malintent, but careful planning can help aid in filtering out fraudulent data. Objective: Using an example with urban American Indian and Alaska Native young women, this paper aims to describe PRIOR (Protocol for Increasing Data Integrity in Online Research), which is a 2-step integration protocol for combating fraudulent participation in online survey research. Methods: From February 2019 to August 2020, we recruited participants for formative research preparatory to an online randomized control trial of a preconceptual health program. First, we described our initial protocol for preventing fraudulent participation, which proved to be unsuccessful. Then, we described modifications we made in May 2020 to improve the protocol performance and the creation of PRIOR. Changes included transferring data collection platforms, collecting embedded geospatial variables, enabling timing features within the screening survey, creating URL links for each method or platform of data collection, and manually confirming potentially eligible participants’ identifying information. Results: Before the implementation of PRIOR, the project experienced substantial fraudulent attempts at study enrollment, with less than 1% (n=6) of 1300 screened participants being identified as truly eligible. With the modified protocol, of the 461 individuals who completed a screening survey, 381 did not meet the eligibility criteria assessed on the survey. Of the 80 that did, 25 (31%) were identified as ineligible via PRIOR. A total of 55 (69%) were identified as eligible and verified in the protocol and were enrolled in the formative study. Conclusions: Fraudulent surveys compromise study integrity, validity of the data, and trust among participant populations. They also deplete scarce research resources including respondent compensation and personnel time. Our approach of PRIOR to prevent online misrepresentation in data was successful. This paper reviews key elements regarding fraudulent data participation in online research and demonstrates why enhanced protocols to prevent fraudulent data collection are crucial for building trust with vulnerable populations. Trial Registration: ClinicalTrials.gov NCT04376346; https://www.clinicaltrials.gov/study/NCT04376346 International Registered Report Identifier (IRRID): DERR1-10.2196/52281 %M 38869930 %R 10.2196/52281 %U https://www.researchprotocols.org/2024/1/e52281 %U https://doi.org/10.2196/52281 %U http://www.ncbi.nlm.nih.gov/pubmed/38869930 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53159 %T Development of an Electronic Health Record Self-Referral Tool for Lung Cancer Screening: One-Group Posttest Study %A Stang,Garrett S %A Tanner,Nichole T %A Hatch,Ashley %A Godbolt,Jakarri %A Toll,Benjamin A %A Rojewski,Alana M %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main St, Box G-S121-3, Providence, RI, 02912, United States, 1 4018633375, garrett_stang@brown.edu %K lung cancer screening %K LCS %K electronic health records %K EHR %K Health Belief Model %K HBM %K self-refer %K tobacco treatment %K cancer screening %K development %K self-referral tool %K electronic health record %K decision-making %D 2024 %7 12.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 14 million individuals in the United States are eligible for lung cancer screening (LCS), but only 5.8% completed screening in 2021. Given the low uptake despite the potential great health benefit of LCS, interventions aimed at increasing uptake are warranted. The use of a patient-facing electronic health record (EHR) patient portal direct messaging tool offers a new opportunity to both engage eligible patients in preventative screening and provide a unique referral pathway for tobacco treatment. Objective: This study sought to develop and pilot an EHR patient-facing self-referral tool for an established LCS program in an academic medical center. Methods: Guided by constructs of the Health Belief Model associated with LCS uptake (eg, knowledge and self-efficacy), formative development of an EHR-delivered engagement message, infographic, and self-referring survey was conducted. The survey submits eligible self-reported patient information to a scheduler for the LCS program. The materials were pretested using an interviewer-administered mixed methods survey captured through venue-day-time sampling in 5 network-affiliated pulmonology clinics. Materials were then integrated into the secure patient messaging feature in the EHR system. Next, a one-group posttest quality improvement pilot test was conducted. Results: A total of 17 individuals presenting for lung screening shared-decision visits completed the pretest survey. More than half were newly referred for LCS (n=10, 60%), and the remaining were returning patients. When asked if they would use a self-referring tool through their EHR messaging portal, 94% (n=16) reported yes. In it, 15 participants provided oral feedback that led to refinement in the tool and infographic prior to pilot-testing. When the initial application of the tool was sent to a convenience sample of 150 random patients, 13% (n=20) opened the self-referring survey. Of the 20 who completed the pilot survey, 45% (n=9) were eligible for LCS based on self-reported smoking data. A total of 3 self-referring individuals scheduled an LCS. Conclusions: Pretest and initial application data suggest this tool is a positive stimulus to trigger the decision-making process to engage in a self-referral process to LCS among eligible patients. This self-referral tool may increase the number of patients engaging in LCS and could also be used to aid in self-referral to other preventative health screenings. This tool has implications for clinical practice. Tobacco treatment clinical services or health care systems should consider using EHR messaging for LCS self-referral. This approach may be cost-effective to improve LCS engagement and uptake. Additional referral pathways could be built into this EHR tool to not only refer patients who currently smoke to LCS but also simultaneously trigger a referral to clinical tobacco treatment. %M 38865702 %R 10.2196/53159 %U https://formative.jmir.org/2024/1/e53159 %U https://doi.org/10.2196/53159 %U http://www.ncbi.nlm.nih.gov/pubmed/38865702 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e54579 %T Mobile Health App and Web Platform (eDOL) for Medical Follow-Up of Patients With Chronic Pain: Cohort Study Involving the French eDOL National Cohort After 1 Year %A Delage,Noémie %A Cantagrel,Nathalie %A Soriot-Thomas,Sandrine %A Frost,Marie %A Deleens,Rodrigue %A Ginies,Patrick %A Eschalier,Alain %A Corteval,Alice %A Laveyssière,Alicia %A Phalip,Jules %A Bertin,Célian %A Pereira,Bruno %A Chenaf,Chouki %A Doreau,Bastien %A Authier,Nicolas %A , %A Kerckhove,Nicolas %+ Service de pharmacologie médicale, CHU Clermont-Ferrand, 58 rue Montalembert, Clermont-Ferrand, 63000, France, 33 473754833, nkerckhove@chu-clermontferrand.fr %K mHealth %K mobile health %K eHealth %K self-monitoring %K chronic pain %K observational study %D 2024 %7 12.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Chronic pain affects approximately 30% of the general population, severely degrades quality of life and professional life, and leads to additional health care costs. Moreover, the medical follow-up of patients with chronic pain remains complex and provides only fragmentary data on painful daily experiences. This situation makes the management of patients with chronic pain less than optimal and may partly explain the lack of effectiveness of current therapies. Real-life monitoring of subjective and objective markers of chronic pain using mobile health (mHealth) programs could better characterize patients, chronic pain, pain medications, and daily impact to help medical management. Objective: This cohort study aimed to assess the ability of our mHealth tool (eDOL) to collect extensive real-life medical data from chronic pain patients after 1 year of use. The data collected in this way would provide new epidemiological and pathophysiological data on chronic pain. Methods: A French national cohort of patients with chronic pain treated at 18 pain clinics has been established and followed up using mHealth tools. This cohort makes it possible to collect the determinants and repercussions of chronic pain and their evolutions in a real-life context, taking into account all environmental events likely to influence chronic pain. The patients were asked to complete several questionnaires, body schemes, and weekly meters, and were able to interact with a chatbot and use educational modules on chronic pain. Physicians could monitor their patients’ progress in real time via an online platform. Results: The cohort study included 1427 patients and analyzed 1178 patients. The eDOL tool was able to collect various sociodemographic data; specific data for characterizing pain disorders, including body scheme; data on comorbidities related to chronic pain and its psychological and overall impact on patients’ quality of life; data on drug and nondrug therapeutics and their benefit-to-risk ratio; and medical or treatment history. Among the patients completing weekly meters, 49.4% (497/1007) continued to complete them after 3 months of follow-up, and the proportion stabilized at 39.3% (108/275) after 12 months of follow-up. Overall, despite a fairly high attrition rate over the follow-up period, the eDOL tool collected extensive data. This amount of data will increase over time and provide a significant volume of health data of interest for future research involving the epidemiology, care pathways, trajectories, medical management, sociodemographic characteristics, and other aspects of patients with chronic pain. Conclusions: This work demonstrates that the mHealth tool eDOL is able to generate a considerable volume of data concerning the determinants and repercussions of chronic pain and their evolutions in a real-life context. The eDOL tool can incorporate numerous parameters to ensure the detailed characterization of patients with chronic pain for future research and pain management. Trial Registration: ClinicalTrials.gov NCT04880096; https://clinicaltrials.gov/ct2/show/NCT04880096 %M 38865173 %R 10.2196/54579 %U https://mhealth.jmir.org/2024/1/e54579 %U https://doi.org/10.2196/54579 %U http://www.ncbi.nlm.nih.gov/pubmed/38865173 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e56643 %T Population Percentage and Population Size of Men Who Have Sex With Men in the United States, 2017-2021: Meta-Analysis of 5 Population-Based Surveys %A Bennett,Brady W %A DuBose,Stephanie %A Huang,Ya-Lin A %A Johnson,Christopher H %A Hoover,Karen W %A Wiener,Jeffrey %A Purcell,David W %A Sullivan,Patrick S %+ Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 706 766 1510, brady.bennett@emory.edu %K sexual behavior %K sexual identity %K sexual attraction %K men who have sex with men %K population estimates %K MSM %K men who have sex with other men %K national surveys %K census %K United States %D 2024 %7 11.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Male-to-male sexual transmission continues to account for the greatest proportion of new HIV diagnoses in the United States. However, calculating population-specific surveillance metrics for HIV and other sexually transmitted infections requires regularly updated estimates of the number and proportion of men who have sex with men (MSM) in the United States, which are not collected by census surveys. Objective: The purpose of this analysis was to estimate the number and percentage of MSM in the United States from population-based surveys. Methods: We used data from 5 population-based surveys to calculate weighted estimates of the proportion of MSM in the United States and pooled these estimates using meta-analytic procedures. We estimated the proportion of MSM using sexual behavior–based questions (encompassing anal or oral sex) for 3 recall periods—past 12 months, past 5 years, and lifetime. In addition, we estimated the proportion of MSM using self-reported identity and attraction survey responses. The total number of MSM and non-MSM in the United States were calculated from estimates of the percentage of MSM who reported sex with another man in the past 12 months. Results: The percentage of MSM varied by recall period: 3.3% (95% CI 1.7%-4.9%) indicated sex with another male in the past 12 months, 4.7% (95% CI 0.0%-33.8%) in the past 5 years, and 6.2% (95% CI 2.9%-9.5%) in their lifetime. There were comparable percentages of men who identified as gay or bisexual (3.4%, 95% CI 2.2%-4.6%) or who indicated that they are attracted to other men (4.9%, 95% CI 3.1%-6.7%) based on pooled estimates. Our estimate of the total number of MSM in the United States is 4,230,000 (95% CI 2,179,000-6,281,000) based on the history of recent sexual behavior (sex with another man in the past 12 months). Conclusions: We calculated the pooled percentage and number of MSM in the United States from a meta-analysis of population-based surveys collected from 2017 to 2021. These estimates update and expand upon those derived from the Centers for Disease Control and Prevention in 2012 by including estimates of the percentage of MSM based on sexual identity and sexual attraction. The percentage and number of MSM in the United States is an important indicator for calculating population-specific disease rates and eligibility for preventive interventions such as pre-exposure prophylaxis. %M 38861303 %R 10.2196/56643 %U https://publichealth.jmir.org/2024/1/e56643 %U https://doi.org/10.2196/56643 %U http://www.ncbi.nlm.nih.gov/pubmed/38861303 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56493 %T Individual-Level Digital Determinants of Health and Technology Acceptance of Patient Portals: Cross-Sectional Assessment %A Philpot,Lindsey M %A Ramar,Priya %A Roellinger,Daniel L %A Njeru,Jane W %A Ebbert,Jon O %+ Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, United States, 1 507 538 1882, Philpot.Lindsey@mayo.edu %K electronic health records %K digital determinants of health %K patient portals %K eHealth %K digital health %K technology acceptance model %K digital health literacy %K digital inclusion %K mobile phone %D 2024 %7 10.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital determinants of health (DDoH), including access to technological tools and digital health literacy, function independently as barriers to health. Assessment for DDoH is not routine within most health care systems, although addressing DDoH could help mitigate differential health outcomes and the digital divide. Objective: This study aims to assess the role of individual-level DDoH factors on patient enrollment in and use of the patient portal. Methods: We developed a multimodal, cross-sectional survey and deployed it to 11,424 individuals based on their preferred mode and language documented within the electronic medical record. Based on the Technology Acceptance Model, enrollment in and intent to use the patient portal were the outcomes of interest. Perceived usefulness and ease of use were assessed to determine construct validity, and exploratory investigations included individual-level DDoH, including internet and device access, availability of technological support, medical complexity, individual relationship with the health care system, and digital health literacy. Counts (n) and proportions (%) were used to describe response categories, and adjusted and unadjusted odds ratios are reported. Results: This study included 1850 respondents (11,424 invited, 16.2% response rate), who were mostly female (1048/1850, 56.6%) and White (1240/1850, 67%), with an average age of 63 years. In the validation of the Technology Acceptance Model, measures of perceived ease of use (ie, using the patient portal will require a lot of mental effort; the patient portal will be very easy to use) and perceived usefulness (ie, the usefulness of the patient portal to send and receive messages with providers, schedule appointments, and refill medications) were positively associated with both enrollment in and intent to use the patient portal. Within adjusted models, perceived ease of use and perceived usefulness constructs, in addition to constructs of digital health literacy, knowing what health resources are available on the internet (adjusted odds ratio [aOR] 3.5, 95% CI 1.8-6.6), portal ease of use (aOR 2.8, 95% CI 1.6-5), and portal usefulness (aOR 2.4, 95% CI 1.4-4.2) were significantly associated with patient portal enrollment. Other factors associated with patient portal enrollment and intent to use included being comfortable reading and speaking English, reported use of the internet to surf the web or to send or receive emails, home internet access, and access to technology devices (computer, tablet, smartphone, etc). Conclusions: Assessing for and addressing individual-level DDoH, including digital health literacy, access to digital tools and technologies, and support of the relational aspects between patients, social support systems, and health care providers, could help mitigate disparities in health. By focusing efforts to assess for and address individual-level DDoH, an opportunity exists to improve digitally driven health care delivery outcomes like access and structural outcomes like bias built within algorithms created with incomplete representation across communities. %M 38695754 %R 10.2196/56493 %U https://formative.jmir.org/2024/1/e56493 %U https://doi.org/10.2196/56493 %U http://www.ncbi.nlm.nih.gov/pubmed/38695754 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50650 %T Detecting and Understanding Social Influence During Drinking Situations: Protocol for a Bluetooth-Based Sensor Feasibility and Acceptability Study %A Jackson,Kristina %A Meisel,Matthew %A Sokolovsky,Alexander %A Chen,Katie %A Barnett,Nancy %+ Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Box G-S121-4, Providence, RI, 02912, United States, 1 (401) 863 6617, kristina_jackson@brown.edu %K Bluetooth technology %K passive sensing %K social influence %K alcohol use %K ecological momentary assessment %K social network %K feasibility %K acceptability %K mobile phone %D 2024 %7 6.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: High-risk alcohol consumption among young adults frequently occurs in the presence of peers who are also drinking. A high-risk drinking situation may consist of particular social network members who have a primary association with drinking. Fine-grained approaches such as ecological momentary assessment (EMA) are growing in popularity for studying real-time social influence, but studies using these approaches exclusively rely on participant self-report. Passive indicators of peer presence using Bluetooth-based technology to detect real-time interactions have the potential to assist in the development of just-in-time interventions. Objective: This study seeks to examine the feasibility and acceptability of using a Bluetooth-based sensor and smartphone app to measure social contact in real-world drinking situations. Methods: Young adults (N=20) who drink heavily and report social drinking will be recruited from the community to participate in a 3-week EMA study. Using a social network interview, index participants will identify and recruit 3 of their friends to carry a Bluetooth beacon. Participants will complete a series of EMA reports on their own personal Android devices including random reports; morning reports; first-drink reports; and signal-contingent reports, which are triggered following the detection of a beacon carried by a peer participant. EMA will assess alcohol use and characteristics of the social environment, including who is nearby and who is drinking. For items about peer proximity and peer drinking, a customized peer list will be presented to participants. Feedback about the study protocol will be ascertained through weekly contact with both index and peer participants, followed by a qualitative interview at the end of the study. We will examine the feasibility and acceptability of recruitment, enrollment of participants and peers, and retention. Feasibility will be determined using indexes of eligibility, enrollment, and recruitment. Acceptability will be determined through participant enrollment and retention, protocol compliance, and participant-reported measures of acceptability. Feasibility and acceptability for peer participants will be informed by enrollment rates, latency to enrollment, compliance with carrying the beacon, and self-reported reasons for compliance or noncompliance with beacon procedures. Finally, EMA data about peer proximity and peer drinking will support the validity of the peer selection process. Results: Participant recruitment began in February 2023, and enrollment was completed in December 2023. Results will be reported in 2025. Conclusions: The protocol allows us to examine the feasibility and acceptability of a Bluetooth-based sensor for the detection of social contact between index participants and their friends, including social interactions during real-world drinking situations. Data from this study will inform just-in-time adaptive interventions seeking to address drinking in the natural environment by providing personalized feedback about a high-risk social context and alerting an individual that they are in a potentially unsafe situation. International Registered Report Identifier (IRRID): DERR1-10.2196/50650 %M 38842927 %R 10.2196/50650 %U https://www.researchprotocols.org/2024/1/e50650 %U https://doi.org/10.2196/50650 %U http://www.ncbi.nlm.nih.gov/pubmed/38842927 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49450 %T Investigating Health and Well-Being Challenges Faced by an Aging Workforce in the Construction and Nursing Industries: Computational Linguistic Analysis of Twitter Data %A Li,Weicong %A Tang,Liyaning Maggie %A Montayre,Jed %A Harris,Celia B %A West,Sancia %A Antoniou,Mark %+ The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Locked Bag 1797, Penrith, 2751, Australia, 61 61 2 97726673, m.antoniou@westernsydney.edu.au %K social media %K construction %K nursing %K aging %K health and well-being %K Twitter %D 2024 %7 5.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Construction and nursing are critical industries. Although both careers involve physically and mentally demanding work, the risks to workers during the COVID-19 pandemic are not well understood. Nurses (both younger and older) are more likely to experience the ill effects of burnout and stress than construction workers, likely due to accelerated work demands and increased pressure on nurses during the COVID-19 pandemic. In this study, we analyzed a large social media data set using advanced natural language processing techniques to explore indicators of the mental status of workers across both industries before and during the COVID-19 pandemic. Objective: This social media analysis aims to fill a knowledge gap by comparing the tweets of younger and older construction workers and nurses to obtain insights into any potential risks to their mental health due to work health and safety issues. Methods: We analyzed 1,505,638 tweets published on Twitter (subsequently rebranded as X) by younger and older (aged <45 vs >45 years) construction workers and nurses. The study period spanned 54 months, from January 2018 to June 2022, which equates to approximately 27 months before and 27 months after the World Health Organization declared COVID-19 a global pandemic on March 11, 2020. The tweets were analyzed using big data analytics and computational linguistic analyses. Results: Text analyses revealed that nurses made greater use of hashtags and keywords (both monograms and bigrams) associated with burnout, health issues, and mental health compared to construction workers. The COVID-19 pandemic had a pronounced effect on nurses’ tweets, and this was especially noticeable in younger nurses. Tweets about health and well-being contained more first-person singular pronouns and affect words, and health-related tweets contained more affect words. Sentiment analyses revealed that, overall, nurses had a higher proportion of positive sentiment in their tweets than construction workers. However, this changed markedly during the COVID-19 pandemic. Since early 2020, sentiment switched, and negative sentiment dominated the tweets of nurses. No such crossover was observed in the tweets of construction workers. Conclusions: The social media analysis revealed that younger nurses had language use patterns consistent with someone experiencing the ill effects of burnout and stress. Older construction workers had more negative sentiments than younger workers, who were more focused on communicating about social and recreational activities rather than work matters. More broadly, these findings demonstrate the utility of large data sets enabled by social media to understand the well-being of target populations, especially during times of rapid societal change. %M 38838308 %R 10.2196/49450 %U https://www.jmir.org/2024/1/e49450 %U https://doi.org/10.2196/49450 %U http://www.ncbi.nlm.nih.gov/pubmed/38838308 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51530 %T Evaluating the Problem of Fraudulent Participants in Health Care Research: Multimethod Pilot Study %A Kumarasamy,Vithusa %A Goodfellow,Nicole %A Ferron,Era Mae %A Wright,Amy L %+ Lawrence S Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada, 1 416 978 0695, amyl.wright@utoronto.ca %K fraudulent participants %K threats to data integrity %K online recruitment %K multimethod study %K health care research %K bots %K social media %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The shift toward online recruitment methods, accelerated by the COVID-19 pandemic, has brought to the forefront the growing concern of encountering fraudulent participants in health care research. The increasing prevalence of this issue poses a serious threat to the reliability and integrity of research data and subsequent findings. Objective: This study aims to explore the experiences of health care researchers (HCRs) who have encountered fraudulent participants while using online recruitment methods and platforms. The primary objective was to gain insights into how researchers detect and mitigate fraudulent behavior in their work and provide prevention recommendations. Methods: A multimethod sequential design was used for this pilot study, comprising a quantitative arm involving a web-based survey followed by a qualitative arm featuring semistructured interviews. The qualitative description approach framed the qualitative arm of the study. Sample sizes for the quantitative and qualitative arms were based on pragmatic considerations that in part stemmed from encountering fraudulent participants in a concurrent study. Content analysis was used to analyze open-ended survey questions and interview data. Results: A total of 37 HCRs participated, with 35% (13/37) of them engaging in qualitative interviews. Online platforms such as Facebook, email, Twitter (subsequently rebranded X), and newsletters were the most used methods for recruitment. A total of 84% (31/37) of participants indicated that fraudulent participation occurred in studies that mentioned incentives in their recruitment communications, with 71% (26/37) of HCRs offering physical or electronic gift cards as incentives. Researchers identified several indicators of suspicious behavior, including email surges, discrepancies in contact or personal information, geographical inconsistencies, and suspicious responses to survey questions. HCRs emphasized the need for a comprehensive screening protocol that extends beyond eligibility checks and is seamlessly integrated into the study protocol, grant applications, and research ethics board submissions. Conclusions: This study sheds light on the intricate and pervasive problem of fraudulent participation in health care research using online recruitment methods. The findings underscore the importance of vigilance and proactivity among HCRs in identifying, preventing, and addressing fraudulent behavior. To effectively tackle this challenge, researchers are encouraged to develop a comprehensive prevention strategy and establish a community of practice, facilitating real-time access to solutions and support and the promotion of ethical research practices. This collaborative approach will enable researchers to effectively address the issue of fraudulent participation, ensuring the conduct of high-quality and ethically sound research in the digital age. %M 38833292 %R 10.2196/51530 %U https://formative.jmir.org/2024/1/e51530 %U https://doi.org/10.2196/51530 %U http://www.ncbi.nlm.nih.gov/pubmed/38833292 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49907 %T Controlling Inputter Variability in Vignette Studies Assessing Web-Based Symptom Checkers: Evaluation of Current Practice and Recommendations for Isolated Accuracy Metrics %A Meczner,András %A Cohen,Nathan %A Qureshi,Aleem %A Reza,Maria %A Sutaria,Shailen %A Blount,Emily %A Bagyura,Zsolt %A Malak,Tamer %+ Healthily, 167-169 Great Portland Street, London, W1W 5PF, United Kingdom, meczner@gmail.com %K symptom checker %K accuracy %K vignette studies %K variability %K methods %K triage %K evaluation %K vignette %K performance %K metrics %K mobile phone %D 2024 %7 31.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The rapid growth of web-based symptom checkers (SCs) is not matched by advances in quality assurance. Currently, there are no widely accepted criteria assessing SCs’ performance. Vignette studies are widely used to evaluate SCs, measuring the accuracy of outcome. Accuracy behaves as a composite metric as it is affected by a number of individual SC- and tester-dependent factors. In contrast to clinical studies, vignette studies have a small number of testers. Hence, measuring accuracy alone in vignette studies may not provide a reliable assessment of performance due to tester variability. Objective: This study aims to investigate the impact of tester variability on the accuracy of outcome of SCs, using clinical vignettes. It further aims to investigate the feasibility of measuring isolated aspects of performance. Methods: Healthily’s SC was assessed using 114 vignettes by 3 groups of 3 testers who processed vignettes with different instructions: free interpretation of vignettes (free testers), specified chief complaints (partially free testers), and specified chief complaints with strict instruction for answering additional symptoms (restricted testers). κ statistics were calculated to assess agreement of top outcome condition and recommended triage. Crude and adjusted accuracy was measured against a gold standard. Adjusted accuracy was calculated using only results of consultations identical to the vignette, following a review and selection process. A feasibility study for assessing symptom comprehension of SCs was performed using different variations of 51 chief complaints across 3 SCs. Results: Intertester agreement of most likely condition and triage was, respectively, 0.49 and 0.51 for the free tester group, 0.66 and 0.66 for the partially free group, and 0.72 and 0.71 for the restricted group. For the restricted group, accuracy ranged from 43.9% to 57% for individual testers, averaging 50.6% (SD 5.35%). Adjusted accuracy was 56.1%. Assessing symptom comprehension was feasible for all 3 SCs. Comprehension scores ranged from 52.9% and 68%. Conclusions: We demonstrated that by improving standardization of the vignette testing process, there is a significant improvement in the agreement of outcome between testers. However, significant variability remained due to uncontrollable tester-dependent factors, reflected by varying outcome accuracy. Tester-dependent factors, combined with a small number of testers, limit the reliability and generalizability of outcome accuracy when used as a composite measure in vignette studies. Measuring and reporting different aspects of SC performance in isolation provides a more reliable assessment of SC performance. We developed an adjusted accuracy measure using a review and selection process to assess data algorithm quality. In addition, we demonstrated that symptom comprehension with different input methods can be feasibly compared. Future studies reporting accuracy need to apply vignette testing standardization and isolated metrics. %M 38820578 %R 10.2196/49907 %U https://formative.jmir.org/2024/1/e49907 %U https://doi.org/10.2196/49907 %U http://www.ncbi.nlm.nih.gov/pubmed/38820578 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54728 %T Daily Time-Use Patterns and Quality of Life in Parents: Protocol for a Pilot Quasi-Experimental, Nonrandomized Controlled Trial Using Ecological Momentary Assessment %A Altweck,Laura %A Schmidt,Silke %A Tomczyk,Samuel %+ Department Health and Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Str 13, Greifswald, 17487, Germany, 49 3834 420 ext 3813, laura.altweck@uni-greifswald.de %K time-use %K well-being %K parents %K ecological momentary assessment %K feasibility %K health-related quality of life %K ambulatory assessment %K work-family conflict %K gender roles %K mixed-methods %K sex differences %K stress %D 2024 %7 31.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The gender gap in time use and its impact on health and well-being are still prevalent. Women work longer hours than men when considering both paid and unpaid (eg, childcare and chores) work, and this gender disparity is particularly visible among parents. Less is known about factors that could potentially mediate or moderate this relationship (eg, work-family conflict and gender role beliefs). Ecological momentary assessment (EMA) allows for the documentation of changes in momentary internal states, such as time use, stress, or mood. It has shown particular validity to measure shorter-term activities (eg, unpaid work) and is thus useful to address gender differences. Objective: The feasibility of the daily EMA surveys in a parent sample will be examined. The associations between time use, well-being, and stress will be examined, along with potential moderating and mediating factors such as gender, gender role beliefs, and work-family conflict. Finally, the act of monitoring one’s own time use, well-being, and stress will be examined in relation to, for example, the quality of life. Methods: We conducted a quasi-experimental, nonrandomized controlled trial with 3 data collection methods, namely, online questionnaires, EMA surveys, and qualitative interviews. The intervention group (n=64) will participate in the online questionnaires and EMA surveys, and a subsample of the intervention group (n=6-17) will also be invited to participate in qualitative interviews. Over a period of 1 week, participants in the intervention group will answer daily EMA surveys (4 times per day). In contrast, the control group (n=17) will only participate in the online questionnaires at baseline and after 1 week. The following constructs were surveyed: sociodemographic background (eg, age, gender, and household composition; baseline questionnaire); mediators and moderators (eg, gender role beliefs and work-family conflict; baseline and follow-up questionnaires); well-being, quality of life, and trait mindfulness (baseline and follow-up questionnaires); momentary activity and well-being, as well as state mindfulness (EMA); and feasibility (baseline and follow-up questionnaires as well as interviews). We anticipate that participants will regard the daily EMA as feasible. Particular daily time-use patterns (eg, high paid and unpaid workload) are expected to be related to lower well-being, higher stress, and health-related quality of life. These associations are expected to be moderated and mediated by factors such as gender, gender role beliefs, work-family conflict, and social support. Participants in the intervention group are expected to show higher values of mindfulness, well-being, health-related quality of life, and lower stress. Results: Patient recruitment started in November 2023 and ended in mid April 2024. Data analysis commenced in mid April 2024. Conclusions: This study aims to provide valuable insights into the feasibility of using EMAs and the potential benefits of activity tracking in various aspects of daily life. Trial Registration: Open Science Framework 8qj3d; https://osf.io/8qj3d International Registered Report Identifier (IRRID): PRR1-10.2196/54728 %M 38820576 %R 10.2196/54728 %U https://www.researchprotocols.org/2024/1/e54728 %U https://doi.org/10.2196/54728 %U http://www.ncbi.nlm.nih.gov/pubmed/38820576 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56653 %T Smartphone App Designed to Collect Health Information in Older Adults: Usability Study %A Murabito,Joanne M %A Faro,Jamie M %A Zhang,Yuankai %A DeMalia,Angelo %A Hamel,Alexander %A Agyapong,Nakesha %A Liu,Hongshan %A Schramm,Eric %A McManus,David D %A Borrelli,Belinda %+ Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E Concord St Suite L-516, Boston, MA, 02118, United States, 1 508 935 3500, murabito@bu.edu %K mobile application surveys %K mixed methods %K electronic data collection %K mHealth %K mobile health %K mobile application %K mobile applications %K app %K apps %K application %K applications %K digital health %K digital technology %K digital intervention %K digital interventions %K smartphone %K smartphones %K usability %K usable %K usableness %K usefulness %K utility %K health information %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Studies evaluating the usability of mobile-phone assessments in older adults are limited. Objective: This study aims to identify design-based barriers and facilitators to mobile app survey completion among 2 samples of older adults; those in the Framingham Heart Study and a more diverse sample from a hospital-based setting. Methods: We used mixed methods to identify challenging and beneficial features of the mobile app in participants from the electronic Framingham Heart Study (n=15; mean age of 72 years; 6/15, 40% women; 15/15, 100% non-Hispanic and White) and among participants recruited from a hospital-based setting (n=15; mean age of 71 years; 7/15, 47% women; 3/15, 20% Hispanic; and 8/15, 53% non-White). A variety of app-based measures with different response formats were tested, including self-reported surveys, pictorial assessments (to indicate body pain sites), and cognitive testing tasks (eg, Trail Making Test and Stroop). Participants completed each measure using a think-aloud protocol, while being audio- and video-recorded with a qualitative interview conducted at the end of the session. Recordings were coded for participant usability errors by 2 pairs of coders. Participants completed the Mobile App Rating Scale to assess the app (response range 1=inadequate to 5=excellent). Results: In electronic Framingham Heart Study participants, the average total Mobile App Rating Scale score was 7.6 (SD 1.1), with no significant differences in the hospital-based sample. In general, participants were pleased with the app and found it easy to use. A large minority had at least 1 navigational issue, most committed only once. Most older adults did not have difficulty completing the self-reported multiple-choice measures unless it included lengthy instructions but participants had usability issues with the Stroop and Trail Making Test. Conclusions: Our methods and results help guide app development and app-based survey construction for older adults, while also giving consideration to sociodemographic differences. %M 38815261 %R 10.2196/56653 %U https://humanfactors.jmir.org/2024/1/e56653 %U https://doi.org/10.2196/56653 %U http://www.ncbi.nlm.nih.gov/pubmed/38815261 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e44827 %T An Accessible Web-Based Survey to Monitor the Mental Health of People With Mild Intellectual Disability or Low Literacy Skills During the COVID-19 Pandemic: Comparative Data Analysis %A Koks-Leensen,Monique CJ %A Menko,Anouk %A Raaijmakers,Fieke %A Fransen-Kuppens,Gerdine AJ %A Bevelander,Kirsten E %+ Department of Primary and Community Care, Radboud university medical center, Geert Grooteplein 21, Nijmegen, 6525 EZ, Netherlands, 31 243618181, monique.koks-leensen@radboudumc.nl %K monitoring %K mental health %K intellectual disabilities %K low literacy %K COVID-19 %K web-based survey %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic and related control measures affected the mental health of all populations. Particular subgroups are underrepresented in mainstream surveys because they are hard to reach, and study measurements are not adapted to their skills. These subgroups include people with lower cognitive and literacy skills, such as people with mild intellectual disability (MID), who were considered vulnerable during the COVID-19 pandemic given their low socioeconomic status, small social networks, increased risks of health problems, and difficulties understanding health-related information. Objective: This study examines the impact of the COVID-19 pandemic on mental health among people with MID or low literacy skills compared with those predominantly represented in national surveys. Methods: A repeated cross-sectional study of people with MID or low literacy skills and a general population sample was conducted in the Netherlands. An easy-read web-based survey was co-designed with, and tested among, people with MID or low literacy skills and conducted in 3 rounds within 1 year of the COVID-19 pandemic (T1: November to December 2020, T2: March to April 2021, and T3: September to October 2021). The survey contained questions about demographics and 6 aspects of mental health: feeling happy, feeling energized, feeling stressed, worry, feeling lonely, and sleeping problems. Results: Our adapted survey and recruitment procedure enabled 1059 persons with MID or low literacy skills to participate (T1: n=412, 38.9%; T2: n=351, 33.1%; and T3: n=296, 28%). They were significantly younger, had a lower level of education, and more often than not were born outside the Netherlands compared to the general population sample (P<.001). Approximately half of them (604/1059, 57.03%) received professional care. They displayed poorer mental health scores than the general population sample. The percentages of people with MID or low literacy skills who reported more negative feelings in T1 ranged from 20.6% (85/412) reporting feeling lonely often or almost always to 57.8% (238/412) reporting feeling happy almost never or sometimes. The general population sample’s percentages were 5.4% (160/2930) and 32.2% (941/2918), respectively. Although scores improved over time in both populations, the disproportional effects remained. Conclusions: General COVID-19–related restrictions for the entire Dutch population affected people with MID or low literacy skills more negatively than the general population. Our study underscores the relevance of including these subpopulations in public health research because they are often overlooked in regular health data. An accessible web-based survey particularly targeted at this population enabled us to do so, and we reached a group of respondents significantly different from regular survey participants. This survey’s results provided insights into the health of people with MID or low literacy skills and gained knowledge to be used by care organizations and policy makers to reduce health disparities during a pandemic and in general. %M 38607229 %R 10.2196/44827 %U https://publichealth.jmir.org/2024/1/e44827 %U https://doi.org/10.2196/44827 %U http://www.ncbi.nlm.nih.gov/pubmed/38607229 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56218 %T Lessons Learned From a Sequential Mixed-Mode Survey Design to Recruit and Collect Data From Case-Control Study Participants: Formative Evaluation %A Tran,Amanda D %A White,Alice E %A Torok,Michelle R %A Jervis,Rachel H %A Albanese,Bernadette A %A Scallan Walter,Elaine J %+ Department of Epidemiology, Colorado School of Public Health, University of Colorado, 13001 East 17th Place, 3rd Floor, Mail Stop B119, Aurora, CO, 80045, United States, 1 303 724 5162, elaine.scallanwalter@cuanschutz.edu %K case-control studies %K mixed-mode design %K epidemiologic study methods %K web-based survey %K telephone interview %K public health %K outbreak preparedness %K COVID-19 %K survey %K recruitment %K epidemiology %K methods %D 2024 %7 27.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Sequential mixed-mode surveys using both web-based surveys and telephone interviews are increasingly being used in observational studies and have been shown to have many benefits; however, the application of this survey design has not been evaluated in the context of epidemiological case-control studies. Objective: In this paper, we discuss the challenges, benefits, and limitations of using a sequential mixed-mode survey design for a case-control study assessing risk factors during the COVID-19 pandemic. Methods: Colorado adults testing positive for SARS-CoV-2 were randomly selected and matched to those with a negative SARS-CoV-2 test result from March to April 2021. Participants were first contacted by SMS text message to complete a self-administered web-based survey asking about community exposures and behaviors. Those who did not respond were contacted for a telephone interview. We evaluated the representativeness of survey participants to sample populations and compared sociodemographic characteristics, participant responses, and time and resource requirements by survey mode using descriptive statistics and logistic regression models. Results: Of enrolled case and control participants, most were interviewed by telephone (308/537, 57.4% and 342/648, 52.8%, respectively), with overall enrollment more than doubling after interviewers called nonresponders. Participants identifying as female or White non-Hispanic, residing in urban areas, and not working outside the home were more likely to complete the web-based survey. Telephone participants were more likely than web-based participants to be aged 18-39 years or 60 years and older and reside in areas with lower levels of education, more linguistic isolation, lower income, and more people of color. While there were statistically significant sociodemographic differences noted between web-based and telephone case and control participants and their respective sample pools, participants were more similar to sample pools when web-based and telephone responses were combined. Web-based participants were less likely to report close contact with an individual with COVID-19 (odds ratio [OR] 0.70, 95% CI 0.53-0.94) but more likely to report community exposures, including visiting a grocery store or retail shop (OR 1.55, 95% CI 1.13-2.12), restaurant or cafe or coffee shop (OR 1.52, 95% CI 1.20-1.92), attending a gathering (OR 1.69, 95% CI 1.34-2.15), or sport or sporting event (OR 1.05, 95% CI 1.05-1.88). The web-based survey required an average of 0.03 (SD 0) person-hours per enrolled participant and US $920 in resources, whereas the telephone interview required an average of 5.11 person-hours per enrolled participant and US $70,000 in interviewer wages. Conclusions: While we still encountered control recruitment challenges noted in other observational studies, the sequential mixed-mode design was an efficient method for recruiting a more representative group of participants for a case-control study with limited impact on data quality and should be considered during public health emergencies when timely and accurate exposure information is needed to inform control measures. %M 38801768 %R 10.2196/56218 %U https://formative.jmir.org/2024/1/e56218 %U https://doi.org/10.2196/56218 %U http://www.ncbi.nlm.nih.gov/pubmed/38801768 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50812 %T A Web-Based, Respondent-Driven Sampling Survey Among Men Who Have Sex With Men (Kai Noi): Description of Methods and Characteristics %A Karuchit,Samart %A Thiengtham,Panupit %A Tanpradech,Suvimon %A Srinor,Watcharapol %A Yingyong,Thitipong %A Naiwatanakul,Thananda %A Northbrook,Sanny %A Hladik,Wolfgang %+ Informatics Section, Business Services Office, US Centers for Disease Control and Prevention, DDC7 Bldg, 3rd Fl. Ministry of Public Health, Tivanon Road, Nonthaburi, 11000, Thailand, 66 2 580 0669 ext 364, hqd5@cdc.gov %K online respondent-driven sampling %K web-based respondent-driven sampling %K virtual architecture %K men who have sex with men %K Thailand %K MSM %K Asia %K Asian %K gay %K homosexual %K homosexuality %K sexual minority %K sexual minorities %K biobehavioral %K surveillance %K respondent driven sampling %K survey %K surveys %K web app %K web application %K coding %K PHP %K web based %K automation %K automated %K design %K architecture %K information system %K information systems %K online sampling %K HIV %K sexually transmitted infection %K STI %K sexually transmitted disease %K STD %K sexual transmission %K sexually transmitted %K RDS %K webRDS %D 2024 %7 20.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Thailand’s HIV epidemic is heavily concentrated among men who have sex with men (MSM), and surveillance efforts are mostly based on case surveillance and local biobehavioral surveys. Objective: We piloted Kai Noi, a web-based respondent-driven sampling (RDS) survey among MSM. Methods: We developed an application coded in PHP that facilitated all procedures and events typically used in an RDS office for use on the web, including e-coupon validation, eligibility screening, consent, interview, peer recruitment, e-coupon issuance, and compensation. All procedures were automated and e-coupon ID numbers were randomly generated. Participants’ phone numbers were the principal means to detect and prevent duplicate enrollment. Sampling took place across Thailand; residents of Bangkok were also invited to attend 1 of 10 clinics for an HIV-related blood draw with additional compensation. Results: Sampling took place from February to June 2022; seeds (21 at the start, 14 added later) were identified through banner ads, micromessaging, and in online chat rooms. Sampling reached all 6 regions and almost all provinces. Fraudulent (duplicate) enrollment using “borrowed” phone numbers was identified and led to the detection and invalidation of 318 survey records. A further 106 participants did not pass an attention filter question (asking recruits to select a specific categorical response) and were excluded from data analysis, leading to a final data set of 1643 valid participants. Only one record showed signs of straightlining (identical adjacent responses). None of the Bangkok respondents presented for a blood draw. Conclusions: We successfully developed an application to implement web-based RDS among MSM across Thailand. Measures to minimize, detect, and eliminate fraudulent survey enrollment are imperative in web-based surveys offering compensation. Efforts to improve biomarker uptake are needed to fully tap the potential of web-based sampling and data collection. %M 38767946 %R 10.2196/50812 %U https://formative.jmir.org/2024/1/e50812 %U https://doi.org/10.2196/50812 %U http://www.ncbi.nlm.nih.gov/pubmed/38767946 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51496 %T Reporting of Ethical Considerations in Qualitative Research Utilizing Social Media Data on Public Health Care: Scoping Review %A Zhang,Yujie %A Fu,Jiaqi %A Lai,Jie %A Deng,Shisi %A Guo,Zihan %A Zhong,Chuhan %A Tang,Jianyao %A Cao,Wenqiong %A Wu,Yanni %+ Nanfang Hospital, Southern Medical University, No 1838 Guangzhou Avenue North, Baiyun District, Guangdong Province, Guangzhou, 510515, China, 86 02061641192, yanniwuSMU@126.com %K qualitative research %K informed consent %K ethics approval %K privacy %K internet community %D 2024 %7 17.5.2024 %9 Review %J J Med Internet Res %G English %X Background: The internet community has become a significant source for researchers to conduct qualitative studies analyzing users’ views, attitudes, and experiences about public health. However, few studies have assessed the ethical issues in qualitative research using social media data. Objective: This study aims to review the reportage of ethical considerations in qualitative research utilizing social media data on public health care. Methods: We performed a scoping review of studies mining text from internet communities and published in peer-reviewed journals from 2010 to May 31, 2023. These studies, limited to the English language, were retrieved to evaluate the rates of reporting ethical approval, informed consent, and privacy issues. We searched 5 databases, that is, PubMed, Web of Science, CINAHL, Cochrane, and Embase. Gray literature was supplemented from Google Scholar and OpenGrey websites. Studies using qualitative methods mining text from the internet community focusing on health care topics were deemed eligible. Data extraction was performed using a standardized data extraction spreadsheet. Findings were reported using PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Results: After 4674 titles, abstracts, and full texts were screened, 108 studies on mining text from the internet community were included. Nearly half of the studies were published in the United States, with more studies from 2019 to 2022. Only 59.3% (64/108) of the studies sought ethical approval, 45.3% (49/108) mentioned informed consent, and only 12.9% (14/108) of the studies explicitly obtained informed consent. Approximately 86% (12/14) of the studies that reported informed consent obtained digital informed consent from participants/administrators, while 14% (2/14) did not describe the method used to obtain informed consent. Notably, 70.3% (76/108) of the studies contained users’ written content or posts: 68% (52/76) contained verbatim quotes, while 32% (24/76) paraphrased the quotes to prevent traceability. However, 16% (4/24) of the studies that paraphrased the quotes did not report the paraphrasing methods. Moreover, 18.5% (20/108) of the studies used aggregated data analysis to protect users’ privacy. Furthermore, the rates of reporting ethical approval were different between different countries (P=.02) and between papers that contained users’ written content (both direct and paraphrased quotes) and papers that did not contain users’ written content (P<.001). Conclusions: Our scoping review demonstrates that the reporting of ethical considerations is widely neglected in qualitative research studies using social media data; such studies should be more cautious in citing user quotes to maintain user privacy. Further, our review reveals the need for detailed information on the precautions of obtaining informed consent and paraphrasing to reduce the potential bias. A national consensus of ethical considerations such as ethical approval, informed consent, and privacy issues is needed for qualitative research of health care using social media data of internet communities. %M 38758590 %R 10.2196/51496 %U https://www.jmir.org/2024/1/e51496 %U https://doi.org/10.2196/51496 %U http://www.ncbi.nlm.nih.gov/pubmed/38758590 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54343 %T Impact of Incentives on Physician Participation in Research Surveys: Randomized Experiment %A Hawa,Saadiya %A Bane,Shalmali %A Kinsler,Kayla %A Rector,Amadeia %A Chaichian,Yashaar %A Falasinnu,Titilola %A Simard,Julia F %+ Department of Epidemiology and Population Health, Stanford School of Medicine, Alway Building, 300 Pasteur Drive, M121L, MC: 5405, Stanford, CA, 94305, United States, 1 650 7239680, jsimard@stanford.edu %K internet survey %K incentive %K physician recruitment %K internet surveys %K online survey %K online surveys %K web-based survey %K web-based surveys %K survey %K surveys %K incentives %K monetary incentive %K monetary incentives %K physician participation %K physician participant %K physician participants %K physician %K physicians %K doctor participation %K doctor participant %K doctor participants %K doctor %K doctors %K neurologist %K neurologists %D 2024 %7 14.5.2024 %9 Short Paper %J JMIR Form Res %G English %X Background: Web-based surveys can be effective data collection instruments; however, participation is notoriously low, particularly among professionals such as physicians. Few studies have explored the impact of varying amounts of monetary incentives on survey completion. Objective: This study aims to conduct a randomized study to assess how different incentive amounts influenced survey participation among neurologists in the United States. Methods: We distributed a web-based survey using standardized email text to 21,753 individuals randomly divided into 5 equal groups (≈4351 per group). In phase 1, each group was assigned to receive either nothing or a gift card for US $10, $20, $50, or $75, which was noted in the email subject and text. After 4 reminders, phase 2 began and each remaining individual was offered a US $75 gift card to complete the survey. We calculated and compared the proportions who completed the survey by phase 1 arm, both before and after the incentive change, using a chi-square test. As a secondary outcome, we also looked at survey participation as opposed to completion. Results: For the 20,820 emails delivered, 879 (4.2%) recipients completed the survey; of the 879 recipients, 622 (70.8%) were neurologists. Among the neurologists, most were male (412/622, 66.2%), White (430/622, 69.1%), non-Hispanic (592/622, 95.2%), graduates of American medical schools (465/622, 74.8%), and board certified (598/622, 96.1%). A total of 39.7% (247/622) completed their neurology residency more than 20 years ago, and 62.4% (388/622) practiced in an urban setting. For phase 1, the proportions of respondents completing the survey increased as the incentive amount increased (46/4185, 1.1%; 76/4165, 1.8%; 86/4160, 2.1%; 104/4162, 2.5%; and 119/4148, 2.9%, for US $0, $10, $20, $50, and $75, respectively; P<.001). In phase 2, the survey completion rate for the former US $0 arm increased to 3% (116/3928). Those originally offered US $10, $20, $50, and $75 who had not yet participated were less likely to participate compared with the former US $0 arm (116/3928, 3%; 90/3936, 2.3%; 80/3902, 2.1%; 88/3845, 2.3%; and 74/3878, 1.9%, for US $0, $10, $20, $50, and $75, respectively; P=.03). For our secondary outcome of survey participation, a trend similar to that of survey completion was observed in phase 1 (55/4185, 1.3%; 85/4165, 2%; 96/4160, 2.3%; 118/4162, 2.8%; and 135/4148, 3.3%, for US $0, $10, $20, $50, and $75, respectively; P<.001) and phase 2 (116/3928, 3%; 90/3936, 2.3%; 80/3902, 2.1%; 88/3845, 2.3%; and 86/3845, 2.2%, for US $0, $10, $20, $50, and $75, respectively; P=.10). Conclusions: As expected, monetary incentives can boost physician survey participation and completion, with a positive correlation between the amount offered and participation. %M 38743466 %R 10.2196/54343 %U https://formative.jmir.org/2024/1/e54343 %U https://doi.org/10.2196/54343 %U http://www.ncbi.nlm.nih.gov/pubmed/38743466 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53790 %T Best Practices and Recommendations for Research Using Virtual Real-Time Data Collection: Protocol for Virtual Data Collection Studies %A Sanchez,Jasmin %A Trofholz,Amanda %A Berge,Jerica M %+ Department of Family Medicine and Community Health, University of Minnesota, 717 Delaware St SE Suite 454, Minneapolis, MN, 55414, United States, 1 2245879545, sanch559@umn.edu %K real-time data collection %K remote research %K virtual data collection %K virtual research protocol %K virtual research visits %D 2024 %7 14.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic and the subsequent need for social distancing required the immediate pivoting of research modalities. Research that had previously been conducted in person had to pivot to remote data collection. Researchers had to develop data collection protocols that could be conducted remotely with limited or no evidence to guide the process. Therefore, the use of web-based platforms to conduct real-time research visits surged despite the lack of evidence backing these novel approaches. Objective: This paper aims to review the remote or virtual research protocols that have been used in the past 10 years, gather existing best practices, and propose recommendations for continuing to use virtual real-time methods when appropriate. Methods: Articles (n=22) published from 2013 to June 2023 were reviewed and analyzed to understand how researchers conducted virtual research that implemented real-time protocols. “Real-time” was defined as data collection with a participant through a live medium where a participant and research staff could talk to each other back and forth in the moment. We excluded studies for the following reasons: (1) studies that collected participant or patient measures for the sole purpose of engaging in a clinical encounter; (2) studies that solely conducted qualitative interview data collection; (3) studies that conducted virtual data collection such as surveys or self-report measures that had no interaction with research staff; (4) studies that described research interventions but did not involve the collection of data through a web-based platform; (5) studies that were reviews or not original research; (6) studies that described research protocols and did not include actual data collection; and (7) studies that did not collect data in real time, focused on telehealth or telemedicine, and were exclusively intended for medical and not research purposes. Results: Findings from studies conducted both before and during the COVID-19 pandemic suggest that many types of data can be collected virtually in real time. Results and best practice recommendations from the current protocol review will be used in the design and implementation of a substudy to provide more evidence for virtual real-time data collection over the next year. Conclusions: Our findings suggest that virtual real-time visits are doable across a range of participant populations and can answer a range of research questions. Recommended best practices for virtual real-time data collection include (1) providing adequate equipment for real-time data collection, (2) creating protocols and materials for research staff to facilitate or guide participants through data collection, (3) piloting data collection, (4) iteratively accepting feedback, and (5) providing instructions in multiple forms. The implementation of these best practices and recommendations for future research are further discussed in the paper. International Registered Report Identifier (IRRID): DERR1-10.2196/53790 %M 38743477 %R 10.2196/53790 %U https://www.researchprotocols.org/2024/1/e53790 %U https://doi.org/10.2196/53790 %U http://www.ncbi.nlm.nih.gov/pubmed/38743477 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53623 %T The Real-World Usability, Feasibility, and Performance Distributions of Deploying a Digital Toolbox of Computerized Assessments to Remotely Evaluate Brain Health: Development and Usability Study %A Attarha,Mouna %A Mahncke,Henry %A Merzenich,Michael %+ Posit Science, 160 Pine St Suite 200, San Francisco, CA, 94111, United States, 1 415 394 3100, Mouna.attarha@positscience.com %K web-based cognitive assessment %K remote data collection %K neurocognition %K cognitive profiles %K normative assessment data %K brain health %K cognitive status %K assessment accessibility %D 2024 %7 13.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: An ongoing global challenge is managing brain health and understanding how performance changes across the lifespan. Objective: We developed and deployed a set of self-administrable, computerized assessments designed to measure key indexes of brain health across the visual and auditory sensory modalities. In this pilot study, we evaluated the usability, feasibility, and performance distributions of the assessments in a home-based, real-world setting without supervision. Methods: Potential participants were untrained users who self-registered on an existing brain training app called BrainHQ. Participants were contacted via a recruitment email and registered remotely to complete a demographics questionnaire and 29 unique assessments on their personal devices. We examined participant engagement, descriptive and psychometric properties of the assessments, associations between performance and self-reported demographic variables, cognitive profiles, and factor loadings. Results: Of the 365,782 potential participants contacted via a recruitment email, 414 (0.11%) registered, of whom 367 (88.6%) completed at least one assessment and 104 (25.1%) completed all 29 assessments. Registered participants were, on average, aged 63.6 (SD 14.8; range 13-107) years, mostly female (265/414, 64%), educated (329/414, 79.5% with a degree), and White (349/414, 84.3% White and 48/414, 11.6% people of color). A total of 72% (21/29) of the assessments showed no ceiling or floor effects or had easily modifiable score bounds to eliminate these effects. When correlating performance with self-reported demographic variables, 72% (21/29) of the assessments were sensitive to age, 72% (21/29) of the assessments were insensitive to gender, 93% (27/29) of the assessments were insensitive to race and ethnicity, and 93% (27/29) of the assessments were insensitive to education-based differences. Assessments were brief, with a mean duration of 3 (SD 1.0) minutes per task. The pattern of performance across the assessments revealed distinctive cognitive profiles and loaded onto 4 independent factors. Conclusions: The assessments were both usable and feasible and warrant a full normative study. A digital toolbox of scalable and self-administrable assessments that can evaluate brain health at a glance (and longitudinally) may lead to novel future applications across clinical trials, diagnostics, and performance optimization. %M 38739916 %R 10.2196/53623 %U https://formative.jmir.org/2024/1/e53623 %U https://doi.org/10.2196/53623 %U http://www.ncbi.nlm.nih.gov/pubmed/38739916 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47064 %T Giving a Voice to Patients With Smell Disorders Associated With COVID-19: Cross-Sectional Longitudinal Analysis Using Natural Language Processing of Self-Reports %A Menger,Nick S %A Tognetti,Arnaud %A Farruggia,Michael C %A Mucignat,Carla %A Bhutani,Surabhi %A Cooper,Keiland W %A Rohlfs Domínguez,Paloma %A Heinbockel,Thomas %A Shields,Vonnie D C %A D'Errico,Anna %A Pereda-Loth,Veronica %A Pierron,Denis %A Koyama,Sachiko %A Croijmans,Ilja %+ Department of Molecular Medicine, University of Padova, Via Francesco Marzolo, Padua, 35131, Italy, 39 0498275304, carla.mucignat@unipd.it %K parosmia %K anosmia %K phantosmia %K hyposmia %K hyperosmia %K long-hauler %K sentiment classification %K web-based study %K COVID-19 %K smell disorders %D 2024 %7 10.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Smell disorders are commonly reported with COVID-19 infection. The smell-related issues associated with COVID-19 may be prolonged, even after the respiratory symptoms are resolved. These smell dysfunctions can range from anosmia (complete loss of smell) or hyposmia (reduced sense of smell) to parosmia (smells perceived differently) or phantosmia (smells perceived without an odor source being present). Similar to the difficulty that people experience when talking about their smell experiences, patients find it difficult to express or label the symptoms they experience, thereby complicating diagnosis. The complexity of these symptoms can be an additional burden for patients and health care providers and thus needs further investigation. Objective: This study aims to explore the smell disorder concerns of patients and to provide an overview for each specific smell disorder by using the longitudinal survey conducted in 2020 by the Global Consortium for Chemosensory Research, an international research group that has been created ad hoc for studying chemosensory dysfunctions. We aimed to extend the existing knowledge on smell disorders related to COVID-19 by analyzing a large data set of self-reported descriptive comments by using methods from natural language processing. Methods: We included self-reported data on the description of changes in smell provided by 1560 participants at 2 timepoints (second survey completed between 23 and 291 days). Text data from participants who still had smell disorders at the second timepoint (long-haulers) were compared with the text data of those who did not (non–long-haulers). Specifically, 3 aims were pursued in this study. The first aim was to classify smell disorders based on the participants’ self-reports. The second aim was to classify the sentiment of each self-report by using a machine learning approach, and the third aim was to find particular food and nonfood keywords that were more salient among long-haulers than those among non–long-haulers. Results: We found that parosmia (odds ratio [OR] 1.78, 95% CI 1.35-2.37; P<.001) as well as hyposmia (OR 1.74, 95% CI 1.34-2.26; P<.001) were more frequently reported in long-haulers than in non–long-haulers. Furthermore, a significant relationship was found between long-hauler status and sentiment of self-report (P<.001). Finally, we found specific keywords that were more typical for long-haulers than those for non–long-haulers, for example, fire, gas, wine, and vinegar. Conclusions: Our work shows consistent findings with those of previous studies, which indicate that self-reports, which can easily be extracted online, may offer valuable information to health care and understanding of smell disorders. At the same time, our study on self-reports provides new insights for future studies investigating smell disorders. %M 38728069 %R 10.2196/47064 %U https://publichealth.jmir.org/2024/1/e47064 %U https://doi.org/10.2196/47064 %U http://www.ncbi.nlm.nih.gov/pubmed/38728069 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e51601 %T Intention to Use Mobile-Based Partograph and Its Predictors Among Obstetric Health Care Providers Working at Public Referral Hospitals in the Oromia Region of Ethiopia in 2022: Cross-Sectional Questionnaire Study %A Tilahun,Kefyalew Naniye %A Adem,Jibril Bashir %A Atinafu,Wabi Temesgen %A Walle,Agmasie Damtew %A Mengestie,Nebyu Demeke %A Birhanu,Abraham Yeneneh %+ College of Medicine and Health Sciences, Ambo University, Addis Ababa, Ambo, Ethiopia, 251 922298660, kefyalewnaniye64@gmail.com %K mobile-based partograph %K mHealth %K mobile health %K cross-sectional %K questionnaire %K questionnaires %K survey %K surveys %K modified TAM %K technology acceptance model %K intention to use %K obstetric health care providers %K Ethiopia %K intent %K intention %K TAM %K experience %K experiences %K attitude %K attitudes %K opinion %K opinions %K perception %K perceptions %K perspective %K perspectives %K acceptance %K adoption %K partograph %K digital health %K health technology %K birth %K women's health %K obstetrics %K obstetric %K obstetric health care %K labor monitoring %D 2024 %7 10.5.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: A partograph is a pictorial representation of the relationship between cervical dilatation and the time used to diagnose prolonged and obstructed labor. However, the utilization of paper-based partograph is low and it is prone to documentation errors, which can be avoided with the use of electronic partographs. There is only limited information on the proportion of intention to use mobile-based partographs and its predictors. Objective: The objective of this study was to determine the proportion of obstetric health care providers at public referral hospitals in Oromia, Ethiopia, in 2022 who had the intention to use mobile-based partographs and to determine the predictors of their intention to use mobile-based partographs. Methods: We performed an institution-based cross-sectional study from June 1 to July 1, 2022. Census was conducted on 649 participants. A self-administered structured English questionnaire was used, and a 5% pretest was performed. Data were entered into EpiData version 4.6 and exported to SPSS version 25 for descriptive analysis and AMOS (analysis of moment structure; version 23) for structural and measurement model assessment. Descriptive and structural equation modeling analyses were performed. The hypotheses developed based on a modified Technology Acceptance Model were tested using path coefficients and P values <.05. Results: About 65.7% (414/630; 95% CI 61.9%-69.4%) of the participants intended to use mobile-based electronic partographs, with a 97% (630/649) response rate. Perceived usefulness had a positive influence on intention to use (β=.184; P=.02) and attitude (β=.521; P=.002). Perceived ease of use had a positive influence on attitude (β=.382; P=.003), perceived usefulness (β=.503; P=.002), and intention to use (β=.369; P=.001). Job relevance had a positive influence on perceived usefulness (β=.408; P=.001) and intention to use (β=.185; P=.008). Attitude positively influenced intention to use (β=.309; P=.002). Subjective norms did not have a significant influence on perceived usefulness (β=.020; P=.61) and intention to use (β=–.066; P=.07). Conclusions: Two-thirds of the obstetric health care providers in our study intended to use mobile-based partographs. Perceived usefulness, perceived ease of use, job relevance, and attitude positively and significantly influenced their intention to use mobile-based electronic partographs. The development of a user-friendly mobile-based partograph that meets job and user expectations can enhance the intention to use. %M 38728079 %R 10.2196/51601 %U https://ojphi.jmir.org/2024/1/e51601 %U https://doi.org/10.2196/51601 %U http://www.ncbi.nlm.nih.gov/pubmed/38728079 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49276 %T Relationship Between Product Features and the Prices of e-Cigarette Devices Sold in Web-Based Vape Shops: Comparison Study Using a Linear Regression Model %A He,Yanyun %A Yang,Qian %A Alish,Yousef %A Ma,Shaoying %A Qiu,Zefeng %A Chen,Jian %A Wagener,Theodore %A Shang,Ce %+ Center for Tobacco Research, The Ohio State University Wexner Medical Center, 3650 Olentangy River Rd, Columbus, OH, 43214, United States, 1 9739607969, yanyun.he@osumc.edu %K e-cigarette devices %K price %K web-based vape shop %K battery capacity %K output wattage %K e-cigarette %K vape %K vaping %K consumers %K costs %K prices %K pricing %K feature %K features %K device %K devices %K consumer %K cost %K smoking products %K product safety %K consumer safety %K smoking %K smoker %K smokers %K tax %K taxes %K taxation %K economic %K economics %K regression %K regression model %K health economics %D 2024 %7 9.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Open-system electronic cigarette (EC) product features, such as battery capacity, maximum output wattage, and so forth, are major components that drive product costs and may influence use patterns. Moreover, continued innovation and monitoring of product features and prices will provide critical information for designing appropriate taxation policies and product regulations. Objective: This study will examine how product features are associated with the prices of devices sold in web-based vape shops. Methods: We draw samples from 5 popular, US-based, web-based vape shops from April to August 2022 to examine starter kits, device-only products, and e-liquid container–only products. We implemented a linear regression model with a store-fixed effect to examine the association between device attributes and prices. Results: EC starter kits or devices vary significantly by type, with mod prices being much higher than pod and vape pen prices. The prices of mod starter kits were even lower than those of mod devices, suggesting that mod starter kits are discounted in web-based vape shops. The price of mod kits, mod device–only products, and pod kits increased as the battery capacity and output wattage increased. For vape pens, the price was positively associated with the volume size of the e-liquid container. On the other hand, the price of pod kits was positively associated with the number of containers. Conclusions: A unit-based specific tax, therefore, will impose a higher tax burden on lower-priced devices such as vape pens or pod systems and a lower tax burden on mod devices. A volume- or capacity-based specific tax on devices will impose a higher tax burden on vape pens with a larger container size. Meanwhile, ad valorem taxes pegged to wholesale or retail prices would apply evenly across device types, meaning those with advanced features such as higher battery capacities and output wattage would face higher rates. Therefore, policy makers could manipulate tax rates by device type to discourage the use of certain device products. %M 38723251 %R 10.2196/49276 %U https://formative.jmir.org/2024/1/e49276 %U https://doi.org/10.2196/49276 %U http://www.ncbi.nlm.nih.gov/pubmed/38723251 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e54162 %T Variation in Trust in Cancer Information Sources by Perceptions of Social Media Health Mis- and Disinformation and by Race and Ethnicity Among Adults in the United States: Cross-Sectional Study %A Stimpson,Jim P %A Park,Sungchul %A Pruitt,Sandi L %A Ortega,Alexander N %+ Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States, 1 (214) 645 2567, james.stimpson@utsouthwestern.edu %K cancer %K United States %K cross-sectional study %K trust %K consumer health information %K misinformation %K disinformation %K race %K ethnicity %K cancer information %K source %K sources %K perception %K perceptions %K social media %K health information %K cross-sectional data %K misleading %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Mis- and disinformation on social media have become widespread, which can lead to a lack of trust in health information sources and, in turn, lead to negative health outcomes. Moreover, the effect of mis- and disinformation on trust in information sources may vary by racial and ethnic minoritized populations. Objective: We evaluated how trust in multiple sources of cancer information varied by perceptions of health mis- and disinformation on social media and by race and ethnicity. Methods: Cross-sectional, nationally representative survey data from noninstitutionalized adults in the United States from the 2022 Health Information National Trends Survey 6 (HINTS 6) were analyzed (N=4137). The dependent variable measured the level of trust in cancer information sources. The independent variables were perceptions about health mis- and disinformation on social media and race and ethnicity. Multivariable logistic regression models were adjusted for survey weight and design, age, birth gender, race and ethnicity, marital status, urban/rural designation, education, employment status, feelings about household income, frequency of social media visits, and personal and family history of cancer. We also tested the interaction effect between perceptions of social media health mis- and disinformation and participants’ self-reported race and ethnicity. Results: Perception of “a lot of” health mis- and disinformation on social media, relative to perception of “less than a lot,” was associated with a lower likelihood of high levels of trusting cancer information from government health agencies (odds ratio [OR] 0.60, 95% CI 0.47-0.77), family or friends (OR 0.56, 95% CI 0.44-0.71), charitable organizations (OR 0.78, 95% CI 0.63-0.96), and religious organizations and leaders (OR 0.64, 95% CI 0.52-0.79). Among White participants, those who perceived a lot of health mis- and disinformation on social media were less likely to have high trust in cancer information from government health agencies (margin=61%, 95% CI 57%-66%) and family or friends (margin=49%, 95% CI 43%-55%) compared to those who perceived less than a lot of health mis- and disinformation on social media. Among Black participants, those who perceived a lot of health mis- and disinformation on social media were less likely to have high trust in cancer information from religious organizations and leaders (margin=20%, 95% CI 10%-30%) compared to participants who perceived no or a little health mis- and disinformation on social media. Conclusions: Certain sources of cancer information may need enhanced support against the threat of mis- and disinformation, such as government health agencies, charitable organizations, religious organizations and leaders, and family or friends. Moreover, interventions should partner with racial and ethnically minoritized populations that are more likely to have low trust in certain cancer information sources associated with mis- and disinformation on social media. %M 38717800 %R 10.2196/54162 %U https://cancer.jmir.org/2024/1/e54162 %U https://doi.org/10.2196/54162 %U http://www.ncbi.nlm.nih.gov/pubmed/38717800 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53441 %T Precision Assessment of Real-World Associations Between Stress and Sleep Duration Using Actigraphy Data Collected Continuously for an Academic Year: Individual-Level Modeling Study %A Vidal Bustamante,Constanza M %A Coombs III,Garth %A Rahimi-Eichi,Habiballah %A Mair,Patrick %A Onnela,Jukka-Pekka %A Baker,Justin T %A Buckner,Randy L %+ Department of Psychology, Harvard University, 52 Oxford Street, Northwest Building, East Wing, Room 295.06, Cambridge, MA, 02138, United States, 1 617 384 8230, constanzavidalbustamante@gmail.com %K deep phenotyping %K individualized models %K intensive longitudinal data %K sleep %K stress %K actigraphy %K accelerometer %K wearable %K mobile phone %K digital health %D 2024 %7 30.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Heightened stress and insufficient sleep are common in the transition to college, often co-occur, and have both been linked to negative health outcomes. A challenge concerns disentangling whether perceived stress precedes or succeeds changes in sleep. These day-to-day associations may vary across individuals, but short study periods and group-level analyses in prior research may have obscured person-specific phenotypes. Objective: This study aims to obtain stable estimates of lead-lag associations between perceived stress and objective sleep duration in the individual, unbiased by the group, by developing an individual-level linear model that can leverage intensive longitudinal data while remaining parsimonious. Methods: In total, 55 college students (n=6, 11% second-year students and n=49, 89% first-year students) volunteered to provide daily self-reports of perceived stress via a smartphone app and wore an actigraphy wristband for the estimation of daily sleep duration continuously throughout the academic year (median usable daily observations per participant: 178, IQR 65.5). The individual-level linear model, developed in a Bayesian framework, included the predictor and outcome of interest and a covariate for the day of the week to account for weekly patterns. We validated the model on the cohort of second-year students (n=6, used as a pilot sample) by applying it to variables expected to correlate positively within individuals: objective sleep duration and self-reported sleep quality. The model was then applied to the fully independent target sample of first-year students (n=49) for the examination of bidirectional associations between daily stress levels and sleep duration. Results: Proof-of-concept analyses captured expected associations between objective sleep duration and subjective sleep quality in every pilot participant. Target analyses revealed negative associations between sleep duration and perceived stress in most of the participants (45/49, 92%), but their temporal association varied. Of the 49 participants, 19 (39%) showed a significant association (probability of direction>0.975): 8 (16%) showed elevated stress in the day associated with shorter sleep later that night, 5 (10%) showed shorter sleep associated with elevated stress the next day, and 6 (12%) showed both directions of association. Of note, when analyzed using a group-based multilevel model, individual estimates were systematically attenuated, and some even reversed sign. Conclusions: The dynamic interplay of stress and sleep in daily life is likely person specific. Paired with intensive longitudinal data, our individual-level linear model provides a precision framework for the estimation of stable real-world behavioral and psychological dynamics and may support the personalized prioritization of intervention targets for health and well-being. %M 38687600 %R 10.2196/53441 %U https://formative.jmir.org/2024/1/e53441 %U https://doi.org/10.2196/53441 %U http://www.ncbi.nlm.nih.gov/pubmed/38687600 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54041 %T Tobacco Smoking or Nicotine Phenotype and Severity of Clinical Presentation at the Emergency Department (SMOPHED): Protocol for a Noninterventional Observational Study %A Campagna,Davide %A Farsalinos,Konstantinos %A Costantino,Giorgio %A Carpinteri,Giuseppe %A Caponnetto,Pasquale %A Cucuzza,Francesca %A Polosa,Riccardo %A , %+ Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia, Catania, 95123, Italy, 39 0953782449, davide.campagna@unict.it %K NEWS %K National Early Warning Score %K emergency department %K smoking %K nicotine/tobacco use %K electronic cigarettes %K heated tobacco products %D 2024 %7 24.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the last few years, several nicotine products have become available as alternatives to smoking tobacco. While laboratory and limited clinical studies suggest that these devices are less toxic compared to classic tobacco cigarettes, very little is known about their epidemiological impact. Visiting the emergency department (ED) often represents the first or even the only contact of patients with the health care system. Therefore, a study conducted at the ED to assess the impact of these products on health can be reliable and reflect a real-life setting. Objective: The aim of this noninterventional observational study (SMOPHED study) is to analyze the association between the severity of clinical presentation observed during ED visits among patients using various nicotine products and the subsequent outcomes, specifically hospitalization and mortality. Methods: Outcomes (hospitalization and mortality in the ED) will be examined in relation to various patterns of nicotine products use. We plan to enroll approximately 2000 participants during triage at the ED. These individuals will be characterized based on their patterns of tobacco and nicotine consumption, identified through a specific questionnaire. This categorization will allow for a detailed analysis of how different usage patterns of nicotine products correlate with the clinical diagnosis made during the ED visits and the consequent outcomes. Results: Enrollment into the study started in March 2024. We enrolled a total of 901 participants in 1 month (approximately 300 potential participants did not provide the informed consent to participate). The data will be analyzed by a statistician as soon as the database is completed. Full data will be published by December 2024. Conclusions: There is substantial debate about the harm reduction potential of alternative nicotine products in terms of their smoking-cessation and risk-reduction potential. This study represents an opportunity to document epidemiological data on the link between the use of different types of nicotine products and disease diagnosis and severity during an ED visit, and thus evaluate the harm reduction potential claims for these products. International Registered Report Identifier (IRRID): PRR1-10.2196/54041 %M 38657239 %R 10.2196/54041 %U https://www.researchprotocols.org/2024/1/e54041 %U https://doi.org/10.2196/54041 %U http://www.ncbi.nlm.nih.gov/pubmed/38657239 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54645 %T Factor Analysis of Patients Who Find Tablets or Capsules Difficult to Swallow Due to Their Large Size: Using the Personal Health Record Infrastructure of Electronic Medication Notebooks %A Asano,Masaki %A Imai,Shungo %A Shimizu,Yuri %A Kizaki,Hayato %A Ito,Yukiko %A Tsuchiya,Makoto %A Kuriyama,Ryoko %A Yoshida,Nao %A Shimada,Masanori %A Sando,Takanori %A Ishijima,Tomo %A Hori,Satoko %+ Division of Drug Informatics, Faculty of Pharmacy and Graduate School of Pharmaceutical Sciences, Keio University, 1-5-30 Shibakoen, Minato-ku, Tokyo, 105-8512, Japan, 81 354002650, satokoh@keio.jp %K tablet %K tablets %K capsules %K capsule %K size %K personal health record %K electronic medication notebook %K patient preference %K drug %K drugs %K pharmacy %K pharmacies %K pharmacology %K pharmacotherapy %K pharmaceutic %K pharmaceutics %K pharmaceuticals %K pharmaceutical %K medication %K medications %K preference %K preferences %K pill %K pills %K machine learning %K decision tree %K swallow %K swallowing %K throat %K pharynx %K risk %K risks %K dysphagia %K speech %K mobile phone %D 2024 %7 24.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Understanding patient preference regarding taking tablet or capsule formulations plays a pivotal role in treatment efficacy and adherence. Therefore, these preferences should be taken into account when designing formulations and prescriptions. Objective: This study investigates the factors affecting patient preference in patients who have difficulties swallowing large tablets or capsules and aims to identify appropriate sizes for tablets and capsules. Methods: A robust data set was developed based on a questionnaire survey conducted from December 1, 2022, to December 7, 2022, using the harmo smartphone app operated by harmo Co, Ltd. The data set included patient input regarding their tablet and capsule preferences, personal health records (including dispensing history), and drug formulation information (available from package inserts). Based on the medication formulation information, 6 indices were set for each of the tablets or capsules that were considered difficult to swallow owing to their large size and concomitant tablets or capsules (used as controls). Receiver operating characteristic (ROC) analysis was used to evaluate the performance of each index. The index demonstrating the highest area under the curve of the ROC was selected as the best index to determine the tablet or capsule size that leads to swallowing difficulties. From the generated ROCs, the point with the highest discriminative performance that maximized the Youden index was identified, and the optimal threshold for each index was calculated. Multivariate logistic regression analysis was performed to identify the risk factors contributing to difficulty in swallowing oversized tablets or capsules. Additionally, decision tree analysis was performed to estimate the combined risk from several factors, using risk factors that were significant in the multivariate logistic regression analysis. Results: This study analyzed 147 large tablets or capsules and 624 control tablets or capsules. The “long diameter + short diameter + thickness” index (with a 21.5 mm threshold) was identified as the best indicator for causing swallowing difficulties in patients. The multivariate logistic regression analysis (including 132 patients with swallowing difficulties and 1283 patients without) results identified the following contributory risk factors: aged <50 years (odds ratio [OR] 1.59, 95% CI 1.03-2.44), female (OR 2.54, 95% CI 1.70-3.78), dysphagia (OR 3.54, 95% CI 2.22-5.65), and taking large tablets or capsules (OR 9.74, 95% CI 5.19-18.29). The decision tree analysis results suggested an elevated risk of swallowing difficulties for patients with taking large tablets or capsules. Conclusions: This study identified the most appropriate index and threshold for indicating that a given tablet or capsule size will cause swallowing difficulties, as well as the contributory risk factors. Although some sampling biases (eg, only including smartphone users) may exist, our results can guide the design of patient-friendly formulations and prescriptions, promoting better medication adherence. %M 38657229 %R 10.2196/54645 %U https://www.jmir.org/2024/1/e54645 %U https://doi.org/10.2196/54645 %U http://www.ncbi.nlm.nih.gov/pubmed/38657229 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50368 %T Preferences on Governance Models for Mental Health Data: Qualitative Study With Young People %A Carey,Emma Grace %A Adeyemi,Faith Oluwasemilore %A Neelakantan,Lakshmi %A Fernandes,Blossom %A Fazel,Mina %A Ford,Tamsin %A , %A Burn,Anne-Marie %+ Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, United Kingdom, 44 01223 336961, amb278@cam.ac.uk %K young people %K mental health %K data %K governance %K deliberative democracy %K mobile phone %D 2024 %7 23.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Improving access to mental health data to accelerate research and improve mental health outcomes is a potentially achievable goal given the substantial data that can now be collected from mobile devices. Smartphones can provide a useful mechanism for collecting mental health data from young people, especially as their use is relatively ubiquitous in high-resource settings such as the United Kingdom and they have a high capacity to collect active and passive data. This raises the interesting opportunity to establish a large bank of mental health data from young people that could be accessed by researchers worldwide, but it is important to clarify how to ensure that this is done in an appropriate manner aligned with the values of young people. Objective: In this study, we discussed the preferences of young people in the United Kingdom regarding the governance, sharing, and use of their mental health data with the establishment of a global data bank in mind. We aimed to determine whether young people want and feel safe to share their mental health data; if so, with whom; and their preferences in doing so. Methods: Young people (N=46) were provided with 2 modules of educational material about data governance models and background in scientific research. We then conducted 2-hour web-based group sessions using a deliberative democracy methodology to reach a consensus where possible. Findings were analyzed using the framework method. Results: Young people were generally enthusiastic about contributing data to mental health research. They believed that broader availability of mental health data could be used to discover what improves or worsens mental health and develop new services to support young people. However, this enthusiasm came with many concerns and caveats, including distributed control of access to ensure appropriate use, distributed power, and data management that included diverse representation and sufficient ethical training for applicants and data managers. Conclusions: Although it is feasible to use smartphones to collect mental health data from young people in the United Kingdom, it is essential to carefully consider the parameters of such a data bank. Addressing and embedding young people’s preferences, including the need for robust procedures regarding how their data are managed, stored, and accessed, will set a solid foundation for establishing any global data bank. %M 38652525 %R 10.2196/50368 %U https://formative.jmir.org/2024/1/e50368 %U https://doi.org/10.2196/50368 %U http://www.ncbi.nlm.nih.gov/pubmed/38652525 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e38170 %T Comparing Contact Tracing Through Bluetooth and GPS Surveillance Data: Simulation-Driven Approach %A Qian,Weicheng %A Cooke,Aranock %A Stanley,Kevin Gordon %A Osgood,Nathaniel David %+ Department of Computer Science, University of Saskatchewan, 110 Science Place, Saskatoon, SK, S7N 5C9, Canada, 1 3069661947, weicheng.qian@usask.ca %K smartphone-based sensing %K proximity contact data %K transmission models %K agent-based simulation %K health informatics %K mobile phone %D 2024 %7 17.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Accurate and responsive epidemiological simulations of epidemic outbreaks inform decision-making to mitigate the impact of pandemics. These simulations must be grounded in quantities derived from measurements, among which the parameters associated with contacts between individuals are notoriously difficult to estimate. Digital contact tracing data, such as those provided by Bluetooth beaconing or GPS colocating, can provide more precise measures of contact than traditional methods based on direct observation or self-reporting. Both measurement modalities have shortcomings and are prone to false positives or negatives, as unmeasured environmental influences bias the data. Objective: We aim to compare GPS colocated versus Bluetooth beacon–derived proximity contact data for their impacts on transmission models’ results under community and types of diseases. Methods: We examined the contact patterns derived from 3 data sets collected in 2016, with participants comprising students and staff from the University of Saskatchewan in Canada. Each of these 3 data sets used both Bluetooth beaconing and GPS localization on smartphones running the Ethica Data (Avicenna Research) app to collect sensor data about every 5 minutes over a month. We compared the structure of contact networks inferred from proximity contact data collected with the modalities of GPS colocating and Bluetooth beaconing. We assessed the impact of sensing modalities on the simulation results of transmission models informed by proximate contacts derived from sensing data. Specifically, we compared the incidence number, attack rate, and individual infection risks across simulation results of agent-based susceptible-exposed-infectious-removed transmission models of 4 different contagious diseases. We have demonstrated their differences with violin plots, 2-tailed t tests, and Kullback-Leibler divergence. Results: Both network structure analyses show visually salient differences in proximity contact data collected between GPS colocating and Bluetooth beaconing, regardless of the underlying population. Significant differences were found for the estimated attack rate based on distance threshold, measurement modality, and simulated disease. This finding demonstrates that the sensor modality used to trace contact can have a significant impact on the expected propagation of a disease through a population. The violin plots of attack rate and Kullback-Leibler divergence of individual infection risks demonstrated discernible differences for different sensing modalities, regardless of the underlying population and diseases. The results of the t tests on attack rate between different sensing modalities were mostly significant (P<.001). Conclusions: We show that the contact networks generated from these 2 measurement modalities are different and generate significantly different attack rates across multiple data sets and pathogens. While both modalities offer higher-resolution portraits of contact behavior than is possible with most traditional contact measures, the differential impact of measurement modality on the simulation outcome cannot be ignored and must be addressed in studies only using a single measure of contact in the future. %M 38422493 %R 10.2196/38170 %U https://www.jmir.org/2024/1/e38170 %U https://doi.org/10.2196/38170 %U http://www.ncbi.nlm.nih.gov/pubmed/38422493 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48144 %T Mobile Technology Use in Clinical Research Examining Challenges and Implications for Health Promotion in South Africa: Mixed Methods Study %A Mabetha,Khuthala %A Soepnel,Larske M %A Mabena,Gugulethu %A Motlhatlhedi,Molebogeng %A Nyati,Lukhanyo %A Norris,Shane A %A Draper,Catherine E %+ South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, 7 York Rd, Parktown, Johannesburg, 2193, South Africa, 27 011 717 2382, khuthala.mabetha@wits.ac.za %K mobile technologies %K health promotion %K mixed methods %K clinical practice %K mobile phone %D 2024 %7 8.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of mobile technologies in fostering health promotion and healthy behaviors is becoming an increasingly common phenomenon in global health programs. Although mobile technologies have been effective in health promotion initiatives and follow-up research in higher-income countries and concerns have been raised within clinical practice and research in low- and middle-income settings, there is a lack of literature that has qualitatively explored the challenges that participants experience in terms of being contactable through mobile technologies. Objective: This study aims to explore the challenges that participants experience in terms of being contactable through mobile technologies in a trial conducted in Soweto, South Africa. Methods: A convergent parallel mixed methods research design was used. In the quantitative phase, 363 young women in the age cohorts 18 to 28 years were contacted telephonically between August 2019 and January 2022 to have a session delivered to them or to be booked for a session. Call attempts initiated by the study team were restricted to only 1 call attempt, and participants who were reached at the first call attempt were classified as contactable (189/363, 52.1%), whereas those whom the study team failed to contact were classified as hard to reach (174/363, 47.9%). Two outcomes of interest in the quantitative phase were “contactability of the participants” and “participants’ mobile number changes,” and these outcomes were analyzed at a univariate and bivariate level using descriptive statistics and a 2-way contingency table. In the qualitative phase, a subsample of young women (20 who were part of the trial for ≥12 months) participated in in-depth interviews and were recruited using a convenience sampling method. A reflexive thematic analysis approach was used to analyze the data using MAXQDA software (version 20; VERBI GmbH). Results: Of the 363 trial participants, 174 (47.9%) were hard to reach telephonically, whereas approximately 189 (52.1%) were easy to reach telephonically. Most participants (133/243, 54.7%) who were contactable did not change their mobile number. The highest percentage of mobile number changes was observed among participants who were hard to reach, with three-quarters of the participants (12/16, 75%) being reported to have changed their mobile number ≥2 times. Eight themes were generated following the analysis of the transcripts, which provided an in-depth account of the reasons why some participants were hard to reach. These included mobile technical issues, coverage issues, lack of ownership of personal cell phones, and unregistered number. Conclusions: Remote data collection remains an important tool in public health research. It could, thus, serve as a hugely beneficial mechanism in connecting with participants while actively leveraging the established relationships with participants or community-based organizations to deliver health promotion and practice. %M 38588527 %R 10.2196/48144 %U https://formative.jmir.org/2024/1/e48144 %U https://doi.org/10.2196/48144 %U http://www.ncbi.nlm.nih.gov/pubmed/38588527 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54787 %T Understanding Physician’s Perspectives on AI in Health Care: Protocol for a Sequential Multiple Assignment Randomized Vignette Study %A Kim,Jane Paik %A Yang,Hyun-Joon %A Kim,Bohye %A Ryan,Katie %A Roberts,Laura Weiss %+ Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 1070 Arastradero Rd, Stanford, CA, 94304, United States, 1 650 736 8996, janepkim@stanford.edu %K AI-based clinical decision support %K decision-making %K hypothetical vignettes %K physician perspective %K web-based survey %K hypothesis-driven research %K ethics %K stakeholder attitudes %D 2024 %7 4.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: As the availability and performance of artificial intelligence (AI)–based clinical decision support (CDS) systems improve, physicians and other care providers poised to be on the front lines will be increasingly tasked with using these tools in patient care and incorporating their outputs into clinical decision-making processes. Vignette studies provide a means to explore emerging hypotheses regarding how context-specific factors, such as clinical risk, the amount of information provided about the AI, and the AI result, may impact physician acceptance and use of AI-based CDS tools. To best anticipate how such factors influence the decision-making of frontline physicians in clinical scenarios involving AI decision-support tools, hypothesis-driven research is needed that enables scenario testing before the implementation and deployment of these tools. Objective: This study’s objectives are to (1) design an original, web-based vignette-based survey that features hypothetical scenarios based on emerging or real-world applications of AI-based CDS systems that will vary systematically by features related to clinical risk, the amount of information provided about the AI, and the AI result; and (2) test and determine causal effects of specific factors on the judgments and perceptions salient to physicians’ clinical decision-making. Methods: US-based physicians with specialties in family or internal medicine will be recruited through email and mail (target n=420). Through a web-based survey, participants will be randomized to a 3-part “sequential multiple assignment randomization trial (SMART) vignette” detailing a hypothetical clinical scenario involving an AI decision support tool. The SMART vignette design is similar to the SMART design but adapted to a survey design. Each respondent will be randomly assigned to 1 of the possible vignette variations of the factors we are testing at each stage, which include the level of clinical risk, the amount of information provided about the AI, and the certainty of the AI output. Respondents will be given questions regarding their hypothetical decision-making in response to the hypothetical scenarios. Results: The study is currently in progress and data collection is anticipated to be completed in 2024. Conclusions: The web-based vignette study will provide information on how contextual factors such as clinical risk, the amount of information provided about an AI tool, and the AI result influence physicians’ reactions to hypothetical scenarios that are based on emerging applications of AI in frontline health care settings. Our newly proposed “SMART vignette” design offers several benefits not afforded by the extensively used traditional vignette design, due to the 2 aforementioned features. These advantages are (1) increased validity of analyses targeted at understanding the impact of a factor on the decision outcome, given previous outcomes and other contextual factors; and (2) balanced sample sizes across groups. This study will generate a better understanding of physician decision-making within this context. International Registered Report Identifier (IRRID): DERR1-10.2196/54787 %M 38573756 %R 10.2196/54787 %U https://www.researchprotocols.org/2024/1/e54787 %U https://doi.org/10.2196/54787 %U http://www.ncbi.nlm.nih.gov/pubmed/38573756 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e50907 %T Developing and Implementing a Web-Based Branching Logic Survey to Support Psychiatric Crisis Evaluations of Individuals With Developmental Disabilities: Qualitative Study and Evaluation of Validity %A Bilder,Deborah A %A Mthembu,Mariah %A Worsham,Whitney %A Aguayo,Patricia %A Knight,Jacob R %A Deng,Steven W %A Singh,Tejinder P %A Davis,John %+ University of Utah Huntsman Mental Health Institute, 383 Colorow Drive, Room 360, Salt Lake City, UT, 84108, United States, 1 801 410 0852, deborah.bilder@hsc.utah.edu %K developmental disabilities %K disruptive behavior %K psychiatric comorbidity %K web-based %K psychiatric crisis %K disability %K mental health %K behavioral crises %K intervention %K general population %K screening %K accuracy %K mood disorder %K sources of distress %K autism %K intellectual disability %D 2024 %7 29.3.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Individuals with developmental disabilities (DD) experience increased rates of emotional and behavioral crises that necessitate assessment and intervention. Psychiatric disorders can contribute to crises; however, screening measures developed for the general population are inadequate for those with DD. Medical conditions can exacerbate crises and merit evaluation. Screening tools using checklist formats, even when designed for DD, are too limited in depth and scope for crisis assessments. The Sources of Distress survey implements a web-based branching logic format to screen for common psychiatric and medical conditions experienced by individuals with DD by querying caregiver knowledge and observations. Objective: This paper aims to (1) describe the initial survey development, (2) report on focus group and expert review processes and findings, and (3) present results from the survey’s clinical implementation and evaluation of validity. Methods: Sources of Distress was reviewed by focus groups and clinical experts; this feedback informed survey revisions. The survey was subsequently implemented in clinical settings to augment providers’ psychiatric and medical history taking. Informal and formal consults followed the completion of Sources of Distress for a subset of individuals. A records review was performed to identify working diagnoses established during these consults. Results: Focus group members (n=17) expressed positive feedback overall about the survey’s content and provided specific recommendations to add categories and items. The survey was completed for 231 individuals with DD in the clinical setting (n=161, 69.7% men and boys; mean age 17.7, SD 10.3; range 2-65 years). Consults were performed for 149 individuals (n=102, 68.5% men and boys; mean age 18.9, SD 10.9 years), generating working diagnoses to compare survey screening results. Sources of Distress accuracy rates were 91% (95% CI 85%-95%) for posttraumatic stress disorder, 87% (95% CI 81%-92%) for anxiety, 87% (95% CI 81%-92%) for episodic expansive mood and bipolar disorder, 82% (95% CI 75%-87%) for psychotic disorder, 79% (95% CI 71%-85%) for unipolar depression, and 76% (95% CI 69%-82%) for attention-deficit/hyperactivity disorder. While no specific survey items or screening algorithm existed for unspecified mood disorder and disruptive mood dysregulation disorder, these conditions were caregiver-reported and working diagnoses for 11.7% (27/231) and 16.8% (25/149) of individuals, respectively. Conclusions: Caregivers described Sources of Distress as an acceptable tool for sharing their knowledge and insights about individuals with DD who present in crisis. As a screening tool, this survey demonstrates good accuracy. However, better differentiation among mood disorders is needed, including the addition of items and screening algorithm for unspecified mood disorder and disruptive mood dysregulation disorder. Additional validation efforts are necessary to include a more geographically diverse population and reevaluate mood disorder differentiation. Future study is merited to investigate the survey’s impact on the psychiatric and medical management of distress in individuals with DD. %M 38551644 %R 10.2196/50907 %U https://mental.jmir.org/2024/1/e50907 %U https://doi.org/10.2196/50907 %U http://www.ncbi.nlm.nih.gov/pubmed/38551644 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52809 %T A Closed-Loop Digital Health Tool to Improve Depression Care in Multiple Sclerosis: Iterative Design and Cross-Sectional Pilot Randomized Controlled Trial and its Impact on Depression Care %A Henderson,Kyra %A Reihm,Jennifer %A Koshal,Kanishka %A Wijangco,Jaeleene %A Sara,Narender %A Miller,Nicolette %A Doyle,Marianne %A Mallory,Alicia %A Sheridan,Judith %A Guo,Chu-Yueh %A Oommen,Lauren %A Rankin,Katherine P %A Sanders,Stephan %A Feinstein,Anthony %A Mangurian,Christina %A Bove,Riley %+ Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, 1651 4th Street, San Francisco, CA, 94158, United States, 1 4155027209, riley.bove@ucsf.edu %K depression %K quality of life %K bring your own device %K mHealth %K closed-loop %K clinical trial %K multiple sclerosis %D 2024 %7 15.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: People living with multiple sclerosis (MS) face a higher likelihood of being diagnosed with a depressive disorder than the general population. Although many low-cost screening tools and evidence-based interventions exist, depression in people living with MS is underreported, underascertained by clinicians, and undertreated. Objective: This study aims to design a closed-loop tool to improve depression care for these patients. It would support regular depression screening, tie into the point of care, and support shared decision-making and comprehensive follow-up. After an initial development phase, this study involved a proof-of-concept pilot randomized controlled trial (RCT) validation phase and a detailed human-centered design (HCD) phase. Methods: During the initial development phase, the technological infrastructure of a clinician-facing point-of-care clinical dashboard for MS management (BRIDGE) was leveraged to incorporate features that would support depression screening and comprehensive care (Care Technology to Ascertain, Treat, and Engage the Community to Heal Depression in people living with MS [MS CATCH]). This linked a patient survey, in-basket messages, and a clinician dashboard. During the pilot RCT phase, a convenience sample of 50 adults with MS was recruited from a single MS center with 9-item Patient Health Questionnaire scores of 5-19 (mild to moderately severe depression). During the routine MS visit, their clinicians were either asked or not to use MS CATCH to review their scores and care outcomes were collected. During the HCD phase, the MS CATCH components were iteratively modified based on feedback from stakeholders: people living with MS, MS clinicians, and interprofessional experts. Results: MS CATCH links 3 features designed to support mood reporting and ascertainment, comprehensive evidence-based management, and clinician and patient self-management behaviors likely to lead to sustained depression relief. In the pilot RCT (n=50 visits), visits in which the clinician was randomized to use MS CATCH had more notes documenting a discussion of depressive symptoms than those in which MS CATCH was not used (75% vs 34.6%; χ21=8.2; P=.004). During the HCD phase, 45 people living with MS, clinicians, and other experts participated in the design and refinement. The final testing round included 20 people living with MS and 10 clinicians including 5 not affiliated with our health system. Most scoring targets for likeability and usability, including perceived ease of use and perceived effectiveness, were met. Net Promoter Scale was 50 for patients and 40 for clinicians. Conclusions: Created with extensive stakeholder feedback, MS CATCH is a closed-loop system aimed to increase communication about depression between people living with MS and their clinicians, and ultimately improve depression care. The pilot findings showed evidence of enhanced communication. Stakeholders also advised on trial design features of a full year long Department of Defense–funded feasibility and efficacy trial, which is now underway. Trial Registration: ClinicalTrials.gov NCT05865405; http://tinyurl.com/4zkvru9x %M 38488827 %R 10.2196/52809 %U https://formative.jmir.org/2024/1/e52809 %U https://doi.org/10.2196/52809 %U http://www.ncbi.nlm.nih.gov/pubmed/38488827 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48186 %T Improving the Efficiency of Inferences From Hybrid Samples for Effective Health Surveillance Surveys: Comprehensive Review of Quantitative Methods %A Fahimi,Mansour %A Hair,Elizabeth C %A Do,Elizabeth K %A Kreslake,Jennifer M %A Yan,Xiaolu %A Chan,Elisa %A Barlas,Frances M %A Giles,Abigail %A Osborn,Larry %+ Marketing Systems Group, 755 Business Center Drive, Suite 200, Horsham, PA, 19044, United States, 1 2156202880, mfahimi@m-s-g.com %K hybrid samples %K composite estimation %K optimal composition factor %K unequal weighting effect %K composite weighting %K weighting %K surveillance %K sample survey %K data collection %K risk factor %D 2024 %7 7.3.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Increasingly, survey researchers rely on hybrid samples to improve coverage and increase the number of respondents by combining independent samples. For instance, it is possible to combine 2 probability samples with one relying on telephone and another on mail. More commonly, however, researchers are now supplementing probability samples with those from online panels that are less costly. Setting aside ad hoc approaches that are void of rigor, traditionally, the method of composite estimation has been used to blend results from different sample surveys. This means individual point estimates from different surveys are pooled together, 1 estimate at a time. Given that for a typical study many estimates must be produced, this piecemeal approach is computationally burdensome and subject to the inferential limitations of the individual surveys that are used in this process. Objective: In this paper, we will provide a comprehensive review of the traditional method of composite estimation. Subsequently, the method of composite weighting is introduced, which is significantly more efficient, both computationally and inferentially when pooling data from multiple surveys. With the growing interest in hybrid sampling alternatives, we hope to offer an accessible methodology for improving the efficiency of inferences from such sample surveys without sacrificing rigor. Methods: Specifically, we will illustrate why the many ad hoc procedures for blending survey data from multiple surveys are void of scientific integrity and subject to misleading inferences. Moreover, we will demonstrate how the traditional approach of composite estimation fails to offer a pragmatic and scalable solution in practice. By relying on theoretical and empirical justifications, in contrast, we will show how our proposed methodology of composite weighting is both scientifically sound and inferentially and computationally superior to the old method of composite estimation. Results: Using data from 3 large surveys that have relied on hybrid samples composed of probability-based and supplemental sample components from online panels, we illustrate that our proposed method of composite weighting is superior to the traditional method of composite estimation in 2 distinct ways. Computationally, it is vastly less demanding and hence more accessible for practitioners. Inferentially, it produces more efficient estimates with higher levels of external validity when pooling data from multiple surveys. Conclusions: The new realities of the digital age have brought about a number of resilient challenges for survey researchers, which in turn have exposed some of the inefficiencies associated with the traditional methods this community has relied upon for decades. The resilience of such challenges suggests that piecemeal approaches that may have limited applicability or restricted accessibility will prove to be inadequate and transient. It is from this perspective that our proposed method of composite weighting has aimed to introduce a durable and accessible solution for hybrid sample surveys. %M 38451620 %R 10.2196/48186 %U https://publichealth.jmir.org/2024/1/e48186 %U https://doi.org/10.2196/48186 %U http://www.ncbi.nlm.nih.gov/pubmed/38451620 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48026 %T Status and Influencing Factors of Social Media Addiction in Chinese Workers: Cross-Sectional Survey Study %A Kong,Weitao %A Li,Yuanyuan %A Luo,Aijing %A Xie,Wenzhao %+ The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410000, China, 86 0731 85292212, luoaj@csu.edu.cn %K social media addiction %K job burnout %K mindfulness %K mobile phone %K technology addiction %K cross-sectional survey %D 2024 %7 6.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media addiction (SMA) caused by excessive dependence on social media is becoming a global problem. At present, most of the SMA studies recruit college students as research participants, with very few studies involving workers and other age groups, especially in China. Objective: This study aims to investigate the current status of SMA among Chinese workers and analyze its influencing factors. Methods: From November 1, 2022, to January 30, 2023, we conducted an anonymous web-based questionnaire survey in mainland China, and a total of 5176 participants completed the questionnaire. The questionnaire included the Social Networking Service Addiction Scale, Maslach Burnout Inventory–General Survey scale, Mindful Attention Awareness Scale, as well as questionnaires regarding participants’ social media use habits and demographic information. Results: Through strict screening, 3468 valid questionnaires were included in this study. The main findings of this study revealed the following: the average SMA score of workers was higher (mean 53.19, SD 12.04), and some of them (393/3468, 11.33%) relied heavily on social media; there were statistically significant differences in SMA scores among workers in different industries (F14,3453=3.98; P<.001); single workers (t3106=8.6; P<.001) and workers in a relationship (t2749=5.67; P<.001) had higher SMA scores than married workers, but some married workers (214/3468, 6.17%) were highly dependent on social media; the level of SMA among female workers was higher than that of male workers (t3466=3.65; P<.001), and the SMA score of workers negatively correlated with age (r=−0.22; P<.001) and positively correlated with education level (r=0.12; P<.001); the frequency of using social media for entertainment during work (r=0.33; P<.001) and the frequency of staying up late using social media (r=0.14; P<.001) were positively correlated with the level of SMA in workers; and the level of SMA in workers was significantly positively correlated with their level of burnout (r=0.35; P<.001), whereas it was significantly negatively correlated with their level of mindfulness (r=−0.55; P<.001). Conclusions: The results of this study suggest that SMA among Chinese workers is relatively serious and that the SMA problem among workers requires more attention from society and academia. In particular, female workers, young workers, unmarried workers, highly educated workers, workers with bad social media habits, workers with high levels of job burnout, and workers with low levels of mindfulness were highly dependent on social media. In addition, occupation is an important influencing factor in SMA. Thus, the government should strengthen the supervision of social media companies. Medical institutions should provide health education on SMA and offer intervention programs for those addicted to social media. Workers should cultivate healthy habits while using social media. %M 38446542 %R 10.2196/48026 %U https://www.jmir.org/2024/1/e48026 %U https://doi.org/10.2196/48026 %U http://www.ncbi.nlm.nih.gov/pubmed/38446542 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e47984 %T Screening and Retaining Adolescents Recruited Through Social Media: Secondary Analysis from a Longitudinal Clinical Trial %A Weisblum,Margaret %A Trussell,Emma %A Schwinn,Traci %A Pacheco,Andrea R %A Nurkin,Paige %+ School of Social Work, Columbia University, 1255 Amsterdam Avenue, Room 1204, New York, NY, 10027, United States, 1 212 851 2280, mw3314@columbia.edu %K adolescents %K attrition prevention %K Instagram %K LGBQ %K online recruitment %K retention %K screening %K sexual minority %K social media %K youth %D 2024 %7 28.2.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Social media has become a popular method to recruit participants, particularly for studies with hard-to-reach populations. These studies still face challenges in data quality and, for longitudinal studies, sample retention. However, in addition to aiding in recruitment, social media platforms can help researchers with participant verification and tracking procedures during the study. There is limited previous research describing how longitudinal studies can use social media to screen and retain participants. Objective: This paper describes strategies implemented to screen and retain a nationwide sample of sexual minority youth who were recruited through social media platforms for a longitudinal study testing a drug abuse prevention program. Methods: Our screening strategies for participants included collecting necessary demographic information (name, phone, email, and social media accounts), verifying this information using publicly available web-based records, and sending confirmation emails to ensure working email addresses and correct dates of birth. Retention strategies included communications designed to develop positive participant relationships, incentives for survey completion, regular updating of participant contact information, targeting hard-to-reach participants, and using social media as an alternative means of contacting participants. Results: During enrollment, although the only demographic data required were a phone number and an email address, 87.58% (1065/1216) of participants provided their Instagram as an alternative means of contact. This form of alternative communication remains the most preferred with 87.40% (1047/1198) of participants continuing to provide an Instagram username as of January 2023, about 3 years after recruitment began. In comparison, other alternative means of contact (eg, Facebook and alternative email) were provided by only 6.43% (77/1198) to 56.18% (673/1198) of participants. Direct messaging on Instagram was used to successfully confirm participant identity, remind participants to take annual follow-up surveys, and update lost participant contact information. Screening and retention strategies used in the study have helped achieve 96.30% (1171/1216) to 96.79% (1177/1216) sample retention across 3 waves of data collection. Conclusions: Though social media can be a helpful tool to recruit participants, attrition and participant authenticity difficulties may be associated with this method. Screening and retention strategies can be implemented to improve retention. Internet searches are effective for screening youth to ensure they meet eligibility requirements. Additionally, social media—Instagram in this study—can help to track and locate participants who do not respond to traditional contact methods. Trial Registration: ClinicalTrials.gov NCT03954535; https://clinicaltrials.gov/study/NCT03954535 %M 38416559 %R 10.2196/47984 %U https://pediatrics.jmir.org/2024/1/e47984 %U https://doi.org/10.2196/47984 %U http://www.ncbi.nlm.nih.gov/pubmed/38416559 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48954 %T Designing and Validating a Novel Method for Assessing Delay Discounting Associated With Health Behaviors: Ecological Momentary Assessment Study %A Luken,Amanda %A Rabinowitz,Jill A %A Wells,Jonathan L %A Sosnowski,David W %A Strickland,Justin C %A Thrul,Johannes %A Kirk,Gregory D %A Maher,Brion S %+ Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 212055, United States, 1 4432878287, brion@jhu.edu %K delay discounting %K measurement %K Monetary Choice Questionnaire %K ecological momentary assessment %K substance use %K substance abuse %K questionnaire %K validity %K validation %K measurement %K monetary %K reward %K rewards %K survey %K mobile phone %D 2024 %7 27.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Delay discounting quantifies an individual’s preference for smaller, short-term rewards over larger, long-term rewards and represents a transdiagnostic factor associated with numerous adverse health outcomes. Rather than a fixed trait, delay discounting may vary over time and place, influenced by individual and contextual factors. Continuous, real-time measurement could inform adaptive interventions for various health conditions. Objective: The goals of this paper are 2-fold. First, we present and validate a novel, short, ecological momentary assessment (EMA)–based delay discounting scale we developed. Second, we assess this tool’s ability to reproduce known associations between delay discounting and health behaviors (ie, substance use and craving) using a convenience-based sample. Methods: Participants (N=97) were adults (age range 18-71 years), recruited on social media. In phase 1, data were collected on participant sociodemographic characteristics, and delay discounting was evaluated via the traditional Monetary Choice Questionnaire (MCQ) and our novel method (ie, 7-item time-selection and 7-item monetary-selection scales). During phase 2 (approximately 6 months later), participants completed the MCQ, our novel delay discounting measures, and health outcomes questions. The correlations between our method and the traditional MCQ within and across phases were examined. For scale reduction, a random number of items were iteratively selected, and the correlation between the full and random scales was assessed. We then examined the association between our time- and monetary-selection scales assessed during phase 2 and the percentage of assessments that participants endorsed using or craving alcohol, tobacco, or cannabis. Results: In total, 6 of the 7 individual time-selection items were highly correlated with the full scale (r>0.89). Both time-selection (r=0.71; P<.001) and monetary-selection (r=0.66; P<.001) delay discounting rates had high test-retest reliability across phases 1 and 2. Phase 1 MCQ delay discounting function highly correlated with phase 1 (r=0.76; P<.001) and phase 2 (r=0.45; P<.001) time-selection delay discounting scales. One or more randomly chosen time-selection items were highly correlated with the full scale (r>0.94). Greater delay discounting measured via the time-selection measure (adjusted mean difference=5.89, 95% CI 1.99-9.79), but not the monetary-selection scale (adjusted mean difference=–0.62, 95% CI –3.57 to 2.32), was associated with more past-hour tobacco use endorsement in follow-up surveys. Conclusions: This study evaluated a novel EMA-based scale’s ability to validly and reliably assess delay discounting. By measuring delay discounting with fewer items and in situ via EMA in natural environments, researchers may be better able to identify individuals at risk for poor health outcomes. %M 38412027 %R 10.2196/48954 %U https://formative.jmir.org/2024/1/e48954 %U https://doi.org/10.2196/48954 %U http://www.ncbi.nlm.nih.gov/pubmed/38412027 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e47817 %T Behavioral Insights from Vaccine Adoption in Nigeria: Cross-Sectional Survey Findings %A Agha,Sohail %A Nsofor,Ifeanyi %A Bernard,Drew %A Francis,Sarah %A Rao,Nandan %+ Behavior Design Lab, Stanford University, 581 Capistrano Way, Stanford, CA, 94305, United States, 1 1 206 351 9346, sohailagha@gmail.com %K behavioral insights %K COVID-19 %K Nigeria %K surveys %K vaccination %D 2024 %7 26.2.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: To generate behavioral insights for the development of effective vaccination interventions, we need approaches that combine rapid and inexpensive survey data collection with instruments based on easy-to-use behavior models. This study demonstrates how an inexpensive digital survey helped identify the drivers of COVID-19 vaccination in Nigeria. Objective: This study aims to illustrate how behavioral insights can be generated through inexpensive digital surveys. Methods: We designed and conducted a cross-sectional survey with multistage sampling. Data were collected from Nigerians (aged ≥18 years) from 120 strata based on age, sex, state, and urban or rural location. Respondents were recruited via advertisements on Meta platforms (Facebook and Instagram) using the Virtual Lab open-source tool. We used a Meta Messenger chatbot for data collection; participants were compensated with 400 naira (US $0.87 cents). Data collection took 2 weeks. In total, 957 respondents completed the survey, at an advertising cost of US $1.55 per respondent. An 18-item instrument measuring core motivators, ability barriers, sociodemographic characteristics, and respondents’ vaccination status was pretested before data collection. We ran separate logistic regression models to examine the relationships between vaccine uptake and core motivators, ability barriers, and sociodemographic variables. A final model that predicted vaccine uptake included all 3 sets of variables. Results: About 56% (n=540) of respondents reported that they had received at least 1 COVID-19 vaccination. Three core motivators were positively associated with vaccine uptake: the belief that the COVID-19 vaccine promised a better life (adjusted odds ratio [aOR] 3.51, 95% CI 2.23-5.52), the belief that the vaccine would allow respondents to do more things they enjoyed (aOR 1.97, 95% CI 1.33-2.93), and respondents’ perception that their friends and family members accepted their decision to get vaccinated (aOR 1.62, 95% CI 1.06-2.48). Two ability barriers were negatively associated with vaccine uptake: cost- or income-related concerns lowered the odds of being vaccinated (aOR 0.35, 95% CI 0.24-0.50) and the lack of availability of vaccines at places respondents routinely visited also lowered their odds of being vaccinated (aOR 0.29, 95% CI 0.21-0.40). After adjusting for other variables, the perceived fear of getting COVID-19 and the hardship associated with the disease were no longer associated with vaccine uptake. Conclusions: These findings suggest that hope is more important for Nigerians than fear when it comes to vaccine adoption, enjoying life is more important than worrying about getting the disease, and approval from friends and family is more powerful than their disapproval. These findings suggest that emphasizing the benefits of leading a fuller life after being vaccinated is more likely to succeed than increasing Nigerians’ fear of COVID-19. This study identifies a very different set of factors associated with COVID-19 vaccine adoption than previous Nigerian studies. %M 38407956 %R 10.2196/47817 %U https://www.i-jmr.org/2024/1/e47817 %U https://doi.org/10.2196/47817 %U http://www.ncbi.nlm.nih.gov/pubmed/38407956 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52195 %T Assessment of a Daily Diary Study Including Biospecimen Collections in a Sample of Sexual and Gender Minority Young Adults: Feasibility and Acceptability Study %A Cook,Stephanie H %A Wood,Erica P %A Rodrigues,Mariana %A Jachero Caldas,Janice %A Delorme,Maxline %+ Department of Social and Behavioral Sciences, School of Global Public Health, New York University, 708 Broadway, Room 757, New York, NY, 10003, United States, 1 212 992 5635, sc5810@nyu.edu %K study protocol %K young sexual minority men %K YSSM %K cardiovascular disease risk %K health behaviors %D 2024 %7 19.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Young sexual minority men (YSMM) engage in cardiometabolic risk behaviors (eg, substance use) at higher rates than their heterosexual counterparts. Theory and previous research suggest that these risk behaviors may stem, in part, from exposure to minority stress (ie, discrimination based on sexual identity and other identities such as race). Objective: This pilot study examined the feasibility and acceptability of a virtual 2-day daily diary study that examined daily experiences with discrimination, cardiometabolic risk behaviors (ie, sleep, physical activity, and substance use behaviors), and patterns of physiological stress and inflammation among YSMM aged 18 to 35 years. Methods: Participants (n=20) were recruited from the greater New York metropolitan area and engaged in a 2-day daily diary protocol wherein they provided web-based consent, took a web-based baseline survey, and then, starting the next day, provided 3 saliva samples a day for 2 consecutive days to measure salivary cortisol, engaged in 3 daily diaries per day, and provided 1 blood spot sample via the finger prick method to measure high-sensitivity C-reactive protein. At follow-up, participants were interviewed via videoconferencing to ascertain their experiences and feelings related to the study protocol. Qualitative analyses explored the feasibility and acceptability of the study protocol, and exploratory quantitative analyses explored the descriptive statistics and Pearson correlations among the main study variables of interest. Results: The retention rate was high (19/20, 95%) in our study sample. Qualitative analyses demonstrated that participants were willing to engage in similar, longer-term studies (eg, studies that include both week and weekend days) in the future and suggested the feasibility and acceptability of our study protocol among YSMM. However, participants noted several areas for improvement (eg, redundancy of survey items and difficulty pricking one’s finger) that should be considered in future research. Preliminary quantitative analyses revealed a moderate negative correlation between everyday discrimination and mean cortisol levels (r=−0.51; P=.03). Furthermore, descriptive analyses suggest that that daily cortisol curves differ across races or ethnicities among YSMM. White and other-identified YSMM experienced the highest cortisol awakening response (mean 0.39, SD 0.21 µg/dL for White participants; mean 0.34, SD 0.34 µg/dL for others) with the steepest decline around bedtime (mean 0.05, SD 0.04 µg/dL for White participants; mean 0.09, SD 0.13 µg/dL for others) followed by a lower cortisol awakening response (mean 0.31, SD 0.11 µg/dL for Hispanic participants; mean 0.23, SD 0.15 µg/dL for Black participants) and a slower decline around bedtime (mean 0.10, SD 0.09 µg/dL for Hispanic participants; mean 0.03, SD 0.02 µg/dL for Black participants) among Hispanic and Black YSMM. Conclusions: Overall, the results suggest that similar study protocols are feasible and acceptable among YSMM. Future research should highlight the pathways through which cardiovascular disease risk may arise among YSMM using longer-term study designs and more diverse study samples. %M 38373036 %R 10.2196/52195 %U https://formative.jmir.org/2024/1/e52195 %U https://doi.org/10.2196/52195 %U http://www.ncbi.nlm.nih.gov/pubmed/38373036 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54194 %T Measurement of Head Circumference Using a Smartphone: Feasibility Cohort Study %A Yordanov,Stefan %A Akhter,Kalsoom %A Quan Teh,Jye %A Naushahi,Jawad %A Jalloh,Ibrahim %+ Academic Division of Neurosurgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Hills Rd, Cambridge, CB2 0QQ, United Kingdom, 44 01223 805000 ext 348134, yordanov.stefan@yahoo.com %K head circumference %K HC %K hydrocephalus %K neurosurgery %K pediatric neurosurgery %K paediatric neurosurgery %K neurology %K neuro %K neurosurgeon %K neurologist %K mobile health %K mHealth %K app %K apps %K application %K applications %K digital health %K smartphone %K smartphones %K pediatric %K pediatrics %K paediatric %K paediatrics %K infant %K infants %K infancy %K baby %K babies %K neonate %K neonates %K neonatal %K toddler %K toddlers %K child %K children %D 2024 %7 14.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Accurate head circumference (HC) measurement is essential when assessing neonates and infants. Tape measure HC measurements are prone to errors, particularly when performed by parents/guardians, due to individual differences in head shape, hair style and texture, subject cooperation, and examiner techniques, including tape measure placement and tautness. There is, therefore, the need for a more reliable method. Objective: The primary objective of this study was to evaluate the validity, reliability, and consistency of HC app measurement compared to the current standard of practice, serving as a proof-of-concept for use by health care professionals. Methods: We recruited infants attending the neurosurgery clinic, and parents/guardians were approached and consented to participate in the study. Along with the standard head circumference measurement, measurements were taken with the head circumference app (HC app) developed in-house, and we also collected baseline medical history and characteristics. For the statistical analysis, we used RStudio (version 4.1.1). In summary, we analyzed covariance and intraclass correlation coefficient (ICC) to compare the measurement's within-rater and interrater reliability. The F test was used to analyze the variance between measurements and the Bland-Altman agreement, t test, and correlation coefficients were used to compare the tape measurement to the measures taken by the HC app. We also used nonvalidated questionnaires to explore parental or guardians’ experiences, assess their views on app utility, and collect feedback. Results: The total number of recruited patients was 37. Comparison between the app measurements and the measurements with a tape measure showed poor reliability (ICC=0.177) and wide within-app variations (ICC=0.341). The agreement between the measurements done by parents/guardians and the tape measurements done by the researcher was good (ICC=0.901). Parental/guardian feedback was overall very positive, with most of the parents/guardians reporting that the app was easy to use (n=31, 84%) and that they are happy to use the app in an unsupervised setting, provided that they are assured of the measurement quality. Conclusions: We developed this project as a proof-of-concept study, and as such, the app has shown great potential to be used both in a clinical setting and by parents/guardians in their own homes. %M 38354022 %R 10.2196/54194 %U https://formative.jmir.org/2024/1/e54194 %U https://doi.org/10.2196/54194 %U http://www.ncbi.nlm.nih.gov/pubmed/38354022 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50465 %T Efficacy of Digital Outreach Strategies for Collecting Smoking Data: Pragmatic Randomized Trial %A Kearney,Lauren E %A Jansen,Emily %A Kathuria,Hasmeena %A Steiling,Katrina %A Jones,Kayla C %A Walkey,Allan %A Cordella,Nicholas %+ The Pulmonary Center, Boston University, 72 East Concord Street, Boston, MA, 02118, United States, 1 9788070286, lekearn@bu.edu %K electronic health records %K EHR %K informatics %K learning health system %K lung cancer screening %K smoking history %D 2024 %7 9.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Tobacco smoking is an important risk factor for disease, but inaccurate smoking history data in the electronic medical record (EMR) limits the reach of lung cancer screening (LCS) and tobacco cessation interventions. Patient-generated health data is a novel approach to documenting smoking history; however, the comparative effectiveness of different approaches is unclear. Objective: We designed a quality improvement intervention to evaluate the effectiveness of portal questionnaires compared to SMS text message–based surveys, to compare message frames, and to evaluate the completeness of patient-generated smoking histories. Methods: We randomly assigned patients aged between 50 and 80 years with a history of tobacco use who identified English as a preferred language and have never undergone LCS to receive an EMR portal questionnaire or a text survey. The portal questionnaire used a “helpfulness” message, while the text survey tested frame types informed by behavior economics (“gain,” “loss,” and “helpfulness”) and nudge messaging. The primary outcome was the response rate for each modality and framing type. Completeness and consistency with documented structured smoking data were also evaluated. Results: Participants were more likely to respond to the text survey (191/1000, 19.1%) compared to the portal questionnaire (35/504, 6.9%). Across all text survey rounds, patients were less responsive to the “helpfulness” frame compared with the “gain” frame (odds ratio [OR] 0.29, 95% CI 0.09-0.91; P<.05) and “loss” frame (OR 0.32, 95% CI 11.8-99.4; P<.05). Compared to the structured data in the EMR, the patient-generated data were significantly more likely to be complete enough to determine LCS eligibility both compared to the portal questionnaire (OR 34.2, 95% CI 3.8-11.1; P<.05) and to the text survey (OR 6.8, 95% CI 3.8-11.1; P<.05). Conclusions: We found that an approach using patient-generated data is a feasible way to engage patients and collect complete smoking histories. Patients are likely to respond to a text survey using “gain” or “loss” framing to report detailed smoking histories. Optimizing an SMS text message approach to collect medical information has implications for preventative and follow-up clinical care beyond smoking histories, LCS, and smoking cessation therapy. %M 38335012 %R 10.2196/50465 %U https://formative.jmir.org/2024/1/e50465 %U https://doi.org/10.2196/50465 %U http://www.ncbi.nlm.nih.gov/pubmed/38335012 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47372 %T Explainable Machine Learning Classification to Identify Vulnerable Groups Among Parenting Mothers: Web-Based Cross-Sectional Questionnaire Study %A Hanai,Akiko %A Ishikawa,Tetsuo %A Sugao,Shoko %A Fujii,Makoto %A Hirai,Kei %A Watanabe,Hiroko %A Matsuzaki,Masayo %A Nakamoto,Goji %A Takeda,Toshihiro %A Kitabatake,Yasuji %A Itoh,Yuichi %A Endo,Masayuki %A Kimura,Tadashi %A Kawakami,Eiryo %+ Medical Data Mathematical Reasoning Team, Advanced Data Science Project, RIKEN Information R&D and Strategy Headquarters, RIKEN, W507/509 West Research Building,, 1-7-22 Suehiro-cho, Tsurumi-ku, Yokohama, 230-0045, Japan, 81 455039455, tetsuo.ishikawa@riken.jp %K explainable machine-learning %K unsupervised clustering %K perceived support %K resilience %K adaptation %K mother’s health %K mobile phone %K machine learning %K web-based %K parenting %K postpartum %K antenatal %K survey %K mother %K women %K newborn %K psychosocial %K infant %K parents %K children %K depression %K digital health %K maternal %D 2024 %7 7.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: One life event that requires extensive resilience and adaptation is parenting. However, resilience and perceived support in child-rearing vary, making the real-world situation unclear, even with postpartum checkups. Objective: This study aimed to explore the psychosocial status of mothers during the child-rearing period from newborn to toddler, with a classifier based on data on the resilience and adaptation characteristics of mothers with newborns. Methods: A web-based cross-sectional survey was conducted. Mothers with newborns aged approximately 1 month (newborn cohort) were analyzed to construct an explainable machine learning classifier to stratify parenting-related resilience and adaptation characteristics and identify vulnerable populations. Explainable k-means clustering was used because of its high explanatory power and applicability. The classifier was applied to mothers with infants aged 2 months to 1 year (infant cohort) and mothers with toddlers aged >1 year to 2 years (toddler cohort). Psychosocial status, including depressed mood assessed by the Edinburgh Postnatal Depression Scale (EPDS), bonding assessed by the Postpartum Bonding Questionnaire (PBQ), and sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI) between the classified groups, was compared. Results: A total of 1559 participants completed the survey. They were split into 3 cohorts, comprising populations of various characteristics, including parenting difficulties and psychosocial measures. The classifier, which stratified participants into 5 groups, was generated from the self-reported scores of resilience and adaptation in the newborn cohort (n=310). The classifier identified that the group with the greatest difficulties in resilience and adaptation to a child’s temperament and perceived support had higher incidences of problems with depressed mood (relative prevalence [RP] 5.87, 95% CI 2.77-12.45), bonding (RP 5.38, 95% CI 2.53-11.45), and sleep quality (RP 1.70, 95% CI 1.20-2.40) compared to the group with no difficulties in perceived support. In the infant cohort (n=619) and toddler cohort (n=461), the stratified group with the greatest difficulties had higher incidences of problems with depressed mood (RP 9.05, 95% CI 4.36-18.80 and RP 4.63, 95% CI 2.38-9.02, respectively), bonding (RP 1.63, 95% CI 1.29-2.06 and RP 3.19, 95% CI 2.03-5.01, respectively), and sleep quality (RP 8.09, 95% CI 4.62-16.37 and RP 1.72, 95% CI 1.23-2.42, respectively) compared to the group with no difficulties. Conclusions: The classifier, based on a combination of resilience and adaptation to the child’s temperament and perceived support, was able identify psychosocial vulnerable groups in the newborn cohort, the start-up stage of childcare. Psychosocially vulnerable groups were also identified in qualitatively different infant and toddler cohorts, depending on their classifier. The vulnerable group identified in the infant cohort showed particularly high RP for depressed mood and poor sleep quality. %M 38324356 %R 10.2196/47372 %U https://formative.jmir.org/2024/1/e47372 %U https://doi.org/10.2196/47372 %U http://www.ncbi.nlm.nih.gov/pubmed/38324356 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46746 %T Attitudes Toward School-Based Surveillance of Adolescents’ Social Media Activity: Convergent Parallel Mixed Methods Survey %A Burke,Colin %A Triplett,Cynthia %A Rubanovich,Caryn Kseniya %A Karnaze,Melissa M %A Bloss,Cinnamon S %+ Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, 9500 Gilman Drive MC0811, La Jolla, CA, 92093-0811, United States, 1 (858) 534 2230, cbloss@eng.ucsd.edu %K social media %K surveillance %K privacy %K public health %K students %K schools %K social media monitoring %K SMM %K school safety %K mental health %K adolescents %D 2024 %7 6.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: US schools increasingly implement commercially available technology for social media monitoring (SMM) of students, purportedly to address youth mental health and school safety. However, little is known about how SMM is perceived by stakeholders, including the students who are the focus of these efforts. Objective: We aimed to assess attitudes toward SMM in schools among 4 stakeholder groups and examine reasons for holding supportive, neutral, or unsupportive views toward the technology. We also sought to explore whether any differences in attitudes were associated with binary sex, race, ethnicity, sexual orientation, or gender identity. Methods: In October 2019, we conducted a convergent parallel mixed methods web-based survey of young adults (aged 18-22 y; n=206), parents (n=205), teachers (n=77), and school administrators (n=41) via Qualtrics web-based panels. We included Likert-type survey items to assess perceived benefits, risks, and overall support of SMM in schools and test for differences based on stakeholder group or demographic characteristics. We also included open-ended questions, and the responses to these items were analyzed using thematic content analysis of reasons given for holding supportive, neutral, or unsupportive views. Results: The tests of group differences showed that young adults perceived lower benefit (P<.001) as well as higher risk (P<.001) and expressed lower overall support (P<.001) of the use of SMM in schools than all other stakeholder groups. Individuals identifying as nonheterosexual also perceived lower benefit (P=.002) and higher risk (P=.02) and expressed lower overall support (P=.02) than their heterosexual counterparts; respondents who identified as people of racial and ethnic minorities also perceived higher risk (P=.04) than their White counterparts. Qualitative thematic content analysis revealed greater nuance in concerns about SMM. Specifically, the primary reasons given for not supporting SMM across all stakeholder groups were (1) skepticism about its utility, (2) perceived privacy violations, and (3) fears of inappropriate or discriminatory use of the data. Within the young adult group in particular, concerns were also raised about (4) unintended and adverse consequences, including the erosion of trust between students and school institutions and administrators, and the chronic adverse effects of constant or prolonged surveillance. Thematic analysis also showed that individuals in every stakeholder group who indicated overall support of SMM were likely to cite the potential for enhanced school safety as the reason. Young adults’ overall stances toward SMM were the most polarized, either strongly for or strongly against SMM, and responses from teachers indicated similar polarization but more often favored support of SMM in schools. Conclusions: This study found differing perspectives among stakeholder groups regarding SMM in schools. More work is needed to assess the ways in which this type of surveillance is being implemented and the range and complexity of possible effects, particularly on students. %M 38319696 %R 10.2196/46746 %U https://formative.jmir.org/2024/1/e46746 %U https://doi.org/10.2196/46746 %U http://www.ncbi.nlm.nih.gov/pubmed/38319696 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52768 %T Exploring the Perspectives of Patients Living With Lupus: Retrospective Social Listening Study %A Spies,Erica %A Andreu,Thomas %A Hartung,Matthias %A Park,Josephine %A Kamudoni,Paul %+ The Healthcare Business of Merck KGaA, Frankfurter Strasse 250, Darmstadt, 64293, Germany, 49 15114543257, paul.kamudoni@emdgroup.com %K systemic lupus erythematosus %K SLE %K cutaneous lupus erythematosus %K CLE %K quality of life %K health-related quality of life %K HRQoL %K social media listening %K lupus %K rare %K cutaneous %K social media %K infodemiology %K infoveillance %K social listening %K natural language processing %K machine learning %K experience %K experiences %K tagged %K tagging %K visualization %K visualizations %K knowledge graph %K chronic %K autoimmune %K inflammation %K inflammatory %K skin %K dermatology %K dermatological %K forum %K forums %K blog %K blogs %D 2024 %7 2.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease affecting various organs with a wide range of clinical manifestations. Cutaneous lupus erythematosus (CLE) can manifest as a feature of SLE or an independent skin ailment. Health-related quality of life (HRQoL) is frequently compromised in individuals living with lupus. Understanding patients’ perspectives when living with a disease is crucial for effectively meeting their unmet needs. Social listening is a promising new method that can provide insights into the experiences of patients living with their disease (lupus) and leverage these insights to inform drug development strategies for addressing their unmet needs. Objective: The objective of this study is to explore the experience of patients living with SLE and CLE, including their disease and treatment experiences, HRQoL, and unmet needs, as discussed in web-based social media platforms such as blogs and forums. Methods: A retrospective exploratory social listening study was conducted across 13 publicly available English-language social media platforms from October 2019 to January 2022. Data were processed using natural language processing and knowledge graph tagging technology to clean, format, anonymize, and annotate them algorithmically before feeding them to Pharos, a Semalytix proprietary data visualization and analysis platform, for further analysis. Pharos was used to generate descriptive data statistics, providing insights into the magnitude of individual patient experience variables, their differences in the magnitude of variables, and the associations between algorithmically tagged variables. Results: A total of 45,554 posts from 3834 individuals who were algorithmically identified as patients with lupus were included in this study. Among them, 1925 (authoring 5636 posts) and 106 (authoring 243 posts) patients were identified as having SLE and CLE, respectively. Patients frequently mentioned various symptoms in relation to SLE and CLE including pain, fatigue, and rashes; pain and fatigue were identified as the main drivers of HRQoL impairment. The most affected aspects of HRQoL included “mobility,” “cognitive capabilities,” “recreation and leisure,” and “sleep and rest.” Existing pharmacological interventions poorly managed the most burdensome symptoms of lupus. Conversely, nonpharmacological treatments, such as exercise and meditation, were frequently associated with HRQoL improvement. Conclusions: Patients with lupus reported a complex interplay of symptoms and HRQoL aspects that negatively influenced one another. This study demonstrates that social listening is an effective method to gather insights into patients’ experiences, preferences, and unmet needs, which can be considered during the drug development process to develop effective therapies and improve disease management. %M 38306157 %R 10.2196/52768 %U https://formative.jmir.org/2024/1/e52768 %U https://doi.org/10.2196/52768 %U http://www.ncbi.nlm.nih.gov/pubmed/38306157 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52560 %T Mental Health and Well-Being in Racial or Ethnic Minority Individuals After Using a Faith and Prayer Mobile App (Pray.com): Feasibility and Preliminary Efficacy Trial %A Laird,Breanne %A Zuniga,Sabrina %A Hook,Joshua N %A Van Tongeren,Daryl R %A Joeman,Lynda %A Huberty,Jennifer %+ Pray, Inc, 4607 Lakeview Canyon Rd #456, Westlack Village, CA, 91361, United States, 1 9095574002, breanne.laird@pray.com %K religion %K spirituality %K mobile apps %K mental health %K well-being %K app %K ethnic %K technology %K engagement %K stress %K depression %K anxiety %K quality of life %K spiritual well-being %K racial %K spiritual practices %K spiritual practice %K mobile phone %K mobile health %K mHealth %D 2024 %7 2.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Research is needed on how faith and prayer apps fit within the values of racial and ethnic minority (REM) groups, as well as whether such apps are effective in promoting mental health and well-being. Objective: This study aims to determine the feasibility and preliminary effectiveness of using the mobile app Pray.com on mental health and well-being among REM participants. Methods: This study was a single-group (N=77), 4-week feasibility trial in REM groups (65/77, 84% Black or African American). Participants were asked to use the Pray.com app at no cost for at least 5 times per week for 5 minutes per day. Participants completed questionnaires at the baseline and postintervention time points. Feasibility questionnaires were only completed at the postintervention time point, including qualitative interviews (n=15). The feasibility questions included acceptability (ie, satisfaction, intent to continue use, perceived appropriateness, and fit within culture), demand (ie, self-reported app use, expressed interest, and perceived demand), and practicality (ie, ease or difficulty of use, ability to use the app, and cost-effectiveness). Frequency and descriptive statistics were used to analyze feasibility outcomes. Changes in dependent variables were analyzed using paired-sample 2-tailed t tests. Partial correlations were conducted to explore the association between app use and outcomes, controlling for baseline scores. Results: Participants reported (54/72, 75% responded with “very likely” or “likely” to the feasibility questions) that they perceived the Pray.com app as acceptable. These findings were supported by qualitative interviews (n=15). Most participants (62/72, 86%) did not meet the app use prescription but expressed interest in using the app in the future and perceived demand for it in their communities. In addition, participants reported that the app was easy to use and perceived it to be inexpensive (US $7.99). Participants reported improved mental health (ie, stress and depressive and anxiety symptoms) and well-being (ie, satisfaction with life, spiritual well-being, religious commitment, and racial or ethnic identity development) at postintervention despite relatively low average levels and high variability of app use (average total of 45.83, SD 111.90 min over the course of the study). Greater app use was significantly associated with improvements in mental health and spiritual well-being. However, app use and study methodology limitations suggest that the study results may not accurately capture the full impact of Pray.com use. Conclusions: This is the first study to assess the feasibility of a faith and prayer app for mental health and well-being in a sample of REM individuals. Our findings suggest that the use of a faith and prayer app (ie, Pray.com) could be feasible and significantly impactful for the improvement of mental health symptoms and well-being in REM individuals and their communities, especially Black and African American individuals with a Christian affiliation. Further research is warranted. %M 38306173 %R 10.2196/52560 %U https://formative.jmir.org/2024/1/e52560 %U https://doi.org/10.2196/52560 %U http://www.ncbi.nlm.nih.gov/pubmed/38306173 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45910 %T Sleep Patterns of Premedical Undergraduate Students: Pilot Study and Protocol Evaluation %A Rajput,Gargi %A Gao,Andy %A Wu,Tzu-Chun %A Tsai,Ching-Tzu %A Molano,Jennifer %A Wu,Danny T Y %+ Department of Biomedical Informatics, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, ML0840, Cincinnati, OH, 45267, United States, 1 5135586464, wutz@ucmail.uc.edu %K patient-generated health data %K Fitbit wearables %K sleep quality %K premedical college students %K sleep %K sleep hygiene %K student %K colleges %K university %K postsecondary %K higher education %K survey %K sleep pattern %K medical student %K adolescence %K behavior change %D 2024 %7 2.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor sleep hygiene persists in college students today, despite its heavy implications on adolescent development and academic performance. Although sleep patterns in undergraduates have been broadly investigated, no study has exclusively assessed the sleep patterns of premedical undergraduate students. A gap also exists in the knowledge of how students perceive their sleep patterns compared to their actual sleep patterns. Objective: This study aims to address 2 research questions: What are the sleep patterns of premedical undergraduate students? Would the proposed study protocol be feasible to examine the perception of sleep quality and promote sleep behavioral changes in premedical undergraduate students? Methods: An anonymous survey was conducted with premedical students in the Medical Science Baccalaureate program at an R1: doctoral university in the Midwest United States to investigate their sleep habits and understand their demographics. The survey consisted of both Pittsburg Sleep Quality Index (PSQI) questionnaire items (1-9) and participant demographic questions. To examine the proposed protocol feasibility, we recruited 5 students from the survey pool for addressing the perception of sleep quality and changes. These participants followed a 2-week protocol wearing Fitbit Inspire 2 watches and underwent preassessments, midassessments, and postassessments. Participants completed daily reflections and semistructured interviews along with PSQI questionnaires during assessments. Results: According to 103 survey responses, premedical students slept an average of 7.1 hours per night. Only a quarter (26/103) of the participants experienced good sleep quality (PSQI<5), although there was no significant difference (P=.11) in the proportions of good (PSQI<5) versus poor sleepers (PSQI≥5) across cohorts. When students perceived no problem at all in their sleep quality, 50% (14/28) of them actually had poor sleep quality. Among the larger proportion of students who perceived sleep quality as only a slight problem, 26% (11/43) of them presented poor sleep quality. High stress levels were associated with poor sleep quality. This study reveals Fitbit as a beneficial tool in raising sleep awareness. Participants highlighted Fitbit elements that aid in comprehension such as being able to visualize their sleep stage breakdown and receive an overview of their sleep pattern by simply looking at their Fitbit sleep scores. In terms of protocol evaluation, participants believed that assessments were conducted within the expected duration, and they did not have a strong opinion about the frequency of survey administration. However, Fitbit was found to provide notable variation daily, leading to missing data. Moreover, the Fitbit app’s feature description was vague and could lead to confusion. Conclusions: Poor sleep quality experienced by unaware premedical students points to a need for raising sleep awareness and developing effective interventions. Future work should refine our study protocol based on lessons learned and health behavior theories and use Fitbit as an informatics solution to promote healthy sleep behaviors. %M 38306175 %R 10.2196/45910 %U https://formative.jmir.org/2024/1/e45910 %U https://doi.org/10.2196/45910 %U http://www.ncbi.nlm.nih.gov/pubmed/38306175 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54747 %T Machine Learning and Symptom Patterns in Degenerative Cervical Myelopathy: Web-Based Survey Study %A Touzet,Alvaro Yanez %A Rujeedawa,Tanzil %A Munro,Colin %A Margetis,Konstantinos %A Davies,Benjamin M %+ University of Cambridge, The Old Schools, Trinity Ln, Cambridge, Cambridge, CB2 1TN, United Kingdom, 44 01223 337733, bd375@cam.ac.uk %K cervical %K myelopathy %K machine learning %K cluster %K clusters %K clustering %K spine %K spinal %K compression %K neck %K degenerative %K k-means %K patient reported %K degenerative cervical myelopathy %D 2024 %7 25.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Degenerative cervical myelopathy (DCM), a progressive spinal cord injury caused by spinal cord compression from degenerative pathology, often presents with neck pain, sensorimotor dysfunction in the upper or lower limbs, gait disturbance, and bladder or bowel dysfunction. Its symptomatology is very heterogeneous, making early detection as well as the measurement or understanding of the underlying factors and their consequences challenging. Increasingly, evidence suggests that DCM may consist of subgroups of the disease, which are yet to be defined. Objective: This study aimed to explore whether machine learning can identify clinically meaningful groups of patients based solely on clinical features. Methods: A survey was conducted wherein participants were asked to specify the clinical features they had experienced, their principal presenting complaint, and time to diagnosis as well as demographic information, including disease severity, age, and sex. K-means clustering was used to divide respondents into clusters according to their clinical features using the Euclidean distance measure and the Hartigan-Wong algorithm. The clinical significance of groups was subsequently explored by comparing their time to presentation, time with disease severity, and other demographics. Results: After a review of both ancillary and cluster data, it was determined by consensus that the optimal number of DCM response groups was 3. In Cluster 1, there were 40 respondents, and the ratio of male to female participants was 13:21. In Cluster 2, there were 92 respondents, with a male to female participant ratio of 27:65. Cluster 3 had 57 respondents, with a male to female participant ratio of 9:48. A total of 6 people did not report biological sex in Cluster 1. The mean age in this Cluster was 56.2 (SD 10.5) years; in Cluster 2, it was 54.7 (SD 9.63) years; and in Cluster 3, it was 51.8 (SD 8.4) years. Patients across clusters significantly differed in the total number of clinical features reported, with more clinical features in Cluster 3 and the least clinical features in Cluster 1 (Kruskal-Wallis rank sum test: χ22=159.46; P<.001). There was no relationship between the pattern of clinical features and severity. There were also no differences between clusters regarding time since diagnosis and time with DCM. Conclusions: Using machine learning and patient-reported experience, 3 groups of patients with DCM were defined, which were different in the number of clinical features but not in the severity of DCM or time with DCM. Although a clearer biological basis for the clusters may have been missed, the findings are consistent with the emerging observation that DCM is a heterogeneous disease, difficult to diagnose or stratify. There is a place for machine learning methods to efficiently assist with pattern recognition. However, the challenge lies in creating quality data sets necessary to derive benefit from such approaches. %M 38271070 %R 10.2196/54747 %U https://formative.jmir.org/2024/1/e54747 %U https://doi.org/10.2196/54747 %U http://www.ncbi.nlm.nih.gov/pubmed/38271070 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47091 %T Assessing and Improving Data Integrity in Web-Based Surveys: Comparison of Fraud Detection Systems in a COVID-19 Study %A Bonett,Stephen %A Lin,Willey %A Sexton Topper,Patrina %A Wolfe,James %A Golinkoff,Jesse %A Deshpande,Aayushi %A Villarruel,Antonia %A Bauermeister,José %+ School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA, 19104, United States, 1 2155734299, stepdo@nursing.upenn.edu %K web-based survey %K data quality %K fraud %K survey methodology %K COVID-19 %K survey %K fraud detection %K Philadelphia %K data privacy %K data protection %K privacy %K security %K data %K information security %K data validation %K cross-sectional %K web-based %D 2024 %7 12.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based surveys increase access to study participation and improve opportunities to reach diverse populations. However, web-based surveys are vulnerable to data quality threats, including fraudulent entries from automated bots and duplicative submissions. Widely used proprietary tools to identify fraud offer little transparency about the methods used, effectiveness, or representativeness of resulting data sets. Robust, reproducible, and context-specific methods of accurately detecting fraudulent responses are needed to ensure integrity and maximize the value of web-based survey research. Objective: This study aims to describe a multilayered fraud detection system implemented in a large web-based survey about COVID-19 attitudes, beliefs, and behaviors; examine the agreement between this fraud detection system and a proprietary fraud detection system; and compare the resulting study samples from each of the 2 fraud detection methods. Methods: The PhillyCEAL Common Survey is a cross-sectional web-based survey that remotely enrolled residents ages 13 years and older to assess how the COVID-19 pandemic impacted individuals, neighborhoods, and communities in Philadelphia, Pennsylvania. Two fraud detection methods are described and compared: (1) a multilayer fraud detection strategy developed by the research team that combined automated validation of response data and real-time verification of study entries by study personnel and (2) the proprietary fraud detection system used by the Qualtrics (Qualtrics) survey platform. Descriptive statistics were computed for the full sample and for responses classified as valid by 2 different fraud detection methods, and classification tables were created to assess agreement between the methods. The impact of fraud detection methods on the distribution of vaccine confidence by racial or ethnic group was assessed. Results: Of 7950 completed surveys, our multilayer fraud detection system identified 3228 (40.60%) cases as valid, while the Qualtrics fraud detection system identified 4389 (55.21%) cases as valid. The 2 methods showed only “fair” or “minimal” agreement in their classifications (κ=0.25; 95% CI 0.23-0.27). The choice of fraud detection method impacted the distribution of vaccine confidence by racial or ethnic group. Conclusions: The selection of a fraud detection method can affect the study’s sample composition. The findings of this study, while not conclusive, suggest that a multilayered approach to fraud detection that includes conservative use of automated fraud detection and integration of human review of entries tailored to the study’s specific context and its participants may be warranted for future survey research. %M 38214962 %R 10.2196/47091 %U https://formative.jmir.org/2024/1/e47091 %U https://doi.org/10.2196/47091 %U http://www.ncbi.nlm.nih.gov/pubmed/38214962 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e50738 %T Identification of Predictors of Mood Disorder Misdiagnosis and Subsequent Help-Seeking Behavior in Individuals With Depressive Symptoms: Gradient-Boosted Tree Machine Learning Approach %A Benacek,Jiri %A Lawal,Nimotalai %A Ong,Tommy %A Tomasik,Jakub %A Martin-Key,Nayra A %A Funnell,Erin L %A Barton-Owen,Giles %A Olmert,Tony %A Cowell,Dan %A Bahn,Sabine %+ Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223334151, sb209@cam.ac.uk %K misdiagnosis %K help-seeking %K gradient-boosted trees %K machine learning %K depression %K bipolar disorder %K diagnose %K diagnosis %K mood %K mental health %K mental disorder %K mental disorders %K depression %K depressive %K predict %K predictive %K prediction %K depressed %K algorithm %K algorithms %D 2024 %7 11.1.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Misdiagnosis and delayed help-seeking cause significant burden for individuals with mood disorders such as major depressive disorder and bipolar disorder. Misdiagnosis can lead to inappropriate treatment, while delayed help-seeking can result in more severe symptoms, functional impairment, and poor treatment response. Such challenges are common in individuals with major depressive disorder and bipolar disorder due to the overlap of symptoms with other mental and physical health conditions, as well as, stigma and insufficient understanding of these disorders. Objective: In this study, we aimed to identify factors that may contribute to mood disorder misdiagnosis and delayed help-seeking. Methods: Participants with current depressive symptoms were recruited online and data were collected using an extensive digital mental health questionnaire, with the World Health Organization World Mental Health Composite International Diagnostic Interview delivered via telephone. A series of predictive gradient-boosted tree algorithms were trained and validated to identify the most important predictors of misdiagnosis and subsequent help-seeking in misdiagnosed individuals. Results: The analysis included data from 924 symptomatic individuals for predicting misdiagnosis and from a subset of 379 misdiagnosed participants who provided follow-up information when predicting help-seeking. Models achieved good predictive power, with area under the receiver operating characteristic curve of 0.75 and 0.71 for misdiagnosis and help-seeking, respectively. The most predictive features with respect to misdiagnosis were high severity of depressed mood, instability of self-image, the involvement of a psychiatrist in diagnosing depression, higher age at depression diagnosis, and reckless spending. Regarding help-seeking behavior, the strongest predictors included shorter time elapsed since last speaking to a general practitioner about mental health, sleep problems disrupting daily tasks, taking antidepressant medication, and being diagnosed with depression at younger ages. Conclusions: This study provides a novel, machine learning–based approach to understand the interplay of factors that may contribute to the misdiagnosis and subsequent help-seeking in patients experiencing low mood. The present findings can inform the development of targeted interventions to improve early detection and appropriate treatment of individuals with mood disorders. %M 38206660 %R 10.2196/50738 %U https://mental.jmir.org/2024/1/e50738 %U https://doi.org/10.2196/50738 %U http://www.ncbi.nlm.nih.gov/pubmed/38206660 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51839 %T Methodological Insights on Recruitment and Retention From a Remote Randomized Controlled Trial Examining the Effectiveness of an Alcohol Reduction App: Descriptive Analysis Study %A Oldham,Melissa %A Dinu,Larisa %A Loebenberg,Gemma %A Field,Matt %A Hickman,Matthew %A Michie,Susan %A Brown,Jamie %A Garnett,Claire %+ University College London, London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 20 7679 883, m.oldham@ucl.ac.uk %K alcohol reduction %K alcohol %K digital care %K digital intervention %K ethnic minority %K methods %K mHealth %K randomised controlled trial %K recruitment %K retention %K social media %D 2024 %7 5.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Randomized controlled trials (RCTs) with no in-person contact (ie, remote) between researchers and participants offer savings in terms of cost and time but present unique challenges. Objective: The goal of this study is to examine the differences between different forms of remote recruitment (eg, National Health Service [NHS] website, social media, and radio advertising) in the proportion of participants recruited, demographic diversity, follow-up rates, and cost. We also examine the cost per participant of sequential methods of follow-up (emails, phone calls, postal surveys, and postcards). Finally, our experience with broader issues around study advertising and participant deception is discussed. Methods: We conducted a descriptive analysis of 5602 increasing-and-higher-risk drinkers (Alcohol Use Disorders Identification Test score ≥8), taking part in a 2-arm, parallel group, remote RCT with a 1:1 allocation, comparing the intervention (Drink Less app) with usual digital care (NHS alcohol advice web page). Participants were recruited between July 2020 and March 2022 and compensated with gift vouchers of up to £36 (a currency exchange rate of £1=US $1.26988 is applicable) for completing follow-up surveys, with 4 stages of follow-up: email reminders, phone calls, postal survey, and postcard. Results: The three main recruitment methods were advertisements on (1) social media (2483/5602, 44.32%), (2) the NHS website (1961/5602, 35.01%), and (3) radio and newspapers (745/5602, 13.3%), with the remaining methods of recruitment accounting 7.37% (413/5602) of the sample. The overall recruitment cost per participant varied from £0 to £11.01. Costs were greater when recruiting participants who were men (£0-£28.85), from an ethnic minority group (£0-£303.81), and more disadvantaged (£0-£49.12). Targeted approaches were useful for recruiting more men but less useful in achieving diversity in ethnicity and socioeconomic status. Follow-up at 6 months was 79.58% (4458/5602). Of those who responded, 92.4% (4119/4458) responded by email. Each additional stage of follow-up resulted in an additional 2-3 percentage points of the overall sample being followed up, although phone calls, postal surveys, and postcards were more resource intensive than email reminders. Conclusions: For remote RCTs, researchers could benefit from using a range of recruitment methods and cost-targeted approaches to achieve demographic diversity. Automated emails with substantial financial incentives for prompt completion can achieve good follow-up rates, and sequential, offline follow-up options, such as phone calls and postal surveys, can further increase follow-up rates but are comparatively expensive. We also make broader recommendations focused on striking the right balance when designing remote RCTs. Careful planning, ongoing maintenance, and dynamic decision-making are required throughout a trial to balance the competing demands of participation among those eligible, deceptive participation among those who are not eligible, and ensuring no postrandomization bias is introduced by data-checking protocols. %M 38180802 %R 10.2196/51839 %U https://formative.jmir.org/2024/1/e51839 %U https://doi.org/10.2196/51839 %U http://www.ncbi.nlm.nih.gov/pubmed/38180802 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e39211 %T Comparing Self-Reported Running Distance and Pace With a Commercial Fitness Watch Data: Reliability Study %A Bullock,Garrett %A Stocks,Joanne %A Feakins,Benjamin %A Alizadeh,Zahra %A Arundale,Amelia %A Kluzek,Stefan %+ Wake Forest School of Medicine, 475 Vine St, Winston-Salem, NC, 27411, United States, 1 3367144264, garrettbullock@gmail.com %K GPS %K Garmin %K training load %K running %K exercise %K fitness %K wearables %K running %K running distance %K pace %K pace distance %D 2024 %7 4.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is substantial evidence exploring the reliability of running distance self-reporting and GPS wearable technology, but there are currently no studies investigating the reliability of participant self-reporting in comparison to GPS wearable technology. There is also a critical sports science and medical research gap due to a paucity of reliability studies assessing self-reported running pace. Objective: The purpose of this study was to assess the reliability of weekly self-reported running distance and pace compared to a commercial GPS fitness watch, stratified by sex and age. These data will give clinicians and sports researchers insights into the reliability of runners’ self-reported pace, which may improve training designs and rehabilitation prescriptions. Methods: A prospective study of recreational runners was performed. Weekly running distance and average running pace were captured through self-report and a fitness watch. Baseline characteristics collected included age and sex. Intraclass correlational coefficients were calculated for weekly running distance and running pace for self-report and watch data. Bland-Altman plots assessed any systemic measurement error. Analyses were then stratified by sex and age. Results: Younger runners reported improved weekly distance reliability (median 0.93, IQR 0.92-0.94). All ages demonstrated similar running pace reliability. Results exhibited no discernable systematic bias. Conclusions: Weekly self-report demonstrated good reliability for running distance and moderate reliability for running pace in comparison to the watch data. Similar reliability was observed for male and female participants. Younger runners demonstrated improved running distance reliability, but all age groups exhibited similar pace reliability. Running pace potentially should be monitored through technological means to increase precision. %M 38175696 %R 10.2196/39211 %U https://formative.jmir.org/2024/1/e39211 %U https://doi.org/10.2196/39211 %U http://www.ncbi.nlm.nih.gov/pubmed/38175696 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45919 %T Improving Transparency in the Residency Application Process: Survey Study %A Ulin,Lindsey %A Bernstein,Simone A %A Nunes,Julio C %A Gu,Alex %A Hammoud,Maya M %A Gold,Jessica A %A Mirza,Kamran M %+ Department of Medicine, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, United States, 1 617 732 5500, lulin@bwh.harvard.edu %K data elaboration %K information transparency %K medical school %K residency application %K residency programs %K resident %D 2023 %7 25.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Increasing numbers of residency applications create challenges for applicants and residency programs to assess if they are a good fit during the residency application and match process. Applicants face limited or conflicting information as they assess programs, leading to overapplying. A holistic review of residency applications is considered a gold standard for programs, but the current volumes and associated time constraints leave programs relying on numerical filters, which do not predict success in residency. Applicants could benefit from increased transparency in the residency application process. Objective: This study aims to determine the information applicants find most beneficial from residency programs when deciding where to apply, by type of medical school education background. Methods: Match 2023 applicants voluntarily completed an anonymous survey through the Twitter and Instagram social media platforms. We asked the respondents to select 3 top factors from a multiple-choice list of what information they would like from residency programs to help determine if the characteristics of their application align with program values. We examined differences in helpful factors selected by medical school backgrounds using ANOVA. Results: There were 4649 survey respondents. When responses were analyzed by United States-allopathic (US-MD), doctor of osteopathic medicine (DO), and international medical graduate (IMG) educational backgrounds, respondents chose different factors as most helpful: minimum United States Medical Licensing Examination (USMLE) or Comprehensive Osteopathic Medical Licensing Examination (COMLEX) Step 2 scores (565/3042, 18.57% US-MD; 485/3042, 15.9% DO; and 1992/3042, 65.48% IMG; P<.001), resident hometown region (281/1132, 24.82% US-MD; 189/1132, 16.7% DO; and 662/1132, 58.48% IMG; P=.02), resident medical school region (476/2179, 22% US-MD; 250/2179, 11.5% DO; and 1453/2179, 66.7% IMG; P=.002), and percent of residents or attendings underrepresented in medicine (417/1815, 22.98% US-MD; 158/1815, 8.71% DO; and 1240/1815, 68.32% IMG; P<.001). Conclusions: When applying to residency programs, this study found that the factors that respondents consider most helpful from programs in deciding where to apply differ by educational background. Across all educational groups, respondents want transparency around standardized exam scores, geography, and the racial or ethnic backgrounds of residents and attendings. %M 38145482 %R 10.2196/45919 %U https://formative.jmir.org/2023/1/e45919 %U https://doi.org/10.2196/45919 %U http://www.ncbi.nlm.nih.gov/pubmed/38145482 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e51238 %T Email-Based Recruitment Into the Health eHeart Study: Cohort Analysis of Invited Eligible Patients %A Ng,Madelena Y %A Olgin,Jeffrey E %A Marcus,Gregory M %A Lyles,Courtney R %A Pletcher,Mark J %+ School of Public Health, University of California, 2121 Berkeley Way, Berkeley, CA, 94720, United States, 1 510 642 6000, madelena.ng@berkeley.edu %K digital health study %K recruitment %K research participants %K campaign evaluation %K email %K advertisement %K enrollment %K registration %K consent %K participation %K engagement %K eHealth %D 2023 %7 22.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Web- or app-based digital health studies allow for more efficient collection of health data for research. However, remote recruitment into digital health studies can enroll nonrepresentative study samples, hindering the robustness and generalizability of findings. Through the comprehensive evaluation of an email-based campaign on recruitment into the Health eHeart Study, we aim to uncover key sociodemographic and clinical factors that contribute to enrollment. Objective: This study sought to understand the factors related to participation, specifically regarding enrollment, in the Health eHeart Study as a result of a large-scale remote email recruitment campaign. Methods: We conducted a cohort analysis on all invited University of California, San Francisco (UCSF) patients to identify sociodemographic and clinical predictors of enrollment into the Health eHeart Study. The primary outcome was enrollment, defined by account registration and consent into the Health eHeart Study. The email recruitment campaign was carried out from August 2015 to February 2016, with electronic health record data extracted between September 2019 and December 2019. Results: The email recruitment campaign delivered at least 1 email invitation to 93.5% (193,606/206,983) of all invited patients and yielded a 3.6% (7012/193,606) registration rate among contacted patients and an 84.1% (5899/7012) consent rate among registered patients. Adjusted multivariate logistic regression models analyzed independent sociodemographic and clinical predictors of (1) registration among contacted participants and (2) consent among registered participants. Odds of registration were higher among patients who are older, women, non-Hispanic White, active patients with commercial insurance or Medicare, with a higher comorbidity burden, with congestive heart failure, and randomized to receive up to 2 recruitment emails. The odds of registration were lower among those with medical conditions such as dementia, chronic pulmonary disease, moderate or severe liver disease, paraplegia or hemiplegia, renal disease, or cancer. Odds of subsequent consent after initial registration were different, with an inverse trend of being lower among patients who are older and women. The odds of consent were also lower among those with peripheral vascular disease. However, the odds of consent remained higher among patients who were non-Hispanic White and those with commercial insurance. Conclusions: This study provides important insights into the potential returns on participant enrollment when digital health study teams invest resources in using email for recruitment. The findings show that participant enrollment was driven more strongly by sociodemographic factors than clinical factors. Overall, email is an extremely efficient means of recruiting participants from a large list into the Health eHeart Study. Despite some improvements in representation, the formulation of truly diverse studies will require additional resources and strategies to overcome persistent participation barriers. %M 38133910 %R 10.2196/51238 %U https://www.jmir.org/2023/1/e51238 %U https://doi.org/10.2196/51238 %U http://www.ncbi.nlm.nih.gov/pubmed/38133910 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46306 %T Testing and Practical Implementation of a User-Friendly Personalized and Long-Term Electronic Informed Consent Prototype in Clinical Research: Mixed Methods Study %A De Sutter,Evelien %A Geerts,David %A Yskout,Koen %A Verreydt,Stef %A Borry,Pascal %A Barbier,Liese %A Huys,Isabelle %+ Catholic University (KU) Leuven Digital Society Institute, Catholic University (KU) Leuven, Parkstraat 45, Box 3605, Leuven, 3000, Belgium, 32 16323195, david.geerts@kuleuven.be %K human-centered design %K digital health %K qualitative research %K informed consent %K trial %K stakeholders %K implementation %D 2023 %7 19.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Over the years, there has been increasing interest in electronic informed consent (eIC) in clinical research. The user-friendliness of an eIC application and its acceptance by stakeholders plays a central role in achieving successful implementation. Objective: This study aims to identify insights for the design and implementation of a user-friendly, personalized, and long-term eIC application based on a usability study with (potential) research participants and semistructured interviews with stakeholders on the practical integration of such an application into their daily practice. Methods: An eIC prototype was evaluated and refined through usability testing among Belgian citizens and iterative redesign. On the basis of a digital literacy questionnaire, a heterogeneous sample of participants was established. Participants needed to complete a series of usability tasks related to personalization and long-term interaction with the research team while using the “think aloud” technique. In addition, usability tests involved completing the System Usability Scale questionnaire and taking part in a semistructured feedback interview. Furthermore, semistructured interviews were conducted with ethics committee members, health care professionals, and pharmaceutical industry representatives active in Belgium and involved in clinical research. Thematic analysis was undertaken using the NVivo software (Lumivero). Results: In total, 3 iterations of usability tests were conducted with 10 participants each. Each cycle involved some participants who reported having low digital skills. The System Usability Scale scores related to the tasks on personalization and long-term interaction increased after each iteration and reached 69.5 (SD 8.35) and 71.3 (SD 16.1) out of 100, respectively, which represents above-average usability. Semistructured interviews conducted with health care professionals (n=4), ethics committee members (n=8), and pharmaceutical industry representatives (n=5) identified the need for an eIC system that can be easily set up. For example, a library could be established enabling stakeholders to easily provide background information about a clinical study, presented in the second layer of the interface. In contrast, some functionalities, such as informing participants about new studies through an eIC system, were not considered useful by stakeholders. Conclusions: This study provides insights for the implementation of a user-friendly personalized and long-term eIC application. The study findings showed that usability testing is key to assessing and increasing the user-friendliness of an eIC application. Although this eIC system has the potential to be usable by a wide audience, participants with low digital literacy may not be able to use it successfully, highlighting the need for additional support for participants or other alternatives to an eIC system. In addition, key lessons emerging from the interviews included ensuring that the application is easy to implement in practice and is interoperable with other established systems. %M 38113088 %R 10.2196/46306 %U https://www.jmir.org/2023/1/e46306 %U https://doi.org/10.2196/46306 %U http://www.ncbi.nlm.nih.gov/pubmed/38113088 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48044 %T Examining Human-Smartphone Interaction as a Proxy for Circadian Rhythm in Patients With Insomnia: Cross-Sectional Study %A Lin,Chen %A Chen,I-Ming %A Chuang,Hai-Hua %A Wang,Zih-Wen %A Lin,Hsiao-Han %A Lin,Yu-Hsuan %+ Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 35053, Taiwan, 886 37206166 ext 36383, yuhsuanlin@nhri.edu.tw %K actigraphy %K circadian rhythm %K digital biomarkers %K human-smartphone interaction %K insomnia %K intradaily variability %K mobile apps %D 2023 %7 15.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The sleep and circadian rhythm patterns associated with smartphone use, which are influenced by mental activities, might be closely linked to sleep quality and depressive symptoms, similar to the conventional actigraphy-based assessments of physical activity. Objective: The primary objective of this study was to develop app-defined circadian rhythm and sleep indicators and compare them with actigraphy-derived measures. Additionally, we aimed to explore the clinical correlations of these indicators in individuals with insomnia and healthy controls. Methods: The mobile app “Rhythm” was developed to record smartphone use time stamps and calculate circadian rhythms in 33 patients with insomnia and 33 age- and gender-matched healthy controls, totaling 2097 person-days. Simultaneously, we used standard actigraphy to quantify participants’ sleep-wake cycles. Sleep indicators included sleep onset, wake time (WT), wake after sleep onset (WASO), and the number of awakenings (NAWK). Circadian rhythm metrics quantified the relative amplitude, interdaily stability, and intradaily variability based on either smartphone use or physical activity data. Results: Comparisons between app-defined and actigraphy-defined sleep onsets, WTs, total sleep times, and NAWK did not reveal any significant differences (all P>.05). Both app-defined and actigraphy-defined sleep indicators successfully captured clinical features of insomnia, indicating prolonged WASO, increased NAWK, and delayed sleep onset and WT in patients with insomnia compared with healthy controls. The Pittsburgh Sleep Quality Index scores were positively correlated with WASO and NAWK, regardless of whether they were measured by the app or actigraphy. Depressive symptom scores were positively correlated with app-defined intradaily variability (β=9.786, SD 3.756; P=.01) and negatively correlated with actigraphy-based relative amplitude (β=–21.693, SD 8.214; P=.01), indicating disrupted circadian rhythmicity in individuals with depression. However, depressive symptom scores were negatively correlated with actigraphy-based intradaily variability (β=–7.877, SD 3.110; P=.01) and not significantly correlated with app-defined relative amplitude (β=–3.859, SD 12.352; P=.76). Conclusions: This study highlights the potential of smartphone-derived sleep and circadian rhythms as digital biomarkers, complementing standard actigraphy indicators. Although significant correlations with clinical manifestations of insomnia were observed, limitations in the evidence and the need for further research on predictive utility should be considered. Nonetheless, smartphone data hold promise for enhancing sleep monitoring and mental health assessments in digital health research. %M 38100195 %R 10.2196/48044 %U https://www.jmir.org/2023/1/e48044 %U https://doi.org/10.2196/48044 %U http://www.ncbi.nlm.nih.gov/pubmed/38100195 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44599 %T Tensorial Principal Component Analysis in Detecting Temporal Trajectories of Purchase Patterns in Loyalty Card Data: Retrospective Cohort Study %A Autio,Reija %A Virta,Joni %A Nordhausen,Klaus %A Fogelholm,Mikael %A Erkkola,Maijaliisa %A Nevalainen,Jaakko %+ Faculty of Social Sciences (Health Sciences), Tampere University, P.O. Box 100, Tampere, FI-33014, Finland, 358 50 318 7364, reija.autio@tuni.fi %K tensorial data %K principal components %K loyalty card data %K purchase pattern %K food expenditure %K seasonality %K food %K diet %D 2023 %7 15.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Loyalty card data automatically collected by retailers provide an excellent source for evaluating health-related purchase behavior of customers. The data comprise information on every grocery purchase, including expenditures on product groups and the time of purchase for each customer. Such data where customers have an expenditure value for every product group for each time can be formulated as 3D tensorial data. Objective: This study aimed to use the modern tensorial principal component analysis (PCA) method to uncover the characteristics of health-related purchase patterns from loyalty card data. Another aim was to identify card holders with distinct purchase patterns. We also considered the interpretation, advantages, and challenges of tensorial PCA compared with standard PCA. Methods: Loyalty card program members from the largest retailer in Finland were invited to participate in this study. Our LoCard data consist of the purchases of 7251 card holders who consented to the use of their data from the year 2016. The purchases were reclassified into 55 product groups and aggregated across 52 weeks. The data were then analyzed using tensorial PCA, allowing us to effectively reduce the time and product group-wise dimensions simultaneously. The augmentation method was used for selecting the suitable number of principal components for the analysis. Results: Using tensorial PCA, we were able to systematically search for typical food purchasing patterns across time and product groups as well as detect different purchasing behaviors across groups of card holders. For example, we identified customers who purchased large amounts of meat products and separated them further into groups based on time profiles, that is, customers whose purchases of meat remained stable, increased, or decreased throughout the year or varied between seasons of the year. Conclusions: Using tensorial PCA, we can effectively examine customers’ purchasing behavior in more detail than with traditional methods because it can handle time and product group dimensions simultaneously. When interpreting the results, both time and product dimensions must be considered. In further analyses, these time and product groups can be directly associated with additional consumer characteristics such as socioeconomic and demographic predictors of dietary patterns. In addition, they can be linked to external factors that impact grocery purchases such as inflation and unexpected pandemics. This enables us to identify what types of people have specific purchasing patterns, which can help in the development of ways in which consumers can be steered toward making healthier food choices. %M 38100168 %R 10.2196/44599 %U https://www.jmir.org/2023/1/e44599 %U https://doi.org/10.2196/44599 %U http://www.ncbi.nlm.nih.gov/pubmed/38100168 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e51616 %T Everyday Digital Literacy Questionnaire for Older Adults: Instrument Development and Validation Study %A Choi,JiYeon %A Choi,Seongmi %A Song,Kijun %A Baek,Jiwon %A Kim,Heejung %A Choi,Mona %A Kim,Yesol %A Chu,Sang Hui %A Shin,Jiyoung %+ Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 3323, jyshin214@yuhs.ac %K aging %K older adults %K digital literacy %K instrument %K validation %K psychometrics %K European Commission’s Digital Competence framework %D 2023 %7 14.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The need for digital literacy in aging populations is increasing in the digitalizing society. Digital literacy involves the identification, evaluation, and communication of information through various digital devices or relevant programs. Objective: The aims of this study were to develop an Everyday Digital Literacy Questionnaire (EDLQ), a digital literacy assessment scale, and subsequently evaluate its psychometric properties using a population of community-dwelling older adults in South Korea. Methods: The EDLQ was developed using an instrument development design. A nationwide survey was conducted, and the study included 1016 community-dwelling older adults (age ≥60 years). To evaluate the psychometric properties, the participants were randomly divided into 2 groups (n=508 each), and the internal consistency (Cronbach α and McDonald ω), structural validity (exploratory factor analysis and confirmatory factor analysis), hypothesis-testing construct validity using the eHealth Literacy Scale (eHEALS), and measurement invariance were analyzed. Results: Among the initial 30 items of the EDLQ, 22 items with a 3-factor solution had a total explained variance of 77%. The domains included “information and communication” (9 items), “content creation and management” (4 items), and “safety and security” (9 items). Confirmatory factor analysis was conducted with this 3-factor solution (χ2206=345.1; normed χ2206=1.7; comparative fit index=0.997; Tucker-Lewis index=0.997; root-mean-square error of approximation=0.036; standardized root-mean-square residual=0.050; composite reliability=0.903-0.959; average variance extracted=0.699-0.724; R2=0.616-0.773). Hypothesis-testing construct validity with the eHEALS revealed a strong correlation (r=0.75). Cronbach α and McDonald ω coefficients were .98 and 0.98, respectively. The fit indices for measurement invariance, including the configural, metric, and scalar invariance models, demonstrated a satisfactory fit to the data. Our findings suggest that the psychometric properties of the 22-item EDLQ are valid and reliable for assessing digital literacy among older Korean adults. Conclusions: In this study, we developed a digital literacy measure with strong psychometric properties that made it suitable for assessing the digital literacy of community-dwelling older adults in Korea. To broaden its applicability, however, further assessment of its feasibility for use with different languages and cultures is necessary. Moreover, more empirical research on digital literacy and related factors in older adults can facilitate the development of personalized digital health care services and educational interventions in the digital society. %M 38095999 %R 10.2196/51616 %U https://www.jmir.org/2023/1/e51616 %U https://doi.org/10.2196/51616 %U http://www.ncbi.nlm.nih.gov/pubmed/38095999 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49354 %T Exploring Different Incentive Structures Among US Adults Who Use e-Cigarettes to Optimize Retention in Longitudinal Web-Based Surveys: Case Study %A Crespi,Elizabeth %A Heller,Johanna %A Hardesty,Jeffrey J %A Nian,Qinghua %A Sinamo,Joshua K %A Welding,Kevin %A Kennedy,Ryan David %A Cohen,Joanna E %+ Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, Baltimore, MD, 21205, United States, 1 410 614 5378, ecrespi2@jhu.edu %K incentive %K conditional incentive %K web-based survey %K longitudinal study %K follow-up %K nicotine %K e-cigarettes %K tobacco %K survey %K retention %K demographics %K case study %K optimization %K adults %D 2023 %7 13.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Longitudinal cohort studies are critical for understanding the evolution of health-influencing behaviors, such as e-cigarette use, over time. Optimizing follow-up rates in longitudinal studies is necessary for ensuring high-quality data with sufficient power for analyses. However, achieving high rates of follow-up in web-based longitudinal studies can be challenging, even when monetary incentives are provided. Objective: This study compares participant progress through a survey and demographics for 2 incentive structures (conditional and hybrid unconditional-conditional) among US adults using e-cigarettes to understand the optimal incentive structure. Methods: The data used in this study are from a web-based longitudinal cohort study (wave 4; July to September 2022) of US adults (aged 21 years or older) who use e-cigarettes ≥5 days per week. Participants (N=1804) invited to the follow-up survey (median completion time=16 minutes) were randomly assigned into 1 of 2 incentive structure groups (n=902 each): (1) conditional (US $30 gift code upon survey completion) and (2) hybrid unconditional-conditional (US $15 gift code prior to survey completion and US $15 gift code upon survey completion). Chi-square tests assessed group differences in participant progress through 5 sequential stages of the survey (started survey, completed screener, deemed eligible, completed survey, and deemed valid) and demographics. Results: Of the 902 participants invited to the follow-up survey in each group, a higher proportion of those in the conditional (662/902, 73.4%) than the hybrid (565/902, 62.6%) group started the survey (P<.001). Of those who started the survey, 643 (97.1%) participants in the conditional group and 548 (97%) participants in the hybrid group completed the screener (P=.89), which was used each wave to ensure participants remained eligible. Of those who completed the screener, 555 (86.3%) participants in the conditional group and 446 (81.4%) participants in the hybrid group were deemed eligible for the survey (P=.02). Of those eligible, 514 (92.6%) participants from the conditional group and 401 (89.9%) participants from the hybrid group completed the survey and were deemed valid after data review (P=.14). Overall, more valid completions were yielded from the conditional (514/902, 57%) than the hybrid group (401/902, 44.5%; P<.001). Among those who validly completed the survey, no significant differences were found by group for gender, income, race, ethnicity, region, e-cigarette use frequency, past 30-day cigarette use, or number of waves previously completed. Conclusions: Providing a US $30 gift code upon survey completion yielded higher rates of survey starts and completions than providing a US $15 gift code both before and after survey completion. These 2 methods yielded participants with similar demographics, suggesting that one approach is not superior in obtaining a balanced sample. Based on this case study, future web-based surveys examining US adults using e-cigarettes could consider providing the full incentive upon completion of the survey. International Registered Report Identifier (IRRID): RR2-10.2196/38732 %M 38090793 %R 10.2196/49354 %U https://www.jmir.org/2023/1/e49354 %U https://doi.org/10.2196/49354 %U http://www.ncbi.nlm.nih.gov/pubmed/38090793 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e39472 %T Hepatitis C Knowledge and Self-Reported Testing Behavior in the General Population in China: Online Cross-Sectional Survey %A Liu,Yin %A Su,Juan %A Wang,Xiaoyang %A Xu,Huifang %A Wang,Hong %A Kang,Ruihua %A Zheng,Liyang %A Wang,Yixian %A Liu,Chunya %A Jing,Yiping %A Zhang,Shaokai %+ Department of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), 127 Dongming Road, Zhengzhou, 450008, China, 86 65587361, shaokaizhang@126.com %K HCV %K hepatitis C virus %K knowledge %K testing behaviors %K general population %K cross-sectional %K online survey %K testing %K screening %K patient education %K China %K Chinese %K patient education %K health education %K hepatitis %K viral disease %K viral infection %K communicable disease %K liver %D 2023 %7 11.12.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The World Health Organization has proposed a worldwide target of eliminating hepatitis C virus (HCV) by 2030. A better understanding of HCV, testing behaviors, and associated factors in the general population is essential. Objective: This study aimed to assess HCV knowledge, self-reported HCV testing behavior, and willingness to undergo HCV screening in the general Chinese population. Methods: A cross-sectional online survey of the general Chinese population aged ≥15 years was conducted from November 2021 to May 2023. Participant characteristics were assessed based on their knowledge level and uptake of HCV testing. Participants ever having heard of HCV were recognized as being aware of HCV and asked additional HCV knowledge questions using a brief, validated 9-item scale. Participants with 0-3 points and who were unaware of HCV were categorized as having poor knowledge, and those with 4-6 points and ≥7 points were categorized as having fair and good knowledge, respectively. Participant uptake of HCV testing, testing results, reasons for undergoing or not undergoing HCV testing, and willingness to undergo HCV screening were collected through self-reports. Ordinal and binary logistic regression analyses were used to assess factors associated with the HCV knowledge level and the uptake of HCV testing, respectively. Results: A total of 1491 valid participants’ questionnaires were included. Of these, 714 (47.6%) participants were aware of HCV. The proportion of participants with poor, fair, and good HCV knowledge was 63.4% (945/1491), 9.3% (139/1491), and 27.3% (407/1491), respectively. A total of 465 (31.2%) participants reported ever undergoing HCV testing, and 4 (0.9%) were anti-HCV antibody positive. Most participants were tested for HCV following blood donation (353/465, 75.9%). The most common reasons for not undergoing HCV screening were a lack of HCV awareness (665/1026, 64.8%), followed by a low self-perceived risk of infection (176/1026, 17.2%). Of 1026 participants who had never undergone HCV testing, 937 (91.3%) were willing to undergo HCV screening if universal screening was provided at no cost. The HCV knowledge level was positively associated with the HCV testing rate. Participants who were less educated, lived in rural areas, resided in West China, and were currently alcohol drinkers had lower HCV knowledge and reduced odds of having undergone HCV testing. In contrast, participants with a blood donation history and a family history of hepatitis B virus or HCV infection had higher HCV knowledge and increased odds of prior testing. Participants aged ≥60 years had lower knowledge, and women had reduced odds of having undergone previous HCV testing. Conclusions: The general population of China has low HCV knowledge and testing rate. There is an urgent need for enhanced HCV awareness and scaled-up HCV screening and treatment. Individuals who are less well educated, reside in less-developed areas, currently drink alcohol, and are female should be prioritized for health education and interventions. %M 38079213 %R 10.2196/39472 %U https://publichealth.jmir.org/2023/1/e39472 %U https://doi.org/10.2196/39472 %U http://www.ncbi.nlm.nih.gov/pubmed/38079213 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45815 %T Mapping the Bibliometrics Landscape of AI in Medicine: Methodological Study %A Shi,Jin %A Bendig,David %A Vollmar,Horst Christian %A Rasche,Peter %+ Institute for Entrepreneurship, University of Münster, Geiststraße 24 - 26, Münster, 48149, Germany, 49 2518323176, jshi1@uni-muenster.de %K artificial intelligence %K AI %K AI in medicine %K medical AI taxonomy %K Python %K latent Dirichlet allocation %K LDA %K topic modeling %K unsupervised machine learning %D 2023 %7 8.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Artificial intelligence (AI), conceived in the 1950s, has permeated numerous industries, intensifying in tandem with advancements in computing power. Despite the widespread adoption of AI, its integration into medicine trails other sectors. However, medical AI research has experienced substantial growth, attracting considerable attention from researchers and practitioners. Objective: In the absence of an existing framework, this study aims to outline the current landscape of medical AI research and provide insights into its future developments by examining all AI-related studies within PubMed over the past 2 decades. We also propose potential data acquisition and analysis methods, developed using Python (version 3.11) and to be executed in Spyder IDE (version 5.4.3), for future analogous research. Methods: Our dual-pronged approach involved (1) retrieving publication metadata related to AI from PubMed (spanning 2000-2022) via Python, including titles, abstracts, authors, journals, country, and publishing years, followed by keyword frequency analysis and (2) classifying relevant topics using latent Dirichlet allocation, an unsupervised machine learning approach, and defining the research scope of AI in medicine. In the absence of a universal medical AI taxonomy, we used an AI dictionary based on the European Commission Joint Research Centre AI Watch report, which emphasizes 8 domains: reasoning, planning, learning, perception, communication, integration and interaction, service, and AI ethics and philosophy. Results: From 2000 to 2022, a comprehensive analysis of 307,701 AI-related publications from PubMed highlighted a 36-fold increase. The United States emerged as a clear frontrunner, producing 68,502 of these articles. Despite its substantial contribution in terms of volume, China lagged in terms of citation impact. Diving into specific AI domains, as the Joint Research Centre AI Watch report categorized, the learning domain emerged dominant. Our classification analysis meticulously traced the nuanced research trajectories across each domain, revealing the multifaceted and evolving nature of AI’s application in the realm of medicine. Conclusions: The research topics have evolved as the volume of AI studies increases annually. Machine learning remains central to medical AI research, with deep learning expected to maintain its fundamental role. Empowered by predictive algorithms, pattern recognition, and imaging analysis capabilities, the future of AI research in medicine is anticipated to concentrate on medical diagnosis, robotic intervention, and disease management. Our topic modeling outcomes provide a clear insight into the focus of AI research in medicine over the past decades and lay the groundwork for predicting future directions. The domains that have attracted considerable research attention, primarily the learning domain, will continue to shape the trajectory of AI in medicine. Given the observed growing interest, the domain of AI ethics and philosophy also stands out as a prospective area of increased focus. %M 38064255 %R 10.2196/45815 %U https://www.jmir.org/2023/1/e45815 %U https://doi.org/10.2196/45815 %U http://www.ncbi.nlm.nih.gov/pubmed/38064255 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48550 %T Online Forums as a Tool for Broader Inclusion of Voices on Health Care Communication Experiences and Serious Illness Care: Mixed Methods Study %A Davila,Carine %A Chan,Stephanie H %A Gosline,Anna %A Arenas,Zamawa %A Kavanagh,Jane %A Feltz,Brian %A McCarthy,Elizabeth %A Pitts,Tyrone %A Ritchie,Christine %+ Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, 55 Fruit St, Austen 600, Boston, MA, 02114, United States, 1 617 724 9197, cdavila@mgh.harvard.edu %K serious illness care %K serious illness communication %K mixed methods research %K community-engaged design %K equity in research %K online forum %K health care experiences %K internet %K illness %K marginalized community %K efficacy %K communication %K engagement %K quantitative survey %K health care %D 2023 %7 6.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Existing health care research, including serious illness research, often underrepresents individuals from historically marginalized communities. Capturing the nuanced perspectives of individuals around their health care communication experiences is difficult. New research strategies are needed that increase engagement of individuals from diverse backgrounds. Objective: The aim of this study was to develop a mixed methods approach with qualitative online forums to better understand health communication experiences of individuals, including people from groups historically marginalized such as Black and Latino individuals; older adults; and people with low income, disability, or serious illness. Methods: We used a multiphase mixed methods, community-informed research approach to design study instruments and engage participants. We engaged a diverse group of collaborators with lived experience of navigating the health care system who provided feedback on instruments, added concepts for testing, and offered guidance on creating a safe experience for participants (phase 1). We conducted a national quantitative survey between April and May 2021 across intrapersonal, interpersonal, and systems-level domains, with particular focus on interpersonal communication between patients and clinicians (phase 2). We conducted two asynchronous, qualitative online forums, a technique used in market research, between June and August 2021, which allowed us to contextualize the learnings and test concepts and messages (phase 3). Using online forums allowed us to probe more deeply into results and hypotheses from the survey to better understand the “whys” and “whats” that surfaced and to test public messages to encourage action around health. Results: We engaged 46 community partners, including patients and clinicians from a Federally Qualified Health Center, to inform study instrument design. In the quantitative survey, 1854 adults responded, including 50.5% women, 25.2% individuals over 65 years old, and 51.9% individuals with low income. Nearly two-thirds identified as non-Hispanic white (65.7%), 10.4% identified as non-Hispanic Black, and 15.5% identified as Hispanic/Latino. An additional 580 individuals participated in online forums, including 60.7% women, 17.4% individuals over 65 years old, and 49.0% individuals with low income. Among the participants, 70.3% identified as non-Hispanic white, 16.0% as non-Hispanic Black, and 9.5% as Hispanic/Latino. We received rich, diverse input from our online forum participants, and they highlighted satisfaction and increased knowledge with engagement in the forums. Conclusions: We achieved modest overrepresentation of people who were over 65 years old, identified as non-Hispanic Black, and had low income in our online forums. The size of the online forums (N=580) reflected the voices of 93 Black and 55 Hispanic/Latino participants. Individuals who identify as Hispanic/Latino remained underrepresented, likely because the online forums were offered only in English. Overall, our findings demonstrate the feasibility of using the online forum qualitative approach in a mixed methods study to contextualize, clarify, and expound on quantitative findings when designing public health and clinical communications interventions. %M 38055311 %R 10.2196/48550 %U https://www.jmir.org/2023/1/e48550 %U https://doi.org/10.2196/48550 %U http://www.ncbi.nlm.nih.gov/pubmed/38055311 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44705 %T Assessment of App-Based Versus Conventional Survey Modalities for Reproductive Health Research in India, South Africa, and the United States: Comparative Cross-Sectional Study %A Shea,Amanda A %A Thornburg,Jonathan %A Vitzthum,Virginia J %+ Centre for Menstrual Cycle and Ovulation Research, Division of Endocrinology/Medicine, The University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada, 1 250 984 3033, dr.vj.vitzthum@gmail.com %K mobile health %K mHealth %K femtech %K reproductive health %K menstrual health %K sexual health %K survey modalities %K menstrual tracking app %K India %K South Africa %K United States %K mobile phone %D 2023 %7 1.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a widely acknowledged global need for more research on reproductive health (including contraception, menstrual health, sexuality, and maternal morbidities) and its impact on overall well-being. However, several factors—notably, high costs, considerable effort, and the sensitivity of these topics—impede the collection of the necessary data, especially in less accessible and lower-income populations. The burgeoning ownership of smartphones and growing use of menstrual tracking apps (MTAs) may present an opportunity to conduct reproductive health research with fewer impediments than those associated with conventional survey methods. Objective: The main objective was to ascertain the feasibility, potential usefulness, and limitations of conducting reproductive health research using a mainstream MTA. Methods: In each of the 3 countries, we evaluated questionnaire responses from (1) current users of an MTA (Clue) and (2) participants surveyed using conventional survey modalities (in-person interviews, SMS text messaging, and web-based questionnaires). We compared these responses with published data collected from large nationally representative benchmark samples (the United States Census and the Demographic and Health Surveys for South Africa and India). Results: Given a sufficiently large user base, app-distributed surveys were able to quickly capture large samples on par with other methods and at low cost, with the additional advantage of being able to deploy remotely and simultaneously across countries. In each country, neither the app nor the conventional modality sample emerged as a consistently closer match to the distributions of the demographic attributes and the patterns of contraceptive use reported for the respective benchmark sample. Despite efforts to obtain representative samples, the conventional modality samples sometimes over- and other times underrepresented some subgroups (eg, underrepresentation of married persons in the United States and overrepresentation of rural residents in India). In all 3 countries, app users were younger, more educated, more likely to be urban residents, and more likely to use nonhormonal rather than hormonal contraceptive methods compared with the respective national benchmark. App users, compared with the conventional modality samples, consistently reported being more comfortable discussing their menstrual periods with other persons (eg, family, friends, and health care providers), suggesting that MTA users may be more likely to respond truthfully to questions on sensitive or taboo health topics. The app samples’ consistency across countries regarding users’ demographic profiles, contraceptive choices, and personal attitudes toward menstruation supports the validity of making cross-country comparisons of survey findings for a given app’s users. Conclusions: MTAs such as Clue can provide a quick, scalable, and cost-effective method for collecting health data, including on sensitive topics, across a wide variety of settings and countries. With expanding global access to technology and the increasing use of these tools, consumer MTAs can be a viable survey modality to strengthen reproductive health research. %M 38039064 %R 10.2196/44705 %U https://formative.jmir.org/2023/1/e44705 %U https://doi.org/10.2196/44705 %U http://www.ncbi.nlm.nih.gov/pubmed/38039064 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e43700 %T Using COVID-19 Vaccine Attitudes Found in Tweets to Predict Vaccine Perceptions in Traditional Surveys: Infodemiology Study %A Sigalo,Nekabari %A Frias-Martinez,Vanessa %+ College of Information Studies, University of Maryland, 4130 Campus Dr, College Park, MD, 20742, United States, 1 301 405 2033, nsigalo@terpmail.umd.edu %K social media %K Twitter %K COVID-19 %K vaccine %K surveys %K SARS-CoV-2 %K vaccinations %K hesitancy %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Traditionally, surveys are conducted to answer questions related to public health but can be costly to execute. However, the information that researchers aim to extract from surveys could potentially be retrieved from social media, which possesses data that are highly accessible and lower in cost to collect. Objective: This study aims to evaluate whether attitudes toward COVID-19 vaccines collected from the Household Pulse Survey (HPS) could be predicted using attitudes extracted from Twitter (subsequently rebranded X). Ultimately, this study aimed to determine whether Twitter can provide us with similar information to that observed in traditional surveys or whether saving money comes at the cost of losing rich data. Methods: COVID-19 vaccine attitudes were extracted from the HPS conducted between January 6 and May 25, 2021. Twitter’s streaming application programming interface was used to collect COVID-19 vaccine tweets during the same period. A sentiment and emotion analysis of tweets was conducted to examine attitudes toward the COVID-19 vaccine on Twitter. Generalized linear models and generalized linear mixed models were used to evaluate the ability of COVID-19 vaccine attitudes on Twitter to predict vaccine attitudes in the HPS. Results: The results revealed that vaccine perceptions expressed on Twitter performed well in predicting vaccine perceptions in the survey. Conclusions: These findings suggest that the information researchers aim to extract from surveys could potentially also be retrieved from a more accessible data source, such as Twitter. Leveraging Twitter data alongside traditional surveys can provide a more comprehensive and nuanced understanding of COVID-19 vaccine perceptions, facilitating evidence-based decision-making and tailored public health strategies. %M 37903294 %R 10.2196/43700 %U https://infodemiology.jmir.org/2023/1/e43700 %U https://doi.org/10.2196/43700 %U http://www.ncbi.nlm.nih.gov/pubmed/37903294 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e49135 %T Using Mobile Ecological Momentary Assessment to Understand Consumption and Context Around Online Food Delivery Use: Pilot Feasibility and Acceptability Study %A Jia,Si Si %A Allman-Farinelli,Margaret %A Roy,Rajshri %A Phongsavan,Philayrath %A Hyun,Karice %A Gibson,Alice Anne %A Partridge,Stephanie Ruth %+ School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown NSW 2006, Sydney, 2006, Australia, 61 2 8627 1697, sisi.jia@sydney.edu.au %K ecological momentary assessment %K mobile applications %K mobile apps %K feasibility studies %K online food delivery %K smartphone %K young adult %K adolescent %K food environment %K consumer behavior %K mobile phone %D 2023 %7 29.11.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile ecological momentary assessment (EMA) is a powerful tool for collecting real-time and contextual data from individuals. As our reliance on online technologies to increase convenience accelerates, the way we access food is changing. Online food delivery (OFD) services may further encourage unhealthy food consumption habits, given the high availability of energy-dense, nutrient-poor foods. We used EMA to understand the real-time effects of OFD on individuals’ food choices and consumption behaviors. Objective: The primary aims of this pilot study were to assess the feasibility and acceptability of using EMA in young users of OFD and compare 2 different EMA sampling methods. The secondary aims were to gather data on OFD events and their context and examine any correlations between demographics, lifestyle chronic disease risk factors, and OFD use. Methods: This study used EMA methods via a mobile app (mEMASense, ilumivu Inc). Existing users of OFD services aged 16 to 35 years in Australia who had access to a smartphone were recruited. Participants were randomly assigned to 1 of 2 groups: signal-contingent or event-contingent. The signal-contingent group was monitored over 3 days between 7 AM and 10 PM. They received 5 prompts each day to complete EMA surveys via the smartphone app. In contrast, the event-contingent group was monitored over 7 days and was asked to self-report any instance of OFD. Results: A total of 102 participants were analyzed, with 53 participants in the signal-contingent group and 49 participants in the event-contingent group. Compliance rates, indicating the feasibility of signal-contingent and event-contingent protocols, were similar at 72.5% (574/792) and 73.2% (251/343), respectively. Feedback from the participants suggested that the EMA app was not easy to use, which affected their acceptability of the study. Participants in the event-contingent group were 3.53 (95% CI 1.52-8.17) times more likely to have had an OFD event captured during the study. Pizza (23/124, 18.5%) and fried chicken (18/124, 14.5%) comprised a bulk of the 124 OFD orders captured. Most orders were placed at home (98/124, 79%) for 1 person (68/124, 54.8%). Age (incidence rate ratio 0.95, 95% CI 0.91-0.99; P=.03) and dependents (incidence rate ratio 2.01, 95% CI 1.16-3.49; P=.01) were significantly associated with the number of OFD events in a week after adjusting for gender, socioeconomic status, diet quality score, and perceived stress levels. Conclusions: This pilot study showed that EMA using an event-contingent sampling approach may be a better method to capture OFD events and context than signal-contingent sampling. The compliance rates showed that both sampling methods were feasible and acceptable. Although the findings from this study have gathered some insight on the consumption and context of OFD in young people, further studies are required to develop targeted interventions. %M 38019563 %R 10.2196/49135 %U https://mhealth.jmir.org/2023/1/e49135 %U https://doi.org/10.2196/49135 %U http://www.ncbi.nlm.nih.gov/pubmed/38019563 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37653 %T Design and Implementation of Survey Quality Control System for Qatar’s First National Mental Health Survey: Case Study %A Petcu,Catalina %A Boukhelif,Ikram %A Davis,Veena %A Shamsi,Hamda %A Al-Assi,Marwa %A Miladi,Anis %A Khaled,Salma M %+ Social and Economic Survey Research Institute, Qatar University, Qatar University Street, Doha, PO Box 2713, Qatar, 974 4403 7290, cpetcu@qu.edu.qa %K World Mental Health Survey %K quality control indicators %K Middle East %K phone interview %K case study %K COVID-19 %D 2023 %7 27.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: All World Mental Health (WMH) Surveys apply high standards of data quality. To date, most of the published quality control (QC) procedures for these surveys were in relation to face-to-face interviews. However, owing to the social restrictions that emerged from the COVID-19 pandemic, telephone interviews are the most effective alternative for conducting complex probability-based large-scale surveys. Objective: In this paper, we present the QC system implemented in the WMH Qatar Survey, the first WMH Survey conducted during the COVID-19 pandemic in the Middle East. The objective of the QC process was to acquire high data quality through the reduction of random errors and bias in data collection. Methods: The QC design and procedures in this study were adapted to the telephone survey mode in response to the COVID-19 pandemic. We focus on the design of the QC indicator system and its implementation, including the investigation process, monitoring interviewers’ performance during survey fielding and applying quality-informed interventions. Results: The study team investigated 11,035 flags triggered during the 2 waves of the survey data collection. The most triggered flags were related to short question administration duration and multiple visits to the same survey questions or responses. Live monitoring of the interviews helped in understanding why certain duration-related flags were triggered and the interviewing patterns of the interviewers. Corrective and preventive actions were taken against interviewers’ behaviors based on the investigation of triggered flags per interviewer and live call monitoring of interviews. Although, in most cases, the interviewers required refresher training sessions and feedback to improve their performance, several interviewers discontinued work because of low productivity and a high number of triggered flags. Conclusions: The specific QC procedures implemented in the course of the WMH Qatar Survey were essential for successfully meeting the target number of interviews (N=5000). The QC strategies and the new indicators customized for telephone interviews contributed to the flag investigation and verification process. The QC data presented in this study shed light on the rigorous methods and quality monitoring processes in the course of conducting a large-scale national survey on sensitive topics during the COVID-19 pandemic. %M 37906213 %R 10.2196/37653 %U https://formative.jmir.org/2023/1/e37653 %U https://doi.org/10.2196/37653 %U http://www.ncbi.nlm.nih.gov/pubmed/37906213 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e49013 %T The Impact of UK Medical Students’ Demographics and Socioeconomic Factors on Their Self-Reported Familiarity With the Postgraduate Training Pathways and Application Process: Cross-Sectional Study %A Davoudi,Kaveh %A Rakhecha,Tushar %A Corriero,Anna Chiara %A Ko,Kar Chang Natalie %A Ismail,Roseanne %A King,Esther R B %A Hollén,Linda %+ Bristol Royal Infirmary, University Hospital Bristol and Weston, Upper Maudlin Street, Bristol, BS2 8HW, United Kingdom, 44 0117 923 0000, kaveh.davoudi@uhbw.NHS.uk %K age %K career progression %K career progression %K clinicians %K cross-sectional study %K demographics %K ethnicity %K gender %K leadership %K medical students demographics %K medical students %K online survey %K research %K students %K teaching %K training %D 2023 %7 24.11.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: UK medical graduates can apply for specialty training after completing a 2-year internship (foundation training). Postfoundation training application requirements vary depending on specialty but fundamentally require key skills such as teaching, research, and leadership. Objective: This study investigated whether medical student demographics impact their self-reported familiarity with the Post-Foundation Training Pathways (PFTPs) and Post-Foundation Application Process (PFAP). Methods: This was a cross-sectional study using a Bristol Online Survey. We invited all UK medical students to answer a range of questions about their demographics. Students were then asked to rank their familiarity with PFTPs and PFAP on a scale of 1 to 5 (1=least familiar and 5=most familiar). The responses were collected between March 2022 and April 2022 and exported for further analysis. Statistical analysis was conducted in Stata (version 17.1; StataCorp) using chi-square tests. Results: A total of 850 students from 31 UK medical schools took part. There was a significant difference between gender and self-reported familiarity with PFTPs (P<.001) and PFAP (P<.001), with male students expressing higher familiarity. Similarly, there was a difference between ethnicity and self-reported familiarity with PFTPs (P=.02) and PFAP (P<.001), with White students more likely to express higher familiarity than their Black, Asian, or Mixed Ethnic counterparts. Lastly, there was an overall difference between medical background and age and self-reported familiarity with PFTPs and PFAP (all P<.001), with students from medical backgrounds and older students being more likely to express higher familiarity. Conclusions: The impact of gender, ethnicity, age, and medical background on students’ self-reported familiarity with PFTPs and PFAP is significant. Further studies are required to evaluate the impact of these factors on tested knowledge of PFTPs and PFAP and whether this impacts the success rate of postfoundation applications. %M 37999951 %R 10.2196/49013 %U https://mededu.jmir.org/2023/1/e49013 %U https://doi.org/10.2196/49013 %U http://www.ncbi.nlm.nih.gov/pubmed/37999951 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e48138 %T Reconsidering the Use of Population Health Surveys for Monitoring of Mental Health %A Arias de la Torre,Jorge %A Vilagut,Gemma %A Ronaldson,Amy %A Bakolis,Ioannis %A Dregan,Alex %A Navarro-Mateu,Fernando %A Pérez,Katherine %A Szücs,Anna %A Bartoll-Roca,Xavier %A Molina,Antonio J %A Elices,Matilde %A Pérez-Solá,Víctor %A Martín,Vicente %A Serrano-Blanco,Antoni %A Valderas,Jose M %A Alonso,Jordi %+ University of Exeter, Magdalen Road, Smeall Building, Exeter, EX12LU, United Kingdom, 44 6772 3874, jmvalderas@nus.edu.sg %K mental health %K public heath %K burden %K health surveys %K monitoring %K status %K data collection %K electronic health record %K challenges %K assessment tool %K population %K population health survey %D 2023 %7 23.11.2023 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Monitoring of the mental health status of the population and assessment of its determinants are 2 of the most relevant pillars of public mental health, and data from population health surveys could be instrumental to support them. Although these surveys could be an important and suitable resource for these purposes, due to different limitations and challenges, they are often relegated to the background behind other data sources, such as electronic health records. These limitations and challenges include those related to measurement properties and cross-cultural validity of the tools used for the assessment of mental disorders, their degree of representativeness, and possible difficulties in the linkage with other data sources. Successfully addressing these limitations could significantly increase the potential of health surveys in the monitoring of mental disorders and ultimately maximize the impact of the relevant policies to reduce their burden at the population level. The widespread use of data from population health surveys, ideally linked to electronic health records data, would enhance the quality of the information available for research, public mental health decision-making, and ultimately addressing the growing burden of mental disorders. %M 37995112 %R 10.2196/48138 %U https://publichealth.jmir.org/2023/1/e48138 %U https://doi.org/10.2196/48138 %U http://www.ncbi.nlm.nih.gov/pubmed/37995112 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e49144 %T Exploring Variations in Sleep Perception: Comparative Study of Chatbot Sleep Logs and Fitbit Sleep Data %A Jang,Hyunchul %A Lee,Siwoo %A Son,Yunhee %A Seo,Sumin %A Baek,Younghwa %A Mun,Sujeong %A Kim,Hoseok %A Kim,Icktae %A Kim,Junho %+ KM Data Division, Korea Institute of Oriental Medicine, 1672 Yuseong-daero, Yuseong-gu, Daejeon, 34054, Republic of Korea, 82 42 868 9555, bfree@kiom.re.kr %K sleep %K sleep time %K chat %K self-report %K sleep log %K sleep diary %K wearables %K Fitbit %K patient-generated health data %K PGHD %D 2023 %7 21.11.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Patient-generated health data are important in the management of several diseases. Although there are limitations, information can be obtained using a wearable device and time-related information such as exercise time or sleep time can also be obtained. Fitbits can be used to acquire sleep onset, sleep offset, total sleep time (TST), and wakefulness after sleep onset (WASO) data, although there are limitations regarding the depth of sleep and satisfaction; therefore, the patient’s subjective response is still important information that cannot be replaced by wearable devices. Objective: To effectively use patient-generated health data related to time such as sleep, it is first necessary to understand the characteristics of the time response recorded by the user. Therefore, the aim of this study was to analyze the characteristics of individuals’ time perception in comparison with wearable data. Methods: Sleep data were acquired for 2 weeks using a Fitbit. Participants’ sleep records were collected daily through chatbot conversations while wearing the Fitbit, and the two sets of data were statistically compared. Results: In total, 736 people aged 30-59 years were recruited for this study, and the sleep data of 543 people who wore a Fitbit and responded to the chatbot for more than 7 days on the same day were analyzed. Research participants tended to respond to sleep-related times on the hour or in 30-minute increments, and each participant responded within the range of 60-90 minutes from the value measured by the Fitbit. On average for all participants, the chat responses and the Fitbit data were similar within a difference of approximately 15 minutes. Regarding sleep onset, the participant response was 8 minutes and 39 seconds (SD 58 minutes) later than that of the Fitbit data, whereas with respect to sleep offset, the response was 5 minutes and 38 seconds (SD 57 minutes) earlier. The participants’ actual sleep time (AST) indicated in the chat was similar to that obtained by subtracting the WASO from the TST measured by the Fitbit. The AST was 13 minutes and 39 seconds (SD 87 minutes) longer than the time WASO was subtracted from the Fitbit TST. On days when the participants reported good sleep, they responded 19 (SD 90) minutes longer on the AST than the Fitbit data. However, for each sleep event, the probability that the participant’s AST was within ±30 and ±60 minutes of the Fitbit TST-WASO was 50.7% and 74.3%, respectively. Conclusions: The chatbot sleep response and Fitbit measured time were similar on average and the study participants had a slight tendency to perceive a relatively long sleep time if the quality of sleep was self-reported as good. However, on a participant-by-participant basis, it was difficult to predict participants’ sleep duration responses with Fitbit data. Individual variations in sleep time perception significantly affect patient responses related to sleep, revealing the limitations of objective measures obtained through wearable devices. %M 37988148 %R 10.2196/49144 %U https://mhealth.jmir.org/2023/1/e49144 %U https://doi.org/10.2196/49144 %U http://www.ncbi.nlm.nih.gov/pubmed/37988148 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46588 %T Association Between Concerns About COVID-19 Infection and Blood Donation Intention: Cross-Sectional Survey Study Through a Mobile Communication Platform %A Hu,Qiuyue %A Hu,Wei %A Pan,Lingling %A Han,Wenjuan %A Zheng,Yue %+ Blood Center of Zhejiang Province, 789 Jianye Road, Binjiang District, Hangzhou, 310052, China, 86 13588707363, huwei0507@126.com %K COVID-19 %K blood donation %K worry %K concern %K intention %K blood %K blood transfusion %K cognition %K blood donor %K communication %K questionnaire %K behavior control %D 2023 %7 9.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The ongoing COVID-19 pandemic has had an unprecedented impact on blood transfusion and collection. At the beginning of the pandemic, most blood transfusion services had a tough challenge in maintaining an optimal blood inventory. Objective: This study aims to understand the public's psychological cognition and intention toward blood donation as well as the factors influencing their worries. We aimed to find a solution for increasing blood donations and provide a scientific reference for policy formulation regarding blood donation during the COVID-19 pandemic and in the future. Methods: A random survey with a 14-item scale on worries related to blood donation was conducted from December 31, 2022, to January 3, 2023, among residents aged 18-60 years in Zhejiang province via SMS text messaging. The results of 8 worry items in this study were compared with the survey results of March 2022, during which COVID-19 was not considered as an epidemic in Zhejiang province. Chi-square test and logistic regression analysis were performed to analyze the factors affecting respondents’ blood donation intention and concerns. The degree of worry about blood donation was assigned from 1 (completely disagree) to 5 (completely agree), and 2-sided t tests were performed to analyze the differences in blood donation intention and worries about blood donation. Results: In total, 1254 valid questionnaire responses were obtained. Males accounted for 62.36% (782/1254) of the sample, 78.39% (983/1254) were 18-45 years old, 60.61% (760/1254) had a university education, and 69.06% (866/1254) had no previous blood donation experience. Approximately 36.52% (458/1254) of the public clearly expressed that they had blood donation worries regarding COVID-19. The main concerns of the respondents were temporary physical weakness caused by blood donation, their own physical conditions not meeting the requirements of blood donation, inconvenient location and working hours for blood donation, and family (or friends) worrying about blood donation. Compared with the results in 2022, the results in 2023 regarding the harmful effects of blood donation on health, temporary physical weakness, infection in donated blood, and family (friends) worrying increased significantly (P<.001). The factors influencing blood donation worries regarding COVID-19 were COVID-19 infection status, adverse reactions to the donated blood, family (or friends) worrying, and unsatisfactory blood donation experience. The factors influencing blood donation intention were gender, age, previous blood donation times, blood donation worries regarding COVID-19, harmful effects of blood donation on health, and blood donation anxiety. Conclusions: Blood transfusion services should make full use of the recovery phase of COVID-19 infection as an important time point, publicize the blood donation process and operation standardization, reduce the public's concerns about blood donation, correct negative evaluations, and increase perceived behavioral control and subjective norms. %M 37943597 %R 10.2196/46588 %U https://www.jmir.org/2023/1/e46588 %U https://doi.org/10.2196/46588 %U http://www.ncbi.nlm.nih.gov/pubmed/37943597 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42916 %T Feasibility of Using Research Electronic Data Capture (REDCap) to Collect Daily Experiences of Parent-Child Dyads: Ecological Momentary Assessment Study %A El Dahr,Yola %A Perquier,Florence %A Moloney,Madison %A Woo,Guyyunge %A Dobrin-De Grace,Roksana %A Carvalho,Daniela %A Addario,Nicole %A Cameron,Emily E %A Roos,Leslie E %A Szatmari,Peter %A Aitken,Madison %+ Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, 80 Workman Way, Toronto, ON, M6J 1H4, Canada, 1 416 535 8501 ext 34091, madison.aitken@camh.ca %K ambulatory assessment %K children %K ecological momentary assessment %K longitudinal %K parents %K survey %D 2023 %7 9.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Intensive longitudinal data collection, including ecological momentary assessment (EMA), has the potential to reduce recall biases, collect more ecologically valid data, and increase our understanding of dynamic associations between variables. EMA is typically administered using an application that is downloaded on participants’ devices, which presents cost and privacy concerns that may limit its use. Research Electronic Data Capture (REDCap), a web-based survey application freely available to nonprofit organizations, may allow researchers to overcome these barriers; however, at present, little guidance is available to researchers regarding the setup of EMA in REDCap, especially for those who are new to using REDCap or lack advanced programming expertise. Objective: We provide an example of a simplified EMA setup in REDCap. This study aims to demonstrate the feasibility of this approach. We provide information on survey completion and user behavior in a sample of parents and children recruited across Canada. Methods: We recruited 66 parents and their children (aged 9-13 years old) from an existing longitudinal cohort study to participate in a study on risk and protective factors for children’s mental health. Parents received survey prompts (morning and evening) by email or SMS text message for 14 days, twice daily. Each survey prompt contained 2 sections, one for parents and one for children to complete. Results: The completion rates were good (mean 82%, SD 8%) and significantly higher on weekdays than weekends and in dyads with girls than dyads with boys. Children were available to respond to their own survey questions most of the time (in 1134/1498, 75.7% of surveys submitted). The number of assessments submitted was significantly higher, and response times were significantly faster among participants who selected SMS text message survey notifications compared to email survey notifications. The average response time was 47.0 minutes after the initial survey notification, and the use of reminder messages increased survey completion. Conclusions: Our results support the feasibility of using REDCap for EMA studies with parents and children. REDCap also has features that can accommodate EMA studies by recruiting participants across multiple time zones and providing different survey delivery methods. Offering the option of SMS text message survey notifications and reminders may be an important way to increase completion rates and the timeliness of responses. REDCap is a potentially useful tool for researchers wishing to implement EMA in settings in which cost or privacy are current barriers. Researchers should weigh these benefits with the potential limitations of REDCap and this design, including staff time to set up, monitor, and clean the data outputs of the project. %M 37943593 %R 10.2196/42916 %U https://formative.jmir.org/2023/1/e42916 %U https://doi.org/10.2196/42916 %U http://www.ncbi.nlm.nih.gov/pubmed/37943593 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e47982 %T Social Determinants of Health and Patients’ Technology Acceptance of Telehealth During the COVID-19 Pandemic: Pilot Survey %A Anil Kumar Vaidhyam,Sneha %A Huang,Kuo-Ting %+ Department of Information Culture and Data Stewardship, School of Computing and Information, University of Pittsburgh, 6th Floor, 135 N Bellefield Ave, Pittsburgh, PA, 15213, United States, 1 3139135501, sav94@pitt.edu %K social determinants of health %K telehealth %K COVID-19 %K technology adoption %D 2023 %7 7.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Telehealth has been widely adopted by patients during the COVID-19 pandemic. Many social determinants of health influence the adoption. Objective: This pilot study aimed to understand the social determinants of patients’ adoption of telehealth in the context of the pandemic. Methods: A survey methodology was used to capture data from 215 participants using Amazon Mechanical Turk. The study was guided by the technology acceptance model and the social determinants of health framework. The questionnaire included technology acceptance model variables (eg, perceived usefulness [PU] and perceived ease of use [PEOU]), social determinants (eg, access to health care, socioeconomic status, education, and health literacy), and demographic information (eg, age, sex, race, and ethnicity). A series of ordinary least squares regressions were conducted to analyze the data using SPSS Statistics (IBM Corp). Results: The results showed that social determinant factors—safe neighborhood and built environment (P=.01) and economic stability (P=.05)—are predictors of the PEOU of telehealth adoption at a statistically significant or marginally statistically significant level. Furthermore, a moderated mediation model (PROCESS model 85) was used to analyze the effects of COVID-19 on the neighborhood, built environment, and economic stability. PEOU and PU significantly positively affected users’ intention to use technology for both variables. Conclusions: This study draws attention to 2 research frameworks that address unequal access to health technologies. It also adds empirical evidence to telehealth research on the adoption of patient technology. Finally, regarding practical implications, this study will provide government agencies, health care organizations, and health care companies with a better perspective of patients’ digital health use. This will further guide them in designing better technology by considering factors such as social determinants of health. %M 37934556 %R 10.2196/47982 %U https://humanfactors.jmir.org/2023/1/e47982 %U https://doi.org/10.2196/47982 %U http://www.ncbi.nlm.nih.gov/pubmed/37934556 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e49788 %T Perspectives of Patients With Chronic Diseases on Future Acceptance of AI–Based Home Care Systems: Cross-Sectional Web-Based Survey Study %A Wang,Bijun %A Asan,Onur %A Mansouri,Mo %+ School of Systems and Enterprises, Stevens Institue of Technology, 1 Castle Point Terrace, Hoboken, NJ, 07030, United States, 1 4145264330, oasan@stevens.edu %K consumer informatics %K artificial intelligence %K AI %K technology acceptance model %K adoption %K chronic %K motivation %K cross-sectional %K home care %K perception %K perceptions %K attitude %K attitudes %K intent %K intention %D 2023 %7 6.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Artificial intelligence (AI)–based home care systems and devices are being gradually integrated into health care delivery to benefit patients with chronic diseases. However, existing research mainly focuses on the technical and clinical aspects of AI application, with an insufficient investigation of patients’ motivation and intention to adopt such systems. Objective: This study aimed to examine the factors that affect the motivation of patients with chronic diseases to adopt AI-based home care systems and provide empirical evidence for the proposed research hypotheses. Methods: We conducted a cross-sectional web-based survey with 222 patients with chronic diseases based on a hypothetical scenario. Results: The results indicated that patients have an overall positive perception of AI-based home care systems. Their attitudes toward the technology, perceived usefulness, and comfortability were found to be significant factors encouraging adoption, with a clear understanding of accountability being a particularly influential factor in shaping patients’ attitudes toward their motivation to use these systems. However, privacy concerns persist as an indirect factor, affecting the perceived usefulness and comfortability, hence influencing patients’ attitudes. Conclusions: This study is one of the first to examine the motivation of patients with chronic diseases to adopt AI-based home care systems, offering practical insights for policy makers, care or technology providers, and patients. This understanding can facilitate effective policy formulation, product design, and informed patient decision-making, potentially improving the overall health status of patients with chronic diseases. %M 37930780 %R 10.2196/49788 %U https://humanfactors.jmir.org/2023/1/e49788 %U https://doi.org/10.2196/49788 %U http://www.ncbi.nlm.nih.gov/pubmed/37930780 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48236 %T Implications for Electronic Surveys in Inpatient Settings Based on Patient Survey Response Patterns: Cross-Sectional Study %A Gregory,Megan E %A Sova,Lindsey N %A Huerta,Timothy R %A McAlearney,Ann Scheck %+ The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, 700 Ackerman Rd, Suite 4000, Columbus, OH, 43202, United States, 1 614 293 8973, Ann.McAlearney@osumc.edu %K surveys %K patient satisfaction %K patient experience %K patient surveys %K electronic survey %K cross-sectional study %K quality of life %K mental health %K symptoms %K data quality %K hospitalization %D 2023 %7 1.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background:  Surveys of hospitalized patients are important for research and learning about unobservable medical issues (eg, mental health, quality of life, and symptoms), but there has been little work examining survey data quality in this population whose capacity to respond to survey items may differ from the general population. Objective:  The aim of this study is to determine what factors drive response rates, survey drop-offs, and missing data in surveys of hospitalized patients. Methods:  Cross-sectional surveys were distributed on an inpatient tablet to patients in a large, midwestern US hospital. Three versions were tested: 1 with 174 items and 2 with 111 items; one 111-item version had missing item reminders that prompted participants when they did not answer items. Response rate, drop-off rate (abandoning survey before completion), and item missingness (skipping items) were examined to investigate data quality. Chi-square tests, Kaplan-Meyer survival curves, and distribution charts were used to compare data quality among survey versions. Response duration was computed for each version. Results: Overall, 2981 patients responded. Response rate did not differ between the 174- and 111-item versions (81.7% vs 83%, P=.53). Drop-off was significantly reduced when the survey was shortened (65.7% vs 20.2% of participants dropped off, P<.001). Approximately one-quarter of participants dropped off by item 120, with over half dropping off by item 158. The percentage of participants with missing data decreased substantially when missing item reminders were added (77.2% vs 31.7% of participants, P<.001). The mean percentage of items with missing data was reduced in the shorter survey (40.7% vs 20.3% of items missing); with missing item reminders, the percentage of items with missing data was further reduced (20.3% vs 11.7% of items missing). Across versions, for the median participant, each item added 24.6 seconds to a survey’s duration. Conclusions:  Hospitalized patients may have a higher tolerance for longer surveys than the general population, but surveys given to hospitalized patients should have a maximum of 120 items to ensure high rates of completion. Missing item prompts should be used to reduce missing data. Future research should examine generalizability to nonhospitalized individuals. %M 37910163 %R 10.2196/48236 %U https://www.jmir.org/2023/1/e48236 %U https://doi.org/10.2196/48236 %U http://www.ncbi.nlm.nih.gov/pubmed/37910163 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e50147 %T Measurement of Health-Related Quality of Life in Individuals With Rare Diseases in China: Nation-Wide Online Survey %A Xu,Richard Huan %A Ng,Shamay S M %A Luo,Nan %A Dong,Dong %A Zhang,Shuyang %+ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, New Territories, , China (Hong Kong), 852 22528488, dongdong@cuhk.edu.hk %K EQ-5D-5L %K rare disease %K normative profile %K utility score %K caregiver %D 2023 %7 31.10.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Rare diseases (RDs) affect millions of people worldwide, and these diseases can severely impact the health-related quality of life (HRQoL) of those affected. Despite this, there is a lack of research measuring HRQoL using the EQ-5D-5L, which is one of the most widely used generic preference-based instruments to measure HRQoL in populations living with RDs. Objective: This study aimed to measure HRQoL using the EQ-5D-5L in a large number of patients with various types of RDs in China, and to examine the relationship between respondents’ socioeconomic characteristics and preference-based health utility scores. Methods: The data used in this study were obtained from a web-based survey conducted in China. The survey aimed to explore and understand the health and socioeconomic status of patients with RDs in China. We recruited registered and eligible members, including patients or their primary caregivers, from 33 RD patient associations to complete the questionnaires via their internal social networks. HRQoL was measured using the EQ-5D-5L utility score, which was calculated based on an established Chinese value set. Utility scores have been presented based on demographics and disease-related information. Univariate linear regression analysis was used to assess the differences in the EQ-5D-5L utility scores between subgroups. Results: A total of 12,502 respondents completed the questionnaire and provided valid responses, including 6919 self-completed respondents and 5583 proxy-completed respondents. Data from 10,102 participants over the age of 12 years were elicited for analysis. Among patients with RDs, 65.3% (6599/10,102), 47.5% (4799/10,102), 47.0% (4746/10,102), 24.8% (2506/10,102), and 18.4% (1855/10,102) reported no problems for “self-care,” “usual activities,” “mobility,” “pain/discomfort,” and “anxiety/depression,” respectively. A full health state was reported by 6.0% (413/6902) and 9.2% (295/3200) of self- and proxy-completed patients, respectively. Among self-completed patients, 69.9% (4826/6902) and 50.4% (3478/6902) reported no problems for “self-care” and “usual activities,” respectively, whereas only 17.7% (1223/6902) reported problems for “anxiety/depression.” Proxy-completed respondents showed a higher proportion of reporting extreme problems than self-completed respondents in all 5 dimensions. The mean utility scores reported by self- and proxy-completed respondents were 0.691 and 0.590, respectively. Different types of caregivers reported different utility scores, and among them, proxy-completed (mother) respondents reported the highest mean utility score. Conclusions: The establishment of a normative profile for RD patients can facilitate patients’ adaptation and assess the effectiveness of interventions to improve the HRQoL and well-being of this population. Differences between self- and proxy-completed HRQoL assessed by the EQ-5D-5L have been identified in this study. This finding highlights the importance of incorporating perspectives from both patients and their proxies in clinical practice. Further development of the patient cohort is necessary to assess long-term changes in HRQoL in the RD population. %M 37906229 %R 10.2196/50147 %U https://publichealth.jmir.org/2023/1/e50147 %U https://doi.org/10.2196/50147 %U http://www.ncbi.nlm.nih.gov/pubmed/37906229 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45764 %T Evaluating the Effects of Rewards and Schedule Length on Response Rates to Ecological Momentary Assessment Surveys: Randomized Controlled Trials %A Edney,Sarah %A Goh,Claire Marie %A Chua,Xin Hui %A Low,Alicia %A Chia,Janelle %A S Koek,Daphne %A Cheong,Karen %A van Dam,Rob %A Tan,Chuen Seng %A Müller-Riemenschneider,Falk %+ Physical Activity and Nutrition Determinants in Asia Programme, Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore, 117549, Singapore, 65 6516 4988, sarah.edney@nus.edu.sg %K experience sampling %K ambulatory assessment %K compliance %K mobile phone %D 2023 %7 19.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Ecological momentary assessments (EMAs) are short, repeated surveys designed to collect information on experiences in real-time, real-life contexts. Embedding periodic bursts of EMAs within cohort studies enables the study of experiences on multiple timescales and could greatly enhance the accuracy of self-reported information. However, the burden on participants may be high and should be minimized to optimize EMA response rates. Objective: We aimed to evaluate the effects of study design features on EMA response rates. Methods: Embedded within an ongoing cohort study (Health@NUS), 3 bursts of EMAs were implemented over a 7-month period (April to October 2021). The response rate (percentage of completed EMA surveys from all sent EMA surveys; 30-42 individual EMA surveys sent/burst) for each burst was examined. Following a low response rate in burst 1, changes were made to the subsequent implementation strategy (SMS text message announcements instead of emails). In addition, 2 consecutive randomized controlled trials were conducted to evaluate the efficacy of 4 different reward structures (with fixed and bonus components) and 2 different schedule lengths (7 or 14 d) on changes to the EMA response rate. Analyses were conducted from 2021 to 2022 using ANOVA and analysis of covariance to examine group differences and mixed models to assess changes across all 3 bursts. Results: Participants (N=384) were university students (n=232, 60.4% female; mean age 23, SD 1.3 y) in Singapore. Changing the reward structure did not significantly change the response rate (F3,380=1.75; P=.16). Changing the schedule length did significantly change the response rate (F1,382=6.23; P=.01); the response rate was higher for the longer schedule (14 d; mean 48.34%, SD 33.17%) than the shorter schedule (7 d; mean 38.52%, SD 33.44%). The average response rate was higher in burst 2 and burst 3 (mean 50.56, SD 33.61 and mean 48.34, SD 33.17, respectively) than in burst 1 (mean 25.78, SD 30.12), and the difference was statistically significant (F2,766=93.83; P<.001). Conclusions: Small changes to the implementation strategy (SMS text messages instead of emails) may have contributed to increasing the response rate over time. Changing the available rewards did not lead to a significant difference in the response rate, whereas changing the schedule length did lead to a significant difference in the response rate. Our study provides novel insights on how to implement EMA surveys in ongoing cohort studies. This knowledge is essential for conducting high-quality studies using EMA surveys. Trial Registration: ClinicalTrials.gov NCT05154227; https://clinicaltrials.gov/ct2/show/NCT05154227 %M 37856188 %R 10.2196/45764 %U https://www.jmir.org/2023/1/e45764 %U https://doi.org/10.2196/45764 %U http://www.ncbi.nlm.nih.gov/pubmed/37856188 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47705 %T Merits and Pitfalls of Social Media as a Platform for Recruitment of Study Participants %A Oudat,Qutaibah %A Bakas,Tamilyn %+ College of Nursing, University of Cincinnati, 3110 Vine St, Cincinnati, OH, 45221, United States, 1 (513) 558 5500, oudatqh@mail.uc.edu %K recruitment %K social media %K review %K study participant %K methods %D 2023 %7 11.10.2023 %9 Viewpoint %J J Med Internet Res %G English %X Efficient and effective methods of recruiting participants for studies have characteristically come with many challenges. The unprecedented rise of social media platforms such as Facebook and Instagram has revolutionized the ease of recruiting participants as compared to more traditional methods such as newspaper or radio advertisements. While these new advancements may seem to increase the success of recruitment, they are not without their own faults and limitations. In this paper, we intend to dissect the advantages and disadvantages of social media platforms in recruiting participants. Specifically, we will discuss the advantages of targeted and rapid recruitment, engagement, and cost reduction as well as the disadvantages of representativeness, privacy concerns, limited control, and limited access. %M 37819692 %R 10.2196/47705 %U https://www.jmir.org/2023/1/e47705 %U https://doi.org/10.2196/47705 %U http://www.ncbi.nlm.nih.gov/pubmed/37819692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48946 %T Evaluating the Feasibility and Acceptance of a Mobile Clinical Decision Support System in a Resource-Limited Country: Exploratory Study %A Ndlovu,Kagiso %A Stein,Nate %A Gaopelo,Ruth %A Annechino,Michael %A Molwantwa,Mmoloki C %A Monkge,Mosadikhumo %A Forrestel,Amy %A Williams,Victoria L %+ Department of Computer Science, University of Botswana, Private Bag UB 0022, Gaborone, 00267, Botswana, 267 71786953 ext 5700, kaygndlovu@gmail.com %K VisualDx %K eHealth %K technology acceptance model %K clinical decision support %K Botswana %K dermatology %K mobile phone %D 2023 %7 10.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In resource-limited countries, access to specialized health care services such as dermatology is limited. Clinical decision support systems (CDSSs) offer innovative solutions to address this challenge. However, the implementation of CDSSs is commonly associated with unique challenges. VisualDx—an exemplar CDSS—was recently implemented in Botswana to provide reference materials in support of the diagnosis and management of dermatological conditions. To inform the sustainable implementation of VisualDx in Botswana, it is important to evaluate the intended users’ perceptions about the technology. Objective: This study aims to determine health care workers’ acceptance of VisualDx to gauge the feasibility of future adoption in Botswana and other similar health care systems. Methods: The study’s design was informed by constructs of the Technology Acceptance Model. An explanatory, sequential, mixed methods study involving surveys and semistructured interviews was conducted. The REDCap (Research Electronic Data Capture; Vanderbilt University) platform supported web-based data capture from March 2021 through August 2021. In total, 28 health care workers participated in the study. Descriptive statistics were generated and analyzed using Excel (Microsoft Corp), and thematic analysis of interview transcripts was performed using Delve software. Results: All survey respondents (N=28) expressed interest in using mobile health technology to support their work. Before VisualDx, participants referenced textbooks, journal articles, and Google search engines. Overall, participants’ survey responses showed their confidence in VisualDx (18/19, 95%); however, some barriers were noted. Frequently used VisualDx features included generating a differential diagnosis through manual entry of patient symptoms (330/681, 48.5% of total uses) or using the artificial intelligence feature to analyze skin conditions (150/681, 22% of total uses). Overall, 61% (17/28) of the survey respondents were also interviewed, and 4 thematic areas were derived. Conclusions: Participants’ responses indicated their willingness to accept VisualDx. The ability to access information quickly without internet connection is crucial in resource-constrained environments. Selected enhancements to VisualDx may further increase its feasibility in Botswana. Study findings can serve as the basis for improving future CDSS studies and innovations in Botswana and similar resource-limited countries. %M 37815861 %R 10.2196/48946 %U https://formative.jmir.org/2023/1/e48946 %U https://doi.org/10.2196/48946 %U http://www.ncbi.nlm.nih.gov/pubmed/37815861 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e41862 %T Mortality Risk and Burden From a Spectrum of Causes in Relation to Size-Fractionated Particulate Matters: Time Series Analysis %A Yang,Jun %A Dong,Hang %A Yu,Chao %A Li,Bixia %A Lin,Guozhen %A Chen,Sujuan %A Cai,Dongjie %A Huang,Lin %A Wang,Boguang %A Li,Mengmeng %+ State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-sen University Cancer Center, No 651 Dongfeng East Road, Guangzhou 510060, Guangzhou, 510060, China, 86 020 87345679, limm@sysucc.org.cn %K size-fractionated particulate matter %K cause-specific mortality %K cardiovascular disease %K respiratory disease %K neoplasm %K attributable burden %D 2023 %7 9.10.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: There is limited evidence regarding the adverse impact of particulate matters (PMs) on multiple body systems from both epidemiological and mechanistic studies. The association between size-fractionated PMs and mortality risk, as well as the burden of a whole spectrum of causes of death, remains poorly characterized. Objective: We aimed to examine the wide range of susceptible diseases affected by different sizes of PMs. We also assessed the association between PMs with an aerodynamic diameter less than 1 µm (PM1), 2.5 µm (PM2.5), and 10 µm (PM10) and deaths from 36 causes in Guangzhou, China. Methods: Daily data were obtained on cause-specific mortality, PMs, and meteorology from 2014 to 2016. A time-stratified case-crossover approach was applied to estimate the risk and burden of cause-specific mortality attributable to PMs after adjusting for potential confounding variables, such as long-term trend and seasonality, relative humidity, temperature, air pressure, and public holidays. Stratification analyses were further conducted to explore the potential modification effects of season and demographic characteristics (eg, gender and age). We also assessed the reduction in mortality achieved by meeting the new air quality guidelines set by the World Health Organization (WHO). Results: Positive and monotonic associations were generally observed between PMs and mortality. For every 10 μg/m3 increase in 4-day moving average concentrations of PM1, PM2.5, and PM10, the risk of all-cause mortality increased by 2.00% (95% CI 1.08%-2.92%), 1.54% (95% CI 0.93%-2.16%), and 1.38% (95% CI 0.95%-1.82%), respectively. Significant effects of size-fractionated PMs were observed for deaths attributed to nonaccidental causes, cardiovascular disease, respiratory disease, neoplasms, chronic rheumatic heart diseases, hypertensive diseases, cerebrovascular diseases, stroke, influenza, and pneumonia. If daily concentrations of PM1, PM2.5, and PM10 reached the WHO target levels of 10, 15, and 45 μg/m3, 7921 (95% empirical CI [eCI] 4454-11,206), 8303 (95% eCI 5063-11,248), and 8326 (95% eCI 5980-10690) deaths could be prevented, respectively. The effect estimates of PMs were relatively higher during hot months, among female individuals, and among those aged 85 years and older, although the differences between subgroups were not statistically significant. Conclusions: We observed positive and monotonical exposure-response curves between PMs and deaths from several diseases. The effect of PM1 was stronger on mortality than that of PM2.5 and PM10. A substantial number of premature deaths could be preventable by adhering to the WHO’s new guidelines for PMs. Our findings highlight the importance of a size-based strategy in controlling PMs and managing their health impact. %M 37812487 %R 10.2196/41862 %U https://publichealth.jmir.org/2023/1/e41862 %U https://doi.org/10.2196/41862 %U http://www.ncbi.nlm.nih.gov/pubmed/37812487 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e47390 %T Readiness for Change in the Implementation of a 3D Printing Initiative in a Catalan Tertiary Hospital Using the Normalization Process Theory: Survey Study %A López Seguí,Francesc %A Cos Codina,Joan %A Ricou Ríos,Laura %A Martínez Segura,María Isabel %A Miró Mezquita,Laura %A Escrich Navarro,Raquel %A Davins Riu,Meritxell %A Estrada Cuxart,Oriol %A Anashkin Kachalin,German %A Moreno-Martínez,Daniel %+ Research Group on Innovation, Health Economics and Digital Transformation, Institut Germans Trias i Pujol, Camí de les Escoles, s/n, Badalona, 08916, Spain, 34 644 26 91 34, dmorenom.germanstrias@gencat.cat %K change management %K normalization process theory %K NPT %K 3D printing %K readiness for change %K Normalization Measure Development questionnaire %K NoMAD %K implementation %K tertiary hospital %K barrier %K readiness %K printing %K survey %K development %K questionnaire %K support %K communicate %K assessment %K users %K transformation %D 2023 %7 6.10.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The high failure rate of innovation projects motivates us to understand the perceptions about resistances and barriers of the main stakeholders to improving success rates. Objective: This study aims to analyze the readiness for change in the implementation of a 3D printing project in a Catalan tertiary hospital prior to its implementation. Methods: We used a web-based, voluntary, and anonymous survey using the Normalization Measurement Development questionnaire (NoMAD) to gather views and perceptions from a selected group of health care professionals at Germans Trias i Pujol University Hospital. Results: In this study, 58 professionals, including heads of service (n=30, 51%), doctors (n=18, 31%), nurses (n=7, 12%), and support staff (n=3, 5%), responded to the questionnaire. All groups saw the value of the project and were willing to enroll and support it. Respondents reported the highest scores (out of 5) in cognitive participation (mean 4.45, SD 0.04), coherence (mean 3.72, SD 0.13), and reflective monitoring (mean 3.80, SD 0.25). The weakest score was in collective action (mean 3.52, SD 0.12). There were no statistically significant differences in scores among professions in the survey. Conclusions: The 3D printing project implementation should pay attention to preparing, defining, sharing, and supporting the operational work involved in its use and implementation. It should also understand, assess, and communicate the ways in which the new set of practices can affect the users and others around them. We suggest that health officers and politicians consider this experience as a solid ground toward the development of a more efficient health innovation system and as a catalyst for transformation. %M 37801353 %R 10.2196/47390 %U https://humanfactors.jmir.org/2023/1/e47390 %U https://doi.org/10.2196/47390 %U http://www.ncbi.nlm.nih.gov/pubmed/37801353 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46747 %T Initiation Patterns and Transitions Among Adults Using Stimulant Drugs: Latent Transition Analysis %A Black,Joshua C %A Burkett,Hannah L %A Rockhill,Karilynn M %A Olson,Richard %A Dart,Richard C %A Iwanicki,Janetta %+ Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, 777 Bannock St, Denver, CO, 80204-4531, United States, 1 3033891652, joshua.black@rmpds.org %K stimulant misuse %K high dimensional analysis %K latent transition analysis %K general population %K stimulant drug %K drug misuse %K overdose %K behavioral trajectory %K drug overdose %K stimulant initiation %K drugs %K substance abuse %K analysis %D 2023 %7 5.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The fourth wave of the drug overdose epidemic in the United States includes increasing rates of stimulant-involved overdose. Recent studies of transitions leading to stimulant misuse have shown complex patterns that are not universally applicable because they have isolated individual populations or individual behaviors. A comprehensive analysis of transitions between behaviors and the associations with present-day problematic drug use has not been conducted. Objective: This study aims to determine whether adults from the general population who use stimulants initiate use through a heterogeneous combination of behaviors and quantify the association between these typologies with present-day problematic drug use. Methods: Individuals who have reported use of any stimulant in their lifetime were recruited from the 2021 Survey of Nonmedical Use of Prescription Drugs Program, a nationally representative web-based survey on drug use, to participate in a rapid follow-up survey about their past stimulant use. Individuals were asked which stimulants they used, the reasons for use, the routes of administration, and the sources of the stimulant. For each stimulant-related behavior, they were asked at what age, between 6 and 30 years, they initiated each behavior in a 6-year time window. A latent transition analysis was used to characterize heterogeneity in initiation typologies. Mutually exclusive pathways of initiation were identified manually by the researchers. The association of these pathways with present-day problematic drug use was calculated using logistic regression adjusted by the current age of the respondent. Results: From a total of 1329 participants, 740 (55.7%) reported lifetime prescription stimulant use and 1077 (81%) reported lifetime illicit stimulant use. Three typologies were identified. The first typology was characterized by illicit stimulant initiation to get high, usually via oral or snorting routes and acquisition from friends or family or a dealer (illicit experimentation). The second typology was characterized by low, but approximately equal probabilities of initiating 1-2 new behaviors in a time window, but no singular set of behaviors characterized the typology (conservative initiation). The third was characterized by a high probability of initiating many diverse combinations of behaviors (nondiscriminatory experimentation). The choice of drug initiated was not a strong differentiator. Categorization of pathways showed those who were only in an illicit experimentation status (reference) had the lowest odds of having severe present-day problematic drug use. Odds were higher for a conservative initiation-only status (odds ratio [OR] 1.84, 95% CI 1.14-2.94), which is higher still for those moving from illicit experimentation to conservative initiation (OR 3.50, 95% CI 2.13-5.74), and highest for a nondiscriminatory experimentation status (OR 5.45, 95% CI 3.39-8.77). Conclusions: Initiation of stimulant-related use behaviors occurred across many time windows, indicating that multiple intervention opportunities are presented. Screening should be continued throughout adulthood to address unhealthy drug use before developing into full substance use disorders. %M 37796607 %R 10.2196/46747 %U https://www.jmir.org/2023/1/e46747 %U https://doi.org/10.2196/46747 %U http://www.ncbi.nlm.nih.gov/pubmed/37796607 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 6 %N %P e45226 %T Outreach Through Facebook: Do Patients With Atopic Dermatitis Provide Clinically Relevant Information When Recruited for Surveys on Social Media? %A Frølunde,Anne Sofie %A Gren,Susanne Thiesen %A Frøstrup,Anne Grete %A Poulsen,Peter Bo %A Vastrup,Anne Skov %A Vestergaard,Christian %+ Department of Dermatology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 97, Aarhus, 8200, Denmark, 45 26188132, chrivest@rm.dk %K social media %K atopic dermatitis %K digital survey %K recruit %K patient perspectives %K patient-reported outcomes %K real-world data %D 2023 %7 5.10.2023 %9 Research Letter %J JMIR Dermatol %G English %X %M 37796547 %R 10.2196/45226 %U https://derma.jmir.org/2023/1/e45226 %U https://doi.org/10.2196/45226 %U http://www.ncbi.nlm.nih.gov/pubmed/37796547 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43824 %T Recruiting Sexual and Gender Minority Veterans for Health Disparities Research: Recruitment Protocol of a Web-Based Prospective Cohort Study %A Fan,Carolyn A %A Upham,Michelle %A Beaver,Kristine %A Dashtestani,Krista %A Skiby,Malachi M %A Pentel,Kimberly Z %A Rhew,Isaac C %A Kauth,Michael R %A Shipherd,Jillian C %A Kaysen,Debra %A Simpson,Tracy %A Lehavot,Keren %+ Department of Health Systems and Population Health, University of Washington School of Public Health, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Box 351616, Seattle, WA, 98195, United States, 1 206 616 2935, cfan5@uw.edu %K lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority %K LGBTQ+ %K veteran %K recruitment %K health disparities %D 2023 %7 2.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The Health for Every Veteran Study is the first Veterans Health Administration–funded, nationwide study on lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) veterans’ health that relies exclusively on primary recruitment methods. This study aimed to recruit 1600 veterans with diverse sexual and gender identities to study the mental health and health risk behaviors of this population. A growing body of literature highlights the health inequities faced by LGBTQ+ veterans when compared with their heterosexual or cisgender peer groups. However, there is little to no guidance in the health disparities literature describing the recruitment of LGBTQ+ veterans. Objective: This paper provides an overview of the recruitment methodology of Health for Every Veteran Study. We describe the demographics of the enrolled cohort, challenges faced during recruitment, and considerations for recruiting LGBTQ+ veterans for health research. Methods: Recruitment for this study was conducted for 15 months, from September 2019 to December 2020, with the goal of enrolling 1600 veterans evenly split among 8 sexual orientation and gender identity subgroups: cisgender heterosexual women, cisgender lesbian women, cisgender bisexual women, cisgender heterosexual men, cisgender gay men, cisgender bisexual men, transgender women, and transgender men. Three primary recruitment methods were used: social media advertising predominantly through Facebook ads, outreach to community organizations serving veterans and LGBTQ+ individuals across the United States, and contracting with a research recruitment company, Trialfacts. Results: Of the 3535 participants screened, 1819 participants met the eligibility criteria, and 1062 completed the baseline survey to enroll. At baseline, 25.24% (268/1062) were recruited from Facebook ads, 40.49% (430/1062) from community outreach, and 34.27% (364/1062) from Trialfacts. Most subgroups neared the target enrollment goals, except for cisgender bisexual men, women, and transgender men. An exploratory group of nonbinary and genderqueer veterans and veterans with diverse gender identities was included in the study. Conclusions: All recruitment methods contributed to significant portions of the enrolled cohort, suggesting that a multipronged approach was a critical and successful strategy in our study of LGBTQ+ veterans. We discuss the strengths and challenges of all recruitment methods, including factors impacting recruitment such as the COVID-19 pandemic, negative comments on Facebook ads, congressional budget delays, and high-volume surges of heterosexual participants from community outreach. In addition, our subgroup stratification offers important disaggregated insights into the recruitment of specific LGBTQ+ subgroups. Finally, the web-based methodology offers important perspectives not only for reaching veterans outside of the Veterans Health Administration but also for research studies taking place in the COVID-19-impacted world. Overall, this study outlines useful recruitment methodologies and lessons learned to inform future research that seeks to recruit marginalized communities. International Registered Report Identifier (IRRID): DERR1-10.2196/43824 %M 37782536 %R 10.2196/43824 %U https://www.researchprotocols.org/2023/1/e43824 %U https://doi.org/10.2196/43824 %U http://www.ncbi.nlm.nih.gov/pubmed/37782536 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47970 %T Effectiveness and Cost of Using Facebook Recruitment to Elicit Canadian Women’s Perspectives on Bone Health and Osteoporosis: Cross-Sectional Survey Study %A Billington,Emma Olive %A Hasselaar,Charley M %A Kembel,Lorena %A Myagishima,Rebecca C %A Arain,Mubashir A %+ Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada, 1 4039558328, emma.billington@ahs.ca %K osteoporosis %K bone health %K bone mineral density %K fracture %K survey %K Facebook %K advertisement %K recruitment %K women’s health %K social media %K bone %K perspective %D 2023 %7 29.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Surveys can help health researchers better understand the public’s perspectives and needs regarding prevalent conditions such as osteoporosis, which affects more than two-thirds of postmenopausal women. However, recruitment of large cohorts for survey research can be time-consuming and expensive. With 2.9 billion active users across the globe and reasonable advertising costs, Facebook (Meta Platforms, Inc) has emerged as an effective recruitment tool for surveys, although previous studies have targeted young populations (<50 years of age) and none have focused on bone health. Objective: We assessed the effectiveness and cost of using Facebook to recruit Canadian women aged ≥45 years to share their perspectives on bone health and osteoporosis via a web-based survey. Methods: We developed a 15-minute web-based survey with the goal of eliciting perspectives on bone health and osteoporosis. A Facebook advertisement was placed for 2 weeks in February 2022, during which time it was shown to women of age ≥45 years who resided in Canada, inviting them to participate and offering a chance to win 1 of 5 CAD $100 gift cards (at the time of this study [February 14, 2022], a currency exchange rate of CAD $1=US $0.79 was applicable). Those who clicked on the advertisement were taken to an eligibility screening question on the survey home screen. Individuals who confirmed eligibility were automatically directed to the first survey question. All individuals who answered the first survey question were considered participants and included in the analyses. We determined the survey reach, click rate, cooperation rate, completion rate, cost per click, and cost per participant. Sociodemographic characteristics of respondents were compared with data from the 2021 Canadian Census. Results: The Facebook advertisement was shown to 34,086 unique Facebook users, resulting in 2033 link clicks (click rate: 6.0%). A total of 1320 individuals completed the eligibility screening question, 1195 started the survey itself (cooperation rate: 58.8%), and 966 completed the survey (completion rate: 47.5%). The cost of the advertising campaign was CAD $280.12, resulting in a cost per click of CAD $0.14 and a cost per participant of CAD $0.23. The 1195 participants ranged in age from 45-89 years (mean 65, SD 7 years), 921 (93.7%) were of White ethnicity, 854 (88.3%) had completed some postsecondary education, and 637 (65.8%) resided in urban areas. Responses were received from residents of all 10 Canadian provinces and 2 of 3 territories. When compared to 2021 Canadian Census data, postsecondary education and rural residence were overrepresented in our study population. Conclusions: Facebook advertising is an efficient, effective, and inexpensive way of recruiting large samples of older women for participation in web-based surveys for health research. However, it is important to recognize that this modality is a form of convenience sampling and the benefits of Facebook recruitment must be balanced with its limitations, which include selection bias and coverage error. %M 37773625 %R 10.2196/47970 %U https://www.jmir.org/2023/1/e47970 %U https://doi.org/10.2196/47970 %U http://www.ncbi.nlm.nih.gov/pubmed/37773625 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 8 %N %P e42100 %T Assessing the Content Validity, Acceptability, and Feasibility of the Hypo-METRICS App: Survey and Interview Study %A Søholm,Uffe %A Zaremba,Natalie %A Broadley,Melanie %A Axelsen,Johanne Lundager %A Divilly,Patrick %A Martine-Edith,Gilberte %A Amiel,Stephanie A %A Mader,Julia K %A Pedersen-Bjergaard,Ulrik %A McCrimmon,Rory J %A Renard,Eric %A Evans,Mark %A de Galan,Bastiaan %A Heller,Simon %A Hendrieckx,Christel %A Choudhary,Pratik %A Speight,Jane %A Pouwer,Frans %A , %+ Medical & Science, Patient Focused Drug Development, Novo Nordisk A/S, Vandtårnsvej 114, Søborg, 2860, Denmark, 45 34481435, uffehs@gmail.com %K hypoglycemia %K diabetes %K ecological momentary assessment %K smartphone app %K content validity %K mobile phone %D 2023 %7 29.9.2023 %9 Original Paper %J JMIR Diabetes %G English %X Background: The Hypoglycaemia – MEasurement, ThResholds and ImpaCtS (Hypo-METRICS) smartphone app was developed to investigate the impact of hypoglycemia on daily functioning in adults with type 1 diabetes mellitus or insulin-treated type 2 diabetes mellitus. The app uses ecological momentary assessments, thereby minimizing recall bias and maximizing ecological validity. It was used in the Hypo-METRICS study, a European multicenter observational study wherein participants wore a blinded continuous glucose monitoring device and completed the app assessments 3 times daily for 70 days. Objective: The 3 aims of the study were to explore the content validity of the app, the acceptability and feasibility of using the app for the duration of the Hypo-METRICS study, and suggestions for future versions of the app. Methods: Participants who had completed the 70-day Hypo-METRICS study in the United Kingdom were invited to participate in a brief web-based survey and an interview (approximately 1h) to explore their experiences with the app during the Hypo-METRICS study. Thematic analysis of the qualitative data was conducted using both deductive and inductive methods. Results: A total of 18 adults with diabetes (type 1 diabetes: n=10, 56%; 5/10, 50% female; mean age 47, SD 16 years; type 2 diabetes: n=8, 44%; 2/8, 25% female; mean age 61, SD 9 years) filled out the survey and were interviewed. In exploring content validity, participants overall described the Hypo-METRICS app as relevant, understandable, and comprehensive. In total, 3 themes were derived: hypoglycemia symptoms and experiences are idiosyncratic; it was easy to select ratings on the app, but day-to-day changes were perceived as minimal; and instructions could be improved. Participants offered suggestions for changes or additional questions and functions that could increase engagement and improve content (such as providing more examples with the questions). In exploring acceptability and feasibility, 5 themes were derived: helping science and people with diabetes; easy to fit in, but more flexibility wanted; hypoglycemia delaying responses and increasing completion time; design, functionality, and customizability of the app; and limited change in awareness of symptoms and impact. Participants described using the app as a positive experience overall and as having a possible, although limited, intervention effect in terms of both hypoglycemia awareness and personal impact. Conclusions: The Hypo-METRICS app shows promise as a new research tool to assess the impact of hypoglycemia on an individual’s daily functioning. Despite suggested improvements, participants’ responses indicated that the app has satisfactory content validity, overall fits in with everyday life, and is suitable for a 10-week research study. Although developed for research purposes, real-time assessments may have clinical value for monitoring and reviewing hypoglycemia symptom awareness and personal impact. %M 37773626 %R 10.2196/42100 %U https://diabetes.jmir.org/2023/1/e42100 %U https://doi.org/10.2196/42100 %U http://www.ncbi.nlm.nih.gov/pubmed/37773626 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e51324 %T The Effects of Suicide Exposure on Mental Health Outcomes Among Post-9/11 Veterans: Protocol for an Explanatory, Sequential, Mixed Methods Study %A Sayer,Nina A %A Nelson,David B %A Gradus,Jaimie L %A Sripada,Rebecca K %A Murdoch,Maureen %A Teo,Alan R %A Orazem,Robert J %A Cerel,Julie %+ Center for Care Delivery and Outcomes Research, Minneapolis VA Healthcare System, One Veterans Drive, Minneapolis, MN, 55417, United States, 1 612 467 4623, nina.sayer@va.gov %K veterans %K suicide %K death %K posttraumatic stress disorder %K bereavement %K health services %D 2023 %7 26.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The toll associated with suicide goes well beyond the individual who died. This study focuses on a risk factor for veteran suicide that has received little previous empirical attention—exposure to the suicide death of another person. Objective: The study’s primary objective is to describe the mental health outcomes associated with suicide exposure among veterans who served on active duty after September 2001 (“post-9/11”). The secondary objective is to elucidate why some veterans develop persistent problems following suicide exposure, whereas others do not. Methods: This is an explanatory, sequential, mixed methods study of a nationally representative sample of post-9/11 veterans enrolled in Department of Veterans Affairs (VA) health care. Our sampling strategy was designed for adequate representation of female and American Indian and Alaska Native veterans to allow for examination of associations between suicide exposure and outcomes within these groups. Primary outcomes comprise mental health problems associated with trauma and loss (posttraumatic stress disorder and prolonged grief disorder) and suicide precursors (suicidal ideation, attempts, and planning). Data collection will be implemented in 3 waves. During wave 1, we will field a brief survey to a national probability sample to assess exposure history (suicide, other sudden death, or neither) and exposure characteristics (eg, closeness with the decedent) among 11,400 respondents. In wave 2, we will include 39.47% (4500/11,400) of the wave-1 respondents, stratified by exposure history (suicide, other sudden death, or neither), to assess health outcomes and other variables of interest. During wave 3, we will conduct interviews with a purposive subsample of 32 respondents exposed to suicide who differ in mental health outcomes. We will supplement the survey and interview data with VA administrative data identifying diagnoses, reported suicide attempts, and health care use. Results: The study began on July 1, 2022, and will end on June 30, 2026. This is the only national, population-based study of suicide exposure in veterans and the first one designed to study differences based on sex and race. Comparing those exposed to suicide with those exposed to sudden death for reasons other than suicide (eg, combat) and those unexposed to any sudden death may allow for the identification of the common and unique contribution of suicide exposure to outcomes and help seeking. Conclusions: Integrating survey, qualitative, and VA administrative data to address significant knowledge gaps regarding the effects of suicide exposure in a national sample will lay the foundation for interventions to address the needs of individuals affected by a suicide death, including female and American Indian and Alaska Native veterans. International Registered Report Identifier (IRRID): DERR1-10.2196/51324 %M 37751271 %R 10.2196/51324 %U https://www.researchprotocols.org/2023/1/e51324 %U https://doi.org/10.2196/51324 %U http://www.ncbi.nlm.nih.gov/pubmed/37751271 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 6 %N %P e51303 %T Impact of an Electronic Medical Record–Connected Questionnaire on Efficient Nursing Documentation: Usability and Efficacy Study %A Kodama,Kana %A Konishi,Shozo %A Manabe,Shirou %A Okada,Katsuki %A Yamaguchi,Junji %A Wada,Shoya %A Sugimoto,Kento %A Itoh,Sakiko %A Takahashi,Daiyo %A Kawasaki,Ryo %A Matsumura,Yasushi %A Takeda,Toshihiro %+ Department of Medical Informatics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, 565-0871, Japan, 81 6 6879 5900, konishi.shozo.med@osaka-u.ac.jp %K nursing system %K electronic questionnaire %K electronic medical record %K medical informatics %K EMR %K medical records %K EHR %K health record %K health records %K nursing %K documentation %K documenting %K usability %K self-reported %K patient data %K questionnaires %K data conversion %K nursing record %K nursing records %K data capture %K information system %K information systems %D 2023 %7 25.9.2023 %9 Original Paper %J JMIR Nursing %G English %X Background: Documentation tasks comprise a large percentage of nurses’ workloads. Nursing records were partially based on a report from the patient. However, it is not a verbatim transcription of the patient's complaints but a type of medical record. Therefore, to reduce the time spent on nursing documentation, it is necessary to assist in the appropriate conversion or citation of patient reports to professional records. However, few studies have been conducted on systems for capturing patient reports in electronic medical records. In addition, there have been no reports on whether such a system reduces the time spent on nursing documentation. Objective: This study aims to develop a patient self-reporting system that appropriately converts data to nursing records and evaluate its effect on reducing the documenting burden for nurses. Methods: An electronic medical record–connected questionnaire and a preadmission nursing questionnaire were administered. The questionnaire responses entered by the patients were quoted in the patient profile for inpatient assessment in the nursing system. To clarify its efficacy, this study examined whether the use of the electronic questionnaire system saved the nurses’ time entering the patient profile admitted between August and December 2022. It also surveyed the usability of the electronic questionnaire between April and December 2022. Results: A total of 3111 (78%) patients reported that they answered the electronic medical questionnaire by themselves. Of them, 2715 (88%) felt it was easy to use and 2604 (85%) were willing to use it again. The electronic questionnaire was used in 1326 of 2425 admission cases (use group). The input time for the patient profile was significantly shorter in the use group than in the no-use group (P<.001). Stratified analyses showed that in the internal medicine wards and in patients with dependent activities of daily living, nurses took 13%-18% (1.3 to 2 minutes) less time to enter patient profiles within the use group (both P<.001), even though there was no difference in the amount of information. By contrast, in the surgical wards and in the patients with independent activities of daily living, there was no difference in the time to entry (P=.50 and P=.20, respectively), but there was a greater amount of information in the use group. Conclusions: The study developed and implemented a system in which self-reported patient data were captured in the hospital information network and quoted in the nursing system. This system contributes to improving the efficiency of nurses’ task recordings. %M 37634203 %R 10.2196/51303 %U https://nursing.jmir.org/2023/1/e51303 %U https://doi.org/10.2196/51303 %U http://www.ncbi.nlm.nih.gov/pubmed/37634203 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44402 %T An Unstructured Supplementary Service Data System to Verify HIV Self-Testing Among Nigerian Youths: Mixed Methods Analysis of Usability and Feasibility %A Oladele,David Ayoola %A Iwelunmor,Juliet %A Gbajabiamila,Titilola %A Obiezu-Umeh,Chisom %A Okwuzu,Jane Ogoamaka %A Nwaozuru,Ucheoma %A Musa,Adesola Zaidat %A Tahlil,Kadija %A Idigbe,Ifeoma %A Ong,Jason %A Tang,Weiming %A Tucker,Joseph %A Ezechi,Oliver %+ Department of Behavioral Science and Health Education, Saint Louis University, 3545 Lafayette Avenue, Saint Louis, MO, 63104, United States, 1 314 7458150, david.oladele@slu.edu %K adolescent %K adolescents and young adults %K Africa %K AYA %K development %K feasibility %K HIV self-testing %K HIV %K HIVST %K information system %K Nigeria %K platform %K testing %K think aloud %K unstructured supplementary service data %K usability %K user-centered %K USSD %K young adult %K youth %D 2023 %7 25.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) interventions among adolescents and young adults (AYAs) are increasingly available in African low- and middle-income countries (LMICs). For example, the unstructured supplementary service data (USSD) could be used to verify HIV self-testing (HIVST) among AYAs with poor bandwidth. Objective: The aim of this study is to describe the creation of an USSD platform and determine its feasibility and usability to promote the verification of HIVST results among AYAs in Nigeria. Methods: We developed and evaluated a USSD platform to verify HIVST results using a user-centered approach. The USSD platform guided AYAs in performing HIVST, interpreting the result, and providing linkage to care after the test. Following the usability assessment, the USSD platform was piloted. We used a mixed methods study to assess the platform’s usability through a process of quantitative heuristic assessment, a qualitative think-aloud method, and an exit interview. Descriptive statistics of quantitative data and inductive thematic analysis of qualitative variables were organized. Results: A total of 19 AYAs participated in the usability test, with a median age of 19 (IQR 16-23) years. There were 11 females, 8 males, and 0 nonbinary individuals. All individuals were out-of-school AYAs. Seven of the 10 Nielsen usability heuristics assessed yielded positive results. The participants found the USSD platform easy to use, preferred the simplicity of the system, felt no need for a major improvement in the design of the platform, and were happy the system provided linkage to care following the interpretation of the HIVST results. The pilot field test of the platform enrolled 164 out-of-school AYAs, mostly young girls and women (101, 61.6%). The mean age was 17.5 (SD 3.18) years, and 92.1% (151/164) of the participants reported that they were heterosexual, while 7.9% (13/164) reported that they were gay. All the participants in the pilot study were able to conduct HIVST, interpret their results, and use the linkage to care feature of the USSD platform without any challenge. A total of 7.9% (13/164) of the AYAs had positive HIV results (reactive to the OraQuick kit). Conclusions: This study demonstrated the usability and feasibility of using a USSD system as an alternative to mobile phone apps to verify HIVST results among Nigerian youth without smartphone access. Therefore, the use of a USSD platform has implications for the verification of HIVST in areas with low internet bandwidth. Further pragmatic trials are needed to scale up this approach. %M 37747780 %R 10.2196/44402 %U https://formative.jmir.org/2023/1/e44402 %U https://doi.org/10.2196/44402 %U http://www.ncbi.nlm.nih.gov/pubmed/37747780 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e44310 %T Normal Workflow and Key Strategies for Data Cleaning Toward Real-World Data: Viewpoint %A Guo,Manping %A Wang,Yiming %A Yang,Qiaoning %A Li,Rui %A Zhao,Yang %A Li,Chenfei %A Zhu,Mingbo %A Cui,Yao %A Jiang,Xin %A Sheng,Song %A Li,Qingna %A Gao,Rui %+ Xiyuan Hospital, China Academy of Chinese Medical Sciences, GCP, Xiyuan Hospital, 1 Xiyuan Playground, Haidian District, Beijing, 100091, China, 86 010 62835653, ruigao@126.com %K data cleaning %K data quality %K key technologies %K real-world data %K viewpoint %D 2023 %7 21.9.2023 %9 Viewpoint %J Interact J Med Res %G English %X With the rapid development of science, technology, and engineering, large amounts of data have been generated in many fields in the past 20 years. In the process of medical research, data are constantly generated, and large amounts of real-world data form a “data disaster.” Effective data analysis and mining are based on data availability and high data quality. The premise of high data quality is the need to clean the data. Data cleaning is the process of detecting and correcting “dirty data,” which is the basis of data analysis and management. Moreover, data cleaning is a common technology for improving data quality. However, the current literature on real-world research provides little guidance on how to efficiently and ethically set up and perform data cleaning. To address this issue, we proposed a data cleaning framework for real-world research, focusing on the 3 most common types of dirty data (duplicate, missing, and outlier data), and a normal workflow for data cleaning to serve as a reference for the application of such technologies in future studies. We also provided relevant suggestions for common problems in data cleaning. %M 37733421 %R 10.2196/44310 %U https://www.i-jmr.org/2023/1/e44310 %U https://doi.org/10.2196/44310 %U http://www.ncbi.nlm.nih.gov/pubmed/37733421 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46742 %T Differing Behaviors Around Adult Nonmedical Use of Prescription Stimulants and Opioids: Latent Class Analysis %A Rockhill,Karilynn M %A Olson,Richard %A Dart,Richard C %A Iwanicki,Janetta L %A Black,Joshua C %+ Rocky Mountain Poison and Drug Safety, Denver Health and Hospital Authority, 777 Bannock St, Denver, CO, 80204-4531, United States, 1 3033891652, joshua.black@rmpds.org %K stimulant misuse %K opioid misuse %K high-dimensional analysis %K latent class analysis %K general population %K drug overdose %K opioid %K drug use pattern %K nonmedical use of prescription stimulant %K substance abuse %K drugs %K adulthood %D 2023 %7 20.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The availability of central nervous system stimulants has risen in recent years, along with increased dispensing of stimulants for treatment of, for example, parent-reported attention-deficit/hyperactivity disorder in children and new diagnoses during adulthood. Typologies of drug use, as has been done with opioids, fail to include a sufficient range of behavioral factors to contextualize person-centric circumstances surrounding drug use. Understanding these patterns across drug classes would bring public health and regulatory practices toward precision public health. Objective: The objective of this study was to quantitatively delineate the unique behavioral profiles of adults who currently nonmedically use stimulants and opioids using a latent class analysis and to contrast the differences in findings by class. We further evaluated whether the subgroups identified were associated with an increased Drug Abuse Screening Test-10 (DAST-10) score, which is an indicator of average problematic drug use. Methods: This study used a national cross-sectional web-based survey, using 3 survey launches from 2019 to 2020 (before the COVID-19 pandemic). Data from adults who reported nonmedical use of prescription stimulants (n=2083) or prescription opioids (n=6127) in the last 12 months were analyzed. A weighted latent class analysis was used to identify the patterns of use. Drug types, motivations, and behaviors were factors in the model, which characterized unique classes of behavior. Results: Five stimulant nonmedical use classes were identified: amphetamine self-medication, network-sourced stimulant for alertness, nonamphetamine performance use, recreational use, and nondiscriminatory behaviors. The drug used nonmedically, acquisition through a friend or family member, and use to get high were strong differentiators among the stimulant classes. The latter 4 classes had significantly higher DAST-10 scores than amphetamine self-medication (P<.001). In addition, 4 opioid nonmedical use classes were identified: moderate pain with low mental health burden, high pain with higher mental health burden, risky behaviors with diverse motivations, and nondiscriminatory behaviors. There was a progressive and significant increase in DAST-10 scores across classes (P<.001). The potency of the opioid, pain history, the routes of administration, and psychoactive effect behaviors were strong differentiators among the opioid classes. Conclusions: A more precise understanding of how behaviors tend to co-occur would improve efficacy and efficiency in developing interventions and supporting the overall health of those who use drugs, and it would improve communication with, and connection to, those at risk for severe drug outcomes. %M 37728974 %R 10.2196/46742 %U https://www.jmir.org/2023/1/e46742 %U https://doi.org/10.2196/46742 %U http://www.ncbi.nlm.nih.gov/pubmed/37728974 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46523 %T Bot or Not? Detecting and Managing Participant Deception When Conducting Digital Research Remotely: Case Study of a Randomized Controlled Trial %A Loebenberg,Gemma %A Oldham,Melissa %A Brown,Jamie %A Dinu,Larisa %A Michie,Susan %A Field,Matt %A Greaves,Felix %A Garnett,Claire %+ UCL Tobacco and Alcohol Research Group, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 20 7679 8781, gemma.loebenberg@ucl.ac.uk %K artificial intelligence %K false information %K mHealth applications %K participant deception %K participant %K recruit %K research subject %K web-based studies %D 2023 %7 14.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Evaluating digital interventions using remote methods enables the recruitment of large numbers of participants relatively conveniently and cheaply compared with in-person methods. However, conducting research remotely based on participant self-report with little verification is open to automated “bots” and participant deception. Objective: This paper uses a case study of a remotely conducted trial of an alcohol reduction app to highlight and discuss (1) the issues with participant deception affecting remote research trials with financial compensation; and (2) the importance of rigorous data management to detect and address these issues. Methods: We recruited participants on the internet from July 2020 to March 2022 for a randomized controlled trial (n=5602) evaluating the effectiveness of an alcohol reduction app, Drink Less. Follow-up occurred at 3 time points, with financial compensation offered (up to £36 [US $39.23]). Address authentication and telephone verification were used to detect 2 kinds of deception: “bots,” that is, automated responses generated in clusters; and manual participant deception, that is, participants providing false information. Results: Of the 1142 participants who enrolled in the first 2 months of recruitment, 75.6% (n=863) of them were identified as bots during data screening. As a result, a CAPTCHA (Completely Automated Public Turing Test to Tell Computers and Humans Apart) was added, and after this, no more bots were identified. Manual participant deception occurred throughout the study. Of the 5956 participants (excluding bots) who enrolled in the study, 298 (5%) were identified as false participants. The extent of this decreased from 110 in November 2020, to a negligible level by February 2022 including a number of months with 0. The decline occurred after we added further screening questions such as attention checks, removed the prominence of financial compensation from social media advertising, and added an additional requirement to provide a mobile phone number for identity verification. Conclusions: Data management protocols are necessary to detect automated bots and manual participant deception in remotely conducted trials. Bots and manual deception can be minimized by adding a CAPTCHA, attention checks, a requirement to provide a phone number for identity verification, and not prominently advertising financial compensation on social media. Trial Registration: ISRCTN Number ISRCTN64052601; https://doi.org/10.1186/ISRCTN64052601 %M 37707943 %R 10.2196/46523 %U https://www.jmir.org/2023/1/e46523 %U https://doi.org/10.2196/46523 %U http://www.ncbi.nlm.nih.gov/pubmed/37707943 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46675 %T Cardiff Online Cognitive Assessment in a National Sample: Cross-Sectional Web-Based Study %A Lynham,Amy Joanne %A Jones,Ian R %A Walters,James T R %+ Division of Psychological Medicine, School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, United Kingdom, 44 2920688434, waltersjt@cardiff.ac.uk %K cognition %K digital assessment %K mental health %K mobile phone %K normative data %K web-based %K cognitive assessment %K CONCA %D 2023 %7 13.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Psychiatric disorders are associated with cognitive impairment. We have developed a web-based, 9-task cognitive battery to measure the core domains affected in people with psychiatric disorders. To date, this assessment has been used to collect data on a clinical sample of participants with psychiatric disorders. Objective: The aims of this study were (1) to establish a briefer version of the battery (called the Cardiff Online Cognitive Assessment [CONCA]) that can give a valid measure of cognitive ability (“g”) and (2) to collect normative data and demonstrate CONCA’s application in a health population sample. Methods: Based on 6 criteria and data from our previous study, we selected 5 out of the original 9 tasks to include in CONCA. These included 3 core tasks that were sufficient to derive a measure of “g” and 2 optional tasks. Participants from a web-based national cohort study (HealthWise Wales) were invited to complete CONCA. Completion rates, sample characteristics, performance distributions, and associations between cognitive performance and demographic characteristics and mental health measures were examined. Results: A total of 3679 participants completed at least one CONCA task, of which 3135 completed all 3 core CONCA tasks. Performance on CONCA was associated with age (B=–0.05, SE 0.002; P<.001), device (tablet computer: B=–0.26, SE 0.05; P<.001; smartphone: B=–0.46, SE 0.05; P<.001), education (degree: B=1.68, SE 0.14; P<.001), depression symptoms (B=–0.04, SE 0.01; P<.001), and anxiety symptoms (B=–0.04, SE 0.01; P<.001). Conclusions: CONCA provides a valid measure of “g,” which can be derived using as few as 3 tasks that take no more than 15 minutes. Performance on CONCA showed associations with demographic characteristics in the expected direction and was associated with current depression and anxiety symptoms. The effect of device on cognitive performance is an important consideration for research using web-based assessments. %M 37703073 %R 10.2196/46675 %U https://www.jmir.org/2023/1/e46675 %U https://doi.org/10.2196/46675 %U http://www.ncbi.nlm.nih.gov/pubmed/37703073 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48321 %T Factors Influencing Surgical Decision-Making in the Posterior Laminectomy With Fixation for Degenerative Cervical Myelopathy (POLYFIX-DCM) Trial: Survey Study %A Yordanov,Stefan %A Yang,Xiaoyu %A Mowforth,Oliver %A K Demetriades,Andreas %A Ivanov,Marcel %A Vergara,Pierluigi %A Gardner,Adrian %A Pereira,Erlick %A Bateman,Antony %A Alamri,Alexander %A Francis,Jibin %A Trivedi,Rikin %A Kotter,Mark %A Davies,Benjamin %A Budu,Alexandru %A , %+ Academic Neurosurgery Unit, Department of Clinical Neurosurgery, Cambridge University, Hills Rd, Cambridge, CB2 0QQ, United Kingdom, 44 7874649949, yordanov.stefan@yahoo.com %K cervical myelopathy %K spondylosis %K spondylotic stenosis %K disc herniation %K ossification posterior longitudinal ligament %K degeneration %K disability %K recovery %K questionnaire %K decision-making %K surgeons %K myelopathy %K stress %K spinal cord %K surgeons %K surgery %K decompression %K laminectomy %D 2023 %7 12.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Degenerative cervical myelopathy (DCM) is estimated to affect 2% of the adult population. DCM occurs when degenerative processes cause compression and injure the spinal cord. Surgery to remove the stress caused by the compression of the spinal cord is the mainstay of treatment, with a range of techniques in use. Although various factors are described to inform the selection of these techniques, there needs to be more consensus and limited comparative evidence. Objective: The main objective of this survey was to explore the variation of practice and decision-making, with a focus on laminectomy versus laminectomy and fusion in posterior surgery of the cervical spine. We present the results of a survey conducted among the principal investigators (PIs) of the National Institute for Health and Care Research (NIHR) randomized controlled trial on posterior laminectomy with fixation for degenerative cervical myelopathy (POLYFIX-DCM). Methods: A series of 7 cases were shared with 24 PIs using SurveyMonkey. Each case consisted of a midsagittal T2-weighted magnetic resonance imaging and lateral cervical x-rays in flexion and extension. Surgeons were asked if their preferred approach was anterior or posterior. If posterior, they were asked whether they preferred to instrument and whether they had the equipoise to randomize in the NIHR POLYFIX-DCM trial. Variability in decision-making was then explored using factors reported to inform decision-making, such as alignment, location of compression, number of levels operated, presence of mobile spondylolisthesis, and patient age. Results: The majority of PIs (16/30, 53%) completed the survey. Overall, PIs favored a posterior approach (12/16, 75%) with instrumentation (75/112, average 66%) and would randomize (67/112, average 62%) most cases. Factors reported to inform decision-making poorly explained variability in responses in both univariate testing and with a multivariate model (R2=0.1). Only surgeon experience of more than 5 years and orthopedic specialty training background were significant predictors, both associated with an anterior approach (odds ratio [OR] 1.255; P=.02 and OR 1.344; P=.007, respectively) and fusion for posterior procedures (OR 0.628; P<.001 and OR 1.344; P<.001, respectively). Surgeon experience also significantly affected the openness to randomize, with those with more than 5 years of experience less likely to randomize (OR –0.68; P<.001). Conclusions: In this representative sample of spine surgeons participating in the POLYFIX-DCM trial as investigators, there is no consensus on surgical strategy, including the role of instrumented fusion following posterior decompression. Overall, this study supports the view that there appears to be a clinical equipoise, and conceptually, a randomized controlled trial appears feasible, which sets the scene for the NIHR POLYFIX-DCM trial. %M 37698903 %R 10.2196/48321 %U https://formative.jmir.org/2023/1/e48321 %U https://doi.org/10.2196/48321 %U http://www.ncbi.nlm.nih.gov/pubmed/37698903 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42756 %T Identification of Risk Groups for and Factors Affecting Metabolic Syndrome in South Korean Single-Person Households Using Latent Class Analysis and Machine Learning Techniques: Secondary Analysis Study %A Lee,Ji-Soo %A Lee,Soo-Kyoung %+ Big Data Convergence and Open Sharing System, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 2 889 5710, soo1005s@gmail.com %K latent class analysis %K machine learning %K metabolic syndrome %K risk factor %K single-person households %D 2023 %7 12.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The rapid increase of single-person households in South Korea is leading to an increase in the incidence of metabolic syndrome, which causes cardiovascular and cerebrovascular diseases, due to lifestyle changes. It is necessary to analyze the complex effects of metabolic syndrome risk factors in South Korean single-person households, which differ from one household to another, considering the diversity of single-person households. Objective: This study aimed to identify the factors affecting metabolic syndrome in single-person households using machine learning techniques and categorically characterize the risk factors through latent class analysis (LCA). Methods: This cross-sectional study included 10-year secondary data obtained from the National Health and Nutrition Examination Survey (2009-2018). We selected 1371 participants belonging to single-person households. Data were analyzed using SPSS (version 25.0; IBM Corp), Mplus (version 8.0; Muthen & Muthen), and Python (version 3.0; Plone & Python). We applied 4 machine learning algorithms (logistic regression, decision tree, random forest, and extreme gradient boost) to identify important factors and then applied LCA to categorize the risk groups of metabolic syndromes in single-person households. Results: Through LCA, participants were classified into 4 groups (group 1: intense physical activity in early adulthood, group 2: hypertension among middle-aged female respondents, group 3: smoking and drinking among middle-aged male respondents, and group 4: obesity and abdominal obesity among middle-aged respondents). In addition, age, BMI, obesity, subjective body shape recognition, alcohol consumption, smoking, binge drinking frequency, and job type were investigated as common factors that affect metabolic syndrome in single-person households through machine learning techniques. Group 4 was the most susceptible and at-risk group for metabolic syndrome (odds ratio 17.67, 95% CI 14.5-25.3; P<.001), and obesity and abdominal obesity were the most influential risk factors for metabolic syndrome. Conclusions: This study identified risk groups and factors affecting metabolic syndrome in single-person households through machine learning techniques and LCA. Through these findings, customized interventions for each generational risk factor for metabolic syndrome can be implemented, leading to the prevention of metabolic syndrome, which causes cardiovascular and cerebrovascular diseases. In conclusion, this study contributes to the prevention of metabolic syndrome in single-person households by providing new insights and priority groups for the development of customized interventions using classification. %M 37698907 %R 10.2196/42756 %U https://formative.jmir.org/2023/1/e42756 %U https://doi.org/10.2196/42756 %U http://www.ncbi.nlm.nih.gov/pubmed/37698907 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e47035 %T Remote Recruitment Strategy and Structured E-Parenting Support (STEPS) App: Feasibility and Usability Study %A Kostyrka-Allchorne,Katarzyna %A Chu,Petrina %A Ballard,Claire %A Lean,Nancy %A French,Blandine %A Hedstrom,Ellen %A Byford,Sarah %A Cortese,Samuele %A Daley,David %A Downs,Johnny %A Glazebrook,Cristine %A Goldsmith,Kimberley %A Hall,Charlotte L %A Kovshoff,Hanna %A Kreppner,Jana %A Sayal,Kapil %A Shearer,James %A Simonoff,Emily %A Thompson,Margaret %A Sonuga-Barke,Edmund J S %+ Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE58AF, United Kingdom, 44 02078483682, edmund.sonuga-barke@kcl.ac.uk %K parenting intervention %K mobile app %K attention-deficit/hyperactivity disorder %K ADHD %K behavior problems %K mobile health %K mHealth %K children %K usability %K mobile phone %D 2023 %7 11.9.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The Structured E-Parenting Support (STEPS) app provides support for parents of children with elevated hyperactivity, impulsivity, inattention, and conduct problems who are awaiting clinical assessment. STEPS will be evaluated in a randomized controlled trial (RCT) within the Online Parent Training for the Initial Management of ADHD Referrals (OPTIMA) research program in the United Kingdom. Phase 1 of the OPTIMA tested the feasibility of participants’ recruitment and the app’s usability. Objective: This study aimed to adapt a digital routine clinical monitoring system, myHealthE, for research purposes to facilitate waitlist recruitment; test using remote methods to screen and identify participants quickly and systematically; pilot the acceptability of the recruitment and assessment protocol; and explore the usability of STEPS. Methods: myHealthE was adapted to screen patients’ data. Parents’ and clinicians’ feedback on myHealthE was collected, and information governance reviews were conducted in clinical services planning to host the RCT. Potential participants for the observational feasibility study were identified from new referrals using myHealthE and non-myHealthE methods. Descriptive statistics were used to summarize the demographic and outcome variables. We estimated whether the recruitment rate would meet the planned RCT sample size requirement (n=352). In addition to the feasibility study participants, another group of parents was recruited to assess the STEPS usability. They completed the adapted System Usability Scale and responded to open-ended questions about the app, which were coded using the Enlight quality construct template. Results: Overall, 124 potential participants were identified as eligible: 121 (97.6%) via myHealthE and 3 (2.4%) via non-myHealthE methods. In total, 107 parents were contacted, and 48 (44.9%) consented and were asked if, hypothetically, they would be willing to participate in the OPTIMA RCT. Of the 28 feasibility study participants who provided demographic data, 21 (75%) identified as White. Their children had an average age of 8.4 (SD 1.7) years and 65% (31/48) were male. During the primary recruitment period (June to July 2021) when 45 participants had consented, 38 (84%) participants agreed hypothetically to take part in the RCT (rate of 19/mo, 95% CI 13.5-26.1), meeting the stop-go criterion of 18 participants per month to proceed with the RCT. All parents were satisfied or very satisfied with the study procedures. Parents (n=12) recruited to assess STEPS’ usability described it as easy to navigate and use and as having an attractive combination of colors and visual design. They described the content as useful, pitched at the right level, and sensitively presented. Suggested improvements included adding captions to videos or making the recorded reflections editable. Conclusions: Remote recruitment and study procedures for testing a parenting intervention app are feasible and acceptable for parents. The parents felt that STEPS was a useful and easy-to-use digital parenting support tool. International Registered Report Identifier (IRRID): RR2-10.1186/s40814-021-00959-0 %M 37695667 %R 10.2196/47035 %U https://pediatrics.jmir.org/2023/1/e47035 %U https://doi.org/10.2196/47035 %U http://www.ncbi.nlm.nih.gov/pubmed/37695667 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43883 %T Comparative Effectiveness of eConsent: Systematic Review %A Cohen,Edwin %A Byrom,Bill %A Becher,Anja %A Jörntén-Karlsson,Magnus %A Mackenzie,Andrew K %+ AstraZeneca BV, Prinses Beatrixlaan, 582, The Hague, 2595 BM, Netherlands, 31 79 363 2546, edwin.cohen@astrazeneca.com %K acceptability %K clinical trial %K comprehension %K digital consent %K eConsent %K effectiveness %K electronic consent %K informed consent form %K patient engagement %K usability %D 2023 %7 1.9.2023 %9 Review %J J Med Internet Res %G English %X Background: Providing informed consent means agreeing to participate in a clinical trial and having understood what is involved. Flawed informed consent processes, including missing dates and signatures, are common regulatory audit findings. Electronic consent (eConsent) uses digital technologies to enable the consenting process. It aims to improve participant comprehension and engagement with study information and to address data quality concerns. Objective: This systematic literature review aimed to assess the effectiveness of eConsent in terms of patient comprehension, acceptability, usability, and study enrollment and retention rates, as well as the effects of eConsent on the time patients took to perform the consenting process (“cycle time”) and on-site workload in comparison with traditional paper-based consenting. Methods: The systematic review was conducted and reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Ovid Embase and Ovid MEDLINE were systematically searched for publications reporting original, comparative data on the effectiveness of eConsent in terms of patient comprehension, acceptability, usability, enrollment and retention rates, cycle time, and site workload. The methodological validity of the studies that compared outcomes for comprehension, acceptability, and usability across paper consent and eConsent was assessed. Study methodologies were categorized as having “high” validity if comprehensive assessments were performed using established instruments. Results: Overall, 37 publications describing 35 studies (13,281 participants) were included. All studies comparing eConsenting and paper-based consenting for comprehension (20/35, 57% of the studies; 10 with “high” validity), acceptability (8/35, 23% of the studies; 1 with “high” validity), and usability (5/35, 14% of the studies; 1 with “high” validity) reported significantly better results with eConsent, better results but without significance testing, or no significant differences in overall results. None of the studies reported better results with paper than with eConsent. Among the “high” validity studies, 6 studies on comprehension reported significantly better understanding of at least some concepts, the study on acceptability reported statistically significant higher satisfaction scores, and the study on usability reported statistically significant higher usability scores with eConsent than with paper (P<.05 for all). Cycle times were increased with eConsent, potentially reflecting greater patient engagement with the content. Data on enrollment and retention were limited. Comparative data from site staff and other study researchers indicated the potential for reduced workload and lower administrative burden with eConsent. Conclusions: This systematic review showed that compared with patients using paper-based consenting, patients using eConsent had a better understanding of the clinical trial information, showed greater engagement with content, and rated the consenting process as more acceptable and usable. eConsent solutions thus have the potential to enhance understanding, acceptability, and usability of the consenting process while inherently being able to address data quality concerns, including those related to flawed consenting processes. %M 37656499 %R 10.2196/43883 %U https://www.jmir.org/2023/1/e43883 %U https://doi.org/10.2196/43883 %U http://www.ncbi.nlm.nih.gov/pubmed/37656499 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43995 %T Using Clinician-Patient WeChat Group Communication Data to Identify Symptom Burdens in Patients With Uterine Fibroids Under Focused Ultrasound Ablation Surgery Treatment: Qualitative Study %A Zhang,Jiayuan %A Xu,Wei %A Lei,Cheng %A Pu,Yang %A Zhang,Yubo %A Zhang,Jingyu %A Yu,Hongfan %A Su,Xueyao %A Huang,Yanyan %A Gong,Ruoyan %A Zhang,Lijun %A Shi,Qiuling %+ School of Public Health, Chongqing Medical University, No 1, Medical College Road, Yuzhong District, Chongqing, 400016, China, 86 18290585397, qshi@cqmu.edu.cn %K social media %K group chats %K text mining %K free texts %K symptom burdens %K WeChat %K natural language processing %K NLP %D 2023 %7 1.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Unlike research project–based health data collection (questionnaires and interviews), social media platforms allow patients to freely discuss their health status and obtain peer support. Previous literature has pointed out that both public and private social platforms can serve as data sources for analysis. Objective: This study aimed to use natural language processing (NLP) techniques to identify concerns regarding the postoperative quality of life and symptom burdens in patients with uterine fibroids after focused ultrasound ablation surgery. Methods: Screenshots taken from clinician-patient WeChat groups were converted into free texts using image text recognition technology and used as the research object of this study. From 408 patients diagnosed with uterine fibroids in Chongqing Haifu Hospital between 2010 and 2020, we searched for symptom burdens in over 900,000 words of WeChat group chats. We first built a corpus of symptoms by manually coding 30% of the WeChat texts and then used regular expressions in Python to crawl symptom information from the remaining texts based on this corpus. We compared the results with a manual review (gold standard) of the same records. Finally, we analyzed the relationship between the population baseline data and conceptual symptoms; quantitative and qualitative results were examined. Results: A total of 408 patients with uterine fibroids were included in the study; 190,000 words of free text were obtained after data cleaning. The mean age of the patients was 39.94 (SD 6.81) years, and their mean BMI was 22.18 (SD 2.78) kg/m2. The median reporting times of the 7 major symptoms were 21, 26, 57, 2, 18, 30, and 49 days. Logistic regression models identified preoperative menstrual duration (odds ratio [OR] 1.14, 95% CI 5.86-6.37; P=.009), age of menophania (OR –1.02 , 95% CI 11.96-13.47; P=.03), and the number (OR 2.34, 95% CI 1.45-1.83; P=.04) and size of fibroids (OR 0.12, 95% CI 2.43-3.51; P=.04) as significant risk factors for postoperative symptoms. Conclusions: Unstructured free texts from social media platforms extracted by NLP technology can be used for analysis. By extracting the conceptual information about patients’ health-related quality of life, we can adopt personalized treatment for patients at different stages of recovery to improve their quality of life. Python-based text mining of free-text data can accurately extract symptom burden and save considerable time compared to manual review, maximizing the utility of the extant information in population-based electronic health records for comparative effectiveness research. %M 37656501 %R 10.2196/43995 %U https://formative.jmir.org/2023/1/e43995 %U https://doi.org/10.2196/43995 %U http://www.ncbi.nlm.nih.gov/pubmed/37656501 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42101 %T Usefulness of Self-Assessment of Gastrointestinal Symptoms: Web-Based Study in Anhui, China %A Guan,Xiaoqin %A Xue,Qun %A Ma,Huan %A Li,Guocheng %A Xu,Xiuze %A Zhang,Kexin %A Tang,Mengsha %A Liu,Rong %A Wang,Debin %A Shen,Xingrong %+ School of Health Service Management, Anhui Medical University, 81 Meishan Road, Shushan District, Hefei, Anhui, 230032, China, 86 13505612172, xinrongshen@sina.com %K gastrointestinal symptoms %K health care seeking %K symptoms reporting %K web-based self-assessment %K China %D 2023 %7 30.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Gastrointestinal symptoms (GISs) are caused by a combination of biopsychosocial factors and are highly prevalent worldwide. Given their complex nature, coupled with ineffective communication of diagnoses by physicians, patients with intimate GISs often feel stigmatized. This, in turn, can inhibit their ability to express their thoughts and feelings adequately, leading them to over- or underreport their symptoms. Moreover, selective service-seeking for and reporting of GISs have a direct bearing on the stage of disease at presentation and, consequently, on the overall prognosis. Objective: This study aimed to investigate the usefulness of a web-based self-assessment of GISs as a supplementary means to cope with potential over- or underreporting during routine consultations. Methods: GIS data were collected using a novel web-based self-assessment tool (n=475) and from nonparticipative observation of doctor-patient consultations (n=447) and household surveys (n=10,552) in Anhui, China. Data analysis focused primarily on the description of the composition of respondents and the occurrence rates of GISs by sociodemographics, and by symptom solicitation methods and settings. Chi-square power tests were used when necessary to compare differences in the occurrence rates between relevant groups. The level of significance for the 2-sided test was set at α<.05. Results: The average occurrence rates of both upper and lower GISs derived from the web-based self-assessment were higher than those from the observation (upper GISs: n=661, 20.9% vs n=382, 14.2%; P<.001; lower GISs: n=342, 12.9% vs n=250, 10.8%; P=.02). The differences in 6 of the 9 upper GISs and 3 of the 11 lower GISs studied were tested with statistical significance (P<.05); moreover, a higher frequency rate was recorded for symptoms with statistical significance via self-assessment than via observation. For upper GISs, the self-assessed versus observed differences ranged from 17.1% for bloating to 100% for bad mood after a meal, while for lower GISs, the differences ranged from −50.5% for hematochezia or melena to 100% for uncontrollable stool. Stomachache, regurgitation, and dysphagia had higher occurrence rates among participants of the self-assessment group than those of the household survey group (20% vs 12.7%, 14% vs 11%, and 3% vs 2.3%, respectively), while the opposite was observed for constipation (5% vs 10.9%), hematochezia or melena (4% vs 5%), and anorexia (4% vs 5.2%). All differences noted in the self-assessed occurrence rates of specific, persistent GISs between sociodemographic groups were tested for nonsignificance (P>.05), while the occurrence rates of any of the 6 persistent GISs among respondents aged 51-60 years was statistically higher than that among other age groups (P=.03). Conclusions: The web-based self-assessment tool piloted in this study is useful and acceptable for soliciting more comprehensive GISs, especially symptoms with concerns about stigmatization, privacy, and shame. Further studies are needed to integrate the web-based self-assessment with routine consultations and to evaluate its efficacy. %M 37583117 %R 10.2196/42101 %U https://formative.jmir.org/2023/1/e42101 %U https://doi.org/10.2196/42101 %U http://www.ncbi.nlm.nih.gov/pubmed/37583117 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44950 %T Checkpoint Travel Numbers as a Proxy Variable in Population-Based Studies During the COVID-19 Pandemic: Validation Study %A Kreslake,Jennifer M %A Aarvig,Kathleen %A Muller-Tabanera,Hope %A Vallone,Donna M %A Hair,Elizabeth C %+ Schroeder Institute, Truth Initiative, 900 G Street Northwest, Floor 4, Washington, DC, 20001, United States, 1 2024545782, jkreslake@truthinitiative.org %K research methods %K public health %K data quality %K psychosocial factors %K history %K COVID-19 %K social %K behavioral %K validation %K social distancing %K tracking survey %K survey %K pandemic %D 2023 %7 29.8.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic had wide-ranging systemic impacts, with implications for social and behavioral factors in human health. The pandemic may introduce history bias in population-level research studies of other health topics during the COVID-19 period. Objective: We sought to identify and validate an accessible, flexible measure to serve as a covariate in research spanning the COVID-19 pandemic period. Methods: Transportation Security Administration checkpoint travel numbers were used to calculate a weekly sum of daily passengers and validated against two measures with strong face validity: (1) a self-reported item on social distancing practices drawn from a continuous tracking survey among a national sample of youths and young adults (15-24 years) in the United States (N=45,080, approximately 280 unique respondents each week); and (2) Google’s Community Mobility Reports, which calculate daily values at the national level to represent rates of change in visits and length of stays to public spaces. For the self-reported survey data, an aggregated week-level variable was calculated as the proportion of respondents who did not practice social distancing that week (January 1, 2019, to May 31, 2022). For the community mobility data, a weekly estimate of change was calculated using daily values compared to a 5-week prepandemic baseline period (January 3, 2020, to February 6, 2020). Spearman rank correlation coefficients were calculated for each comparison. Results: Checkpoint travel data ranged from 668,719 travelers in the week of April 8, 2020, to nearly 15.5 million travelers in the week of May 18, 2022. The weekly proportion of survey respondents who did not practice social distancing ranged from 18.1% (n=42; week of April 15, 2020) to 70.9% (n=213; week of May 25, 2022). The measures were strongly correlated from January 2019 to May 2022 (ρ=0.90, P<.001) and March 2020 to May 2022 (ρ=0.87, P<.001). Strong correlations were observed when analyses were restricted to age groups (15-17 years: ρ=0.90; P<.001; 18-20 years: ρ=0.87; P<.001; 21-24 years: ρ=0.88; P<.001), racial or ethnic minorities (ρ=0.86, P<.001), and respondents with lower socioeconomic status (ρ=0.88, P<.001). There were also strong correlations between the weekly change from the baseline period for checkpoint travel data and community mobility data for transit stations (ρ=0.92, P<.001) and retail and recreation (ρ=0.89, P<.001), and moderate significant correlations for grocery and pharmacy (ρ=0.68, P<.001) and parks (ρ=0.62, P<.001). A strong negative correlation was observed for places of residence (ρ=−0.78, P<.001), and a weak but significant positive correlation was found for workplaces (ρ=0.24, P<.001). Conclusions: The Transportation Security Administration’s travel checkpoint data provide a publicly available flexible time-varying metric to control for history bias introduced by the pandemic in research studies spanning the COVID-19 period in the United States. %M 37191643 %R 10.2196/44950 %U https://publichealth.jmir.org/2023/1/e44950 %U https://doi.org/10.2196/44950 %U http://www.ncbi.nlm.nih.gov/pubmed/37191643 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44414 %T A Novel, Expert-Endorsed, Neurocognitive Digital Assessment Tool for Addictive Disorders: Development and Validation Study %A Lee,Rico S C %A Albertella,Lucy %A Christensen,Erynn %A Suo,Chao %A Segrave,Rebecca A %A Brydevall,Maja %A Kirkham,Rebecca %A Liu,Chang %A Fontenelle,Leonardo F %A Chamberlain,Samuel R %A Rotaru,Kristian %A Yücel,Murat %+ QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, 4006, Australia, 61 412494834, muratyucel40@gmail.com %K cognitive neuroscience %K addictive behaviors %K mental health %K gaming %K gamified %K gamification %K development %K assessment %K software %K addiction %K mental disorder %K neurocognition %K neurocognitive %K brain health %K gamified task %K psychometric %K game developer %K game development %K validation %K validate %K validity %D 2023 %7 25.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Many people with harmful addictive behaviors may not meet formal diagnostic thresholds for a disorder. A dimensional approach, by contrast, including clinical and community samples, is potentially key to early detection, prevention, and intervention. Importantly, while neurocognitive dysfunction underpins addictive behaviors, established assessment tools for neurocognitive assessment are lengthy and unengaging, difficult to administer at scale, and not suited to clinical or community needs. The BrainPark Assessment of Cognition (BrainPAC) Project sought to develop and validate an engaging and user-friendly digital assessment tool purpose-built to comprehensively assess the main consensus-driven constructs underpinning addictive behaviors. Objective: The purpose of this study was to psychometrically validate a gamified battery of consensus-based neurocognitive tasks against standard laboratory paradigms, ascertain test-retest reliability, and determine their sensitivity to addictive behaviors (eg, alcohol use) and other risk factors (eg, trait impulsivity). Methods: Gold standard laboratory paradigms were selected to measure key neurocognitive constructs (Balloon Analogue Risk Task [BART], Stop Signal Task [SST], Delay Discounting Task [DDT], Value-Modulated Attentional Capture [VMAC] Task, and Sequential Decision-Making Task [SDT]), as endorsed by an international panel of addiction experts; namely, response selection and inhibition, reward valuation, action selection, reward learning, expectancy and reward prediction error, habit, and compulsivity. Working with game developers, BrainPAC tasks were developed and validated in 3 successive cohorts (total N=600) and a separate test-retest cohort (N=50) via Mechanical Turk using a cross-sectional design. Results: BrainPAC tasks were significantly correlated with the original laboratory paradigms on most metrics (r=0.18-0.63, P<.05). With the exception of the DDT k function and VMAC total points, all other task metrics across the 5 tasks did not differ between the gamified and nongamified versions (P>.05). Out of 5 tasks, 4 demonstrated adequate to excellent test-retest reliability (intraclass correlation coefficient 0.72-0.91, P<.001; except SDT). Gamified metrics were significantly associated with addictive behaviors on behavioral inventories, though largely independent of trait-based scales known to predict addiction risk. Conclusions: A purpose-built battery of digitally gamified tasks is sufficiently valid for the scalable assessment of key neurocognitive processes underpinning addictive behaviors. This validation provides evidence that a novel approach, purported to enhance task engagement, in the assessment of addiction-related neurocognition is feasible and empirically defensible. These findings have significant implications for risk detection and the successful deployment of next-generation assessment tools for substance use or misuse and other mental disorders characterized by neurocognitive anomalies related to motivation and self-regulation. Future development and validation of the BrainPAC tool should consider further enhancing convergence with established measures as well as collecting population-representative data to use clinically as normative comparisons. %M 37624635 %R 10.2196/44414 %U https://www.jmir.org/2023/1/e44414 %U https://doi.org/10.2196/44414 %U http://www.ncbi.nlm.nih.gov/pubmed/37624635 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44150 %T Consumer Awareness of Food Defense Measures at Food Delivery Service Providers and Food Manufacturers: Web-Based Consumer Survey Study %A Akahane,Manabu %A Kanagawa,Yoshiyuki %A Takahata,Yoshihisa %A Nakanishi,Yasuhiro %A Akahane,Takemi %A Imamura,Tomoaki %+ Department of Health and Welfare Services, National Institute of Public Health, 2-3-6 Minami, Wako, 351-0197, Japan, 81 484586347, akahane.m.aa@niph.go.jp %K food defense %K health hazards %K intentional contamination %K foreign substances %K food delivery service %D 2023 %7 24.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Various stages of the food chain, from production to processing to distribution, can impact food safety. The concept of “food defense” has emerged as a countermeasure against intentional contamination of food with foreign substances. Although knowledge of food hygiene is common among consumers, there are currently no reports of consumer surveys on food defense. Objective: This study aims to investigate consumer awareness of food defense and food safety. We analyzed the results focusing on how consumers behave when they find abnormalities in food to further our knowledge on promoting food defense measures. Methods: Participants completed a web-based questionnaire that included items related to awareness of food safety and food defense, as well as actions to be taken in cases of food abnormalities, such as contamination by foreign substances, the presence of a bad smell in purchased food, and the inclusion of extra items not selected by the individual. The participants were asked to indicate their preference among the 5 suggested actions in each case using a 6-point Likert scale. Data analysis involved aggregating responses into binary values. Stepwise linear regression analysis was conducted to examine the relationship between selected actions and questionnaire items, such as sex, age, and personality. Results: A total of 1442 respondents completed the survey, and the majority of participants placed importance on food safety when making food purchases. The recognition of each term was as follows: 95.2% (n=1373) for “food security and safety,” 95.6% (n=1379) for “food hygiene,” and 17.1% (n=247) for “food defense.” The percentages of those who answered that they would “eat without worrying” in the case of “contamination by foreign substances,” “bad smell,” or “including unpurchased product” in the frozen food they purchased were 9.1% (n=131), 4.8% (n=69), and 30.7% (n=443), respectively. The results showed that contacting the manufacturer was the most common action when faced with contaminated food or food with a bad smell. Interestingly, a significant percentage of respondents indicated they would upload the issue on social networking sites. Logistic regression analysis revealed that male participants and the younger generation were more likely to choose the option of eating contaminated food without worrying. Additionally, the tendency to upload the issue on social networking sites was higher among respondents who were sociable and brand-conscious. Conclusions: The findings of this study indicate that if food intentionally contaminated with a foreign substance is sold and delivered to consumers, it is possible consumers may eat it and experience health problems. Therefore, it is crucial for not only food manufacturers but also food delivery service providers to consider food defense measures such as protecting food from intentional contamination. Additionally, promoting consumer education and awareness regarding food defense can contribute to enhancing food safety throughout the food chain. %M 37616047 %R 10.2196/44150 %U https://formative.jmir.org/2023/1/e44150 %U https://doi.org/10.2196/44150 %U http://www.ncbi.nlm.nih.gov/pubmed/37616047 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43790 %T Improving Surveillance of Human Tick-Borne Disease Risks: Spatial Analysis Using Multimodal Databases %A Maxwell,Sarah P %A Brooks,Chris %A Kim,Dohyeong %A McNeely,Connie L %A Cho,Seonga %A Thomas,Kevin C %+ School of Economic, Political and Policy Sciences, University of Texas at Dallas, 800 West Campbell Avenue, Richardson, TX, 75080, United States, 1 972 883 6469, sarah.maxwell@utdallas.edu %K tick-borne disease surveillance %K Lyme disease %K tick bite encounter %K One Health model %K triangulation %K entomology %K entomological %K tick %K thematic mapping %K spatial %K risk %K surveillance %K vector %D 2023 %7 23.8.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The extent of tick-borne disease (TBD) risk in the United States is generally unknown. Active surveillance using entomological measures, such as presence and density of infected nymphal Ixodes scapularis ticks, have served as indicators for assessing human risk, but results have been inconsistent and passive surveillance via public health systems suggests TBDs are underreported. Objective: Research using various data sources and collection methods (eg, Google Trends, apps, and tick bite encounters [TBEs] reports) has shown promise for assessing human TBD risk. In that vein, and engaging a One Health perspective, this study used multimodal databases, geographically overlaying patient survey data on TBEs and concomitant reports of TBDs with data drawn from other sources, such as canine serological reports, to glean insights and to determine and assess the use of various indicators as proxies for human TBD risk. Methods: This study used a mixed methods research strategy, relying on triangulation techniques and drawing on multiple data sources to provide insights into various aspects of human disease risk from TBEs and TBDs in the United States. A web-based survey was conducted over a 15-month period beginning in December 2020 to collect data on TBEs. To maximize the value of the covariate data, related analyses included TBE reports that occurred in the United States between January 1, 2000, and March 31, 2021. TBEs among patients diagnosed with Lyme disease were analyzed at the county level and compared to I scapularis and I pacificus tick presence, human cases identified by the Centers for Disease Control and Prevention (CDC), and canine serological data. Spatial analyses employed multilayer thematic mapping and other techniques. Results: After cleaning, survey results showed a total of 249 (75.7%) TBEs spread across 148 respondents (61.9% of all respondents, 81.7% of TBE-positive respondents); 144 (4.7%) counties in 30 states (60%) remained eligible for analysis, with an average of 1.68 (SD 1.00) and median of 1 (IQR 1) TBEs per respondent. Analysis revealed significant spatial matching at the county level among patient survey reports of TBEs and disease risk indicators from the CDC and other official sources. Thematic mapping results included one-for-one county-level matching of reported TBEs with at least 1 designated source of human disease risk (ie, positive canine serological tests, CDC-reported Lyme disease, or known tick presence). Conclusions: Use of triangulation methods to integrate patient data on TBE recall with established canine serological reports, tick presence, and official human TBD information offers more granular, county-level information regarding TBD risk to inform clinicians and public health officials. Such data may supplement public health sources to offer improved surveillance and provide bases for developing robust proxies for TBD risk among humans. %M 37610812 %R 10.2196/43790 %U https://publichealth.jmir.org/2023/1/e43790 %U https://doi.org/10.2196/43790 %U http://www.ncbi.nlm.nih.gov/pubmed/37610812 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45589 %T Using Machine Learning of Online Expression to Explain Recovery Trajectories: Content Analytic Approach to Studying a Substance Use Disorder Forum %A Yang,Ellie Fan %A Kornfield,Rachel %A Liu,Yan %A Chih,Ming-Yuan %A Sarma,Prathusha %A Gustafson,David %A Curtin,John %A Shah,Dhavan %+ School of Communication and Mass Media, Northwest Missouri State University, 800 University Dr, 239 Wells Hall, Maryville, MO, 64468, United States, 1 6605621618, eyang@nwmissouri.edu %K supervised machine learning %K online peer support forum %K expression effects %K content analysis %K substance use disorder %K mobile phone %D 2023 %7 22.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphone-based apps are increasingly used to prevent relapse among those with substance use disorders (SUDs). These systems collect a wealth of data from participants, including the content of messages exchanged in peer-to-peer support forums. How individuals self-disclose and exchange social support in these forums may provide insight into their recovery course, but a manual review of a large corpus of text by human coders is inefficient. Objective: The study sought to evaluate the feasibility of applying supervised machine learning (ML) to perform large-scale content analysis of an online peer-to-peer discussion forum. Machine-coded data were also used to understand how communication styles relate to writers’ substance use and well-being outcomes. Methods: Data were collected from a smartphone app that connects patients with SUDs to online peer support via a discussion forum. Overall, 268 adult patients with SUD diagnoses were recruited from 3 federally qualified health centers in the United States beginning in 2014. Two waves of survey data were collected to measure demographic characteristics and study outcomes: at baseline (before accessing the app) and after 6 months of using the app. Messages were downloaded from the peer-to-peer forum and subjected to manual content analysis. These data were used to train supervised ML algorithms using features extracted from the Linguistic Inquiry and Word Count (LIWC) system to automatically identify the types of expression relevant to peer-to-peer support. Regression analyses examined how each expression type was associated with recovery outcomes. Results: Our manual content analysis identified 7 expression types relevant to the recovery process (emotional support, informational support, negative affect, change talk, insightful disclosure, gratitude, and universality disclosure). Over 6 months of app use, 86.2% (231/268) of participants posted on the app’s support forum. Of these participants, 93.5% (216/231) posted at least 1 message in the content categories of interest, generating 10,503 messages. Supervised ML algorithms were trained on the hand-coded data, achieving F1-scores ranging from 0.57 to 0.85. Regression analyses revealed that a greater proportion of the messages giving emotional support to peers was related to reduced substance use. For self-disclosure, a greater proportion of the messages expressing universality was related to improved quality of life, whereas a greater proportion of the negative affect expressions was negatively related to quality of life and mood. Conclusions: This study highlights a method of natural language processing with potential to provide real-time insights into peer-to-peer communication dynamics. First, we found that our ML approach allowed for large-scale content coding while retaining moderate-to-high levels of accuracy. Second, individuals’ expression styles were associated with recovery outcomes. The expression types of emotional support, universality disclosure, and negative affect were significantly related to recovery outcomes, and attending to these dynamics may be important for appropriate intervention. %M 37606984 %R 10.2196/45589 %U https://www.jmir.org/2023/1/e45589 %U https://doi.org/10.2196/45589 %U http://www.ncbi.nlm.nih.gov/pubmed/37606984 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e43837 %T Novel At-Home Mother’s Milk Conductivity Sensing Technology as an Identification System of Delay in Milk Secretory Activation Progress and Early Breastfeeding Problems: Feasibility Assessment %A Haramati,Sharon %A Firsow,Anastasia %A Navarro,Daniela Abigail %A Shechter,Ravid %+ MyMilk Laboratories Ltd, Glil Yam, Kibbutz, Glil Yam, 4690500, Israel, 972 526166705, shechter.ravid@gmail.com %K breastfeeding %K feasibility %K human milk %K biomarker %K remote sensing technology %K mobile health %K retrospective %K secretory activation %K lactogenesis %K milk supply %K milk %K sensing technology %K monitoring tool %K lactation %K exclusive breastfeeding %K breastfeed %K maternal health %K maternal and infant health %K infant health %K maternal and child health %K prolactin %K lactation consultant %K lactation support provider %K mother %K milk maturation %D 2023 %7 22.8.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Prolonged exclusive breastfeeding is a public health priority and a personal desire by mothers; however, rates are low with milk supply challenges as a predominant cause. Early breastfeeding management at home is key. Milk electrolytes, mainly sodium ions, are accepted as biomarkers of secretory activation processes throughout the first weeks after birth and predictors for prolonged breastfeeding success, although they are not incorporated into routine care practice. Objective: The aim of this study was to test the feasibility of a novel handheld smartphone-operated milk conductivity sensing system that was designed to compute a novel parameter, milk maturation percent (MM%), calculated from milk sample conductivity for tracking individual secretory activation progress in a real-world home setting. Methods: System performance was initially evaluated in data collected from laboratory-based milk analysis, followed by a retrospective analysis of observational real-world data gathered with the system, on the spot in an at-home setting, implemented by lactation support providers or directly by mothers (N=592). Data collected included milk sample sensing data, baby age, and self-reported breastfeeding status and breastfeeding-related conditions. The data were retroactively classified in a day after birth–dependent manner. Results were compared between groups classified according to breastfeeding exclusivity and breastfeeding problems associated with ineffective breastfeeding and low milk supply. Results: Laboratory analysis in a set of breast milk samples demonstrated a strong correlation between the system’s results and sodium ion levels. In the real-world data set, a total of 1511 milk sensing records were obtained on the spot with over 592 real-world mothers. Data gathered with the system revealed a typical time-dependent increase in the milk maturation parameter (MM%), characterized by an initial steep increase, followed by a moderate increase, and reaching a plateau during the first weeks postpartum. Additionally, MM% levels captured by the system were found to be sensitive to breastfeeding status classifications of exclusive breastfeeding and breastfeeding problems, manifested by differences in group means in the several-day range after birth, predominantly during the first weeks postpartum. Differences could also be demonstrated for the per-case time after birth–dependent progress in individual mothers. Conclusions: This feasibility study demonstrates that the use of smart milk conductivity sensing technology can provide a robust, objective measure of individual breastfeeding efficiency, facilitating remote data collection within a home setting. This system holds considerable potential to augment both self-monitoring and remote breastfeeding management capabilities, as well as to refine clinical classifications. To further validate the clinical relevance and potential of this home milk monitoring tool, future controlled clinical studies are necessary, which will provide insights into its impact on user and care provider satisfaction and its potential to meet breastfeeding success goals. %M 37464893 %R 10.2196/43837 %U https://pediatrics.jmir.org/2023/1/e43837 %U https://doi.org/10.2196/43837 %U http://www.ncbi.nlm.nih.gov/pubmed/37464893 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46415 %T Internet-Based Recruitment and Retention of Young Adults With Type 1 Diabetes: Cross-Sectional Study %A Griggs,Stephanie %A Ash,Garrett I %A Pignatiello,Grant %A Papik,AnnMarie %A Huynh,Johnathan %A Leuchtag,Mary %A Hickman Jr,Ronald L %+ Case Western Reserve University Frances Payne Bolton School of Nursing, 2120 Cornell Road, Cleveland, OH, 44145, United States, 1 216 385 1244, stephanie.griggs@case.edu %K type 1 diabetes %K internet-based recruitment %K young adult %K diabetes %K diabetic %K type 1 %K recruit %K research platform %K T1D %K social media %K research subject %K research participant %K study participant %D 2023 %7 22.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Multiple research strategies are required to recruit and engage a representative cohort of young adults in diabetes research. In this report, we describe an approach for internet-based recruitment for a repeated-measures descriptive study. Objective: The objective of this cross-sectional study was to determine whether internet-based recruitment through multiple social media platforms, a clinical research platform, and cooperation with community partnerships—College Diabetes Network and Beyond Type 1—would serve as an effective way to recruit a representative sample of young adults aged 18-25 years with type 1 diabetes (T1D). Methods: We conducted a repeated-measures descriptive study. We captured enrollment rates and participant characteristics acquired from each social media platform through survey data and Facebook analytics. This study was advertised via paid postings across a combination of different social media platforms (eg, Facebook, Instagram, Twitter, and Reddit). We used quarterly application postings, quarterly newsletters, and participation in the ResearchMatch registry to identify potentially eligible participants from February 3, 2021, to June 6, 2022. Results: ResearchMatch proved to be the most cost-effective strategy overall, yielding the highest gender and racial diversity compared to other internet platforms (eg, Facebook, Instagram, Twitter, and Reddit), application postings (eg, Beyond Type 1), and newsletters (eg, College Diabetes Network and a local area college). However, we propose that the combination of these approaches yielded a larger, more diverse sample compared to any individual strategy. Our recruitment cost was US $16.69 per eligible participant, with a 1.27% conversion rate and a 30% eligibility rate. Conclusions: Recruiting young adults with T1D across multiple internet-based platforms was an effective strategy to yield a moderately diverse sample. Leveraging various recruitment strategies is necessary to produce a representative sample of young adults with T1D. As the internet becomes a larger forum for study recruitment, participants from underrepresented backgrounds may continue engaging in research through advertisements on the internet and other internet-based recruitment platforms. %M 37606985 %R 10.2196/46415 %U https://formative.jmir.org/2023/1/e46415 %U https://doi.org/10.2196/46415 %U http://www.ncbi.nlm.nih.gov/pubmed/37606985 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43593 %T Response Consistency of Crowdsourced Web-Based Surveys on Type 1 Diabetes %A Lin,Yu Kuei %A Newman,Sean %A Piette,John %+ Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, 1000 Wall Street, Brehm 5119, Ann Arbor, MI, 48105, United States, 1 734 232 1573, yuklin@med.umich.edu %K diabetes %K Amazon Mechanical Turk %K MTurk %K crowdsourcing %K survey %K type 1 diabetes %K T1D %K cross-sectional survey %K website %K online platform %K web-based platform %K reliability %D 2023 %7 18.8.2023 %9 Research Letter %J J Med Internet Res %G English %X Although Amazon Mechanical Turk facilitates the quick surveying of a large sample from various demographic and socioeconomic backgrounds, it may not be an optimal platform for obtaining reliable diabetes-related information from the online type 1 diabetes population. %M 37594797 %R 10.2196/43593 %U https://www.jmir.org/2023/1/e43593 %U https://doi.org/10.2196/43593 %U http://www.ncbi.nlm.nih.gov/pubmed/37594797 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46478 %T Video Recording Patients for Direct Care Purposes: Systematic Review and Narrative Synthesis of International Empirical Studies and UK Professional Guidance %A Lear,Rachael %A Ellis,Sophia %A Ollivierre-Harris,Tiffany %A Long,Susannah %A Mayer,Erik K %+ Imperial Clinical Analytics, Research & Evaluation (iCARE), Digital Collaboration Space, St Mary's Hospital Campus, 1a Sheldon Square, Imperial College London, London, W2 6PY, United Kingdom, 44 07969064617, r.lear12@imperial.ac.uk %K video recording %K audio-visual media %K digital health %K electronic health records %K mobile phone %D 2023 %7 16.8.2023 %9 Review %J J Med Internet Res %G English %X Background: Video recordings of patients may offer advantages to supplement patient assessment and clinical decision-making. However, little is known about the practice of video recording patients for direct care purposes. Objective: We aimed to synthesize empirical studies published internationally to explore the extent to which video recording patients is acceptable and effective in supporting direct care and, for the United Kingdom, to summarize the relevant guidance of professional and regulatory bodies. Methods: Five electronic databases (MEDLINE, Embase, APA PsycINFO, CENTRAL, and HMIC) were searched from 2012 to 2022. Eligible studies evaluated an intervention involving video recording of adult patients (≥18 years) to support diagnosis, care, or treatment. All study designs and countries of publication were included. Websites of UK professional and regulatory bodies were searched to identify relevant guidance. The acceptability of video recording patients was evaluated using study recruitment and retention rates and a framework synthesis of patients’ and clinical staff’s perspectives based on the Theoretical Framework of Acceptability by Sekhon. Clinically relevant measures of impact were extracted and tabulated according to the study design. The framework approach was used to synthesize the reported ethico-legal considerations, and recommendations of professional and regulatory bodies were extracted and tabulated. Results: Of the 14,221 abstracts screened, 27 studies met the inclusion criteria. Overall, 13 guidance documents were retrieved, of which 7 were retained for review. The views of patients and clinical staff (16 studies) were predominantly positive, although concerns were expressed about privacy, technical considerations, and integrating video recording into clinical workflows; some patients were anxious about their physical appearance. The mean recruitment rate was 68.2% (SD 22.5%; range 34.2%-100%; 12 studies), and the mean retention rate was 73.3% (SD 28.6%; range 16.7%-100%; 17 studies). Regarding effectiveness (10 studies), patients and clinical staff considered video recordings to be valuable in supporting assessment, care, and treatment; in promoting patient engagement; and in enhancing communication and recall of information. Observational studies (n=5) favored video recording, but randomized controlled trials (n=5) did not demonstrate that video recording was superior to the controls. UK guidelines are consistent in their recommendations around consent, privacy, and storage of recordings but lack detailed guidance on how to operationalize these recommendations in clinical practice. Conclusions: Video recording patients for direct care purposes appears to be acceptable, despite concerns about privacy, technical considerations, and how to incorporate recording into clinical workflows. Methodological quality prevents firm conclusions from being drawn; therefore, pragmatic trials (particularly in older adult care and the movement disorders field) should evaluate the impact of video recording on diagnosis, treatment monitoring, patient-clinician communication, and patient safety. Professional and regulatory documents should signpost to practical guidance on the implementation of video recording in routine practice. Trial Registration: PROSPERO CRD42022331825: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=331825 %M 37585249 %R 10.2196/46478 %U https://www.jmir.org/2023/1/e46478 %U https://doi.org/10.2196/46478 %U http://www.ncbi.nlm.nih.gov/pubmed/37585249 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45146 %T The Adverse Effects and Nonmedical Use of Methylphenidate Before and After the Outbreak of COVID-19: Machine Learning Analysis %A Shin,Hocheol %A Yuniar,Cindra Tri %A Oh,SuA %A Purja,Sujata %A Park,Sera %A Lee,Haeun %A Kim,Eunyoung %+ Evidence-Based Clinical Research Laboratory, Department of Health Science and Clinical Pharmacy, Chung-Ang University, Heok-seok Ro 84, Seoul, 06974, Republic of Korea, 82 28205791, eykimjcb777@cau.ac.kr %K methylphenidate %K attention-deficit/hyperactivity disorder (ADHD) %K social network services %K adverse effect %K nonmedical use %K machine learning %K deep learning %K child %K adolescent %K psychiatric disorder %D 2023 %7 16.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Methylphenidate is an effective first-line treatment for attention-deficit/hyperactivity disorder (ADHD). However, many adverse effects of methylphenidate have been recorded from randomized clinical trials and patient-reported outcomes, but it is difficult to determine abuse from them. In the context of COVID-19, it is important to determine how drug use evaluation, as well as misuse of drugs, have been affected by the pandemic. As people share their reasons for using medication, patient sentiments, and the effects of medicine on social networking services (SNSs), the application of machine learning and SNS data can be a method to overcome the limitations. Proper machine learning models could be evaluated to validate the effects of the COVID-19 pandemic on drug use. Objective: To analyze the effect of the COVID-19 pandemic on the use of methylphenidate, this study analyzed the adverse effects and nonmedical use of methylphenidate and evaluated the change in frequency of nonmedical use based on SNS data before and after the outbreak of COVID-19. Moreover, the performance of 4 machine learning models for classifying methylphenidate use based on SNS data was compared. Methods: In this cross-sectional study, SNS data on methylphenidate from Twitter, Facebook, and Instagram from January 2019 to December 2020 were collected. The frequency of adverse effects, nonmedical use, and drug use before and after the COVID-19 pandemic were compared and analyzed. Interrupted time series analysis about the frequency and trends of nonmedical use of methylphenidate was conducted for 24 months from January 2019 to December 2020. Using the labeled training data set and features, the following 4 machine learning models were built using the data, and their performance was evaluated using F-1 scores: naïve Bayes classifier, random forest, support vector machine, and long short-term memory. Results: This study collected 146,352 data points and detected that 4.3% (6340/146,352) were firsthand experience data. Psychiatric problems (521/1683, 31%) had the highest frequency among the adverse effects. The highest frequency of nonmedical use was for studies or work (741/2016, 36.8%). While the frequency of nonmedical use before and after the outbreak of COVID-19 has been similar (odds ratio [OR] 1.02 95% CI 0.91-1.15), its trend has changed significantly due to the pandemic (95% CI 2.36-22.20). Among the machine learning models, RF had the highest performance of 0.75. Conclusions: The trend of nonmedical use of methylphenidate has changed significantly due to the COVID-19 pandemic. Among the machine learning models using SNS data to analyze the adverse effects and nonmedical use of methylphenidate, the random forest model had the highest performance. %M 37585250 %R 10.2196/45146 %U https://www.jmir.org/2023/1/e45146 %U https://doi.org/10.2196/45146 %U http://www.ncbi.nlm.nih.gov/pubmed/37585250 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41774 %T Web-Based 24-Hour Dietary Recall Tool for Russian Adults and School-Aged Children: Validation Study %A Pigat,Sandrine %A Soshina,Mariya %A Berezhnaya,Yulia %A Kryzhanovskaya,Ekaterina %+ PepsiCo, Inc, Leningradskii Prospect, 72/4, Moscow, 125315, Russian Federation, 7 495 937 05 50, Mariya.Soshina@pepsico.com %K dietary assessment %K 24-hour dietary recall %K extent of agreement %K energy and nutrient intake %K Russian diet %K interviewer-administered %K web-based self-administered %K diet %K food intake %K dietary recall %K energy intake %K nutrient intake %D 2023 %7 16.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Data on dietary intakes in Russian adults and children are assessed very infrequently primarily due to the time, cost, and burden to the participants for assessing dietary patterns. To overcome some of those challenges, the use of web-based 24-hour recall methods can be successfully used. Objective: The study objective is to assess the extent of agreement between a self-administered and an interviewer-administered 24-hour dietary recall in Russian adults and school-aged children using an adaptation of a web-based 24-hour recall tool. Methods: This web-based dietary assessment tool is based on a previously validated tool, which has been adapted to the Russian diet and language. A randomized 50% (n=97) of 194 participants initially completed a self-administered web-based dietary recall, followed by an interviewer-administered 24-hour dietary recall later that same day, and vice versa for the other 50% (n=97) of participants. Following at least 1 week wash-out period, during visit 2, participant groups completed the 2 dietary recalls in the opposite order. Statistical analysis was carried out on the intake results from both methods for the 2 recalls. Finally, an evaluation questionnaire on ease-of-use of the tool was also completed. Results: In total, intakes of 28 nutrients and energy were analyzed in this study. The Bland-Altman analysis showed that between 98.4% and 90.5% of data points were within the limits of agreement among all age groups and nutrients analyzed. A “moderate to excellent” reliability between the 2 methods was observed in younger children. In older children, a “moderate to good” reliability was observed, with the exception of sodium. In adults, “moderate to excellent” reliability between both methods was observed with the exception of vitamins B1, B2, and B6, and pantothenic acid. The level of agreement between the categorization of estimates into thirds of the intake distribution for the average of the 2 days was satisfactory, since the percentages of participants categorized into the same tertile of intake were ˃50%, and the percentages of participants categorized into the opposite tertile of intake were <10%. The majority of respondents were very positive in their evaluation of the web-based dietary assessment tool. Conclusions: Overall, the web-based dietary assessment tool performs well when compared with a face-to-face, interviewer-administered 24-hour dietary recall and provides comparable estimates of energy and nutrient intakes in Russian adults and children. Trial Registration: ClinicalTrials.gov NCT04372160; https://clinicaltrials.gov/ct2/show/NCT04372160 %M 37585243 %R 10.2196/41774 %U https://formative.jmir.org/2023/1/e41774 %U https://doi.org/10.2196/41774 %U http://www.ncbi.nlm.nih.gov/pubmed/37585243 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48308 %T Investigating Individuals’ Preferences in Determining the Functions of Smartphone Apps for Fighting Pandemics: Best-Worst Scaling Survey Study %A Xu,Richard Huan %A Shi,Lushaobo %A Shi,Zengping %A Li,Ting %A Wang,Dong %+ School of Health Management, Southern Medical University, Shatai Road, Guangzhou, 1838, China, 86 61647576, dongw96@smu.edu.cn %K best-worst scaling %K BWS %K smartphone app %K app %K pandemic %K preference %K health care %K survey %D 2023 %7 15.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphone apps have been beneficial in controlling and preventing the COVID-19 pandemic. However, there is a gap in research surrounding the importance of smartphone app functions from a user’s perspective. Although the insights and opinions of different stakeholders, such as policymakers and medical professionals, can influence the success of a public health policy, any strategy will face difficulty in achieving the expected effect if it is not based on a method that users can accept. Objective: This study aimed to assess the importance of a hypothetical smartphone app’s functions for managing health during a pandemic based on the perspective of user preferences. Methods: A cross-sectional and web-based survey using the best-worst scaling (BWS) method was used to investigate the general population’s preferences for important smartphone app functions. Participants were recruited from a professional surveying company’s web-based surveying panel. The attributes of the BWS questionnaire were developed based on a robust process, including literature review, interviews, and expert discussion. A balanced incomplete block design was used to construct the choice task to ensure the effectiveness of the research design. Count analysis, conditional logit model analysis, and mixed logit analysis were used to estimate preference heterogeneity among respondents. Results: The responses of 2153 participants were eligible for analysis. Nearly 55% (1192/2153) were female, and the mean age was 31.4 years. Most participants (1765/2153, 81.9%) had completed tertiary or higher education, and approximately 70% (1523/2153) were urban residents. The 3 most vital functions according to their selection were “surveillance and monitoring of infected cases,” “quick self-screening,” and “early detection of infected cases.” The mixed logit regression model identified significant heterogeneity in preferences among respondents, and stratified analysis showed that some heterogeneities varied in respondents by demographics and COVID-19–related characteristics. Participants who preferred to use the app were more likely to assign a high weight to the preventive functions than those who did not prefer to use it. Conversely, participants who showed lower willingness to use the app tended to indicate a higher preference for supportive functions than those who preferred to use it. Conclusions: This study ranks the importance of smartphone app features that provide health care services during a pandemic based on the general population’s preferences in China. It provides empirical evidence for decision-makers to develop eHealth policies and strategies that address future public health crises from a person-centered care perspective. Continued use of apps and smart investment in digital health can help improve health outcomes and reduce the burden of disease on individuals and communities. %M 37581916 %R 10.2196/48308 %U https://www.jmir.org/2023/1/e48308 %U https://doi.org/10.2196/48308 %U http://www.ncbi.nlm.nih.gov/pubmed/37581916 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45952 %T Gender Affirmation–Related Information-Seeking Behaviors in a Diverse Sample of Transgender and Gender-Diverse Young Adults: Survey Study %A Boskey,Elizabeth R %A Quint,Meg %A Xu,Rena %A Kremen,Jessica %A Estrada,Carlos %A Tham,Regina %A Kane,Kaiden %A Reisner,Sari L %+ Division of Gynecology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States, 1 617 919 6525, Elizabeth.Boskey@childrens.harvard.edu %K web-based health %K information seeking %K transgender youth %K health communication %K survey %K gender diverse %K youth %K United States %K support %K gender identity %K accessibility %K transgender community %K web-based information %D 2023 %7 15.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Of the 1.6 million transgender and gender-diverse (TGD) people in the United States, approximately 700,000 are youth aged 13-24 years. Many factors make it difficult for TGD young people to identify resources for support and information related to gender identity and medical transition. These range from lack of knowledge to concerns about personal safety in the setting of increased antitransgender violence and legislative limitations on transgender rights. Web-based resources may be able to address some of the barriers to finding information and support, but youth may have difficulty finding relevant content or have concerns about the quality and content of information they find on the internet. Objective: We aim to understand ways TGD young adults look for web-based information about gender and health. Methods: In August 2022, 102 young adults completed a 1-time survey including closed- and open-ended responses. Individuals were recruited through the Prolific platform. Eligibility was restricted to people between the ages of 18-25 years who identified as transgender and were residents of the United States. The initial goal was to recruit 50 White individuals and 50 individuals who identified as Black, indigenous, or people of color. In total, 102 people were eventually enrolled. Results: Young adults reported looking on the internet for information about a broad range of topics related to both medical- and social-gender affirmation. Most participants preferred to obtain information via personal stories. Participants expressed a strong preference for obtaining information from other trans people. Conclusions: There is a need for accessible, expert-informed information for TGD youth, particularly more information generated for the transgender community by members of the community. %M 37581925 %R 10.2196/45952 %U https://formative.jmir.org/2023/1/e45952 %U https://doi.org/10.2196/45952 %U http://www.ncbi.nlm.nih.gov/pubmed/37581925 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44813 %T Identifying the Most Effective Recruitment Strategy Using Financial Reimbursements for a Web-Based Peer Network Study With Young People Aged 16-18 Years: Protocol for a Randomized Controlled Trial %A Raggatt,Michelle %A Wright,Cassandra J C %A Sacks-Davis,Rachel %A Dietze,Paul M %A Hellard,Margaret E %A Hocking,Jane S %A Lim,Megan S C %+ Burnet Institute, 85 Commercial Rd, Burnet Institute, Melbourne, 3004, Australia, 61 0413104901, megan.lim@burnet.edu.au %K young adult %K incentive reimbursement %K research subject %K study participant %K financial %K research subject recruitment %K social network %K peer network %K web-based network %K randomized %K friend %K recruit %K incentive %K reimburse %K reward %K incentivized %K youth %K adolescent %K teenage %K recruitment %K reinforcing factor %K enabling factor %K disambiguation %K intrinsic incentive %K extrinsic incentive %K motivation %K reward system %K positive reinforcement %K compensation %K monetary %K remuneration %K remunerative incentive %K financial incentive %K bonus %K stipend %K donation %D 2023 %7 11.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Peers are an important determinant of health and well-being during late adolescence; however, there is limited quantitative research examining peer influence. Previous peer network research with adolescents faced methodological limitations and difficulties recruiting young people. Objective: This study aims to determine whether a web-based peer network survey is effective at recruiting adolescent peer networks by comparing 2 strategies for reimbursement. Methods: This study will use a 2-group randomized trial design to test the effectiveness of reimbursements for peer referral in a web-based cross-sectional peer network survey. Young people aged 16-18 years recruited through Instagram, Snapchat, and a survey panel will be randomized to receive either scaled group reimbursement (the experimental group) or fixed individual reimbursement (the control group). All participants will receive a reimbursement of Aus $5 (US $3.70) for their own survey completion. In the experimental group (scaled group reimbursement), all participants within a peer network will receive an additional Aus $5 (US $3.70) voucher for each referred participant who completes the study, up to a maximum total value of Aus $30 (US $22.20) per participant. In the control group (fixed individual reimbursement), participants will only be reimbursed for their own survey completion. Participants’ peer networks are assessed during the survey by asking about their close friends. A unique survey link will be generated to share with the participant’s nominated friends for the recruitment of secondary participants. Outcomes are the proportion of a participant’s peer network and the number of referred peers who complete the survey. The required sample size is 306 primary participants. Using a multilevel logistic regression model, we will assess the effect of the reimbursement intervention on the proportion of primary participants’ close friends who complete the survey. The secondary aim is to determine participant characteristics that are associated with successfully recruiting close friends. Young people aged 16-18 years were involved in the development of the study design through focus groups and interviews (n=26). Results: Participant recruitment commenced in 2022. Conclusions: A longitudinal web-based social network study could provide important data on how social networks and their influence change over time. This trial aims to determine whether scaled group reimbursement can increase the number of peers referred. The outcomes of this trial will improve the recruitment of young people to web-based network studies of sensitive health issues. International Registered Report Identifier (IRRID): DERR1-10.2196/44813 %M 37566448 %R 10.2196/44813 %U https://www.researchprotocols.org/2023/1/e44813 %U https://doi.org/10.2196/44813 %U http://www.ncbi.nlm.nih.gov/pubmed/37566448 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42153 %T Evaluating the Usability of Electronic Patient-Reported Outcome Apps: Comment on a Symptom Management Platform for Outpatients With Advanced Cancer %A Haniuda,Yu %A Tsubaki,Michihiro %A Ito,Yoshiyasu %+ Department of Emergency Nursing, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara City, Kanagawa, 252-0375, Japan, 81 42 778 8111, h.yuuuu.1994@gmail.com %K electronic patient-reported outcome %K symptom management %K advanced cancer %K outpatient %K follow-up %K cancer %D 2023 %7 7.8.2023 %9 Letter to the Editor %J JMIR Form Res %G English %X %M 37548992 %R 10.2196/42153 %U https://formative.jmir.org/2023/1/e42153 %U https://doi.org/10.2196/42153 %U http://www.ncbi.nlm.nih.gov/pubmed/37548992 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e48270 %T Accuracy and Reliability of a Suite of Digital Measures of Walking Generated Using a Wrist-Worn Sensor in Healthy Individuals: Performance Characterization Study %A Kowahl,Nathan %A Shin,Sooyoon %A Barman,Poulami %A Rainaldi,Erin %A Popham,Sara %A Kapur,Ritu %+ Verily Life Sciences, 269 E Grand Ave, South San Francisco, CA, 94080, United States, 1 415 504 2681, natekowahl@verily.com %K digital measurements %K wearable technology %K mobility measurements %K walking patterns %K wearable %K wearables %K sensor %K sensors %K mobility %K measurement %K measurements %K walk %K walking %K gait %K step %K wrist-worn %K reliability %K accuracy %D 2023 %7 3.8.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobility is a meaningful aspect of an individual’s health whose quantification can provide clinical insights. Wearable sensor technology can quantify walking behaviors (a key aspect of mobility) through continuous passive monitoring. Objective: Our objective was to characterize the analytical performance (accuracy and reliability) of a suite of digital measures of walking behaviors as critical aspects in the practical implementation of digital measures into clinical studies. Methods: We collected data from a wrist-worn device (the Verily Study Watch) worn for multiple days by a cohort of volunteer participants without a history of gait or walking impairment in a real-world setting. On the basis of step measurements computed in 10-second epochs from sensor data, we generated individual daily aggregates (participant-days) to derive a suite of measures of walking: step count, walking bout duration, number of total walking bouts, number of long walking bouts, number of short walking bouts, peak 30-minute walking cadence, and peak 30-minute walking pace. To characterize the accuracy of the measures, we examined agreement with truth labels generated by a concurrent, ankle-worn, reference device (Modus StepWatch 4) with known low error, calculating the following metrics: intraclass correlation coefficient (ICC), Pearson r coefficient, mean error, and mean absolute error. To characterize the reliability, we developed a novel approach to identify the time to reach a reliable readout (time to reliability) for each measure. This was accomplished by computing mean values over aggregation scopes ranging from 1 to 30 days and analyzing test-retest reliability based on ICCs between adjacent (nonoverlapping) time windows for each measure. Results: In the accuracy characterization, we collected data for a total of 162 participant-days from a testing cohort (n=35 participants; median observation time 5 days). Agreement with the reference device–based readouts in the testing subcohort (n=35) for the 8 measurements under evaluation, as reflected by ICCs, ranged between 0.7 and 0.9; Pearson r values were all greater than 0.75, and all reached statistical significance (P<.001). For the time-to-reliability characterization, we collected data for a total of 15,120 participant-days (overall cohort N=234; median observation time 119 days). All digital measures achieved an ICC between adjacent readouts of >0.75 by 16 days of wear time. Conclusions: We characterized the accuracy and reliability of a suite of digital measures that provides comprehensive information about walking behaviors in real-world settings. These results, which report the level of agreement with high-accuracy reference labels and the time duration required to establish reliable measure readouts, can guide the practical implementation of these measures into clinical studies. Well-characterized tools to quantify walking behaviors in research contexts can provide valuable clinical information about general population cohorts and patients with specific conditions. %M 37535417 %R 10.2196/48270 %U https://humanfactors.jmir.org/2023/1/e48270 %U https://doi.org/10.2196/48270 %U http://www.ncbi.nlm.nih.gov/pubmed/37535417 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41412 %T Predicting Participation Willingness in Ecological Momentary Assessment of General Population Health and Behavior: Machine Learning Study %A Murray,Aja %A Ushakova,Anastasia %A Zhu,Xinxin %A Yang,Yi %A Xiao,Zhuoni %A Brown,Ruth %A Speyer,Lydia %A Ribeaud,Denis %A Eisner,Manuel %+ Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, United Kingdom, 44 0131 650 3455, aja.murray@ed.ac.uk %K ecological momentary assessment %K experience sampling %K machine learning %K recruitment %K sampling %D 2023 %7 2.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Ecological momentary assessment (EMA) is widely used in health research to capture individuals’ experiences in the flow of daily life. The majority of EMA studies, however, rely on nonprobability sampling approaches, leaving open the possibility of nonrandom participation concerning the individual characteristics of interest in EMA research. Knowledge of the factors that predict participation in EMA research is required to evaluate this possibility and can also inform optimal recruitment strategies. Objective: This study aimed to examine the extent to which being willing to participate in EMA research is related to respondent characteristics and to identify the most critical predictors of participation. Methods: We leveraged the availability of comprehensive data on a general young adult population pool of potential EMA participants and used and compared logistic regression, classification and regression trees, and random forest approaches to evaluate respondents’ characteristic predictors of willingness to participate in the Decades-to-Minutes EMA study. Results: In unadjusted logistic regression models, gender, migration background, anxiety, attention deficit hyperactivity disorder symptoms, stress, and prosociality were significant predictors of participation willingness; in logistic regression models, mutually adjusting for all predictors, migration background, tobacco use, and social exclusion were significant predictors. Tree-based approaches also identified migration status, tobacco use, and prosociality as prominent predictors. However, overall, willingness to participate in the Decades-to-Minutes EMA study was only weakly predictable from respondent characteristics. Cross-validation areas under the curve for the best models were only in the range of 0.56 to 0.57. Conclusions: Results suggest that migration background is the single most promising target for improving EMA participation and sample representativeness; however, more research is needed to improve prediction of participation in EMA studies in health. %M 37531181 %R 10.2196/41412 %U https://www.jmir.org/2023/1/e41412 %U https://doi.org/10.2196/41412 %U http://www.ncbi.nlm.nih.gov/pubmed/37531181 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48405 %T Results and Methodological Implications of the Digital Epidemiology of Prescription Drug References Among Twitter Users: Latent Dirichlet Allocation (LDA) Analyses %A Parker,Maria A %A Valdez,Danny %A Rao,Varun K %A Eddens,Katherine S %A Agley,Jon %+ Department of Epidemiology and Biostatistics, School of Public Health, Indiana University Bloomington, 809 E 9th St, Bloomington, IN, 47405, United States, 1 812 856 5950, map2@iu.edu %K Twitter %K LDA %K drug use %K digital epidemiology %K unsupervised analysis %K tweet %K tweets %K social media %K epidemiology %K epidemiological %K machine learning %K text mining %K data mining %K pharmacy %K pharmaceutic %K pharmaceutical %K pharmaceuticals %K drug %K prescription %K NLP %K natural language processing %D 2023 %7 28.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media is an important information source for a growing subset of the population and can likely be leveraged to provide insight into the evolving drug overdose epidemic. Twitter can provide valuable insight into trends, colloquial information available to potential users, and how networks and interactivity might influence what people are exposed to and how they engage in communication around drug use. Objective: This exploratory study was designed to investigate the ways in which unsupervised machine learning analyses using natural language processing could identify coherent themes for tweets containing substance names. Methods: This study involved harnessing data from Twitter, including large-scale collection of brand name (N=262,607) and street name (N=204,068) prescription drug–related tweets and use of unsupervised machine learning analyses (ie, natural language processing) of collected data with data visualization to identify pertinent tweet themes. Latent Dirichlet allocation (LDA) with coherence score calculations was performed to compare brand (eg, OxyContin) and street (eg, oxys) name tweets. Results: We found people discussed drug use differently depending on whether a brand name or street name was used. Brand name categories often contained political talking points (eg, border, crime, and political handling of ongoing drug mitigation strategies). In contrast, categories containing street names occasionally referenced drug misuse, though multiple social uses for a term (eg, Sonata) muddled topic clarity. Conclusions: Content in the brand name corpus reflected discussion about the drug itself and less often reflected personal use. However, content in the street name corpus was notably more diverse and resisted simple LDA categorization. We speculate this may reflect effective use of slang terminology to clandestinely discuss drug-related activity. If so, straightforward analyses of digital drug-related communication may be more difficult than previously assumed. This work has the potential to be used for surveillance and detection of harmful drug use information. It also might be used for appropriate education and dissemination of information to persons engaged in drug use content on Twitter. %M 37505795 %R 10.2196/48405 %U https://www.jmir.org/2023/1/e48405 %U https://doi.org/10.2196/48405 %U http://www.ncbi.nlm.nih.gov/pubmed/37505795 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47320 %T Studying Movement-Related Behavioral Maintenance and Adoption in Real Time: Protocol for an Intensive Ecological Momentary Assessment Study Among Older Adults %A Maher,Jaclyn P %A Hevel,Derek J %A Bittel,Kelsey M %A Hudgins,Brynn L %A Labban,Jeffery D %A Kennedy-Malone,Laurie %+ Department of Kinesiology, University of North Carolina Greensboro, 1408 Walker Avenue, Coleman Bldg, Rm 250, Greensboro, NC, 27401, United States, 1 3362561379, jpmaher@uncg.edu %K physical activity %K sedentary behavior %K aging %K multiburst design %K ambulatory assessment %K experience sampling method %K accelerometers %K stage of change %K dual process %K motivation %K mobile phone %D 2023 %7 28.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older adults struggle to maintain newly initiated levels of physical activity (PA) or sedentary behavior (SB) and often regress to baseline levels over time. This is partly because health behavior theories that inform interventions rarely address how the changing contexts of daily life influence the processes regulating PA and SB or how those processes differ across the behavior change continuum. Few studies have focused on motivational processes that regulate the dynamic nature of PA and SB adoption and maintenance on microtimescales (ie, across minutes, hours, or days). Objective: The overarching goal of Project Studying Maintenance and Adoption in Real Time (SMART) is to determine the motivational processes that regulate behavioral adoption versus maintenance over microtimescales, using a dual process framework combined with ecological momentary assessment and sensor-based monitoring of behavior. This paper describes the recruitment, enrollment, data collection, and analytics protocols for Project SMART. Methods: In Project SMART, older adults engaging in at least 30 minutes of moderate-to-vigorous intensity PA per week complete 3 data collection periods over 1 year, with each data collection period lasting 14 days. Across each data collection period, participants wear an ActiGraph GT3X accelerometer (ActiGraph, LLC) on their nondominant waist and an ActivPAL micro4 accelerometer (PAL Technologies, Ltd) on their anterior thigh to measure PA and SB, respectively. Ecological momentary assessment questionnaires are randomly delivered via smartphone 10 times per day on 4 selected days in each data collection period and assess reflective processes (eg, evaluating one’s efficacy and exerting self-control) and reactive processes (eg, contextual cues) within the dual process framework. At the beginning and end of each data collection period, participants complete a computer-based questionnaire to learn more about their typical motivation for PA and SB, physical and mental health, and life events over the course of the study. Results: Recruitment and enrollment began in January 2021; enrollment in the first data collection period was completed by February 2022; and all participants completed their second and third data collection by July 2022 and December 2022, respectively. Data were collected from 202 older adults during the first data collection period, with approximate retention rates of 90.1% (n=182) during the second data collection period and 88.1% (n=178) during the third data collection period. Multilevel models and mixed-effects location scale modeling will be used to evaluate the study aims. Conclusions: Project SMART seeks to predict and model the adoption and maintenance of optimal levels of PA and SB among older adults. In turn, this will inform the future delivery of personalized intervention content under conditions where the content will be most effective to promote sustained behavior change among older adults. International Registered Report Identifier (IRRID): DERR1-10.2196/47320 %M 37505805 %R 10.2196/47320 %U https://www.researchprotocols.org/2023/1/e47320 %U https://doi.org/10.2196/47320 %U http://www.ncbi.nlm.nih.gov/pubmed/37505805 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47662 %T Monitoring Cigarette Smoking and Relapse in Young Adults With and Without Remote Biochemical Verification: Randomized Brief Cessation Study %A McClure,Erin A %A Baker,Nathaniel %A Walters,Kyle J %A Tomko,Rachel L %A Carpenter,Matthew J %A Bradley,Elizabeth %A Squeglia,Lindsay M %A Gray,Kevin M %+ Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, Charleston, SC, 29425, United States, 1 843 792 7192, mccluree@musc.edu %K technology %K mHealth %K young adults %K cessation %K relapse %K biochemical verification %K cigarette %K smoking %K monitoring %K abstinence %K mobile phone %D 2023 %7 27.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Technological advancements to study young adult smoking, relapse, and to deliver interventions remotely offer conceptual appeal, but the incorporation of technological enhancement must demonstrate benefit over traditional methods without adversely affecting outcomes. Further, integrating remote biochemical verification of smoking and abstinence may yield value in the confirmation of self-reported smoking, in addition to ecologically valid, real-time assessments. Objective: The goal of this study was to evaluate the impact of remote biochemical verification on 24-hour self-reported smoking and biochemical verification agreement, retention, compliance with remote sessions, and abstinence during a brief, 5-week cessation attempt and relapse monitoring phase. Methods: Participants (N=39; aged 18-25 years; mean age 21.6, SD 2.1 years; n=22, 56% male; n=29, 74% White) who smoked cigarettes daily engaged in a 5-week cessation and monitoring study (including a 48-hour quit attempt and provision of tobacco treatment in the form of nicotine replacement therapy, brief cessation counseling, and financial incentives for abstinence during the 2-day quit attempt only). Smoking (cigarettes per day) was self-reported through ecological momentary assessment (EMA) procedures, and participants were randomized to either (1) the inclusion of remote biochemical verification (EMA + remote carbon monoxide [rCO]) 2× per day or (2) in-person, weekly CO (wCO). Groups were compared on the following outcomes: (1) agreement in self-reported smoking and breath carbon monoxide (CO) at common study time points, (2) EMA session compliance, (3) retention in study procedures, and (4) abstinence from smoking during the 2-day quit attempt and at the end of the 5-week study. Results: No significant differences were demonstrated between the rCO group and the wCO (weekly in-person study visit) group on agreement between 24-hour self-reported smoking and breath CO (moderate to poor), compliance with remote sessions, or retention, though these outcomes numerically favored the wCO group. Abstinence was numerically higher in the wCO group after the 2-day quit attempt and significantly different at the end of treatment (day 35), favoring the wCO group. Conclusions: Though study results should be interpreted with caution given the small sample size, findings suggest that the inclusion of rCO breath added to EMA compared to EMA with weekly, in-person CO collection in young adults did not yield benefit and may have even adversely affected outcomes. Our results suggest that technological advancements may improve data accuracy through objective measurement but may also introduce barriers and burdens and could result in higher rates of missing data. The inclusion of technology to inform smoking cessation research and intervention delivery among young adults should consider (1) the research question and necessity of biochemical verification and then (2) how to seamlessly incorporate monitoring into personalized and dynamic systems to avoid the added burden and detrimental effects to compliance and honesty in self-report. %M 37498643 %R 10.2196/47662 %U https://formative.jmir.org/2023/1/e47662 %U https://doi.org/10.2196/47662 %U http://www.ncbi.nlm.nih.gov/pubmed/37498643 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47121 %T Behavioral Economic Strategies to Improve Enrollment Rates in Clinical Research: Embedded Recruitment Pilot Trial %A Greene,Brittney %A Bernardo,Leah %A Thompson,Morgan %A Loughead,James %A Ashare,Rebecca %+ State University of New York at Buffalo, 334 Diefendorf Hall, Buffalo, NY, 14214, United States, 1 7168296273, rlashare@buffalo.edu %K behavior change %K behavioral economics %K clinical trials %K contingency management %K evidence based %K information provision %K recruitment %K retention %K SMS text messaging %K study within a trial %K SWAT %D 2023 %7 21.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Nearly 1 in 3 clinical trials end prematurely due to underenrollment. Strategies to enhance recruitment are often implemented without scientific rigor to evaluate efficacy. Evidence-based, cost-effective behavioral economic strategies designed to influence decision-making may be useful to promote clinical trial enrollment. Objective: This study evaluated 2 behavioral economic strategies to improve enrollment and retention rates across 4 clinical trials: information provision (IP) and contingency management (CM; ie, lottery). IP targets descriptive and injunctive norms about participating in research and CM provides participants incentives to reinforce a target behavior. Methods: A sample of 212 participants was enrolled across 4 clinical trials focused on tobacco use: 2 focused on HIV and 2 focused on neuroimaging. The CM condition included a lottery: for each study visit completed, participants received 5 “draws” from a bowl containing 500 “chips” valued at US $0, US $1, US $5, or US $100. In the IP condition, text messages that targeted injunctive norms about research (eg, “Many find it a rewarding way to advance science and be part of a community”) were sent through the Way to Health platform before all study visits. Participants were randomized to 1 of 4 conditions: IP, CM, IP+CM, or standard recruitment (SR). We performed logistic regression, controlling for sex and study, with condition as a between-subject predictor. Outcomes were the percentage of participants who attended a final eligibility visit (primary), met intent-to-treat (ITT) criteria (secondary), and completed the study (secondary). Recruitment was evaluated by the percentage of participants who attended a final eligibility visit, enrollment by ITT status, and retention by the percentage of participants who completed the study. Results: Rates of attending the eligibility visit and meeting ITT status were 58.9% (33/56) and 33.9% (19/56) for IP+CM; 45.5% (25/55) and 18.2% (10/55) for IP only; 41.5% (22/53) and 18.9% (10/53) for CM only; and 37.5% (18/48) and 12.5% (6/48) for SR, respectively. In the logistic regression, females were more likely to meet ITT status than males (odds ratio [OR] 2.7, 95% CI 1.2-5.7; P=.01). The IP+CM group was twice as likely to attend the final eligibility visit than the SR group (OR 2.4, 95% CI 1.1-5.2; P=.04). The IP+CM group was also significantly more likely to reach ITT status than the SR condition (OR 3.9, 95% CI 1.3-11.1; P=.01). Those who received any active intervention (IP, CM, or IP+CM) had a higher study completion rate (33/53, 63.5%) compared to those who received SR (5/12, 41.7%), but this difference was not significant (P=.26). Conclusions: Combining IP and CM strategies may motivate participants to participate in research and improve recruitment and retention rates. Evidence from this study provides preliminary support for the utility of behavioral economics strategies to improve enrollment and reduce attrition in clinical trials. %M 37477975 %R 10.2196/47121 %U https://formative.jmir.org/2023/1/e47121 %U https://doi.org/10.2196/47121 %U http://www.ncbi.nlm.nih.gov/pubmed/37477975 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44614 %T A Web-Based Instrument for Infantile Atopic Dermatitis Identification (Electronic Version of the Modified Child Eczema Questionnaire): Development and Implementation %A Fang,Heping %A Chen,Lin %A Li,Juan %A Ren,Luo %A Yin,Yu %A Chen,Danleng %A Yin,Huaying %A Liu,Enmei %A Hu,Yan %A Luo,Xiaoyan %+ Department of Child Health Care, Children’s Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Health and Nutrition, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China, 86 02363622764, hy420@126.com %K atopic dermatitis %K identification %K infant %K web-based questionnaire %K public health %D 2023 %7 19.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Atopic dermatitis (AD) is a chronic inflammatory cutaneous disease that affects 30.48% of young children; thus, there is a need for epidemiological studies in community settings. Web-based questionnaires (WBQs) are more convenient, time-saving, and efficient than traditional surveys, but the reliability of identifying AD through WBQs and whether AD can be identified without the attendance of doctors, especially in community or similar settings, remains unknown. Objective: This study aimed to develop and validate a web-based instrument for infantile AD identification (electronic version of the modified Child Eczema Questionnaire [eCEQ]) and to clarify the possibility of conducting WBQs to identify infantile AD without the attendance of doctors in a community-representative population. Methods: This study was divided into 2 phases. Phase 1 investigated 205 children younger than 2 years to develop and validate the eCEQ by comparison with the diagnoses of dermatologists. Phase 2 recruited 1375 children younger than 2 years to implement the eCEQ and verify the obtained prevalence by comparison with the previously published prevalence. Results: In phase 1, a total of 195 questionnaires were analyzed from children with a median age of 8.8 (IQR 4.5-15.0) months. The identification values of the eCEQ according to the appropriate rules were acceptable (logic rule: sensitivity 89.2%, specificity 91.5%, positive predictive value 97.1%, and negative predictive value 72.9%; statistic rule: sensitivity 90.5%, specificity 89.4%, positive predictive value 96.4%, and negative predictive value 75%). In phase 2, a total of 837 questionnaires were analyzed from children with a median age of 8.4 (IQR 5.2-14.6) months. The prevalence of infantile AD obtained by the eCEQ (logic rule) was 31.9% (267/837), which was close to the published prevalence (30.48%). Based on the results of phase 2, only 20.2% (54/267) of the participants identified by the eCEQ had previously received a diagnosis from doctors. Additionally, among the participants who were not diagnosed by doctors but were identified by the eCEQ, only 6.1% (13/213) were actually aware of the possible presence of AD. Conclusions: Infantile AD can be identified without the attendance of doctors by using the eCEQ, which can be easily applied to community-based epidemiological studies and provide acceptable identification reliability. In addition, the eCEQ can also be applied to the field of public health to improve the health awareness of the general population. %M 37467020 %R 10.2196/44614 %U https://www.jmir.org/2023/1/e44614 %U https://doi.org/10.2196/44614 %U http://www.ncbi.nlm.nih.gov/pubmed/37467020 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47053 %T A Technology-Enriched Approach to Studying Microlongitudinal Aging Among Adults Aged 18 to 85 Years: Protocol for the Labs Without Walls Study %A Brady,Brooke %A Zhou,Shally %A Ashworth,Daniel %A Zheng,Lidan %A Eramudugolla,Ranmalee %A Huque,Md Hamidul %A Anstey,Kaarin Jane %+ School of Psychology, University of New South Wales, 139 Barker Street, Randwick, 2031, Australia, 61 0410128221, b.brady@unsw.edu.au %K life-course aging %K longitudinal research %K subjective age %K gender %K cognition %K sensory function %K app %K mobile app %K eHealth %K mobile health %K mHealth %K measurement burst design %K ecological momentary assessment %K health information technology %K personalized health %K mobile phone %D 2023 %7 6.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Traditional longitudinal aging research involves studying the same individuals over a long period, with measurement intervals typically several years apart. App-based studies have the potential to provide new insights into life-course aging by improving the accessibility, temporal specificity, and real-world integration of data collection. We developed a new research app for iOS named Labs Without Walls to facilitate the study of life-course aging. Combined with data collected using paired smartwatches, the app collects complex data including data from one-time surveys, daily diary surveys, repeated game-like cognitive and sensory tasks, and passive health and environmental data. Objective: The aim of this protocol is to describe the research design and methods of the Labs Without Walls study conducted between 2021 and 2023 in Australia. Methods: Overall, 240 Australian adults will be recruited, stratified by age group (18-25, 26-35, 36-45, 46-55, 56-65, 66-75, and 76-85 years) and sex at birth (male and female). Recruitment procedures include emails to university and community networks, as well as paid and unpaid social media advertisements. Participants will be invited to complete the study onboarding either in person or remotely. Participants who select face-to-face onboarding (n=approximately 40) will be invited to complete traditional in-person cognitive and sensory assessments to be cross-validated against their app-based counterparts. Participants will be sent an Apple Watch and headphones for use during the study period. Participants will provide informed consent within the app and then begin an 8-week study protocol, which includes scheduled surveys, cognitive and sensory tasks, and passive data collection using the app and a paired watch. At the conclusion of the study period, participants will be invited to rate the acceptability and usability of the study app and watch. We hypothesize that participants will be able to successfully provide e-consent, input survey data through the Labs Without Walls app, and have passive data collected over 8 weeks; participants will rate the app and watch as user-friendly and acceptable; the app will allow for the study of daily variability in self-perceptions of age and gender; and data will allow for the cross-validation of app- and laboratory-based cognitive and sensory tasks. Results: Recruitment began in May 2021, and data collection was completed in February 2023. The publication of preliminary results is anticipated in 2023. Conclusions: This study will provide evidence regarding the acceptability and usability of the research app and paired watch for studying life-course aging processes on multiple timescales. The feedback obtained will be used to improve future iterations of the app, explore preliminary evidence for intraindividual variability in self-perceptions of aging and gender expression across the life span, and explore the associations between performance on app-based cognitive and sensory tests and that on similar traditional cognitive and sensory tests. International Registered Report Identifier (IRRID): DERR1-10.2196/47053 %M 37410527 %R 10.2196/47053 %U https://www.researchprotocols.org/2023/1/e47053 %U https://doi.org/10.2196/47053 %U http://www.ncbi.nlm.nih.gov/pubmed/37410527 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46783 %T Use of Electronic Ecological Momentary Assessment Methodologies in Physical Activity, Sedentary Behavior, and Sleep Research in Young Adults: Systematic Review %A Hartson,Kimberly R %A Huntington-Moskos,Luz %A Sears,Clara G %A Genova,Gina %A Mathis,Cara %A Ford,Wessly %A Rhodes,Ryan E %+ School of Nursing, University of Louisville, 555 South Floyd Street, Louisville, KY, 40202, United States, 1 502 852 8388, kimberly.rapp@louisville.edu %K ecological momentary assessment %K young adults %K 24-hour movement behaviors %K physical activity %K sedentary behavior %K sleep %K mobile phone %D 2023 %7 29.6.2023 %9 Review %J J Med Internet Res %G English %X Background: Recent technological advances allow for the repeated sampling of real-time data in natural settings using electronic ecological momentary assessment (eEMA). These advances are particularly meaningful for investigating physical activity, sedentary behavior, and sleep in young adults who are in a critical life stage for the development of healthy lifestyle behaviors. Objective: This study aims to describe the use of eEMA methodologies in physical activity, sedentary behavior, and sleep research in young adults. Methods: The PubMed, CINAHL, PsycINFO, Embase, and Web of Science electronic databases were searched through August 2022. Inclusion criteria were use of eEMA; sample of young adults aged 18 to 25 years; at least 1 measurement of physical activity, sedentary behavior, or sleep; English language; and a peer-reviewed report of original research. Study reports were excluded if they were abstracts, protocols, or reviews. The risk of bias assessment was conducted using the National Heart, Lung, and Blood Institute’s Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Screening, data extraction, and risk of bias assessments were conducted by independent authors, with discrepancies resolved by consensus. Descriptive statistics and narrative synthesis were used to identify overarching patterns within the following categories guided by the Checklist for Reporting Ecological Momentary Assessments Studies: study characteristics, outcomes and measures, eEMA procedures, and compliance. Results: The search resulted in 1221 citations with a final sample of 37 reports describing 35 unique studies. Most reports (28/37, 76%) were published in the last 5 years (2017-2022), used observational designs (35/37, 95%), consisted of samples of college students or apprentices (28/35, 80%), and were conducted in the United States (22/37, 60%). The sample sizes ranged from 14 to 1584 young adults. Physical activity was measured more frequently (28/37, 76%) than sleep (16/37, 43%) or sedentary behavior (4/37, 11%). Of the 37 studies, 11 (30%) reports included 2 movement behaviors and no reports included 3 movement behaviors. eEMA was frequently used to measure potential correlates of movement behaviors, such as emotional states or feelings (25/37, 68%), cognitive processes (7/37, 19%), and contextual factors (9/37, 24%). There was wide variability in the implementation and reporting of eEMA procedures, measures, missing data, analysis, and compliance. Conclusions: The use of eEMA methodologies in physical activity, sedentary behavior, and sleep research in young adults has greatly increased in recent years; however, reports continue to lack standardized reporting of features unique to the eEMA methodology. Additional areas in need of future research include the use of eEMA with more diverse populations and the incorporation of all 3 movement behaviors within a 24-hour period. The findings are intended to assist investigators in the design, implementation, and reporting of physical activity, sedentary behavior, and sleep research using eEMA in young adults. Trial Registration: PROSPERO CRD42021279156; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021279156 %M 37384367 %R 10.2196/46783 %U https://www.jmir.org/2023/1/e46783 %U https://doi.org/10.2196/46783 %U http://www.ncbi.nlm.nih.gov/pubmed/37384367 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44687 %T Differences Between Online Trial Participants Who Have Used Statutory Mental Health Services and Those Who Have Not: Analysis of Baseline Data From 2 Pragmatic Trials of a Digital Health Intervention %A Rennick-Egglestone,Stefan %A Newby,Chris %A Robinson,Clare %A Yeo,Caroline %A Ng,Fiona %A Elliott,Rachel A %A Ali,Yasmin %A Llewellyn-Beardsley,Joy %A Pomberth,Scott %A Harrison,Julian %A Gavan,Sean P %A Cuijpers,Pim %A Priebe,Stefan %A Hall,Charlotte L %A Slade,Mike %+ School of Health Sciences, Institute of Mental Health, University of Nottingham, Institute of Mental Health, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 115 85 ext 30926, stefan.egglestone@nottingham.ac.uk %K open recruitment %K service use %K nonservice use %K online intervention %K online trial %K mobile phone %D 2023 %7 27.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health interventions (DHIs) are an established element of mental health service provision internationally. Regulators have positioned the best practice standard of evidence as an interventional study with a comparator reflective of standard care, often operationalized as a pragmatic trial. DHIs can extend health provision to those not currently using mental health services. Hence, for external validity, trials might openly recruit a mixture of people who have used mental health services and people who have not. Prior research has demonstrated phenomenological differences in mental health experience between these groups. Some differences between service users and nonservice users might influence the change created by DHIs; hence, research should systematically examine these differences to inform intervention development and evaluation work. This paper analyzes baseline data collected in the NEON (Narrative Experiences Online; ie, for people with experience of psychosis) and NEON-O (NEON for other [eg, nonpsychosis] mental health problems) trials. These were pragmatic trials of a DHI that openly recruited people who had used specialist mental health services and those who had not. All participants were experiencing mental health distress. NEON Trial participants had experienced psychosis in the previous 5 years. Objective: This study aims to identify differences in baseline sociodemographic and clinical characteristics associated with specialist mental health service use for NEON Trial and NEON-O Trial participants. Methods: For both trials, hypothesis testing was used to compare baseline sociodemographic and clinical characteristics of participants in the intention-to-treat sample who had used specialist mental health services and those who had not. Bonferroni correction was applied to significance thresholds to account for multiple testing. Results: Significant differences in characteristics were identified in both trials. Compared with nonservice users (124/739, 16.8%), NEON Trial specialist service users (609/739, 82.4%) were more likely to be female (P<.001), older (P<.001), and White British (P<.001), with lower quality of life (P<.001) and lower health status (P=.002). There were differences in geographical distribution (P<.001), employment (P<.001; more unemployment), current mental health problems (P<.001; more psychosis and personality disorders), and recovery status (P<.001; more recovered). Current service users were more likely to be experiencing psychosis than prior service users. Compared with nonservice users (399/1023, 39%), NEON-O Trial specialist service users (614/1023, 60.02%) had differences in employment (P<.001; more unemployment) and current mental health problems (P<.001; more personality disorders), with lower quality of life (P<.001), more distress (P<.001), less hope (P<.001), less empowerment (P<.001), less meaning in life (P<.001), and lower health status (P<.001). Conclusions: Mental health service use history was associated with numerous differences in baseline characteristics. Investigators should account for service use in work to develop and evaluate interventions for populations with mixed service use histories. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04428-6 %M 37368471 %R 10.2196/44687 %U https://www.jmir.org/2023/1/e44687 %U https://doi.org/10.2196/44687 %U http://www.ncbi.nlm.nih.gov/pubmed/37368471 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42175 %T Reducing Clinical Trial Monitoring Resources and Costs With Remote Monitoring: Retrospective Study Comparing On-Site Versus Hybrid Monitoring %A Fu,Zhiying %A Liu,Xiaohong %A Zhao,Shuhua %A Yuan,Yannan %A Jiang,Min %+ Peking University Cancer Hospital & Institute, No 52 Fucheng Road, Haidian District, Beijing, 100142, China, 86 1088197729, gcp_jiangm@bjcancer.org %K clinical trial %K management %K on-site monitoring %K hybrid monitoring model %K remote monitoring %K hybrid %K monitoring %K cost %K economic %K trial monitoring %K research quality %K scientific research %K trials methodology %K trial management %K research management %D 2023 %7 27.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinical research associates (CRAs) monitor the progress of a trial, verify the data collected, and ensure that the trial is carried out and reported in accordance with the trial protocol, standard operating procedures, and relevant laws and regulations. In response to monitoring challenges during the COVID-19 pandemic, Peking University Cancer Hospital launched a remote monitoring system and established a monitoring model, combining on-site and remote monitoring of clinical trials. Considering the increasing digitization of clinical trials, it is important to determine the optimal monitoring model for the general benefit of centers conducting clinical trials worldwide. Objective: We sought to summarize our practical experience of a hybrid model of remote and on-site monitoring of clinical trials and provide guidance for clinical trial monitoring management. Methods: We evaluated 201 trials conducted by our hospital that used on-site monitoring alone or a hybrid monitoring model, of which 91 trials used on-site monitoring alone (arm A) and 110 used a hybrid model of remote and on-site monitoring (arm B). We reviewed trial monitoring reports from June 20, 2021, to June 20, 2022, and used a customized questionnaire to collect and compare the following information: monitoring cost of trials in the 2 models as a sum of the CRAs’ transportation (eg, taxi fare and air fare), accommodation, and meal costs; differences in monitoring frequency; the number of monitored documents; and monitoring duration. Results: From June 20, 2021, to June 20, 2022, a total of 320 CRAs representing 201 sponsors used the remote monitoring system for source data review and the verification of data from 3299 patients in 320 trials. Arm A trials were monitored 728 times and arm B trials were monitored 849 times. The hybrid model in arm B had 52.9% (449/849) remote visits and 48.1% (409/849) on-site visits. The number of patients’ visits that could be reviewed in the hybrid monitoring model increased by 34% (4.70/13.80; P=.004) compared with that in the traditional model, whereas the duration of monitoring decreased by 13.8% (3.96/28.61; P=.03) and the total cost of monitoring decreased by 46.2% (CNY ¥188.74/408.80; P<.001). These differences were shown by nonparametric testing to be statistically significant (P<.05). Conclusions: The hybrid monitoring model can ensure timely detection of monitoring issues, improve monitoring efficiency, and reduce the cost of clinical trials and should therefore be applied more broadly in future clinical studies. %M 37368468 %R 10.2196/42175 %U https://www.jmir.org/2023/1/e42175 %U https://doi.org/10.2196/42175 %U http://www.ncbi.nlm.nih.gov/pubmed/37368468 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 6 %N %P e45865 %T Acceptability of a Hypothetical Reduction in Routinely Scheduled Clinic Visits Among Patients With History of a Localized Melanoma (MEL-SELF): Pilot Randomized Clinical Trial %A Drabarek,Dorothy %A Ackermann,Deonna %A Medcalf,Ellie %A Bell,Katy J L %+ Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building, Fisher Rd, Sydney, 2006, Australia, 61 415764321, katy.bell@sydney.edu.au %K melanoma %K surveillance %K medical overuse %K teledermatology %K pilot %K clinical visit %K treatment %K clinics %K monitoring %K self-examination %K online questionnaire %K diagnosis %K patient %K safe %K effective %D 2023 %7 26.6.2023 %9 Original Paper %J JMIR Dermatol %G English %X Background: After treatment for a localized melanoma, patients attend routinely scheduled clinics to monitor for new primary or recurrent melanoma. Patient-led surveillance (skin self-examination with patient-performed teledermoscopy) is an alternative model of follow-up that could replace some routinely scheduled visits. Objective: This study aims to assess the acceptability of a hypothetical reduction in routinely scheduled visits among participants of the Melanoma Self Surveillance (MEL-SELF) pilot randomized clinical trial of patient-led surveillance (intervention) versus usual care (control). Methods: Patients previously treated for localized melanoma in New South Wales who were participating in the MEL-SELF pilot randomized clinical trial were asked to respond to a web-based questionnaire at baseline and after 6 months on trial. We used mixed methods to analyze the data. The main outcome of interest was the acceptability of a hypothetical reduction in routinely scheduled visits for melanoma surveillance. Results: Of 100 randomized participants, 87 answered the questionnaire at baseline, 66 answered the questionnaire at 6 months, and 79 provided a free-text explanation at either time point. At 6 months, 33% (17/51) of the control group and 35% (17/49) of the intervention group indicated that a hypothetical reduction in routinely scheduled visits with all melanoma doctors was at least slightly acceptable (difference in proportions –1%, 95% CI –20% to 17%; P=.89). Participants suggested that prerequisites for a reduction in routinely scheduled visits would include that sufficient time had elapsed since the previous diagnosis without a new primary melanoma or recurrence, an unscheduled appointment could be made at short notice if the patient noticed something concerning, their melanoma doctor had suggested reducing their clinic visit frequency, and patients had confidence that patient-led surveillance was a safe and effective alternative. Participants suggested that a reduction in routinely scheduled visits would not be acceptable where they perceived a very high risk of new or recurrent melanoma, low self-efficacy in skin self-examination and in the use of technologies for the patient-led surveillance intervention, and where they had a preference for clinician-led surveillance. Some patients said that a partial reduction to once a year may be acceptable. Conclusions: Some patients may be receptive to a reduction in routinely scheduled visits if they are assured that patient-led surveillance is safe and effective. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616001716459; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371865&isReview=true; ClinicalTrials.gov NCT03581188; https://clinicaltrials.gov/ct2/show/NCT03581188 International Registered Report Identifier (IRRID): RR2-10.1001/jamadermatol.2021.4704 %M 37632976 %R 10.2196/45865 %U https://derma.jmir.org/2023/1/e45865 %U https://doi.org/10.2196/45865 %U http://www.ncbi.nlm.nih.gov/pubmed/37632976 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46464 %T Real-Time Real-World Digital Monitoring of Adolescent Suicide Risk During the Six Months Following Emergency Department Discharge: Protocol for an Intensive Longitudinal Study %A Barzilay,Shira %A Fine,Shai %A Akhavan,Shannel %A Haruvi-Catalan,Liat %A Apter,Alan %A Brunstein-Klomek,Anat %A Carmi,Lior %A Zohar,Mishael %A Kinarty,Inbar %A Friedman,Talia %A Fennig,Silvana %+ Department of Community Mental Health, University of Haifa, Abba Khoushy Ave 199, Haifa, 3498838, Israel, 972 545309759, shirabarzilay@univ.haifa.ac.il %K suicide %K suicide ideation %K suicide prevention %K adolescents %K real-time assessment %K digital phenotyping %K risk assessment %K mobile phone %D 2023 %7 26.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Suicide is the second leading cause of death in adolescents, and self-harm is one of the strongest predictors of death by suicide. The rates of adolescents presenting to emergency departments (EDs) for suicidal thoughts and behaviors (STBs) have increased. Still, existing follow-up after ED discharge is inadequate, leaving a high-risk period for reattempts and suicide. There is a need for innovative evaluation of imminent suicide risk factors in these patients, focusing on continuous real-time evaluations with low assessment burden and minimal reliance on patient disclosure of suicidal intent. Objective: This study examines prospective longitudinal associations between observed real-time mobile passive sensing, including communication and activity patterns, and clinical and self-reported assessments of STB over 6 months. Methods: This study will include 90 adolescents recruited on their first outpatient clinic visit following their discharge from the ED due to a recent STB. Participants will complete brief weekly assessments and be monitored continuously for their mobile app usage, including mobility, activity, and communication patterns, over 6 months using the iFeel research app. Participants will complete 4 in-person visits for clinical assessment at baseline and at the 1-, 3-, and 6-month follow-ups. The digital data will be processed, involving feature extraction, scaling, selection, and dimensionality reduction. Passive monitoring data will be analyzed using both classical machine learning models and deep learning models to identify proximal associations between real-time observed communication, activity patterns, and STB. The data will be split into a training and validation data set, and predictions will be matched against the clinical evaluations and self-reported STB events (ie, labels). To use both labeled and unlabeled digital data (ie, passively collected), we will use semisupervised methods in conjunction with a novel method that is based on anomaly detection notions. Results: Participant recruitment and follow-up started in February 2021 and are expected to be completed by 2024. We expect to find prospective proximal associations between mobile sensor communication, activity data, and STB outcomes. We will test predictive models for suicidal behaviors among high-risk adolescents. Conclusions: Developing digital markers of STB in a real-world sample of high-risk adolescents presenting to ED can inform different interventions and provide an objective means to assess the risk of suicidal behaviors. The results of this study will be the first step toward large-scale validation that may lead to suicide risk measures that aid psychiatric follow-up, decision-making, and targeted treatments. This novel assessment could facilitate timely identification and intervention to save young people’s lives. International Registered Report Identifier (IRRID): DERR1-10.2196/46464 %M 37358906 %R 10.2196/46464 %U https://www.researchprotocols.org/2023/1/e46464 %U https://doi.org/10.2196/46464 %U http://www.ncbi.nlm.nih.gov/pubmed/37358906 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43826 %T Evaluating Declines in Compliance With Ecological Momentary Assessment in Longitudinal Health Behavior Research: Analyses From a Clinical Trial %A Tonkin,Sarah %A Gass,Julie %A Wray,Jennifer %A Maguin,Eugene %A Mahoney,Martin %A Colder,Craig %A Tiffany,Stephen %A Hawk Jr,Larry W %+ Stephenson Cancer Center, Tobacco Settlement Endowment Trust Health Promotion Research Center, University of Oklahoma Health Sciences Center, 655 Research Park Way, Suite 400, Oklahoma City, OK, 73104, United States, 1 3013670453, sarah-tonkin@ouhsc.edu %K ecological momentary assessment %K compliance %K health behavior %K methodology %K longitudinal %K health behavior %K smoking %K smoker %K cessation %K quit %K adherence %K dropout %K RCT %K cigar %K retention %D 2023 %7 22.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Ecological momentary assessment (EMA) is increasingly used to evaluate behavioral health processes over extended time periods. The validity of EMA for providing representative, real-world data with high temporal precision is threatened to the extent that EMA compliance drops over time. Objective: This research builds on prior short-term studies by evaluating the time course of EMA compliance over 9 weeks and examines predictors of weekly compliance rates among cigarette-using adults. Methods: A total of 257 daily cigarette-using adults participating in a randomized controlled trial for smoking cessation completed daily smartphone EMA assessments, including 1 scheduled morning assessment and 4 random assessments per day. Weekly EMA compliance was calculated and multilevel modeling assessed the rate of change in compliance over the 9-week assessment period. Participant and study characteristics were examined as predictors of overall compliance and changes in compliance rates over time. Results: Compliance was higher for scheduled morning assessments (86%) than for random assessments (58%) at the beginning of the EMA period (P<.001). EMA compliance declined linearly across weeks, and the rate of decline was greater for morning assessments (2% per week) than for random assessments (1% per week; P<.001). Declines in compliance were stronger for younger participants (P<.001), participants who were employed full-time (P=.03), and participants who subsequently dropped out of the study (P<.001). Overall compliance was higher among White participants compared to Black or African American participants (P=.001). Conclusions: This study suggests that EMA compliance declines linearly but modestly across lengthy EMA protocols. In general, these data support the validity of EMA for tracking health behavior and hypothesized treatment mechanisms over the course of several months. Future work should target improving compliance among subgroups of participants and investigate the extent to which rapid declines in EMA compliance might prove useful for triggering interventions to prevent study dropout. Trial Registration: ClinicalTrials.gov NCT03262662; https://clinicaltrials.gov/ct2/show/NCT03262662 %M 37347538 %R 10.2196/43826 %U https://www.jmir.org/2023/1/e43826 %U https://doi.org/10.2196/43826 %U http://www.ncbi.nlm.nih.gov/pubmed/37347538 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41089 %T Artificial Intelligence Bias in Health Care: Web-Based Survey %A Vorisek,Carina Nina %A Stellmach,Caroline %A Mayer,Paula Josephine %A Klopfenstein,Sophie Anne Ines %A Bures,Dominik Martin %A Diehl,Anke %A Henningsen,Maike %A Ritter,Kerstin %A Thun,Sylvia %+ Core Facility Digital Medicine and Interoperability, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Anna-Louisa-Karsch-Str 2, Berlin, 10178, Germany, 49 30450543049, carina-nina.vorisek@charite.de %K bias %K artificial intelligence %K machine learning %K deep learning %K FAIR data %K digital health %K health care %K online %K survey %K AI %K application %K diagnosis %K treatment %K prevention %K disease %K age %K gender %K development %K clinical %D 2023 %7 22.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Resources are increasingly spent on artificial intelligence (AI) solutions for medical applications aiming to improve diagnosis, treatment, and prevention of diseases. While the need for transparency and reduction of bias in data and algorithm development has been addressed in past studies, little is known about the knowledge and perception of bias among AI developers. Objective: This study’s objective was to survey AI specialists in health care to investigate developers’ perceptions of bias in AI algorithms for health care applications and their awareness and use of preventative measures. Methods: A web-based survey was provided in both German and English language, comprising a maximum of 41 questions using branching logic within the REDCap web application. Only the results of participants with experience in the field of medical AI applications and complete questionnaires were included for analysis. Demographic data, technical expertise, and perceptions of fairness, as well as knowledge of biases in AI, were analyzed, and variations among gender, age, and work environment were assessed. Results: A total of 151 AI specialists completed the web-based survey. The median age was 30 (IQR 26-39) years, and 67% (101/151) of respondents were male. One-third rated their AI development projects as fair (47/151, 31%) or moderately fair (51/151, 34%), 12% (18/151) reported their AI to be barely fair, and 1% (2/151) not fair at all. One participant identifying as diverse rated AI developments as barely fair, and among the 2 undefined gender participants, AI developments were rated as barely fair or moderately fair, respectively. Reasons for biases selected by respondents were lack of fair data (90/132, 68%), guidelines or recommendations (65/132, 49%), or knowledge (60/132, 45%). Half of the respondents worked with image data (83/151, 55%) from 1 center only (76/151, 50%), and 35% (53/151) worked with national data exclusively. Conclusions: This study shows that the perception of biases in AI overall is moderately fair. Gender minorities did not once rate their AI development as fair or very fair. Therefore, further studies need to focus on minorities and women and their perceptions of AI. The results highlight the need to strengthen knowledge about bias in AI and provide guidelines on preventing biases in AI health care applications. %M 37347528 %R 10.2196/41089 %U https://www.jmir.org/2023/1/e41089 %U https://doi.org/10.2196/41089 %U http://www.ncbi.nlm.nih.gov/pubmed/37347528 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 6 %N %P e44405 %T Rapid Web-Based Recruitment of Patients With Psoriasis: Multinational Cohort Study %A Duus Holm,Zacharias %A Zibert,John Robert %A Thomsen,Simon Francis %A Isberg,Ari Pall %A Andersen,Anders Daniel %A Ali,Zarqa %+ Department of Dermato-Venereology and Wound Healing Centre, Copenhagen University Hospital Bispebjerg, Nielsine Nielsens Vej 9, Copenhagen, 2400, Denmark, 45 38636173, z.duusholm@gmail.com %K web-based recruitment %K remote recruitment %K conversion rate %K recruitment rate %K psoriasis %K population %K dermatologist %K derma %K itchy skin %K Insomnia Severity Index %K ISI %K Pittsburgh Sleep Quality Index %K PSQI %K Dermatology Life Quality Index %K DLQI %K quantile-quantile plot %K Q-Q plot %K dermatology %D 2023 %7 20.6.2023 %9 Original Paper %J JMIR Dermatol %G English %X Background: Wide-ranging patient recruitment not restricted to the location of the investigator will provide a better representation of the patient population in clinical studies. Objective: Our goal was to assess the feasibility of a broad web-based recruitment strategy in an 8-week observational study of 500 study participants with psoriasis and healthy controls from locations remote from the investigator and to assess the cost associated with each participant. Methods: A decentralized team in Denmark recruited patients with psoriasis and healthy controls using Google and Facebook advertisements and posts to Facebook groups. All individuals were screened via the internet, and patients diagnosed with psoriasis were included. Questionnaires regarding itch and sleep were completed by both groups at inclusion, week 4, and week 8. Results: During a 2-week recruitment period, 12,887 unique advertisement views were registered, and 839 participants were enrolled, of which 507 completed the study (220 with psoriasis and 287 healthy controls) with a retention rate of 60.4%. Participants were recruited from 11 different countries on 4 separate continents, mainly from the United States, Canada, and the United Kingdom. The recruitment rate was 59.9 participants per day, and the conversion rate was 57.2%. Recruitment costs were US $13 per enrolled participant and US $22 per participant completing the study. Conclusions: It is feasible and rapid to recruit a large number of participants from locations different from the investigator and to retain patients in an observational study with no visits to a clinical site at low costs. %M 37632941 %R 10.2196/44405 %U https://derma.jmir.org/2023/1/e44405 %U https://doi.org/10.2196/44405 %U http://www.ncbi.nlm.nih.gov/pubmed/37632941 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42244 %T Associations Between Personality Traits and Energy Balance Behaviors in Emerging Adulthood: Cross-Sectional Study %A Champion,Katrina E %A Chapman,Cath %A Sunderland,Matthew %A Slade,Tim %A Barrett,Emma %A Kelly,Erin %A Stapinski,Lexine %A Gardner,Lauren A %A Teesson,Maree %A Newton,Nicola C %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building, Sydney, 2006, Australia, 61 2 8627 9007, cath.chapman@sydney.edu.au %K personality %K emerging adulthood %K screen time %K sedentary %K sleep %K diet %K physical activity %K prevention %K mental health %K risk factor %K sedentary behavior %K chronic disease %D 2023 %7 15.6.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Internalizing and externalizing personality traits are robust risk factors for substance use and mental health, and personality-targeted interventions are effective in preventing substance use and mental health problems in youth. However, there is limited evidence for how personality relates to other lifestyle risk factors, such as energy balance–related behaviors, and how this might inform prevention efforts. Objective: This study aimed to examine concurrent cross-sectional associations between personality traits (ie, hopelessness, anxiety sensitivity, impulsivity, and sensation seeking) and sleep, diet, physical activity (PA), and sedentary behaviors (SB), 4 of the leading risk factors for chronic disease, among emerging adults. Methods: Data were drawn from a cohort of young Australians who completed a web-based, self-report survey in 2019 during early adulthood. A series of Poisson and logistic regressions were conducted to examine the concurrent associations between the risk behaviors (sleep, diet, PA, and sitting and screen time) and personality traits (hopelessness, anxiety sensitivity, impulsivity, and sensation seeking) among emerging adults in Australia. Results: A total of 978 participants (mean age 20.4, SD 0.5 years) completed the web-based survey. The results indicated that higher scores on hopelessness were associated with a greater daily screen (risk ratio [RR] 1.12, 95% CI 1.10-1.15) and sitting time (RR 1.05, 95% CI 1.0-1.08). Similarly, higher scores on anxiety sensitivity were associated with a greater screen (RR 1.04, 95% CI 1.02-1.07) and sitting time (RR 1.04, 95% CI 1.02-1.07). Higher impulsivity was associated with greater PA (RR 1.14, 95% CI 1.08-1.21) and screen time (RR 1.06, 95% CI 1.03-1.08). Finally, higher scores on sensation seeking were associated with greater PA (RR 1.08, 95% CI 1.02-1.14) and lower screen time (RR 0.96, 95% CI 0.94-0.99). Conclusions: The results suggest that personality should be considered when designing preventive interventions for lifestyle risk behaviors, particularly in relation to SB, such as sitting and screen time. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12612000026820; https://tinyurl.com/ykwcxspr %M 37318870 %R 10.2196/42244 %U https://publichealth.jmir.org/2023/1/e42244 %U https://doi.org/10.2196/42244 %U http://www.ncbi.nlm.nih.gov/pubmed/37318870 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45556 %T Patient Engagement in a Multimodal Digital Phenotyping Study of Opioid Use Disorder %A Campbell,Cynthia I %A Chen,Ching-Hua %A Adams,Sara R %A Asyyed,Asma %A Athale,Ninad R %A Does,Monique B %A Hassanpour,Saeed %A Hichborn,Emily %A Jackson-Morris,Melanie %A Jacobson,Nicholas C %A Jones,Heather K %A Kotz,David %A Lambert-Harris,Chantal A %A Li,Zhiguo %A McLeman,Bethany %A Mishra,Varun %A Stanger,Catherine %A Subramaniam,Geetha %A Wu,Weiyi %A Zegers,Christopher %A Marsch,Lisa A %+ Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA, 94612, United States, 1 5108913584, cynthia.i.campbell@kp.org %K opioid use disorder %K digital phenotyping %K medication for opioid use disorder %K MOUD %K ecological momentary assessment %K EMA %K passive sensing %K social media %K opioid %K OUD %K data collection %K smartphone %K digital health %D 2023 %7 13.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Multiple digital data sources can capture moment-to-moment information to advance a robust understanding of opioid use disorder (OUD) behavior, ultimately creating a digital phenotype for each patient. This information can lead to individualized interventions to improve treatment for OUD. Objective: The aim is to examine patient engagement with multiple digital phenotyping methods among patients receiving buprenorphine medication for OUD. Methods: The study enrolled 65 patients receiving buprenorphine for OUD between June 2020 and January 2021 from 4 addiction medicine programs in an integrated health care delivery system in Northern California. Ecological momentary assessment (EMA), sensor data, and social media data were collected by smartphone, smartwatch, and social media platforms over a 12-week period. Primary engagement outcomes were meeting measures of minimum phone carry (≥8 hours per day) and watch wear (≥18 hours per day) criteria, EMA response rates, social media consent rate, and data sparsity. Descriptive analyses, bivariate, and trend tests were performed. Results: The participants’ average age was 37 years, 47% of them were female, and 71% of them were White. On average, participants met phone carrying criteria on 94% of study days, met watch wearing criteria on 74% of days, and wore the watch to sleep on 77% of days. The mean EMA response rate was 70%, declining from 83% to 56% from week 1 to week 12. Among participants with social media accounts, 88% of them consented to providing data; of them, 55% of Facebook, 54% of Instagram, and 57% of Twitter participants provided data. The amount of social media data available varied widely across participants. No differences by age, sex, race, or ethnicity were observed for any outcomes. Conclusions: To our knowledge, this is the first study to capture these 3 digital data sources in this clinical population. Our findings demonstrate that patients receiving buprenorphine treatment for OUD had generally high engagement with multiple digital phenotyping data sources, but this was more limited for the social media data. International Registered Report Identifier (IRRID): RR2-10.3389/fpsyt.2022.871916 %M 37310787 %R 10.2196/45556 %U https://www.jmir.org/2023/1/e45556 %U https://doi.org/10.2196/45556 %U http://www.ncbi.nlm.nih.gov/pubmed/37310787 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45028 %T Ecological Momentary Assessment of Cognition in Clinical and Community Samples: Reliability and Validity Study %A Singh,Shifali %A Strong,Roger %A Xu,Irene %A Fonseca,Luciana M %A Hawks,Zoe %A Grinspoon,Elizabeth %A Jung,Lanee %A Li,Frances %A Weinstock,Ruth S %A Sliwinski,Martin J %A Chaytor,Naomi S %A Germine,Laura T %+ McLean Hospital, 1010 Pleasant Street, Belmont, MA, 02478, United States, 1 617 855 2675, ssingh@mclean.harvard.edu %K ecological momentary assessment %K cognition %K digital neuropsychology %K remote assessment %K digital technology %K type 1 diabetes, teleneuropsychology %K reliability %K validity %K cognitive functioning %K psychological %K physiological %K glucose %K community %D 2023 %7 2.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The current methods of evaluating cognitive functioning typically rely on a single time point to assess and characterize an individual’s performance. However, cognitive functioning fluctuates within individuals over time in relation to environmental, psychological, and physiological contexts. This limits the generalizability and diagnostic utility of single time point assessments, particularly among individuals who may exhibit large variations in cognition depending on physiological or psychological context (eg, those with type 1 diabetes [T1D], who may have fluctuating glucose concentrations throughout the day). Objective: We aimed to report the reliability and validity of cognitive ecological momentary assessment (EMA) as a method for understanding between-person differences and capturing within-person variation in cognition over time in a community sample and sample of adults with T1D. Methods: Cognitive performance was measured 3 times a day for 15 days in the sample of adults with T1D (n=198, recruited through endocrinology clinics) and for 10 days in the community sample (n=128, recruited from TestMyBrain, a web-based citizen science platform) using ultrabrief cognitive tests developed for cognitive EMA. Our cognitive EMA platform allowed for remote, automated assessment in participants’ natural environments, enabling the measurement of within-person cognitive variation without the burden of repeated laboratory or clinic visits. This allowed us to evaluate reliability and validity in samples that differed in their expected degree of cognitive variability as well as the method of recruitment. Results: The results demonstrate excellent between-person reliability (ranging from 0.95 to 0.99) and construct validity of cognitive EMA in both the sample of adults with T1D and community sample. Within-person reliability in both samples (ranging from 0.20 to 0.80) was comparable with that observed in previous studies in healthy older adults. As expected, the full-length baseline and EMA versions of TestMyBrain tests correlated highly with one another and loaded together on the expected cognitive domains when using exploratory factor analysis. Interruptions had higher negative impacts on accuracy-based outcomes (β=−.34 to −.26; all P values <.001) than on reaction time–based outcomes (β=−.07 to −.02; P<.001 to P=.40). Conclusions: We demonstrated that ultrabrief mobile assessments are both reliable and valid across 2 very different clinic versus community samples, despite the conditions in which cognitive EMAs are administered, which are often associated with more noise and variability. The psychometric characteristics described here should be leveraged appropriately depending on the goals of the cognitive assessment (eg, diagnostic vs everyday functioning) and the population being studied. %M 37266996 %R 10.2196/45028 %U https://www.jmir.org/2023/1/e45028 %U https://doi.org/10.2196/45028 %U http://www.ncbi.nlm.nih.gov/pubmed/37266996 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e38176 %T A Video-Observed Treatment Strategy to Improve Adherence to Treatment Among Persons Who Inject Drugs Infected With Hepatitis C Virus: Qualitative Study of Stakeholder Perceptions and Experiences %A Karasz,Alison %A Merchant,Krupa %A Arnsten,Julia %A Feinberg,Judith %A Kim,Arthur Y %A Lum,Paula J %A McKee,Melissa Diane %A Mehta,Shruti H %A Meissner,Paul %A Norton,Brianna L %A Page,Kimberly %A Pericot-Valverde,Irene %A Singh,Reena %A Stein,Ellen %A Taylor,Lynn E %A Tsui,Judith I %A Wagner,Katherine %A Litwin,Alain %+ University of Massachusetts Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, United States, 1 508 856 8989, alison.karasz@umassmed.edu %K mHealth %K video-observed therapy %K directly observed treatment %K hepatitis C virus %K persons who inject drugs %K antiviral %K adherence %K HCV %K opioid treatment %K mobile health %K adherence behavior %K behavior intervention %K telemedicine %K digital health %K perception %K therapy %K treatment %D 2023 %7 2.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Direct-acting antiviral medications have the potential to eliminate the hepatitis C virus (HCV) epidemic among people who inject drugs; yet, suboptimal adherence remains a barrier. Directly observed treatment (DOT), an effective strategy for optimizing adherence, has been frequently implemented in opioid treatment programs but less commonly in community health settings due to the heavy burden of daily visits. An alternative is video-observed therapy (VOT), which uses mobile health technology to monitor adherence. VOT has not been widely studied among people who inject drugs with HCV. Objective: This qualitative study, part of a larger implementation evaluation, investigates stakeholder perceptions and experiences with VOT in Project HERO (Hepatitis C Real Outcomes), a multisite pragmatic trial testing treatment delivery models for people who inject drugs with HCV. Our goal was to understand the potential barriers and facilitators to the implementation of the VOT technology. Methods: Qualitative interviews were conducted with 27 Project HERO study staff and 7 patients. Interviews focused on perceptions and experiences with the VOT app and barriers and facilitators to implementation. Team meeting minutes over the first 2 years of the project were transcribed. A coding system was developed and applied to the data. We summarized thematic data and compared participant perceptions to generate a close understanding of the data. Results: Frequent barriers to VOT included mechanical failure, stolen or lost phones, and a steep learning curve for participants and study staff. In sites with older and less technically skilled participants, staff found it difficult to implement the VOT app. Research staff found that the routine monitoring of app use led to closer engagement with participants. This was both a benefit and a potential threat to the validity of this pragmatic trial. Patient participants reported mixed experiences. Conclusions: VOT may be a useful alternative to DOT for some patients, but it may not be feasible for all. Significant staff involvement may be required. %M 37266986 %R 10.2196/38176 %U https://www.jmir.org/2023/1/e38176 %U https://doi.org/10.2196/38176 %U http://www.ncbi.nlm.nih.gov/pubmed/37266986 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 6 %N %P e40816 %T Skin of Color Representation Trends in JAAD Case Reports 2015-2021: Content Analysis %A Marroquin,Nathaniel A %A Carboni,Alexa %A Zueger,Morgan %A Szeto,Mindy D %A Kirk,Jessica %A Wu,Jieying %A Ajmal,Hamza %A Dellavalle,Robert P %+ Rocky Vista University College of Osteopathic Medicine, 8401 S Chambers Rd, Parker, CO, 80112, United States, 1 303 373 2008, Nathaniel.Marroquin@rvu.edu %K skin of color %K case report %K diversity %K diverse %K equity %K inclusion %K representation %K skin tone %K image classification %K case photo %K case image %K racism %K skin color %K race %K racial %K skin %D 2023 %7 2.6.2023 %9 Research Letter %J JMIR Dermatol %G English %X %M 37632932 %R 10.2196/40816 %U https://derma.jmir.org/2023/1/e40816 %U https://doi.org/10.2196/40816 %U http://www.ncbi.nlm.nih.gov/pubmed/37632932 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45102 %T Evaluating the Mental Health of Physician-Trainees Using an SMS Text Message–Based Assessment Tool: Longitudinal Pilot Study %A Goldhaber,Nicole H %A Chea,Annie %A Hekler,Eric B %A Zhou,Wenjia %A Fergerson,Byron %+ Department of Surgery, School of Medicine, University of California, San Diego Health, 9300 Campus Point Drive, #7220, La Jolla, CA, 92037, United States, 1 310 889 8678, nhgoldhaber@health.ucsd.edu %K physician burnout %K mental health %K text-message assessment %K text %K mobile text %K stress assessment %K text message %K pilot study %K physician %K burnout %K United States %K survey %K trainee %K stress %K engagement %K users %K tracking %D 2023 %7 2.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Physician burnout is a multibillion-dollar issue in the United States. Despite its prevalence, burnout is difficult to accurately measure. Institutions generally rely on periodic surveys that are subject to recall bias. SMS text message–based surveys or assessments have been used in health care and have the advantage of easy accessibility and high response rates. Objective: In this pilot project, we evaluated the utility of and participant engagement with a simple, longitudinal, and SMS text message–based mental health assessment system for physician-trainees at the study institution. The goal of the SMS text message–based assessment system was to track stress, burnout, empathy, engagement, and work satisfaction levels faced by users in their normal working conditions. Methods: Three SMS text message-based questions per week for 5 weeks were sent to each participant. All data received were deidentified. Additionally, each participant had a deidentified personal web page to follow their scores as well as the aggregated scores of all participants over time. A 13-question optional survey was sent at the conclusion of the study to evaluate the usability of the platform. Descriptive statistics were performed. Results: In all, 81 participants were recruited and answered at least six (mean 14; median 14; range 6-16) questions for a total of 1113 responses. Overall, 10 (17%) out of 59 participants responded “Yes” to having experienced a traumatic experience during the study period. Only 3 participants ever answered being “Not at all satisfied” with their job. The highest number of responses indicating that participants were stressed or burnt out came on day 25 in the 34-day study period. There were mixed levels of concern for the privacy of responses. No substantial correlations were noted between responses and having experienced a traumatic experience during the study period. Furthermore, 12 participants responded to the optional feedback survey, and all either agreed or strongly agreed that the SMS text message–based assessment system was easy to use and the number of texts received was reasonable. None of the 12 respondents indicated that using the SMS text message–based assessment system caused stress. Conclusions: Responses demonstrated that SMS text message–based mental health assessments are potentially useful for recording physician-trainee mental health levels in real time with minimal burden, but further study of SMS text message–based mental health assessments should address limitations such as improving response rates and clarifying participants’ sense of privacy when using the SMS text message–based assessment system. The findings of this pilot study can inform the development of institution-wide tools for assessing physician burnout and protecting physicians from occupational stress. %M 37266985 %R 10.2196/45102 %U https://formative.jmir.org/2023/1/e45102 %U https://doi.org/10.2196/45102 %U http://www.ncbi.nlm.nih.gov/pubmed/37266985 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39854 %T Using Digital Tools to Study the Health of Adults Born Preterm at a Large Scale: e-Cohort Pilot Study %A Lorthe,Elsa %A Santos,Carolina %A Ornelas,José Pedro %A Doetsch,Julia Nadine %A Marques,Sandra C S %A Teixeira,Raquel %A Santos,Ana Cristina %A Rodrigues,Carina %A Gonçalves,Gonçalo %A Ferreira Sousa,Pedro %A Correia Lopes,João %A Rocha,Artur %A Barros,Henrique %+ EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, Porto, 4050-600, Portugal, 351 222061820, elsa.lorthe@gmail.com %K e-cohort %K prematurity %K preterm birth %K life course epidemiology %K participant involvement %K citizen science %K Research on European Children and Adults born Preterm %K RECAP Preterm %K premature %K preterm %K cohort study %K epidemiology %K observational study %K global health %K global burden %K survey %K questionnaire %K health outcome %K mobile phone %D 2023 %7 15.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Preterm birth is a global health concern. Its adverse consequences may persist throughout the life course, exerting a potentially heavy burden on families, health systems, and societies. In high-income countries, the first children who benefited from improved care are now adults entering middle age. However, there is a clear gap in the knowledge regarding the long-term outcomes of individuals born preterm. Objective: This study aimed to assess the feasibility of recruiting and following up an e-cohort of adults born preterm worldwide and provide estimations of participation, characteristics of participants, the acceptability of questions, and the quality of data collected. Methods: We implemented a prospective, open, observational, and international e-cohort pilot study (Health of Adult People Born Preterm—an e-Cohort Pilot Study [HAPP-e]). Inclusion criteria were being an adult (aged ≥18 years), born preterm (<37 weeks of gestation), having internet access and an email address, and understanding at least 1 of the available languages. A large, multifaceted, and multilingual communication strategy was established. Between December 2019 and June 2021, inclusion and repeated data collection were performed using a secured web platform. We provided descriptive statistics regarding participation in the e-cohort, namely, the number of persons who registered on the platform, signed the consent form, initiated and completed the baseline questionnaire, and initiated and completed the follow-up questionnaire. We also described the main characteristics of the HAPP-e participants and provided an assessment of the quality of the data and the acceptability of sensitive questions. Results: As of December 31, 2020, a total of 1004 persons had registered on the platform, leading to 527 accounts with a confirmed email and 333 signed consent forms. A total of 333 participants initiated the baseline questionnaire. All participants were invited to follow-up, and 35.7% (119/333) consented to participate, of whom 97.5% (116/119) initiated the follow-up questionnaire. Completion rates were very high both at baseline (296/333, 88.9%) and at follow-up (112/116, 96.6%). This sample of adults born preterm in 34 countries covered a wide range of sociodemographic and health characteristics. The gestational age at birth ranged from 23+6 to 36+6 weeks (median 32, IQR 29-35 weeks). Only 2.1% (7/333) of the participants had previously participated in a cohort of individuals born preterm. Women (252/333, 75.7%) and highly educated participants (235/327, 71.9%) were also overrepresented. Good quality data were collected thanks to validation controls implemented on the web platform. The acceptability of potentially sensitive questions was excellent, as very few participants chose the “I prefer not to say” option when available. Conclusions: Although we identified room for improvement in specific procedures, this pilot study confirmed the great potential for recruiting a large and diverse sample of adults born preterm worldwide, thereby advancing research on adults born preterm. %M 37184902 %R 10.2196/39854 %U https://www.jmir.org/2023/1/e39854 %U https://doi.org/10.2196/39854 %U http://www.ncbi.nlm.nih.gov/pubmed/37184902 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43645 %T An Intervention to Increase Condom Use Among Users of Sexually Transmitted Infection Self-sampling Websites (Wrapped): Protocol for a Randomized Controlled Feasibility Trial %A Newby,Katie %A Kwah,Kayleigh %A Schumacher,Lauren %A Crutzen,Rik %A Bailey,Julia V %A Jackson,Louise J %A Bremner,Stephen %A Brown,Katherine E %+ Department of Psychology, Sport and Geography, School of Life and Medical Sciences, University of Hertfordshire, Room 1H273, CP Snow Building, School of Life and Medical Sciences, Hatfield, AL10 9AB, United Kingdom, 44 7842600795, k.newby@herts.ac.uk %K adolescent %K condom use %K digital health %K eHealth %K feasibility randomized controlled trial %K sexual health %K sexually transmitted infections %K STIs %K self-testing %K young people %D 2023 %7 11.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Reducing the rates of sexually transmitted infections (STIs) among young people is a public health priority. The best way to avoid STIs from penetrative sex is to use a condom, but young people report inconsistent use. A missed opportunity to intervene to increase condom use is when young people access self-sampling kits for STIs through the internet. The potential of this opportunity is enhanced by the increasing numbers of young people being tested through this route every year in England. Hence, in a cocreation by young people, stakeholders, and researchers, Wrapped was developed––a fully automated, multicomponent, and interactive digital behavior change intervention developed for users of STI self-sampling websites, who are aged 16-24 years. Objective: This paper is a protocol for a feasibility randomized controlled trial (fRCT). The fRCT seeks to establish whether it is feasible to run a randomized controlled trial to test the effectiveness and cost-effectiveness of Wrapped. Wrapped aims to reduce the incidence of STIs through increasing correct and consistent use of condoms among users of STI self-sampling websites, who are aged 16-24 years. Methods: A 2-arm parallel-group randomized fRCT of Wrapped plus usual care, compared to usual care only (basic information on STIs and condom use), with a nested qualitative study. A minimum of 230 participants (aged 16-24 years) are recruited from an existing chlamydia self-sampling website. Participants are randomized into 1 of 2 parallel groups (1:1 allocation). Primary outcomes are the percentage of users recruited to the fRCT and the percentage of randomized participants who return a chlamydia self-sampling kit at month 12. Additionally, besides chlamydia positivity based on biological samples, surveys at baseline, month 3, month 6, and month 12, are used to assess condom use attitude, behavioral capability, self-efficacy, and intention, along with details of any partnered sexual activity and condom use, and health economic data. Nested qualitative interviews with trial participants are used to gain insight into the factors affecting recruitment and attrition. Results: Recruitment to the fRCT began in March 2021 and was completed in October 2021. Data collection was completed in December 2022. Conclusions: This feasibility study will provide data to inform the design of a future-definitive trial. This work is timely given a rapid rise in the use of internet testing for STIs and the sustained high levels of STIs among young people. Trial Registration: ISRCTN Registry ISRCTN17478654; http://www.isrctn.com/ISRCTN17478654 International Registered Report Identifier (IRRID): DERR1-10.2196/43645 %M 37166958 %R 10.2196/43645 %U https://www.researchprotocols.org/2023/1/e43645 %U https://doi.org/10.2196/43645 %U http://www.ncbi.nlm.nih.gov/pubmed/37166958 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45521 %T Using the New “Life’s Essential 8” Metrics to Evaluate Trends in Cardiovascular Health Among US Adults From 2005 to 2018: Analysis of Serial Cross-sectional Studies %A Li,Cheng %A Li,Yanzhi %A Zhao,Min %A Zhang,Cheng %A Bovet,Pascal %A Xi,Bo %+ Department of Epidemiology, School of Public Health, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road, Jinan, 250012, China, 86 88382141, xibo2007@126.com %K trends %K cardiovascular health %K primordial prevention %K adult %K nutrition examination %K survey %K diet %K physical activity %K data collection %K cross-sectional %D 2023 %7 8.5.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The recently published “Life’s Essential 8” (LE8) by the American Heart Association has overcome some limitations in evaluating cardiovascular health (CVH) in the previous “Life’s Simple 7.” Objective: We aimed to examine the secular trends in CVH, as assessed by the LE8, in US adults from 2005 to 2018. Methods: Using cross-sectional data from the National Health and Nutrition Examination Survey between 2005-2006 and 2017-2018, we calculated the age-standardized mean scores of overall CVH and each of the LE8 components, where a higher score (range 0-100 points) means a better health status. A total of 21,667 adults aged 20-79 years were included in this analysis. Results: The overall CVH did not significantly change between 2005-2006 and 2017-2018 (65.5, 95% CI 63.9-67.1 to 65.0, 95% CI 62.8-67.1; P=.82). The individual metrics did not significantly change for diet (41.0, 95% CI 38.0-43.9 to 41.5, 95% CI 36.5-46.6; P=.94), physical activity (57.5, 95% CI 53.0-61.9 to 53.0, 95% CI 48.7-57.3; P=.26), and blood pressure (68.4, 95% CI 65.2-71.5 to 68.6, 95% CI 65.3-71.9, P=.35), improved for nicotine exposure (64.7, 95% CI 61.1-68.4 to 71.9, 95% CI 67.7-76.2; P<.001), sleep health (83.7, 95% CI 81.6-85.7 to 84.1, 95% CI 81.2-87.1; P=.006), and blood lipids (61.6, 95% CI 59.1-64.0 to 67.0, 95% CI 63.5-70.4; P<.001), and worsened for BMI (63.4, 95% CI 59.7-67.1 to 56.2, 95% CI 52.5-59.9; P<.001) and blood glucose (83.9, 95% CI 82.4-85.4 to 77.4, 95% CI 74.5-80.3; P<.001). Conclusions: According to the LE8, the overall CVH did not change among US adults from 2005 to 2018, as well as 3 components (diet, physical activity, and blood pressure). Other metrics such as nicotine exposure, blood lipids, and sleep health improved, while BMI and blood glucose deteriorated over time. %M 37155232 %R 10.2196/45521 %U https://publichealth.jmir.org/2023/1/e45521 %U https://doi.org/10.2196/45521 %U http://www.ncbi.nlm.nih.gov/pubmed/37155232 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e39720 %T Long-term Memory Testing in Children With Typical Development and Neurodevelopmental Disorders: Remote Web-based Image Task Feasibility Study %A Bui,Truong An %A Rosenfelt,Cory Scott %A Whitlock,Kerri Hope %A Leclercq,Mickael %A Weber,Savannah %A Droit,Arnaud %A Wiebe,Sandra A %A Pei,Jacqueline %A Bolduc,Francois V %+ Department of Pediatrics, University of Alberta, 3020 Katz Group Centre, 11315 87 Ave, Edmonton, AB, T6G 2E1, Canada, 1 780 492 9616, fbolduc@ualberta.ca %K memory %K neurodevelopmental disorder %K autism spectrum disorder %K intellectual disability %K developmental delay %K hippocampus %K recognition %K paired association learning %K remote testing %K autism %K disorder %K genetics %K developmental %K developmental disorder %K game %K remote %K testing %K diagnose %K diagnosis %D 2023 %7 8.5.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Neurodevelopmental disorders (NDD) cause individuals to have difficulty in learning facts, procedures, or social skills. NDD has been linked to several genes, and several animal models have been used to identify potential therapeutic candidates based on specific learning paradigms for long-term and associative memory. In individuals with NDD, however, such testing has not been used so far, resulting in a gap in translating preclinical results to clinical practice. Objective: We aim to assess if individuals with NDD could be tested for paired association learning and long-term memory deficit, as shown in previous animal models. Methods: We developed an image-based paired association task, which can be performed at different time points using remote web-based testing, and evaluated its feasibility in children with typical development (TD), as well as NDD. We included 2 tasks: object recognition as a simpler task and paired association. Learning was tested immediately after training and also the next day for long-term memory. Results: We found that children aged 5-14 years with TD (n=128) and with NDD of different types (n=57) could complete testing using the Memory Game. Children with NDD showed deficits in both recognition and paired association tasks on the first day of learning, in both 5-9–year old (P<.001 and P=.01, respectively) and 10-14–year old groups (P=.001 and P<.001, respectively). The reaction times to stimuli showed no significant difference between individuals with TD or NDD. Children with NDD exhibited a faster 24-hour memory decay for the recognition task than those with TD in the 5-9–year old group. This trend is reversed for the paired association task. Interestingly, we found that children with NDD had their retention for recognition improved and matched with typically developing individuals by 10-14 years of age. The NDD group also showed improved retention deficits in the paired association task at 10-14 years of age compared to the TD group. Conclusions: We showed that web-based learning testing using simple picture association is feasible for children with TD, as well as with NDD. We showed how web-based testing allows us to train children to learn the association between pictures, as shown in immediate test results and those completed 1 day after. This is important as many models for learning deficits in NDD target both short- and long-term memory for therapeutic intervention. We also demonstrated that despite potential confounding factors, such as self-reported diagnosis bias, technical issues, and varied participation, the Memory Game shows significant differences between typically developing children and those with NDD. Future experiments will leverage this potential of web-based testing for larger cohorts and cross-validation with other clinical or preclinical cognitive tasks. %M 37155237 %R 10.2196/39720 %U https://pediatrics.jmir.org/2023/1/e39720 %U https://doi.org/10.2196/39720 %U http://www.ncbi.nlm.nih.gov/pubmed/37155237 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43917 %T Personal Health Data Tracking by Blind and Low-Vision People: Survey Study %A Lee,Jarrett G W %A Lee,Kyungyeon %A Lee,Bongshin %A Choi,Soyoung %A Seo,JooYoung %A Choe,Eun Kyoung %+ College of Information Studies, University of Maryland, Hornbake Building, 2117F, 4130 Campus Drive, College Park, MD, 20742, United States, 1 3014051085, choe@umd.edu %K personal health data %K self-tracking %K blind and low vision %K survey %K consumer health information %K mobile phone %D 2023 %7 4.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Personal health technologies, including wearable tracking devices and mobile apps, have great potential to equip the general population with the ability to monitor and manage their health. However, being designed for sighted people, much of their functionality is largely inaccessible to the blind and low-vision (BLV) population, threatening the equitable access to personal health data (PHD) and health care services. Objective: This study aims to understand why and how BLV people collect and use their PHD and the obstacles they face in doing so. Such knowledge can inform accessibility researchers and technology companies of the unique self-tracking needs and accessibility challenges that BLV people experience. Methods: We conducted a web-based and phone survey with 156 BLV people. We reported on quantitative and qualitative findings regarding their PHD tracking practices, needs, accessibility barriers, and work-arounds. Results: BLV respondents had strong desires and needs to track PHD, and many of them were already tracking their data despite many hurdles. Popular tracking items (ie, exercise, weight, sleep, and food) and the reasons for tracking were similar to those of sighted people. BLV people, however, face many accessibility challenges throughout all phases of self-tracking, from identifying tracking tools to reviewing data. The main barriers our respondents experienced included suboptimal tracking experiences and insufficient benefits against the extended burden for BLV people. Conclusions: We reported the findings that contribute to an in-depth understanding of BLV people’s motivations for PHD tracking, tracking practices, challenges, and work-arounds. Our findings suggest that various accessibility challenges hinder BLV individuals from effectively gaining the benefits of self-tracking technologies. On the basis of the findings, we discussed design opportunities and research areas to focus on making PHD tracking technologies accessible for all, including BLV people. %M 37140967 %R 10.2196/43917 %U https://www.jmir.org/2023/1/e43917 %U https://doi.org/10.2196/43917 %U http://www.ncbi.nlm.nih.gov/pubmed/37140967 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41225 %T Validation of an Interoperability Framework for Linking mHealth Apps to Electronic Record Systems in Botswana: Expert Survey Study %A Ndlovu,Kagiso %A Mars,Maurice %A Scott,Richard E %+ Department of Telehealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Mazisi Kunene Road, Glenwood, Durban, 4041, South Africa, 27 0312601075, ndlovuk@ub.ac.bw %K mobile health %K mHealth %K electronic record systems %K eRecord systems %K mHealth-eRecord Interoperability Framework %K mHeRIF %K interoperability architecture %K validation %K Botswana %K mobile phone %D 2023 %7 2.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic record (eRecord) systems and mobile health (mHealth) apps have documented potential to improve health service delivery, resulting in increased global uptake. However, their interoperability remains a global challenge hindering diagnosis, monitoring of health conditions, and data access irrespective of geographic location. Given the widespread use of mobile devices by patients and health care providers, linking mHealth apps and eRecord systems could result in a comprehensive and seamless data exchange within a health care community. The Botswana National eHealth Strategy recognizes interoperability as an issue and mHealth as a potential solution for some health care needs but is silent on how to make mHealth apps interoperable with existing eRecord systems. A literature review and analysis of existing mHealth interoperability frameworks found none suitable for Botswana. As such, it was critical to conceptualize, design, and develop an mHealth-eRecord Interoperability Framework (mHeRIF) to enhance the interoperability pillar of the Botswana National eHealth Strategy and leverage the full benefits of linking mHealth apps with other health information systems. Objective: This study aimed to validate the developed mHeRIF and determine whether it requires further refinement before consideration towards enhancing the National eHealth Strategy. Methods: Published framework validation approaches guided the development of a survey administered to 12 purposively selected local and international eHealth experts. In total, 25% (3/12) of the experts were drawn from Botswana, 25% (3/12) were drawn from low- and middle-income countries in sub-Saharan Africa, 25% (3/12) were drawn from low- and middle-income countries outside Africa, and 25% (3/12) were drawn from high-income countries. Quantitative responses were collated in a Microsoft Excel (Microsoft Corp) spreadsheet for descriptive analysis, and the NVivo software (version 11; QSR International) was used to aid the thematic analysis of the qualitative open-ended questions. Results: The analysis of responses showed overall support for the content and format of the proposed mHeRIF. However, some experts’ suggestions led to 4 modest revisions of the mHeRIF. Conclusions: Overall, the experts’ reviews showed that the mHeRIF could contribute to the National eHealth Strategy by guiding the linking of mHealth apps to existing eRecord systems in Botswana. Similarly, the experts validated an architectural model derived from the mHeRIF in support of the first mobile telemedicine initiative considered for national rollout in Botswana. The mHeRIF helps identify key components to consider before and after linking mHealth apps to eRecord systems and is being considered for use as the foundation of such interoperability in Botswana. %M 37129939 %R 10.2196/41225 %U https://formative.jmir.org/2023/1/e41225 %U https://doi.org/10.2196/41225 %U http://www.ncbi.nlm.nih.gov/pubmed/37129939 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43555 %T Hesitancy to Undergo SARS-CoV-2 Rapid Antigen Testing in China: Nationwide Cross-sectional Study %A Lu,Zhen %A Fu,Leiwen %A Yang,Luoyao %A Tian,Tian %A Gao,Yanxiao %A Meng,Xiaojun %A Zou,Huachun %+ School of Public Health (Shenzhen), Sun Yat-sen University, No. 66, Gongchang Road, Guangming District, Shenzhen, 518107, China, 86 20 8733 5651, zouhuachun@mail.sysu.edu.cn %K COVID-19 %K SARS-CoV-2 %K vaccine %K hesitancy %K rapid antigen testing %K China %D 2023 %7 1.5.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: SARS-CoV-2 rapid antigen testing (RAT) could be a useful supplementary test to diagnose larger numbers of acute asymptomatic infections and alleviate the limitations of polymerase chain reaction testing. However, hesitancy to undergo SARS-CoV-2 RAT may compromise its implementation. Objective: We aimed to understand the prevalence and correlates of hesitancy to undergo RAT among adults not infected with SARS-CoV-2 in mainland China. Methods: A nationwide cross-sectional survey on hesitancy to undergo SARS-CoV-2 RAT was conducted among adults not infected with SARS-CoV-2 in mainland China between April 29, 2022, and May 10, 2022. Participants completed an online questionnaire that covered the following COVID-19–related factors: sociodemographic characteristics, experiences of COVID-19 restrictions and knowledge of COVID-19, and attitude toward COVID-19 and its screening. This study was a secondary analysis of data from the survey. We compared the characteristics of participants by hesitancy to undergo SARS-CoV-2 RAT. Thereafter, logistic regression with a sparse group minimax concave penalty was used to identify correlates of hesitancy to undergo RAT. Results: We recruited 8856 individuals with diverse demographic, socioeconomic, and geographic characteristics in China. Eventually, 5388 participants (valid response rate of 60.84%; 52.32% [2819/5388] women; median age 32 years) were included in the analysis. Among the 5388 participants, 687 (12.75%) expressed hesitancy to undergo RAT and 4701 (87.25%) were willing to undergo RAT. Notably, those who were from the central region (adjusted odds ratio [aOR] 1.815, 95% CI 1.441-2.278) and those who received COVID-19 information from traditional media (aOR 1.544, 95% CI 1.279-1.863) were significantly more likely to report hesitancy to undergo RAT (both P<.001). However, those who were women (aOR 0.720, 95% CI 0.599-0.864), were older (aOR 0.982, 95% CI 0.969-0.995), had postgraduate education (aOR 0.612, 95% CI 0.435-0.858), had children (<6 years old) and elders (>60 years old) in the family (aOR 0.685, 95% CI 0.510-0.911), had better knowledge about COVID-19 (aOR 0.942, 95% CI 0.916-0.970), and had mental health disorders (aOR 0.795, 95% CI 0.646-0.975) were less likely to report hesitancy to undergo RAT. Conclusions: Hesitancy to undergo SARS-CoV-2 RAT was low among individuals who were not yet infected with SARS-CoV-2. Efforts should be made to improve the awareness and acceptance of RAT among men, younger adults, individuals with a lower education or salary, families without children and elders, and individuals who access COVID-19 information via traditional media. In a reopening world, our study could inform the development of contextualized mass screening strategies in general and the scale-up of RAT in particular, which remains an indispensable option in emergency preparedness. %M 36888911 %R 10.2196/43555 %U https://publichealth.jmir.org/2023/1/e43555 %U https://doi.org/10.2196/43555 %U http://www.ncbi.nlm.nih.gov/pubmed/36888911 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40993 %T Influence of E-consultation on the Intention of First-Visit Patients to Select Medical Services: Results of a Scenario Survey %A Qi,Miaojie %A Cui,Jiyu %A Li,Xing %A Han,Youli %+ Department of Health Management and Policy, School of Public Health, Capital Medical University, Number 10, Xi Toutiao Road, Youanmenwai District, Beijing, 100069, China, 86 83911790, hanyouli@ccmu.edu.cn %K e-consultation %K medical selection %K influence mechanism %K scenario survey %D 2023 %7 28.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: E-consultation is expected to improve the information level of patients, affect patients’ subsequent judgments of medical services, and guide patients to make a reasonable medical selection in the future. Thus, it is important to understand the influence mechanism of e-consultation on patients’ medical selection. Objective: This study aims to explore the changes in first-visit patients’ understanding of disease and medical resources after e-consultation as well as the choice of follow-up medical services. Methods: Patients’ medical selection before and after e-consultation was compared using a scenario survey. Based on the service characteristics of the e-consultation platform, representative simulation scenarios were determined, and parallel control groups were set up considering the order effect in comparison. Finally, a total of 4 scenario simulation questionnaires were designed. A total of 4164 valid questionnaires were collected through the online questionnaire collection platform. Patients’ perception of disease severity, evaluation of treatment capacity of medical institutions, selection of hospitals and doctors, and other outcome indicators were tested to analyze the differences in patients’ evaluation and choice of medical services before and after e-consultation. Additionally, the results’ stability was tested by regression analysis. Results: In scenario 1 (mild case), before e-consultation, 14.1% (104/740) of participants considered their conditions as not serious. After e-consultation, 69.5% (539/775) of them considered their diseases as not serious. Furthermore, participants’ evaluation of the disease treatment capacity of medical institutions at all levels had improved after using e-consultation. In scenario 3 (severe case), before e-consultation, 54.1% (494/913) of the participants believed their diseases were very serious. After e-consultation, 16.6% (157/945) considered their diseases were very serious. The evaluation of disease treatment capacity of medical institutions in nontertiary hospitals decreased, whereas that of tertiary hospitals improved. In both mild and severe cases, before e-consultation, all of the participants were inclined to directly visit the hospital. After e-consultation, more than 71.4% (553/775) of the patients with mild diseases chose self-treatment, whereas those with severe diseases still opted for a face-to-face consultation. After e-consultation, patients who were set on being treated in a hospital, regardless of the disease severity, preferred to select the tertiary hospitals. Of the patients with mild diseases who chose to go to a hospital, 25.7% (57/222) wanted to consult online doctors face-to-face. By contrast, 56.4% (506/897) of the severe cases wanted to consult online doctors face-to-face. Conclusions: E-consultation can help patients accurately enhance their awareness of the disease and guide them to make a more reasonable medical selection. However, it is likely that e-consultation makes online medical services centralized. Additionally, the guiding effect of e-consultation is limited, and e-consultation needs to be combined with other supporting systems conducive to medical selection to play an improved role. %M 37115615 %R 10.2196/40993 %U https://www.jmir.org/2023/1/e40993 %U https://doi.org/10.2196/40993 %U http://www.ncbi.nlm.nih.gov/pubmed/37115615 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43929 %T Validation of the Attitudes Towards Psychological Online Interventions Questionnaire Among Black Americans: Cross-cultural Confirmatory Factor Analysis %A Ellis,Donovan Michael %A Anderson,Page Lyn %+ Department of Psychology, Georgia State University, Urban Life Bldg, 11th Floor, 140 Decatur Street, Atlanta, GA, 30303, United States, 1 404 413 6258, panderson@gsu.edu %K acceptability %K Black American %K iCBT %K internet-based cognitive behavioral therapy %K digital treatment %K confirmatory factor analysis %K bifactor model %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Acceptability of digital mental health interventions is a significant predictor of treatment-seeking behavior and engagement. However, acceptability has been conceptualized and operationalized in various ways, which decreases measurement precision and leads to heterogeneous conclusions about acceptability. Standardized self-report measures of acceptability have been developed, which have the potential to ameliorate these problems, but none have demonstrated evidence for validation among Black communities, which limits our understanding of attitudes toward these interventions among racially minoritized groups with well-documented barriers to mental health treatment. Objective: This study aims to examine the psychometric validity and reliability of one of the first and most widely used measures of acceptability, the Attitudes Towards Psychological Online Interventions Questionnaire, among a Black American sample. Methods: Participants (N=254) were recruited from a large southeastern university and the surrounding metropolitan area and completed the self-report measure via a web-based survey. A confirmatory factor analysis using mean and variance adjusted weighted least squares estimation was conducted to examine the validity of the underlying hierarchical 4-factor structure proposed by the original authors of the scale. An alternative, hierarchical 2-factor structure model and bifactor model were examined for comparative fit. Results: The findings indicated that the bifactor model demonstrated a superior fit (comparative fit index=0.96, Tucker-Lewis index=0.94, standardized root mean squared residual=0.03, and root mean square error of approximation=0.09) compared with both 2- and 4-factor hierarchical structure models. Conclusions: The findings suggest that, within a Black American sample, there may be greater utility in interpreting the Attitudes Towards Psychological Online Interventions Questionnaire subscales as attitudinal constructs that are distinct from the global acceptability factor. The theoretical and practical implications for culturally responsive measurements were explored. %M 37103983 %R 10.2196/43929 %U https://mental.jmir.org/2023/1/e43929 %U https://doi.org/10.2196/43929 %U http://www.ncbi.nlm.nih.gov/pubmed/37103983 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e39697 %T Eliciting Opinions on Health Messaging During the COVID-19 Pandemic: Qualitative Survey Study %A Ruiz,Sienna %A Okere,Uzoma Charles %A Eggers,Michelle %A O'Leary,Catina %A Politi,Mary %A Wan,Fei %A Housten,Ashley J %+ Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, 660 S Euclid Ave, MSC 8100-0094-02, St. Louis, MO, 63110, United States, 1 (314) 454 7958, ahousten@wustl.edu %K COVID-19 %K health messaging %K rural populations %K urban populations %K communication %K health information %K messaging %K dissemination %K health equity %K prevention %K implementation %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Effective public health messaging has been necessary throughout the COVID-19 pandemic, but stakeholders have struggled to communicate critical information to the public, especially in different types of locations such as urban and rural areas. Objective: This study aimed to identify opportunities to improve COVID-19 messages for community distribution in rural and urban settings and to summarize the findings to inform future messaging. Methods: We purposively sampled by region (urban or rural) and participant type (general public or health care professional) to survey participants about their opinions on 4 COVID-19 health messages. We designed open-ended survey questions and analyzed the data using pragmatic health equity implementation science approaches. Following the qualitative analysis of the survey responses, we designed refined COVID-19 messages incorporating participant feedback and redistributed them via a short survey. Results: In total, 67 participants consented and enrolled: 31 (46%) community participants from the rural Southeast Missouri Bootheel, 27 (40%) community participants from urban St Louis, and 9 (13%) health care professionals from St Louis. Overall, we found no qualitative differences between the responses of our urban and rural samples to the open-ended questions. Participants across groups wanted familiar COVID-19 protocols, personal choice in COVID-19 preventive behaviors, and clear source information. Health care professionals contextualized their suggestions within the specific needs of their patients. All groups suggested practices consistent with health-literate communications. We reached 83% (54/65) of the participants for message redistribution, and most had overwhelmingly positive responses to the refined messages. Conclusions: We suggest convenient methods for community involvement in the creation of health messages by using a brief web-based survey. We identified areas of improvement for future health messaging, such as reaffirming the preventive practices advertised early in a crisis, framing messages such that they allow for personal choice of preventive behavior, highlighting well-known source information, using plain language, and crafting messages that are applicable to the readers’ circumstances. %M 36848256 %R 10.2196/39697 %U https://humanfactors.jmir.org/2023/1/e39697 %U https://doi.org/10.2196/39697 %U http://www.ncbi.nlm.nih.gov/pubmed/36848256 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37139 %T Individual Factors Influencing the Public’s Perceptions About the Importance of COVID-19 Immunity Certificates in the United Kingdom: Cross-sectional Web-based Questionnaire Survey %A Niculaescu,Corina-Elena %A Sassoon,Isabel Karen %A Landa-Avila,Irma Cecilia %A Colak,Ozlem %A Jun,Gyuchan Thomas %A Balatsoukas,Panagiotis %+ School of Design and Creative Arts, Loughborough University, Design School, East Park, Loughborough University, Loughborough, LE11 3TU, United Kingdom, 44 7854801211, P.Balatsoukas@lboro.ac.uk %K immunity passports %K immunity certificates %K vaccine passports %K COVID-19 %K health belief model %K vaccination %K pandemic %K cross-sectional survey %K low income %K vulnerable population %K socioeconomic %K public perception %K public policy %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Understanding how perceptions around immunity certificates are influenced by individual characteristics is important to inform evidence-based policy making and implementation strategies for services around immunity and vaccine certification. Objective: This study aimed to assess what were the main individual factors influencing people’s perception of the importance of using COVID-19 immunity certificates, including health beliefs about COVID-19, vaccination views, sociodemographics, and lifestyle factors. Methods: A cross-sectional web-based survey with a nationally representative sample in the United Kingdom was conducted on August 3, 2021. Responses were collected and analyzed from 534 participants, aged 18 years and older, who were residents of the United Kingdom. The primary outcome measure (dependent variable) was the participants’ perceived importance of using immunity certificates, computed as an index of 6 items. The following individual drivers were used as the independent variables: (1) personal beliefs about COVID-19 (using constructs adapted from the Health Belief Model), (2) personal views on vaccination, (3) willingness to share immunity status with service providers, and (4) variables related to respondents’ lifestyle and sociodemographic characteristics. Results: The perceived importance of immunity certificates was higher among respondents who felt that contracting COVID-19 would have a severe negative impact on their health (β=0.2564; P<.001) and felt safer if vaccinated (β=0.1552; P<.001). The prospect of future economic recovery positively influenced the perceived importance of immunity certificates. Respondents who were employed or self-employed (β=–0.2412; P=.001) or experienced an increase in income after the COVID-19 pandemic (β=–0.1287; P=.002) perceived the use of immunity certificates as less important compared to those who were unemployed or had retired or those who had experienced a reduction in their income during the pandemic. Conclusions: The findings of our survey suggest that more vulnerable members in our society (those unemployed or retired and those who believe that COVID-19 would have a severe impact on their health) and people who experienced a reduction in income during the pandemic perceived the severity of not using immunity certificates in their daily life as higher. %M 36920837 %R 10.2196/37139 %U https://formative.jmir.org/2023/1/e37139 %U https://doi.org/10.2196/37139 %U http://www.ncbi.nlm.nih.gov/pubmed/36920837 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46514 %T Implementation Cascade of a Social Network–Based HIV Self-testing Approach for Men Who Have Sex With Men: Cross-sectional Study %A Kwan,Tsz Ho %A Chan,Denise Pui Chung %A Wong,Samuel Yeung-shan %A Lee,Shui Shan %+ Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Room 207, Postgraduate Education Centre, Prince of Wales Hospital, Hong Kong, China (Hong Kong), 852 22528862, sslee@cuhk.edu.hk %K community-based testing service %K cross-sectional study %K HIV self-test %K HIV testing %K HIV %K implementation cascade %K men who have sex with men %K social network %K virus transmission %D 2023 %7 26.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: HIV testing is the cornerstone of strategies for achieving the fast-track target to end the AIDS epidemic by 2030. Self-testing has been proven to be an effective health intervention for men who have sex with men (MSM). While social network–based approaches for distributing HIV self-tests are recommended by the World Health Organization, their implementation consists of multiple steps that need to be properly evaluated. Objective: This study aimed to assess the implementation cascade of a social network–based HIV self-test approach for reaching MSM who had never undergone testing in Hong Kong. Methods: This is a cross-sectional study. Seed MSM participants were recruited through different web-based channels, who in turn invited their peers to participate in this study. A web-based platform was set up to support the recruitment and referral process. Participants could request for an oral fluid or a finger-prick HIV self-test, with or without real-time support, after completing a self-administered questionnaire. Referrals could be made upon uploading the test result and passing the web-based training. Characteristics of participants completing each of these steps and their preferences for the type of HIV self-test were evaluated. Results: A total of 463 MSM were recruited, including 150 seeds. Participants recruited by seeds were less likely to have previously been tested for HIV (odds ratio [OR] 1.80, 95% CI 1.06-3.04, P=.03) and have lower confidence in performing self-tests (OR 0.66, 95% CI 0.45-0.99, P=.045). Almost all (434/442, 98%) MSM who completed the questionnaire requested a self-test, of whom 82% (354/434) had uploaded their test results. Participants requesting support were new to self-testing (OR 3.65, 95% CI 2.10-6.35, P<.001) and less confident in carrying out the self-test correctly (OR 0.35, 95% CI 0.22-0.56, P<.001). More than half (216/354, 61%) of the eligible participants initiated the referral process by attempting the web-based training with a passing rate of 93% (200/216). They were more likely to have sought sex partners (OR 2.20, 95% CI 1.14-4.25, P=.02), especially through location-based networking apps (OR 2.13, 95% CI 1.31-3.49, P=.002). They also gave higher usability scores along the implementation cascade (median 81 vs 75, P=.003). Conclusions: The social network approach was effective in diffusing HIV self-tests in the MSM community and reaching nontesters. Support and option to choose a preferable type of self-test are essential to address users’ individual needs when delivering HIV self-tests. A positive user experience throughout the processes along the implementation cascade is vital to transform a tester into a promoter. Trial Registration: ClinicalTrials.gov NCT04379206; https://clinicaltrials.gov/ct2/show/NCT04379206 %M 37099364 %R 10.2196/46514 %U https://www.jmir.org/2023/1/e46514 %U https://doi.org/10.2196/46514 %U http://www.ncbi.nlm.nih.gov/pubmed/37099364 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38774 %T Effect of the Data Collection Method on Mobile Phone Survey Participation in Bangladesh and Tanzania: Secondary Analyses of a Randomized Crossover Trial %A Pariyo,George %A Meghani,Ankita %A Gibson,Dustin %A Ali,Joseph %A Labrique,Alain %A Khan,Iqbal Ansary %A Kibria,Gulam Muhammed Al %A Masanja,Honorati %A Hyder,Adnan Ali %A Ahmed,Saifuddin %+ Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E8141, Baltimore, MD, 21205, United States, 1 4434779403, gkibria1@jhu.edu %K mobile phone survey %K interactive voice response survey %K non-communicable disease surveillance %K response rate %K cooperation rate %K phone %K risk %K survey %K public health %K interview %K voice %K response %K cooperation %K female %K women %K rural %K school %K countries %K non-communicable disease %K surveillance %K interactive survey %D 2023 %7 20.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile phone surveys provide a novel opportunity to collect population-based estimates of public health risk factors; however, nonresponse and low participation challenge the goal of collecting unbiased survey estimates. Objective: This study compares the performance of computer-assisted telephone interview (CATI) and interactive voice response (IVR) survey modalities for noncommunicable disease risk factors in Bangladesh and Tanzania. Methods: This study used secondary data from a randomized crossover trial. Between June 2017 and August 2017, study participants were identified using the random digit dialing method. Mobile phone numbers were randomly allocated to either a CATI or IVR survey. The analysis examined survey completion, contact, response, refusal, and cooperation rates of those who received the CATI and IVR surveys. Differences in survey outcomes between modes were assessed using multilevel, multivariable logistic regression models to adjust for confounding covariates. These analyses were adjusted for clustering effects by mobile network providers. Results: For the CATI surveys, 7044 and 4399 phone numbers were contacted in Bangladesh and Tanzania, respectively, and 60,863 and 51,685 phone numbers, respectively, were contacted for the IVR survey. The total numbers of completed interviews in Bangladesh were 949 for CATI and 1026 for IVR and in Tanzania were 447 for CATI and 801 for IVR. Response rates for CATI were 5.4% (377/7044) in Bangladesh and 8.6% (376/4391) in Tanzania; response rates for IVR were 0.8% (498/60,377) in Bangladesh and 1.1% (586/51,483) in Tanzania. The distribution of the survey population was significantly different from the census distribution. In both countries, IVR respondents were younger, were predominantly male, and had higher education levels than CATI respondents. IVR respondents had a lower response rate than CATI respondents in Bangladesh (adjusted odds ratio [AOR]=0.73, 95% CI 0.54-0.99) and Tanzania (AOR=0.32, 95% CI 0.16-0.60). The cooperation rate was also lower with IVR than with CATI in Bangladesh (AOR=0.12, 95% CI 0.07-0.20) and Tanzania (AOR=0.28, 95% CI 0.14-0.56). Both in Bangladesh (AOR=0.33, 95% CI 0.25-0.43) and Tanzania (AOR=0.09, 95% CI 0.06-0.14), there were fewer completed interviews with IVR than with CATI; however, there were more partial interviews with IVR than with CATI in both countries. Conclusions: There were lower completion, response, and cooperation rates with IVR than with CATI in both countries. This finding suggests that, to increase representativeness in certain settings, a selective approach may be needed to design and deploy mobile phone surveys to increase population representativeness. Overall, CATI surveys may offer a promising approach for surveying potentially under-represented groups like women, rural residents, and participants with lower levels of education in some countries. %M 37079373 %R 10.2196/38774 %U https://formative.jmir.org/2023/1/e38774 %U https://doi.org/10.2196/38774 %U http://www.ncbi.nlm.nih.gov/pubmed/37079373 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41189 %T Development of the Emoji Faces Pain Scale and Its Validation on Mobile Devices in Adult Surgery Patients: Longitudinal Observational Study %A Li,Lili %A Wu,Sicheng %A Wang,Jian %A Wang,Chunchun %A Zuo,Weixin %A Yu,Liping %A Song,Jiangang %+ Anesthesiology Department, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 528 Zhangheng Road, Pudong New Area, Shanghai, 20011, China, 86 021 20256301, songjg1993@shutcm.edu.cn %K pain %K mHealth %K scale development %K emoji %K surgery %D 2023 %7 17.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Measuring pain on digital devices using classic unidimensional pain scales such as the visual analog scale (VAS), numerical rating scale (NRS), and faces pain scale (FPS) has been proven to be reliable and valid. Emoji are pictographs designed in colorful form following the Unicode standard. It could be more beneficial to use emoji as faces of FPS on digital devices because emoji can easily fit on most devices and emoji are open-source so no approval would be needed before use. With a concise and user-friendly design, the emoji faces pain scale (Emoji-FPS) might be more generalizable to a wider population and more preferred by digital device users. Objective: This study was designed to develop an Emoji-FPS as well as to evaluate its reliability, validity, and preference on mobile devices in adult patients who underwent surgery. Methods: A modified Delphi technique with 2 rounds of web-based surveys was applied to obtain panelists’ consensus on the sequence of emoji that can best represent 6 levels of pain. The initial candidate sequences of emoji for the Delphi process were constructed referring to 2 well-validated FPSs (Wong-Baker FACES pain rating scale [Wong-Baker FACES] and faces pain scale-revised [FPS-R]). Then, a prospective cohort of patients scheduled to receive perianal surgery was recruited and asked to complete a web-based questionnaire on a mobile device at 5 time points (before surgery [T1], wake up after surgery [T2], 4 hours after surgery [T3], the second day after surgery [T4], and 15 minutes after T4 [T5]). The 4 well-validated pain scales (NRS, VAS, Wong-Baker FACES, and FPS-R) were used as reference scales. Results: After 2 rounds of surveys on 40 Delphi panelists, an Emoji-FPS was finally determined to represent 6 pain levels (0, 2, 4, 6, 8, and 10) from “no hurt” to “hurts worst.” For validation, 300 patients were recruited and 299 were analyzed, the mean age of whom was 38.5 (SD 10.5) years, and 106 (35.5%) were women. For concurrent validity, the Emoji-FPS was highly correlated with 4 reference scales with Spearman correlation coefficient ρ ranging from 0.91 to 0.95. Excellent agreements were observed between 4 versions of Emoji-FPS (iOS, Android, Microsoft, and OpenMoji), with weighted κ coefficients ranging from 0.96 to 0.97. For discriminant validity, patients’ mean preoperative Emoji-FPS score (T1) was significantly higher than their postoperative Emoji-FPS score (T4) with a difference of 1.4 (95% CI 1.3-1.6; P<.001). For test-retest reliability, Emoji-FPS scores measured at T4 and T5 were highly correlated with a ρ of 0.91. The Emoji-FPS was mostly preferred, followed by the Wong-Baker FACES, FPS-R, NRS, and VAS. Conclusions: The Emoji-FPS is reliable and valid compared with traditional pain scales in adult surgery patients. %M 37067854 %R 10.2196/41189 %U https://www.jmir.org/2023/1/e41189 %U https://doi.org/10.2196/41189 %U http://www.ncbi.nlm.nih.gov/pubmed/37067854 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37358 %T A Web-Based Audio Computer-Assisted Self-interview Application With Illustrated Pictures to Administer a Hepatitis B Survey Among a Myanmar-Born Community in Perth, Australia: Development and User Acceptance Study %A Phoo,Nang Nge Nge %A Reid,Alison %A Lobo,Roanna %A Davies,Murray %A Vujcich,Daniel %+ School of Population Health, Curtin University, Kent Street, Bentley, Perth, 6102, Australia, 61 0414954410, nangngenge.phoo@curtin.edu.au %K audio computer-assisted self-interview %K ACASI %K audio computer %K survey mode %K application %K picture %K digital health %D 2023 %7 14.4.2023 %9 Early Reports %J JMIR Form Res %G English %X Background: Self-administered paper or electronic surveys can create accessibility issues for people with language barriers and limited literacy, whereas face-to-face interviews can create privacy issues and give rise to reporting biases, particularly in the context of sensitive subject matters. An audio computer-assisted self-interview (ACASI) offers an alternative mode of survey administration, and its use has been tested against other survey modes to determine whether the presence of a background narration helps overcome literacy and privacy issues. There are still gaps with the ACASI survey administration because audio narration alone does not assist respondents with limited literacy in choosing response options. To overcome literacy issues, a few studies have used illustrated pictures for a limited number of response options. Objective: This study aimed to illustrate all the questions and response options in an ACASI application. This research is part of a larger study comparing different modes of survey administration (ACASI, face-to-face interviews, and self-administered paper surveys) to collect data on hepatitis B knowledge, attitudes, and practices among the Myanmar-born community in Perth, Australia. This study describes the 2-phase process of developing a web-based ACASI application using illustrated pictures. Methods: The first phase was the preparation of the ACASI elements, such as questionnaire, pictures, brief descriptions of response options, and audio files. Each element was pretested on 20 participants from the target population. The second phase involved synchronizing all the elements into the web-based ACASI application and adapting the application features, in particular, autoplay audio and illustrated pictures. The preprototype survey application was tested for user acceptance on 5 participants from the target population, resulting in minor adjustments to the display and arrangement of response options. Results: After a 12-month development process, the prototype ACASI application with illustrated pictures was fully functional for electronic survey administration and secure data storage and export. Conclusions: Pretesting each element separately was a useful approach because it saved time to reprogram the application at a later stage. Future studies should also consider the participatory development of pictures and visual design of user interfaces. This picture-assisted ACASI survey administration mode can be further developed and used to collect sensitive information from populations that are usually marginalized because of literacy and language barriers. %M 37058345 %R 10.2196/37358 %U https://formative.jmir.org/2023/1/e37358 %U https://doi.org/10.2196/37358 %U http://www.ncbi.nlm.nih.gov/pubmed/37058345 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43512 %T Examining Visual Attention to Tobacco Marketing Materials Among Young Adult Smokers: Protocol for a Remote Webcam-Based Eye-Tracking Experiment %A Chen-Sankey,Julia %A Elhabashy,Maryam %A Gratale,Stefanie %A Geller,Jason %A Mercincavage,Melissa %A Strasser,Andrew A %A Delnevo,Cristine D %A Jeong,Michelle %A Wackowski,Olivia A %+ Center for Tobacco Studies, School of Public Health, Rutgers Biomedical and Health Sciences, 303 George St. Room 525, New Brunswick, NJ, 08901, United States, 1 838 932 1855, jc.sankey@rutgers.edu %K eye tracking %K remote eye tracking %K e-cigarette marketing %K young adults %K mobile phone %D 2023 %7 13.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Eye tracking provides an objective way to measure attention, which can advance researchers’ and policy makers’ understanding of tobacco marketing influences. The development of remote webcam-based eye-tracking technology, integrated with web-based crowdsourcing studies, may be a cost-effective and time-efficient alternative to laboratory-based eye-tracking methods. However, research is needed to evaluate the utility of remote eye-tracking methods. Objective: This study aimed to detail the process of designing a remote webcam-based eye-tracking experiment and provide data on associations between participant characteristics and the outcomes of experiment completion. Methods: A total of 2023 young adult (aged 18-34 years) cigarette smokers in the United States were recruited to complete a web-based survey that included a 90-second remote eye-tracking experiment that examined attention to e-cigarette marketing materials. Primary outcome measures assessed the completion of the remote eye-tracking experiment—specifically, experiment initiated versus not initiated, experiment completed versus not completed, and usable versus nonusable eye-tracking data generated. Multivariable logistic regressions examined the associations between outcome measures and participants’ sociodemographic backgrounds, tobacco use history, and electronic devices (mobile vs desktop) used during the experiment. Results: Study recruitment began on April 14, 2022, and ended on May 3, 2022. Of the 2023 survey participants, 1887 (93.28%) initiated the experiment, and 777 (38.41%) completed the experiment. Of the 777 participants who completed the experiment, 381 (49%) generated usable data. Results from the full regression models show that non-Hispanic Black participants (adjusted odds ratio [AOR] 0.64, 95% CI 0.45-0.91) were less likely to complete the eye-tracking experiment than non-Hispanic White participants. In addition, female (vs male) participants (AOR 1.46, 95% CI 1.01-2.11), those currently using (vs not using) e-cigarettes (AOR 2.08, 95% CI 1.13-3.82), and those who used mobile (vs desktop) devices (AOR 5.10, 95% CI 3.05-8.52) were more likely to generate usable eye-tracking data. Conclusions: Young adult participants were willing to try remote eye-tracking technology, and nearly half of those who completed the experiment generated usable eye-tracking data (381/777, 49%). Thus, we believe that the use of remote eye-tracking tools, integrated with crowdsourcing recruitment, can be a useful approach for the tobacco regulatory science research community to collect high-quality, large-scale eye-tracking data in a timely fashion and thereby address research questions related to the ever-evolving tobacco marketing landscape. It would be useful to investigate techniques to enhance completion rates and data usability. International Registered Report Identifier (IRRID): RR1-10.2196/43512 %M 37052989 %R 10.2196/43512 %U https://www.researchprotocols.org/2023/1/e43512 %U https://doi.org/10.2196/43512 %U http://www.ncbi.nlm.nih.gov/pubmed/37052989 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40660 %T An Investigation of Factors Influencing the Postponement of the Use of Distributed Research Networks in South Korea: Web-Based Users’ Survey Study %A Rho,Mi Jung %A Park,Jihwan %+ Department of Computer Education, Dankook Liberal Art College, Dankook University, 119, Dandae-ro, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 31116, Republic of Korea, 82 415501391, bosoagalaxy@gmail.com %K distributed research networks %K postponement %K performance risk %K workload %D 2023 %7 12.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Distributed research networks (DRNs) offer researchers the advantage of using various big data sets that are difficult to access and use. In addition, since the data are not physically exposed to the outside, it is possible to conduct research using medical data safely without data exposure. However, researchers still have difficulties and are concerned about using DRNs. Few studies involving DRNs have been conducted from the user’s viewpoint. Therefore, it is necessary to look at DRNs from the researcher’s point of view and find ways to facilitate the active use of DRNs. Objective: This study aimed to identify the factors that made researchers hesitate to use DRNs and to derive a method to facilitate active DRN use. Methods: We conducted a web-based survey of people working in the medical fields, such as hospitals and universities. We used 131 respondents’ data from a survey from December 6 to 17, 2021. We conducted multiple regression analyses to determine the factors affecting the postponement of using DRNs. In addition, 2 independent sample t tests were conducted to analyze the difference between the 2 groups according to the following factors: organization, gender, experience with DRNs, length of the research career, position, and age. Results: Performance risk (t5=2.725, P=.007) and workload from DRNs (t5=3.543, P=.001) were significantly associated with users’ postponement of DRN use. Researchers working at hospitals were found to feel more burdened by DRN use than researchers working at universities (t129=1.975, P=.05). It was also found that women perceived a higher privacy risk of DRNs than men (t129=–2.303, P=.02) and that those who had experience using DRNs delayed their use less than those without experience (t129=–4.215, P<.001). Conclusions: It is necessary to simplify the research and approval processes to reduce the performance risk and workload of research using DRNs. To optimize the process, DRN providers should develop a way to improve users’ experiences. More user-friendly functionalities should be developed from the researcher's point of view. It is necessary to continuously promote effective functionalities for DRNs to reduce concerns about privacy risks. This study identified the concerns of DRN users in terms of DRN use and suggested ways to actively use DRNs. The derived results can be reflected in planning and developing DRNs. Our research will be helpful to prepare an activation plan for DRNs. %M 37043286 %R 10.2196/40660 %U https://formative.jmir.org/2023/1/e40660 %U https://doi.org/10.2196/40660 %U http://www.ncbi.nlm.nih.gov/pubmed/37043286 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43503 %T German Health Update Fokus (GEDA Fokus) among Residents with Croatian, Italian, Polish, Syrian, or Turkish Citizenship in Germany: Protocol for a Multilingual Mixed-Mode Interview Survey %A Koschollek,Carmen %A Zeisler,Marie-Luise %A Houben,Robin A %A Geerlings,Julia %A Kajikhina,Katja %A Bug,Marleen %A Blume,Miriam %A Hoffmann,Robert %A Hintze,Marcel %A Kuhnert,Ronny %A Gößwald,Antje %A Schmich,Patrick %A Hövener,Claudia %+ Department for Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Straße 62-66, Berlin, 12101, Germany, 49 30187543142, KoschollekC@rki.de %K migration %K interview survey %K hard-to-survey %K health inequalities %K mixed-mode %K multilingual %D 2023 %7 12.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Germany has a long history of migration. In 2020, more than 1 person in every 4 people had a statistically defined, so-called migration background in Germany, meaning that the person or at least one of their parents was born with a citizenship other than German citizenship. People with a history of migration are not represented proportionately to the population within public health monitoring at the Robert Koch Institute, thus impeding differentiated analyses of migration and health. To develop strategies for improving the inclusion of people with a history of migration in health surveys, we conducted a feasibility study in 2018. The lessons learned were implemented in the health interview survey German Health Update (Gesundheit in Deutschland aktuell [GEDA]) Fokus, which was conducted among people with selected citizenships representing the major migrant groups in Germany. Objective: GEDA Fokus aimed to collect comprehensive data on the health status and social, migration-related, and structural factors among people with selected citizenships to enable differentiated explanations of the associations between migration-related aspects and their impact on migrant health. Methods: GEDA Fokus is an interview survey among people with Croatian, Italian, Polish, Syrian, or Turkish citizenship living in Germany aged 18-79 years, with a targeted sample size of 1200 participants per group. The gross sample of 33,436 people was drawn from the residents’ registration offices of 99 German municipalities based on citizenship. Sequentially, multiple modes of administration were offered. The questionnaire was available for self-administration (web-based and paper-based); in larger municipalities, personal or phone interviews were possible later on. Study documents and the questionnaire were bilingual—in German and the respective translation language depending on the citizenship. Data were collected from November 2021 to May 2022. Results: Overall, 6038 respondents participated in the survey, of whom 2983 (49.4%) were female. The median age was 39 years; the median duration of residence in Germany was 10 years, with 19.69% (1189/6038) of the sample being born in Germany. The overall response rate was 18.4% (American Association for Public Opinion Research [AAPOR] response rate 1) and was 6.8% higher in the municipalities where personal interviews were offered (19.3% vs 12.5%). Overall, 78.12% (4717/6038) of the participants self-administered the questionnaire, whereas 21.88% (1321/6038) took part in personal interviews. In total, 41.85% (2527/6038) of the participants answered the questionnaire in the German language only, 16.69% (1008/6038) exclusively used the translation. Conclusions: Offering different modes of administration, as well as multiple study languages, enabled us to recruit a heterogeneous sample of people with a history of migration. The data collected will allow differentiated analyses of the role and interplay of migration-related and social determinants of health and their impact on the health status of people with selected citizenships. International Registered Report Identifier (IRRID): DERR1-10.2196/43503 %M 36790192 %R 10.2196/43503 %U https://www.researchprotocols.org/2023/1/e43503 %U https://doi.org/10.2196/43503 %U http://www.ncbi.nlm.nih.gov/pubmed/36790192 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41832 %T General Practices’ Experiences With Patients’ Web-Based Access to Medical Records: Survey Study %A Keuper,Jelle %A Batenburg,Ronald %A van Tuyl,Lilian %A Verheij,Robert %+ Netherlands Institute for Health Services Research, Otterstraat 118, Utrecht, 3513CR, Netherlands, 31 627460492, j.keuper@nivel.nl %K patient access to records %K electronic health record %K patient portals %K general practice %K administrative burden %K health information %K shared decision-making %K health care professionals %D 2023 %7 7.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients’ web-based access to their medical records is expected to promote their role and responsibility in managing their own health and treatments and supporting shared decision-making. As of July 2020, general practices in the Netherlands are legally obliged to provide their patients access to their electronic medical records. Web-based access provision is facilitated and stimulated through a national support program named OPEN. Objective: We aimed to investigate general practice staff experiences with providing web-based access; investigate its impact on patient consultations, administrative actions, and patient inquiries; and investigate how it affects routine general practice workflow processes. Methods: In October 2021, a total of 3813 general practices in the Netherlands were invited to complete a web-based survey that included questions regarding their experiences with the provision of web-based access to medical records and how it affects routine general practice workflow. Responses of general practices that started providing web-based access before 2020, in 2020, or in 2021 were analyzed to identify trends. Results: Of 3813 invited general practices, 523 (13.72%) completed the survey. Approximately all responding general practices (487/523, 93.1%) indicated that they provide web-based access. Experiences with patients’ web-based access were diverse, with 36.9% (178/482) primarily positive, 8.1% (39/482) primarily negative, 42.3% (204/482) neutral, and 12.7% (61/482) could not (yet) indicate how they experienced web-based access. Of the total, two-thirds (311/473, 65.8%) reported an increase in e-consultations and a similar percentage (302/474, 63.7%) indicated an increase in administrative actions associated with web-based access provision. A small proportion of the practices (≤10%) experienced a decrease in patient contacts. Earlier adoption of web-based access was associated with a more positive attitude toward web-based access and more positive experienced effects related to patient contacts and general practice workflow. Conclusions: The surveyed general practices mainly experienced providing web-based access as either neutral or mostly positive, despite an increased number of patient contacts and administrative burden that were associated with its adoption. Periodic monitoring of experiences is needed to understand the temporal or structural nature of both the intended and unintended effects of patients’ web-based access to medical records for general practices and their staff. %M 37027195 %R 10.2196/41832 %U https://www.jmir.org/2023/1/e41832 %U https://doi.org/10.2196/41832 %U http://www.ncbi.nlm.nih.gov/pubmed/37027195 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e38066 %T Smartphone Keyboard Interaction Monitoring as an Unobtrusive Method to Approximate Rest-Activity Patterns: Experience Sampling Study Investigating Interindividual and Metric-Specific Variations %A Smolders,Karin %A Druijff-van de Woestijne,Gerrieke %A Meijer,Kim %A Mcconchie,Hannah %A de Kort,Yvonne %+ Eindhoven University of Technology, Human-Technology Interaction group, Groene Loper, Eindhoven, 5600MB, Netherlands, 31 402474491, k.c.h.j.smolders@tue.nl %K smartphone keyboard interactions monitoring %K rest-activity patters %K sleep quality %K chronotype %K trait self-control %K mobile phone %D 2023 %7 7.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Sleep is an important determinant of individuals’ health and behavior during the wake phase. Novel research methods for field assessments are required to enable the monitoring of sleep over a prolonged period and across a large number of people. The ubiquity of smartphones offers new avenues for detecting rest-activity patterns in everyday life in a noninvasive an inexpensive manner and on a large scale. Recent studies provided evidence for the potential of smartphone interaction monitoring as a novel tracking method to approximate rest-activity patterns based on the timing of smartphone activity and inactivity throughout the 24-hour day. These findings require further replication and more detailed insights into interindividual variations in the associations and deviations with commonly used metrics for monitoring rest-activity patterns in everyday life. Objective: This study aimed to replicate and expand on earlier findings regarding the associations and deviations between smartphone keyboard–derived and self-reported estimates of the timing of the onset of the rest and active periods and the duration of the rest period. Moreover, we aimed to quantify interindividual variations in the associations and time differences between the 2 assessment modalities and to investigate to what extent general sleep quality, chronotype, and trait self-control moderate these associations and deviations. Methods: Students were recruited to participate in a 7-day experience sampling study with parallel smartphone keyboard interaction monitoring. Multilevel modeling was used to analyze the data. Results: In total, 157 students participated in the study, with an overall response rate of 88.9% for the diaries. The results revealed moderate to strong relationships between the keyboard-derived and self-reported estimates, with stronger associations for the timing-related estimates (β ranging from .61 to .78) than for the duration-related estimates (β=.51 and β=.52). The relational strength between the time-related estimates was lower, but did not substantially differ for the duration-related estimates, among students experiencing more disturbances in their general sleep quality. Time differences between the keyboard-derived and self-reported estimates were, on average, small (<0.5 hours); however, large discrepancies were also registered for quite some nights. The time differences between the 2 assessment modalities were larger for both timing-related and rest duration–related estimates among students who reported more disturbances in their general sleep quality. Chronotype and trait self-control did not significantly moderate the associations and deviations between the 2 assessment modalities. Conclusions: We replicated the positive potential of smartphone keyboard interaction monitoring for estimating rest-activity patterns among populations of regular smartphone users. Chronotype and trait self-control did not significantly influence the metrics’ accuracy, whereas general sleep quality did: the behavioral proxies obtained from smartphone interactions appeared to be less powerful among students who experienced lower general sleep quality. The generalization and underlying process of these findings require further investigation. %M 37027202 %R 10.2196/38066 %U https://www.jmir.org/2023/1/e38066 %U https://doi.org/10.2196/38066 %U http://www.ncbi.nlm.nih.gov/pubmed/37027202 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44541 %T Health Care–Seeking Behaviors, Disease Progression, Medications, Knowledge of, and Attitudes Toward Systemic Lupus Erythematosus in China: Cross-sectional Survey Study %A Dai,Zonglin %A Huang,Xinxiang %A Yuan,Fei %A Li,Tianwang %A Xie,Baozhao %A Lin,He %A Yang,Pingting %A Li,Xueyi %A Xu,Shuiming %A Zhao,Jinjun %A Wang,Yukai %A Peng,Xiang %A Wei,Simin %A Huang,Wei %A Li,Jingyang %A Liang,Jing %A Liu,Xiuhua %A Chu,Yongliang %A Zhang,Zhiming %A Zhang,Renpeng %A Lau,Eric H Y %A Lin,Zhiming %+ Department of Rheumatology and Immunology, The Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China, 86 13632346950, lzm-zj99@163.com %K systemic lupus erythematosus %K health care–seeking behaviors %K disease progression %K medications %K knowledge %K attitudes %D 2023 %7 7.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease involving multiple organs throughout the body. The health care–seeking behaviors, disease progression of SLE, and patients' knowledge of and attitudes toward SLE have not been characterized in China. Objective: The aim of this study was to depict the health care–seeking behaviors, disease progression, and medications in patients with SLE and to examine the factors associated with their disease flares, knowledge, and attitudes toward SLE in China. Methods: We conducted a cross-sectional survey in 27 provinces in China. Descriptive statistical methods were used to depict the demographic characteristics, health care–seeking behaviors, medications, and health status. Multivariable logistic regression models were used to identify the factors associated with disease flares, medication changes, and attitudes toward SLE. An ordinal regression model was used to examine the factors associated with the knowledge of the treatment guidelines. Results: We recruited 1509 patients with SLE, and 715 had lupus nephritis (LN). Approximately 39.96% (603/1509) of the patients with SLE were primarily diagnosed with LN, and 12.4% (112/906) developed LN (mean time 5.2 years) from non-LN. Patients whose registered permanent residences or workplaces in other cities from the same province and adjacent provinces seeking health care accounted for 66.9% (569/850) and 48.8% (479/981) of the patients with SLE in the provincial capital cities, respectively. Mycophenolate mofetil was the most commonly used immunosuppressive drug in patients without LN (185/794, 23.3%) and patients with LN (307/715, 42.9%). Femoral head necrosis (71/228, 31.1%) and hypertension (99/229, 43.2%) were the most common adverse event (AE) and chronic disease during treatment, respectively. Change of hospitals for medical consultation (odds ratio [OR] 1.90, 95% CI 1.24-2.90) and development of 1 chronic disease (OR 3.60, 95% CI 2.04-6.24) and AE (OR 2.06, 95% CI 1.46-2.92) and more were associated with disease flares. A pregnancy plan (OR 1.58, 95% CI 1.18-2.13) was associated with changes in medication. Only 242 (16.03%) patients with SLE were familiar with the treatment guidelines, and patients with LN tended to be more familiar with the disease (OR 2.20, 95% CI 1.81-2.68). After receiving treatment, 891 (59.04%) patients changed their attitudes toward SLE from fear to acceptance, and patients with college education or higher (OR 2.09, 95% CI 1.10-4.04) were associated with a positive attitude toward SLE. Conclusions: A large proportion of patients seeking health care in the provincial capital cities of China migrated from other cities. Persistent monitoring of potential AEs and chronic diseases during SLE treatment and managing patients who changed hospitals for medical consultation are essential for controlling disease flares. Patients had insufficient knowledge about SLE treatment guidelines and would benefit from health education to maintain a positive attitude toward SLE. %M 37027203 %R 10.2196/44541 %U https://publichealth.jmir.org/2023/1/e44541 %U https://doi.org/10.2196/44541 %U http://www.ncbi.nlm.nih.gov/pubmed/37027203 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42739 %T Patient Satisfaction With Speech Recognition in the Exam Room: Exploratory Survey %A Sippel,Jeffrey %A Podhajsky,Tim %A Lin,Chen-Tan %+ Department of Internal Medicine, University of Colorado School of Medicine, 12700 E 19th Avenue, RC2, Room 9C03, Box C272, Aurora, CO, 80045, United States, 1 303 724 4075, jeffrey.sippel@cuanschutz.edu %K speech recognition %K exam room %K primary care %K general practitioner %K satisfaction %K survey %K perception %K opinion %K speech %K voice %K eHealth %K digital health %K health technology %K communication technology %D 2023 %7 5.4.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Medical speech recognition technology uses a microphone and computer software to transcribe the spoken word into text and is not typically used in outpatient clinical exam rooms. Patient perceptions regarding speech recognition in the exam room (SRIER) are therefore unknown. Objective: This study aims to characterize patient perceptions of SRIER by administering a survey to consecutive patients scheduled for acute, chronic, and wellness care in three outpatient clinic sites. Methods: We used a microphone and medical speech recognition software to complete the “assessment and plan” portion of the after-visit summary in the patient’s presence, immediately printed the after-visit summary, and then administered a 4-question exploratory survey to 65 consecutive patients in internal medicine and pulmonary medicine clinics at an academic medical center and a community family practice clinic in 2021 to characterize patient perceptions of SRIER. All questions were completed by all participants. Results: When compared to patients’ recollection of usual care (visits with no microphone and an after-visit summary without an “assessment and plan”), 86% (n=56) of respondents agreed or strongly agreed that their provider addressed their concerns better, and 73% (n=48) agreed or strongly agreed that they understood their provider’s advice better. A total of 99% (n=64) of respondents agreed or strongly agreed that a printed after-visit summary including the “assessment and plan” was helpful. By comparing the “agree” and “strongly agree” responses to the neutral responses, we found that patients felt that clinicians using SRIER addressed their concerns better (P<.001), they understood their clinician’s advice better (P<.001), and receiving a paper summary was helpful (P<.001). Patients were likely to recommend a provider using a microphone based on the Net Promoter Score of 58. Conclusions: This survey suggests patients have a very positive perception of speech recognition use in the exam room. %M 37018039 %R 10.2196/42739 %U https://humanfactors.jmir.org/2023/1/e42739 %U https://doi.org/10.2196/42739 %U http://www.ncbi.nlm.nih.gov/pubmed/37018039 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41117 %T Collecting Food and Drink Intake Data With Voice Input: Development, Usability, and Acceptability Study %A Millard,Louise A C %A Johnson,Laura %A Neaves,Samuel R %A Flach,Peter A %A Tilling,Kate %A Lawlor,Deborah A %+ Medical Research Council (MRC) Integrative Epidemiology Unit, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, United Kingdom, 44 0117 455 7676, louise.millard@bristol.ac.uk %K digital health %K data collection %K voice-based approaches %K Amazon Alexa %K self-reported data %K food and drink %D 2023 %7 31.3.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Voice-based systems such as Amazon Alexa may be useful for collecting self-reported information in real time from participants of epidemiology studies using verbal input. In epidemiological research studies, self-reported data tend to be collected using short, infrequent questionnaires, in which the items require participants to select from predefined options, which may lead to errors in the information collected and lack of coverage. Voice-based systems give the potential to collect self-reported information “continuously” over several days or weeks. At present, to the best of our knowledge, voice-based systems have not been used or evaluated for collecting epidemiological data. Objective: We aimed to demonstrate the technical feasibility of using Alexa to collect information from participants, investigate participant acceptability, and provide an initial evaluation of the validity of the collected data. We used food and drink information as an exemplar. Methods: We recruited 45 staff members and students at the University of Bristol (United Kingdom). Participants were asked to tell Alexa what they ate or drank for 7 days and to also submit this information using a web-based form. Questionnaires asked for basic demographic information, about their experience during the study, and the acceptability of using Alexa. Results: Of the 37 participants with valid data, most (n=30, 81%) were aged 20 to 39 years and 23 (62%) were female. Across 29 participants with Alexa and web entries corresponding to the same intake event, 60.1% (357/588) of Alexa entries contained the same food and drink information as the corresponding web entry. Most participants reported that Alexa interjected, and this was worse when entering the food and drink information (17/35, 49% of participants said this happened often; 1/35, 3% said this happened always) than when entering the event date and time (6/35, 17% of participants said this happened often; 1/35, 3% said this happened always). Most (28/35, 80%) said they would be happy to use a voice-controlled system for future research. Conclusions: Although there were some issues interacting with the Alexa skill, largely because of its conversational nature and because Alexa interjected if there was a pause in speech, participants were mostly willing to participate in future research studies using Alexa. More studies are needed, especially to trial less conversational interfaces. %M 37000476 %R 10.2196/41117 %U https://mhealth.jmir.org/2023/1/e41117 %U https://doi.org/10.2196/41117 %U http://www.ncbi.nlm.nih.gov/pubmed/37000476 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41082 %T Turning When Using Smartphone in Persons With and Those Without Neurologic Conditions: Observational Study %A Bianchini,Edoardo %A Warmerdam,Elke %A Romijnders,Robbin %A Stürner,Klarissa Hanja %A Baron,Ralf %A Heinzel,Sebastian %A Pontieri,Francesco Ernesto %A Hansen,Clint %A Maetzler,Walter %+ Department of Neurology, Kiel University, Klinik für Neurologie UKSH, Campus Kiel, Arnold-Heller-Strasse 3, Haus D, Kiel, 24105, Germany, 49 431500 23981, w.maetzler@neurologie.uni-kiel.de %K turning %K turning coordination %K smartphone %K dual task %K dual task cost %K Parkinson disease %K Parkinson %K stroke %K multiple sclerosis %K low back pain %K neurology %K neurological %K movement %K biomechanics %K gait %K balance %K walk %K kinesiology %K fall %D 2023 %7 30.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Turning during walking is a relevant and common everyday movement and it depends on a correct top-down intersegmental coordination. This could be reduced in several conditions (en bloc turning), and an altered turning kinematics has been linked to increased risk of falls. Smartphone use has been associated with poorer balance and gait; however, its effect on turning-while-walking has not been investigated yet. This study explores turning intersegmental coordination during smartphone use in different age groups and neurologic conditions. Objective: This study aims to evaluate the effect of smartphone use on turning behavior in healthy individuals of different ages and those with various neurological diseases. Methods: Younger (aged 18-60 years) and older (aged >60 years) healthy individuals and those with Parkinson disease, multiple sclerosis, subacute stroke (<4 weeks), or lower-back pain performed turning-while-walking alone (single task [ST]) and while performing 2 different cognitive tasks of increasing complexity (dual task [DT]). The mobility task consisted of walking up and down a 5-m walkway at self-selected speed, thus including 180° turns. Cognitive tasks consisted of a simple reaction time test (simple DT [SDT]) and a numerical Stroop test (complex DT [CDT]). General (turn duration and the number of steps while turning), segmental (peak angular velocity), and intersegmental turning parameters (intersegmental turning onset latency and maximum intersegmental angle) were extracted for head, sternum, and pelvis using a motion capture system and a turning detection algorithm. Results: In total, 121 participants were enrolled. All participants, irrespective of age and neurologic disease, showed a reduced intersegmental turning onset latency and a reduced maximum intersegmental angle of both pelvis and sternum relative to head, thus indicating an en bloc turning behavior when using a smartphone. With regard to change from the ST to turning when using a smartphone, participants with Parkinson disease reduced their peak angular velocity the most, which was significantly different from lower-back pain relative to the head (P<.01). Participants with stroke showed en bloc turning already without smartphone use. Conclusions: Smartphone use during turning-while-walking may lead to en bloc turning and thus increase fall risk across age and neurologic disease groups. This behavior is probably particularly dangerous for those groups with the most pronounced changes in turning parameters during smartphone use and the highest fall risk, such as individuals with Parkinson disease. Moreover, the experimental paradigm presented here might be useful in differentiating individuals with lower-back pain without and those with early or prodromal Parkinson disease. In individuals with subacute stroke, en bloc turning could represent a compensative strategy to overcome the newly occurring mobility deficit. Considering the ubiquitous smartphone use in daily life, this study should stimulate future studies in the area of fall risk and neurological and orthopedic diseases. Trial Registration: German Clinical Trials Register DRKS00022998; https://drks.de/search/en/trial/DRKS00022998 %M 36995756 %R 10.2196/41082 %U https://www.jmir.org/2023/1/e41082 %U https://doi.org/10.2196/41082 %U http://www.ncbi.nlm.nih.gov/pubmed/36995756 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45721 %T Prediction Models for Sleep Quality Among College Students During the COVID-19 Outbreak: Cross-sectional Study Based on the Internet New Media %A Zheng,Wanyu %A Chen,Qingquan %A Yao,Ling %A Zhuang,Jiajing %A Huang,Jiewei %A Hu,Yiming %A Yu,Shaoyang %A Chen,Tebin %A Wei,Nan %A Zeng,Yifu %A Zhang,Yixiang %A Fan,Chunmei %A Wang,Youjuan %+ The Second Affiliated Hospital of Fujian Medical University, No. 34, Zhongshan North Road, Licheng District, Quanzhou City, Fujian Province, P. R. China, Quanzhou, 362018, China, 86 13055603250, youjuan@fyey4.wecom.work %K artificial neural network %K college students %K COVID-19 %K internet new media %K logistic regression %K machine learning %K sleep quality %D 2023 %7 24.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has been reported to affect the sleep quality of Chinese residents; however, the epidemic’s effects on the sleep quality of college students during closed-loop management remain unclear, and a screening tool is lacking. Objective: This study aimed to understand the sleep quality of college students in Fujian Province during the epidemic and determine sensitive variables, in order to develop an efficient prediction model for the early screening of sleep problems in college students. Methods: From April 5 to 16, 2022, a cross-sectional internet-based survey was conducted. The Pittsburgh Sleep Quality Index (PSQI) scale, a self-designed general data questionnaire, and the sleep quality influencing factor questionnaire were used to understand the sleep quality of respondents in the previous month. A chi-square test and a multivariate unconditioned logistic regression analysis were performed, and influencing factors obtained were applied to develop prediction models. The data were divided into a training-testing set (n=14,451, 70%) and an independent validation set (n=6194, 30%) by stratified sampling. Four models using logistic regression, an artificial neural network, random forest, and naïve Bayes were developed and validated. Results: In total, 20,645 subjects were included in this survey, with a mean global PSQI score of 6.02 (SD 3.112). The sleep disturbance rate was 28.9% (n=5972, defined as a global PSQI score >7 points). A total of 11 variables related to sleep quality were taken as parameters of the prediction models, including age, gender, residence, specialty, respiratory history, coffee consumption, stay up, long hours on the internet, sudden changes, fears of infection, and impatient closed-loop management. Among the generated models, the artificial neural network model proved to be the best, with an area under curve, accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 0.713, 73.52%, 25.51%, 92.58%, 57.71%, and 75.79%, respectively. It is noteworthy that the logistic regression, random forest, and naive Bayes models achieved high specificities of 94.41%, 94.77%, and 86.40%, respectively. Conclusions: The COVID-19 containment measures affected the sleep quality of college students on multiple levels, indicating that it is desiderate to provide targeted university management and social support. The artificial neural network model has presented excellent predictive efficiency and is favorable for implementing measures earlier in order to improve present conditions. %M 36961495 %R 10.2196/45721 %U https://www.jmir.org/2023/1/e45721 %U https://doi.org/10.2196/45721 %U http://www.ncbi.nlm.nih.gov/pubmed/36961495 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43359 %T Preliminary Attainability Assessment of Real-World Data for Answering Major Clinical Research Questions in Breast Cancer Brain Metastasis: Framework Development and Validation Study %A Kim,Min Jeong %A Kim,Hyo Jung %A Kang,Danbee %A Ahn,Hee Kyung %A Shin,Soo-Yong %A Park,Seri %A Cho,Juhee %A Park,Yeon Hee %+ Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Ilwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea, 82 10 9933 1780, yhparkhmo@skku.edu %K real-world data %K preliminary attainability assessment %K observational study %K clinical data warehouse %K PAR framework %K brain metastasis %K breast cancer %D 2023 %7 23.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent decades, real-world evidence (RWE) in oncology has rapidly gained traction for its potential to answer clinical questions that cannot be directly addressed by randomized clinical trials. Integrating real-world data (RWD) into clinical research promises to contribute to more sustainable research designs, including extension, augmentation, enrichment, and pragmatic designs. Nevertheless, clinical research using RWD is still limited because of concerns regarding the shortage of best practices for extracting, harmonizing, and analyzing RWD. In particular, pragmatic screening methods to determine whether the content of a data source is sufficient to answer the research questions before conducting the research with RWD have not yet been established. Objective: We examined the PAR (Preliminary Attainability Assessment of Real-World Data) framework and assessed its utility in breast cancer brain metastasis (BCBM), which has an unmet medical need for data attainability screening at the preliminary step of observational studies that use RWD. Methods: The PAR framework was proposed to assess data attainability from a particular data source during the early research process. The PAR framework has four sequential stages, starting with clinical question clarification: (1) operational definition of variables, (2) data matching (structural/semantic), (3) data screening and extraction, and (4) data attainability diagramming. We identified 5 clinical questions to be used for PAR framework evaluation through interviews and validated them with a survey of breast cancer experts. We used the Samsung Medical Center Breast Cancer Registry, a hospital-based real-time registry implemented in March 2021, leveraging the institution’s anonymized and deidentified clinical data warehouse platform. The number of breast cancer patients in the registry was 45,129; it covered the period from June 1995 to December 2021. The registry consists of 24 base data marts that represent disease-specific breast cancer characteristics and care pathways. The outcomes included screening results of the clinical questions via the PAR framework and a procedural diagram of data attainability for each research question. Results: Data attainability was tested for study feasibility according to the PAR framework with 5 clinical questions for BCBM. We obtained data sets that were sufficient to conduct studies with 4 of 5 clinical questions. The research questions stratified into 3 types when we developed data fields for clearly defined research variables. In the first, only 1 question could be answered using direct data variables. In the second, the other 3 questions required surrogate definitions that combined data variables. In the third, the question turned out to be not feasible for conducting further analysis. Conclusions: The adoption of the PAR framework was associated with more efficient preliminary clinical research using RWD from BCBM. Furthermore, this framework helped accelerate RWE generation through clinical research by enhancing transparency and reproducibility and lowering the entry barrier for clinical researchers. %M 36951923 %R 10.2196/43359 %U https://www.jmir.org/2023/1/e43359 %U https://doi.org/10.2196/43359 %U http://www.ncbi.nlm.nih.gov/pubmed/36951923 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40814 %T Understanding Public Attitudes and Willingness to Share Commercial Data for Health Research: Survey Study in the United Kingdom %A Hirst,Yasemin %A Stoffel,Sandro T %A Brewer,Hannah R %A Timotijevic,Lada %A Raats,Monique M %A Flanagan,James M %+ Lancaster Medical School, Lancaster University, Sir John Fisher Drive, Bailrigg, Lancaster, LA1 4YW, United Kingdom, 44 1524 65201, y.hirst@lancaster.ac.uk %K commercial data %K data sharing %K participant recruitment %K loyalty cards %K sociodemographic factors %K data donation %K data %K health %K public %K acceptability %K digital %K mobile phone %D 2023 %7 23.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Health research using commercial data is increasing. The evidence on public acceptability and sociodemographic characteristics of individuals willing to share commercial data for health research is scarce. Objective: This survey study investigates the willingness to share commercial data for health research in the United Kingdom with 3 different organizations (government, private, and academic institutions), 5 different data types (internet, shopping, wearable devices, smartphones, and social media), and 10 different invitation methods to recruit participants for research studies with a focus on sociodemographic characteristics and psychological predictors. Methods: We conducted a web-based survey using quota sampling based on age distribution in the United Kingdom in July 2020 (N=1534). Chi-squared tests tested differences by sociodemographic characteristics, and adjusted ordered logistic regressions tested associations with trust, perceived importance of privacy, worry about data misuse and perceived risks, and perceived benefits of data sharing. The results are shown as percentages, adjusted odds ratios, and 95% CIs. Results: Overall, 61.1% (937/1534) of participants were willing to share their data with the government and 61% (936/1534) of participants were willing to share their data with academic research institutions compared with 43.1% (661/1534) who were willing to share their data with private organizations. The willingness to share varied between specific types of data—51.8% (794/1534) for loyalty cards, 35.2% (540/1534) for internet search history, 32% (491/1534) for smartphone data, 31.8% (488/1534) for wearable device data, and 30.4% (467/1534) for social media data. Increasing age was consistently and negatively associated with all the outcomes. Trust was positively associated with willingness to share commercial data, whereas worry about data misuse and the perceived importance of privacy were negatively associated with willingness to share commercial data. The perceived risk of sharing data was positively associated with willingness to share when the participants considered all the specific data types but not with the organizations. The participants favored postal research invitations over digital research invitations. Conclusions: This UK-based survey study shows that willingness to share commercial data for health research varies; however, researchers should focus on effectively communicating their data practices to minimize concerns about data misuse and improve public trust in data science. The results of this study can be further used as a guide to consider methods to improve recruitment strategies in health-related research and to improve response rates and participant retention. %M 36951929 %R 10.2196/40814 %U https://publichealth.jmir.org/2023/1/e40814 %U https://doi.org/10.2196/40814 %U http://www.ncbi.nlm.nih.gov/pubmed/36951929 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42888 %T Patient-Reported Outcomes Collection at an Urban HIV Clinic Associated With a Historically Black Medical College in the Southern United States: Qualitative Interview Study Among Patients With HIV %A Parisot III,Paul E %A Wheeler,Facerlyn %A Bonnet,Kemberlee %A Rebeiro,Peter F %A Schember,Cassandra O %A McCainster,Korlu %A Cooper,Robert L %A Berthaud,Vladimir %A Schlundt,David G %A Pettit,April C %+ Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, Nashville, TN, 37232, United States, 1 615 853 1156, paul.parisot@vumc.org %K patient-reported outcomes %K HIV infection %K HIV continuum of care %K HIV epidemic %K questionnaire experience %K cognitive behavioral model %K implementation %K vulnerable population %K racial disparity %D 2023 %7 22.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Black Americans, particularly in the southern United States, are disproportionately affected by the US HIV epidemic. Patient-reported outcome (PRO) data collection can improve patient outcomes and provide oft-overlooked data on mental health, substance use, and patient adherence to antiretroviral therapy. Objective: We piloted the use of an electronic tablet to collect PRO data on social and behavioral determinants of health among people with HIV at the Meharry Community Wellness Center, an HIV clinic affiliated with a Historically Black Medical College in Nashville, Tennessee. Our primary objective was to better understand patients’ experiences and comfort with using an electronic PRO tool through patient interviews. Methods: We enrolled 100 people with HIV in care at the Meharry Community Wellness Center consecutively to completely validate PRO tools using the Research Electronic Data Capture platform on a hand-held tablet. Using a purposive sampling strategy, we enrolled 20 of the 100 participants in an in-depth interview (IDI). Interview guide development was grounded in the cognitive-behavioral model, in which thoughts, feelings, and behaviors are interrelated. IDIs were audio recorded, transcribed, deidentified, and formatted for coding. A hierarchical coding system was developed and refined using an inductive-deductive approach. Results: Among the 100 people with HIV enrolled, the median age was 50 (IQR 42-54) years; 89% (n=89) were Black, 60% (n=60) were male, and 82% (n=82) were living below 100% of the federal poverty level in 2016. Five major interview themes emerged: overall experience, question content, sensitive topics, clinic visit impact, and future recommendations. IDI participants felt that the tablet was easy to use and that the question content was meaningful. Question content related to trauma, sexual and drug use behaviors, mental health, stigma, and discrimination elicited uncomfortable or distressing feelings in some participants. Patients expressed a strong desire to be truthful, and most would complete these surveys without compensation at future visits if offered. Conclusions: The use of an electronic tablet to complete PRO data collection was well received by this cohort of vulnerable persons in HIV care in the southern United States. Despite some discomfort related to question content, our cohort overwhelmingly believed this was a meaningful part of their medical experience and expressed a high desire for truthfulness. Future research will focus on scaling up the implementation and evaluation of PRO data collection in a contextually appropriate manner while obtaining input from providers and staff to ensure that the collected data are both applicable and actionable. %M 36947109 %R 10.2196/42888 %U https://formative.jmir.org/2023/1/e42888 %U https://doi.org/10.2196/42888 %U http://www.ncbi.nlm.nih.gov/pubmed/36947109 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44055 %T Tracking Population-Level Anxiety Using Search Engine Data: Ecological Study %A Gilbert,Barnabas James %A Lu,Chunling %A Yom-Tov,Elad %+ Department of Brain Sciences, Imperial College London, The Commonwealth Building, Hammersmith Hospital, Du Cane Road, London, W12 0NN, United Kingdom, 44 2075943278, bgilbert@ic.ac.uk %K anxiety disorders %K anxiety themes %K Bing search %K country-level %K epidemiology %K Google trends %K internet search data %K mental disorder %K search engine %K socioeconomic %D 2023 %7 22.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Anxiety disorders are the most prevalent mental disorders globally, with a substantial impact on quality of life. The prevalence of anxiety disorders has increased substantially following the COVID-19 pandemic, and it is likely to be further affected by a global economic recession. Understanding anxiety themes and how they change over time and across countries is crucial for preventive and treatment strategies. Objective: The aim of this study was to track the trends in anxiety themes between 2004 and 2020 in the 50 most populous countries with high volumes of internet search data. This study extends previous research by using a novel search-based methodology and including a longer time span and more countries at different income levels. Methods: We used a crowdsourced questionnaire, alongside Bing search query data and Google Trends search volume data, to identify themes associated with anxiety disorders across 50 countries from 2004 to 2020. We analyzed themes and their mutual interactions and investigated the associations between countries’ socioeconomic attributes and anxiety themes using time-series linear models. This study was approved by the Microsoft Research Institutional Review Board. Results: Query volume for anxiety themes was highly stable in countries from 2004 to 2019 (Spearman r=0.89) and moderately correlated with geography (r=0.49 in 2019). Anxiety themes were predominantly long-term and personal, with “having kids,” “pregnancy,” and “job” the most voluminous themes in most countries and years. In 2020, “COVID-19” became a dominant theme in 27 countries. Countries with a constant volume of anxiety themes over time had lower fragile state indexes (P=.007) and higher individualism (P=.003). An increase in the volume of the most searched anxiety themes was associated with a reduction in the volume of the remaining themes in 13 countries and an increase in 17 countries, and these 30 countries had a lower prevalence of mental disorders (P<.001) than the countries where no correlations were found. Conclusions: Internet search data could be a potential source for predicting the country-level prevalence of anxiety disorders, especially in understudied populations or when an in-person survey is not viable. %M 36947130 %R 10.2196/44055 %U https://formative.jmir.org/2023/1/e44055 %U https://doi.org/10.2196/44055 %U http://www.ncbi.nlm.nih.gov/pubmed/36947130 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42584 %T Reliability and Validity of the Arabic Version of the Game Experience Questionnaire: Pilot Questionnaire Study %A Rebhi,Mahmoud %A Ben Aissa,Mohamed %A Tannoubi,Amayra %A Saidane,Mouna %A Guelmami,Noomen %A Puce,Luca %A Chen,Wen %A Chalghaf,Nasr %A Azaiez,Fairouz %A Zghibi,Makrem %A Bragazzi,Nicola Luigi %+ Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100 ext 66093, robertobragazzi@gmail.com %K Arab countries %K game experience %K reliability %K scale %K validity %D 2023 %7 20.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Nowadays, digital gaming occupies a central position in the entertainment industry where it has developed into a cherished kind of entertainment in markets all over the world. In addition, it provides other sectors with various social and economic benefits. The Game Experience Questionnaire (GEQ) is a free, quantitative, and comprehensive self-report measure that was developed to assess the player game experience. Despite having been widely used by many research projects in the past, it has not been adapted into Arabic. Furthermore, several components of the scale proved problematic from a psychometric point of view. Therefore, a modified version of the scale is needed to measure the gaming experience of the Arab population. Objective: The aim of this study was to validate and examine the psychometrics of an adapted Arabic version of the GEQ in Tunisia. Methods: A total of 771 volunteer participants completed an online survey, which included an Arabic version of the GEQ, gaming data, and a sociodemographic questionnaire. Subjects were randomized in order to complete two phases of the study: exploratory and confirmatory. The exploratory data were acquired from 360 respondents whose mean age was 23.89 (SD 2.29) years. Out of 360 respondents, 111 (30.8%) were female and 249 (69.2%) were male. Confirmatory data were obtained from the remaining 411 subjects whose mean age was 21.94 (SD 1.80) years. Out of 411 subjects, 169 (41.1%) were female and 242 (58.9%) were male. Results: After the elimination of two items, the exploratory and the confirmatory factor analyses provided an adequate factor structure of the Arabic version of the GEQ. In addition, the internal consistency coefficients suggested the reliability of the instrument. Significant differences were revealed for three subcomponents: flow by age (η2=0.013, P=.002), gender (η2=0.007, P=.02), and game type (η2=0.03, P<.001). For competence (η2=0.01, P=.03) and immersion (η2=0.02, P=.01), significant differences were highlighted by the type of game. The discriminant and convergent validities of the instrument were supported by calculating the average variance extracted (AVE) and comparing the square roots of the AVE values to the correlation coefficients, respectively. Conclusions: The Arabic adapted version of the GEQ is valid and reliable and can be administered to measure the game experience in Arab countries. %M 36482747 %R 10.2196/42584 %U https://formative.jmir.org/2023/1/e42584 %U https://doi.org/10.2196/42584 %U http://www.ncbi.nlm.nih.gov/pubmed/36482747 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40503 %T Digital-Assisted Self-interview of HIV or Sexually Transmitted Infection Risk Behaviors in Transmasculine Adults: Development and Field Testing of the Transmasculine Sexual Health Assessment %A Reisner,Sari L %A Pletta,David R %A Pardee,Dana J %A Deutsch,Madeline B %A Peitzmeier,Sarah M %A Hughto,Jaclyn MW %A Quint,Meg %A Potter,Jennifer %+ Brigham and Women's Hospital, 221 Longwood Ave, 5th Floor, Boston, MA, 02115, United States, 1 15712437532, sreisner@bwh.harvard.edu %K transgender %K sexual health %K HIV %K sexually transmitted infection %K STI %K epidemiology %K mobile phone %D 2023 %7 17.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The sexual health of transmasculine (TM) people—those who identify as male, men, or nonbinary and were assigned a female sex at birth—is understudied. One barrier to conducting HIV- and sexually transmitted infection (STI)–related research with this population is how to best capture sexual risk data in an acceptable, gender-affirming, and accurate manner. Objective: This study aimed to report on the community-based process of developing, piloting, and refining a digitally deployed measure to assess self-reported sexual behaviors associated with HIV and STI transmission for research with TM adults. Methods: A multicomponent process was used to develop a digital-assisted self-interview to assess HIV and STI risk in TM people: gathering input from a Community Task Force; working with an interdisciplinary team of content experts in transgender medicine, epidemiology, and infectious diseases; conducting web-based focus groups; and iteratively refining the measure. We field-tested the measure with 141 TM people in the greater Boston, Massachusetts area to assess HIV and STI risk. Descriptive statistics characterized the distribution of sexual behaviors and HIV and STI transmission risk by the gender identity of sexual partners. Results: The Transmasculine Sexual Health Assessment (TM-SHA) measures the broad range of potential sexual behaviors TM people may engage in, including those which may confer risk for STIs and not just for HIV infection (ie, oral-genital contact); incorporates gender-affirming language (ie, genital or frontal vs vaginal); and asks sexual partnership characteristics (ie, partner gender). Among 141 individual participants (mean age 27, SD 5 years; range 21-29 years; n=21, 14.9% multiracial), 259 sexual partnerships and 15 sexual risk behaviors were reported. Participants engaged in a wide range of sexual behaviors, including fingering or fisting (receiving: n=170, 65.6%; performing: n=173, 66.8%), oral-genital sex (receiving: n=182, 70.3%; performing: n=216, 83.4%), anal-genital sex (receptive: n=31, 11.9%; insertive: n=9, 3.5%), frontal-genital sex (receptive: n=105, 40.5%; insertive: n=46, 17.8%), and sharing toys or prosthetics during insertive sex (n=62, 23.9%). Overall barrier use for each sexual behavior ranged from 10.9% (20/182) to 81% (25/31). Frontal receptive sex with genitals and no protective barrier was the highest (21/42, 50%) with cisgender male partners. In total, 14.9% (21/141) of participants reported a lifetime diagnosis of STI. The sexual history tool was highly acceptable to TM participants. Conclusions: The TM-SHA is one of the first digital sexual health risk measures developed specifically with and exclusively for TM people. TM-SHA successfully integrates gender-affirming language and branching logic to capture a wide array of sexual behaviors. The measure elicits sexual behavior information needed to assess HIV and STI transmission risk behaviors. A strength of the tool is that detailed partner-by-partner data can be used to model partnership-level characteristics, not just individual-level participant data, to inform HIV and STI interventions. %M 36930204 %R 10.2196/40503 %U https://publichealth.jmir.org/2023/1/e40503 %U https://doi.org/10.2196/40503 %U http://www.ncbi.nlm.nih.gov/pubmed/36930204 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44853 %T Study Features and Response Compliance in Ecological Momentary Assessment Research in Borderline Personality Disorder: Systematic Review and Meta-analysis %A Davanzo,Antonella %A d´Huart,Delfine %A Seker,Süheyla %A Moessner,Markus %A Zimmermann,Ronan %A Schmeck,Klaus %A Behn,Alex %+ Escuela de Psicología, Pontificia Universidad Católica de Chile, Instituto Milenio para la Investigación en Depresión y Personalidad, Av. Vicuña Mackenna 4860, Santiago, 7820436, Chile, 56 942152484, albehn@uc.cl %K borderline personality disorder %K ecological momentary assessment %K compliance %K study design features %K e–mental health %K mobile phone %D 2023 %7 15.3.2023 %9 Review %J J Med Internet Res %G English %X Background: Borderline personality disorder (BPD) is characterized by frequent and intense moment-to-moment changes in affect, behavior, identity, and interpersonal relationships, which typically result in significant and negative deterioration of the person’s overall functioning and well-being. Measuring and characterizing the rapidly changing patterns of instability in BPD dysfunction as they occur in a person’s daily life can be challenging. Ecological momentary assessment (EMA) is a method that can capture highly dynamic processes in psychopathology research and, thus, is well suited to study intense variability patterns across areas of dysfunction in BPD. EMA studies are characterized by frequent repeated assessments that are delivered to participants in real-life, real-time settings using handheld devices capable of registering responses to short self-report questions in daily life. Compliance in EMA research is defined as the proportion of prompts answered by the participant, considering all planned prompts sent. Low compliance with prompt schedules can compromise the relative advantages of using this method. Despite the growing EMA literature on BPD in recent years, findings regarding study design features that affect compliance with EMA protocols have not been compiled, aggregated, and estimated. Objective: This systematic meta-analytic review aimed to investigate the relationship between study design features and participant compliance in EMA research of BPD. Methods: A systematic review was conducted on November 12, 2021, following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and MOOSE (Meta-analyses of Observational Studies in Epidemiology) guidelines to search for articles featuring EMA studies of BPD that reported compliance rates and included sufficient data to extract relevant design features. For studies with complete data, random-effect models were used to estimate the overall compliance rate and explore its association with design features. Results: In total, 28 peer-reviewed EMA studies comprising 2052 participants were included in the study. Design features (sampling strategy, average prompting frequency, number of items, response window, sampling device, financial incentive, and dropout rate) showed a large variability across studies, and many studies did not report design features. The meta-analytic synthesis was restricted to 64% (18/28) of articles and revealed a pooled compliance rate of 79% across studies. We did not find any significant relationship between design features and compliance rates. Conclusions: Our results show wide variability in the design and reporting of EMA studies assessing BPD. Compliance rates appear to be stable across varying setups, and it is likely that standard design features are not directly responsible for improving or diminishing compliance. We discuss possible nonspecific factors of study design that may have an impact on compliance. Given the promise of EMA research in BPD, we also discuss the importance of unifying standards for EMA reporting so that data stemming from this rich literature can be aggregated and interpreted jointly. %M 36920466 %R 10.2196/44853 %U https://www.jmir.org/2023/1/e44853 %U https://doi.org/10.2196/44853 %U http://www.ncbi.nlm.nih.gov/pubmed/36920466 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37550 %T A Digital Health Initiative (COVIDsmart) for Remote Data Collection and Study of COVID-19’s Impact on the State of Virginia: Prospective Cohort Study %A Schilling,Josh %A Klein,Dave %A Bartholmae,Marilyn M %A Shokouhi,Sepideh %A Toepp,Angela J %A Roess,Amira A %A Sill,Joshua M %A Karpov,Matvey V %A Maney,Kathleen %A Brown,K Pearson %A Levy,Brian L %A Renshaw,Keith D %A Dodani,Sunita %A Jain,Praduman %+ Vibrent Health, 4114 Legato Rd, Fairfax, VA, 22033, United States, 1 571 459 2372, pj@vibrenthealth.com %K COVID-19 %K digital health technology %K human subjects %K partnership %K community health %K diversity %K mobile health %K mHealth %K medical subject headings %K MeSH %K medical informatics %K internet %K digital health %K digital solution %K digital recruitment %K precision medicine %K digital marketing %K decision-making %K COVIDsmart %D 2023 %7 15.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has affected people's lives beyond severe and long-term physical health symptoms. Social distancing and quarantine have led to adverse mental health outcomes. COVID-19–induced economic setbacks have also likely exacerbated the psychological distress affecting broader aspects of physical and mental well-being. Remote digital health studies can provide information about the pandemic's socioeconomic, mental, and physical impact. COVIDsmart was a collaborative effort to deploy a complex digital health research study to understand the impact of the pandemic on diverse populations. We describe how digital tools were used to capture the effects of the pandemic on the overall well-being of diverse communities across large geographical areas within the state of Virginia. Objective: The aim is to describe the digital recruitment strategies and data collection tools applied in the COVIDsmart study and share the preliminary study results. Methods: COVIDsmart conducted digital recruitment, e-Consent, and survey collection through a Health Insurance Portability and Accountability Act–compliant digital health platform. This is an alternative to the traditional in-person recruitment and onboarding method used for studies. Participants in Virginia were actively recruited over 3 months using widespread digital marketing strategies. Six months of data were collected remotely on participant demographics, COVID-19 clinical parameters, health perceptions, mental and physical health, resilience, vaccination status, education or work functioning, social or family functioning, and economic impact. Data were collected using validated questionnaires or surveys, completed in a cyclical fashion and reviewed by an expert panel. To retain a high level of engagement throughout the study, participants were incentivized to stay enrolled and complete more surveys to further their chances of receiving a monthly gift card and one of multiple grand prizes. Results: Virtual recruitment demonstrated relatively high rates of interest in Virginia (N=3737), and 782 (21.1%) consented to participate in the study. The most successful recruitment technique was the effective use of newsletters or emails (n=326, 41.7%). The primary reason for contributing as a study participant was advancing research (n=625, 79.9%), followed by the need to give back to their community (n=507, 64.8%). Incentives were only reported as a reason among 21% (n=164) of the consented participants. Overall, the primary reason for contributing as a study participant was attributed to altruism at 88.6% (n=693). Conclusions: The COVID-19 pandemic has accelerated the need for digital transformation in research. COVIDsmart is a statewide prospective cohort to study the impact of COVID-19 on Virginians' social, physical, and mental health. The study design, project management, and collaborative efforts led to the development of effective digital recruitment, enrollment, and data collection strategies to evaluate the pandemic’s effects on a large, diverse population. These findings may inform effective recruitment techniques across diverse communities and participants' interest in remote digital health studies. %M 36795656 %R 10.2196/37550 %U https://formative.jmir.org/2023/1/e37550 %U https://doi.org/10.2196/37550 %U http://www.ncbi.nlm.nih.gov/pubmed/36795656 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e40675 %T Design and Implementation of the Surveys of Women: Protocol for an Address-Based Sampling Multimodal Study %A Poland,Stephanie %A Stern,Michael %A English,Ned %A Pedlow,Steven %A Archambeau,Katherine %A Carris,Kari %+ National Opinion Research Center at the University of Chicago, 55 E Monroe, Ste 3000, Chicago, IL, 60603, United States, 1 3127594261, poland-stephanie@norc.org %K multimode %K web survey %K cross-sectional %K women’s health %K reproductive health %K methods %K data collection %K implementation %K survey %K contraceptive health %K contraception %K survey methods %K data collection %K data processing %D 2023 %7 15.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Studies conducted in the United States such as the National Survey of Family Growth (NSFG) and the Pregnancy Risk Assessment Monitoring System (PRAMS) collect data on pregnancy intentions to aid in improving health education, services, and programs. PRAMS collects data from specific sites, and NSFG is a national household-based survey. Like NSFG, the Surveys of Women was designed to survey participants residing in households using an address-based sample and a multimode data collection approach. The Surveys of Women collects data from eligible participants in 9 states within the United States on contraception use, reproductive health, and pregnancy intentions. In this paper, we focus on the baseline data collection protocol, including sample design, data collection procedures, and data processing. We also include a brief discussion on the follow-up and endline survey methodologies. Our goal is to inform other researchers on methods to consider when fielding a household-level reproductive health survey. Objective: The Surveys of Women was developed to support state-specific research and evaluation projects, with an overall goal of understanding contraceptive health practices among women aged 18-44 years. The project collects data from respondents in 9 different states (Arizona, Alabama, Delaware, Iowa, Maryland, New Jersey, Ohio, South Carolina, and Wisconsin) over multiple rounds. Methods: Households were selected at random using address-based sampling methods. This project includes a cross-sectional baseline survey, 2 or 3 follow-up surveys with an opt-in panel of respondents, and a cross-sectional endline survey. Each round of data collection uses a multimode design through the use of a programmed web survey and a formatted hard copy questionnaire. Participants from the randomly selected households access their personalized surveys through a web survey or mail in a hard copy questionnaire. To maximize responses, these surveys follow a rigorous schedule of various prompts bolstering the survey implementation design, and the participants received a modest monetary incentive. Results: This is an ongoing project with results published separately by the evaluation teams involved with data analysis. Conclusions: The methods used in the first baseline survey informed modifications to the methods used in subsequent statewide surveys. Data collected from this project will provide insight into women’s reproductive health, contraceptive use, and abortion attitudes in the 9 selected states. The long-term goal of the project is to use a data collection methodology that collects data from a representative sample of participants to assess changes in reproductive health behaviors over time. International Registered Report Identifier (IRRID): DERR1-10.2196/40675 %M 36920469 %R 10.2196/40675 %U https://www.researchprotocols.org/2023/1/e40675 %U https://doi.org/10.2196/40675 %U http://www.ncbi.nlm.nih.gov/pubmed/36920469 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39262 %T Direct-to-Consumer Recruitment Methods via Traditional and Social Media to Aid in Research Accrual for Clinical Trials for Rare Diseases: Comparative Analysis Study %A Applequist,Janelle %A Burroughs,Cristina %A Merkel,Peter A %A Rothenberg,Marc %A Trapnell,Bruce %A Desnick,Robert %A Sahin,Mustafa %A Krischer,Jeffrey %+ Zimmerman School of Advertising & Mass Communications, University of South Florida, 4202 E. Fowler Ave., CIS 1040, Tampa, FL, 33620, United States, 1 (813) 974 4462, applequist@usf.edu %K direct-to-consumer advertising %K clinical trial recruitment %K clinical trial accrual %K research recruitment %K research participant recruitment %K social media recruitment %K web-based recruitment %K patient-centered research %K rare diseases %K clinical trial %D 2023 %7 14.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Recruitment into clinical trials is a challenging process, with as many as 40% of studies failing to meet their target sample sizes. The principles of direct-to-consumer (DTC) advertising rely upon novel marketing strategies. The ability to reach expansive audiences in the web-based realm presents a unique opportunity for researchers to overcome various barriers to enrollment in clinical trials. Research has investigated the use of individual web-based platforms to aid in recruitment and accrual into trials; however, a gap in the literature exists, whereby multiple mass communication platforms have yet to be investigated across a range of clinical trials. Objective: There is a need to better understand how individual factors combine to collectively influence trial recruitment. We aimed to test whether DTC recruitment of potentially eligible study participants via social media platforms (eg, Facebook [Meta Platforms Inc] and Twitter [Twitter Inc]) was an effective strategy or whether this acted as an enhancement to traditional (eg, email via contact registries) recruitment strategies through established clinical research sites. Methods: This study tested multiple DTC web-based recruitment efforts (Facebook, Twitter, email, and patient advocacy group [PAG] involvement) across 6 national and international research studies from 5 rare disease consortia. Targeted social media messaging, social media management software, and individual study websites with prescreening questions were used in the Protocol for Increasing Accrual Using Social Media (PRISM). Results: In total, 1465 PRISM website referrals occurred across all 6 studies. Organic (unpaid) Facebook posts (676/1465, 46.14%) and Rare Diseases Clinical Research Network patient contact registry emails (461/1465, 31.47%) represented the most successful forms of engagement. PRISM was successful in accumulating a 40.1% (136/339) lead generation (those who screened positive and consented to share their contact information to be contacted by a clinical site coordinator). Despite the large number of leads generated from PRISM recruitment efforts, the number of patients who were subsequently enrolled in studies was low. Across 6 studies, 3 participants were ultimately enrolled, meaning that 97.8% (133/136) of leads dropped off. Conclusions: The results indicate that although accrual results were low, this is consistent with previously documented challenges of studying populations with rare diseases. Targeted messaging integrated throughout the recruitment process (eg, referral, lead, and accrual) remains an area for further research. Key elements to consider include structuring the communicative workflow in such a way that PAG involvement is central to the process, with clinical site coordinators actively involved after an individual consents to share their contact information. Customized approaches are needed for each population and research study, with observational studies best suited for social media recruitment. As evidenced by lead generation, results suggest that web-based recruitment efforts, coupled with targeted messaging and PAG partnerships, have the potential to supplement clinical trial accrual. %M 36917158 %R 10.2196/39262 %U https://www.jmir.org/2023/1/e39262 %U https://doi.org/10.2196/39262 %U http://www.ncbi.nlm.nih.gov/pubmed/36917158 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38491 %T Contraceptive Access and Use Among Undergraduate and Graduate Students During COVID-19: Online Survey Study %A Chen,Emily %A Hollowell,Adam %A Truong,Tracy %A Bentley-Edwards,Keisha %A Myers,Evan %A Erkanli,Alaattin %A Holt,Lauren %A Swartz,Jonas J %+ Department of Obstetrics & Gynecology, Duke University Medical Center, DUMC 3084, Durham, NC, 27710, United States, 1 919 668 7594, jonas.swartz@duke.edu %K COVID-19 %K contraception %K college %K disparities %K LARC %K sexual health %K social media %K health promotion %K telehealth %K health messaging %K health resource %K health disparity %K risk factor %K healthcare access %D 2023 %7 14.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic led to widespread college campus closures in the months of March to June 2020, endangering students’ access to on-campus health resources, including reproductive health services. Objective: To assess contraceptive access and use among undergraduate and graduate students in North Carolina during the COVID-19 pandemic. Methods: We conducted a cross-sectional web-based survey of undergraduate and graduate students enrolled at degree-granting institutions in North Carolina. Participants were recruited using targeted Instagram advertisements. The survey queried several aspects of participants’ sexual behavior, including sex drive, level of sexual experience, number of sexual partners, digital sexual experience, dating patterns, and types of contraception used. Participants were asked to compare many of these behaviors before and after the pandemic. The survey also assessed several sociodemographic factors that we hypothesized would be associated with contraceptive use based on prior data, including educational background, sexual orientation and gender minority status (ie, lesbian, gay, bisexual, transgender, queer), health insurance status, race, ethnicity, degree of sensation seeking, religiosity, and desire to become pregnant. Results: Over 10 days, 2035 Instagram users began our survey, of whom 1002 met eligibility criteria. Of these 1002 eligible participants, 934 completed the survey, for a 93% completion rate. Our respondents were mostly female (665/934, 71%), cisgender (877/934, 94%), heterosexual (592/934, 64%), white (695/934 75%), not Hispanic (835/934, 89%), and enrolled at a 4-year college (618/934, 66%). Over 95% (895/934) of respondents reported that they maintained access to their preferred contraception during the COVID-19 pandemic. In a multivariable analysis, participants who were enrolled in a 4-year college or graduate program were less likely to lose contraceptive access when compared to participants enrolled in a 2-year college (risk ratio [RR] 0.34, 95% CI 0.16-0.71); in addition, when compared to cisgender participants, nonbinary and transgender participants were more likely to lose contraceptive access (RR 2.43, 95% CI 1.01-5.87). Respondents reported that they were more interested in using telehealth to access contraception during the pandemic. The contraceptive methods most commonly used by our participants were, in order, condoms (331/934, 35.4%), oral contraception (303/934, 32.4%), and long-acting reversible contraception (LARC; 221/934, 23.7%). The rate of LARC use among our participants was higher than the national average for this age group (14%). Emergency contraception was uncommonly used (25/934, 2.7%). Conclusions: Undergraduate and graduate students in North Carolina overwhelmingly reported that they maintained access to their preferred contraceptive methods during the COVID-19 pandemic and through changing patterns of health care access, including telehealth. Gender nonbinary and transgender students and 2-year college students may have been at greater risk of losing access to contraception during the first year of the COVID-19 pandemic. %M 36827491 %R 10.2196/38491 %U https://formative.jmir.org/2023/1/e38491 %U https://doi.org/10.2196/38491 %U http://www.ncbi.nlm.nih.gov/pubmed/36827491 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41408 %T Assessment of Stakeholder Perceptions and Attitudes Toward Health Data Governance Principles in Botswana: Web-Based Survey %A Ndlovu,Kagiso %A Mauco,Kabelo Leonard %A Chibemba,Star %A Wanyee,Steven %A Oluoch,Tom %+ Department of Health Information Management, Botho University, Botho Education Park, Diratsame Mosielele, Gaborone, PO Box 501564, Botswana, 267 3919999, kabelo.mauco@bothouniversity.ac.bw %K health data %K governance %K Botswana %K digital health %K decision-making %K health care stakeholders %K perceptions %K health policy %K data governance %K data policy %K implementation %D 2023 %7 13.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of information and communication technologies for health—eHealth—is described as having potential to improve the quality of health care service delivery. Consequently, there is an increased global trend toward adoption of eHealth interventions by health care systems worldwide. Despite the proliferation of eHealth solutions, many health care institutions especially in transitioning countries are struggling to attain effective data governance approaches. The Ministry of Health in Botswana is an exemplar institution continually seeking better approaches to strengthen health data governance (HDG) approaches following the adoption of eHealth solutions. Recognizing the need for a global HDG framework, the Transform Health coalition conceptualized HDG principles that are structured around 3 interconnected objectives: protecting people, promoting the value of health, and prioritizing equity. Objective: The aim of the study is to solicit and evaluate perceptions and attitudes of health sector workers in Botswana toward the HDG principles by Transform Health and derive any future guidance. Methods: Purposive sampling was used to select participants. A total of 23 participants from various health care organizations in Botswana completed a web-based survey and 10 participated in a follow-up remote round-table discussion. The aim of the round-table discussion was to gain further insight into participants’ responses from the web-based survey. Participants were from the following health care cadres: nurses, doctors, information technology professionals, and health informaticians. Both validity and reliability testing were performed for the survey tool before sharing it with study participants. An analysis of participants’ close-ended responses from the survey was performed using descriptive statistics. Thematic analysis of open-ended responses from the questionnaire and the round-table discussion was achieved using the Delve software and the widely accepted principles of thematic analysis. Results: Although some participants highlighted having measures in place similar to the HDG principles, there were some who either did not know or disagreed that their organizations already had in place mechanisms similar to the proposed HDG principles. Participants further expressed relevance and importance of the HDG principles in the context of Botswana. However, some modifications to the principles were also suggested. Conclusions: This study highlights the necessity of data governance in health care particularly toward meeting the requirements for Universal Health Coverage. The existence of other health data governance frameworks calls for a critical analysis to assess the most appropriate and applicable framework in the context of Botswana and similar transitioning countries. An organization-centered approach may be most appropriate, as well as strengthening of existing organizations’ HDG practices with the Transform Health principles. %M 36912870 %R 10.2196/41408 %U https://formative.jmir.org/2023/1/e41408 %U https://doi.org/10.2196/41408 %U http://www.ncbi.nlm.nih.gov/pubmed/36912870 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41937 %T An Assessment of Perspectives and Concerns Among Research Participants of Childbearing Age Regarding the Health-Relatedness of Data, Online Data Privacy, and Donating Data to Researchers: Survey Study %A Hendricks-Sturrup,Rachele %A Lu,Christine Y %+ Duke-Margolis Center for Health Policy, 1201 Pennsylvania Avenue NW, 5th Floor, Washington, DC, 20004, United States, 1 2026212800, rachele.hendricks.sturrup@duke.edu %K privacy %K digital data %K research %K abortion %K women's health %K reproductive health %K reproductive informatics %K digital footprint %K family planning %D 2023 %7 10.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The June 2022 US Supreme Court decision to ban abortion care in Dobbs v Jackson Women’s Health Organization sparked ominous debate about the privacy and safety of women and families of childbearing age with digital footprints who actively engage in family planning, including abortion and miscarriage care. Objective: To assess the perspectives of a subpopulation of research participants of childbearing age regarding the health-relatedness of their digital data, their concerns about the use and sharing of personal data online, and their concerns about donating data from various sources to researchers today or in the future. Methods: An 18-item electronic survey was developed using Qualtrics and administered to adults (aged ≥18 years) registered in the ResearchMatch database in April 2021. Individuals were invited to participate in the survey regardless of health status, race, gender, or any other mutable or immutable characteristics. Descriptive statistical analyses were conducted using Microsoft Excel and manual queries (single layer, bottom-up topic modeling) and used to categorize illuminating quotes from free-text survey responses. Results: A total of 470 participants initiated the survey and 402 completed and submitted the survey (for an 86% completion rate). Nearly half the participants (189/402, 47%) self-reported to be persons of childbearing age (18 to 50 years). Most participants of childbearing age agreed or strongly agreed that social media data, email data, text message data, Google search history data, online purchase history data, electronic medical record data, fitness tracker and wearable data, credit card statement data, and genetic data are health-related. Most participants disagreed or strongly disagreed that music streaming data, Yelp review and rating data, ride-sharing history data, tax records and other income history data, voting history data, and geolocation data are health-related. Most (164/189, 87%) participants were concerned about fraud or abuse based on their personal information, online companies and websites sharing information with other parties without consent, and online companies and websites using information for purposes that are not explicitly stated in their privacy policies. Free-text survey responses showed that participants were concerned about data use beyond scope of consent; exclusion from health care and insurance; government and corporate mistrust; and data confidentiality, security, and discretion. Conclusions: Our findings in light of Dobbs and other related events indicate there are opportunities to educate research participants about the health-relatedness of their digital data. Developing strategies and best privacy practices for discretion regarding digital-footprint data related to family planning should be a priority for companies, researchers, families, and other stakeholders. %M 36897637 %R 10.2196/41937 %U https://www.jmir.org/2023/1/e41937 %U https://doi.org/10.2196/41937 %U http://www.ncbi.nlm.nih.gov/pubmed/36897637 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 6 %N %P e37758 %T Recommendations From a Chinese-Language Survey of Knowledge and Prevention of Skin Cancer Among Chinese Populations Internationally: Cross-sectional Questionnaire Study %A Chen,Lily Ye %A Niu,Wei %A Lim,Kristina %A Solomon,James A %+ College of Medicine, University of Central Florida, 6850 Lake Nona Blvd, Orlando, FL, 32827, United States, 1 4128487998, LChen639@gmail.com %K skin cancer %K basal cell carcinoma %K squamous cell carcinoma %K melanoma %K people of color %K skin of color %K risk and prevention %K photoprotection %K sun protection %K sunscreen %K prevention %K cancer risk %K cancer prevention %K Chinese Asian %K Chinese %K Asian %K North American Chinese %K Fitzpatrick score %K cultural difference %K awareness %K education %D 2023 %7 9.3.2023 %9 Original Paper %J JMIR Dermatol %G English %X Background: There is a paucity of studies assessing awareness and prevention of skin cancer among Chinese populations. Objective: The aim of the study is to compare attitudes and practices regarding skin cancer risks and prevention between Chinese Asian and North American Chinese populations and between Fitzpatrick scores. Methods: A cross-sectional, internet-based, 74-question survey in Chinese was conducted focusing on Han Chinese participants internationally. The survey included Likert-type scales and multiple-choice questions. All participants were required to read Chinese and self-identify as being 18 years or older and Chinese by ethnicity, nationality, or descent. Participants were recruited on the internet over a 6-month period from July 2017 through January 2018 via advertisements in Chinese on popular social media platforms: WeChat, QQ, Weibo, Facebook, and Twitter. Results: Of the 113 completed responses collected (participation rate of 65.7%), 95 (84.1%) were ethnically Han Chinese, of which 93 (96.9%) were born in China and 59 (62.1%) were female. The mean age of these 95 participants was 35.8 (SD 13.3) years; 72 (75.8%) participants were born after 1975. Few but more North American Chinese reported that Chinese Asian populations received annual skin checks (4/30, 4.2% vs 0/65, 0%; P=.009) and believed that their clinician provided adequate sun safety education (13/30, 43.3% vs 15/65, 23.1%; P=.04). Participants with higher Fitzpatrick scores less frequently received sun safety education from a clinician (4/34, 11.8% vs 22/61, 36.1%; P=.02). More participants with lower Fitzpatrick scores used sunscreen (41/61, 67.2% vs 16/34, 47.1%; P=.05), but alternative sun protection use rates are similar across groups. Conclusions: Cultural differences and Fitzpatrick scores can affect knowledge and practices with respect to sun protection and skin cancer among social media–using Chinese Asian and North American Chinese communities based on respondent demographics. Most participants in all groups understood that people of color have some risk of skin cancer, but >30% of all groups across regions and Fitzpatrick scores are unaware of current skin protection recommendations, receive insufficient sun safety education, and do not use sunscreen. Outreach efforts may begin broadly with concerted public and private efforts to train and fund dermatologists to perform annual total body skin exams and provide more patient education. They should spark community interest through mass media and empower Chinese people to perform self-examinations and recognize risks and risk mitigation methods. %M 37632936 %R 10.2196/37758 %U https://derma.jmir.org/2023/1/e37758 %U https://doi.org/10.2196/37758 %U http://www.ncbi.nlm.nih.gov/pubmed/37632936 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43123 %T Step Count, Self-reported Physical Activity, and Predicted 5-Year Risk of Atrial Fibrillation: Cross-sectional Analysis %A Shapira-Daniels,Ayelet %A Kornej,Jelena %A Spartano,Nicole L %A Wang,Xuzhi %A Zhang,Yuankai %A Pathiravasan,Chathurangi H %A Liu,Chunyu %A Trinquart,Ludovic %A Borrelli,Belinda %A McManus,David D %A Murabito,Joanne M %A Benjamin,Emelia J %A Lin,Honghuang %+ Department of Medicine, University of Massachusetts Chan Medical School, 55 North Lake Avenue, Worcester, MA, 01655, United States, 1 774 455 4881, Honghuang.Lin@umassmed.edu %K atrial fibrillation %K physical activity %K fitness tracker %K cardiovascular epidemiology %K fitness %K exercise %K tracker %K cardiology %K heart %K walk %K step count %K smartwatch %K wearable %K risk %K cross-sectional analysis %D 2023 %7 6.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Physical inactivity is a known risk factor for atrial fibrillation (AF). Wearable devices, such as smartwatches, present an opportunity to investigate the relation between daily step count and AF risk. Objective: The objective of this study was to investigate the association between daily step count and the predicted 5-year risk of AF. Methods: Participants from the electronic Framingham Heart Study used an Apple smartwatch. Individuals with diagnosed AF were excluded. Daily step count, watch wear time (hours and days), and self-reported physical activity data were collected. Individuals’ 5-year risk of AF was estimated, using the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE)–AF score. The relation between daily step count and predicted 5-year AF risk was examined via linear regression, adjusting for age, sex, and wear time. Secondary analyses examined effect modification by sex and obesity (BMI≥30 kg/m2), as well as the relation between self-reported physical activity and predicted 5-year AF risk. Results: We examined 923 electronic Framingham Heart Study participants (age: mean 53, SD 9 years; female: n=563, 61%) who had a median daily step count of 7227 (IQR 5699-8970). Most participants (n=823, 89.2%) had a <2.5% CHARGE-AF risk. Every 1000 steps were associated with a 0.08% lower CHARGE-AF risk (P<.001). A stronger association was observed in men and individuals with obesity. In contrast, self-reported physical activity was not associated with CHARGE-AF risk. Conclusions: Higher daily step counts were associated with a lower predicted 5-year risk of AF, and this relation was stronger in men and participants with obesity. The utility of a wearable daily step counter for AF risk reduction merits further investigation. %M 36877540 %R 10.2196/43123 %U https://www.jmir.org/2023/1/e43123 %U https://doi.org/10.2196/43123 %U http://www.ncbi.nlm.nih.gov/pubmed/36877540 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41028 %T Determinants of Implementation of a Critical Care Registry in Asia: Lessons From a Qualitative Study %A Tolppa,Timo %A Pari,Vrindha %A Pell,Christopher %A Aryal,Diptesh %A Hashmi,Madiha %A Shamal Ghalib,Maryam %A Jawad,Issrah %A Tripathy,Swagata %A Tirupakuzhi Vijayaraghavan,Bharath Kumar %A Beane,Abi %A Dondorp,Arjen M %A Haniffa,Rashan %A , %+ Network for Improving Critical Care Systems and Training, Second floor, YMBA Building, Colombo, 08, Sri Lanka, 94 114 063739, timo@nicslk.com %K CCU %K critical care %K registry %K implementation %K qualitative research %K stakeholders %K South Asia %K health care %D 2023 %7 6.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The Collaboration for Research, Implementation, and Training in Critical Care in Asia (CCA) is implementing a critical care registry to capture real-time data to facilitate service evaluation, quality improvement, and clinical studies. Objective: The purpose of this study is to examine stakeholder perspectives on the determinants of implementation of the registry by examining the processes of diffusion, dissemination, and sustainability. Methods: This study is a qualitative phenomenological inquiry using semistructured interviews with stakeholders involved in registry design, implementation, and use in 4 South Asian countries. The conceptual model of diffusion, dissemination, and sustainability of innovations in health service delivery guided interviews and analysis. Interviews were coded using the Rapid Identification of Themes from Audio recordings procedure and were analyzed based on the constant comparison approach. Results: A total of 32 stakeholders were interviewed. Analysis of stakeholder accounts identified 3 key themes: innovation-system fit; influence of champions; and access to resources and expertise. Determinants of implementation included data sharing, research experience, system resilience, communication and networks, and relative advantage and adaptability. Conclusions: The implementation of the registry has been possible due to efforts to increase the innovation-system fit, influence of motivated champions, and the support offered by access to resources and expertise. The reliance on individuals and the priorities of other health care actors pose a risk to sustainability. %M 36877557 %R 10.2196/41028 %U https://www.jmir.org/2023/1/e41028 %U https://doi.org/10.2196/41028 %U http://www.ncbi.nlm.nih.gov/pubmed/36877557 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e29480 %T Real-time Symptom Assessment in Patients With Endometriosis: Psychometric Evaluation of an Electronic Patient-Reported Outcome Measure, Based on the Experience Sampling Method %A van Barneveld,Esther %A Lim,Arianne %A van Hanegem,Nehalennia %A van Osch,Frits %A Vork,Lisa %A Kruimel,Joanna %A Bongers,Marlies %A Leue,Carsten %+ Department of Gynaecology and Obstetrics, Maastricht University Medical Center+, P. Debyelaan 25, Maastricht, 6229 HX, Netherlands, 31 613403725, esthervb@gmail.com %K endometriosis %K pelvic pain %K positive affect %K negative affect %K patient-reported outcome measure %K momentary symptom assessment %K experience sampling method %K pain %K PROM %K outcome %K patient-reported %K assessment %K symptom %K sampling %K method %K evaluation %K psychometric %K real-time %K prospective %D 2023 %7 3.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The experience sampling method (ESM) holds advantages over traditional retrospective questionnaires including a high ecological validity, no recall bias, the ability to assess fluctuation of symptoms, and the ability to analyze the temporal relationship between variables. Objective: This study aimed to evaluate the psychometric properties of an endometriosis-specific ESM tool. Methods: This is a short-term follow-up prospective study, including patients with premenopausal endometriosis aged ≥18 years who reported dysmenorrhea, chronic pelvic pain, or dyspareunia between December 2019 and November 2020. An ESM-based questionnaire was sent out by a smartphone application 10 times a day during 1 week on randomly chosen moments. Additionally, patients completed questionnaires concerning demographics, end-of-day pain scores, and end-of-week symptom scores. The psychometric evaluation included compliance, concurrent validity, and internal consistency. Results: Twenty-eight patients with endometriosis completed the study. Compliance for answering the ESM questions was as high as 52%. End-of-week pain scores were higher than ESM mean scores and showed peak reporting. ESM scores showed strong concurrent validity when compared with symptoms scored by the Gastrointestinal Symptom Rating Scale–Irritable Bowel Syndrome, 7-item Generalized Anxiety Disorders Scale, 9-question Patient Health Questionnaire, and the majority of questions of the 30-item Endometriosis Health Profile. Cronbach α coefficients demonstrated a good internal consistency for abdominal symptoms, general somatic symptoms, and positive affect, and an excellent internal consistency for negative affect. Conclusions: This study supports the validity and reliability of a newly developed electronic instrument for the measurement of symptoms in women with endometriosis, based on momentary assessments. This ESM patient-reported outcome measure has the advantage of providing a more detailed view on individual symptom patterns and offers the possibility for patients to have insight in their symptomatology, leading to more individualized treatment strategies that can improve the quality of life of women with endometriosis. %M 36867439 %R 10.2196/29480 %U https://formative.jmir.org/2023/1/e29480 %U https://doi.org/10.2196/29480 %U http://www.ncbi.nlm.nih.gov/pubmed/36867439 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e38732 %T The Vaping and Patterns of e-Cigarette Use Research Study: Protocol for a Web-Based Cohort Study %A Hardesty,Jeffrey J %A Crespi,Elizabeth %A Nian,Qinghua %A Sinamo,Joshua K %A Breland,Alison B %A Eissenberg,Thomas %A Welding,Kevin %A Kennedy,Ryan David %A Cohen,Joanna E %+ Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElddery St, Fourth Floor, Baltimore, MD, 21205, United States, 1 410 502 8835, jhardesty@jhu.edu %K internet %K web-based %K cohort %K survey %K e-cigarettes %K electronic nicotine delivery systems %K ENDS %K tobacco %K recruitment %K data collection %K strategies %K lessons learned %K mobile phone %D 2023 %7 2.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: In total, 3.2% of American adults report using e-cigarettes every day or some days. The Vaping and Patterns of E-cigarette Use Research (VAPER) Study is a web-based longitudinal survey designed to observe patterns in device and liquid use that suggest the benefits and unintended consequences of potential e-cigarette regulations. The heterogeneity of the e-cigarette devices and liquids on the market, the customizability of the devices and liquids, and the lack of standardized reporting requirements result in unique measurement challenges. Furthermore, bots and survey takers who submit falsified responses are threats to data integrity that require mitigation strategies. Objective: This paper aims to describe the protocols for 3 waves of the VAPER Study and discuss recruitment and data processing experiences and lessons learned, including the benefits and limitations of bot- and fraudulent survey taker–related strategies. Methods: American adults (aged ≥21 years) who use e-cigarettes ≥5 days per week are recruited from up to 404 Craigslist catchment areas covering all 50 states. The questionnaire measures and skip logic are designed to accommodate marketplace heterogeneity and user customization (eg, different skip logic pathways for different device types and customizations). To reduce reliance on self-report data, we also require participants to submit a photo of their device. All data are collected using REDCap (Research Electronic Data Capture; Vanderbilt University). Incentives are US $10 Amazon gift codes delivered by mail to new participants and electronically to returning participants. Those lost to follow-up are replaced. Several strategies are applied to maximize the odds that participants who receive incentives are not bots and are likely to possess an e-cigarette (eg, required identity check and photo of a device). Results: In total, 3 waves of data were collected between 2020 and 2021 (wave 1: n=1209; wave 2: n=1218; wave 3: n=1254). Retention from waves 1 to 2 was 51.94% (628/1209), and 37.55% (454/1209) of the wave 1 sample completed all 3 waves. These data were mostly generalizable to daily e-cigarette users in the United States, and poststratification weights were generated for future analyses. Our data offer a detailed examination of users’ device features and specifications, liquid characteristics, and key behaviors, which can provide more insights into the benefits and unintended consequences of potential regulations. Conclusions: Relative to existing e-cigarette cohort studies, this study methodology has some advantages, including efficient recruitment of a lower-prevalence population and collection of detailed data relevant to tobacco regulatory science (eg, device wattage). The web-based nature of the study requires several bot- and fraudulent survey taker–related risk-mitigation strategies, which can be time-intensive. When these risks are addressed, web-based cohort studies can be successful. We will continue to explore methods for maximizing recruitment efficiency, data quality, and participant retention in subsequent waves. International Registered Report Identifier (IRRID): DERR1-10.2196/38732 %M 36862467 %R 10.2196/38732 %U https://www.researchprotocols.org/2023/1/e38732 %U https://doi.org/10.2196/38732 %U http://www.ncbi.nlm.nih.gov/pubmed/36862467 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42131 %T Opt-In and Opt-Out Consent Procedures for the Reuse of Routinely Recorded Health Data in Scientific Research and Their Consequences for Consent Rate and Consent Bias: Systematic Review %A de Man,Yvonne %A Wieland-Jorna,Yvonne %A Torensma,Bart %A de Wit,Koos %A Francke,Anneke L %A Oosterveld-Vlug,Mariska G %A Verheij,Robert A %+ Nivel, Netherlands Institute for Health Services Research, Otterstraat 118, Utrecht, 3513 CR, the Netherlands, 31 621951136, y.jorna@nivel.nl %K real-world data %K secondary data use %K electronic health records %K routine health data %K consent resentativeness %K consent bias %K procedure %K opt-in %K opt-out %K consent rate %K representativeness %D 2023 %7 28.2.2023 %9 Review %J J Med Internet Res %G English %X Background: Scientific researchers who wish to reuse health data pertaining to individuals can obtain consent through an opt-in procedure or opt-out procedure. The choice of procedure may have consequences for the consent rate and representativeness of the study sample and the quality of the research, but these consequences are not well known. Objective: This review aimed to provide insight into the consequences for the consent rate and consent bias of the study sample of opt-in procedures versus opt-out procedures for the reuse of routinely recorded health data for scientific research purposes. Methods: A systematic review was performed based on searches in PubMed, Embase, CINAHL, PsycINFO, Web of Science Core Collection, and the Cochrane Library. Two reviewers independently included studies based on predefined eligibility criteria and assessed whether the statistical methods used in the reviewed literature were appropriate for describing the differences between consenters and nonconsenters. Statistical pooling was conducted, and a description of the results was provided. Results: A total of 15 studies were included in this meta-analysis. Of the 15 studies, 13 (87%) implemented an opt-in procedure, 1 (7%) implemented an opt-out procedure, and 1 (7%) implemented both the procedures. The average weighted consent rate was 84% (60,800/72,418 among the studies that used an opt-in procedure and 96.8% (2384/2463) in the single study that used an opt-out procedure. In the single study that described both procedures, the consent rate was 21% in the opt-in group and 95.6% in the opt-out group. Opt-in procedures resulted in more consent bias compared with opt-out procedures. In studies with an opt-in procedure, consenting individuals were more likely to be males, had a higher level of education, higher income, and higher socioeconomic status. Conclusions: Consent rates are generally lower when using an opt-in procedure compared with using an opt-out procedure. Furthermore, in studies with an opt-in procedure, participants are less representative of the study population. However, both the study populations and the way in which opt-in or opt-out procedures were organized varied widely between the studies, which makes it difficult to draw general conclusions regarding the desired balance between patient control over data and learning from health data. The reuse of routinely recorded health data for scientific research purposes may be hampered by administrative burdens and the risk of bias. %M 36853745 %R 10.2196/42131 %U https://www.jmir.org/2023/1/e42131 %U https://doi.org/10.2196/42131 %U http://www.ncbi.nlm.nih.gov/pubmed/36853745 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e41239 %T Selection of and Response to Physical Activity–Based Social Comparisons in a Digital Environment: Series of Daily Assessment Studies %A Arigo,Danielle %A Gray,Robert C %A Dallal,Diane H %A Villareale,Jennifer %A Zhu,Jichen %+ Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, United States, 1 856 256 4500 ext 53775, arigo@rowan.edu %K social comparison %K physical activity %K motivation %K web platform %K selection %K exercise %K fitness %K mobile phone %D 2023 %7 27.2.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Innovative approaches are needed to understand barriers to and facilitators of physical activity among insufficiently active adults. Although social comparison processes (ie, self-evaluations relative to others) are often used to motivate physical activity in digital environments, user preferences and responses to comparison information are poorly understood. Objective: We used an iterative approach to better understand users’ selection of comparison targets, how they interacted with their selected targets, and how they responded to these targets. Methods: Across 3 studies, different samples of insufficiently active college students used the Fitbit system (Fitbit LLC) to track their steps per day as well as a separate, adaptive web platform each day for 7 to 9 days (N=112). The adaptive platform was designed with different layouts for each study; each allowed participants to select their preferred comparison target from various sets of options, view the desired amount of information about their selected target, and rate their physical activity motivation before and after viewing information about their selected target. Targets were presented as achieving physical activity at various levels below and above their own, which were accessed via the Fitbit system each day. We examined the types of comparison target selections, time spent viewing and number of elements viewed for each type of target, and day-level associations between comparison selections and physical activity outcomes (motivation and behavior). Results: Study 1 (n=5) demonstrated that the new web platform could be used as intended and that participants’ interactions with the platform (ie, the type of target selected, the time spent viewing the selected target’s profile, and the number of profile elements viewed) varied across the days. Studies 2 (n=53) and 3 (n=54) replicated these findings; in both studies, age was positively associated with time spent viewing the selected target’s profile and the number of profile elements viewed. Across all studies, upward targets (who had more steps per day than the participant) were selected more often than downward targets (who had fewer steps per day than the participant), although only a subset of either type of target selection was associated with benefits for physical activity motivation or behavior. Conclusions: Capturing physical activity–based social comparison preferences is feasible in an adaptive digital environment, and day-to-day differences in preferences for social comparison targets are associated with day-to-day changes in physical activity motivation and behavior. Findings show that participants only sometimes focus on the comparison opportunities that support their physical activity motivation or behavior, which helps explain previous, equivocal findings regarding the benefits of physical activity–based comparisons. Additional investigation of day-level determinants of comparison selections and responses is needed to fully understand how best to harness comparison processes in digital tools to promote physical activity. %M 36848204 %R 10.2196/41239 %U https://humanfactors.jmir.org/2023/1/e41239 %U https://doi.org/10.2196/41239 %U http://www.ncbi.nlm.nih.gov/pubmed/36848204 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37987 %T Mobile Phone Apps for HIV Prevention Among College-Aged Black Women in Atlanta: Mixed Methods Study and User-Centered Prototype %A Tesema,Naomi %A Guillaume,Dominique %A Francis,Sherilyn %A Paul,Sudeshna %A Chandler,Rasheeta %+ Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, 30322, United States, 1 404 727 7980, dguilla@emory.edu %K Black women %K HIV prevention %K mobile health %K mHealth app %K mobile technology %K reproductive health %K women’s health %D 2023 %7 23.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Black women in college are disproportionately affected by HIV diagnoses. Mobile apps can facilitate the innovative delivery of accurate HIV and sexual and reproductive health information. However, mobile health interventions are severely underused in this population. Objective: We aimed to quantitatively and qualitatively explore the perspectives of college-aged Black women on using a mobile health app for HIV prevention and sexual and reproductive health. The data obtained from Black women were used to design preliminary mobile app wireframes and features. Methods: This explanatory, sequential mixed methods study took place from 2019 to 2020 and targeted Black women who were enrolled in college or who had recently graduated from college. Convenience sampling was used during the quantitative phase, followed by purposive sampling in the qualitative phase. A cross-sectional web-based survey evaluating the willingness to use a mobile app for HIV prevention was conducted in the quantitative phase. Descriptive statistics were used for all variables. A separate focus group discussion was conducted with Black women in college to expand on the quantitative results. Focus group discussions explored their perceptions on HIV and health content delivered through a mobile app along with potential features that participants desired within the app. Using the data obtained, we selected the primary features for the app prototype. Results: In total, we enrolled 34 participants in the survey, with 6 participating in focus group discussions. Over half of the respondents reported a willingness to use an app that contained pre-exposure prophylaxis content. Women who claimed recent sexual activity reported being more likely to use an app feature that would allow them to order an at-home HIV testing kit than their non–sexually active counterparts. The emerging themes from the focus group session were Black women’s health concerns, HIV risk, sources of health information, and preferred app features. The content in our prototype included speaking with a specialist, HIV and pre-exposure prophylaxis information, holistic wellness, and features promoting engagement and retention. Conclusions: The results of our study guided the design of wireframes for an app prototype targeting HIV prevention in college-aged Black women. The rapid growth of mobile devices in Black communities, coupled with high rates of smartphone ownership among Black youth, makes mobile health interventions a promising strategy for addressing sexual and reproductive health disparities. Participants in our sample were willing to use a culturally appropriate and gender-considerate app for their sexual health needs. Our findings indicate that Black women in college may be excellent candidates for mobile app–based interventions. %M 36821362 %R 10.2196/37987 %U https://formative.jmir.org/2023/1/e37987 %U https://doi.org/10.2196/37987 %U http://www.ncbi.nlm.nih.gov/pubmed/36821362 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40536 %T Feasibility and Acceptability of Wearable Cameras to Assess Self-care in People With Heart Failure: Pilot Study %A Askman,Sanna %A Löf,Marie %A Maddison,Ralph %A Nourse,Rebecca %+ Department of Health, Medicine and Caring Sciences, Linköping University, Norra Skolgatan 18, Malmö, 21152, Sweden, 46 0730773773, sanna.askman@hotmail.se %K heart failure %K HF %K life logging %K self-management %K cardiovascular disease %K wearable devices %K self management %K self-care %D 2023 %7 17.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Heart failure (HF) is a common chronic condition that affects over 26 million people worldwide. It is a progressive and debilitating disease with a broad symptom profile, intermittently marked by periods of acute decompensation. People with HF generally do not self-manage their condition well (eg, monitoring symptoms, taking medications regularly, physical activity, etc). A better understanding of self-care activities and what factors may indicate deterioration is warranted. Objective: The aim of this study was to determine the feasibility and acceptability of using wearable cameras to assess self-care activities in people with HF. The study objectives were to (1) explore whether changes in self-care activities could be identified prior to hospitalization and (2) determine the acceptability of wearable cameras to people with HF. Methods: A total of 30 people recently diagnosed with HF wore a camera for a maximum of 30 days; the camera took a photo every 30 seconds in the forward-facing direction. At the end of the study, all 30 participants were presented with 8 statements of acceptability, scored on a 5-point Likert scale. To determine whether camera images could identify changes in self-care activities and lifestyle risk factors before hospitalization, we analyzed images from participants (n=8) who were hospitalized during the 30-day study period. Images from the period immediately prior to hospitalization and a comparison were selected for each participant. Images were manually coded according to 9 different event categories relating to self-care and lifestyle risk factors, and events were compared between the 2 periods. Results: The participants reported high acceptability for wearing the cameras, as most strongly agreed or agreed that they were comfortable to wear (28/30, 93%) and easy to use (30/30, 100%). The results of the camera image analysis showed that participants undertook fewer activities of daily living (P=.008) and were more sedentary (P=.02) prior to being hospitalized, compared to a period nonadjacent to hospitalization. Conclusions: Adults with HF were accepting of using a wearable camera for periods within a 30-day time frame. Wearable cameras were a feasible approach for providing data on selected self-care activities and lifestyle risk factors for HF and offer the potential to be a valuable tool for improving our understanding of self-care. %M 36800215 %R 10.2196/40536 %U https://formative.jmir.org/2023/1/e40536 %U https://doi.org/10.2196/40536 %U http://www.ncbi.nlm.nih.gov/pubmed/36800215 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 11 %N %P e39876 %T The Current Status of Secondary Use of Claims, Electronic Medical Records, and Electronic Health Records in Epidemiology in Japan: Narrative Literature Review %A Zhao,Yang %A Tsubota,Tadashi %+ Audit & Assurance Deloitte Analytics R&D, Deloitte Touche Tohmatsu LLC, Marunouchi Nijubashi Building, 3-2-3 Marunouchi, Chiyoda-ku, Tokyo, 1008360, Japan, 81 80 9350 0848, yang1.zhao@tohmatsu.co.jp %K claims %K electronic medical records %K EMRs %K electronic health records %K EHRs %K epidemiology %K narrative literature review %D 2023 %7 14.2.2023 %9 Review %J JMIR Med Inform %G English %X Background: Real-world data, such as claims, electronic medical records (EMRs), and electronic health records (EHRs), are increasingly being used in clinical epidemiology. Understanding the current status of existing approaches can help in designing high-quality epidemiological studies. Objective: We conducted a comprehensive narrative literature review to clarify the secondary use of claims, EMRs, and EHRs in clinical epidemiology in Japan. Methods: We searched peer-reviewed publications in PubMed from January 1, 2006, to June 30, 2021 (the date of search), which met the following 3 inclusion criteria: involvement of claims, EMRs, EHRs, or medical receipt data; mention of Japan; and published from January 1, 2006, to June 30, 2021. Eligible articles that met any of the following 6 exclusion criteria were filtered: review articles; non–disease-related articles; articles in which the Japanese population is not the sample; articles without claims, EMRs, or EHRs; full text not available; and articles without statistical analysis. Investigations of the titles, abstracts, and full texts of eligible articles were conducted automatically or manually, from which 7 categories of key information were collected. The information included organization, study design, real-world data type, database, disease, outcome, and statistical method. Results: A total of 620 eligible articles were identified for this narrative literature review. The results of the 7 categories suggested that most of the studies were conducted by academic institutes (n=429); the cohort study was the primary design that longitudinally measured outcomes of proper patients (n=533); 594 studies used claims data; the use of databases was concentrated in well-known commercial and public databases; infections (n=105), cardiovascular diseases (n=100), neoplasms (n=78), and nutritional and metabolic diseases (n=75) were the most studied diseases; most studies have focused on measuring treatment patterns (n=218), physiological or clinical characteristics (n=184), and mortality (n=137); and multivariate models were commonly used (n=414). Most (375/414, 90.6%) of these multivariate modeling studies were performed for confounder adjustment. Logistic regression was the first choice for assessing many of the outcomes, with the exception of hospitalization or hospital stay and resource use or costs, for both of which linear regression was commonly used. Conclusions: This literature review provides a good understanding of the current status and trends in the use of claims, EMRs, and EHRs data in clinical epidemiology in Japan. The results demonstrated appropriate statistical methods regarding different outcomes, Japan-specific trends of disease areas, and the lack of use of artificial intelligence techniques in existing studies. In the future, a more precise comparison of relevant domestic research with worldwide research will be conducted to clarify the Japan-specific status and challenges. %M 36787161 %R 10.2196/39876 %U https://medinform.jmir.org/2023/1/e39876 %U https://doi.org/10.2196/39876 %U http://www.ncbi.nlm.nih.gov/pubmed/36787161 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41892 %T Alarming Trends of Cesarean Section—Time to Rethink: Evidence From a Large-Scale Cross-sectional Sample Survey in India %A Pandey,Anuj Kumar %A Raushan,Mukesh Ravi %A Gautam,Diksha %A Neogi,Sutapa Bandyopadhyay %+ Department of Health Research, International Institute of Health Management Research, Plot-3, Sector-18A, Dwarka, New Delhi, 110075, India, 91 30418901, sutapa@iihmrdelhi.edu.in %K cesarean section %K surgical obstetric procedure %K abdominal delivery %K reproductive health service %K women health services %K obstetrics %K health promotion %D 2023 %7 13.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Cesarean section (CS) delivery rate has increased significantly both globally and in India, thereby posing a burden on overstretched health systems. Objective: This study plans to understand the factors associated with CS rate with an objective to (1) analyze the trends of CS delivery from 1998-99 to 2019-21 and (2) understand the proximate determinants of CS deliveries in India. Methods: Analysis of secondary data (National Family Health Survey) of a nationally representative sample of 230,870 women (year 2019-21) was undertaken to explore the trends, distribution, and determinants of CS deliveries in India and within states. Multivariable analyses were performed to determine the proximate variables associated with CS and elective CS. The relative interaction effect of confounding factors, such as number of antenatal care (ANC) visits, place of residence, and wealth status, on cesarean delivery was assessed. A composite index was generated using trust, support, and intimate partner violence variables (termed the partner human capital index [PHI]) to study its influence on CS deliveries, with a low PHI indicating abusive partner and a high PHI indicating supportive partner. Statewise spatial distribution of the most significantly associated factors, namely, wealth quintile and ANC checkups, were also analyzed. Results: The overall prevalence of CS was 21.50% (49,634/230,870) which had risen from 16.72% (2312/13,829) in 1998-99. The adjusted odds of CS deliveries were significantly higher among women who were highly educated (odds ratio [OR] 7.30, 95% CI 7.02-7.60; P<.001), had 4 or more ANC visits (OR 2.28, 95% CI 2.15-2.42; P<.001), belonging to the high-wealth quintile (OR 7.87, 95% CI 7.57-8.18; P<.001), and from urban regions. Increasing educational level of the head of the household (OR 3.05, 95% CI 2.94-3.16; P<.001) was also found to be a significant determinant of CS deliveries. The odds of selection of elective and emergency CS were also significantly higher among women from richer families (OR 1.66, 95% CI 1.25-2.21; P<.001) and those belonging to Christian religion (OR 1.67, 95% CI 1.14-2.43; P=.008). Adjusting the cesarean delivery by PHI, the odds of outcome were significantly higher among women with moderate and high PHI compared with those with low PHI (OR 1.46, 95% CI 1.36-1.56 and OR 1.61, 95% CI 1.49-1.74, respectively; P<.001 for both). The interaction effect result reiterates that women with more than 4 ANC checkups, high PHI, and belonging to the richer wealth quintile were more likely to undergo cesarean delivery (OR 22.22, 95% CI 14.99-32.93; P<.001) compared with those with no ANC visit, low PHI, and poorest women. Conclusions: The increasing trend of CS deliveries across India is raising concerns. Better education, wealth, and good support from the partner have been incriminated as the contributory factors. There is a need to institute proper monitoring mechanisms to assess the need for CS, especially when performed electively. %R 10.2196/41892 %U https://www.jmir.org/2023/1/e41892/ %U https://doi.org/10.2196/41892 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42892 %T Parent-Reported Use of Pediatric Primary Care Telemedicine: Survey Study %A Ray,Kristin N %A Wittman,Samuel R %A Burns,Sarah %A Doan,Tran T %A Schweiberger,Kelsey A %A Yabes,Jonathan G %A Hanmer,Janel %A Krishnamurti,Tamar %+ Department of Pediatrics, University of Pittsburgh, 3414 Fifth Avenue, Pittsburgh, PA, 15213, United States, 1 4126927518, knr16@pitt.edu %K telehealth %K telemedicine %K pediatrics %K primary care %D 2023 %7 9.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemedicine delivered from primary care practices became widely available for children during the COVID-19 pandemic. Objective: Focusing on children with a usual source of care, we aimed to examine factors associated with use of primary care telemedicine. Methods: In February 2022, we surveyed parents of children aged ≤17 years on the AmeriSpeak panel, a probability-based panel of representative US households, about their children’s telemedicine use. We first compared sociodemographic factors among respondents who did and did not report a usual source of care for their children. Among those reporting a usual source of care, we used Rao-Scott F tests to examine factors associated with parent-reported use versus nonuse of primary care telemedicine for their children. Results: Of 1206 respondents, 1054 reported a usual source of care for their children. Of these respondents, 301 of 1054 (weighted percentage 28%) reported primary care telemedicine visits for their children. Factors associated with primary care telemedicine use versus nonuse included having a child with a chronic medical condition (87/301, weighted percentage 27% vs 113/753, 15%, respectively; P=.002), metropolitan residence (262/301, weighted percentage 88% vs 598/753, 78%, respectively; P=.004), greater internet connectivity concerns (60/301, weighted percentage 24% vs 116/753, 16%, respectively; P=.05), and greater health literacy (285/301, weighted percentage 96% vs 693/753, 91%, respectively; P=.005). Conclusions: In a national sample of respondents with a usual source of care for their children, approximately one-quarter reported use of primary care telemedicine for their children as of 2022. Equitable access to primary care telemedicine may be enhanced by promoting access to primary care, sustaining payment for primary care telemedicine, addressing barriers in nonmetropolitan practices, and designing for lower health-literacy populations. %M 36757763 %R 10.2196/42892 %U https://www.jmir.org/2023/1/e42892 %U https://doi.org/10.2196/42892 %U http://www.ncbi.nlm.nih.gov/pubmed/36757763 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42449 %T Charting a Course for Smartphones and Wearables to Transform Population Health Research %A Dixon,William G %A van der Veer,Sabine N %A Ali,Syed Mustafa %A Laidlaw,Lynn %A Dobson,Richard J B %A Sudlow,Cathie %A Chico,Tim %A MacArthur,Jacqueline A L %A Doherty,Aiden %+ Big Data Institute, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, United Kingdom, 44 01865 617794, aiden.doherty@ndph.ox.ac.uk %K mHealth %K wearable %K person-generated health data %K population health research %K devices %K research %K health %K data %K mobile health %K clinical %K digital %D 2023 %7 7.2.2023 %9 Viewpoint %J J Med Internet Res %G English %X The use of data from smartphones and wearable devices has huge potential for population health research, given the high level of device ownership; the range of novel health-relevant data types available from consumer devices; and the frequency and duration with which data are, or could be, collected. Yet, the uptake and success of large-scale mobile health research in the last decade have not met this intensely promoted opportunity. We make the argument that digital person-generated health data are required and necessary to answer many top priority research questions, using illustrative examples taken from the James Lind Alliance Priority Setting Partnerships. We then summarize the findings from 2 UK initiatives that considered the challenges and possible solutions for what needs to be done and how such solutions can be implemented to realize the future opportunities of digital person-generated health data for clinically important population health research. Examples of important areas that must be addressed to advance the field include digital inequality and possible selection bias; easy access for researchers to the appropriate data collection tools, including how best to harmonize data items; analysis methodologies for time series data; patient and public involvement and engagement methods for optimizing recruitment, retention, and public trust; and methods for providing research participants with greater control over their data. There is also a major opportunity, provided through the linkage of digital person-generated health data to routinely collected data, to support novel population health research, bringing together clinician-reported and patient-reported measures. We recognize that well-conducted studies need a wide range of diverse challenges to be skillfully addressed in unison (eg, challenges regarding epidemiology, data science and biostatistics, psychometrics, behavioral and social science, software engineering, user interface design, information governance, data management, and patient and public involvement and engagement). Consequently, progress would be accelerated by the establishment of a new interdisciplinary community where all relevant and necessary skills are brought together to allow for excellence throughout the life cycle of a research study. This will require a partnership of diverse people, methods, and technologies. If done right, the synergy of such a partnership has the potential to transform many millions of people’s lives for the better. %M 36749628 %R 10.2196/42449 %U https://www.jmir.org/2023/1/e42449 %U https://doi.org/10.2196/42449 %U http://www.ncbi.nlm.nih.gov/pubmed/36749628 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e38713 %T Identifying Desired Features That Would Be Acceptable and Helpful in a Wrist-Worn Biosensor–Based Alcohol Intervention: Interview Study Among Adults Who Drink Heavily %A Richards,Veronica L %A Rajendran,Saahas %A Cook,Robert L %A Leeman,Robert F %A Wang,Yan %A Prins,Cindy %A Cook,Christa %+ Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, 320 Biobehavioral Health Building, University Park, PA, 16802, United States, 1 814 867 2119, vlr5157@psu.edu %K transdermal %K biosensor %K alcohol %K intervention %K qualitative interview %K patient preferences %K mobile phone %D 2023 %7 2.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Alcohol misuse is highly prevalent in the United States and results in a huge financial and public health burden. Current alcohol reduction treatments are underused, and there is a critical need for innovation in the field. Transdermal alcohol biosensors measure alcohol use passively and continuously and may be helpful tools in alcohol interventions. To date, however, alcohol biosensors have not been widely used to directly intervene on alcohol use. There is a new wrist-worn biosensor that could be used to help people reduce their drinking, although it is unclear how best to incorporate such a device into an alcohol intervention. Objective: We aimed to identify desired features that would be acceptable and helpful in a wrist-worn biosensor–based alcohol intervention for adults who drink heavily. Methods: Participants were recruited through an alcohol contingency management study, a contact registry, and participant referral. To qualify, participants had to be aged at least 40 years, report drinking at least twice per week, and indicate interest in reducing their drinking. We conducted a semistructured interview with each participant via Zoom (Zoom Video Communications, Inc). The interview guide addressed general thoughts on the wrist-worn biosensor, how participants thought a wrist-worn biosensor could be used to help people quit or reduce drinking, types of information that participants would want to receive from the biosensor, how they would want to receive this information, and how they thought this information could be used to change their behavior. Interviews were transcribed verbatim and analyzed using thematic analysis. Results: The sample comprised 20 adults (mean age 55.1, SD 6.1 years; 11/20, 55%, women; and 17/20, 85%, Black). Of the 20 participants, 9 (45%) had previous experience with the Secure Continuous Remote Alcohol Monitor continuous alcohol monitoring ankle biosensor from participating in an alcohol contingency management study. The desirable features could be grouped into 5 main themes: features that would influence willingness to use the biosensor (it should look attractive and be both comfortable to wear and accessible), personalized messaging (personalized biosensor-based prompts and feedback could be helpful), preference for time wearing the biosensor (for some, just wearing the biosensor could have an intervention effect), sharing data with others (this was appealing to many but not to all), and mental health support (many felt that mental health support could be incorporated into the biosensor). Conclusions: Five main themes that would maximize interest in using a wrist-worn biosensor for alcohol intervention were identified. Taken together, the identified themes could inform the development of a just-in-time adaptive intervention that uses a wrist-worn biosensor to help adults who drink heavily reduce their alcohol use. %M 36729576 %R 10.2196/38713 %U https://www.jmir.org/2023/1/e38713 %U https://doi.org/10.2196/38713 %U http://www.ncbi.nlm.nih.gov/pubmed/36729576 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e36764 %T Nominal Versus Realized Costs of Recruiting and Retaining a National Sample of Sexual Minority Adolescents in the United States: Longitudinal Study %A Mamey,Mary Rose %A Schrager,Sheree M %A Rhoades,Harmony %A Goldbach,Jeremy T %+ University of Southern California, 3620 S Vermont Ave, Los Angeles, CA, 90089, United States, 1 949 933 4700, maryrosemamey@gmail.com %K cost analysis %K study recruitment %K longitudinal retention %K sexual minority adolescents %K mobile phone %D 2023 %7 2.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based recruitment for research studies is becoming increasingly popular and necessary. When compared with the traditional methods of recruitment, these methods may enable researchers to reach more diverse participants in less time. Social media use is highly prevalent among adolescents, and the unique context of social media may be particularly important for the recruitment of sexual minority young people who would not be captured by traditional methods. Objective: This paper described the details of a national web-based study recruitment approach aimed at sexual minority adolescents across the United States, focusing on important details of this relatively novel approach, including cost, time efficiency, and retention outcomes. Methods: This study recruited sexual minority adolescents aged 14-17 years living in the United States through targeted advertisements on Facebook, Instagram, and YouTube and through respondent-driven sampling (RDS). Potential participants completed eligibility screening surveys and were automatically directed to a baseline survey if they were eligible. After baseline survey completion, additional data checks were implemented, and the remaining participants were contacted for recruitment into a longitudinal study (surveys every 6 months for 3 years). Results: Recruitment lasted 44 weeks, and 9843 participants accessed the initial screening survey, with 2732 (27.76%) meeting the eligibility criteria and completing the baseline survey. Of those, 2558 (93.63%) were determined to have provided nonfraudulent, usable study data and 1076 (39.39%) subsequently enrolled in the longitudinal study. Of the baseline sample, 79.05% (2022/2558) was recruited through Facebook and Instagram, 3.05% (78/2558) through YouTube, and 17.9% (458/2558) through RDS. The average cost of recruiting a participant into the study was US $12.98, but the recruitment cost varied by method or platform, with a realized cost of US $13 per participant on Facebook and Instagram, US $24 on YouTube, and US $10 through RDS. Participant differences (sex assigned at birth, race and ethnicity, sexual orientation, region, and urbanicity) were identified between platforms and methods both in terms of overall number of participants and cost per participant. Facebook and Instagram were the most time efficient (approximately 15 days to recruit 100 participants), whereas RDS was the least time efficient (approximately 70 days to recruit 100 participants). Participants recruited through YouTube were the most likely to be longitudinally retained, followed by Facebook and Instagram, and then RDS. Conclusions: Large differences exist in study recruitment cost and efficiency when using social media and RDS. Demographic, region, and urbanicity differences in recruitment methods highlight the need for attention to demographic diversity when planning and implementing recruitment across platforms. Finally, it is more cost-effective to retain than recruit samples, and this study provided evidence that with thorough screening and data quality practices, social media recruitment can result in diverse, highly involved study populations. %M 36729597 %R 10.2196/36764 %U https://www.jmir.org/2023/1/e36764 %U https://doi.org/10.2196/36764 %U http://www.ncbi.nlm.nih.gov/pubmed/36729597 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41591 %T The Current Knowledge, Attitudes, and Practices of the Neglected Methodology of Web-Based Questionnaires Among Chinese Health Workers: Web-Based Questionnaire Study %A Fang,Heping %A Lv,Yuxin %A Chen,Lin %A Zhang,Xuan %A Hu,Yan %+ Department of Child Health Care, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Pediatrics, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China, 86 02363622764, hy420@126.com %K epidemiological survey %K knowledge, attitudes, and practices (KAP) %K medical education %K methodology %K web-based questionnaire (WBQ) %D 2023 %7 27.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based questionnaire (WBQ) surveys are popular, but the quality of reporting WBQ survey research is uneven and unsatisfactory worldwide. Education and training on WBQ methodology may be necessary. However, the current knowledge, attitudes, and practices (KAP) of its methodology remain unknown. Objective: We investigated the KAP of WBQ methodology among Chinese health workers for the first time to clarify the possible reasons for the unsatisfactory reporting quality of WBQ survey research from China’s experience, aiming to provide a basis for improvement. Methods: We developed a structured WBQ based on the current recommendations and knowledge and investigated 458 health workers from June 7 to July 6, 2022. A total of 381 valid questionnaires were analyzed after data processing. We defined 50% and 75% as “qualified” and “satisfactory” in knowledge and practice topics to describe the results and analyzed the basic characteristics of the participants who had difficulties in conducting WBQ survey research. Results: A total of 215 (56.4%) participants had used WBQs for investigation, mostly more than 2 times (88.3%), but only 95 (44.2%) of them had ever received methodological training. A total of 134 (62.3%) users believed that WBQs were practical, but 126 (58.6%) had doubts about the reliability of the results. Most of the knowledge and practice topics did not reach a satisfactory level, and some even did not reach a qualified level. A total of 95 (44.2%)-136 (63.3%) of the users had reported difficulties in conducting WBQ survey research, and different participants could have different difficulties according to their characteristics. In addition, 191 (88.8%) users believed training was necessary. Conclusions: We found that Chinese health workers seriously underestimated and neglected the importance of the WBQ methodology, which may be an important reason for the reduced reporting quality of WBQ survey research. Medical educators need to strengthen methodological training on WBQs, which may help to improve the quality of WBQ survey research. %M 36533302 %R 10.2196/41591 %U https://www.jmir.org/2023/1/e41591 %U https://doi.org/10.2196/41591 %U http://www.ncbi.nlm.nih.gov/pubmed/36533302 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e36663 %T A Novel Digital Digit-Symbol Substitution Test Measuring Processing Speed in Adults At Risk for Alzheimer Disease: Validation Study %A Campitelli,Anthony %A Paulson,Sally %A Gills,Josh L %A Jones,Megan D %A Madero,Erica N %A Myers,Jennifer %A Glenn,Jordan M %A Gray,Michelle %+ Exercise Science Research Center, University of Arkansas, 308 HPER Building, 115 Stadium Drive, Fayetteville, AR, 72701, United States, 1 479 575 6762, rgray@uark.edu %K Alzheimer disease %K dementia %K processing speed %K digit-symbol substitution %K aging %K cognitive %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Assessing cognitive constructs affected by Alzheimer disease, such as processing speed (PS), is important to screen for potential disease and allow for early detection. Digital PS assessments have been developed to provide widespread, efficient cognitive testing, but all have been validated only based on the correlation between test scores. Best statistical practices dictate that concurrent validity should be assessed for agreement or equivalence rather than using correlation alone. Objective: This study aimed to assess the concurrent validity of a novel digital PS assessment against a gold-standard measure of PS. Methods: Adults aged 45-75 years (n=191) participated in this study. Participants completed the novel digital digit-symbol substitution test (DDSST) and the Repeatable Battery for the Assessment of Neuropsychological Status coding test (RBANS-C). The correlation between the test scores was determined using a Pearson product-moment correlation, and a difference in mean test scores between tests was checked for using a 2-tailed dependent samples t test. Data were analyzed for agreement between the 2 tests using Bland-Altman limits of agreement and equivalency using a two one-sided t tests (TOST) approach. Results: A significant moderate, positive correlation was found between DDSST and RBANS-C scores (r=.577; P<.001), and no difference in mean scores was detected between the tests (P=.93). Bias was nearly zero (0.04). Scores between the tests were found to display adequate agreement with 90% of score differences falling between –22.66 and 22.75 (90% limits of agreement=–22.91 to 22.99), and the scores were equivalent (P=.049). Conclusions: Analyses indicate that the DDSST is a valid digital assessment of PS. The DDSST appears to be a suitable option for widespread, immediate, and efficient PS testing. Trial Registration: ClinicalTrials.gov NCT04559789; https://clinicaltrials.gov/ct2/show/NCT04559789 %M 36705951 %R 10.2196/36663 %U https://aging.jmir.org/2023/1/e36663 %U https://doi.org/10.2196/36663 %U http://www.ncbi.nlm.nih.gov/pubmed/36705951 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42956 %T Supporting Youth Vaping Cessation With the Crush the Crave Smartphone App: Protocol for a Randomized Controlled Trial %A Sanchez,Sherald %A Deck,Alicia %A Baskerville,Neill Bruce %A Chaiton,Michael %+ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada, 1 416 435 8501, Michael.Chaiton@camh.ca %K e-cigarettes %K vaping cessation %K youth and young adult health %K adult %K youth %K effectiveness %K smartphone %K application %K vaping %K cessation %K assessment %K intervention %D 2023 %7 27.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The use of e-cigarettes, or vaping, has increased exponentially in the past decade, particularly among youth. Emerging evidence indicates growing nicotine dependence among youth, revealing historically higher rates of dependence among current e-cigarette users compared to rates seen in earlier research. Despite the urgent need for youth vaping cessation interventions, there is limited knowledge about the process of vaping cessation, and few evidence-based interventions are available to young people seeking support. A notable literature review on vaping cessation resources for young people recommended technology-based interventions, such as smartphone apps and SMS text messaging services, as a promising area of vaping cessation research and intervention development. Objective: The primary aim of our study is to determine the effectiveness of the Crush the Crave app in supporting vaping cessation among youth recruited to the intervention arm via comparison with an assessment-only control group. The primary hypothesis is that participants in the intervention group—those using Crush the Crave—will be more likely to be abstinent at the 6-month follow-up point than participants in the assessment-only control arm. Methods: A 2-arm, single-blind, parallel randomized controlled trial will be conducted over 12 months. Study invitations will be sent to 600 youth (age: 16-18 years) and young adult (age: 19-29 years) e-cigarette users and randomized between an intervention arm, which will be using Crush the Crave (n=300), and an assessment-only control arm (n=300) in a 1:1 ratio. The primary hypothesis is that participants in the intervention group—those using Crush the Crave—will be more likely to be abstinent at the 6-month follow-up point. Results: Study recruitment began on March 4, 2022. Recruitment is anticipated to be completed in December 2022. Conclusions: This protocol describes one of the first-ever randomized controlled trial studies to evaluate the effectiveness of an app-based intervention for supporting vaping cessation among youth aged 16 to 18 years and young adults aged 19 to 29 years. The findings from our trial will help increase our understanding of the process of vaping cessation among youth and provide evidence on the effectiveness of an app-based intervention in helping young people quit vaping. The trial results will also have implications in the development of current and future approaches to youth vaping cessation. Trial Registration: OSF Registries osf.io/hmd87; https://doi.org/10.17605/OSF.IO/HMD87 International Registered Report Identifier (IRRID): DERR1-10.2196/42956 %M 36705967 %R 10.2196/42956 %U https://www.researchprotocols.org/2023/1/e42956 %U https://doi.org/10.2196/42956 %U http://www.ncbi.nlm.nih.gov/pubmed/36705967 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43028 %T The Ability of Austrian Qualified Physiotherapists to Make Accurate Keep-Refer Decisions and to Detect Serious Pathologies Based on Clinical Vignettes: Protocol for a Cross-sectional Web-Based Survey %A Lackenbauer,Wolfgang %A Gasselich,Simon %A Lickel,Martina Edda %A Beikircher,Reinhard %A Keip,Christian %A Rausch,Florian %A Wieser,Manfred %A Selfe,James %A Janssen,Jessie %+ Institute of Therapeutic and Midwifery Sciences, Department of Health Sciences, University of Applied Sciences Krems, Piaristengasse 1, Krems, 3500, Austria, 43 2732 802 0, wolfgang.lackenbauer@fh-krems.ac.at %K red flags %K clinical reasoning %K physiotherapy %K screening %K referral %K musculoskeletal %D 2023 %7 24.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The recognition of serious pathologies affecting the musculoskeletal (MSK) system, especially in the early stage of a disease, is an important but challenging task. The prevalence of such serious pathologies is currently low. However, in our progressing aging population, it is anticipated that serious pathologies affecting the MSK system will be on the rise. Physiotherapists, as part of a wider health care team, can play a valuable role in the recognition of serious pathologies. It is at present unknown how accurately Austrian qualified physiotherapists can detect the presence of serious pathologies affecting the MSK system and therefore determine whether physiotherapy management is indicated (keep patients) or not (refer patients to a medical doctor). Objective: We will explore the current ability of Austrian qualified physiotherapists to recognize serious pathologies by using validated clinical vignettes. Methods: As part of an electronic web-based survey, these vignettes will be distributed among a convenience sample of qualified Austrian physiotherapists working in a hospital or private setting. The survey will consist of four sections: (1) demographics and general information, (2) the clinical vignettes, (3) questions concerning the clinical vignettes, and (4) self-perceived knowledge gaps and learning preferences from the perspective of study participants. Results will further be used for (1) international comparison with similar studies from the existing literature and (2) gaining insight into the participants’ self-perceived knowledge gaps and learning preferences for increasing their knowledge level about keep-refer decision-making and detecting serious pathologies. Results: Data collection took place between May 2022 and June 2022. As of June 2022, a total of 479 Austrian physiotherapists completed the survey. Data analysis has started, and we aim to publish the results in 2023. Conclusions: The results of this survey will provide insights into the ability of Austrian physiotherapists to make accurate keep-refer decisions and to recognize the presence of serious pathologies using clinical vignettes. The results of this survey are expected to serve as a basis for future training in this area. International Registered Report Identifier (IRRID): DERR1-10.2196/43028 %M 36692940 %R 10.2196/43028 %U https://www.researchprotocols.org/2023/1/e43028 %U https://doi.org/10.2196/43028 %U http://www.ncbi.nlm.nih.gov/pubmed/36692940 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 11 %N %P e38412 %T Agreement Between Experts and an Untrained Crowd for Identifying Dermoscopic Features Using a Gamified App: Reader Feasibility Study %A Kentley,Jonathan %A Weber,Jochen %A Liopyris,Konstantinos %A Braun,Ralph P %A Marghoob,Ashfaq A %A Quigley,Elizabeth A %A Nelson,Kelly %A Prentice,Kira %A Duhaime,Erik %A Halpern,Allan C %A Rotemberg,Veronica %+ Dermatology Section, Memorial Sloan Kettering Cancer Center, 530 E 74th Street, New York, NY, 10021, United States, 1 8336854126, rotembev@mskcc.org %K dermatology %K dermatologist %K diagnosis %K diagnostic %K labeling %K classification %K deep learning %K dermoscopy %K dermatoscopy %K skin %K pigmentation %K microscopy %K dermascopic %K artificial intelligence %K machine learning %K crowdsourcing %K crowdsourced %K melanoma %K cancer %K lesion %K medical image %K imaging %K development %K feasibility %D 2023 %7 18.1.2023 %9 Original Paper %J JMIR Med Inform %G English %X Background: Dermoscopy is commonly used for the evaluation of pigmented lesions, but agreement between experts for identification of dermoscopic structures is known to be relatively poor. Expert labeling of medical data is a bottleneck in the development of machine learning (ML) tools, and crowdsourcing has been demonstrated as a cost- and time-efficient method for the annotation of medical images. Objective: The aim of this study is to demonstrate that crowdsourcing can be used to label basic dermoscopic structures from images of pigmented lesions with similar reliability to a group of experts. Methods: First, we obtained labels of 248 images of melanocytic lesions with 31 dermoscopic “subfeatures” labeled by 20 dermoscopy experts. These were then collapsed into 6 dermoscopic “superfeatures” based on structural similarity, due to low interrater reliability (IRR): dots, globules, lines, network structures, regression structures, and vessels. These images were then used as the gold standard for the crowd study. The commercial platform DiagnosUs was used to obtain annotations from a nonexpert crowd for the presence or absence of the 6 superfeatures in each of the 248 images. We replicated this methodology with a group of 7 dermatologists to allow direct comparison with the nonexpert crowd. The Cohen κ value was used to measure agreement across raters. Results: In total, we obtained 139,731 ratings of the 6 dermoscopic superfeatures from the crowd. There was relatively lower agreement for the identification of dots and globules (the median κ values were 0.526 and 0.395, respectively), whereas network structures and vessels showed the highest agreement (the median κ values were 0.581 and 0.798, respectively). This pattern was also seen among the expert raters, who had median κ values of 0.483 and 0.517 for dots and globules, respectively, and 0.758 and 0.790 for network structures and vessels. The median κ values between nonexperts and thresholded average–expert readers were 0.709 for dots, 0.719 for globules, 0.714 for lines, 0.838 for network structures, 0.818 for regression structures, and 0.728 for vessels. Conclusions: This study confirmed that IRR for different dermoscopic features varied among a group of experts; a similar pattern was observed in a nonexpert crowd. There was good or excellent agreement for each of the 6 superfeatures between the crowd and the experts, highlighting the similar reliability of the crowd for labeling dermoscopic images. This confirms the feasibility and dependability of using crowdsourcing as a scalable solution to annotate large sets of dermoscopic images, with several potential clinical and educational applications, including the development of novel, explainable ML tools. %M 36652282 %R 10.2196/38412 %U https://medinform.jmir.org/2023/1/e38412 %U https://doi.org/10.2196/38412 %U http://www.ncbi.nlm.nih.gov/pubmed/36652282 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38112 %T Estimation of Bedtimes of Reddit Users: Integrated Analysis of Time Stamps and Surveys %A Meyerson,William U %A Fineberg,Sarah K %A Song,Ye Kyung %A Faber,Adam %A Ash,Garrett %A Andrade,Fernanda C %A Corlett,Philip %A Gerstein,Mark B %A Hoyle,Rick H %+ Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, 3643 N Roxboro St, Durham, NC, 27704, United States, 1 919 695 3567, william.ulysses@gmail.com %K social media %K sleep %K parametric models %K Reddit %K observational model %K research tool %K sleep patterns %K usage data %K model %K bedtime %D 2023 %7 17.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with later bedtimes have an increased risk of difficulties with mood and substances. To investigate the causes and consequences of late bedtimes and other sleep patterns, researchers are exploring social media as a data source. Pioneering studies inferred sleep patterns directly from social media data. While innovative, these efforts are variously unscalable, context dependent, confined to specific sleep parameters, or rest on untested assumptions, and none of the reviewed studies apply to the popular Reddit platform or release software to the research community. Objective: This study builds on this prior work. We estimate the bedtimes of Reddit users from the times tamps of their posts, test inference validity against survey data, and release our model as an R package (The R Foundation). Methods: We included 159 sufficiently active Reddit users with known time zones and known, nonanomalous bedtimes, together with the time stamps of their 2.1 million posts. The model’s form was chosen by visualizing the aggregate distribution of the timing of users’ posts relative to their reported bedtimes. The chosen model represents a user’s frequency of Reddit posting by time of day, with a flat portion before bedtime and a quadratic depletion that begins near the user’s bedtime, with parameters fitted to the data. This model estimates the bedtimes of individual Reddit users from the time stamps of their posts. Model performance is assessed through k-fold cross-validation. We then apply the model to estimate the bedtimes of 51,372 sufficiently active, nonbot Reddit users with known time zones from the time stamps of their 140 million posts. Results: The Pearson correlation between expected and observed Reddit posting frequencies in our model was 0.997 on aggregate data. On average, posting starts declining 45 minutes before bedtime, reaches a nadir 4.75 hours after bedtime that is 87% lower than the daytime rate, and returns to baseline 10.25 hours after bedtime. The Pearson correlation between inferred and reported bedtimes for individual users was 0.61 (P<.001). In 90 of 159 cases (56.6%), our estimate was within 1 hour of the reported bedtime; 128 cases (80.5%) were within 2 hours. There was equivalent accuracy in hold-out sets versus training sets of k-fold cross-validation, arguing against overfitting. The model was more accurate than a random forest approach. Conclusions: We uncovered a simple, reproducible relationship between Reddit users’ reported bedtimes and the time of day when high daytime posting rates transition to low nighttime posting rates. We captured this relationship in a model that estimates users’ bedtimes from the time stamps of their posts. Limitations include applicability only to users who post frequently, the requirement for time zone data, and limits on generalizability. Nonetheless, it is a step forward for inferring the sleep parameters of social media users passively at scale. Our model and precomputed estimated bedtimes of 50,000 Reddit users are freely available. %M 36649054 %R 10.2196/38112 %U https://formative.jmir.org/2023/1/e38112 %U https://doi.org/10.2196/38112 %U http://www.ncbi.nlm.nih.gov/pubmed/36649054 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44175 %T Sampling Sexual and Gender Minority Youth With UnACoRN (Understanding Affirming Communities, Relationships, and Networks): Lessons From a Web-Based Survey %A Delgado-Ron,Jorge Andrés %A Jeyabalan,Thiyaana %A Watt,Sarah %A Black,Stéphanie %A Gumprich,Martha %A Salway,Travis %+ Reaffirm Collaborative, Centre for Gender and Sexual Health Equity, 1190 Hornby St. (11th floor), Vancouver, BC, V6Z 2K5, Canada, 1 604 806 8881, travis_salway@sfu.ca %K sexual and gender minorities %K transgender persons %K sexual orientation %K conversion therapy %K web-based survey %K surveys and questionnaires %K adolescence %K sexual minority youth %K transgender youth %K same-sex attraction %K gender minority %K health inequality %K online recruitment %K advertisement %K social media recruitment %D 2023 %7 12.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Periodic surveys of sexual and gender minority (SGM) populations are essential for monitoring and investigating health inequities. Recent legislative efforts to ban so-called conversion therapy make it necessary to adapt youth surveys to reach a wider range of SGM populations, including those <18 years of age and those who may not adopt an explicit two-spirit, lesbian, gay, bisexual, transgender, and queer (2S/LGBTQ) identity. Objective: We aimed to share our experiences in recruiting SGM youth through multiple in-person and online channels and to share lessons learned for future researchers. Methods: The Understanding Affirming Communities, Relationships, and Networks (UnACoRN) web-based survey collected anonymous data in English and French from 9679 mostly SGM respondents in the United States and Canada. Respondents were recruited from March 2022 to August 2022 using word-of-mouth referrals, leaflet distribution, bus advertisements, and paid and unpaid campaigns on social media and a pornography website. We analyzed the metadata provided by these and other online resources we used for recruitment (eg, Bitly and Qualtrics) and describe the campaign’s effectiveness by recruitment venue based on calculating the cost per completed survey and other secondary metrics. Results: Most participants were recruited through Meta (13,741/16,533, 83.1%), mainly through Instagram; 88.96% (visitors: 14,888/18,179) of our sample reached the survey through paid advertisements. Overall, the cost per survey was lower for Meta than Pornhub or the bus advertisements. Similarly, the proportion of visitors who started the survey was higher for Meta (8492/18,179, 46.7%) than Pornhub (58/18,179, 1.02%). Our subsample of 7037 residents of Canada had a similar geographic distribution to the general population, with an average absolute difference in proportion by province or territory of 1.4% compared to the Canadian census. Our US subsample included 2521 participants from all US states and the District of Columbia. A total of CAD $8571.58 (the currency exchange rate was US $1=CAD $1.25) was spent across 4 paid recruitment channels (Facebook, Instagram, PornHub, and bus advertisements). The most cost-effective tool of recruitment was Instagram, with an average cost per completed survey of CAD $1.48. Conclusions: UnACoRN recruited nearly 10,000 SGM youth in the United States and Canada, and the cost per survey was CAD $1.48. Researchers using online recruitment strategies should be aware of the differences in campaign management each website or social media platform offers and be prepared to engage with their framing (content selection and delivery) to correct any imbalances derived from it. Those who focus on SGM populations should consider how 2S/LGBTQ-oriented campaigns might deter participation from cisgender or heterosexual people or SGM people not identifying as 2S/LGBTQ, if relevant to their research design. Finally, those with limited resources may select fewer venues with lower cost per completed survey or that appeal more to their specific audience, if needed. %M 36633900 %R 10.2196/44175 %U https://www.jmir.org/2023/1/e44175 %U https://doi.org/10.2196/44175 %U http://www.ncbi.nlm.nih.gov/pubmed/36633900 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39155 %T Social Media Use Among Members of the Assessment of Spondyloarthritis International Society: Results of a Web-Based Survey %A Kwan,Yu Heng %A Phang,Jie Kie %A Woon,Ting Hui %A Liew,Jean W %A Dubreuil,Maureen %A Proft,Fabian %A Ramiro,Sofia %A Molto,Anna %A Navarro-Compán,Victoria %A de Hooge,Manouk %A Meghnathi,Bhowmik %A Ziade,Nelly %A Zhao,Sizheng Steven %A Llop,Maria %A Baraliakos,Xenofon %A Fong,Warren %+ Program in Health Services and Systems Research, Duke-National University of Singapore Medical School, 8 College Rd, Singapore, 169857, Singapore, 65 90231226, phakyh@nus.edu.sg %K social media %K spondyloarthritis %K cross-sectional survey %D 2023 %7 10.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of social media in health care may serve as a beneficial tool for education, information dissemination, telemedicine, research, networking, and communications. To better leverage the benefits of social media, it is imperative to understand the patterns of its use and potential barriers to its implementation in health care. A previous study in 2016 that investigated social media use among young clinical rheumatologists (≤45 years) and basic scientists showed that there was substantial social media use among them for social and professional reasons. However, there is a limited inquiry into social media use in different areas of rheumatology, such as spondyloarthritis. Objective: We aimed to explore the motivations, barriers, and patterns of social media use among an international group of experts in spondyloarthritis. Methods: We distributed a web-based survey via email from March 2021 to June 2021 to 198 members of the Assessment of Spondyloarthritis International Society. It contained 24 questions about demographic characteristics, patterns of current social media use, and perceptions of utility. Univariable and multivariable logistic regression analyses were performed to identify the characteristics associated with use trends. Results: The response rate was 78.8% (156/198). Of these, 93.6% (146/156) of participants used at least one social media platform. Apart from internet-based shopping and entertainment, the use of social media for clinical updates (odds ratio [OR] 6.25, 95% CI 2.43-16.03) and research updates (OR 3.45, 95% CI 1.35-8.78) were associated with higher social media consumption. Among the respondents, 66% (103/156) used social media in a work-related manner. The use of social media for new web-based resources (OR 6.55, 95% CI 2.01-21.37), interaction with international colleagues (OR 4.66, 95% CI 1.21-17.90), and establishing a web-based presence (OR 4.05, 95% CI 1.25-13.13) were associated with higher levels of consumption for work-related purposes. Time investment, confidentiality concerns, and security concerns were the top 3 challenges to a wider adoption of social media. Conclusions: Most respondents (103/156, 66%) use social media in a work-related manner. Professional development, establishing a web-based presence, and international collaboration were associated with higher use. Challenges to social media adoption should be addressed to maximize its benefits. %M 36626201 %R 10.2196/39155 %U https://www.jmir.org/2023/1/e39155 %U https://doi.org/10.2196/39155 %U http://www.ncbi.nlm.nih.gov/pubmed/36626201 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 15 %N %P e38078 %T Co-design of the Transgender Health Information Resource: Web-Based Participatory Design %A Morse,Brad %A Soares,Andrey %A Ytell,Kate %A DeSanto,Kristen %A Allen,Marvyn %A Holliman,Brooke Dorsey %A Lee,Rita S %A Kwan,Bethany M %A Schilling,Lisa M %+ Division of General Internal Medicine, University of Colorado Anschutz Medical Campus, 1890 North Revere Court | Mailstop F443, Aurora, CO, 80045, United States, 1 3037245138, brad.morse@cuanschutz.edu %K transgender %K gender diverse %K participatory design %K web-based design %K co-design %K health information resource %K smartphone %K app %K mobile phone %D 2023 %7 10.1.2023 %9 Original Paper %J J Particip Med %G English %X Background: There is an urgent and unmet need for accessible and credible health information within the transgender and gender-diverse (TGD) community. Currently, TGD individuals often seek and must find relevant resources by vetting social media posts. A resource that provides accessible and credible health-related resources and content via a mobile phone app may have a positive impact on and support the TGD population. Objective: COVID-19 stay-at-home orders forced a shift in the methods used in participatory design. In this paper, we aimed to describe the web-based participatory methods used to develop the Transgender Health Information Resource. We also described and characterized the web-based engagement that occurred during a single session of the overall design process. Methods: We planned and conducted web-based design sessions to replace the proposed in-person sessions. We used web-based collaborative tools, including Zoom (Zoom Video Communications), Mural (Mural), REDCap (Research Electronic Data Capture; Vanderbilt University), and Justinmind (Justinmind), to engage the participants in the design process. Zoom was used as an integrated platform for design activities. Mural was used to perform exercises, such as free listing, brainstorming, and grouping. REDCap allowed us to collect survey responses. Justinmind was used to create prototypes that were shared and discussed via Zoom. Recruitment was led by one of our community partners, One Colorado, who used private Facebook groups in which web-based flyers were dispersed. The design process took place in several workshops over a period of 10 months. We described and characterized engagement during a single design session by tracking the number of influential interactions among participants. We defined an influential interaction as communication, either verbal or web-based content manipulation, that advanced the design process. Results: We presented data from a single design session that lasted 1 hour and 48 minutes and included 4 participants. During the session, there were 301 influential interactions, consisting of 79 verbal comments and 222 web-based content manipulations. Conclusions: Web-based participatory design can elicit input and decisions from participants to develop a health information resource, such as a mobile app user interface. Overall, participants were highly engaged. This approach maintained the benefits and fidelity of traditional in-person design sessions, mitigated deficits, and exploited the previously unconsidered benefits of web-based methods, such as enhancing the ability to participate for those who live far from academic institutions. The web-based approach to participatory design was an efficient and feasible methodological design approach. %M 36626222 %R 10.2196/38078 %U https://jopm.jmir.org/2023/1/e38078 %U https://doi.org/10.2196/38078 %U http://www.ncbi.nlm.nih.gov/pubmed/36626222 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e37731 %T Enhancing Nurse–Robot Engagement: Two-Wave Survey Study %A Liao,Gen-Yih %A Huang,Tzu-Ling %A Wong,May-Kuen %A Shyu,Yea-Ing Lotus %A Ho,Lun-Hui %A Wang,Chi %A Cheng,T C E %A Teng,Ching-I %+ Department of Nursing, Chang Gung Memorial Hospital, Linkou, 5, Fuxing St, Taoyuan, 333, Taiwan, 886 3 3281200, gigy@cgmh.org.tw %K healthcare %K health care %K eHealth %K digital heath %K health technology %K personal innovativeness %K robot %K structural equation modeling %K survey %K intelligent technology %K smart technology %K robotics %K nurse %K nursing %K attitude %K engagement %K healthcare professional %K benefit %K Taiwan %K Asia %D 2023 %7 9.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Robots are introduced into health care contexts to assist health care professionals. However, we do not know how the benefits and maintenance of robots influence nurse–robot engagement. Objective: This study aimed to examine how the benefits and maintenance of robots and nurses’ personal innovativeness impact nurses’ attitudes to robots and nurse–robot engagement. Methods: Our study adopted a 2-wave follow-up design. We surveyed 358 registered nurses in operating rooms in a large-scale medical center in Taiwan. The first-wave data were collected from October to November 2019. The second-wave data were collected from December 2019 to February 2020. In total, 344 nurses participated in the first wave. We used telephone to follow up with them and successfully followed-up with 331 nurses in the second wave. Results: Robot benefits are positively related to nurse–robot engagement (β=.13, P<.05), while robot maintenance requirements are negatively related to nurse–robot engagement (β=–.15, P<.05). Our structural model fit the data acceptably (comparative fit index=0.96, incremental fit index=0.96, nonnormed fit index=0.95, root mean square error of approximation=0.075). Conclusions: Our study is the first to examine how the benefits and maintenance requirements of assistive robots influence nurses’ engagement with them. We found that the impact of robot benefits on nurse–robot engagement outweighs that of robot maintenance requirements. Hence, robot makers should consider emphasizing design and communication of robot benefits in the health care context. %M 36622738 %R 10.2196/37731 %U https://www.jmir.org/2023/1/e37731 %U https://doi.org/10.2196/37731 %U http://www.ncbi.nlm.nih.gov/pubmed/36622738 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 8 %N %P e39750 %T Glycemic Variability and Fluctuations in Cognitive Status in Adults With Type 1 Diabetes (GluCog): Observational Study Using Ecological Momentary Assessment of Cognition %A Mascarenhas Fonseca,Luciana %A Strong,Roger W %A Singh,Shifali %A Bulger,Jane D %A Cleveland,Michael %A Grinspoon,Elizabeth %A Janess,Kamille %A Jung,Lanee %A Miller,Kellee %A Passell,Eliza %A Ressler,Kerry %A Sliwinski,Martin John %A Verdejo,Alandra %A Weinstock,Ruth S %A Germine,Laura %A Chaytor,Naomi S %+ Department of Community and Behavioral Health, Elson S Floyd College of Medicine, Washington State University, Office 453, 665 N Riverpoint Blvd, Spokane, WA, 99202, United States, 1 509 368 6948, luciana.fonseca@wsu.edu %K ecological momentary assessment %K type 1 diabetes %K cognitive variability %K digital neuropsychology %K digital technology %K remote assessment %K continuous glucose monitoring %K cognition %K diabetes %K physiological %K behavioral %K psychological %K cognitive %K adults %K glucose %K data %K study design %K assessment %K sample %K hypoglycemia %D 2023 %7 5.1.2023 %9 Original Paper %J JMIR Diabetes %G English %X Background: Individuals with type 1 diabetes represent a population with important vulnerabilities to dynamic physiological, behavioral, and psychological interactions, as well as cognitive processes. Ecological momentary assessment (EMA), a methodological approach used to study intraindividual variation over time, has only recently been used to deliver cognitive assessments in daily life, and many methodological questions remain. The Glycemic Variability and Fluctuations in Cognitive Status in Adults with Type 1 Diabetes (GluCog) study uses EMA to deliver cognitive and self-report measures while simultaneously collecting passive interstitial glucose in adults with type 1 diabetes. Objective: We aimed to report the results of an EMA optimization pilot and how these data were used to refine the study design of the GluCog study. An optimization pilot was designed to determine whether low-frequency EMA (3 EMAs per day) over more days or high-frequency EMA (6 EMAs per day) for fewer days would result in a better EMA completion rate and capture more hypoglycemia episodes. The secondary aim was to reduce the number of cognitive EMA tasks from 6 to 3. Methods: Baseline cognitive tasks and psychological questionnaires were completed by all the participants (N=20), followed by EMA delivery of brief cognitive and self-report measures for 15 days while wearing a blinded continuous glucose monitor. These data were coded for the presence of hypoglycemia (<70 mg/dL) within 60 minutes of each EMA. The participants were randomized into group A (n=10 for group A and B; starting with 3 EMAs per day for 10 days and then switching to 6 EMAs per day for an additional 5 days) or group B (N=10; starting with 6 EMAs per day for 5 days and then switching to 3 EMAs per day for an additional 10 days). Results: A paired samples 2-tailed t test found no significant difference in the completion rate between the 2 schedules (t17=1.16; P=.26; Cohen dz=0.27), with both schedules producing >80% EMA completion. However, more hypoglycemia episodes were captured during the schedule with the 3 EMAs per day than during the schedule with 6 EMAs per day. Conclusions: The results from this EMA optimization pilot guided key design decisions regarding the EMA frequency and study duration for the main GluCog study. The present report responds to the urgent need for systematic and detailed information on EMA study designs, particularly those using cognitive assessments coupled with physiological measures. Given the complexity of EMA studies, choosing the right instruments and assessment schedules is an important aspect of study design and subsequent data interpretation. %M 36602848 %R 10.2196/39750 %U https://diabetes.jmir.org/2023/1/e39750 %U https://doi.org/10.2196/39750 %U http://www.ncbi.nlm.nih.gov/pubmed/36602848 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e39704 %T Acceptability of Telemedicine Among Parents of Adolescent Patients in an Adolescent Clinic: Cross-sectional Survey Study %A Olateju,Adetola %A Cervantes,Marbella %A Dowshen,Nadia %A Kuhns,Lisa M %A Dhar,Cherie Priya %+ Ann and Robert H Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 161B, Chicago, IL, 60611-2605, United States, 1 312 227 6800, cpdhar@luriechildrens.org %K adolescent medicine %K telemedicine %K acceptability %K privacy %K confidentiality %K satisfaction %K caregivers %D 2022 %7 21.12.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Since the beginning of the COVID-19 pandemic, new literature has described the perceptions of adolescent patients on the use of telemedicine for their health care, but less attention has been devoted to parents’ and caregivers’ perspectives on telemedicine usage for their adolescents. Parents’ perspectives are important, as they undoubtedly influence how children learn to make decisions about their health care. Objective: This study describes the level of acceptability (measured based on accessibility and satisfaction) expressed by caregivers of adolescent patients with regard to telemedicine visits in an urban adolescent medicine practice. Methods: A cross-sectional survey was sent electronically to parents and guardians of patients aged <18 years who completed outpatient telemedicine visits to an adolescent medicine practice in Chicago, Illinois, from March 2020 to February 2021. The questions focused on accessibility and satisfaction. The data were analyzed to describe response frequencies. Results: Among a sample of 71 survey respondents, the vast majority reported that telemedicine was very easy to use (58/71, 82%) and was at least as convenient as in-person visits (70/71, 99%). Over 90% of respondents reported that their adolescents’ needs were addressed (69/69, 100%) and that they were at least as comfortable with the level of privacy and the confidential conversations between their adolescents and medical providers in telemedicine visits (65/71, 92%) as they were with those in in-person visits. Conclusions: Our findings suggest that parents and guardians find telemedicine to be an acceptable way for their children and adolescents to receive appropriate health care. %M 36542447 %R 10.2196/39704 %U https://pediatrics.jmir.org/2022/4/e39704 %U https://doi.org/10.2196/39704 %U http://www.ncbi.nlm.nih.gov/pubmed/36542447 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e36755 %T Sample Bias in Web-Based Patient-Generated Health Data of Dutch Patients With Gastrointestinal Stromal Tumor: Survey Study %A Dirkson,Anne %A den Hollander,Dide %A Verberne,Suzan %A Desar,Ingrid %A Husson,Olga %A van der Graaf,Winette T A %A Oosten,Astrid %A Reyners,Anna K L %A Steeghs,Neeltje %A van Loon,Wouter %A van Oortmerssen,Gerard %A Gelderblom,Hans %A Kraaij,Wessel %+ Leiden Institute of Advanced Computer Science, Leiden University, Niels Bohrweg 1, Leiden, 2333 CA, Netherlands, 31 71 527 7096, s.verberne@liacs.leidenuniv.nl %K social media %K patient forum %K sample bias %K representativeness %K pharmacovigilance %K rare cancer %D 2022 %7 15.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Increasingly, social media is being recognized as a potential resource for patient-generated health data, for example, for pharmacovigilance. Although the representativeness of the web-based patient population is often noted as a concern, studies in this field are limited. Objective: This study aimed to investigate the sample bias of patient-centered social media in Dutch patients with gastrointestinal stromal tumor (GIST). Methods: A population-based survey was conducted in the Netherlands among 328 patients with GIST diagnosed 2-13 years ago to investigate their digital communication use with fellow patients. A logistic regression analysis was used to analyze clinical and demographic differences between forum users and nonusers. Results: Overall, 17.9% (59/328) of survey respondents reported having contact with fellow patients via social media. Moreover, 78% (46/59) of forum users made use of GIST patient forums. We found no statistically significant differences for age, sex, socioeconomic status, and time since diagnosis between forum users (n=46) and nonusers (n=273). Patient forum users did differ significantly in (self-reported) treatment phase from nonusers (P=.001). Of the 46 forum users, only 2 (4%) were cured and not being monitored; 3 (7%) were on adjuvant, curative treatment; 19 (41%) were being monitored after adjuvant treatment; and 22 (48%) were on palliative treatment. In contrast, of the 273 patients who did not use disease-specific forums to communicate with fellow patients, 56 (20.5%) were cured and not being monitored, 31 (11.3%) were on curative treatment, 139 (50.9%) were being monitored after treatment, and 42 (15.3%) were on palliative treatment. The odds of being on a patient forum were 2.8 times as high for a patient who is being monitored compared with a patient that is considered cured. The odds of being on a patient forum were 1.9 times as high for patients who were on curative (adjuvant) treatment and 10 times as high for patients who were in the palliative phase compared with patients who were considered cured. Forum users also reported a lower level of social functioning (84.8 out of 100) than nonusers (93.8 out of 100; P=.008). Conclusions: Forum users showed no particular bias on the most important demographic variables of age, sex, socioeconomic status, and time since diagnosis. This may reflect the narrowing digital divide. Overrepresentation and underrepresentation of patients with GIST in different treatment phases on social media should be taken into account when sourcing patient forums for patient-generated health data. A further investigation of the sample bias in other web-based patient populations is warranted. %M 36520526 %R 10.2196/36755 %U https://formative.jmir.org/2022/12/e36755 %U https://doi.org/10.2196/36755 %U http://www.ncbi.nlm.nih.gov/pubmed/36520526 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e36827 %T Perceptions of, and Obstacles to, SARS-CoV-2 Vaccination Among Adults in Lebanon: Cross-sectional Online Survey %A Abou-Arraj,Nadeem Elias %A Maddah,Diana %A Buhamdan,Vanessa %A Abbas,Roua %A Jawad,Nadine Kamel %A Karaki,Fatima %A Alami,Nael H %A Geldsetzer,Pascal %+ School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94704, United States, 1 510 643 0881, narraj@berkeley.edu %K Lebanon %K COVID-19 %K SARS-CoV-2 %K coronavirus %K vaccination %K vaccine hesitancy %K vaccine acceptance %K health care system %K misinformation %K public health %D 2022 %7 14.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic is an additional burden on Lebanon’s fragmented health care system and adds to its ongoing political, economic, and refugee crises. Vaccination is an important means of reducing the impact of the pandemic. Objective: Our study’s aims were to (1) assess the prevalences of intention to vaccinate and vaccine hesitancy in Lebanon; (2) determine how vaccine hesitancy in Lebanon varies by sociodemographic, economic, and geographic characteristics; and (3) understand individuals’ motivations for vaccinating as well as concerns and obstacles to vaccination. Methods: We performed a cross-sectional study from January 29, 2021, to March 11, 2021, using an online questionnaire of open- and closed-ended questions in Arabic via convenience “snowball” sampling to assess the perceptions of adults residing in Lebanon. Results: Of the 1185 adults who participated in the survey, 46.1% (95% CI: 43.2%-49.0%) intended to receive the SARS-CoV-2 vaccine when available to them, 19.0% (95% CI 16.8%-21.4%) indicated they would not, and 34.0% (95% CI 31.3%-36.8%) were unsure (with an additional 0.9% skipping this question). The most common reasons for hesitancy were concerns about safety, limited testing, side effects, and efficacy. Top motivations for vaccinating were to protect oneself, protect one’s family and the public, and end the pandemic. Despite financial hardships in Lebanon, barriers to vaccine access were not frequently described as concerns. Established health care facilities, rather than new temporary vaccination centers, were most frequently selected as preferred vaccination sites. Conclusions: Vaccine hesitancy appears to be high in Lebanon. Disseminating clear, consistent, evidence-based safety and efficacy information on vaccines may help reduce vaccine hesitancy, especially among the large proportion of adults who appear to be unsure about (rather than opposed to) vaccination. %M 36383635 %R 10.2196/36827 %U https://formative.jmir.org/2022/12/e36827 %U https://doi.org/10.2196/36827 %U http://www.ncbi.nlm.nih.gov/pubmed/36383635 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e40298 %T Social Media Recruitment Strategies to Recruit Pregnant Women Into a Longitudinal Observational Cohort Study: Usability Study %A Pekarsky,Chloe %A Skiffington,Janice %A Leijser,Lara M %A Slater,Donna %A Metcalfe,Amy %+ Department of Obstetrics and Gynecology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada, 1 4035606717, chloe.pekarsky@ucalgary.ca %K social media %K Facebook %K Twitter %K Instagram %K recruitment %K pregnancy %K surveys %K questionnaires %K fraudulent responses %D 2022 %7 12.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Use of social media for study recruitment is becoming increasingly common. Previous studies have typically focused on using Facebook; however, there are limited data to support the use of other social media platforms for participant recruitment, notably in the context of a pregnancy study. Objective: Our study aimed to evaluate the effectiveness of Facebook, Twitter, and Instagram in recruiting a representative sample of pregnant women in a longitudinal pregnancy cohort study in Calgary, Alberta, between September 27, 2021, and April 24, 2022. Methods: Paid advertisements were targeted at 18- to 50-year-old women in Calgary, with interests in pregnancy. Data regarding reach, link clicks, and costs were collected through Facebook Ads Manager (Meta Platforms, Inc) and Twitter Analytics (Twitter, Inc). The feasibility of each platform for recruitment was assessed based on the recruitment rate and cost-effectiveness. The demographic characteristics of the participants recruited through each source were compared using the chi-square test. Results: Paid advertisements reached 159,778 social media users, resulting in 2390 link clicks and 324 participants being recruited. Facebook reached and recruited the highest number of participants (153/324, 47.2%), whereas Instagram saw the highest number of link clicks relative to the number of users who saw the advertisement (418/19,764, 2.11%). Facebook and Instagram advertisements were cost-effective, with an average cost-per-click of CAD $0.65 (US $0.84; SD $0.27, US $0.35) and cost-per-completer of CAD $7.89 (US $10.25; SD CAD $4.08, US $5.30). Twitter advertisements were less successful in terms of recruitment and costs. Demographic characteristics of participants did not differ based on recruitment source, except for education and income, where more highly educated and higher-income participants were recruited through Instagram or Twitter. Many issues related to fraudulent responses were encountered throughout the recruitment period. Conclusions: Paid social media advertisements (especially Facebook and Instagram) are feasible and cost-effective methods for recruiting a large sample of pregnant women for survey-based research. However, future research should be aware of the potential for fraudulent responses when using social media for recruitment and consider strategies to mitigate this problem. %M 36508244 %R 10.2196/40298 %U https://www.jmir.org/2022/12/e40298 %U https://doi.org/10.2196/40298 %U http://www.ncbi.nlm.nih.gov/pubmed/36508244 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e39488 %T Data Quality and Study Compliance Among College Students Across 2 Recruitment Sources: Two Study Investigation %A Braitman,Abby L %A Strowger,Megan %A Shipley,Jennifer L %A Ortman,Jordan %A MacIntyre,Rachel I %A Bauer,Elizabeth A %+ Department of Psychology, Old Dominion University, 250 Mills Godwin Bldg, Norfolk, VA, 23529, United States, 1 757 683 3708, abraitma@odu.edu %K data quality %K attention checks %K recruitment %K retention %K college students %K mobile phone %D 2022 %7 9.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Models of satisficing suggest that study participants may not fully process survey items and provide accurate responses when survey burden is higher and when participant motivation is lower. Participants who do not fully process survey instructions can reduce a study’s power and hinder generalizability. Common concerns among researchers using self-report measures are data quality and participant compliance. Similarly, attrition can hurt the power and generalizability of a study. Objective: Given that college students comprise most samples in psychological studies, especially examinations of student issues and psychological health, it is critical to understand how college student recruitment sources impact data quality (operationalized as attention check items with directive instructions and correct answers) and retention (operationalized as the completion of follow-up surveys over time). This examination aimed to examine the following: whether data quality varies across recruitment sources, whether study retention varies across recruitment sources, the impact of data quality on study variable associations, the impact of data quality on measures of internal consistency, and whether the demographic qualities of participants significantly vary across those who failed attention checks versus those who did not. Methods: This examination was a follow-up analysis of 2 previously published studies to explore data quality and study compliance. Study 1 was a cross-sectional, web-based survey examining college stressors and psychological health (282/407, 69.3% female; 230/407, 56.5% White, 113/407, 27.8% Black; mean age 22.65, SD 6.73 years). Study 2 was a longitudinal college drinking intervention trial with an in-person baseline session and 2 web-based follow-up surveys (378/528, 71.6% female; 213/528, 40.3% White, 277/528, 52.5% Black; mean age 19.85, SD 1.65 years). Attention checks were included in both studies to assess data quality. Participants for both studies were recruited from a psychology participation pool (a pull-in method; for course credit) and the general student body (a push-out method; for monetary payment or raffle entry). Results: A greater proportion of participants recruited through the psychology pool failed attention checks in both studies, suggesting poorer data quality. The psychology pool was also associated with lower retention rates over time. After screening out those who failed attention checks, some correlations among the study variables were stronger, some were weaker, and some were fairly similar, potentially suggesting bias introduced by including these participants. Differences among the indicators of internal consistency for the study measures were negligible. Finally, attention check failure was not significantly associated with most demographic characteristics but varied across some racial identities. This suggests that filtering out data from participants who failed attention checks may not limit sample diversity. Conclusions: Investigators conducting college student research should carefully consider recruitment and include attention checks or other means of detecting poor quality data. Recommendations for researchers are discussed. %M 36485020 %R 10.2196/39488 %U https://formative.jmir.org/2022/12/e39488 %U https://doi.org/10.2196/39488 %U http://www.ncbi.nlm.nih.gov/pubmed/36485020 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40404 %T Predicting Overweight and Obesity Status Among Malaysian Working Adults With Machine Learning or Logistic Regression: Retrospective Comparison Study %A Wong,Jyh Eiin %A Yamaguchi,Miwa %A Nishi,Nobuo %A Araki,Michihiro %A Wee,Lei Hum %+ Centre for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, 50300, Malaysia, 60 39289 ext 7683, wjeiin@ukm.edu.my %K overweight %K obesity %K prediction %K machine learning %K logistic regression %K etiology %K algorithms %K Malaysia %K adults %K predictive models %K accuracy %K working adults %K surveillance %D 2022 %7 7.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Overweight or obesity is a primary health concern that leads to a significant burden of noncommunicable disease and threatens national productivity and economic growth. Given the complexity of the etiology of overweight or obesity, machine learning (ML) algorithms offer a promising alternative approach in disentangling interdependent factors for predicting overweight or obesity status. Objective: This study examined the performance of 3 ML algorithms in comparison with logistic regression (LR) to predict overweight or obesity status among working adults in Malaysia. Methods: Using data from 16,860 participants (mean age 34.2, SD 9.0 years; n=6904, 41% male; n=7048, 41.8% with overweight or obesity) in the Malaysia’s Healthiest Workplace by AIA Vitality 2019 survey, predictor variables, including sociodemographic characteristics, job characteristics, health and weight perceptions, and lifestyle-related factors, were modeled using the extreme gradient boosting (XGBoost), random forest (RF), and support vector machine (SVM) algorithms, as well as LR, to predict overweight or obesity status based on a BMI cutoff of 25 kg/m2. Results: The area under the receiver operating characteristic curve was 0.81 (95% CI 0.79-0.82), 0.80 (95% CI 0.79-0.81), 0.80 (95% CI 0.78-0.81), and 0.78 (95% CI 0.77-0.80) for the XGBoost, RF, SVM, and LR models, respectively. Weight satisfaction was the top predictor, and ethnicity, age, and gender were also consistent predictor variables of overweight or obesity status in all models. Conclusions: Based on multi-domain online workplace survey data, this study produced predictive models that identified overweight or obesity status with moderate to high accuracy. The performance of both ML-based and logistic regression models were comparable when predicting obesity among working adults in Malaysia. %M 36476813 %R 10.2196/40404 %U https://formative.jmir.org/2022/12/e40404 %U https://doi.org/10.2196/40404 %U http://www.ncbi.nlm.nih.gov/pubmed/36476813 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e39647 %T Social Determinants of Digital Health Adoption: Pilot Cross-sectional Survey %A Patel,Sharvil Piyush %A Sun,Elizabeth %A Reinhardt,Alec %A Geevarghese,Sanjaly %A He,Simon %A Gazmararian,Julie A %+ Omnimed Inc, 5363 Veterans Parkway, Suite C, Columbus, GA, 31904, United States, 1 706 905 2971, spatel@omnimedinc.org %K digital health %K health accessibility %K utilization %K mobile health %K mHealth %K telemedicine %D 2022 %7 6.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Interest in and funding for digital health interventions have rapidly grown in recent years. Despite the increasing familiarity with mobile health from regulatory bodies, providers, and patients, overarching research on digital health adoption has been primarily limited to morbidity-specific and non-US samples. Consequently, there is a limited understanding of what personal factors hold statistically significant relationships with digital health uptake. Moreover, this limits digital health communities’ knowledge of equity along digital health use patterns. Objective: This study aims to identify the social determinants of digital health tool adoption in Georgia. Methods: Web-based survey respondents in Georgia 18 years or older were recruited from mTurk to answer primarily closed-ended questions within the following domains: participant demographics and health consumption background, telehealth, digital health education, prescription management tools, digital mental health services, and doctor finder tools. Participants spent around 15 to 20 minutes on a survey to provide demographic and personal health care consumption data. This data was analyzed with multivariate linear and logistic regressions to identify which of these determinants, if any, held statistically significant relationships with the total number of digital health tool categories adopted and which of these determinants had absolute relationships with specific categories. Results: A total of 362 respondents completed the survey. Private insurance, residence in an urban area, having a primary care provider, fewer urgent emergency room (ER) visits, more ER visits leading to inpatient stays, and chronic condition presence were significantly associated with the number of digital health tool categories adopted. The separate logistic regressions exhibited substantial variability, with 3.5 statistically significant predictors per model, on average. Age, federal poverty level, number of primary care provider visits in the past 12 months, number of nonurgent ER visits in the past 12 months, number of urgent ER visits in the past 12 months, number of ER visits leading to inpatient stays in the past 12 months, race, gender, ethnicity, insurance, education, residential area, access to the internet, difficulty accessing health care, usual source of care, status of primary care provider, and status of chronic condition all had at least one statistically significant relationship with the use of a specific digital health category. Conclusions: The results demonstrate that persons who are socioeconomically disadvantaged may not adopt digital health tools at disproportionately higher rates. Instead, digital health tools may be adopted along social determinants of health, providing strong evidence for the digital health divide. The variability of digital health adoption necessitates investing in and building a common framework to increase mobile health access. With a common framework and a paradigm shift in the design, evaluation, and implementation strategies around digital health, disparities can be further mitigated and addressed. This likely will begin with a coordinated effort to determine barriers to adopting digital health solutions. %M 36472905 %R 10.2196/39647 %U https://formative.jmir.org/2022/12/e39647 %U https://doi.org/10.2196/39647 %U http://www.ncbi.nlm.nih.gov/pubmed/36472905 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e37507 %T Assessing Associations Between COVID-19 Symptomology and Adverse Outcomes After Piloting Crowdsourced Data Collection: Cross-sectional Survey Study %A Flaks-Manov,Natalie %A Bai,Jiawei %A Zhang,Cindy %A Malpani,Anand %A Ray,Stuart C %A Taylor,Casey Overby %+ Johns Hopkins University School of Medicine, 3101 Wyman Park Dr., Baltimore, MD, 21218, United States, 1 443 287 6657, cot@jhu.edu %K COVID-19 %K coronavirus %K symptoms %K symptomology %K crowdsourcing %K adverse outcomes %K data quality %D 2022 %7 6.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Crowdsourcing is a useful way to rapidly collect information on COVID-19 symptoms. However, there are potential biases and data quality issues given the population that chooses to participate in crowdsourcing activities and the common strategies used to screen participants based on their previous experience. Objective: The study aimed to (1) build a pipeline to enable data quality and population representation checks in a pilot setting prior to deploying a final survey to a crowdsourcing platform, (2) assess COVID-19 symptomology among survey respondents who report a previous positive COVID-19 result, and (3) assess associations of symptomology groups and underlying chronic conditions with adverse outcomes due to COVID-19. Methods: We developed a web-based survey and hosted it on the Amazon Mechanical Turk (MTurk) crowdsourcing platform. We conducted a pilot study from August 5, 2020, to August 14, 2020, to refine the filtering criteria according to our needs before finalizing the pipeline. The final survey was posted from late August to December 31, 2020. Hierarchical cluster analyses were performed to identify COVID-19 symptomology groups, and logistic regression analyses were performed for hospitalization and mechanical ventilation outcomes. Finally, we performed a validation of study outcomes by comparing our findings to those reported in previous systematic reviews. Results: The crowdsourcing pipeline facilitated piloting our survey study and revising the filtering criteria to target specific MTurk experience levels and to include a second attention check. We collected data from 1254 COVID-19–positive survey participants and identified the following 6 symptomology groups: abdominal and bladder pain (Group 1); flu-like symptoms (loss of smell/taste/appetite; Group 2); hoarseness and sputum production (Group 3); joint aches and stomach cramps (Group 4); eye or skin dryness and vomiting (Group 5); and no symptoms (Group 6). The risk factors for adverse COVID-19 outcomes differed for different symptomology groups. The only risk factor that remained significant across 4 symptomology groups was influenza vaccine in the previous year (Group 1: odds ratio [OR] 6.22, 95% CI 2.32-17.92; Group 2: OR 2.35, 95% CI 1.74-3.18; Group 3: OR 3.7, 95% CI 1.32-10.98; Group 4: OR 4.44, 95% CI 1.53-14.49). Our findings regarding the symptoms of abdominal pain, cough, fever, fatigue, shortness of breath, and vomiting as risk factors for COVID-19 adverse outcomes were concordant with the findings of other researchers. Some high-risk symptoms found in our study, including bladder pain, dry eyes or skin, and loss of appetite, were reported less frequently by other researchers and were not considered previously in relation to COVID-19 adverse outcomes. Conclusions: We demonstrated that a crowdsourced approach was effective for collecting data to assess symptomology associated with COVID-19. Such a strategy may facilitate efficient assessments in a dynamic intersection between emerging infectious diseases, and societal and environmental changes. %M 36343205 %R 10.2196/37507 %U https://formative.jmir.org/2022/12/e37507 %U https://doi.org/10.2196/37507 %U http://www.ncbi.nlm.nih.gov/pubmed/36343205 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e37455 %T The Socioeconomic Indicators Linked to Parent Health-Related Technology Use: Cross-sectional Survey %A McCall,Madison P %A Hineline,Megan T %A Anton,Margaret T %A Highlander,April %A Jones,Deborah J %+ Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, 235 E Cameron Avenue, Chapel Hill, NC, 27599, United States, 1 919 843 2351, mmccall@unc.edu %K parenting %K child %K health behavior %K information seeking %K health-related technology use %K health information %K digital health %K mobile health %K socioeconomic status %K accessibility %D 2022 %7 30.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the prevalence of parent health information seeking on the internet and its impact on parenting behavior, there is a paucity of research on parents of young children (ages 3 to 8 years). Given the importance of this developmental period, exploring how family socioeconomic indicators linked to the digital divide and health inequities affect parent proxy- and self-seeking is critical to further understanding variability in health information seeking and associated outcomes. Objective: This study aimed to explore parental health-related technology use (HTU), the process by which parents engage in support, advice, and information-seeking behavior related to their (self-seeking) and their children’s (proxy seeking) health across a range of hardware devices (eg, tablet, wearable, smartphone, laptop, and desktop computer) and sources (eg, search engines, mobile applications, social media, and other digital media). Methods: A cross-sectional study including 313 parents and guardians of children ages 3 to 8 years recruited through Amazon Mechanical Turk (MTurk) was conducted. Parents were asked to complete a self-administered questionnaire on a broad range of parenting and parent-related constructs, including sociodemographic information, technology device ownership, and engagement in and use, features, and perceptions of HTU. Descriptive and bivariate analyses (chi-square tests) were performed to identify patterns and investigate associations between family socioeconomic indicators and parent HTU. Results: The overwhelming majority (301/313, 96%) of parents of young children reported engaging in HTU, of which 99% (300/301) reported using search engines (eg, Google), followed by social media (62%, 188/301), other forms of digital media (eg, podcasts; 145/301, 48%), and mobile applications (114/301, 38%). Parents who engaged in HTU reported seeking information about their child’s behavior and discipline practices (260/313, 83%), mental or physical health (181/313, 58%), and academic performance (142/313, 45%). Additionally, nearly half (134/313, 43%) of parents reported searching for advice on managing their stress. Among parents who reported using each source, an overwhelming majority (280/300, 93%) indicated that search engines were a helpful online source for proxy- and self-seeking, followed by social media (89%, 167/188), other digital media (120/145, 83%), and mobile apps (87/114, 76%). Among parents who reported using any technology source, approximately one-fifth reported that technology sources were most comfortable (61/311, 20%), most understanding (69/311, 22%), and most influential toward behavior change (73/312, 23%) compared to traditional sources of health information–seeking, including mental health professionals, other health care professionals, school professionals, community leaders, friends, and family members. Indicators of family socioeconomic status were differentially associated with frequency and perceptions of and search content associated with parent HTU across technology sources. Conclusions: The findings of this study underscore critical considerations in the design and dissemination of digital resources, programs, and interventions targeting parent and child health, especially for families in traditionally underserved communities. %M 36449346 %R 10.2196/37455 %U https://www.jmir.org/2022/11/e37455 %U https://doi.org/10.2196/37455 %U http://www.ncbi.nlm.nih.gov/pubmed/36449346 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e40041 %T Using Semistructured Telephone Interviews to Collect Qualitative Data From People With HIV Who Are Not in Medical Care: Implementation Study %A Padilla,Mabel %A Gutierrez,Mariana %A Fagan,Jennifer %+ Division of HIV Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, United States, 1 4046398013, ymj0@cdc.gov %K qualitative research %K methods %K telephone interviews %K HIV %K semistructured interviews %K recruitment %D 2022 %7 28.11.2022 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The Medical Monitoring Qualitative (MMP-Qual) Project was designed to collect qualitative data from people with HIV not engaged in medical care that would complement quantitative data collected by the Medical Monitoring Project (MMP)—a national surveillance system—and inform the MMP’s recruitment and data collection methods. Objective: Our objectives were to describe the methodology of this project, reflect on the challenges and lessons learned from conducting qualitative telephone interviews at a national level, and describe how we used and plan to use the qualitative data to evaluate our recruitment procedures and quantitative data collection instrument as well as knowledge of HIV care engagement. Methods: We used stratified purposive sampling to identify and recruit participants who had participated in the structured MMP interview into the MMP-Qual Project. To be eligible, participants must have had an HIV diagnosis, be aged ≥18 years, have lived in an MMP jurisdiction, and have not been engaged in HIV medical care. From August 1, 2018, to May 31, 2019, we conducted semistructured telephone interviews with 36 people with HIV across the United States about several topics (eg, facilitators and barriers to care and experience with surveys). Four trained interviewers conducted semistructured 60-minute telephone interviews with 36 participants. Data collection lasted from August 1, 2018, to May 31, 2019. Results: From 2018 to 2019, 113 people were eligible to participate in the MMP-Qual Project. Of the people recruited, 28% (22/79) refused to participate. Of those who agreed to participate, 63% (36/57) were interviewed, and 37% (21/57) were no-shows. Of the 34 participants for whom we had complete data, 15 (44%) were aged ≥50 years, 26 (76%) identified as male, 22 (65%) were Black or African American, and 12 (35%) lived in the Southern United States. Conclusions: We learned that it is possible to obtain rich qualitative data from people with HIV who are not in care via telephone interviews and that this mode might be conducive to talking about sensitive topics. We also learned the importance of flexibility, communication, and coordination because we relied on health department staff to perform recruitment and had difficulty implementing our original sampling strategy. We hope that other projects will learn from our experience conducting qualitative telephone interviews with people with HIV on a national level. International Registered Report Identifier (IRRID): RR1-10.2196/40041 %M 36441569 %R 10.2196/40041 %U https://www.researchprotocols.org/2022/11/e40041 %U https://doi.org/10.2196/40041 %U http://www.ncbi.nlm.nih.gov/pubmed/36441569 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e30285 %T Identifying Personality Characteristics and Indicators of Psychological Well-Being Associated With Attrition in the Motivation Makes the Move! Physical Activity Intervention: Randomized Technology-Supported Trial %A Kaseva,Kaisa %A Tervaniemi,Mari %A Heikura,Enni %A Kostilainen,Kaisamari %A Pöyhönen-Alho,Maritta %A Shoemaker,J Kevin %A Petrella,Robert J %A Peltonen,Juha E %+ Department of Sport and Exercise Medicine, Clinicum, Faculty of Medicine, University of Helsinki, Alppikatu 2, Helsinki, 00530, Finland, 358 443077737, kaisa.kaseva@helsinki.fi %K randomized trial %K physical activity %K lifestyles %K personality %K psychological well-being %K study attrition %K mental health %K lifestyle interventions %D 2022 %7 25.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Data attrition has been a common problem in longitudinal lifestyle interventions. The contributors to attrition in technology-supported physical activity interventions have not been thoroughly studied. Objective: The present study examined the roles of personality characteristics and indicators of psychological well-being in data attrition within a technology-supported, longitudinal intervention study with overweight adults. Methods: Participants (N=89) were adults from the Motivation Makes the Move! intervention study. Data attrition was studied after a 3-month follow-up. Participants’ personality characteristics were studied using the Short Five self-report questionnaire. Psychological well-being indicators were assessed with the RAND 36-item health survey, Positive and Negative Affect Schedule, and Beck Depression Inventory. Logistic regression analyses were conducted to assess the risk of discontinuing the study. The analyses were adjusted for sex, age, study group, and educational status. Results: At the 3-month follow-up, 65 of 89 participants (73% of the initial sample) had continued in the study. Participants’ personality characteristics and indicators of psychological well-being were not associated with the risk of dropping out of the study (all P values >.05). The results remained the same after covariate controls. Conclusions: Participant attrition was not attributable to personality characteristics or psychological well-being in the Motivation Makes the Move! study conducted with overweight adults. As attrition remains a challenge within longitudinal, technology-supported lifestyle interventions, attention should be paid to the potentially dynamic natures of personality and psychological well-being, as well as other elements beyond these. Trial Registration: ClinicalTrials.gov NCT02686502; https://clinicaltrials.gov/ct2/show/NCT02686502 %M 36427239 %R 10.2196/30285 %U https://formative.jmir.org/2022/11/e30285 %U https://doi.org/10.2196/30285 %U http://www.ncbi.nlm.nih.gov/pubmed/36427239 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 11 %P e37394 %T Positive Affective Recovery in Daily Life as a Momentary Mechanism Across Subclinical and Clinical Stages of Mental Disorder: Experience Sampling Study %A Ader,Leonie %A Schick,Anita %A Simons,Claudia %A Delespaul,Philippe %A Myin-Germeys,Inez %A Vaessen,Thomas %A Reininghaus,Ulrich %+ Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, Mannheim, 68159, Germany, 49 621 1703 1930, ulrich.reininghaus@zi-mannheim.de %K experience sampling methodology %K ecological momentary assessment %K trajectory %K transdiagnostic %K resilience %K stress reactivity %K psychosis %K depression %D 2022 %7 23.11.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Identifying momentary risk and protective mechanisms may enhance our understanding and treatment of mental disorders. Affective stress reactivity is one mechanism that has been reported to be altered in individuals with early and later stages of mental disorder. Additionally, initial evidence suggests individuals with early and enduring psychosis may have an extended recovery period of negative affect in response to daily stressors (ie, a longer duration until affect reaches baseline levels after stress), but evidence on positive affective recovery as a putative protective mechanism remains limited. Objective: This study aimed to investigate trajectories of positive affect in response to stress across the continuum of mental disorder in a transdiagnostic sample. Methods: Using the Experience Sampling Method, minor activity-, event-, and overall stress and positive affect were assessed 10 times a day, with time points approximately 90 minutes apart on six consecutive days in a pooled data set including 367 individuals with a mental disorder, 217 individuals at risk for a severe mental disorder, and 227 controls. Multilevel analysis and linear contrasts were used to investigate trajectories of positive affect within and between groups. Results: Baseline positive affect differed across groups, and we observed stress reactivity in positive affect within each group. We found evidence for positive affective recovery after reporting activity- or overall stress within each group. While controls recovered to baseline positive affect about 90 minutes after stress, patients and at-risk individuals required about 180 minutes to recover. However, between-group differences in the affective recovery period fell short of significance (all P>.05). Conclusions: The results provide first evidence that positive affective recovery may be relevant within transdiagnostic subclinical and clinical stages of mental disorder, suggesting that it may be a potential target for mobile health interventions fostering resilience in daily life. %M 36416883 %R 10.2196/37394 %U https://mental.jmir.org/2022/11/e37394 %U https://doi.org/10.2196/37394 %U http://www.ncbi.nlm.nih.gov/pubmed/36416883 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e39973 %T Perceptions of Quality of Care Among Users of a Web-Based Patient Portal: Cross-sectional Survey Analysis %A Lear,Rachael %A Freise,Lisa %A Kybert,Matthew %A Darzi,Ara %A Neves,Ana Luisa %A Mayer,Erik K %+ National Institute for Health and Care Research Imperial Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, 10F Queen Elizabeth Queen Mother Wing Praed Street, St Mary's Campus, London, W2 1NY, United Kingdom, 44 (0)20 7594 1419, r.lear12@imperial.ac.uk %K electronic health records %K personal health records %K patient participation %K patient safety %K care quality %K digital health literacy %D 2022 %7 17.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based patient portals enable patients access to, and interaction with, their personal electronic health records. However, little is known about the impact of patient portals on quality of care. Users of patient portals can contribute important insights toward addressing this knowledge gap. Objective: We aimed to describe perceived changes in the quality of care among users of a web-based patient portal and to identify the characteristics of patients who perceive the greatest benefit of portal use. Methods: A cross-sectional web-based survey study was conducted to understand patients’ experiences with the Care Information Exchange (CIE) portal. Patient sociodemographic data were collected, including age, sex, ethnicity, educational level, health status, geographic location, motivation to self-manage, and digital health literacy (measured by the eHealth Literacy Scale). Patients with experience using CIE, who specified both age and sex, were included in these analyses. Relevant survey items (closed-ended questions) were mapped to the Institute of Medicine’s 6 domains of quality of care. Users’ responses were examined to understand their perceptions of how portal use has changed the overall quality of their care, different aspects of care related to the 6 domains of care quality, and patient’s satisfaction with care. Multinomial logistic regression analyses were performed to identify patient characteristics associated with perceived improvements in overall care quality and greater satisfaction with care. Results: Of 445 CIE users, 38.7% (n=172) reported that the overall quality of their care was better; 3.2% (n=14) said their care was worse. In the patient centeredness domain, 61.2% (273/445) of patients felt more in control of their health care, and 53.9% (240/445) felt able to play a greater role in decision-making. Regarding timeliness, 40.2% (179/445) of patients reported they could access appointments, diagnoses, and treatment more quickly. Approximately 30% of CIE users reported better care related to the domains of effectiveness (123/445, 27.6%), safety (138/445, 31%), and efficiency (174/445, 28.6%). Regarding equity, patients self-reporting higher digital health literacy (odds ratio 2.40, 95% CI 1.07-5.42; P=.03) and those belonging to ethnic minority groups (odds ratio 2.27, 95% CI 1.26-3.73; P<.005) were more likely to perceive improvements in care quality. Across ethnic groups, Asian and British Asian patients perceived the greatest benefits. Increased frequency of CIE use also predicted perceived better care quality and greater satisfaction with care. Conclusions: A large proportion of CIE users perceived better care quality and greater satisfaction with care, although many portal users reported no change. The most favorable perceived improvements related to the domain of patient centeredness. With national policy directed toward addressing health disparities, patient portals could be valuable in improving care quality for ethnic minority groups. Future research should test the causal relationship between patient portal use and care quality. %M 36394922 %R 10.2196/39973 %U https://www.jmir.org/2022/11/e39973 %U https://doi.org/10.2196/39973 %U http://www.ncbi.nlm.nih.gov/pubmed/36394922 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 11 %P e37976 %T Automatic Estimation of the Most Likely Drug Combination in Electronic Health Records Using the Smooth Algorithm: Development and Validation Study %A Ouchi,Dan %A Giner-Soriano,Maria %A Gómez-Lumbreras,Ainhoa %A Vedia Urgell,Cristina %A Torres,Ferran %A Morros,Rosa %+ Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Gran Via de les Corts Catalanes 587, àtic, Barcelona, 08007, Spain, 34 934824110, douchi@idiapjgol.info %K electronic health records %K data mining %K complex drug patterns %K algorithms %K drug utilization %K polypharmacy %K EHR %K medication %K drug combination %K therapy %K automation %K drug exposition %K treatment %K adherence %D 2022 %7 15.11.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Since the use of electronic health records (EHRs) in an automated way, pharmacovigilance or pharmacoepidemiology studies have been used to characterize the therapy using different algorithms. Although progress has been made in this area for monotherapy, with combinations of 2 or more drugs the challenge to characterize the treatment increases significantly, and more research is needed. Objective: The goal of the research was to develop and describe a novel algorithm that automatically returns the most likely therapy of one drug or combinations of 2 or more drugs over time. Methods: We used the Information System for Research in Primary Care as our reference EHR platform for the smooth algorithm development. The algorithm was inspired by statistical methods based on moving averages and depends on a parameter Wt, a flexible window that determines the level of smoothing. The effect of Wt was evaluated in a simulation study on the same data set with different window lengths. To understand the algorithm performance in a clinical or pharmacological perspective, we conducted a validation study. We designed 4 pharmacological scenarios and asked 4 independent professionals to compare a traditional method against the smooth algorithm. Data from the simulation and validation studies were then analyzed. Results: The Wt parameter had an impact over the raw data. As we increased the window length, more patient were modified and the number of smoothed patients augmented, although we rarely observed changes of more than 5% of the total data. In the validation study, significant differences were obtained in the performance of the smooth algorithm over the traditional method. These differences were consistent across pharmacological scenarios. Conclusions: The smooth algorithm is an automated approach that standardizes, simplifies, and improves data processing in drug exposition studies using EHRs. This algorithm can be generalized to almost any pharmacological medication and model the drug exposure to facilitate the detection of treatment switches, discontinuations, and terminations throughout the study period. %M 36378514 %R 10.2196/37976 %U https://medinform.jmir.org/2022/11/e37976 %U https://doi.org/10.2196/37976 %U http://www.ncbi.nlm.nih.gov/pubmed/36378514 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e37797 %T Lessons Learned From Transition of an In-Person to a Virtual Randomized Controlled Trial for Weight and Fitness Concerns in Active-Duty Service Members: Survey Study %A Afari,Niloofar %A Yarish,Natalie M %A Wooldridge,Jennalee S %A Materna,Karla %A Hernandez,Jeffrey %A Blanco,Brian H %A Camodeca,Angela L %A Peters,Joshua J %A Herbert,Matthew S %+ Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, 0737, La Jolla, CA, 92093, United States, 1 858 642 3387, nafari@ucsd.edu %K virtualization %K weight-loss intervention %K lessons learned %K military personnel %K acceptance and commitment therapy %D 2022 %7 10.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: This paper describes and discusses the transition of and modifications to a weight management randomized controlled trial among active-duty military personnel from an in-person to a virtual format as a result of the COVID-19 pandemic. The original pragmatic cohort-randomized controlled trial was designed to compare the effectiveness of an 8-week group weight management program, ShipShape, to a version of ShipShape enhanced with acceptance and commitment therapy. Objective: The objective of our study was to assess potential differences between in-person and virtual participation in participants’ demographics, motivation, confidence, credibility, expectations, and satisfaction with the interventions; we also examined the pragmatics of the technology and participants’ experiences in virtual-format intervention groups. Methods: A total of 178 active-duty personnel who had failed or were at risk of failing their physical fitness assessment or were overweight or obese were enrolled in the study. In-person (n=149) and virtual (n=29) participants reported demographics, motivation, confidence, credibility, expectations, and satisfaction. Interventionists recorded attendance and participation in the group sessions. Independent-sample 2-tailed t tests and chi-square tests were used to compare the characteristics of the in-person and virtual participants. Pragmatics of the technology and participants’ experiences in the virtual format were assessed through surveys and open-ended questions. Results: Participants were 29.7 (SD 6.9) years old on average, 61.8% (110/178) female, and 59.6% (106/178) White and had an average BMI of 33.1 (SD 3.9) kg/m2. Participants were highly motivated to participate and confident in their ability to complete a weight management program. A total of 82.6% (147/178) of all participants attended 5 of the 8 sessions, and participation was rated as “excellent” by interventionists in both formats. The interventions were found to be credible and to have adequate expectations for effectiveness and high satisfaction in both formats. There were no differences between in-person and virtual participants in any of these metrics, other than interventionist-rated participation, for which virtual participants had significantly higher ratings (P<.001). Technical satisfaction with the virtual sessions was rated as “good” to “very good,” and participants were satisfied with the content of the virtual sessions. A word cloud of responses identified “mindfulness,” “helpful,” “different,” “food,” “binder,” and “class” as concepts the virtual participants found most useful about the program. Conclusions: Modifications made in response to the COVID-19 pandemic were successful, given the recruitment of active-duty personnel with similar demographic characteristics, attendance levels, and indicators of credibility, expectancy, and satisfaction in the virtual format and the in-person format. This successful transition provides support for the use of virtual or digital weight management interventions to increase accessibility and reach among highly mobile active-duty personnel. Trial Registration: ClinicalTrials.gov NCT03029507; https://clinicaltrials.gov/ct2/show/NCT03029507 %M 36201851 %R 10.2196/37797 %U https://www.jmir.org/2022/11/e37797 %U https://doi.org/10.2196/37797 %U http://www.ncbi.nlm.nih.gov/pubmed/36201851 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e33676 %T Digital Technology in Psychiatry: Survey Study of Clinicians %A Sterling,William Andrew %A Sobolev,Michael %A Van Meter,Anna %A Guinart,Daniel %A Birnbaum,Michael L %A Rubio,Jose M %A Kane,John M %+ Institute of Behavioral Science, Department of Psychiatry, Zucker Hillside Hospital, 75-59 263rd St, Glen Oaks, NY, 11004, United States, 1 718 470 8005, daniguinart@gmail.com %K digital psychiatry %K passive monitoring technology %K digital phenotype %K psychiatry %K mental health %K clinicians %K clinician perspectives %K digital health %K physicians %K psychiatrists %D 2022 %7 10.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital technology has the potential to transform psychiatry, but its adoption has been limited. The proliferation of telepsychiatry during the COVID-19 pandemic has increased the urgency of optimizing technology for clinical practice. Understanding clinician attitudes and preferences is crucial to effective implementation and patient benefit. Objective: Our objective was to elicit clinician perspectives on emerging digital technology. Methods: Clinicians in a large psychiatry department (inpatient and outpatient) were invited to complete a web-based survey about their attitudes toward digital technology in practice, focusing on implementation, clinical benefits, and expectations about patients’ attitudes. The survey consisted of 23 questions that could be answered on either a 3-point or 5-point Likert scale. We report the frequencies and percentages of responses. Results: In total, 139 clinicians completed the survey—they represent a variety of years of experience, credentials, and diagnostic subspecialties (response rate 69.5%). Overall, 83.4% (n=116) of them stated that digital data could improve their practice, and 23.0% (n=32) of responders reported that they had viewed patients’ profiles on social media. Among anticipated benefits, clinicians rated symptom self-tracking (n=101, 72.7%) as well as clinical intervention support (n=90, 64.7%) as most promising. Among anticipated challenges, clinicians mostly expressed concerns over greater time demand (n=123, 88.5%) and whether digital data would be actionable (n=107, 77%). Furthermore, 95.0% (n=132) of clinicians expected their patients to share digital data. Conclusions: Overall, clinicians reported a positive attitude toward the use of digital data to not only improve patient outcomes but also highlight significant barriers that implementation would need to overcome. Although clinicians’ self-reported attitudes about digital technology may not necessarily translate into behavior, our results suggest that technologies that reduce clinician burden and are easily interpretable have the greatest likelihood of uptake. %M 36355414 %R 10.2196/33676 %U https://formative.jmir.org/2022/11/e33676 %U https://doi.org/10.2196/33676 %U http://www.ncbi.nlm.nih.gov/pubmed/36355414 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e40681 %T Investigating Patients' Continuance Intention Toward Conversational Agents in Outpatient Departments: Cross-sectional Field Survey %A Li,Xingyi %A Xie,Shirong %A Ye,Zhengqiang %A Ma,Shishi %A Yu,Guangjun %+ Shanghai Children’s Hospital, Shanghai Jiao Tong University School of Medicine, No 355 Luding Road, Shanghai, 200062, China, 86 18917762998, gjyu@shchildren.com.cn %K conversational agent %K continuance intention %K expectation-confirmation model %K partial least squares %K structural equation modeling %K chatbot %K virtual assistant %K cross-sectional %K field study %K optimization %K outpatient %K interview %K qualitative %K questionnaire %K satisfaction %K perceived usefulness %K intention %K adoption %K attitude %K perception %D 2022 %7 7.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Conversational agents (CAs) have been developed in outpatient departments to improve physician-patient communication efficiency. As end users, patients’ continuance intention is essential for the sustainable development of CAs. Objective: The aim of this study was to facilitate the successful usage of CAs by identifying key factors influencing patients’ continuance intention and proposing corresponding managerial implications. Methods: This study proposed an extended expectation-confirmation model and empirically tested the model via a cross-sectional field survey. The questionnaire included demographic characteristics, multiple-item scales, and an optional open-ended question on patients’ specific expectations for CAs. Partial least squares structural equation modeling was applied to assess the model and hypotheses. The qualitative data were analyzed via thematic analysis. Results: A total of 172 completed questionaries were received, with a 100% (172/172) response rate. The proposed model explained 75.5% of the variance in continuance intention. Both satisfaction (β=.68; P<.001) and perceived usefulness (β=.221; P=.004) were significant predictors of continuance intention. Patients' extent of confirmation significantly and positively affected both perceived usefulness (β=.817; P<.001) and satisfaction (β=.61; P<.001). Contrary to expectations, perceived ease of use had no significant impact on perceived usefulness (β=.048; P=.37), satisfaction (β=−.004; P=.63), and continuance intention (β=.026; P=.91). The following three themes were extracted from the 74 answers to the open-ended question: personalized interaction, effective utilization, and clear illustrations. Conclusions: This study identified key factors influencing patients’ continuance intention toward CAs. Satisfaction and perceived usefulness were significant predictors of continuance intention (P<.001 and P<.004, respectively) and were significantly affected by patients’ extent of confirmation (P<.001 and P<.001, respectively). Developing a better understanding of patients’ continuance intention can help administrators figure out how to facilitate the effective implementation of CAs. Efforts should be made toward improving the aspects that patients reasonably expect CAs to have, which include personalized interactions, effective utilization, and clear illustrations. %M 36342768 %R 10.2196/40681 %U https://www.jmir.org/2022/11/e40681 %U https://doi.org/10.2196/40681 %U http://www.ncbi.nlm.nih.gov/pubmed/36342768 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e35510 %T Data Completeness and Concordance in the FeverApp Registry: Comparative Study %A Rathjens,Larisa %A Fingerhut,Ingo %A Martin,David %A Hamideh Kerdar,Sara %A Gwiasda,Moritz %A Schwarz,Silke %A Jenetzky,Ekkehart %+ Faculty of Health/School of Medicine, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, Witten, 58455, Germany, 49 2302 926 ext 7730, Ekkehart.Jenetzky@uni-wh.de %K registry %K data quality %K completeness %K concordance %K ecological momentary assessment %D 2022 %7 2.11.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The FeverApp registry uses ecological momentary assessment (EMA) to collect parental data on pediatric fever for scientific research. The mobile app FeverApp educates parents on safe fever management and serves as a fever diary. Objective: The focus of this study was to evaluate the completeness and concordance of the EMA-based FeverApp registry with regard to its data quality from a multilevel perspective. Methods: Structured descriptions of fever episodes by health care professionals from an office were used as reference. The number of children, their sociodemographic data, and agreement of fever episodes, with maximum temperature, intake of antipyretics and antibiotics, and physician visits, were compared with the entries in the corresponding physician’s reference records. The data quality indicators for completeness, meaning the extent to which the necessary data for the registry has actually been submitted, and concordance, which is the correspondence of the value of a data element with a reference source, were chosen to analyze whether EMA may be a suitable method for this kind of registry. Results: In both data sources, 1012 children were available for comparison over 16 months. The completeness of gender (1012/1012, 100%) and date of birth (1004/1012, 99.2%) information was high, and the mismatches were 0.69% (7/1012) and 1.19% (12/1012), respectively, between the sources. Of these 1012 children, 668 (66%) registered fever episodes in FeverApp. They relate to 534 families with 953 fever episodes in the reference records and 1452 episodes in the FeverApp registry. Of the 534 families, 183 (34.3%) refrained from visiting the office during fever episodes but nevertheless documented them in FeverApp. Largest part (766/1452, 52.75%) episodes were recorded exclusively in the FeverApp registry by 371 (371/534, 69.5%) families. The remaining 686 (47.2%) episodes of 391 (58.5%) children from 351 (65.7%) families were comparable with the reference data source in terms of physician visits, medication, and temperature. The completeness ranged, depending on the kind of variable, from 11.5% to 65% in the registry and from 7.6% to 42.6% in the office. The 953 fever episodes reported by the reference office consisted of 681 (71.5%) acute and 272 (28.5%) past episodes. In FeverApp, most past (262/272, 96.3%) but less acute (424/681, 62.3%) episodes have been entered. The concordance rates were varied: 90.2% for antibiotic use, 66.6% for antipyretic use, 61.7% for physician visits, and 16% for the highest temperature during the fever episode. Conclusions: Both sources delivered only partial data, and the rates of completeness and concordance depended on the kind of variable. However, the FeverApp registry showed higher documentation and precision rates than professional records for all considered variables. Therefore, EMA may play a unique supplement for research in ambulatory care. FeverApp could support pediatric offices, especially during the pandemic. %M 36322119 %R 10.2196/35510 %U https://pediatrics.jmir.org/2022/4/e35510 %U https://doi.org/10.2196/35510 %U http://www.ncbi.nlm.nih.gov/pubmed/36322119 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e40704 %T Youth Perspectives on the Recommended Age of Mobile Phone Adoption: Survey Study %A Richter,Aliah %A Adkins,Victoria %A Selkie,Ellen %+ Child Health Evaluation and Research Center, University of Michigan, 300 N Ingalls St, Ann Arbor, MI, 48104, United States, 1 419 779 4111, vadkins@wisc.edu %K adolescent %K youth %K child %K mobile phone %K technology %K media %K phone use %K phone ownership %K parental guidance %K parenting %K cell phone %K smartphone %D 2022 %7 31.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite increasing prevalence of phone ownership in early adolescence, there is a deficit of evidence-based guidance on the appropriate time to provide youth their first phone. Objective: This survey study explored age recommendations for phone ownership among a diverse panel of youths, as their experiences are an important contribution to the development of ownership guidelines. Methods: Participants were recruited from MyVoice, a national panel of over 765 youth (14 to 24 years old) who respond to weekly SMS text message–based surveys. Questions were distributed between January 24 2018, and March 20, 2018. Inductive qualitative analysis was used to identify major themes among youths’ open-ended responses. Results: In all, 469 youth (mean age 18.8 years; female: 299/469, 63.8%; White race: 332/468, 70.8%) responded. On average, respondents obtained their first phone at 12.2 years of age. Most participants (325/459, 71.1%) stated they received their first phone out of necessity rather than for entertainment or social reasons. Youth recommended that early adolescents receive their first phone between 12 and 13 years of age primarily for reasons of necessity (146/448, 32.6%). Conclusions: According to the participants, phones supported safety and independence by allowing communication with parents and participation in activities. Youth-serving professionals and parents can incorporate these youth perspectives into shared decision-making about phone ownership among families. This can include discussions about essential features, safety, or phone use, as well as maturity and responsibility milestones, which were all key considerations reported by participants in the survey. %M 36315219 %R 10.2196/40704 %U https://pediatrics.jmir.org/2022/4/e40704 %U https://doi.org/10.2196/40704 %U http://www.ncbi.nlm.nih.gov/pubmed/36315219 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 10 %P e29890 %T Provider-Initiated HIV Testing in Puerto Rico from Data of the National HIV Behavioral Surveillance–Heterosexual Cycle (NHBS-HET) 2016: National Cross-sectional Survey %A Colón-López,Vivian %A Pérez-Guzmán,Derick %A Canario De La Torre,Maureen M %A Centeno-Alvarado,Nadia %A Agudelo-Salas,Ivony Y %A Rolón,Yadira %A Miranda,Sandra %A Pabón,Maria %A Rodríguez-Lebrón,Jorge %A Girona Lozada,Gladys %+ Cancer Control and Population Sciences Program, Comprehensive Cancer Center, University of Puerto Rico, Edificio Centro Comprensivo de Cáncer de la Universidad de Puerto Rico,, Segundo Piso Oficina # 225, Paseo José C Barbosa, San Juan, 00935, Puerto Rico, 1 787 772 8300 ext 1225, vivian.colon@upr.edu %K HIV %K HIV testing %K heterosexual %K health care provider %K Puerto Rico %K National HIV Behavioral Surveillance %K NHBS %K behavioral surveillance system %K HIV infection %K Centers for Disease Control and Prevention %K CDC %K respondent-driven sampling %D 2022 %7 26.10.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: According to the Centers for Disease Control and Prevention and World Health Organization guidelines, all individuals aged 13-64 years should get screened for HIV infection as part of their routine medical examinations. Individuals at high risk should get tested annually. Objective: This study aimed to identify the sociodemographic, health care, and sexual behavioral characteristics of provider-initiated HIV testing using data from the Puerto Rico National HIV Behavioral Surveillance 2016 cycle, directed toward heterosexual individuals at increased risk of HIV infection. Methods: A sample of 358 eligible participants were recruited through respondent-driven sampling, where sociodemographic characteristics, health care use, and HIV test referral were used to assess a description of the study sample. Pearson chi-square and Fisher tests were used to evaluate proportional differences. Multivariate logistic regression models were performed to determine the association between independent variables and HIV test referral. Adjusted prevalence ratios by sex and age with their 95% CIs were determined using a statistical significance level of .05. Results: Despite 67.9% (243/358) of participants showing high-risk sexual behavioral practices and 67.4% (236/350) reporting a low perceived risk of HIV infection among those who visited a health care provider within the last 12 months, 80.7% (289/358) of the study sample did not receive an HIV test referral at a recent medical visit. Multivariate analysis showed that the estimated prevalence of the participants who received an HIV test referral among those who reported being engaged in high-risk sexual behaviors was 41% (adjusted prevalence ratio .59, 95% CI .39-.91; P=.02) lower than the estimated prevalence among those who did not engage in high-risk sexual behavior. Conclusions: This sample of Puerto Rican adults reported a significantly lower prevalence of receiving an HIV test referral among heterosexual individuals at increased risk of HIV infection who engaged in high-risk behaviors. This study further emphasizes the need for health care providers to follow recommended guidelines for HIV test referrals in health care settings. Promotion practices in the future should include enhancing referral and access to HIV tests and implementing preventive measures to counteract the HIV epidemic in Puerto Rico. %M 36287600 %R 10.2196/29890 %U https://publichealth.jmir.org/2022/10/e29890 %U https://doi.org/10.2196/29890 %U http://www.ncbi.nlm.nih.gov/pubmed/36287600 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e38041 %T Visualization Techniques of Time-Oriented Data for the Comparison of Single Patients With Multiple Patients or Cohorts: Scoping Review %A Scheer,Jan %A Volkert,Alisa %A Brich,Nicolas %A Weinert,Lina %A Santhanam,Nandhini %A Krone,Michael %A Ganslandt,Thomas %A Boeker,Martin %A Nagel,Till %+ Human Data Interaction Lab, Mannheim University of Applied Sciences, Paul-Wittsack-Straße 10, Mannheim, 68163, Germany, 49 621 292 6886, t.nagel@hs-mannheim.de %K patient data %K comparison %K visualization systems %K visual analytics %K information visualization %K cohorts %K multiple patients %K single patients %K time-oriented data %D 2022 %7 24.10.2022 %9 Review %J J Med Internet Res %G English %X Background: Visual analysis and data delivery in the form of visualizations are of great importance in health care, as such forms of presentation can reduce errors and improve care and can also help provide new insights into long-term disease progression. Information visualization and visual analytics also address the complexity of long-term, time-oriented patient data by reducing inherent complexity and facilitating a focus on underlying and hidden patterns. Objective: This review aims to provide an overview of visualization techniques for time-oriented data in health care, supporting the comparison of patients. We systematically collected literature and report on the visualization techniques supporting the comparison of time-based data sets of single patients with those of multiple patients or their cohorts and summarized the use of these techniques. Methods: This scoping review used the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. After all collected articles were screened by 16 reviewers according to the criteria, 6 reviewers extracted the set of variables under investigation. The characteristics of these variables were based on existing taxonomies or identified through open coding. Results: Of the 249 screened articles, we identified 22 (8.8%) that fit all criteria and reviewed them in depth. We collected and synthesized findings from these articles for medical aspects such as medical context, medical objective, and medical data type, as well as for the core investigated aspects of visualization techniques, interaction techniques, and supported tasks. The extracted articles were published between 2003 and 2019 and were mostly situated in clinical research. These systems used a wide range of visualization techniques, most frequently showing changes over time. Timelines and temporal line charts occurred 8 times each, followed by histograms with 7 occurrences and scatterplots with 5 occurrences. We report on the findings quantitatively through visual summarization, as well as qualitatively. Conclusions: The articles under review in general mitigated complexity through visualization and supported diverse medical objectives. We identified 3 distinct patient entities: single patients, multiple patients, and cohorts. Cohorts were typically visualized in condensed form, either through prior data aggregation or through visual summarization, whereas visualization of individual patients often contained finer details. All the systems provided mechanisms for viewing and comparing patient data. However, explicitly comparing a single patient with multiple patients or a cohort was supported only by a few systems. These systems mainly use basic visualization techniques, with some using novel visualizations tailored to a specific task. Overall, we found the visual comparison of measurements between single and multiple patients or cohorts to be underdeveloped, and we argue for further research in a systematic review, as well as the usefulness of a design space. %M 36279164 %R 10.2196/38041 %U https://www.jmir.org/2022/10/e38041 %U https://doi.org/10.2196/38041 %U http://www.ncbi.nlm.nih.gov/pubmed/36279164 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e38963 %T Assessment of the Popularity and Perceived Effectiveness of Smartphone Tools That Track and Limit Smartphone Use: Survey Study and Machine Learning Analysis %A Aboujaoude,Elias %A Vera Cruz,Germano %A Rochat,Lucien %A Courtois,Robert %A Ben Brahim,Farah %A Khan,Riaz %A Khazaal,Yasser %+ Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd, Stanford, CA, 94305, United States, 1 650 498 9111, eaboujaoude@stanford.edu %K smartphone addiction %K internet addiction %K internet gaming disorder %K smartphone tools %K telepsychiatry %K machine learning %K telemedicine %K social media %K digital mental health interventions %K mobile phone %D 2022 %7 20.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Problematic smartphone use, like problematic internet use, is a condition for which treatment is being sought on the web. In the absence of established treatments, smartphone-provided tools that monitor or control smartphone use have become increasingly popular, and their dissemination has largely occurred without oversight from the mental health field. Objective: We aimed to assess the popularity and perceived effectiveness of smartphone tools that track and limit smartphone use. We also aimed to explore how a set of variables related to mental health, smartphone use, and smartphone addiction may influence the use of these tools. Methods: First, we conducted a web-based survey in a representative sample of 1989 US-based adults using the crowdsourcing platform Prolific. Second, we used machine learning and other statistical tools to identify latent user classes; the association between latent class membership and demographic variables; and any predictors of latent class membership from covariates such as daily average smartphone use, social problems from smartphone use, smartphone addiction, and other psychiatric conditions. Results: Smartphone tools that monitor and control smartphone use were popular among participants, including parents targeting their children; for example, over two-thirds of the participants used sleep-related tools. Among those who tried a tool, the highest rate of perceived effectiveness was 33.1% (58/175). Participants who experienced problematic smartphone use were more likely to be younger and more likely to be female. Finally, 3 latent user classes were uncovered: nonusers, effective users, and ineffective users. Android operating system users were more likely to be nonusers, whereas younger adults and females were more likely to be effective users. The presence of psychiatric symptoms did not discourage smartphone tool use. Conclusions: If proven effective, tools that monitor and control smartphone use are likely to be broadly embraced. Our results portend well for the acceptability of mobile interventions in the treatment of smartphone-related psychopathologies and, potentially, non–smartphone-related psychopathologies. Better tools, targeted marketing, and inclusive design, as well as formal efficacy trials, are required to realize their potential. %M 36264627 %R 10.2196/38963 %U https://www.jmir.org/2022/10/e38963 %U https://doi.org/10.2196/38963 %U http://www.ncbi.nlm.nih.gov/pubmed/36264627 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e41356 %T Women’s Satisfaction With Telehealth Services During The COVID-19 Pandemic: Cross-sectional Survey Study %A Mittone,Diletta F %A Bailey,Caitlin P %A Eddy,Ebony L %A Napolitano,Melissa A %A Vyas,Amita %+ Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW, Washington, DC, DC, 20052, United States, 1 202 994 3695, avyas@gwu.edu %K telehealth %K COVID-19 %K maternal-child health %K Perinatal %K pediatrics %K telemedicine %K pregnancy %K women's health %K patient outcome %D 2022 %7 14.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Since March 2020, the need to reduce patients’ exposure to COVID-19 has resulted in a large-scale pivot to telehealth service delivery. Although studies report that pregnant women have been generally satisfied with their prenatal telehealth experiences during the pandemic, less is known about telehealth satisfaction among postpartum women. Objective: This study examined telehealth satisfaction among both pregnant and recently pregnant women during the COVID-19 pandemic, to determine whether demographic factors (ie, race, age, marital status, education level, household income, and employment status) are associated with telehealth satisfaction in this population. Methods: A web-based cross-sectional survey designed to capture data on health-related behaviors and health care experiences of pregnant and recently pregnant women in the United States was disseminated in Spring 2022. Eligible participants were at least 18 years old, identified as a woman, and were currently pregnant or had been pregnant in the last 3 years. Results: In the final analytic sample of N=403, the mean telehealth satisfaction score was 3.97 (SD 0.66; score range 1-5). In adjusted linear regression models, being aged 35-44 years (vs 18-24 years), having an annual income of ≥ US $100,000 (vs < US $50,000), and being recently (vs currently) pregnant were associated with greater telehealth satisfaction (P≤.049). Conclusions: Although perinatal women are generally satisfied with telehealth, disparities exist. Specifically, being aged 18-24 years, having an annual income of < US $50,000, and being currently pregnant were associated with lower telehealth satisfaction. It is critical that public health policies or programs consider these factors, especially if the expanded use of telehealth is to persist beyond the pandemic. %M 36125862 %R 10.2196/41356 %U https://pediatrics.jmir.org/2022/4/e41356 %U https://doi.org/10.2196/41356 %U http://www.ncbi.nlm.nih.gov/pubmed/36125862 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e37090 %T Validation of a Remote and Fully Automated Story Recall Task to Assess for Early Cognitive Impairment in Older Adults: Longitudinal Case-Control Observational Study %A Skirrow,Caroline %A Meszaros,Marton %A Meepegama,Udeepa %A Lenain,Raphael %A Papp,Kathryn V %A Weston,Jack %A Fristed,Emil %+ Novoic Ltd, Wenlock Studios, Office G.05, 50-52 Wharf Road, Islington, London, N1 7EU, United Kingdom, 44 7759 093006, caroline@novoic.com %K neurology %K memory %K episodic %K speech %K psychometrics %K reliability %K validity %K aging %K elder %K older adult %K Alzheimer disease %K mild cognitive impairment %K mobile apps %K mobile health %K mHealth %K smartphone %K cognition %K cognitive decline %K cognitive impairment %K development %K validation %K recall %K memory %K story %K stories %K observational study %K acceptability %K usability %K semantic %K cognitive test %K speech %K linguistic %K mobile phone %D 2022 %7 30.9.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Story recall is a simple and sensitive cognitive test that is commonly used to measure changes in episodic memory function in early Alzheimer disease (AD). Recent advances in digital technology and natural language processing methods make this test a candidate for automated administration and scoring. Multiple parallel test stimuli are required for higher-frequency disease monitoring. Objective: This study aims to develop and validate a remote and fully automated story recall task, suitable for longitudinal assessment, in a population of older adults with and without mild cognitive impairment (MCI) or mild AD. Methods: The “Amyloid Prediction in Early Stage Alzheimer’s disease” (AMYPRED) studies recruited participants in the United Kingdom (AMYPRED-UK: NCT04828122) and the United States (AMYPRED-US: NCT04928976). Participants were asked to complete optional daily self-administered assessments remotely on their smart devices over 7 to 8 days. Assessments included immediate and delayed recall of 3 stories from the Automatic Story Recall Task (ASRT), a test with multiple parallel stimuli (18 short stories and 18 long stories) balanced for key linguistic and discourse metrics. Verbal responses were recorded and securely transferred from participants’ personal devices and automatically transcribed and scored using text similarity metrics between the source text and retelling to derive a generalized match score. Group differences in adherence and task performance were examined using logistic and linear mixed models, respectively. Correlational analysis examined parallel-forms reliability of ASRTs and convergent validity with cognitive tests (Logical Memory Test and Preclinical Alzheimer’s Cognitive Composite with semantic processing). Acceptability and usability data were obtained using a remotely administered questionnaire. Results: Of the 200 participants recruited in the AMYPRED studies, 151 (75.5%)—78 cognitively unimpaired (CU) and 73 MCI or mild AD—engaged in optional remote assessments. Adherence to daily assessment was moderate and did not decline over time but was higher in CU participants (ASRTs were completed each day by 73/106, 68.9% participants with MCI or mild AD and 78/94, 83% CU participants). Participants reported favorable task usability: infrequent technical problems, easy use of the app, and a broad interest in the tasks. Task performance improved modestly across the week and was better for immediate recall. The generalized match scores were lower in participants with MCI or mild AD (Cohen d=1.54). Parallel-forms reliability of ASRT stories was moderate to strong for immediate recall (mean rho 0.73, range 0.56-0.88) and delayed recall (mean rho=0.73, range=0.54-0.86). The ASRTs showed moderate convergent validity with established cognitive tests. Conclusions: The unsupervised, self-administered ASRT task is sensitive to cognitive impairments in MCI and mild AD. The task showed good usability, high parallel-forms reliability, and high convergent validity with established cognitive tests. Remote, low-cost, low-burden, and automatically scored speech assessments could support diagnostic screening, health care, and treatment monitoring. %M 36178715 %R 10.2196/37090 %U https://aging.jmir.org/2022/3/e37090 %U https://doi.org/10.2196/37090 %U http://www.ncbi.nlm.nih.gov/pubmed/36178715 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e38244 %T Engagement With HIV and COVID-19 Prevention: Nationwide Cross-sectional Analysis of Users on a Geosocial Networking App %A Gaither,Thomas W %A Sigalos,John T %A Landovitz,Raphael J %A Mills,Jesse N %A Litwin,Mark S %A Eleswarapu,Sriram V %+ Department of Urology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, 10833 Le Conte Avenue, CHS 27-139, Los Angeles, CA, 90095, United States, 1 310 794 7700, tgaither@mednet.ucla.edu %K geosocial networking apps %K pre-exposure prophylaxis %K vaccination %K rural %K men who have sex with men %K surveillance %K digital surveillance %K COVID-19 %K digital application %K geosocial network %K public health %K surveillance platform %K health platform %K mobile health %D 2022 %7 22.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Geosocial networking (GSN) apps play a pivotal role in catalyzing sexual partnering, especially among men who have sex with men. Objective: To quantify the prevalence and disparities in disclosure of pre-exposure prophylaxis (PrEP) use and COVID-19 vaccination among GSN app users, mostly men who have sex with men, in the United States. Methods: Web-based Grindr profiles from the top 50 metropolitan areas as well as the 50 most rural counties in the United States by population were randomly sampled. Grindr provides an option to disclose current PrEP use (HIV positive, HIV negative, or HIV negative with PrEP use). The free text in all profiles was analyzed, and any mention of COVID-19 vaccination was recorded. Multivariable logistic regression to assess independent associations with PrEP disclosure and COVID-19 vaccination was performed. Imputation analyses were used to test the robustness of the results. Results: We evaluated 1889 urban and 384 rural profiles. Mean age among urban profiles was 32.9 (SD 9.6) years; mean age among rural profiles was 33.5 (SD 12.1) years (P=.41). Among the urban profiles, 16% reported being vaccinated against COVID-19 and 23% reported PrEP use compared to 10% and 8% in rural profiles, respectively (P=.002 and P<.001, respectively). Reporting COVID-19 vaccination (adjusted odds ratio [aOR] 1.7, 95% CI 1.2-2.4), living in an urban center (aOR 3.2, 95% CI 1.8-5.7), and showing a face picture as part of the Grindr profile (aOR 4.0, 95% CI 2.3-7.0) were positively associated with PrEP disclosure. Self-identified Black and Latino users were less likely to report PrEP use (aOR 0.6, 95% CI 0.4-0.9 and aOR 0.5, 95% CI 0.4-0.9, respectively). Reporting PrEP use (aOR 1.7, 95% CI 1.2-2.4), living in an urban center (aOR 2.5, 95% CI 1.4-4.5), having a “discreet” status (aOR 1.6, 95% CI 1.0-2.5), and showing a face picture (aOR 2.7, 95% CI 1.5-4.8) were positively associated with reporting COVID-19 vaccination on their profile. Users in the southern United States were less likely to report COVID-19 vaccination status than those in the northeast United States (aOR 0.6, 95% CI 0.3-0.9). Conclusions: Variations in PrEP disclosure are associated with race, whereas COVID-19 vaccination disclosure is associated with geographic area. However, rural GSN users were less likely to report both PrEP use and COVID-19 vaccination. The data demonstrate a need to expand health preventative services in the rural United States for sexual minorities. GSN platforms may be ideal for deployment of preventative interventions to improve access for this difficult-to-reach population. %M 36026586 %R 10.2196/38244 %U https://www.jmir.org/2022/9/e38244 %U https://doi.org/10.2196/38244 %U http://www.ncbi.nlm.nih.gov/pubmed/36026586 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e38589 %T The Impacts of Social Media Use and Online Racial Discrimination on Asian American Mental Health: Cross-sectional Survey in the United States During COVID-19 %A Layug,Alyan %A Krishnamurthy,Samiksha %A McKenzie,Rachel %A Feng,Bo %+ Department of Asian American Studies, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, United States, 1 530 752 1880, alayug@ucdavis.edu %K Asian Americans %K mental health %K COVID-19 pandemic %K racial discrimination %K social media %K anxiety %K depression %K secondary traumatic stress %K negative affect %K racial/ethnic identification %D 2022 %7 19.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, increased social media usage has led to worsened mental health outcomes for many people. Moreover, due to the sociopolitical climate during the pandemic, the prevalence of online racial discrimination has contributed to worsening psychological well-being. With increases in anti-Asian hate, Asian and Asian American social media users may experience the negative effects of online racial discrimination in addition to the reduced psychological well-being resulting from exposure to online COVID-19 content. Objective: This study aims to investigate the impact of COVID-19–related social media use and exposure to online racial discrimination during the pandemic on the mental health outcomes (ie, anxiety, depression, and secondary traumatic stress [STS]) of Asian Americans compared with those of non-Asian Americans. In addition, this study explores the mediating role of negative affect and the moderating role of racial/ethnic identification. Methods: An online survey was conducted through Amazon Mechanical Turk and a university-wide research portal from March 3 to March 15, 2021. A total of 1147 participants took the survey. Participants’ social media usage related to COVID-19 and exposure to 2 online forms of racial discrimination (individual and vicarious), mental health outcomes (anxiety, depression, and STS), racial/ethnic identification, negative affect, and demographics were assessed. Results: Our results showed that COVID-19–related social media use, individual discrimination, and vicarious discrimination were predictors of negative mental health outcomes (anxiety, depression, and STS). Asian Americans reported higher vicarious discrimination than Latinx and White Americans, but Asian Americans’ mental health outcomes did not differ substantially from those of the other racial/ethnic groups. Racial/ethnic identification moderated the relationship between both types of discrimination and STS, and negative affect served as a mediator between both types of discrimination and all 3 mental health outcomes. Conclusions: These results suggest that social media exposure continues to have a dire effect on mental health during the COVID-19 pandemic. This study helps to contextualize the rise of anti-Asian American hate and its impact on mental health outcomes in the United States. %M 36121698 %R 10.2196/38589 %U https://formative.jmir.org/2022/9/e38589 %U https://doi.org/10.2196/38589 %U http://www.ncbi.nlm.nih.gov/pubmed/36121698 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e38297 %T Social Media Perceptions and Internet Verification Skills Associated With Human Papillomavirus Vaccine Decision-Making Among Parents of Children and Adolescents: Cross-sectional Survey %A Thompson,Erika L %A Preston,Sharice M %A Francis,Jenny K R %A Rodriguez,Serena A %A Pruitt,Sandi L %A Blackwell,James-Michael %A Tiro,Jasmin A %+ Department of Biostatistics & Epidemiology, School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, United States, 1 817 735 5162, Erika.Thompson@unthsc.edu %K HPV vaccination %K human papillomavirus %K social media %K decision-making %K vaccination %K teens %K adolescents %K parent %K USA %K United States %K misinformation %K internet %K survey %K unvaccinated %K child %K online %K health %K literacy %K decision %K health care %K decision %K teen %K vaccine %D 2022 %7 14.9.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Human Papillomavirus (HPV) vaccination is recommended for children aged 11-12 years in the United States. One factor that may contribute to low national HPV vaccine uptake is parental exposure to misinformation on social media. Objective: This study aimed to examine the association between parents’ perceptions of the HPV vaccine information on social media and internet verification strategies used with the HPV vaccine decision-making stage for their child. Methods: Parents of children and adolescents aged 9-17 years were recruited for a cross-sectional survey in North Texas (n=1192) and classified into 3 groups: children and adolescents who (1) were vaccinated, (2) unvaccinated and did not want the vaccine, and (3) unvaccinated and wanted the vaccine. Multinomial logistic regression models were estimated to identify factors associated with the HPV vaccine decision-making stage with children and adolescents who were vaccinated as the referent group. Results: Of the 1192 respondents, 44.7% (n=533) had an HPV-vaccinated child, 38.8% (n=463) had an unvaccinated child and did not want the vaccine, and 16.4% (n=196) had an unvaccinated child and wanted the vaccine. Respondents were less likely to be “undecided/not wanting the vaccine” if they agreed that HPV information on social media is credible (adjusted odds ratio [aOR] 0.40, 95% CI 0.26-0.60; P=.001), disagreed that social media makes them question the HPV vaccine (aOR 0.22, 95% CI 0.15-0.33; P<.001), or had a higher internet verification score (aOR 0.74, 95% CI 0.62-0.88; P<.001). Conclusions: Interventions that promote web-based health literacy skills are needed so parents can protect their families from misinformation and make informed health care decisions. %M 36103216 %R 10.2196/38297 %U https://pediatrics.jmir.org/2022/3/e38297 %U https://doi.org/10.2196/38297 %U http://www.ncbi.nlm.nih.gov/pubmed/36103216 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e39046 %T Digital Global Recruitment for Women’s Health Research: Cross-sectional Study %A Rodriguez,Erika %A Peer,Komal %A Fruh,Victoria %A James,Kaitlyn %A Williams,Anna %A de Figueiredo Veiga,Alexis %A Winter,Michael R %A Shea,Amanda %A Aschengrau,Ann %A Lane,Kevin J %A Mahalingaiah,Shruthi %+ Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, United States, 1 6174147305, shruthi@hsph.harvard.edu %K digital recruitment %K internet %K menstrual tracking app %K menstrual %K menstruation %K reproductive health %K reproduction %K mobile health %K menstrual health %K mHealth %K women's health %K Facebook %K social media %K epidemiology research %K in-app message %K tracking app %K health application %K health app %K eHealth %K digital health %K health technology %K ovulation %K recruit %K attrition %K research subject %K participation %K participant %D 2022 %7 14.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: With the increased popularity of mobile menstrual tracking apps and boosted Facebook posts, there is a unique opportunity to recruit research study participants from across the globe via these modalities to evaluate women’s health. However, no studies to date have assessed the feasibility of using these recruitment sources for epidemiological research on ovulation and menstruation. Objective: The objective of this study was to assess the feasibility of recruiting a diverse sample of women to an epidemiological study of ovulation and menstruation (OM) health (OM Global Health Study) using digital recruitment sources. The feasibility and diversity were assessed via click and participation rates, geographic location, BMI, smoking status, and other demographic information. Methods: Participants were actively recruited via in-app messages using the menstrual tracking app Clue (BioWink GmbH) and a boosted Facebook post by DivaCup (Diva International Inc.). Other passive recruitment methods also took place throughout the recruitment period (eg, email communications, blogs, other social media). The proportion of participants who visited the study website after viewing and clicking the hypertext link (click rates) in the in-app messages and boosted Facebook post and the proportion of participants who completed the surveys per the number of completed consent and eligibility screeners (participation rates) were used to quantify the success of recruiting participants to the study website and study survey completion, respectively. Survey completion was defined as finishing the pregnancy and birth history section of the OM Global Health Study questionnaire. Results: The recruitment period was from February 27, 2018, through January 24, 2020. In-app messages and the boosted Facebook post were seen by 104,000 and 21,400 people, respectively. Overall, 215 participants started the OM Global Health Study survey, of which 140 (65.1%), 39 (18.1%), and 36 (16.8%) participants were recruited via the app, the boosted Facebook post, and other passive recruitment methods, respectively. The click rate via the app was 18.9% (19,700 clicks/104,000 ad views) and 1.6% via the boosted Facebook post (340 clicks/21,400 ad views.) The overall participation rate was 44.6% (198/444), and the average participant age was 21.8 (SD 6.1) years. In terms of geographic and racial/ethnic diversity, 91 (44.2%) of the participants resided outside the United States and 147 (70.7%) identified as non-Hispanic White. In-app recruitment produced the most geographically diverse stream, with 44 (32.8%) of the 134 participants in Europe, 77 (57.5%) in North America, and 13 (9.8%) in other parts of the world. Both human error and nonhuman procedural breakdowns occurred during the recruitment process, including a computer programming error related to age eligibility and a hacking attempt by an internet bot. Conclusions: In-app messages using the menstrual tracking app Clue were the most successful method for recruiting participants from many geographic regions and producing the greatest numbers of started and completed surveys. This study demonstrates the utility of digital recruitment to enroll participants from diverse geographic locations and provides some lessons to avoid technical recruitment errors in future digital recruitment strategies for epidemiological research. %M 35969168 %R 10.2196/39046 %U https://formative.jmir.org/2022/9/e39046 %U https://doi.org/10.2196/39046 %U http://www.ncbi.nlm.nih.gov/pubmed/35969168 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 9 %P e37887 %T The Impact of Nonrandom Missingness in Surveillance Data for Population-Level Summaries: Simulation Study %A Weiss,Paul Samuel %A Waller,Lance Allyn %+ Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Room 308, Atlanta, GA, 30322-4201, United States, 1 404 712 9641, paul.weiss@emory.edu %K surveillance %K estimation %K missing data %K population-level estimates %K health policy %K public health policy %K estimates %K data %K policy decision %K bias %K response rate %D 2022 %7 9.9.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Surveillance data are essential public health resources for guiding policy and allocation of human and capital resources. These data often consist of large collections of information based on nonrandom sample designs. Population estimates based on such data may be impacted by the underlying sample distribution compared to the true population of interest. In this study, we simulate a population of interest and allow response rates to vary in nonrandom ways to illustrate and measure the effect this has on population-based estimates of an important public health policy outcome. Objective: The aim of this study was to illustrate the effect of nonrandom missingness on population-based survey sample estimation. Methods: We simulated a population of respondents answering a survey question about their satisfaction with their community’s policy regarding vaccination mandates for government personnel. We allowed response rates to differ between the generally satisfied and dissatisfied and considered the effect of common efforts to control for potential bias such as sampling weights, sample size inflation, and hypothesis tests for determining missingness at random. We compared these conditions via mean squared errors and sampling variability to characterize the bias in estimation arising under these different approaches. Results: Sample estimates present clear and quantifiable bias, even in the most favorable response profile. On a 5-point Likert scale, nonrandom missingness resulted in errors averaging to almost a full point away from the truth. Efforts to mitigate bias through sample size inflation and sampling weights have negligible effects on the overall results. Additionally, hypothesis testing for departures from random missingness rarely detect the nonrandom missingness across the widest range of response profiles considered. Conclusions: Our results suggest that assuming surveillance data are missing at random during analysis could provide estimates that are widely different from what we might see in the whole population. Policy decisions based on such potentially biased estimates could be devastating in terms of community disengagement and health disparities. Alternative approaches to analysis that move away from broad generalization of a mismeasured population at risk are necessary to identify the marginalized groups, where overall response may be very different from those observed in measured respondents. %M 36083618 %R 10.2196/37887 %U https://publichealth.jmir.org/2022/9/e37887 %U https://doi.org/10.2196/37887 %U http://www.ncbi.nlm.nih.gov/pubmed/36083618 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e36797 %T Patients’ and Publics’ Preferences for Data-Intensive Health Research Governance: Survey Study %A Muller,Sam H A %A van Thiel,Ghislaine J M W %A Vrana,Marilena %A Mostert,Menno %A van Delden,Johannes J M %+ Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Universiteitsweg 100, Utrecht, 3584 CX, Netherlands, 31 623034456, s.h.a.muller-4@umcutrecht.nl %K data-intensive health research %K big data %K data sharing %K patient and public preferences %K health data sharing conditions %K ethics %K governance %K policy %K patient and public involvement %K research participants %K trust %D 2022 %7 7.9.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Patients and publics are generally positive about data-intensive health research. However, conditions need to be fulfilled for their support. Ensuring confidentiality, security, and privacy of patients’ health data is pivotal. Patients and publics have concerns about secondary use of data by commercial parties and the risk of data misuse, reasons for which they favor personal control of their data. Yet, the potential of public benefit highlights the potential of building trust to attenuate these perceptions of harm and risk. Nevertheless, empirical evidence on how conditions for support of data-intensive health research can be operationalized to that end remains scant. Objective: This study aims to inform efforts to design governance frameworks for data-intensive health research, by gaining insight into the preferences of patients and publics for governance policies and measures. Methods: We distributed a digital questionnaire among a purposive sample of patients and publics. Data were analyzed using descriptive statistics and nonparametric inferential statistics to compare group differences and explore associations between policy preferences. Results: Study participants (N=987) strongly favored sharing their health data for scientific health research. Personal decision-making about which research projects health data are shared with (346/980, 35.3%), which researchers/organizations can have access (380/978, 38.9%), and the provision of information (458/981, 46.7%) were found highly important. Health data–sharing policies strengthening direct personal control, like being able to decide under which conditions health data are shared (538/969, 55.5%), were found highly important. Policies strengthening collective governance, like reliability checks (805/967, 83.2%) and security safeguards (787/976, 80.6%), were also found highly important. Further analysis revealed that participants willing to share health data, to a lesser extent, demanded policies strengthening direct personal control than participants who were reluctant to share health data. This was the case for the option to have health data deleted at any time (P<.001) and the ability to decide the conditions under which health data can be shared (P<.001). Overall, policies and measures enforcing conditions for support at the collective level of governance, like having an independent committee to evaluate requests for access to health data (P=.02), were most strongly favored. This also applied to participants who explicitly stressed that it was important to be able to decide the conditions under which health data can be shared, for instance, whether sanctions on data misuse are in place (P=.03). Conclusions: This study revealed that both a positive attitude toward health data sharing and demand for personal decision-making abilities were associated with policies and measures strengthening control at the collective level of governance. We recommend pursuing the development of this type of governance policy. More importantly, further study is required to understand how governance policies and measures can contribute to the trustworthiness of data-intensive health research. %M 36069794 %R 10.2196/36797 %U https://humanfactors.jmir.org/2022/3/e36797 %U https://doi.org/10.2196/36797 %U http://www.ncbi.nlm.nih.gov/pubmed/36069794 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 9 %P e38385 %T Evaluating the Impact of a Point-of-Care Cardiometabolic Clinical Decision Support Tool on Clinical Efficiency Using Electronic Health Record Audit Log Data: Algorithm Development and Validation %A Yan,Xiaowei %A Husby,Hannah %A Mudiganti,Satish %A Gbotoe,Madina %A Delatorre-Reimer,Jake %A Knobel,Kevin %A Hudnut,Andrew %A Jones,J B %+ Center for Health Systems Research, Sutter Health, 2121 N California Blvd, Suite 310, Walnut Creek, CA, 94596, United States, 1 925 287 4025, YanSX@sutterhealth.org %K digital health %K electronic health record %K EHR audit logs %K workflow efficiency %K cardiometabolic conditions %D 2022 %7 6.9.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Electronic health record (EHR) systems are becoming increasingly complicated, leading to concerns about rising physician burnout, particularly for primary care physicians (PCPs). Managing the most common cardiometabolic chronic conditions by PCPs during a limited clinical time with a patient is challenging. Objective: This study aimed to evaluate a Cardiometabolic Sutter Health Advanced Reengineered Encounter (CM-SHARE), a web-based application to visualize key EHR data, on the EHR use efficiency. Methods: We developed algorithms to identify key clinic workflow measures (eg, total encounter time, total physician time in the examination room, and physician EHR time in the examination room) using audit data, and we validated and calibrated the measures with time-motion data. We used a pre-post parallel design to identify propensity score–matched CM-SHARE users (cases), nonusers (controls), and nested-matched patients. Cardiometabolic encounters from matched case and control patients were used for the workflow evaluation. Outcome measures were compared between the cases and controls. We applied this approach separately to both the CM-SHARE pilot and spread phases. Results: Time-motion observation was conducted on 101 primary care encounters for 9 PCPs in 3 clinics. There was little difference (<0.8 minutes) between the audit data–derived workflow measures and the time-motion observation. Two key unobservable times from audit data, physician entry into and exiting the examination room, were imputed based on time-motion studies. CM-SHARE was launched with 6 pilot PCPs in April 2016. During the prestudy period (April 1, 2015, to April 1, 2016), 870 control patients with 2845 encounters were matched with 870 case patients and encounters, and 727 case patients with 852 encounters were matched with 727 control patients and 3754 encounters in the poststudy period (June 1, 2016, to June 30, 2017). Total encounter time was slightly shorter (mean −2.7, SD 1.4 minutes, 95% CI −4.7 to −0.9; mean –1.6, SD 1.1 minutes, 95% CI −3.2 to −0.1) for cases than controls for both periods. CM-SHARE saves physicians approximately 2 minutes EHR time in the examination room (mean −2.0, SD 1.3, 95% CI −3.4 to −0.9) compared with prestudy period and poststudy period controls (mean −1.9, SD 0.9, 95% CI −3.8 to −0.5). In the spread phase, 48 CM-SHARE spread PCPs were matched with 84 control PCPs and 1272 cases with 3412 control patients, having 1119 and 4240 encounters, respectively. A significant reduction in total encounter time for the CM-SHARE group was observed for short appointments (≤20 minutes; 5.3-minute reduction on average) only. Total physician EHR time was significantly reduced for both longer and shorter appointments (17%-33% reductions). Conclusions: Combining EHR audit log files and clinical information, our approach offers an innovative and scalable method and new measures that can be used to evaluate clinical EHR efficiency of digital tools used in clinical settings. %M 36066940 %R 10.2196/38385 %U https://medinform.jmir.org/2022/9/e38385 %U https://doi.org/10.2196/38385 %U http://www.ncbi.nlm.nih.gov/pubmed/36066940 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 8 %P e33402 %T Electronic Data Capture System (REDCap) for Health Care Research and Training in a Resource-Constrained Environment: Technology Adoption Case Study %A Maré,Irma Adele %A Kramer,Beverley %A Hazelhurst,Scott %A Nhlapho,Mapule Dorcus %A Zent,Roy %A Harris,Paul A %A Klipin,Michael %+ Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000, South Africa, 27 0117171000, aicm.v2@gmail.com %K electronic data capture %K implementation science %K Research Electronic Data Capture %K REDCap %K biomedical informatics %K South Africa %D 2022 %7 30.8.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Electronic data capture (EDC) in academic health care organizations provides an opportunity for the management, aggregation, and secondary use of research and clinical data. It is especially important in resource-constrained environments such as the South African public health care sector, where paper records are still the main form of clinical record keeping. Objective: The aim of this study was to describe the strategies followed by the University of the Witwatersrand Faculty of Health Sciences (Wits FHS) during the period from 2013 to 2021 to overcome resistance to, and encourage the adoption of, the REDCap (Research Electronic Data Capture; Vanderbilt University) system by academic and clinical staff. REDCap has found wide use in varying domains, including clinical studies and research projects as well as administrative, financial, and human resource applications. Given REDCap’s global footprint in >5000 institutions worldwide and potential for future growth, the strategies followed by the Wits FHS to support users and encourage adoption may be of importance to others using the system, particularly in resource-constrained settings. Methods: The strategies to support users and encourage adoption included top-down organizational support; secure and reliable application, hosting infrastructure, and systems administration; an enabling and accessible REDCap support team; regular hands-on training workshops covering REDCap project setup and data collection instrument design techniques; annual local symposia to promote networking and awareness of all the latest software features and best practices for using them; participation in REDCap Consortium activities; and regular and ongoing mentorship from members of the Vanderbilt University Medical Center. Results: During the period from 2013 to 2021, the use of the REDCap EDC system by individuals at the Wits FHS increased, respectively, from 129 active user accounts to 3447 active user accounts. The number of REDCap projects increased from 149 in 2013 to 12,865 in 2021. REDCap at Wits also supported various publications and research outputs, including journal articles and postgraduate monographs. As of 2020, a total of 233 journal articles and 87 postgraduate monographs acknowledged the use of the Wits REDCap system. Conclusions: By providing reliable infrastructure and accessible support resources, we were able to successfully implement and grow the REDCap EDC system at the Wits FHS and its associated academic medical centers. We believe that the increase in the use of REDCap was driven by offering a dependable, secure service with a strong end-user training and support model. This model may be applied by other academic and health care organizations in resource-constrained environments planning to implement EDC technology. %M 36040763 %R 10.2196/33402 %U https://medinform.jmir.org/2022/8/e33402 %U https://doi.org/10.2196/33402 %U http://www.ncbi.nlm.nih.gov/pubmed/36040763 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e25735 %T Birth and Death Notifications for Improving Civil Registration and Vital Statistics in Bangladesh: Pilot Exploratory Study %A Tahsina,Tazeen %A Iqbal,Afrin %A Rahman,Ahmed Ehsanur %A Chowdhury,Suman Kanti %A Chowdhury,Atique Iqbal %A Billah,Sk Masum %A Rahman,Ataur %A Parveen,Monira %A Ahmed,Lubana %A Rahman,Qazi Sadequr %A Ashrafi,Shah Ali Akbar %A Arifeen,Shams El %+ International Centre for Diarrhoeal Disease Research, Bangladesh, 68, Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh, 880 9827077, tahsina.tazeen@gmail.com %K notification %K registration %K birth %K death %K CRVS %K mobile phone %K mobile app %K mobile technology %K technology-based platform %K community health %K low- and middle-income countries %K mHealth %K Bangladesh %D 2022 %7 29.8.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Effective health policy formulation requires sound information of the numerical data and causes of deaths in a population. Currently, in Bangladesh, neither births nor deaths are fully and promptly registered. Birth registration in Bangladesh is around 54% nationally. Although the legal requirements are to register within 45 days of an event, only 4.5% of births and 35.9% of deaths were reported within the required time frame in 2020. This study adopted an innovative digital notification approach to improve the coverage of registration of these events at the community level. Objective: Our primary objective was to assess (1) the proportion of events identified by the new notification systems (success rate) and the contribution of the different notifiers individually and in combination (completeness) and (2) the proportion of events notified within specific time limits (timeliness of notifications) after introducing the innovative approach. Methods: We conducted a pilot study in 2016 in 2 subdistricts of Bangladesh to understand whether accurate, timely, and complete information on births and deaths can be collected and notified by facility-based service providers; community health workers, including those who routinely visit households; local government authorities; and key informants from the community. We designed a mobile technology–based platform, an app, and a call center through which the notifications were recorded. All notifications were verified through the confirmation of events by family members during visits to the concerned households. We undertook a household survey–based assessment at the end of the notification period. Results: Our innovative system gathered 13,377 notifications for births and deaths from all channels, including duplicate reports from multiple sources. Project workers were able to verify 92% of the births and 93% of the deaths through household visits. The household survey conducted among a subsample of the project population identified 1204 births and 341 deaths. After matching the notifications with the household survey, we found that the system was able to capture over 87% of the births in the survey areas. Health assistants and family welfare assistants were the primary sources of information. Notifications from facilities were very low for both events. Conclusions: The Global Civil Registration and Vital Statistics: Scaling Up Investment Plan 2015-2024 and the World Health Organization reiterated the importance of building an evidence base for improving civil registration and vital statistics. Our pilot innovation revealed that it is possible to coordinate with the routine health information system to note births and deaths as the first step to ensure registration. Health assistants could capture more than half of the notifications as a stand-alone source. %M 36036979 %R 10.2196/25735 %U https://publichealth.jmir.org/2022/8/e25735 %U https://doi.org/10.2196/25735 %U http://www.ncbi.nlm.nih.gov/pubmed/36036979 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e39387 %T Predicting Psychological Symptoms When Facebook’s Digital Well-being Features Are Used: Cross-sectional Survey Study %A Barsova,Tamara %A Cheong,Zi Gi %A Mak,Ann R %A Liu,Jean CJ %+ Yale-NUS College, 28 College Avenue West, #01-501, Singapore, 138533, Singapore, 65 66013694, jeanliu@yale-nus.edu.sg %K mental health %K social media %K digital well-being %K depression %K anxiety %K stress %D 2022 %7 29.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Prior research has linked social media usage to poorer mental health. To address these concerns, social media platforms have introduced digital well-being tools to help users monitor their engagement. Nonetheless, little is known about the effectiveness of these tools. Objective: In this study, we focused on Facebook to assess users’ awareness and usage of the following six Facebook well-being tools: the Unfollow, Snooze, Off-Facebook Activity, Your Time on Facebook, Set Daily Reminders, and Notification Settings features. Additionally, we examined whether the use of these tools was associated with better mental health outcomes. Methods: We conducted a cross-sectional survey of 598 Facebook users. The survey comprised questions about (1) baseline Facebook use, (2) the adoption of Facebook’s digital well-being tools, and (3) participant demographics. These were used to predict the primary outcome measure—scores on the 21-item Depression, Anxiety, and Stress Scale. Results: Most participants (580/598, 97%) knew about Facebook’s digital well-being tools, but each tool was used by only 17.4% (104/598) to 55.5% (332/598) of participants. In turn, the use of two tools was associated with better well-being; although participants who spent more time on Facebook reported higher levels of depression, anxiety, and stress, those who managed their feed content or notifications by using the Unfollow or Notification Settings features had lower scores on each of these measures. However, the use of the Snooze, Off-Facebook Activity, Your Time on Facebook, or Set Time Reminder features was not associated with lower depression, anxiety, or stress scores. Conclusions: Of the 6 Facebook digital well-being tools, only 2 were associated with better mental health among users. This underscores the complexity of designing social media platforms to promote user welfare. Consequently, we urge further research into understanding the efficacy of various digital well-being tools. Trial Registration: ClinicalTrials.gov NCT04967846; https://clinicaltrials.gov/ct2/show/study/NCT04967846 %M 36036971 %R 10.2196/39387 %U https://formative.jmir.org/2022/8/e39387 %U https://doi.org/10.2196/39387 %U http://www.ncbi.nlm.nih.gov/pubmed/36036971 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e37856 %T Assessing the Feasibility of Studying Awareness of a Digital Health Campaign on Facebook: Pilot Study Comparing Young Adult Subsamples %A Tulsiani,Shreya %A Ichimiya,Megumi %A Gerard,Raquel %A Mills,Sarah %A Bingenheimer,Jeffrey B %A Hair,Elizabeth C %A Vallone,Donna %A Evans,W Douglas %+ Schroeder Institute, Truth Initiative, 900 G St NW, 4th Fl, Washington, DC, 20001, United States, 1 202 454 5765, stulsiani@truthinitiative.org %K campaign evaluation %K outcome evaluation %K young adults %K social marketing %K health communications %K tobacco control and policy %K health campaign %K youth %K Facebook %K digital media %D 2022 %7 29.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mass media campaigns for preventive health messaging have been shown to be effective through years of research. However, few studies have assessed the effectiveness of campaigns on digital media, which is currently how youths and young adults are primarily consuming media. In particular, a platform that can accurately assess exposure to digital messaging in a real-life setting has yet to be developed. Objective: This study examines the feasibility of a unique survey platform, Virtual Lab, to conduct a study on exposure to a media campaign within Facebook using a chatbot-style survey administration technique. Methods: Virtual Lab is a survey platform that was used to recruit and survey participants within Facebook and Facebook Messenger, respectively. We created a Facebook business account with 2 Facebook pages: one for recruitment and disseminating the survey and the other one for serving the target advertisements. Pre- and postexposure surveys were administered via Facebook Messenger using a chatbot-style questionnaire 1 week apart. During this time, the target advertisements were shown to participants who completed the pre-exposure survey. The total time from recruitment to completion of the postexposure survey was 13 days, and incentive costs were US $10 per participant. Survey data were compared between those who completed both pre- and postexposure surveys and those who only completed the pre-exposure survey; that is, those who were lost to follow-up. The demographics of the complete cases were also compared to the US census data. Results: A total of 375 Facebook users aged between 18 and 24 years met eligibility requirements and consented to the study, which consisted of complete cases (n=234) and participants lost to follow-up (n=141). A few differences between complete cases and participants lost to follow-up were observed. Regarding gender, complete cases comprised 40.2% males and 59.4% females, and among participants lost to follow-up, 44.0% were male and 50.4% were female (P=.003). Differences were also observed for e-cigarette use status, where a greater number of current users and fewer past and never users were lost to follow-up than complete cases (P=.01). Conclusions: The use of Virtual Lab yielded a diverse sample quickly and cost-effectively. Demographic characteristics of participants who completed the study and those who were lost to follow-up were similar, indicating that no biases were caused by the platform during recruitment or testing. This study suggests the feasibility of the Virtual Lab survey platform for studies of media campaign exposure within Facebook. This platform can advance health campaign research by providing more accurate data to inform digital messaging. %M 36036974 %R 10.2196/37856 %U https://formative.jmir.org/2022/8/e37856 %U https://doi.org/10.2196/37856 %U http://www.ncbi.nlm.nih.gov/pubmed/36036974 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e40015 %T Testing the Effectiveness of an Animated Decision Aid to Improve Recruitment of Control Participants in a Case-Control Study: Web-Based Experiment %A Stoffel,Sandro T %A Law,Jing Hui %A Kerrison,Robert %A Brewer,Hannah R %A Flanagan,James M %A Hirst,Yasemin %+ Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 2076791615, y.hirst@ucl.ac.uk %K animation %K research participation %K online experiment %K case-control %K recruitment %K decision %K effectiveness %K epidemiology %K recruitment %K online %K experiment %K volunteer %K survey %K willingness %K data %K health research %K research %D 2022 %7 26.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Participation in case-control studies is crucial in epidemiological research. The self-sampling bias, low response rate, and poor recruitment of population representative controls are often reported as limitations of case-control studies with limited strategies to improve participation. With greater use of web-based methods in health research, there is a further need to understand the effectiveness of different tools to enhance informed decision-making and willingness to take part in research. Objective: This study tests whether the inclusion of an animated decision aid in the recruitment page of a study website can increase participants’ intentions to volunteer as controls. Methods: A total of 1425 women were included in a web-based experiment and randomized to one of two experimental conditions: one in which they were exposed to a simulated website that included the animation (animation; n=693, 48.6%), and one in which they were exposed to the simulated website without the animation (control; n=732, 51.4%). The simulated website was adapted from a real website for a case-control study, which invites people to consider taking part in a study that investigates differences in purchasing behaviors between women with and without ovarian cancer and share their loyalty card data collected through 2 high street retailers with the researchers. After exposure to the experimental manipulation, participants were asked to state (1) their intention to take part in the case-control study, (2) whether they would be willing to share their loyalty card for research, and (3) their willingness to be redirected to the real website after completing the survey. Data were assessed using ordinal and binary logistic regression, reported in percentages (%), adjusted odds ratio (AOR), and 95% confidence intervals. Results: Including the animation in the simulated website did not increase intentions to participate in the study (AOR 1.09; 95% CI 0.88-1.35) or willingness to visit the real study website after the survey (control 50.5% vs animation 52.6%, AOR 1.08; 95% CI 0.85-1.37). The animation, however, increased the participants’ intentions to share the data from their loyalty cards for research in general (control 17.9% vs animation 26%; AOR 1.64; 95% CI 1.23-2.18). Conclusions: While the results of this study indicate that the animated decision aid did not lead to greater intention to take part in our web-based case-control study, they show that they can be effective in increasing people’s willingness to share sensitive data for health research. %M 36018628 %R 10.2196/40015 %U https://www.jmir.org/2022/8/e40015 %U https://doi.org/10.2196/40015 %U http://www.ncbi.nlm.nih.gov/pubmed/36018628 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e34721 %T Evaluation of Positive Choices, a National Initiative to Disseminate Evidence-Based Alcohol and Other Drug Prevention Strategies: Web-Based Survey Study %A Stapinski,Lexine Ann %A Nepal,Smriti %A Guckel,Tara %A Grummitt,Lucinda Rachel %A Chapman,Cath %A Lynch,Samantha Jane %A Lawler,Siobhan Maree %A Teesson,Maree %A Newton,Nicola Clare %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6 Jane Foss Russell Building, G02, Camperdown, 2006, Australia, 61 0426200221, tara.guckel@sydney.edu.au %K alcohol and other drugs %K prevention %K adolescence %K schools %K drug prevention %K drug prevention website %D 2022 %7 26.8.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: To prevent adolescents from initiating alcohol and other drug use and reduce the associated harms, effective strategies need to be implemented. Despite their availability, effective school-based programs and evidence-informed parental guidelines are not consistently implemented. The Positive Choices alcohol and other drug prevention initiative and website was launched to address this research and practice gap. The intended end users were school staff, parents, and school students. An 8-month postlaunch evaluation of the website showed that end users generally had positive feedback on the website’s usability, and following its use, most of them would consider the evidence base and effectiveness of drug education resources. This study extends this initial evaluation by examining the effectiveness and impact of the Positive Choices initiative over a 3-year period. Objective: Guided by the five dimensions of the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, the study assessed the impact of the Positive Choices initiative in increasing awareness and implementation of evidence-based drug prevention. Methods: Data were collected between 2017 and 2019, using web-based evaluation and community awareness surveys. Data from the surveys were merged to examine reach, effectiveness, adoption, implementation, and maintenance using descriptive statistics. Google Analytics was used to further understand the reach of the website. The System Usability Scale was used to measure website usability. In addition, inductive analysis was used to assess the participants’ feedback about Positive Choices. Results: A total of 5 years after launching, the Positive Choices website has reached 1.7 million users. A national Australian campaign increased awareness from 8% to 14% among school staff and from 15% to 22% among parents after the campaign. Following a brief interaction with the website, most participants, who were not already following the recommended strategies, reported an intention to shift toward evidence-based practices. The System Usability Scale score for the website was good for both user groups. The participants intended to maintain their use of the Positive Choices website in the future. Both user groups reported high level of confidence in communicating about topics related to alcohol and other drugs. Participants’ suggestions for improvement informed a recent website update. Conclusions: The Positive Choices website has the capacity to be an effective strategy for disseminating evidence-based drug prevention information and resources widely. The findings highlight the importance of investing in ongoing maintenance and promotion to enhance awareness of health websites. With the increased use and acceptability of health education websites, teams should ensure that websites are easy to navigate, are engaging, use simple language, contain evidence-informed resources, and are supported by ongoing promotional activities. %M 36018617 %R 10.2196/34721 %U https://pediatrics.jmir.org/2022/3/e34721 %U https://doi.org/10.2196/34721 %U http://www.ncbi.nlm.nih.gov/pubmed/36018617 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e37682 %T Determining the Influencing Factors on Acceptance of eHealth Pain Management Interventions Among Patients With Chronic Pain Using the Unified Theory of Acceptance and Use of Technology: Cross-sectional Study %A Stoppok,Paula %A Teufel,Martin %A Jahre,Lisa %A Rometsch,Caroline %A Müßgens,Diana %A Bingel,Ulrike %A Skoda,Eva-Maria %A Bäuerle,Alexander %+ Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, Essen, Germany, 49 201 43 87 55 20, alexander.baeuerle@uni-due.de %K eHealth %K eHealth interventions %K Unified Theory of Acceptance and Use of Technology %K UTAUT %K chronic pain %K pain management %K acceptance %D 2022 %7 17.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic pain is a complex disease with high prevalence rates, and many individuals who are affected do not receive adequate treatment. As a complement to conventional therapies, eHealth interventions could provide many benefits to a multimodal treatment approach for patients with chronic pain, whereby future use is associated with the acceptance of these interventions. Objective: This study aims to assess the acceptance of eHealth pain management interventions among patients with chronic pain and identify the influencing factors on acceptance. A further objective of the study is to evaluate the viability of the Unified Theory of Acceptance and Use of Technology (UTAUT) model and compare it with its extended version in terms of explained variance of acceptance. Methods: We performed a cross-sectional web-based study. In total, 307 participants with chronic pain, as defined according to the International Association for the Study of Pain criteria, were recruited through flyers, posters, and web-based inquiries between December 2020 and July 2021. In addition to sociodemographic and medical data, the assessment included validated psychometric instruments and an extended version of the well-established UTAUT model. For statistical analyses, group comparisons and multiple hierarchical regression analyses were performed. Results: The acceptance of eHealth pain management interventions among patients with chronic pain was overall moderate to high (mean 3.67, SD 0.89). There was significant difference in acceptance among age groups (W=9674.0; r=0.156; P=.04). Effort expectancy (β=.37; P<.001), performance expectancy (β=.33; P<.001), and social influence (β=.34; P<.001) proved to be the most important predictors of acceptance. The extended UTAUT (including the original UTAUT factors as well as sociodemographic, medical, and eHealth-related factors) model explained 66.4% of the variance in acceptance, thus supporting the viability of the model. Compared with the original UTAUT model (performance expectancy, effort expectancy, and social influence), the extended model explained significantly more variance (F25,278=1.74; P=.02). Conclusions: Given the association between acceptance and future use, the knowledge of the influencing factors on acceptance should be used in the development and promotion of eHealth pain management interventions. Overall, the acceptance of eHealth pain management interventions was moderate to high. In total, 8 predictors proved to be significant predictors of acceptance. The UTAUT model is a valuable instrument for determining acceptance as well as the factors that influence acceptance of eHealth pain management interventions among patients with chronic pain. The extended UTAUT model provided the greatest predictive value for acceptance. %M 35976199 %R 10.2196/37682 %U https://formative.jmir.org/2022/8/e37682 %U https://doi.org/10.2196/37682 %U http://www.ncbi.nlm.nih.gov/pubmed/35976199 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e37422 %T Preferences for Attributes of Initial COVID-19 Diagnosis in the United States and China During the Pandemic: Discrete Choice Experiment With Propensity Score Matching %A Zhang,Yimin %A Liu,Taoran %A He,Zonglin %A Chan,Sze Ngai %A Akinwunmi,Babatunde %A Huang,Jian %A Wong,Tak-Hap %A Zhang,Casper J P %A Ming,Wai-Kit %+ Department of Infectious Diseases and Public Health, City University of Hong Kong, Room 1A-503, 5/F, Block 1, To Yuen Building, 31 To Yuen Street, Hong Kong, China, 852 3442 6956, wkming2@cityu.edu.hk %K COVID-19 %K public health %K discrete choice experiment %K patient preference %K propensity score matching %K patients with fever %D 2022 %7 16.8.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: China and the United States play critical leading roles in the global effort to contain the COVID-19 virus. Therefore, their population’s preferences for initial diagnosis were compared to provide policy and clinical insights. Objective: We aim to quantify and compare the public’s preferences for medical management of fever and the attributes of initial diagnosis in the case of presenting symptoms during the COVID-19 pandemic in China and the United States. Methods: We conducted a cross-sectional study from January to March 2021 in China and the United States using an online discrete choice experiment (DCE) questionnaire distributed through Amazon Mechanical Turk (MTurk; in the United States) and recruited volunteers (in China). Propensity score matching (PSM) was used to match the 2 groups of respondents from China and the United States to minimize confounding effects. In addition, the respondents’ preferences for different diagnosis options were evaluated using a mixed logit model (MXL) and latent class models (LCMs). Moreover, demographic data were collected and compared using the chi-square test, Fisher test, and Mann-Whitney U test. Results: A total of 9112 respondents (5411, 59.4%, from China and 3701, 40.6%, from the United States) who completed our survey were included in our analysis. After PSM, 1240 (22.9%) respondents from China and 1240 (33.5%) from the United States were matched for sex, age, educational level, occupation, and annual salary levels. The segmented sizes of 3 classes of respondents from China were 870 (70.2%), 270 (21.8%), and 100 (8.0%), respectively. Meanwhile, the US respondents’ segmented sizes were 269 (21.7%), 139 (11.2%), and 832 (67.1%), respectively. Respondents from China attached the greatest importance to the type of medical institution (weighted importance=40.0%), while those from the United States valued the waiting time (weighted importance=31.5%) the most. Respondents from China preferred the emergency department (coefficient=0.973, reference level: online consultation) and fever clinic (a special clinic for the treatment of fever patients for the prevention and control of acute infectious diseases in China; coefficient=0.974, reference level: online consultation), while those from the United States preferred private clinics (general practices; coefficient=0.543, reference level: online consultation). Additionally, shorter waiting times, COVID-19 nucleic acid testing arrangements, higher reimbursement rates, and lower costs were always preferred. Conclusions: Improvements in the availability of COVID-19 testing and medical professional skills and increased designated health care facilities may help boost potential health care seeking during COVID-19 and prevent unrecognized community spreading of SARS-CoV-2 in China and the United States. Moreover, to better prevent future waves of pandemics, identify undiagnosed patients, and encourage those undiagnosed to seek health care services to curb the pandemic, the hierarchical diagnosis and treatment system needs improvement in China, and the United States should focus on reducing diagnosis costs and raising the reimbursement rate of medical insurance. %M 35759683 %R 10.2196/37422 %U https://publichealth.jmir.org/2022/8/e37422 %U https://doi.org/10.2196/37422 %U http://www.ncbi.nlm.nih.gov/pubmed/35759683 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e37054 %T Feasibility of Conducting Long-term Health and Behaviors Follow-up in Adolescents: Longitudinal Observational Study %A Cucchiaro,Giovanni %A Ahumada,Luis %A Gray,Geoffrey %A Fierstein,Jamie %A Yates,Hannah %A Householder,Kym %A Frye,William %A Rehman,Mohamed %+ Johns Hopkins All Children's Hospital, 601 5th Street South, St. Petersburg, FL, 33701, United States, 1 6266168290, gcucchi1@jhmi.edu %K Fitbit %K wearables %K health tracker %K survey %K adolescents %K psychosocial %K long term %K follow-up %K feasibility %K artificial intelligence %K machine learning %K posterior spine fusion %K operation %K surgery %D 2022 %7 15.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Machine learning uses algorithms that improve automatically through experience. This statistical learning approach is a natural extension of traditional statistical methods and can offer potential advantages for certain problems. The feasibility of using machine learning techniques in health care is predicated on access to a sufficient volume of data in a problem space. Objective: This study aimed to assess the feasibility of data collection from an adolescent population before and after a posterior spine fusion operation. Methods: Both physical and psychosocial data were collected. Adolescents scheduled for a posterior spine fusion operation were approached when they were scheduled for the surgery. The study collected repeated measures of patient data, including at least 2 weeks prior to the operation and 6 months after the patients were discharged from the hospital. Patients were provided with a Fitbit Charge 4 (consumer-grade health tracker) and instructed to wear it as often as possible. A third-party web-based portal was used to collect and store the Fitbit data, and patients were trained on how to download and sync their personal device data on step counts, sleep time, and heart rate onto the web-based portal. Demographic and physiologic data recorded in the electronic medical record were retrieved from the hospital data warehouse. We evaluated changes in the patients’ psychological profile over time using several validated questionnaires (ie, Pain Catastrophizing Scale, Patient Health Questionnaire, Generalized Anxiety Disorder Scale, and Pediatric Quality of Life Inventory). Questionnaires were administered to patients using Qualtrics software. Patients received the questionnaire prior to and during the hospitalization and again at 3 and 6 months postsurgery. We administered paper-based questionnaires for the self-report of daily pain scores and the use of analgesic medications. Results: There were several challenges to data collection from the study population. Only 38% (32/84) of the patients we approached met eligibility criteria, and 50% (16/32) of the enrolled patients dropped out during the follow-up period—on average 17.6 weeks into the study. Of those who completed the study, 69% (9/13) reliably wore the Fitbit and downloaded data into the web-based portal. These patients also had a high response rate to the psychosocial surveys. However, none of the patients who finished the study completed the paper-based pain diary. There were no difficulties accessing the demographic and clinical data stored in the hospital data warehouse. Conclusions: This study identifies several challenges to long-term medical follow-up in adolescents, including willingness to participate in these types of studies and compliance with the various data collection approaches. Several of these challenges—insufficient incentives and personal contact between researchers and patients—should be addressed in future studies. %M 35969442 %R 10.2196/37054 %U https://formative.jmir.org/2022/8/e37054 %U https://doi.org/10.2196/37054 %U http://www.ncbi.nlm.nih.gov/pubmed/35969442 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e38443 %T Racial Bias Beliefs Related to COVID-19 Among Asian Americans, Native Hawaiians, and Pacific Islanders: Findings From the COVID-19 Effects on the Mental and Physical Health of Asian Americans and Pacific Islanders Survey Study (COMPASS) %A Park,Van Ta %A Tsoh,Janice Y %A Dougan,Marcelle %A Nam,Bora %A Tzuang,Marian %A Park,Linda G %A Vuong,Quyen N %A Bang,Joon %A Meyer,Oanh L %+ Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way, San Francisco, CA, 94143, United States, 1 (415) 514 3318, van.park@ucsf.edu %K COVID-19 %K racial bias %K Asian American %K Native Hawaiian and Pacific Islander %K mobile phone %D 2022 %7 9.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, there have been increased reports of racial biases against Asian American and Native Hawaiian and Pacific Islander individuals. However, the extent to which different Asian American and Native Hawaiian and Pacific Islander groups perceive and experience (firsthand or as a witness to such experiences) how COVID-19 has negatively affected people of their race has not received much attention. Objective: This study used data from the COVID-19 Effects on the Mental and Physical Health of Asian Americans and Pacific Islanders Survey Study (COMPASS), a nationwide, multilingual survey, to empirically examine COVID-19–related racial bias beliefs among Asian American and Native Hawaiian and Pacific Islander individuals and the factors associated with these beliefs. Methods: COMPASS participants were Asian American and Native Hawaiian and Pacific Islander adults who were able to speak English, Chinese (Cantonese or Mandarin), Korean, Samoan, or Vietnamese and who resided in the United States during the time of the survey (October 2020 to May 2021). Participants completed the survey on the web, via phone, or in person. The Coronavirus Racial Bias Scale (CRBS) was used to assess COVID-19–related racial bias beliefs toward Asian American and Native Hawaiian and Pacific Islander individuals. Participants were asked to rate the degree to which they agreed with 9 statements on a 5-point Likert scale (ie, 1=strongly disagree to 5=strongly agree). Multivariable linear regression was used to examine the associations between demographic, health, and COVID-19–related characteristics and perceived racial bias. Results: A total of 5068 participants completed the survey (mean age 45.4, SD 16.4 years; range 18-97 years). Overall, 73.97% (3749/5068) agreed or strongly agreed with ≥1 COVID-19–related racial bias belief in the past 6 months (during the COVID-19 pandemic). Across the 9 racial bias beliefs, participants scored an average of 2.59 (SD 0.96, range 1-5). Adjusted analyses revealed that compared with Asian Indians, those who were ethnic Chinese, Filipino, Hmong, Japanese, Korean, Vietnamese, and other or multicultural had significantly higher mean CRBS scores, whereas no significant differences were found among Native Hawaiian and Pacific Islander individuals. Nonheterosexual participants had statistically significant and higher mean CRBS scores than heterosexual participants. Compared with participants aged ≥60 years, those who were younger (aged <30, 30-39, 40-49, and 50-59 years) had significantly higher mean CRBS scores. US-born participants had significantly higher mean CRBS scores than foreign-born participants, whereas those with limited English proficiency (relative to those reporting no limitation) had lower mean CRBS scores. Conclusions: Many COMPASS participants reported racial bias beliefs because of the COVID-19 pandemic. Relevant sociodemographic contexts and pre-existing and COVID-19–specific factors across individual, community, and society levels were associated with the perceived racial bias of being Asian during the pandemic. The findings underscore the importance of addressing the burden of racial bias on Asian American and Native Hawaiian and Pacific Islander communities among other COVID-19–related sequelae. %M 35658091 %R 10.2196/38443 %U https://www.jmir.org/2022/8/e38443 %U https://doi.org/10.2196/38443 %U http://www.ncbi.nlm.nih.gov/pubmed/35658091 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e38015 %T Social Media Use for Research Participant Recruitment: Integrative Literature Review %A Darko,Elizabeth Mirekuwaa %A Kleib,Manal %A Olson,Joanne %+ College of Health Sciences, Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada, 1 7807826810, darko@ualberta.ca %K advertisement %K recruitment %K research participants %K social media %K mobile phone %D 2022 %7 4.8.2022 %9 Review %J J Med Internet Res %G English %X Background: Social media tools have provided health researchers with the opportunity to engage with communities and groups in a nonconventional manner to recruit participants for health research. Using social media to advertise research opportunities and recruit participants facilitates accessibility to participants from broad geographical areas and diverse populations. However, little guidance is provided by ethics review boards for researchers to effectively use this recruitment method in their research. Objective: This study sought to explore the literature on the use of social media for participant recruitment for research studies and identify the best practices for recruiting participants using this method. Methods: An integrative review approach was used to synthesize the literature. A total of 5 health sciences databases, namely, EMBASE (Ovid), MEDLINE (Ovid and EBSCOhost), PsycINFO (Ovid), Scopus (Elsevier), and CINAHL Plus with Full Text (EBSCOhost), were searched using predefined keywords and inclusion and exclusion criteria. The initial search was conducted in October 2020 and was updated in February 2022. Descriptive and content analyses were applied to synthesize the results, and the findings are presented in a narrative and tabular format. Results: A total of 96 records were included in this review, 83 (86%) from the initial search and 13 (14%) from the updated search. The publication year ranged between 2011 and 2022, with most publications (63/96, 66%) being from the United States. Regarding recruitment strategy, 45% (43/96) of the studies exclusively used social media, whereas 51% (49/96) used social media in conjunction with other strategies. The remaining 4% (4/96) provided guidelines and recommendations for social media recruitment. Notably, 38% (36/96) of these studies involved hard-to-reach populations. The findings also revealed that the use of social media is a cost-effective and efficient strategy for recruiting research participants. Despite the expanded use across different populations, there is limited participation of older adults in social media recruitment. Conclusions: This review provides important insights into the current use of social media for health research participant recruitment. Ethics boards and research support services in academic institutions are encouraged to explicitly provide researchers with guidelines on the use of social media for health research participant recruitment. A preliminary guideline prepared based on the findings of this review is proposed to spark further development in this area. %M 35925655 %R 10.2196/38015 %U https://www.jmir.org/2022/8/e38015 %U https://doi.org/10.2196/38015 %U http://www.ncbi.nlm.nih.gov/pubmed/35925655 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e36850 %T Social Media Users’ Perceptions of a Wearable Mixed Reality Headset During the COVID-19 Pandemic: Aspect-Based Sentiment Analysis %A Jeong,Heejin %A Bayro,Allison %A Umesh,Sai Patipati %A Mamgain,Kaushal %A Lee,Moontae %+ Department of Mechanical and Industrial Engineering, University of Illinois Chicago, 842 W Taylor St, Chicago, IL, 60607, United States, 1 312 355 5558, heejinj@uic.edu %K HoloLens 2 %K sentiment analysis %K natural language processing, Twitter %K COVID-19 %K usability evaluation %D 2022 %7 4.8.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Mixed reality (MR) devices provide real-time environments for physical-digital interactions across many domains. Owing to the unprecedented COVID-19 pandemic, MR technologies have supported many new use cases in the health care industry, enabling social distancing practices to minimize the risk of contact and transmission. Despite their novelty and increasing popularity, public evaluations are sparse and often rely on social interactions among users, developers, researchers, and potential buyers. Objective: The purpose of this study is to use aspect-based sentiment analysis to explore changes in sentiment during the onset of the COVID-19 pandemic as new use cases emerged in the health care industry; to characterize net insights for MR developers, researchers, and users; and to analyze the features of HoloLens 2 (Microsoft Corporation) that are helpful for certain fields and purposes. Methods: To investigate the user sentiment, we collected 8492 tweets on a wearable MR headset, HoloLens 2, during the initial 10 months since its release in late 2019, coinciding with the onset of the pandemic. Human annotators rated the individual tweets as positive, negative, neutral, or inconclusive. Furthermore, by hiring an interannotator to ensure agreements between the annotators, we used various word vector representations to measure the impact of specific words on sentiment ratings. Following the sentiment classification for each tweet, we trained a model for sentiment analysis via supervised learning. Results: The results of our sentiment analysis showed that the bag-of-words tokenizing method using a random forest supervised learning approach produced the highest accuracy of the test set at 81.29%. Furthermore, the results showed an apparent change in sentiment during the COVID-19 pandemic period. During the onset of the pandemic, consumer goods were severely affected, which aligns with a drop in both positive and negative sentiment. Following this, there is a sudden spike in positive sentiment, hypothesized to be caused by the new use cases of the device in health care education and training. This pandemic also aligns with drastic changes in the increased number of practical insights for MR developers, researchers, and users and positive net sentiments toward the HoloLens 2 characteristics. Conclusions: Our approach suggests a simple yet effective way to survey public opinion about new hardware devices quickly. The findings of this study contribute to a holistic understanding of public perception and acceptance of MR technologies during the COVID-19 pandemic and highlight several new implementations of HoloLens 2 in health care. We hope that these findings will inspire new use cases and technological features. %M 35708916 %R 10.2196/36850 %U https://games.jmir.org/2022/3/e36850 %U https://doi.org/10.2196/36850 %U http://www.ncbi.nlm.nih.gov/pubmed/35708916 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 6 %N 2 %P e34959 %T Attitudes of Patients With Chronic Heart Failure Toward Digital Device Data for Self-documentation and Research in Germany: Cross-sectional Survey Study %A Buhr,Lorina %A Kaufmann,Pauline Lucie Martiana %A Jörß,Katharina %+ Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, University of Göttingen, Humboldtallee 36, Göttingen, 37037, Germany, 49 551 3969 006, lorina.buhr@med.uni-goettingen.de %K mobile health %K mHealth %K digital devices %K wearables %K heart failure %K data sharing %K consent %K mobile phone %D 2022 %7 3.8.2022 %9 Original Paper %J JMIR Cardio %G English %X Background: In recent years, the use of digital mobile measurement devices (DMMDs) for self-documentation in cardiovascular care in Western industrialized health care systems has increased. For patients with chronic heart failure (cHF), digital self-documentation plays an increasingly important role in self-management. Data from DMMDs can also be integrated into telemonitoring programs or data-intensive medical research to collect and evaluate patient-reported outcome measures through data sharing. However, the implementation of data-intensive devices and data sharing poses several challenges for doctors and patients as well as for the ethical governance of data-driven medical research. Objective: This study aims to explore the potential and challenges of digital device data in cardiology research from patients’ perspectives. Leading research questions of the study concerned the attitudes of patients with cHF toward health-related data collected in the use of digital devices for self-documentation as well as sharing these data and consenting to data sharing for research purposes. Methods: A cross-sectional survey of patients of a research in cardiology was conducted at a German university medical center (N=159) in 2020 (March to July). Eligible participants were German-speaking adult patients with cHF at that center. A pen-and-pencil questionnaire was sent by mail. Results: Most participants (77/105, 73.3%) approved digital documentation, as they expected the device data to help them observe their body and its functions more objectively. Digital device data were believed to provide cognitive support, both for patients’ self-assessment and doctors’ evaluation of their patients’ current health condition. Interestingly, positive attitudes toward DMMD data providing cognitive support were, in particular, voiced by older patients aged >65 years. However, approximately half of the participants (56/105, 53.3%) also reported difficulty in dealing with self-documented data that lay outside the optimal medical target range. Furthermore, our findings revealed preferences for the self-management of DMMD data disclosed for data-intensive medical research among German patients with cHF, which are best implemented with a dynamic consent model. Conclusions: Our findings provide potentially valuable insights for introducing DMMD in cardiovascular research in the German context. They have several practical implications, such as a high divergence in attitudes among patients with cHF toward different data-receiving organizations as well as a large variance in preferences for the modes of receiving information included in the consenting procedure for data sharing for research. We suggest addressing patients’ multiple views on consenting and data sharing in institutional normative governance frameworks for data-intensive medical research. %M 35921134 %R 10.2196/34959 %U https://cardio.jmir.org/2022/2/e34959 %U https://doi.org/10.2196/34959 %U http://www.ncbi.nlm.nih.gov/pubmed/35921134 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e39094 %T An Identity-Affirming Web Application to Help Sexual and Gender Minority Youth Cope With Minority Stress: Pilot Randomized Controlled Trial %A Bauermeister,Jose %A Choi,Seul Ki %A Bruehlman-Senecal,Emma %A Golinkoff,Jesse %A Taboada,Arianna %A Lavra,Joshua %A Ramazzini,Lionel %A Dillon,Fred %A Haritatos,Jana %+ Department of Family and Community Health, University of Pennsylvania, 418 Curie Blvd, Suite 222L, Philadelphia, PA, 19104, United States, 1 215 898 9993, bjose@upenn.edu %K lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority %K LGBTQ+ %K youth %K adolescence %K discrimination %K minority stress %K mental health %K resilience %K sexual and gender minority %K SGM %K intersectionality %D 2022 %7 1.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Efficacious mental health interventions for sexual and gender minority youth have had limited reach, given their delivery as time-intensive, in-person sessions. Internet-based interventions may facilitate reach to sexual and gender minority youth; however, there is little research examining their efficacy. Objective: This study aims to describe the results of a pilot randomized controlled trial of imi, a web application designed to improve mental health by supporting lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority identity affirmation, coping self-efficacy, and coping skill practice. Methods: Sexual and gender minority youth (N=270) aged 13 to 19 (mean 16.5, SD 1.5) years and living in the United States were recruited through Instagram advertisements. Approximately 78% (210/270) of the sample identified as racial or ethnic minorities. Participants were randomized in a 1:1 fashion to the full imi intervention web application (treatment; 135/270, 50%) or a resource page–only version of the imi site (control; 135/270, 50%). The imi application covered four topical areas: gender identity; lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority identity; stress and coping; and internalized homophobia and transphobia. Participants explored these areas by engaging with informational resources, exercises, and peer stories at a self-guided pace. Both arms were assessed via web-based surveys at baseline and 4-week follow-up for intervention satisfaction, stress appraisals (ie, challenge, threat, and resource), coping skills (ie, instrumental support, positive reframing, and planning), and mental health symptoms among other outcomes. Main intent-to-treat analyses compared the arms at week 4, controlling for baseline values on each outcome. Results: Survey retention was 90.4% (244/270) at week 4. Participants in the treatment arm reported greater satisfaction with the intervention than participants in the control arm (t241=–2.98; P=.003). The treatment arm showed significantly greater improvement in challenge appraisals (ie, belief in one’s coping abilities) than the control (Cohen d=0.26; P=.008). There were no differences between the arms for threat (d=0.10; P=.37) or resource (d=0.15; P=.14) appraisals. The treatment arm showed greater increases in coping skills than the control arm (instrumental support: d=0.24, P=.005; positive reframing: d=0.27, P=.02; planning: d=0.26, P=.02). Mental health symptoms improved across both the treatment and control arms; however, there were no differences between arms. Within the treatment arm, higher engagement with imi (≥5 sessions, >10 minutes, or >10 pages) predicted greater improvement in stress appraisals (all P values <.05). Conclusions: The results provide initial evidence that asynchronous psychosocial interventions delivered via a web application to sexual and gender minority youth can support their ability to cope with minority stress. Further research is needed to examine the long-term effects of the imi application. Trial Registration: ClinicalTrials.gov NCT05061966; https://clinicaltrials.gov/ct2/show/NCT05061966 %M 35916700 %R 10.2196/39094 %U https://www.jmir.org/2022/8/e39094 %U https://doi.org/10.2196/39094 %U http://www.ncbi.nlm.nih.gov/pubmed/35916700 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e35168 %T The World Mental Health International College Student Survey in Canada: Protocol for a Mental Health and Substance Use Trend Study %A Jones,Laura B %A Judkowicz,Carolina %A Hudec,Kristen L %A Munthali,Richard J %A Prescivalli,Ana Paula %A Wang,Angel Y %A Munro,Lonna %A Xie,Hui %A Pendakur,Krishna %A Rush,Brian %A Gillett,James %A Young,Marisa %A Singh,Diana %A Todorova,Antoaneta A %A Auerbach,Randy P %A Bruffaerts,Ronny %A Gildea,Sarah M %A McKechnie,Irene %A Gadermann,Anne %A Richardson,Chris G %A Sampson,Nancy A %A Kessler,Ronald C %A Vigo,Daniel V %+ Department of Psychiatry, Faculty of Medicine, University of British Columbia, UBC Hospital- Detwiller Pavilion, 2255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada, 1 6048228048, Daniel.vigo@ubc.ca %K mental health %K substance use %K student health %K World Mental Health International College Student Initiative %K Canada %K Canadian %K online survey %K survey %K questionnaire %K screen %K epidemiology %K depression %K anxiety %K trend %D 2022 %7 29.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The World Health Organization World Mental Health International College Student (WMH-ICS) initiative aims to screen for mental health and substance use problems among postsecondary students on a global scale as well as to develop and evaluate evidence-based preventive and ameliorative interventions for this population. This protocol paper presents the Canadian version of the WMH-ICS survey, detailing the adapted survey instrument, the unique weekly cross-sectional administration, the multitiered recruitment strategy, and the associated risk mitigation protocols. Objective: This paper aims to provide a methodological resource for researchers conducting cross-national comparisons of WMH-ICS data, as well as to serve as a useful guide for those interested in replicating the outlined cross-sectional methodology to better understand how mental health and substance use vary over time among university students. Methods: The online survey is based on the WMH-ICS survey instrument, modified to the Canadian context by the addition of questions pertaining to Canadian-based guidelines and the translation of the survey to Canadian French. The survey is administered through the Qualtrics survey platform and is sent to an independent stratified random sample of 350 students per site weekly, followed by two reminder emails. Upon survey closure every week, a random subsample of 70 nonresponders are followed up with via phone or through a personal email in an effort to decrease nonresponder bias. The survey is accompanied by an extensive risk mitigation protocol that stratifies respondents by the level of need and provides tailored service recommendations, including a facilitated expedited appointment to student counseling services for those at increased risk of suicide. The anticipated sample size is approximately 5500 students per site per year. Results: In February 2020, the Canadian survey was deployed at the University of British Columbia. This was followed by deployment at Simon Fraser University (November 2020), McMaster University (January 2021), and the University of Toronto (January 2022). Data collection at all 4 sites is ongoing. As of May 6, 2022, 29,503 responses have been collected. Conclusions: Based on international collaboration, the Canadian version of the WMH-ICS survey incorporates a novel methodological approach centered on the weekly administration of a comprehensive cross-sectional survey to independent stratified random samples of university students. After 27 months of consecutive survey administration, we have developed and refined a survey protocol that has proven effective in engaging students at four Canadian institutions, allowing us to track how mental health and substance use vary over time using an internationally developed university student survey based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). International Registered Report Identifier (IRRID): RR1-10.2196/35168 %M 35696337 %R 10.2196/35168 %U https://www.researchprotocols.org/2022/7/e35168 %U https://doi.org/10.2196/35168 %U http://www.ncbi.nlm.nih.gov/pubmed/35696337 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e35290 %T Study Protocol and Preliminary Results of the Impact of Occupational Health Workers' Activities on Their Health: Nationwide Prospective Internet-Based Survey %A Ikegami,Kazunori %A Yoshimoto,Yasuro %A Baba,Hiroka %A Sekoguchi,Shingo %A Ando,Hajime %A Ogami,Akira %+ Department of Work Systems and Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, 1-1, Iseigaoka, Yahata-nishi-ku, Kitakyushu, Fukuoka, 807-8555, Japan, 81 93 603 1611, kikegami@med.uoeh-u.ac.jp %K Japan %K occupational health %K worker %K internet surveys %K questionnaires %K cohort study %K COVID-19 %K mental health %K online health %D 2022 %7 28.7.2022 %9 Protocol %J JMIR Form Res %G English %X Background: Owing to the impact of the COVID-19 pandemic, work environments and systems, as well as occupational health measures or activities that fall within our research field, are constantly changing. It is necessary to assess the impact of these changes on the physical and mental health of workers. Objective: To assess how occupational health measures affect the health of workers, we conducted a baseline, longitudinal internet-based survey among Japanese workers in October 2021 and additionally scheduled 2 follow-up surveys for 2022 and 2023. We describe the details of the protocol of the work systems and health internet research (WSHIR) study, provide an overview of the results of the baseline survey, and discuss the study procedures and data used in the study. Methods: This prospective cohort study was conducted online among internet monitors. The baseline survey was conducted from October 1 to 7, 2021. This study targeted those who were working and between the ages of 20 and 69 years. A total of 5111 respondents who passed the screening survey and proceeded to the main survey were enrolled according to collection units organized by sex and age. For the screening and main surveys, the questionnaire consisted of 9 and 33 items with 9 and 55 questions, respectively. Consistency and completeness checks were performed after the questionnaires were submitted. We compared basic characteristics, such as sex, age group, educational background, and marital status, among all participants, including those who withdrew from the analysis. Results: Of the 5111 initial survey respondents, 571 (11.2%) were considered fraudulent. The data of the remaining 4540 (88.8%) participants (2273, 50.1%, males; 2267, 49.9%, females) included in the analysis were well balanced across participant sex and age groups according to the sampling plan because there was no significant difference by sex and age group using the chi-square test for checking the distribution bias of the participants (P=.84). Compared to female participants, male participants tended to be more likely to be managers and supervisors (323, 14.2%, males; 86, 3.8%, females), to work in a secondary industry (742, 32.6%, males; 357, 15.7%, females), and to have an annual income of ≥5 million yen (976, 42.9%, males; 429, 18.9%, females). For the evaluation of a psychological indicator, Kessler 6 (K6) score, by sex and age group, the characteristics of the score distribution of the included participants were similar to those reported in previous studies. Conclusions: This study presents a protocol and overview of the results of an internet-based occupational health survey of workers. Using the results of this survey, we hope to evaluate the changes in occupational health activities and their impact on workers' health while controlling for the COVID-19 pandemic. %M 35900807 %R 10.2196/35290 %U https://formative.jmir.org/2022/7/e35290 %U https://doi.org/10.2196/35290 %U http://www.ncbi.nlm.nih.gov/pubmed/35900807 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e36917 %T Mobile Health Technology Use and the Acceptability of an mHealth Platform for HIV Prevention Among Men Who Have Sex With Men in Malaysia: Cross-sectional Respondent-Driven Sampling Survey %A Shrestha,Roman %A Maviglia,Francesca %A Altice,Frederick L %A DiDomizio,Elizabeth %A Khati,Antoine %A Mistler,Colleen %A Azwa,Iskandar %A Kamarulzaman,Adeeba %A Halim,Mohd Akbar Ab %A Wickersham,Jeffrey A %+ Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Rd, Storrs, CT, 06269, United States, 1 860 486 2446, roman.shrestha@uconn.edu %K HIV %K mHealth %K men who have sex with men %K mobile phone %K Malaysia %K mobile health %K HIV prevention %K sexual health %K public health %K digital health %K communication technology %K health technology %K technology accessibility %K smartphone app %K HIV treatment %D 2022 %7 25.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The growth in mobile technology access, utilization, and services holds great promise in facilitating HIV prevention efforts through mobile health (mHealth) interventions in Malaysia. Despite these promising trends, there is a dearth of evidence on the use of mHealth platforms that addresses HIV prevention among Malaysian men who have sex with men. Objective: The goal of this study was to gain insight into (1) access and utilization of communication technology (eg, landline phone, internet, mobile phone), (2) acceptability of mHealth-based interventions for HIV prevention services, and (3) preferences regarding the format and frequency of mHealth interventions among Malaysian men who have sex with men. Methods: We conducted a cross-sectional survey with Malaysian men who have sex with men between July 2018 and March 2020. Participants were recruited using respondent-driven sampling in the Greater Kuala Lumpur region of Malaysia. We collected information on demographic characteristics, HIV risk-related behaviors, access to and the frequency of use of communication technology, and acceptability of using mHealth for HIV prevention using a self-administered questionnaire with a 5-point scale (1, never; 2, rarely; 3, sometimes; 4, often; 5, all the time). Results: A total of 376 men participated in the survey. Almost all respondents owned or had access to a smartphone with internet access (368/376, 97.9%) and accessed the internet daily (373/376, 99.2%), mainly on a smartphone (334/376, 88.8%). Participants on average used smartphones primarily for social networking (mean 4.5, SD 0.8), followed by sending or receiving emails (mean 4.0, SD 1.0), and searching for health-related information (mean 3.5, SD 0.9). There was high acceptance of the use of mHealth for HIV prevention (mean 4.1, SD 1.5), including for receiving HIV prevention information (345/376, 91.8%), receiving medication reminders (336/376, 89.4%), screening and monitoring sexual activity (306/376, 81.4%) or illicit drug use (281/376, 74.7%), and monitoring drug cravings (280/376, 74.5%). Participants overwhelmingly preferred a smartphone app over other modalities (eg, text, phone call, email) for engaging in mHealth HIV prevention tools. Preference for app notifications ranged from 186/336 (53.9%), for receiving HIV prevention information, to 212/336 (69.3%), for screening and monitoring sexual activity. Acceptance of mHealth was higher for those who were university graduates (P=.003), living in a relationship with a partner (P=.04), engaged in sexualized drug use (P=.01), and engaged in receptive anal sex (P=.006). Conclusions: Findings from this study provide support for developing and deploying mHealth strategies for HIV prevention using a smartphone app in men who have sex with men—a key population with suboptimal engagement in HIV prevention and treatment. %M 35877172 %R 10.2196/36917 %U https://www.jmir.org/2022/7/e36917 %U https://doi.org/10.2196/36917 %U http://www.ncbi.nlm.nih.gov/pubmed/35877172 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e32969 %T Papers Please - Predictive Factors of National and International Attitudes Toward Immunity and Vaccination Passports: Online Representative Surveys %A Garrett,Paul M %A White,Joshua P %A Dennis,Simon %A Lewandowsky,Stephan %A Yang,Cheng-Ta %A Okan,Yasmina %A Perfors,Andrew %A Little,Daniel R %A Kozyreva,Anastasia %A Lorenz-Spreen,Philipp %A Kusumi,Takashi %A Kashima,Yoshihisa %+ Melbourne School of Psychological Sciences, The University of Melbourne, 12th Floor Redmond Barry Building, Parkville Campus, Melbourne, 3010, Australia, 61 8344 6377 ext 03, paul.garrett@unimelb.edu.au %K COVID-19 %K immunity passport %K vaccination passport %K cross-cultural %K health policy %K digital certificates %K SARS-CoV-2 %K vaccine %K policy %K international %D 2022 %7 15.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In response to the COVID-19 pandemic, countries are introducing digital passports that allow citizens to return to normal activities if they were previously infected with (immunity passport) or vaccinated against (vaccination passport) SARS-CoV-2. To be effective, policy decision-makers must know whether these passports will be widely accepted by the public and under what conditions. This study focuses attention on immunity passports, as these may prove useful in countries both with and without an existing COVID-19 vaccination program; however, our general findings also extend to vaccination passports. Objective: We aimed to assess attitudes toward the introduction of immunity passports in six countries, and determine what social, personal, and contextual factors predicted their support. Methods: We collected 13,678 participants through online representative sampling across six countries—Australia, Japan, Taiwan, Germany, Spain, and the United Kingdom—during April to May of the 2020 COVID-19 pandemic, and assessed attitudes and support for the introduction of immunity passports. Results: Immunity passport support was moderate to low, being the highest in Germany (775/1507 participants, 51.43%) and the United Kingdom (759/1484, 51.15%); followed by Taiwan (2841/5989, 47.44%), Australia (963/2086, 46.16%), and Spain (693/1491, 46.48%); and was the lowest in Japan (241/1081, 22.94%). Bayesian generalized linear mixed effects modeling was used to assess predictive factors for immunity passport support across countries. International results showed neoliberal worldviews (odds ratio [OR] 1.17, 95% CI 1.13-1.22), personal concern (OR 1.07, 95% CI 1.00-1.16), perceived virus severity (OR 1.07, 95% CI 1.01-1.14), the fairness of immunity passports (OR 2.51, 95% CI 2.36-2.66), liking immunity passports (OR 2.77, 95% CI 2.61-2.94), and a willingness to become infected to gain an immunity passport (OR 1.6, 95% CI 1.51-1.68) were all predictive factors of immunity passport support. By contrast, gender (woman; OR 0.9, 95% CI 0.82-0.98), immunity passport concern (OR 0.61, 95% CI 0.57-0.65), and risk of harm to society (OR 0.71, 95% CI 0.67-0.76) predicted a decrease in support for immunity passports. Minor differences in predictive factors were found between countries and results were modeled separately to provide national accounts of these data. Conclusions: Our research suggests that support for immunity passports is predicted by the personal benefits and societal risks they confer. These findings generalized across six countries and may also prove informative for the introduction of vaccination passports, helping policymakers to introduce effective COVID-19 passport policies in these six countries and around the world. %M 35377317 %R 10.2196/32969 %U https://publichealth.jmir.org/2022/7/e32969 %U https://doi.org/10.2196/32969 %U http://www.ncbi.nlm.nih.gov/pubmed/35377317 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 7 %P e36828 %T Acoustic and Linguistic Features of Impromptu Speech and Their Association With Anxiety: Validation Study %A Teferra,Bazen Gashaw %A Borwein,Sophie %A DeSouza,Danielle D %A Simpson,William %A Rheault,Ludovic %A Rose,Jonathan %+ The Edward S Rogers Sr Department of Electrical and Computer Engineering, University of Toronto, 10 King’s College Road, Toronto, ON, M5S 3G4, Canada, 1 416 978 6992, bazen.teferra@mail.utoronto.ca %K mental health %K generalized anxiety disorder %K impromptu speech %K acoustic features %K linguistic features %K mobile phone %D 2022 %7 8.7.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The measurement and monitoring of generalized anxiety disorder requires frequent interaction with psychiatrists or psychologists. Access to mental health professionals is often difficult because of high costs or insufficient availability. The ability to assess generalized anxiety disorder passively and at frequent intervals could be a useful complement to conventional treatment and help with relapse monitoring. Prior work suggests that higher anxiety levels are associated with features of human speech. As such, monitoring speech using personal smartphones or other wearable devices may be a means to achieve passive anxiety monitoring. Objective: This study aims to validate the association of previously suggested acoustic and linguistic features of speech with anxiety severity. Methods: A large number of participants (n=2000) were recruited and participated in a single web-based study session. Participants completed the Generalized Anxiety Disorder 7-item scale assessment and provided an impromptu speech sample in response to a modified version of the Trier Social Stress Test. Acoustic and linguistic speech features were a priori selected based on the existing speech and anxiety literature, along with related features. Associations between speech features and anxiety levels were assessed using age and personal income as covariates. Results: Word count and speaking duration were negatively correlated with anxiety scores (r=–0.12; P<.001), indicating that participants with higher anxiety scores spoke less. Several acoustic features were also significantly (P<.05) associated with anxiety, including the mel-frequency cepstral coefficients, linear prediction cepstral coefficients, shimmer, fundamental frequency, and first formant. In contrast to previous literature, second and third formant, jitter, and zero crossing rate for the z score of the power spectral density acoustic features were not significantly associated with anxiety. Linguistic features, including negative-emotion words, were also associated with anxiety (r=0.10; P<.001). In addition, some linguistic relationships were sex dependent. For example, the count of words related to power was positively associated with anxiety in women (r=0.07; P=.03), whereas it was negatively associated with anxiety in men (r=–0.09; P=.01). Conclusions: Both acoustic and linguistic speech measures are associated with anxiety scores. The amount of speech, acoustic quality of speech, and gender-specific linguistic characteristics of speech may be useful as part of a system to screen for anxiety, detect relapse, or monitor treatment. %M 35802401 %R 10.2196/36828 %U https://mental.jmir.org/2022/7/e36828 %U https://doi.org/10.2196/36828 %U http://www.ncbi.nlm.nih.gov/pubmed/35802401 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e37600 %T Pilot Implementation of a User-Driven, Web-Based Application Designed to Improve Sexual Health Knowledge and Communication Among Young Zambians: Mixed Methods Study %A Sharma,Anjali %A Mwamba,Chanda %A Ng'andu,Mwila %A Kamanga,Vikwato %A Zoonadi Mendamenda,Mayamiko %A Azgad,Yael %A Jabbie,Zainab %A Chipungu,Jenala %A Pry,Jake M %+ Department of Public Health Sciences, University of California, Medical Sciences 1-C, One Shield's Ave, Davis, CA, 95616, United States, 1 9366616885, Jmpry@ucdavis.edu %K sexual and reproductive health %K web application %K digital health intervention %K pilot study %K quasi-experiment %K adolescent %K young people %K Zambia %K sub-Saharan Africa %K mobile phone %D 2022 %7 7.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health interventions show promise in improving the uptake of HIV services among adolescents and young people aged 15 to 24 years in sub-Saharan Africa. Objective: This study aimed to pilot-test a theory-based, empirically grounded web-based application designed to increase condom-related knowledge, sexual and reproductive health (SRH) communication, and healthier choices among young Zambians. Methods: We conducted a pre-post quasi-experimental evaluation of the user-driven Be in the Know Zambia (BITKZ) web application using web-based surveys and in-depth interviews (IDIs) on the phone. We enrolled participants using social media advertisements. Our final analysis set comprised 46.04% (749/1627) of participants in the intervention group (which received the BITKZ link) and 53.96% (878/1627) of participants in the comparison group (no intervention). We collected survey data at study enrollment (baseline) and 5 weeks after the first enrollment in each group. Approximately 85% (637/749) of BITKZ users completed a user survey, of whom 9.3% (59/637) participated in IDIs. We calculated the time interfacing with BITKZ using the application log files. We conducted descriptive analyses to describe baseline characteristics and the user experience. At the endline, we assessed association using a t test and adjusted logistic regression for binary outcomes and ordinal regression for ordered outcomes, conditioning on age, sex, marital status, and employment status. We used adjusted average treatment effects (aATE) to assess the effects of BITKZ intervention. We conducted rapid matrix analyses of IDI transcripts in Microsoft Excel, sorting the data by theme, gender, and experience rating. Results: Users rated BITKZ highly (excellent: 352/609, 57.8%; good: 218/609, 35.8%). At the endline, the intervention group had a higher level of knowledge related to condoms (adjusted odds ratio [aOR]: 1.35, 95% CI 1.06-1.69) and on wearing condoms correctly (aOR: 1.23, 95% CI 1.02-1.49). Those who had full-time employment had increased odds of knowing how to wear condoms correctly (aOR: 1.67, 95% CI 1.06-2.63) compared with those who reported being unemployed, as did men when compared with women (aOR: 1.92, 95% CI 1.59-2.31). Those in the intervention group were more likely to score higher for intention to test for sexually transmitted infections (STIs; aATE 0.21; P=.01) and HIV (aATE 0.32; P=.05), as well as for resisting peer pressure (aATE 2.64; P=.02). IDIs corroborated increased knowledge on correct condom use among men and female condoms among women, awareness of STIs and testing, and resistance to peer pressure. Interviewees provided examples of more open SRH communication with partners and peers and of considering, adopting, and influencing others to adopt healthier behaviors. Conclusions: Despite the high baseline awareness of SRH among Zambian adolescents and young people with internet access, BITKZ provided modest gains in condom-related knowledge, resistance to peer pressure, and intention to test for STIs and HIV. %M 35797099 %R 10.2196/37600 %U https://www.jmir.org/2022/7/e37600 %U https://doi.org/10.2196/37600 %U http://www.ncbi.nlm.nih.gov/pubmed/35797099 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e30088 %T Sociocultural Adjustment and Well-being Among Third Culture Kids and Their Families: Protocol for a Longitudinal Study %A Ooi,Yoon Phaik %A Reed,Marnie %A Marchal-Jones,Emma %A Meyer,Andrea Hans %A Gaab,Jens %+ Division of Clinical Psychology and Psychotherapy, Department of Psychology, University of Basel, Missionsstrasse 62, Basel, 4055, Switzerland, 41 61 20 70748, y.ooi@unibas.ch %K family functioning %K resilience %K sociocultural adjustment %K stress %K third culture kids %K well-being %D 2022 %7 1.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Increasing globalization has led to more families with children being relocated each year, highlighting the importance of issues, such as adjustment and psychological well-being, in this population. These children, commonly known as third culture kids, often spend a significant part of their developmental years in countries and cultures foreign to them. Objective: Our longitudinal study aims to examine the roles of cognitive, psychological, sociocultural, and family factors in the longitudinal trajectories of the well-being and sociocultural adjustment of third culture kids and their families over time. Methods: This study adopts both quantitative and qualitative procedures. Data from both procedures will be collected at baseline and at a 1-year follow-up. We aim to recruit 150 to 200 participants between 7 and 17 years old and one of their primary caregivers. After providing informed consent, participants will complete an online survey. Outcome measures include validated questionnaires on well-being and sociocultural adjustment. Predictor measures include validated questionnaires on negative self-thoughts, emotion regulation, resilience, psychological attributes, self-esteem, stress, acculturative stress, cultural intelligence, couple satisfaction, and family functioning. A multiple regression model will be used to analyze quantitative data. In addition, 15 to 20 families who participate in the online survey will be randomly selected to take part in a family interview focusing on questions related to well-being, relocation experiences, cultural issues, and challenges. A concurrent triangulation mixed methods design will be used to analyze and interpret data from both quantitative and qualitative methods. Results: As of March 15, 2022, a total of 138 children and 126 parents have completed the baseline online survey. In addition, 44 children and 48 parents have completed the 1-year follow-up online survey. A total of 8 families have completed the baseline family interview, while 4 families have completed the 1-year follow-up interview. Data analyses, transcription of the interview, and preparation for publication are on-going. Conclusions: Findings from this study would enable us to understand the adjustment processes, and risk and protective factors associated with the well-being and sociocultural adjustment of third culture kids and their families in Switzerland, which could have implications on the development of intervention programs for individuals and families to address acculturation and adjustment issues. International Registered Report Identifier (IRRID): RR1-10.2196/30088 %M 35776500 %R 10.2196/30088 %U https://www.researchprotocols.org/2022/7/e30088 %U https://doi.org/10.2196/30088 %U http://www.ncbi.nlm.nih.gov/pubmed/35776500 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e28637 %T Present Situation and the Future Development of Web-Based Prenatal Education in China: Cross-sectional Web-Based Survey %A Huang,Xinyu %A Sun,Weiwei %A Wang,Renyu %A Wu,Huailiang %A Yu,Shinning %A Fang,Xuanbi %A Liu,Yiyan %A Akinwunmi,Babatunde %A Huang,Jian %A Ming,Wai-kit %+ Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, 5/F, Block 1, To Yuen Building, 31 To Yuen Street, Tat Chee Avenue, Kowloon, Hong Kong, China (Hong Kong), 852 3442 6956, wkming2@cityu.edu.hk %K web-based prenatal education %K pregnancy %K prenatal %K information technology %D 2022 %7 30.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Pregnancy serves as an important chapter in the life of women since more attention needs to be paid to both their physical and psychological health during this period. Adequate prenatal knowledge plays a key role in ensuring the health and safety of not only the pregnant women but also their fetuses and the entire family. With the development of information technology, web-based prenatal education has been brought into focus owing to its accessibility to comprehensive information, with high-quality information available to improve the quality of the overall gestation period, labor process, perinatal outcomes, and fetal outcomes. Objective: This study aims to investigate the present situation of web-based prenatal education and to predict the future research direction of web-based prenatal education in China, thereby providing insights into improving the quality of health care of pregnant women. Methods: A national cross-sectional study was conducted on 590,912 pregnant women in 31 provincial administrations of mainland China between August 2018 and August 2019. These pregnant women were initially recruited from local hospitals across the nation during antenatal and postnatal periods via a web-based education school. Demographic information and course completion status (including the categories and the number of courses they completed) of all the participants were collected. Results: A total of 590,912 pregnant women participated in the web-based prenatal education in 2018. Among them, 188,508 (31.90%) participants were excluded because they did not complete any course, while 17,807 (3.01%) actively participated in web-based prenatal education and completed more than 100 courses. There were 5 categories of web-based courses; almost half of the pregnant women attended the courses on first and second trimesters (293,262/590,912, 49.63% and 298,168/590,912, 50.46%, respectively). We found that pregnant women were more concerned about the gestational diet, fetal-related knowledge, and other precautions before the labor. Conclusions: In the era of digitalization where information is rapidly disseminated, web-based prenatal education could become a more convenient, productive, and effective pathway for pregnant women since it could help them obtain adequate and optimal pregnancy-related information and gain more intellectual awareness about their pregnancy or preparation for pregnancy. %M 35771613 %R 10.2196/28637 %U https://www.jmir.org/2022/6/e28637 %U https://doi.org/10.2196/28637 %U http://www.ncbi.nlm.nih.gov/pubmed/35771613 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e33414 %T The Association Between Preoperative Patient-Reported Health Status and Postoperative Survey Completion Following Arthroplasty: Registry-Based Cohort Study %A Harris,Ian A %A Peng,Yi %A Ackerman,Ilana %A Graves,Stephen E %+ Ingham Institute for Applied Medical Research, School of Clinical Medicine, University of New South Wales, Medicine and Health, 1 Campbell Street, Liverpool, 2170, Australia, 61 87389254, ianharris@unsw.edu.au %K total knee arthroplasty %K total hip arthroplasty %K patient-reported outcomes %K perioperative medicine %K postoperative medicine %K knee surgery %K arthroplasty %K quality of life %K surgical outcomes %K cohort study %K survey %K health survey %K hip %K knee %K %D 2022 %7 30.6.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Patient-reported outcome measures (PROMs) are commonly used to report outcomes after hip and knee arthroplasty, but response rates are rarely complete. Given that preoperative health status (as measured by PROMs) is a strong predictor of outcomes (using the same measures) and that these outcomes may influence the response rate, it is possible that postoperative response rates (the proportion of patients providing preoperative PROMs who also provide postoperative PROMs) may be influenced by preoperative health status. Objective: This study aims to test the association between preoperative PROMs and postoperative response status following hip and knee arthroplasty. Methods: Data from the PROMs program of the Australian national joint registry were used. The preoperative PROMs were the Oxford Hip Score or Oxford Knee Score, The EQ-5D Utility Index, and the EQ visual analog scale (VAS) for overall health. Logistic regression, adjusting for age, sex, BMI, and the American Society of Anesthesiologists (ASA) Physical Status Classification System, was used to test the association between each preoperative PROM and response status for the 6-month postsurgery survey. Results: Data from 9499 and 16,539 patients undergoing elective total hip arthroplasty (THA) and total knee arthroplasty (TKA) for osteoarthritis, respectively, were included in the analysis. Adjusting for age, sex, BMI, and ASA, there was no significant difference in response status at the postoperative follow-up based on the preoperative Oxford Hip or Knee Scores (odds ratio [OR] 1.00, 95% CI 0.99-1.01 for both; P=.70 for THA and P=.85 for TKA). Healthier patients (based on the EQ VAS scores) preoperatively were more likely to respond postoperatively, but this difference was negligible (OR 1.00, 95% CI 1.00-1.01 for THA and TKA; P=.004 for THA and P<.001 for TKA). The preoperative EQ Utility Index was not associated with the postoperative response rate for THA (OR 1.14, 95% CI 0.96-1.36; P=.13) or TKA patients (OR 1.05, 95% CI 0.91-1.22; P=.49). Conclusions: The likelihood of responding to a postoperative PROMs survey for patients undergoing hip or knee arthroplasty was not associated with clinically important differences in preoperative patient-reported joint pain, function, or health-related quality of life. This suggests that the assessment of postoperative outcomes in hip and knee arthroplasty is not biased by differences in preoperative health measures between responders and nonresponders. %M 35771616 %R 10.2196/33414 %U https://periop.jmir.org/2022/1/e33414 %U https://doi.org/10.2196/33414 %U http://www.ncbi.nlm.nih.gov/pubmed/35771616 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e37192 %T Usability of the Swedish Accessible Electronic Health Record: Qualitative Survey Study %A Hägglund,Maria %A Scandurra,Isabella %+ Healthcare Sciences and e-Health, Department of Women's and Children's Health, Uppsala University, Akademiska Sjukhuset, Dag Hammarskjölds väg 14B, 1tr, Uppsala, 751 85, Sweden, 46 729999381, maria.hagglund@kbh.uu.se %K usability %K evaluation %K patient-accessible electronic health records %K open notes %K patient portals %K mobile phone %D 2022 %7 23.6.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Patient portals are increasingly being implemented worldwide to ensure that patients have timely access to their health data, including patients’ access to their electronic health records. In Sweden, the e-service Journalen is a national patient-accessible electronic health record (PAEHR), accessible on the web through the national patient portal. User characteristics and perceived benefits of using a PAEHR will influence behavioral intentions to use and adoption; however, poor usability, which increases effort expectancy, may have a negative impact. Therefore, it is of interest to further explore how users of the PAEHR Journalen perceive its usability and usefulness. Objective: On the basis of the analysis of the survey respondents’ experiences of the usability of the Swedish PAEHR, this study aimed to identify specific usability problems that may need to be addressed in the future. Methods: A survey study was conducted to elicit opinions and experiences of patients using Journalen. Data were collected from June to October 2016. The questionnaire included a free-text question regarding the usability of the system, and the responses were analyzed using content analysis with a sociotechnical framework as guidance when grouping identified usability issues. Results: During the survey period, 423,141 users logged into Journalen, of whom 2587 (0.61%) completed the survey (unique users who logged in; response rate 0.61%). Of the 2587 respondents, 186 (7.19%) provided free-text comments on the usability questions. The analysis resulted in 19 categories, which could be grouped under 7 of the 8 dimensions in the sociotechnical framework of Sittig and Singh. The most frequently mentioned problems were related to regional access limitations, structure and navigation of the patient portal, and language and understanding. Conclusions: Although the survey respondents, who were also end users of the PAEHR Journalen, were overall satisfied with its usability, they also experienced important challenges when accessing their records. For all patients to be able to reap the benefits of record access, it is essential to understand both the usability challenges they encounter and, more broadly, how policies, regulations, and technical implementation decisions affect the usefulness of record access. The results presented here are specific to the Swedish PAEHR Journalen but also provide important insights into how design and implementation of record access can be improved in any context. %M 35737444 %R 10.2196/37192 %U https://humanfactors.jmir.org/2022/2/e37192 %U https://doi.org/10.2196/37192 %U http://www.ncbi.nlm.nih.gov/pubmed/35737444 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35797 %T Strategies and Lessons Learned During Cleaning of Data From Research Panel Participants: Cross-sectional Web-Based Health Behavior Survey Study %A Arevalo,Mariana %A Brownstein,Naomi C %A Whiting,Junmin %A Meade,Cathy D %A Gwede,Clement K %A Vadaparampil,Susan T %A Tillery,Kristin J %A Islam,Jessica Y %A Giuliano,Anna R %A Christy,Shannon M %+ Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 Magnolia Drive, MFC-EDU, Tampa, FL, 33612, United States, 1 813 745 8840, shannon.christy@moffitt.org %K data cleaning %K data management %K data integrity %K quality assessment %K research panel %K web-based survey %K interdisciplinary research %K surveys and questionnaires %K health behavior %K internet %D 2022 %7 23.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of web-based methods to collect population-based health behavior data has burgeoned over the past two decades. Researchers have used web-based platforms and research panels to study a myriad of topics. Data cleaning prior to statistical analysis of web-based survey data is an important step for data integrity. However, the data cleaning processes used by research teams are often not reported. Objective: The objectives of this manuscript are to describe the use of a systematic approach to clean the data collected via a web-based platform from panelists and to share lessons learned with other research teams to promote high-quality data cleaning process improvements. Methods: Data for this web-based survey study were collected from a research panel that is available for scientific and marketing research. Participants (N=4000) were panelists recruited either directly or through verified partners of the research panel, were aged 18 to 45 years, were living in the United States, had proficiency in the English language, and had access to the internet. Eligible participants completed a health behavior survey via Qualtrics. Informed by recommendations from the literature, our interdisciplinary research team developed and implemented a systematic and sequential plan to inform data cleaning processes. This included the following: (1) reviewing survey completion speed, (2) identifying consecutive responses, (3) identifying cases with contradictory responses, and (4) assessing the quality of open-ended responses. Implementation of these strategies is described in detail, and the Checklist for E-Survey Data Integrity is offered as a tool for other investigators. Results: Data cleaning procedures resulted in the removal of 1278 out of 4000 (31.95%) response records, which failed one or more data quality checks. First, approximately one-sixth of records (n=648, 16.20%) were removed because respondents completed the survey unrealistically quickly (ie, <10 minutes). Next, 7.30% (n=292) of records were removed because they contained evidence of consecutive responses. A total of 4.68% (n=187) of records were subsequently removed due to instances of conflicting responses. Finally, a total of 3.78% (n=151) of records were removed due to poor-quality open-ended responses. Thus, after these data cleaning steps, the final sample contained 2722 responses, representing 68.05% of the original sample. Conclusions: Examining data integrity and promoting transparency of data cleaning reporting is imperative for web-based survey research. Ensuring a high quality of data both prior to and following data collection is important. Our systematic approach helped eliminate records flagged as being of questionable quality. Data cleaning and management procedures should be reported more frequently, and systematic approaches should be adopted as standards of good practice in this type of research. %M 35737436 %R 10.2196/35797 %U https://formative.jmir.org/2022/6/e35797 %U https://doi.org/10.2196/35797 %U http://www.ncbi.nlm.nih.gov/pubmed/35737436 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e38099 %T Health Indicators as Measures of Individual Health Status and Their Public Perspectives: Cross-sectional Survey Study %A Sokoya,Temiloluwa %A Zhou,Yuchun %A Diaz,Sebastian %A Law,Timothy %A Himawan,Lina %A Lekey,Francisca %A Shi,Lu %A Gimbel,Ronald W %A Jing,Xia %+ Department of Public Health Sciences, College of Behavioral, Social, and Health Sciences, Clemson University, 511 Edwards Hall, Clemson, SC, 29634, United States, 1 8646563347, xia.xjing@gmail.com %K health status measurement %K individual health indicators %K public perspectives %K surveys and questionnaires %D 2022 %7 21.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Disease status (eg, cancer stage) has been used in routine clinical practice to determine more accurate treatment plans. Health-related indicators, such as mortality, morbidity, and population group life expectancy, have also been used. However, few studies have specifically focused on the comprehensive and objective measures of individual health status. Objective: The aim of this study was to analyze the perspectives of the public toward 29 health indicators obtained from a literature review to provide evidence for further prioritization of the indicators. The difference between health status and disease status should be considered. Methods: This study used a cross-sectional design. Online surveys were administered through Ohio University, ResearchMatch, and Clemson University, resulting in three samples. Participants aged 18 years or older rated the importance of the 29 health indicators. The rating results were aggregated and analyzed as follows (in each case, the dependent variables were the individual survey responses): (1) to determine the agreement among the three samples regarding the importance of each indicator, where the independent variables (IVs) were the three samples; (2) to examine the mean differences between the retained indicators with agreement across the three samples, where the IVs were the identified indicators; and (3) to rank the groups of indicators into various levels after grouping the indicators with no mean differences, where the IVs were the groups of indicators. Results: In total, 1153 valid responses were analyzed. Descriptive statistics revealed that the top five–rated indicators were drug or substance abuse, smoking or tobacco use, alcohol abuse, major depression, and diet and nutrition. Among the 29 health indicators, the three samples agreed upon the importance of 13 indicators. Inferential statistical analysis indicated that some of the 13 indicators held equal importance. Therefore, the 13 indicators were categorized by rank into seven levels: level 1 included blood sugar level and immunization and vaccination; level 2 included LDL cholesterol; level 3 included HDL cholesterol, blood triglycerides, cancer screening detection, and total cholesterol; level 4 included health literacy rate; level 5 included personal care needs and air quality index greater than 100; level 6 included self-rated health status and HIV testing; and level 7 included the supply of dentists. Levels 1 to 3 were rated significantly higher than levels 4 to 7. Conclusions: This study provides a baseline for prioritizing 29 health indicators, which can be used by electronic health record or personal health record system designers or developers to determine what can be included in the systems to capture an individual’s health status. Currently, self-rated health status is the predominantly used health indicator. Additionally, this study provides a foundation for tracking and measuring preventive health care services more accurately and for developing an individual health status index. %M 35623051 %R 10.2196/38099 %U https://www.jmir.org/2022/6/e38099 %U https://doi.org/10.2196/38099 %U http://www.ncbi.nlm.nih.gov/pubmed/35623051 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e30216 %T The Benefits of Crowdsourcing to Seed and Align an Algorithm in an mHealth Intervention for African American and Hispanic Adults: Survey Study %A Sehgal,Neil Jay %A Huang,Shuo %A Johnson,Neil Mason %A Dickerson,John %A Jackson,Devlon %A Baur,Cynthia %+ Department of Health Policy and Management, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD, 20742, United States, 1 3014052469, sehgal@umd.edu %K crowdsourcing %K health information %K health promotion %K prevention %K public health informatics %K African American, Black, Latino, and Hispanic populations %K recommender system %K RecSys %K machine learning %K Mechanical Turk %K MTurk %K mobile phone %D 2022 %7 21.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The lack of publicly available and culturally relevant data sets on African American and bilingual/Spanish-speaking Hispanic adults’ disease prevention and health promotion priorities presents a major challenge for researchers and developers who want to create and test personalized tools built on and aligned with those priorities. Personalization depends on prediction and performance data. A recommender system (RecSys) could predict the most culturally and personally relevant preventative health information and serve it to African American and Hispanic users via a novel smartphone app. However, early in a user’s experience, a RecSys can face the “cold start problem” of serving untailored and irrelevant content before it learns user preferences. For underserved African American and Hispanic populations, who are consistently being served health content targeted toward the White majority, the cold start problem can become an example of algorithmic bias. To avoid this, a RecSys needs population-appropriate seed data aligned with the app’s purposes. Crowdsourcing provides a means to generate population-appropriate seed data. Objective: Our objective was to identify and test a method to address the lack of culturally specific preventative personal health data and sidestep the type of algorithmic bias inherent in a RecSys not trained in the population of focus. We did this by collecting a large amount of data quickly and at low cost from members of the population of focus, thereby generating a novel data set based on prevention-focused, population-relevant health goals. We seeded our RecSys with data collected anonymously from self-identified Hispanic and self-identified non-Hispanic African American/Black adult respondents, using Amazon Mechanical Turk (MTurk). Methods: MTurk provided the crowdsourcing platform for a web-based survey in which respondents completed a personal profile and a health information–seeking assessment, and provided data on family health history and personal health history. Respondents then selected their top 3 health goals related to preventable health conditions, and for each goal, reviewed and rated the top 3 information returns by importance, personal utility, whether the item should be added to their personal health library, and their satisfaction with the quality of the information returned. This paper reports the article ratings because our intent was to assess the benefits of crowdsourcing to seed a RecSys. The analysis of the data from health goals will be reported in future papers. Results: The MTurk crowdsourcing approach generated 985 valid responses from 485 (49%) self-identified Hispanic and 500 (51%) self-identified non-Hispanic African American adults over the course of only 64 days at a cost of US $6.74 per respondent. Respondents rated 92 unique articles to inform the RecSys. Conclusions: Researchers have options such as MTurk as a quick, low-cost means to avoid the cold start problem for algorithms and to sidestep bias and low relevance for an intended population of app users. Seeding a RecSys with responses from people like the intended users allows for the development of a digital health tool that can recommend information to users based on similar demography, health goals, and health history. This approach minimizes the potential, initial gaps in algorithm performance; allows for quicker algorithm refinement in use; and may deliver a better user experience to individuals seeking preventative health information to improve health and achieve health goals. %M 35727616 %R 10.2196/30216 %U https://www.jmir.org/2022/6/e30216 %U https://doi.org/10.2196/30216 %U http://www.ncbi.nlm.nih.gov/pubmed/35727616 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e34666 %T Vaccination Intention and Behavior of the General Public in China: Cross-sectional Survey and Moderated Mediation Model Analysis %A Yang,Liuqing %A Ji,Lili %A Wang,Qiang %A Xu,Yan %A Yang,Guoping %A Cui,Tingting %A Shi,Naiyang %A Zhu,Lin %A Xiu,Shixin %A Jin,Hui %A Zhen,Shiqi %+ Department of Epidemiology and Health Statistic, School of Public Health, Southeast University, 87# Dingjiaqiao, Nanjing, 210009, China, 86 025 8327 2572, jinhui_hld@163.com %K vaccine %K theory of planned behavior %K attitude %K subjective norms %K perceived behavior control %K moderator %K mediation %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Promoting vaccination and eliminating vaccine hesitancy are key measures for controlling vaccine-preventable diseases. Objective: We aimed to understand the beliefs surrounding and drivers of vaccination behavior, and their relationships with and influence on vaccination intention and practices. Methods: We conducted a web-based survey in 31 provinces in mainland China from May 24, 2021 to June 15, 2021, with questions pertaining to vaccination in 5 dimensions: attitude, subjective norms, perceived behavioral control, intention, and behavior. We performed hierarchical regression analysis and structural equation modeling based on the theory of planned behavior—in which, the variables attitude, subjective norms, and intention each affect the variable intention; the variable intention mediates the relationships of attitude and subjective norms with behavior, and the variable perceived behavioral control moderates the strength of this mediation—to test the validity of the theoretical framework. Results: A total of 9924 participants, aged 18 to 59 years, were included in this study. Vaccination intention mediated the relationships of attitude and subjective norms with vaccination behavior. The indirect effect of attitude on vaccination behavior was 0.164 and that of subjective norms was 0.255, and the difference was statistically significant (P<.001). The moderated mediation analysis further indicated that perceived behavioral control would affect the mediation when used as moderator, and the interaction terms for attitude (β=–0.052, P<.001) and subjective norms (β=–0.028, P=.006) with perceived behavioral control were significant. Conclusions: Subjective norms have stronger positive influences on vaccination practices than attitudes. Perceived behavioral control, as a moderator, has a substitution relationship with attitudes and subjective norms and weakens their positive effects on vaccination behavior. %M 35723904 %R 10.2196/34666 %U https://publichealth.jmir.org/2022/6/e34666 %U https://doi.org/10.2196/34666 %U http://www.ncbi.nlm.nih.gov/pubmed/35723904 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33709 %T Evaluation of Normalization After Implementation of the Digital Dutch Obstetric Telephone Triage System: Mixed Methods Study With a Questionnaire Survey and Focus Group Discussion %A Engeltjes,Bernice %A Rosman,Ageeth %A Scheele,Fedde %A Vis,Christiaan %A Wouters,Eveline %+ Department of Healthcare Studies, Rotterdam University of Applied Sciences, Rochussenstraat 198, Rotterdam, 3015AK, Netherlands, 31 641804881, engeltjesbernice@gmail.com %K obstetric triage %K Normalization Process Theory %K implementation strategy %K hierarchy %K medical staff %D 2022 %7 17.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Dutch Obstetric Telephone Triage System (DOTTS) was developed to improve the quality of acute obstetric care. To achieve optimal effect, the DOTTS should be adopted in the daily care process by triage staff. Objective: The primary aim was to evaluate the degree of implementation (ie, normalization) of the DOTTS, and the secondary aim was to evaluate which lessons can be learned from its current implementation in Dutch hospitals. Methods: An evaluation study with a mixed methods design was performed. All triage staff in 9 Dutch hospitals that implemented the DOTTS before September 1, 2019, were invited to complete the Normalization Measure Development (NoMAD) questionnaire between December 2019 and July 2020. The questionnaire is based on the Normalization Process Theory (NPT). This self-reported questionnaire provides insights into the work people do in order to integrate and embed new practice in routine care. The NPT is based on the following 4 constructs: coherence, cognitive participation, collective action, and reflexive monitoring. Within the questionnaire, each construct is represented by 4-7 questions. Questions are scored on a 5-point normalization process scale. Descriptive statistics were used for analysis of questionnaire scores. Subsequently, the questionnaire findings were discussed during a focus group. Template analysis following the 4 constructs was used for analyzing the results of the focus group. Results: Overall, 173 of 294 (58.8%) triage staff members completed the NoMAD questionnaire, and 90.2% (156/173) of the participants had used the DOTTS for over 6 months. The digital application was used as much as possible or always by 137 of 173 (79.2%) participants. The overall normalization process score was 3.77 (SD 0.36). The constructs coherence, cognitive participation, collective action, and reflexive monitoring scored 4.01 (SD 0.47), 4.05 (SD 0.45), 3.5 (SD 0.45), and 3.72 (SD 0.47), respectively. Analysis of the focus group discussion showed that the added value of the DOTTS was seen as a quality improvement for the care of pregnant women. Dedication of the complete multidisciplinary implementation team was important for facilitating normalization. Support from the medical staff and proper use by all disciplines involved in the triage were seen as facilitating factors. Participants appreciated training and evaluation, and indicated a need for ongoing training and evaluation in relation to goal achievement. Conclusions: The DOTTS has been integrated into normal care in daily practice. Evaluation by the NoMAD questionnaire provided a positive overall score. These results are in line with or, in some aspects, better than the results of other evaluation studies. Key factors in the normalization process of the DOTTS in obstetric triage are the shared added value for stakeholders, the dedication of the complete multidisciplinary implementation team, and implementation plans that are tailor made in the practical context of the hospital. %M 35616176 %R 10.2196/33709 %U https://formative.jmir.org/2022/6/e33709 %U https://doi.org/10.2196/33709 %U http://www.ncbi.nlm.nih.gov/pubmed/35616176 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e29856 %T Tailoring Mobile Data Collection for Intervention Research in a Challenging Context: Development and Implementation in the Malakit Study %A Lambert,Yann %A Galindo,Muriel %A Suárez-Mutis,Martha %A Mutricy,Louise %A Sanna,Alice %A Garancher,Laure %A Cairo,Hedley %A Hiwat,Helene %A Bordalo Miller,Jane %A Gomes,José Hermenegildo %A Marchesini,Paola %A Adenis,Antoine %A Nacher,Mathieu %A Vreden,Stephen %A Douine,Maylis %+ Centre d’Investigation Clinique Antilles-Guyane, Institut national de la santé et de la recherche médicale (Inserm 1424), Centre Hospitalier de Cayenne Andrée Rosemon, Avenue des Flamboyants, Cayenne, 97300, French Guiana, 594 594 39 48 64, yann.lambert@ch-cayenne.fr %K malaria %K Guiana Shield %K information system %K mobile data collection %K Open Data Kit %K ODK %D 2022 %7 16.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: An interventional study named Malakit was implemented between April 2018 and March 2020 to address malaria in gold mining areas in French Guiana, in collaboration with Suriname and Brazil. This innovative intervention relied on the distribution of kits for self-diagnosis and self-treatment to gold miners after training by health mediators, referred to in the project as facilitators. Objective: This paper aims to describe the process by which the information system was designed, developed, and implemented to achieve the monitoring and evaluation of the Malakit intervention. Methods: The intervention was implemented in challenging conditions at five cross-border distribution sites, which imposed strong logistical constraints for the design of the information system: isolation in the Amazon rainforest, tropical climate, and lack of reliable electricity supply and internet connection. Additional constraints originated from the interaction of the multicultural players involved in the study. The Malakit information system was developed as a patchwork of existing open-source software, commercial services, and tools developed in-house. Facilitators collected data from participants using Android tablets with ODK (Open Data Kit) Collect. A custom R package and a dashboard web app were developed to retrieve, decrypt, aggregate, monitor, and clean data according to feedback from facilitators and supervision visits on the field. Results: Between April 2018 and March 2020, nine facilitators generated a total of 4863 form records, corresponding to an average of 202 records per month. Facilitators’ feedback was essential for adapting and improving mobile data collection and monitoring. Few technical issues were reported. The median duration of data capture was 5 (IQR 3-7) minutes, suggesting that electronic data capture was not taking more time from participants, and it decreased over the course of the study as facilitators become more experienced. The quality of data collected by facilitators was satisfactory, with only 3.03% (147/4849) of form records requiring correction. Conclusions: The development of the information system for the Malakit project was a source of innovation that mirrored the inventiveness of the intervention itself. Our experience confirms that even in a challenging environment, it is possible to produce good-quality data and evaluate a complex health intervention by carefully adapting tools to field constraints and health mediators’ experience. Trial Registration: ClinicalTrials.gov NCT03695770; https://clinicaltrials.gov/ct2/show/NCT03695770 %M 35708763 %R 10.2196/29856 %U https://formative.jmir.org/2022/6/e29856 %U https://doi.org/10.2196/29856 %U http://www.ncbi.nlm.nih.gov/pubmed/35708763 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e37327 %T COVID-19 Surveillance in the Biobank at the Colorado Center for Personalized Medicine: Observational Study %A Johnson,Randi K %A Marker,Katie M %A Mayer,David %A Shortt,Jonathan %A Kao,David %A Barnes,Kathleen C %A Lowery,Jan T %A Gignoux,Christopher R %+ Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado School of Medicine, 13001 E 17th Place, Mail Stop 563, Aurora, CO, 80045, United States, 1 3037245375, randi.johnson@cuanschutz.edu %K COVID-19 %K surveillance %K pandemic %K biobank %K EHR %K public health %K integrated data %K population health %K health monitoring %K electronic health record %K eHealth %K health record %K emergency response %K vaccination status %K vaccination %K testing %K symptom %K disease impact %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Characterizing the experience and impact of the COVID-19 pandemic among various populations remains challenging due to the limitations inherent in common data sources, such as electronic health records (EHRs) or cross-sectional surveys. Objective: This study aims to describe testing behaviors, symptoms, impact, vaccination status, and case ascertainment during the COVID-19 pandemic using integrated data sources. Methods: In summer 2020 and 2021, we surveyed participants enrolled in the Biobank at the Colorado Center for Personalized Medicine (CCPM; N=180,599) about their experience with COVID-19. The prevalence of testing, symptoms, and impacts of COVID-19 on employment, family life, and physical and mental health were calculated overall and by demographic categories. Survey respondents who reported receiving a positive COVID-19 test result were considered a “confirmed case” of COVID-19. Using EHRs, we compared COVID-19 case ascertainment and characteristics in EHRs versus the survey. Positive cases were identified in EHRs using the International Statistical Classification of Diseases, 10th revision (ICD-10) diagnosis codes, health care encounter types, and encounter primary diagnoses. Results: Of the 25,063 (13.9%) survey respondents, 10,661 (42.5%) had been tested for COVID-19, and of those, 1366 (12.8%) tested positive. Nearly half of those tested had symptoms or had been exposed to someone who was infected. Young adults (18-29 years) and Hispanics were more likely to have positive tests compared to older adults and persons of other racial/ethnic groups. Mental health (n=13,688, 54.6%) and family life (n=12,233, 48.8%) were most negatively affected by the pandemic and more so among younger groups and women; negative impacts on employment were more commonly reported among Black respondents. Of the 10,249 individuals who responded to vaccination questions from version 2 of the survey (summer 2021), 9770 (95.3%) had received the vaccine. After integration with EHR data up to the time of the survey completion, 1006 (4%) of the survey respondents had a discordant COVID-19 case status between EHRs and the survey. Using all longitudinal EHR and survey data, we identified 11,472 (6.4%) COVID-19-positive cases among Biobank participants. In comparison to COVID-19 cases identified through the survey, EHR-identified cases were younger and more likely to be Hispanic. Conclusions: We found that the COVID-19 pandemic has had far-reaching and varying effects among our Biobank participants. Integrated data assets, such as the Biobank at the CCPM, are key resources for population health monitoring in response to public health emergencies, such as the COVID-19 pandemic. %M 35486493 %R 10.2196/37327 %U https://publichealth.jmir.org/2022/6/e37327 %U https://doi.org/10.2196/37327 %U http://www.ncbi.nlm.nih.gov/pubmed/35486493 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e34191 %T Electronic Health Record–Based Recruitment and Retention and Mobile Health App Usage: Multisite Cohort Study %A Coughlin,Janelle W %A Martin,Lindsay M %A Zhao,Di %A Goheer,Attia %A Woolf,Thomas B %A Holzhauer,Katherine %A Lehmann,Harold P %A Lent,Michelle R %A McTigue,Kathleen M %A Clark,Jeanne M %A Bennett,Wendy L %+ Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 5510 Nathan Shock Drive Suite 100, Baltimore, MD, 21224, United States, 1 410 550 7988, jwilder3@jhmi.edu %K mHealth %K mobile apps %K recruitment %K engagement %K retention %K timing of eating %K timing of sleep %K obesity %K EHR %D 2022 %7 10.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: To address the obesity epidemic, there is a need for novel paradigms, including those that address the timing of eating and sleep in relation to circadian rhythms. Electronic health records (EHRs) are an efficient way to identify potentially eligible participants for health research studies. Mobile health (mHealth) apps offer available and convenient data collection of health behaviors, such as timing of eating and sleep. Objective: The aim of this descriptive analysis was to report on recruitment, retention, and app use from a 6-month cohort study using a mobile app called Daily24. Methods: Using an EHR query, adult patients from three health care systems in the PaTH clinical research network were identified as potentially eligible, invited electronically to participate, and instructed to download and use the Daily24 mobile app, which focuses on eating and sleep timing. Online surveys were completed at baseline and 4 months. We described app use and identified predictors of app use, defined as 1 or more days of use, versus nonuse and usage categories (ie, immediate, consistent, and sustained) using multivariate regression analyses. Results: Of 70,661 patients who were sent research invitations, 1021 (1.44%) completed electronic consent forms and online baseline surveys; 4 withdrew, leaving a total of 1017 participants in the analytic sample. A total of 53.79% (n=547) of the participants were app users and, of those, 75.3% (n=412), 50.1% (n=274), and 25.4% (n=139) were immediate, consistent, and sustained users, respectively. Median app use was 28 (IQR 7-75) days over 6 months. Younger age, White race, higher educational level, higher income, having no children younger than 18 years, and having used 1 to 5 health apps significantly predicted app use (vs nonuse) in adjusted models. Older age and lower BMI predicted early, consistent, and sustained use. About half (532/1017, 52.31%) of the participants completed the 4-month online surveys. A total of 33.5% (183/547), 29.3% (157/536), and 27.1% (143/527) of app users were still using the app for at least 2 days per month during months 4, 5, and 6 of the study, respectively. Conclusions: EHR recruitment offers an efficient (ie, high reach, low touch, and minimal participant burden) approach to recruiting participants from health care settings into mHealth research. Efforts to recruit and retain less engaged subgroups are needed to collect more generalizable data. Additionally, future app iterations should include more evidence-based features to increase participant use. %M 35687400 %R 10.2196/34191 %U https://www.jmir.org/2022/6/e34191 %U https://doi.org/10.2196/34191 %U http://www.ncbi.nlm.nih.gov/pubmed/35687400 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35032 %T An Electronic Data Capture Tool for Data Collection During Public Health Emergencies: Development and Usability Study %A Brown,Joan %A Bhatnagar,Manas %A Gordon,Hugh %A Goodner,Jared %A Cobb,J Perren %A Lutrick,Karen %+ Clinical Operations Business Intelligence, The Keck School of Medicine of the University of Southern California, 1520 San Pablo St, Los Angeles, CA, 90033, United States, 1 310 245 8079, joancbrown@gmail.com %K clinical research design %K disaster management %K informatics %K public health emergencies %K electronic data capture %K design tenet %K public health emergency %K electronic data %K EDCT %K real time data %D 2022 %7 9.6.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The Discovery Critical Care Research Network Program for Resilience and Emergency Preparedness (Discovery PREP) partnered with a third-party technology vendor to design and implement an electronic data capture tool that addressed multisite data collection challenges during public health emergencies (PHE) in the United States. The basis of the work was to design an electronic data capture tool and to prospectively gather data on usability from bedside clinicians during national health system stress queries and influenza observational studies. Objective: The aim of this paper is to describe the lessons learned in the design and implementation of a novel electronic data capture tool with the goal of significantly increasing the nation’s capability to manage real-time data collection and analysis during PHE. Methods: A multiyear and multiphase design approach was taken to create an electronic data capture tool, which was used to pilot rapid data capture during a simulated PHE. Following the pilot, the study team retrospectively assessed the feasibility of automating the data captured by the electronic data capture tool directly from the electronic health record. In addition to user feedback during semistructured interviews, the System Usability Scale (SUS) questionnaire was used as a basis to evaluate the usability and performance of the electronic data capture tool. Results: Participants included Discovery PREP physicians, their local administrators, and data collectors from tertiary-level academic medical centers at 5 different institutions. User feedback indicated that the designed system had an intuitive user interface and could be used to automate study communication tasks making for more efficient management of multisite studies. SUS questionnaire results classified the system as highly usable (SUS score 82.5/100). Automation of 17 (61%) of the 28 variables in the influenza observational study was deemed feasible during the exploration of automated versus manual data abstraction. The creation and use of the Project Meridian electronic data capture tool identified 6 key design requirements for multisite data collection, including the need for the following: (1) scalability irrespective of the type of participant; (2) a common data set across sites; (3) automated back end administrative capability (eg, reminders and a self-service status board); (4) multimedia communication pathways (eg, email and SMS text messaging); (5) interoperability and integration with local site information technology infrastructure; and (6) natural language processing to extract nondiscrete data elements. Conclusions: The use of the electronic data capture tool in multiple multisite Discovery PREP clinical studies proved the feasibility of using the novel, cloud-based platform in practice. The lessons learned from this effort can be used to inform the improvement of ongoing global multisite data collection efforts during the COVID-19 pandemic and transform current manual data abstraction approaches into reliable, real time, and automated information exchange. Future research is needed to expand the ability to perform automated multisite data extraction during a PHE and beyond. %M 35679114 %R 10.2196/35032 %U https://humanfactors.jmir.org/2022/2/e35032 %U https://doi.org/10.2196/35032 %U http://www.ncbi.nlm.nih.gov/pubmed/35679114 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e37356 %T Comparison of the ACASI Mode to Other Survey Modes in Sexual Behavior Surveys in Asia and Sub-Saharan Africa: Systematic Literature Review %A Phoo,Nang Nge Nge %A Lobo,Roanna %A Vujcich,Daniel %A Reid,Alison %+ School of Population Health, Curtin University, Kent Street, Bentley WA, Perth, 6102, Australia, 61 0414954410, nangngenge.phoo@curtin.edu.au %K ACASI %K survey mode %K sexual behaviors %K HIV %K STI %K hepatitis %K blood-borne virus %K Asia %K sub-Saharan Africa %K review %D 2022 %7 31.5.2022 %9 Review %J J Med Internet Res %G English %X Background: Reliable data about sexual behaviors is fundamental in the prevention and control of HIV, hepatitis, and other sexually transmitted infections. Generally, sexual behaviors are regarded as a sociocultural taboo in Africa and Asia, and this results in biased sexual behavior survey data due to social desirability. Various modes of survey delivery, including audio computer-assisted self-interviews (ACASIs), have been investigated to improve data quality. Objective: This study aimed to review studies that compared the ACASI mode to other survey modes in sexual behavior surveys in Asia and sub-Saharan Africa to ascertain the impact of survey mode on responses to sexual behavior questions. Methods: A systematic literature review was conducted according to the Joanna Briggs Institute Manual for Evidence Synthesis. The review protocol was registered at PROSPERO (International Prospective Register of Systematic Reviews). Six databases were searched. Results: A total of 21 papers were included. The face-to-face interview (FTFI) mode was the survey mode most frequently compared to the ACASI mode. Among the most commonly reported outcome variable groups, ACASI participants were more likely to report sexual behaviors, such as “forced sex,” “multiple partners,” “transactional sex,” and “ever had sex,” as compared to FTFI participants. In addition to the survey mode effect, other factors were found to have had an impact on data quality, for example, participant characteristics, social norms, study design, and data collection setting. Conclusions: Use of ACASIs for administering sexual behavior surveys among populations in Asia and sub-Saharan Africa demonstrated higher reports for some sexual behaviors than the use of FTFIs. More studies that compare the ACASI mode to other survey modes would improve our understanding of the usefulness of ACASIs in sexual behavior surveys in these regions. %M 35639465 %R 10.2196/37356 %U https://www.jmir.org/2022/5/e37356 %U https://doi.org/10.2196/37356 %U http://www.ncbi.nlm.nih.gov/pubmed/35639465 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e37328 %T The Efficacy of a Brief, Altruism-Eliciting Video Intervention in Enhancing COVID-19 Vaccination Intentions Among a Population-Based Sample of Younger Adults: Randomized Controlled Trial %A Zhu,Patricia %A Tatar,Ovidiu %A Griffin-Mathieu,Gabrielle %A Perez,Samara %A Haward,Ben %A Zimet,Gregory %A Tunis,Matthew %A Dubé,Ève %A Rosberger,Zeev %+ Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, QC, H3T1E4, Canada, 1 514 340 8222 ext 23978, ovidiu.tatar@mail.mcgill.ca %K COVID-19 %K vaccination %K altruism %K prosocial motives %K video intervention %K randomized controlled trial %K younger adults %K vaccine hesitancy %K public health %K youth %K digital intervention %K health intervention %K health promotion %K web survey %K digital health %K online health %K health information %D 2022 %7 30.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: High COVID-19 vaccine uptake is crucial to containing the pandemic and reducing hospitalizations and deaths. Younger adults (aged 20-39 years) have demonstrated lower levels of vaccine uptake compared to older adults, while being more likely to transmit the virus due to a higher number of social contacts. Consequently, this age group has been identified by public health authorities as a key target for vaccine uptake. Previous research has demonstrated that altruistic messaging and motivation is associated with vaccine acceptance. Objective: This study had 2 objectives: (1) to evaluate the within-group efficacy of an altruism-eliciting short, animated video intervention in increasing COVID-19 vaccination intentions amongst unvaccinated Canadian younger adults and (2) to examine the video’s efficacy compared to a text-based intervention focused exclusively on non-vaccine-related COVID-19 preventive health measures. Methods: Using a web-based survey in a pre-post randomized control trial (RCT) design, we recruited Canadians aged 20-39 years who were not yet vaccinated against COVID-19 and randomized them in a 1:1 ratio to receive either the video intervention or an active text control. The video intervention was developed by our team in collaboration with a digital media company. The measurement of COVID-19 vaccination intentions before and after completing their assigned intervention was informed by the multistage Precaution Adoption Process Model (PAPM). The McNemar chi-square test was performed to evaluate within-group changes of vaccine intentions. Exact tests of symmetry using pairwise McNemar tests were applied to evaluate changes in multistaged intentions. Between-group vaccine intentions were assessed using the Pearson chi-square test postintervention. Results: Analyses were performed on 1373 participants (n=686, 50%, in the video arm, n=687, 50%, in the text arm). Within-group results for the video intervention arm showed that there was a significant change in the intention to receive the vaccine (χ21=20.55, P<.001). The between-group difference in postintervention intentions (χ23=1.70, P=.64) was not significant. When administered the video intervention, we found that participants who had not thought about or were undecided about receiving a COVID-19 vaccine were more amenable to change than participants who had already decided not to vaccinate. Conclusions: Although the video intervention was limited in its effect on those who had firmly decided not to vaccinate, our study demonstrates that prosocial and altruistic messages could increase COVID-19 vaccine uptake, especially when targeted to younger adults who are undecided or unengaged regarding vaccination. This might indicate that altruistic messaging provides a “push” for those who are tentative toward, or removed from, the decision to receive the vaccine. The results of our study could also be applied to more current COVID-19 vaccination recommendations (eg, booster shots) and for other vaccine-preventable diseases. Trial Registration: ClinicalTrials.gov NCT04960228; https://clinicaltrials.gov/ct2/show/NCT04960228 %M 35544437 %R 10.2196/37328 %U https://publichealth.jmir.org/2022/5/e37328 %U https://doi.org/10.2196/37328 %U http://www.ncbi.nlm.nih.gov/pubmed/35544437 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e35771 %T Telephone and Web-Based Delivery of Healthy Eating and Active Living Interventions for Parents of Children Aged 2 to 6 Years: Mixed Methods Process Evaluation of the Time for Healthy Habits Translation Trial %A Hammersley,Megan L %A Wyse,Rebecca J %A Jones,Rachel A %A Okely,Anthony D %A Wolfenden,Luke %A Eckermann,Simon %A Xu,Joe %A Green,Amanda %A Stacey,Fiona %A Yoong,Sze Lin %A Jackson,Jacklyn %A Innes-Hughes,Christine %A Li,Vincy %A Rissel,Chris %+ Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Northfields Ave, Wollongong, 2522, Australia, 61 242215670, mhammers@uow.edu.au %K dietary intake %K physical activity %K screen time %K sleep %K movement behaviors %K online %K internet %K telephone %K mobile phone %D 2022 %7 26.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Few translational trials have provided detailed reports of process evaluation results. Objective: This study reported on findings from a mixed methods process evaluation of a large translational trial comparing 2 remotely delivered healthy eating and active living interventions with an active control, targeting parents of young children. Methods: Mixed methods process evaluation data were collected as part of a 3-arm, partially randomized preference trial targeting parents of children aged 2 to 6 years from New South Wales, Australia. Recruitment strategies were assessed through the participant baseline questionnaire and a questionnaire completed by the health promotion staff involved in recruitment. Data on participants’ intervention preferences were collected at baseline and after the intervention. Intervention acceptability and demographic data were collected via a postintervention questionnaire (approximately 3 months after baseline), which was supplemented by qualitative participant interviews. Implementation data on intervention fidelity and withdrawal were also recorded. Differences in intervention acceptability, fidelity, and withdrawal rates between telephone and web-based interventions and between randomized and nonrandomized participants were analyzed. The significance level was set at P<.05 for all tests. The interview content was analyzed, key themes were drawn from participant responses, and findings were described narratively. Results: Data were collected from 458 participants in the baseline survey and 144 (31.4%) participants in the 3-month postintervention survey. A total of 30 participants completed the qualitative interviews. A total of 6 health promotion staff members participated in the survey on recruitment strategies. Most participants were recruited from Early Childhood Education and Care services. There was a broad reach of the study; however, better take-up rates were observed in regional and rural areas compared with metropolitan areas. Parents with a university education were overrepresented. Most participants preferred the web-based medium of delivery at baseline. There was high acceptability of the web-based and telephone interventions. Participants found the healthy eating content to be the most useful component of the modules (web-based) and calls (telephone). They regarded text (web-based) or verbal (telephone) information as the most useful component. A high proportion of participants completed the telephone intervention compared with the web-based intervention; however, more participants actively withdrew from the telephone intervention. Conclusions: This is one of the first studies to comprehensively report on process evaluation data from a translation trial, which demonstrated high acceptability of all interventions but a strong participant preference for the web-based intervention. This detailed process evaluation is critical to inform further implementation and be considered alongside the effectiveness outcomes. %M 35616994 %R 10.2196/35771 %U https://www.jmir.org/2022/5/e35771 %U https://doi.org/10.2196/35771 %U http://www.ncbi.nlm.nih.gov/pubmed/35616994 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e32278 %T Factors Associated With Protective Mask-Wearing Behavior to Avoid COVID-19 Infection in China: Internet-Based Cross-sectional Study %A Xu,Yue %A Wu,Qingqing %A Xu,Shuiyang %A Zhao,Yusui %A Zhang,Xuehai %+ Department of Health Education, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China, 86 87115248, xhzhang@cdc.zj.cn %K COVID-19 %K internet-based %K disease prevention %K mask %K knowledge %K behavior %D 2022 %7 26.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The novel coronavirus disease COVID-19 is likely to spread from person to person in close-contact settings. The Chinese Center for Disease Control and Prevention released a handbook on COVID-19, which introduced health information to the public, specifically related to wearing masks correctly and adopting preventive measures to avoid COVID-19 infection. Objective: The aim of this study was to assess the level of mask knowledge, behavior related to mask usage, and major information channels used for obtaining mask- and COVID-19–related information in China. Methods: An internet-based survey was conducted primarily using DingXiang Doctor WeChat public accounts. The data about mask knowledge and behavior were collected and analyzed. In addition to descriptive statistics, logistic regression was used to analyze significant risk factors contributing to protective mask behavior. Results: Data were collected from a total of 10,304 respondents to the survey. More than half of the respondents were under 30 years old and nearly three-quarters were women. Over 80% of participants had a bachelor’s degree or higher, and the largest proportion of respondents (n=4204, 40.80%) were employed as business/service workers. Over half of the study participants were married (n=5302, 51.46%). The findings revealed that 67.49% (6954/10,304) of the participants practiced protective mask behavior; 97.93% (10,091/10,304) believed that wearing masks is an effective protective measure against COVID-19; 96.85% (9979/10,304) chose a mask that has two or more layers of washable, breathable fabric; and 70.57% (7272/10,304) wore the masks correctly. Gender, age, occupation, and education level had significant effects on behavior, whereas marital status and the infection status of family members were not significantly related to mask-wearing behavior. In addition, WeChat public accounts (9227/10,304, 89.55%) were the most prominent source of obtaining health information for Chinese netizens after the outbreak of COVID-19. Conclusions: This study elucidated that Chinese netizens’ protective mask behavior is far lower than their mask-related knowledge. Improved information channels and adequate information on wearing masks are necessary to improve the public’s protective mask behavior, particularly among men, the elderly, and people with less education. %M 35486491 %R 10.2196/32278 %U https://publichealth.jmir.org/2022/5/e32278 %U https://doi.org/10.2196/32278 %U http://www.ncbi.nlm.nih.gov/pubmed/35486491 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e37451 %T Prevalence and Associated Factors of Problematic Use of Smartphones Among Adults in Qassim, Saudi Arabia: Cross-sectional Survey %A Al-Mohaimeed,Abdulrahman %A Alharbi,Mansour %A Mahmud,Ilias %+ Department of Public Health, College of Public Health and Health Informatics, Qassim University, King Abdulaziz Rd, Al Bukairiyah, 52741, Saudi Arabia, 966 594190118, i.emdadulhaque@qu.edu.sa %K smartphone %K smartphone addiction %K problematic use of smartphones %K mobile phone dependence %K problematic use of mobile phones %K Saudi Arabia %K addiction %K psychosocial %K cross-sectional survey %K psychological health %K student %K mental health %D 2022 %7 23.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Kingdom of Saudi Arabia (KSA) ranks third globally in smartphone use. Smartphones have made many aspects of life easier. However, the overuse of smartphones is associated with physical and psychosocial problems. Objective: The aim of this paper is to estimate the prevalence and associated factors of problematic use of smartphones among adults in the Qassim region of KSA. Methods: We enrolled 715 participants using cluster random sampling for this cross-sectional survey. We assessed the problematic use of smartphones using the short version of the Smartphone Addiction Scale. Results: We estimated the prevalence of problematic smartphone use among adults at 64% (453/708). Multivariable logistic regression analysis suggested that students are 3 times more likely to demonstrate problematic use compared with unemployed individuals (P=.03); adults using more than five apps are 2 times more likely to demonstrate problematic use compared to those using a maximum of three apps (P=.007). Protective factors against problematic smartphone use include using apps for academic (odds ratio [OR] 0.66; P=.04) or religious needs (OR 0.55; P=.007) and having a monthly family income of 5001-10,000 SAR (Saudi Riyal; US $1300-$2700; OR 0.46; P=.01) or 10,001-20,000 SAR (US $2700-$5400; OR 0.51; P=.03) compared to the <1501 SAR (US $400) income group. Conclusions: We reported a very high prevalence of problematic use of smartphones in KSA. Considering its negative impact on physical and psychosocial health, public health programs should develop preventive strategies. %M 35604756 %R 10.2196/37451 %U https://publichealth.jmir.org/2022/5/e37451 %U https://doi.org/10.2196/37451 %U http://www.ncbi.nlm.nih.gov/pubmed/35604756 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e37876 %T Health-Related Quality of Life Outcomes With Regular Yoga and Heartfulness Meditation Practice: Results From a Multinational, Cross-sectional Study %A Thimmapuram,Jayaram %A Patel,Kamlesh %A Madhusudhan,Divya K %A Deshpande,Snehal %A Bouderlique,Ekta %A Nicolai,Veronique %A Rao,Raghavendra %+ Internal Medicine Department, Wellspan York Hospital, 1001 S George St, York, PA, 17405, United States, 1 7174956027, drthimmapuram@yahoo.com %K yoga %K meditation %K health-related quality of life %K Heartfulness %K COVID-19 %K healthy living %K wellness %K quality of life %K stress %K mental health %K psychological health %K online survey %K cross-sectional study %K health outcome %D 2022 %7 17.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Although the benefits of yoga are well established across the world, there are limited studies exploring the long-term interrelation between yoga, meditation, and health. Specifically, there is limited research exploring the differences in health-related quality of life (HRQOL) among regular meditators and nonmeditators. Objective: This study explored the differences in 7 domains of HRQOL (including quality of life, ability to adopt a healthy lifestyle, ability to relax, frequency of nervousness and stress, coping with day-to-day stress, workplace productivity, and staying healthy during the COVID-19 pandemic) among practitioners of yoga and meditation. Methods: A cross-sectional, online survey was distributed to all members who participated in a 100-day yoga and meditation program, culminating in the International Day of Yoga event, organized by the Heartfulness Institute in partnership with the Central Council for Research in Yoga and Naturopathy, Ministry of Ayush, SVYASA Yoga University, and Patanjali Yoga Institute, India. The program consisted of daily virtual yoga, meditation, and speaker sessions. The data were analyzed by nonparametric Mann-Whitney U test and Kruskal-Wallis tests for continuous variables and chi-square test for categorical variables. Results: A total of 3164 participants from 39 countries completed the survey. Mean age was 33.8 (SD 13.6) years. The majority of the participants were female (n=1643, 52%) and students (n=1312, 41.5%). Regular yoga and meditation practice was associated with a positive impact on all 7 domains of HRQOL (Mann-Whitney P<.05 and χ2P<.05). Notably, experienced Heartfulness (≥2 years) meditators reported better outcomes in all the domains of HRQOL as compared to those not currently practicing this form of meditation and participants with ≤1 year of Heartfulness meditation experience (P<.05). Conclusions: This is one of the first cross-sectional studies to explore HRQOL outcomes among participants of a 100-day virtual yoga and meditation program. Overall, a yoga and meditation practice was found to be an effective tool for promoting HRQOL. Regular yoga and meditation practice was associated with factors promoting health and well-being, with long-term meditation practice associated with increased benefits. %M 35470800 %R 10.2196/37876 %U https://formative.jmir.org/2022/5/e37876 %U https://doi.org/10.2196/37876 %U http://www.ncbi.nlm.nih.gov/pubmed/35470800 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e35969 %T Developing Reporting Guidelines for Studies of HIV Drug Resistance Prevalence: Protocol for a Mixed Methods Study %A Garcia,Cristian %A Rehman,Nadia %A Lawson,Daeria O %A Djiadeu,Pascal %A Mbuagbaw,Lawrence %+ Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada, 1 905 522 1155 ext 35929, mbuagblc@mcmaster.ca %K HIV %K drug resistance %K reporting guideline %K prevalence %K surveillance %K antiretroviral therapy %K report %K global health %K problem %K antiretroviral therapy %D 2022 %7 13.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: HIV drug resistance is a global health problem that limits the effectiveness of antiretroviral therapy. Adequate surveillance of HIV drug resistance is challenged by heterogenous and inadequate data reporting, which compromises the accuracy, interpretation, and usability of prevalence estimates. Previous research has found that the quality of reporting in studies of HIV drug resistance prevalence is low, and thus better guidance is needed to ensure complete and uniform reporting. Objective: This paper contributes to the process of developing reporting guidelines for prevalence studies of HIV drug resistance by reporting the methodology used in creating a reporting item checklist and generating key insights on items that are important to report. Methods: We will conduct a sequential explanatory mixed methods study among authors and users of studies of HIV drug resistance. The two-phase design will include a cross-sectional electronic survey (quantitative phase) followed by a focus group discussion (qualitative phase). Survey participants will rate the essentiality of various reporting items. This data will be analyzed using content validity ratios to determine the items that will be retained for focus group discussions. Participants in these discussions will revise the items and any additionally suggested items and settle on a complete reporting item checklist. We will also conduct a thematic analysis of the group discussions to identify emergent themes regarding the agreement process. Results: As of November 2021, data collection for both phases of the study is complete. In July 2021, 51 participants had provided informed consent and completed the electronic survey. In October 2021, focus group discussions were held. Nine participants in total participated in two virtual focus group discussions. As of May 2022, data are being analyzed. Conclusions: This study supports the development of a reporting checklist for studies of HIV drug resistance by achieving agreement among experts on what items should be reported in these studies. The results of this work will be refined and elaborated on by a writing committee of HIV drug resistance experts and external reviewers to develop finalized reporting guidelines. International Registered Report Identifier (IRRID): DERR1-10.2196/35969 %M 35559984 %R 10.2196/35969 %U https://www.researchprotocols.org/2022/5/e35969 %U https://doi.org/10.2196/35969 %U http://www.ncbi.nlm.nih.gov/pubmed/35559984 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e30716 %T Ownership, Use of, and Interest in Digital Mental Health Technologies Among Clinicians and Young People Across a Spectrum of Clinical Care Needs: Cross-sectional Survey %A Bell,Imogen H %A Thompson,Andrew %A Valentine,Lee %A Adams,Sophie %A Alvarez-Jimenez,Mario %A Nicholas,Jennifer %+ Orygen, 35 Poplar Rd, Parkville, 3052, Australia, 61 430156222, imogen.bell@orygen.org.au %K adolescent %K youth mental health %K mental health %K attitude %K digital technology %K internet-based interventions %K digital mental health %K mental health services %K clinician %K mobile phone %D 2022 %7 11.5.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: There is currently an increased interest in and acceptance of technology-enabled mental health care. To adequately harness this opportunity, it is critical that the design and development of digital mental health technologies be informed by the needs and preferences of end users. Despite young people and clinicians being the predominant users of such technologies, few studies have examined their perspectives on different digital mental health technologies. Objective: This study aims to understand the technologies that young people have access to and use in their everyday lives and what applications of these technologies they are interested in to support their mental health. The study also explores the technologies that youth mental health clinicians currently use within their practice and what applications of these technologies they are interested in to support their clients’ mental health. Methods: Youth mental health service users (aged 12-25 years) from both primary and specialist services, young people from the general population (aged 16-25 years), and youth mental health clinicians completed a web-based survey exploring technology ownership, use of, and interest levels in using different digital interventions to support their mental health or that of their clients. Results: A total of 588 young people and 73 youth mental health clinicians completed the survey. Smartphone ownership or private access among young people within mental health services and the general population was universal (611/617, 99%), with high levels of access to computers and social media. Youth technology use was frequent, with 63.3% (387/611) using smartphones several times an hour. Clinicians reported using smartphones (61/76, 80%) and video chat (69/76, 91%) commonly in clinical practice and found them to be helpful. Approximately 50% (296/609) of the young people used mental health apps, which was significantly less than the clinicians (χ23=28.8, n=670; P<.001). Similarly, clinicians were significantly more interested in using technology for mental health support than young people (H3=55.90; P<.001), with 100% (73/73) of clinicians being at least slightly interested in technology to support mental health compared with 88% (520/591) of young people. Follow-up tests revealed no difference in interest between young people from the general population, primary mental health services, and specialist mental health services (all P>.23). Young people were most interested in web-based self-help, mobile self-help, and blended therapy. Conclusions: Technology access is pervasive among young people within and outside of youth mental health services; clinicians are already using technology to support clinical care, and there is widespread interest in digital mental health technologies among these groups of end users. These findings provide important insights into the perspectives of young people and clinicians regarding the value of digital mental health interventions in supporting youth mental health. %M 35544295 %R 10.2196/30716 %U https://mental.jmir.org/2022/5/e30716 %U https://doi.org/10.2196/30716 %U http://www.ncbi.nlm.nih.gov/pubmed/35544295 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e34347 %T Self-administered Web-Based Tests of Executive Functioning and Perceptual Speed: Measurement Development Study With a Large Probability-Based Survey Panel %A Liu,Ying %A Schneider,Stefan %A Orriens,Bart %A Meijer,Erik %A Darling,Jill E %A Gutsche,Tania %A Gatz,Margaret %+ Center for Economic and Social Research, University of Southern California, 635 Downey Way, Los Angeles, CA, 90089, United States, 1 2138211850, liu.ying@usc.edu %K cognitive tests %K internet %K probability-based %K web-based %K executive function %K response speed %K self-administered test %K mobile phone %D 2022 %7 9.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive testing in large population surveys is frequently used to describe cognitive aging and determine the incidence rates, risk factors, and long-term trajectories of the development of cognitive impairment. As these surveys are increasingly administered on internet-based platforms, web-based and self-administered cognitive testing calls for close investigation. Objective: Web-based, self-administered versions of 2 age-sensitive cognitive tests, the Stop and Go Switching Task for executive functioning and the Figure Identification test for perceptual speed, were developed and administered to adult participants in the Understanding America Study. We examined differences in cognitive test scores across internet device types and the extent to which the scores were associated with self-reported distractions in everyday environments in which the participants took the tests. In addition, national norms were provided for the US population. Methods: Data were collected from a probability-based internet panel representative of the US adult population—the Understanding America Study. Participants with access to both a keyboard- and mouse-based device and a touch screen–based device were asked to complete the cognitive tests twice in a randomized order across device types, whereas participants with access to only 1 type of device were asked to complete the tests twice on the same device. At the end of each test, the participants answered questions about interruptions and potential distractions that occurred during the test. Results: Of the 7410 (Stop and Go) and 7216 (Figure Identification) participants who completed the device ownership survey, 6129 (82.71% for Stop and Go) and 6717 (93.08% for Figure Identification) participants completed the first session and correctly responded to at least 70% of the trials. On average, the standardized differences across device types were small, with the absolute value of Cohen d ranging from 0.05 (for the switch score in Stop and Go and the Figure Identification score) to 0.13 (for the nonswitch score in Stop and Go). Poorer cognitive performance was moderately associated with older age (the absolute value of r ranged from 0.32 to 0.61), and this relationship was comparable across device types (the absolute value of Cohen q ranged from 0.01 to 0.17). Approximately 12.72% (779/6123 for Stop and Go) and 12.32% (828/6721 for Figure Identification) of participants were interrupted during the test. Interruptions predicted poorer cognitive performance (P<.01 for all scores). Specific distractions (eg, watching television and listening to music) were inconsistently related to cognitive performance. National norms, calculated as weighted average scores using sampling weights, suggested poorer cognitive performance as age increased. Conclusions: Cognitive scores assessed by self-administered web-based tests were sensitive to age differences in cognitive performance and were comparable across the keyboard- and touch screen–based internet devices. Distraction in everyday environments, especially when interrupted during the test, may result in a nontrivial bias in cognitive testing. %M 35532966 %R 10.2196/34347 %U https://www.jmir.org/2022/5/e34347 %U https://doi.org/10.2196/34347 %U http://www.ncbi.nlm.nih.gov/pubmed/35532966 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e36943 %T Promised and Lottery Airtime Incentives to Improve Interactive Voice Response Survey Participation Among Adults in Bangladesh and Uganda: Randomized Controlled Trial %A Gibson,Dustin Garrett %A Kibria,Gulam Muhammed Al %A Pariyo,George William %A Ahmed,Saifuddin %A Ali,Joseph %A Labrique,Alain Bernard %A Khan,Iqbal Ansary %A Rutebemberwa,Elizeus %A Flora,Meerjady Sabrina %A Hyder,Adnan Ali %+ Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E8650, Baltimore, MD, 21205, United States, 1 443 287 8763, dgibso28@jhu.edu %K mobile phone survey %K interactive voice response survey %K survey %K interactive voice response %K non-communicable disease %K surveillance %K airtime incentive %K response rate %K cooperation rate %K communicable disease %K Uganda %K Bangladesh %K low income %K middle income %K LMIC %K Africa %K incentive %K RCT %K randomized controlled trial %K lottery %K cooperation %K participation %D 2022 %7 9.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Increased mobile phone penetration allows the interviewing of respondents using interactive voice response surveys in low- and middle-income countries. However, there has been little investigation of the best type of incentive to obtain data from a representative sample in these countries. Objective: We assessed the effect of different airtime incentives options on cooperation and response rates of an interactive voice response survey in Bangladesh and Uganda. Methods: The open-label randomized controlled trial had three arms: (1) no incentive (control), (2) promised airtime incentive of 50 Bangladeshi Taka (US $0.60; 1 BDT is approximately equivalent to US $0.012) or 5000 Ugandan Shilling (US $1.35; 1 UGX is approximately equivalent to US $0.00028), and (3) lottery incentive (500 BDT and 100,000 UGX), in which the odds of winning were 1:20. Fully automated random-digit dialing was used to sample eligible participants aged ≥18 years. The risk ratios (RRs) with 95% confidence intervals for primary outcomes of response and cooperation rates were obtained using log-binomial regression. Results: Between June 14 and July 14, 2017, a total of 546,746 phone calls were made in Bangladesh, with 1165 complete interviews being conducted. Between March 26 and April 22, 2017, a total of 178,572 phone calls were made in Uganda, with 1248 complete interviews being conducted. Cooperation rates were significantly higher for the promised incentive (Bangladesh: 39.3%; RR 1.38, 95% CI 1.24-1.55, P<.001; Uganda: 59.9%; RR 1.47, 95% CI 1.33-1.62, P<.001) and the lottery incentive arms (Bangladesh: 36.6%; RR 1.28, 95% CI 1.15-1.45, P<.001; Uganda: 54.6%; RR 1.34, 95% CI 1.21-1.48, P<.001) than those for the control arm (Bangladesh: 28.4%; Uganda: 40.9%). Similarly, response rates were significantly higher for the promised incentive (Bangladesh: 26.5%%; RR 1.26, 95% CI 1.14-1.39, P<.001; Uganda: 41.2%; RR 1.27, 95% CI 1.16-1.39, P<.001) and lottery incentive arms (Bangladesh: 24.5%%; RR 1.17, 95% CI 1.06-1.29, P=.002; Uganda: 37.9%%; RR 1.17, 95% CI 1.06-1.29, P=.001) than those for the control arm (Bangladesh: 21.0%; Uganda: 32.4%). Conclusions: Promised or lottery airtime incentives improved survey participation and facilitated a large sample within a short period in 2 countries. Trial Registration: ClinicalTrials.gov NCT03773146; http://clinicaltrials.gov/ct2/show/NCT03773146 %M 35532997 %R 10.2196/36943 %U https://www.jmir.org/2022/5/e36943 %U https://doi.org/10.2196/36943 %U http://www.ncbi.nlm.nih.gov/pubmed/35532997 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e31739 %T Developing Reporting Guidelines for Social Media Research (RESOME) by Using a Modified Delphi Method: Protocol for Guideline Development %A Kaushal,Aradhna %A Bravo,Caroline %A Duffy,Stephen %A Lewins,Douglas %A Möhler,Ralph %A Raine,Rosalind %A Vlaev,Ivo %A Waller,Jo %A von Wagner,Christian %+ Research Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 02076705723, aradhnakaushal@gmail.com %K social media %K research design %K web-based social networking %K health behavior %K health promotion %K public health %D 2022 %7 9.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social media platforms, such as Facebook, Twitter, and Instagram, are being increasingly used to deliver public health interventions. Despite the high level of research interest, there is no consensus or guidance on how to report on social media interventions. Reporting guidelines that incorporate elements from behavior change theories and social media engagement frameworks could foster more robust evaluations that capture outcomes that have an impact on behavior change and engagement. Objective: The aim of this project is to develop, publish, and promote a list of items for our Reporting Guidelines for Social Media Research (RESOME) checklist. Methods: RESOME will be developed by using a modified Delphi approach wherein 2 rounds of questionnaires will be sent to experts and stakeholders. The questionnaires will ask them to rate their agreement with a series of statements until a level of consensus is reached. This will be followed by a web-based consensus meeting to finalize the reporting guidelines. After the consensus meeting, the reporting guidelines will be published in the form of a paper outlining the need for the new guidelines and how the guidelines were developed, along with the finalized checklist for reporting. Prior to publication, the guidelines will be piloted to check for understanding and simplify the language used, if necessary. Results: The first draft of RESOME has been developed. Round 1 of the Delphi survey took place between July and December 2021. Round 2 is due to take place in February 2022, and the web-based consensus meeting will be scheduled for the spring of 2022. Conclusions: Developing RESOME has the potential to contribute to improved reporting, and such guidelines will make it easier to assess the effectiveness of social media interventions. Future work will be needed to evaluate our guidelines’ usefulness and practicality. International Registered Report Identifier (IRRID): PRR1-10.2196/31739 %M 35532999 %R 10.2196/31739 %U https://www.researchprotocols.org/2022/5/e31739 %U https://doi.org/10.2196/31739 %U http://www.ncbi.nlm.nih.gov/pubmed/35532999 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e33505 %T Health Care Professionals’ Experiences of Web-Based Symptom Checkers for Triage: Cross-sectional Survey Study %A Kujala,Sari %A Hörhammer,Iiris %+ Department of Computer Science, Aalto University, PO Box 15400, Espoo, FI-00076, Finland, 358 503862768, sari.kujala@aalto.fi %K adoption %K symptom checker %K triage %K health care professional %K survey %K online health %K digital health %K health organizations %K health care %D 2022 %7 5.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based symptom checkers are promising tools that provide help to patients seeking guidance on health problems. Many health organizations have started using them to enhance triage. Patients use the symptom checker to report their symptoms online and submit the report to the health care center through the system. Health care professionals (registered nurse, practical nurse, general physician, physiotherapist, etc) receive patient inquiries with urgency rating, decide on actions to be taken, and communicate these to the patients. The success of the adoption, however, depends on whether the tools can efficiently support health care professionals’ workflow and achieve their support. Objective: This study explores the factors influencing health care professionals’ support for a web-based symptom checker for triage. Methods: Data were collected through a web-based survey of 639 health care professionals using either of the two most used web-based symptom checkers in the Finnish public primary care. Linear regression models were fitted to study the associations between the study variables and health care professionals’ support for the symptom checkers. In addition, the health care professionals’ comments collected via survey were qualitatively analyzed to elicit additional insights about the benefits and challenges of the clinical use of symptom checkers. Results: Results show that the perceived beneficial influence of the symptom checkers on health care professionals’ work and the perceived usability of the tools were positively associated with professionals’ support. The perceived benefits to patients and organizational support for use were positively associated, and threat to professionals’ autonomy was negatively associated with health care professionals’ support. These associations were, however, not independent of other factors included in the models. The influences on professionals’ work were both positive and negative; the tools streamlined work by providing preliminary information on patients and reduced the number of phone calls, but they also created extra work as the professionals needed to call patients and ask clarifying questions. Managing time between the use of symptom checkers and other tasks was also challenging. Meanwhile, according to health care professionals’ experience, the symptom checkers benefited patients as they received help quickly with a lower threshold for care. Conclusions: The efficient use of symptom checkers for triage requires usable solutions that support health care professionals’ work. High-quality information about the patients’ conditions and an efficient way of communicating with patients are needed. Using a new eHealth tool also requires that health organizations and teams reorganize their workflows and work distributions to support clinical processes. %M 35511254 %R 10.2196/33505 %U https://www.jmir.org/2022/5/e33505 %U https://doi.org/10.2196/33505 %U http://www.ncbi.nlm.nih.gov/pubmed/35511254 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e35540 %T Digital Technology and Media Use by Adolescents: Latent Class Analysis %A Moreno,Megan A %A Binger,Kole %A Zhao,Qianqian %A Eickhoff,Jens %A Minich,Matt %A Uhls,Yalda Tehranian %+ University of Wisconsin-Madison, 2870 University Ave, Suite 200, Madison, WI, 53705, United States, 1 608 2632846, mamoreno@pediatrics.wisc.edu %K digital technology %K adolescents %K latent class analysis %K social media %K mobile phone %D 2022 %7 4.5.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Digital technology and media use is integral to adolescents’ lives and has been associated with both positive and negative health consequences. Previous studies have largely focused on understanding technology behaviors and outcomes within adolescent populations, which can promote assumptions about adolescent technology use as homogeneous. Furthermore, many studies on adolescent technology use have focused on risks and negative outcomes. To better understand adolescent digital technology use, we need new approaches that can assess distinct profiles within study populations and take a balanced approach to understanding the risks and benefits of digital technology use. Objective: The purpose of this study was to identify profiles of adolescent technology use within a large study population focusing on four evidence-based constructs: technology ownership and use, parental involvement, health outcomes, and well-being indicators. Methods: Adolescent-parent dyads were recruited for a cross-sectional web-based survey using the Qualtrics (Qualtrics International, Inc) platform and panels. Technology use measures included ownership of devices, social media use frequency, and the Adolescents’ Digital Technology Interactions and Importance scale. Parent involvement measures included household media rules, technology-related parenting practices, parent social media use frequency, and the parent-child relationship. Health outcome measures included physical activity, sleep, problematic internet use, and mental health assessments. Well-being indicators included mental wellness, communication, and empathy. We used latent class analysis (LCA) to identify distinct profile groups across the aforementioned 4 critical constructs. Results: Among the 3981 adolescent-parent dyads recruited, adolescent participants had a mean age of 15.0 (SD 1.43) years; a total of 46.3% (1842/3981) were female, 67.8% (2701/3981) were White, and 75% (2986/3981) lived in a household with an income above the poverty line. The LCA identified 2 discrete classes. Class 1 was made up of 62.8% (2501/3981) of the participants. Class 1 participants were more likely than Class 2 participants to report family-owned devices, have lower technology importance scores, have household technology rules often centered on content, have positive parent relationships and lower parent social media use, and report better health outcomes and well-being indicators. Conclusions: Findings from this national cross-sectional survey using LCA led to 2 distinct profile groups of adolescent media use and their association with technology use and parent involvement as well as health and well-being outcomes. The two classes included a larger Class 1 (Family-Engaged Adolescents) and a smaller Class 2 (At-Risk Adolescents). The findings of this study can inform interventions to reinforce positive technology use and family support. %M 35507401 %R 10.2196/35540 %U https://pediatrics.jmir.org/2022/2/e35540 %U https://doi.org/10.2196/35540 %U http://www.ncbi.nlm.nih.gov/pubmed/35507401 %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 e34015 %T Using Smartphone Sensor Paradata and Personalized Machine Learning Models to Infer Participants’ Well-being: Ecological Momentary Assessment %A Hart,Alexander %A Reis,Dorota %A Prestele,Elisabeth %A Jacobson,Nicholas C %+ Research Group Applied Statistical Modeling, Department of Psychology, Saarland University, Campus A2 4, Saarbrücken, 66123, Germany, 49 6813023130, hart.research@pm.me %K digital biomarkers %K machine learning %K ecological momentary assessment %K smartphone sensors %K internal states %K paradata %K accelerometer %K gyroscope %K mood %K mobile phone %D 2022 %7 28.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Sensors embedded in smartphones allow for the passive momentary quantification of people’s states in the context of their daily lives in real time. Such data could be useful for alleviating the burden of ecological momentary assessments and increasing utility in clinical assessments. Despite existing research on using passive sensor data to assess participants’ moment-to-moment states and activity levels, only limited research has investigated temporally linking sensor assessment and self-reported assessment to further integrate the 2 methodologies. Objective: We investigated whether sparse movement-related sensor data can be used to train machine learning models that are able to infer states of individuals’ work-related rumination, fatigue, mood, arousal, life engagement, and sleep quality. Sensor data were only collected while the participants filled out the questionnaires on their smartphones. Methods: We trained personalized machine learning models on data from employees (N=158) who participated in a 3-week ecological momentary assessment study. Results: The results suggested that passive smartphone sensor data paired with personalized machine learning models can be used to infer individuals’ self-reported states at later measurement occasions. The mean R2 was approximately 0.31 (SD 0.29), and more than half of the participants (119/158, 75.3%) had an R2 of ≥0.18. Accuracy was only slightly attenuated compared with earlier studies and ranged from 38.41% to 51.38%. Conclusions: Personalized machine learning models and temporally linked passive sensing data have the capability to infer a sizable proportion of variance in individuals’ daily self-reported states. Further research is needed to investigate factors that affect the accuracy and reliability of the inference. %M 35482397 %R 10.2196/34015 %U https://www.jmir.org/2022/4/e34015 %U https://doi.org/10.2196/34015 %U http://www.ncbi.nlm.nih.gov/pubmed/35482397 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e33656 %T Agreement Between Self-reports and Photos to Assess e-Cigarette Device and Liquid Characteristics in Wave 1 of the Vaping and Patterns of e-Cigarette Use Research Study: Web-Based Longitudinal Cohort Study %A Crespi,Elizabeth %A Hardesty,Jeffrey J %A Nian,Qinghua %A Sinamo,Joshua %A Welding,Kevin %A Kennedy,Ryan David %A Cohen,Joanna E %+ Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, Baltimore, MD, 21205, United States, 1 410 614 5378, ecrespi2@jhu.edu %K tobacco %K e-cigarette %K methodology %K internet %K photo %K survey %K self-report %D 2022 %7 27.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: e-Cigarette device and liquid characteristics are highly customizable; these characteristics impact nicotine delivery and exposure to toxic constituents. It is critical to understand optimal methods for measuring these characteristics to accurately assess their impacts on user behavior and health. Objective: To inform future survey development, we assessed the agreement between responses from survey participants (self-reports) and photos uploaded by participants and the quantity of usable data derived from each approach. Methods: Adult regular e-cigarette users (≥5 days per week) aged ≥21 years (N=1209) were asked questions about and submitted photos of their most used e-cigarette device (1209/1209, 100%) and liquid (1132/1209, 93.63%). Device variables assessed included brand, model, reusability, refillability, display, and adjustable power. Liquid variables included brand, flavor, nicotine concentration, nicotine formulation, and bottle size. For each variable, percentage agreement was calculated where self-report and photo data were available. Krippendorff α and intraclass correlation coefficient (ICC) were calculated for categorical and continuous variables, respectively. Results were stratified by device (disposable, reusable with disposable pods or cartridges, and reusable with refillable pods, cartridges, or tanks) and liquid (customized and noncustomized) type. The sample size for each calculation ranged from 3.89% (47/1209; model of disposable devices) to 95.12% (1150/1209; device reusability). Results: Percentage agreement between photos and self-reports was substantial to very high across device and liquid types for all variables except nicotine concentration. These results are consistent with Krippendorff α calculations, except where prevalence bias was suspected. ICC results for nicotine concentration and bottle size were lower than percentage agreement, likely because ICC accounts for the level of disagreement between values. Agreement varied by device and liquid type. For example, percentage agreement for device brand was higher among users of reusable devices (94%) than among users of disposable devices (75%). Low percentage agreement may result from poor participant knowledge of characteristics, user modifications of devices inconsistent with manufacturer-intended use, inaccurate or incomplete information on websites, or photo submissions that are not a participant’s most used device or liquid. The number of excluded values (eg, self-report was “don’t know” or no photo submitted) differed between self-reports and photos; for questions asked to participants, self-reports had more usable data than photos for all variables except device model and nicotine formulation. Conclusions: Photos and self-reports yield data of similar accuracy for most variables assessed in this study: device brand, device model, reusability, adjustable power, display, refillability, liquid brand, flavor, and bottle size. Self-reports provided more data for all variables except device model and nicotine formulation. Using these approaches simultaneously may optimize data quantity and quality. Future research should examine how to assess nicotine concentration and variables not included in this study (eg, wattage and resistance) and the resource requirements of these approaches. %M 35475727 %R 10.2196/33656 %U https://www.jmir.org/2022/4/e33656 %U https://doi.org/10.2196/33656 %U http://www.ncbi.nlm.nih.gov/pubmed/35475727 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e32996 %T Gamification in Diplomacy Studies as an Effective Tool for Knowledge Transfer: Questionnaire Study %A Cercel,Mihai Ovidiu %+ Department of International Relations and European Integration, National University of Political Studies and Public Administration, 30A, Expozitiei Boulevard, Bucharest, 012104, Romania, 40 371 445 076, mihai.cercel@dri.snspa.ro %K modern diplomacy %K international relations %K innovations in learning experience %K gamification %K serious games %K role play design %K knowledge transfer %K competency development %D 2022 %7 25.4.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Graduate education in modern diplomacy poses several challenges, as it requires several competencies to be developed before diplomatic service is joined. Incorporation of simulation games can have a positive impact on the design of international relations and diplomacy learning process. We have designed a novel role play game (MAEDRI) to simulate part of the activities of a typical Ministry of Foreign Affairs. Objective: This study aims to evaluate the effectiveness of MAEDRI in transferring knowledge in international relations education programs at the National University of Political Studies and Public Administration, Bucharest, Romania, across a 4-year period. Methods: The game enrolled master’s level graduate students. The data were collected through a voluntary and anonymous questionnaire between 2017 and 2020. At the end of each of the 4 editions we organized debriefing sessions that gave students the opportunity to provide feedback on their experience with this exercise, level of collaboration within the team, lessons learned, and to make suggestions for improvements. Using an online questionnaire, we measured the participants’ perception regarding the level of effectiveness in increasing knowledge transfer, motivation, and engagement. Questionnaire data were consolidated in percentages for each item. Results: A total of 49 participants completed the study. A total of 24 skills (13 professional and 11 social skills) were assessed. We identified a strong positive correlation between stress management and conflict management (r=.86; P<.001) as well as significantly positive correlations between building relations within the team and the ability to dialog and be persuasive (r=.7; P<.001), between procedure compliance and planning and organizing the work (r=.69; P<.001), and between analysis capacity and decision based on data received (r=.68; P<.001). Among social skills, self-control, confidence, and flexibility were the most substantially improved. Conclusions: We describe several benefits of a novel game, used as an education tool to enhance a series of competencies necessary in international relations studies. Our results demonstrate a significant level of student engagement and motivation while playing MAEDRI, improvement of several essential skills, and enhanced knowledge transfer to real-life situations. While the data are encouraging, further research is needed to evaluate the full impact of role play as an effective experiential learning method. %M 35468081 %R 10.2196/32996 %U https://games.jmir.org/2022/2/e32996 %U https://doi.org/10.2196/32996 %U http://www.ncbi.nlm.nih.gov/pubmed/35468081 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e29077 %T Associations Between Addictive Behaviors, Individual Characteristics, and the Use of Gambling Services Within the World of Gaming: Cross-sectional Survey Study %A Kisch,Mark %A Håkansson,Anders %+ Division of Psychiatry, Department of Clinical Sciences, Lund University, Baravägen 1, Lund, 22100, Sweden, 46 070 3135677, anders_c.hakansson@med.lu.se %K gambling disorder %K gaming disorder %K behavioral addiction %K mental health %K gambling %K gaming %K addiction %K behavior %K cross-sectional %K online survey %K age %K gender %D 2022 %7 22.4.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Gambling within the world of gaming is an emerging phenomenon that may share common conceptual characteristics with traditional forms of gambling. The current literature suggests a higher degree of problematic behaviors in this gambling pattern, but studies are few, prompting for further research regarding individual characteristics and comorbid conditions associated with this activity. Objective: The aim of the study is to investigate correlations between the use of gambling services within the world of gaming and individual characteristics and addictive behaviors including problem gambling. Methods: A cross-sectional web survey was distributed to an existing panel of online respondents in Sweden. A total of 2001 respondents were included. Chi-square and Mann-Whitney U tests, followed by a logistic regression, were used in order to determine independent variables associated with gambling in the context of gaming. Results: A total of 2.9% (58/1984) of respondents reported past-year gambling within gaming. Significant associations were found with male sex, younger age, history of treatment-seeking for alcohol problems, and higher Gaming Addiction Scale scores. Conclusions: The demonstrated findings strengthen previously found associations between gambling in gaming and younger age, male sex, and problematic gaming behaviors. Additionally, the association with a history of treatment needs for alcohol problems adds to the previous impression of increased problem severity and comorbidity in within-gaming gamblers. %M 35451974 %R 10.2196/29077 %U https://games.jmir.org/2022/2/e29077 %U https://doi.org/10.2196/29077 %U http://www.ncbi.nlm.nih.gov/pubmed/35451974 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e28222 %T Using GPS Tracking to Investigate Outdoor Navigation Patterns in Patients With Alzheimer Disease: Cross-sectional Study %A Puthusseryppady,Vaisakh %A Morrissey,Sol %A Aung,Min Hane %A Coughlan,Gillian %A Patel,Martyn %A Hornberger,Michael %+ Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom, 44 1603 59 7139, m.hornberger@uea.ac.uk %K Alzheimer disease %K dementia %K spatial disorientation %K getting lost %K outdoor navigation %K risk factors %K environmental %K GPS tracking %K community %K mobile phone %D 2022 %7 21.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Spatial disorientation is one of the earliest and most distressing symptoms seen in patients with Alzheimer disease (AD) and can lead to them getting lost in the community. Although it is a prevalent problem worldwide and is associated with various negative consequences, very little is known about the extent to which outdoor navigation patterns of patients with AD explain why spatial disorientation occurs for them even in familiar surroundings. Objective: This study aims to understand the outdoor navigation patterns of patients with AD in different conditions (alone vs accompanied; disoriented vs not disoriented during the study) and investigate whether patients with AD experienced spatial disorientation when navigating through environments with a high outdoor landmark density and complex road network structure (road intersection density, intersection complexity, and orientation entropy). Methods: We investigated the outdoor navigation patterns of community-dwelling patients with AD (n=15) and age-matched healthy controls (n=18) over a 2-week period using GPS tracking and trajectory mining analytical techniques. Here, for the patients, the occurrence of any spatial disorientation behavior during this tracking period was recorded. We also used a spatial buffer methodology to capture the outdoor landmark density and features of the road network in the environments that the participants visited during the tracking period. Results: The patients with AD had outdoor navigation patterns similar to those of the controls when they were accompanied; however, when they were alone, they had significantly fewer outings per day (total outings: P<.001; day outings: P=.003; night outings: P<.001), lower time spent moving per outing (P=.001), lower total distance covered per outing (P=.009), lower walking distance per outing (P=.02), and lower mean distance from home per outing (P=.004). Our results did not identify any mobility risk factors for spatial disorientation. We also found that the environments visited by patients who experienced disorientation versus those who maintained their orientation during the tracking period did not significantly differ in outdoor landmark density (P=.60) or road network structure (road intersection density: P=.43; intersection complexity: P=.45; orientation entropy: P=.89). Conclusions: Our findings suggest that when alone, patients with AD restrict the spatial and temporal extent of their outdoor navigation in the community to successfully reduce their perceived risk of spatial disorientation. Implications of this work highlight the importance for future research to identify which of these individuals may be at an actual high risk for spatial disorientation as well as to explore the implementation of health care measures to help maintain a balance between patients’ right to safety and autonomy when making outings alone in the community. %M 35451965 %R 10.2196/28222 %U https://aging.jmir.org/2022/2/e28222 %U https://doi.org/10.2196/28222 %U http://www.ncbi.nlm.nih.gov/pubmed/35451965 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e34354 %T Inpatient Telehealth Experience of Patients With Limited English Proficiency: Cross-sectional Survey and Semistructured Interview Study %A Payvandi,Lily %A Parsons,Chase %A Bourgeois,Fabienne C %A Hron,Jonathan D %+ Division of General Pediatrics, Department of Pediatrics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States, 1 617 355 6000, lpayvandi@gmail.com %K telemedicine %K telehealth %K inpatient %K social determinants of health %K limited English proficiency %K health-related social needs %K Spanish %K English as a second language %K English proficiency %D 2022 %7 19.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with limited English proficiency (LEP) are at a higher risk of poor health outcomes and are less likely to use telehealth than English-speaking patients. To date, there is no formal evaluation of inpatient (IP) telehealth user experience of patients and their families by language preference during visits with their clinicians. Objective: This study aims to compare the experiences of English- and Spanish-speaking patients and their families using IP telehealth, as well as to evaluate the experience of Spanish interpreters providing services through IP telehealth. Methods: We prospectively administered a survey to English- and Spanish-speaking patients and their families who used IP telehealth from October 1, 2020, to March 31, 2021. We performed semistructured phone interviews of hospital-based Spanish interpreters who provided services through IP telehealth. Results: A total of 661 surveys were administered, with completion rates of 18% (112/621) in English and 62% (25/40) in Spanish. On a 10-point scale, the overall satisfaction of Spanish speakers (median 10, IQR 10-10) was higher than that of English speakers (median 9, IQR 8-10; P=.001). Both English- and Spanish-speaking patients used IP telehealth for visits with their primary IP care team, subspecialty consultants, and other clinicians. Hospital tablets were used more often than personal devices, and only English-speaking patients used personal laptops. Patients and their families encountered challenges with log-in, team coordination with multiple users, and equipment availability. Interpreters encountered challenges with audio and video quality, communication, safety, and Wi-Fi access. Conclusions: Both English- and Spanish-speaking patients reported high satisfaction using IP telehealth across multiple disciplines despite the workflow challenges identified by interpreters. Significant investment is needed to provide robust infrastructure to support use by all patients, especially the integration of multiple users to provide interpreter services for patients with LEP. %M 35438641 %R 10.2196/34354 %U https://formative.jmir.org/2022/4/e34354 %U https://doi.org/10.2196/34354 %U http://www.ncbi.nlm.nih.gov/pubmed/35438641 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e33537 %T Recommendations for Defining and Reporting Adherence Measured by Biometric Monitoring Technologies: Systematic Review %A Olaye,Iredia M %A Belovsky,Mia P %A Bataille,Lauren %A Cheng,Royce %A Ciger,Ali %A Fortuna,Karen L %A Izmailova,Elena S %A McCall,Debbe %A Miller,Christopher J %A Muehlhausen,Willie %A Northcott,Carrie A %A Rodriguez-Chavez,Isaac R %A Pratap,Abhishek %A Vandendriessche,Benjamin %A Zisman-Ilani,Yaara %A Bakker,Jessie P %+ Signifier Medical Technologies, 175 Highland Ave, Needham, MA, United States, 1 6173866968, jessie.b@signifiermedical.com %K digital medicine %K digital measures %K adherence %K compliance %K mobile phone %D 2022 %7 14.4.2022 %9 Review %J J Med Internet Res %G English %X Background: Suboptimal adherence to data collection procedures or a study intervention is often the cause of a failed clinical trial. Data from connected sensors, including wearables, referred to here as biometric monitoring technologies (BioMeTs), are capable of capturing adherence to both digital therapeutics and digital data collection procedures, thereby providing the opportunity to identify the determinants of adherence and thereafter, methods to maximize adherence. Objective: We aim to describe the methods and definitions by which adherence has been captured and reported using BioMeTs in recent years. Identifying key gaps allowed us to make recommendations regarding minimum reporting requirements and consistency of definitions for BioMeT-based adherence data. Methods: We conducted a systematic review of studies published between 2014 and 2019, which deployed a BioMeT outside the clinical or laboratory setting for which a quantitative, nonsurrogate, sensor-based measurement of adherence was reported. After systematically screening the manuscripts for eligibility, we extracted details regarding study design, participants, the BioMeT or BioMeTs used, and the definition and units of adherence. The primary definitions of adherence were categorized as a continuous variable based on duration (highest resolution), a continuous variable based on the number of measurements completed, or a categorical variable (lowest resolution). Results: Our PubMed search terms identified 940 manuscripts; 100 (10.6%) met our eligibility criteria and contained descriptions of 110 BioMeTs. During literature screening, we found that 30% (53/177) of the studies that used a BioMeT outside of the clinical or laboratory setting failed to report a sensor-based, nonsurrogate, quantitative measurement of adherence. We identified 37 unique definitions of adherence reported for the 110 BioMeTs and observed that uniformity of adherence definitions was associated with the resolution of the data reported. When adherence was reported as a continuous time-based variable, the same definition of adherence was adopted for 92% (46/50) of the tools. However, when adherence data were simplified to a categorical variable, we observed 25 unique definitions of adherence reported for 37 tools. Conclusions: We recommend that quantitative, nonsurrogate, sensor-based adherence data be reported for all BioMeTs when feasible; a clear description of the sensor or sensors used to capture adherence data, the algorithm or algorithms that convert sample-level measurements to a metric of adherence, and the analytic validation data demonstrating that BioMeT-generated adherence is an accurate and reliable measurement of actual use be provided when available; and primary adherence data be reported as a continuous variable followed by categorical definitions if needed, and that the categories adopted are supported by clinical validation data and/or consistent with previous reports. %M 35436221 %R 10.2196/33537 %U https://www.jmir.org/2022/4/e33537 %U https://doi.org/10.2196/33537 %U http://www.ncbi.nlm.nih.gov/pubmed/35436221 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e27775 %T Developing a Mobile Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events Administration System to Capture Postradiation Toxicity in Oncology: Usability and Feasibility Study %A Underwood,Jody %A McCloskey,Susan %A Raldow,Ann %A Kishan,Amar %A Zalkin,Chad %A Navarro,Daniel %A Holt,Lisa Scott %A Webb,Andrew %A Lynch,Kathleen A %A Atkinson,Thomas M %+ Intelligent Automation, Inc, 15400 Calhoun Drive, Suite 190, Rockville, MD, 20855, United States, 1 3012944256, junderwood@i-a-i.com %K neoplasms %K patient outcome assessment %K radiation oncology %K toxicity %K public health informatics %K mobile apps %K mobile health %K mobile administration system %K radiation therapy %K eHealth %D 2022 %7 12.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Accurate self-reported symptomatic toxicity documentation via the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) is essential throughout cancer treatment to ensure safety and understand therapeutic efficacy. However, the capture of accurate toxicities from patients undergoing radiation therapy is challenging because this is generally provided only at the time of scheduled visits. Objective: This study seeks to establish the usability and feasibility of a mobile PRO-CTCAE Administration System (mPROS) to capture toxicities related to radiation therapy. Methods: English-speaking adult patients who were undergoing radiation therapy for cancer were enrolled and given a brief demonstration of the Say All Your Symptoms (SAYS) and Symptom Tracking Entry Program (STEP) interfaces of the mPROS app, followed by a patient-use phase where patient actions were observed as they navigated mPROS to enter toxicities. Patient feedback was captured via a semistructured interview and brief questionnaire. Results: We enrolled 25 patients (age: mean 60.7 years; females: n=13, 52%; White patients: n=13; 52%; non-Hispanic patients: n=19, 76%; college graduates: n=17, 68%). Patients almost equally preferred the SAYS (n=14, 56%) or STEP (n=11, 44%) interfaces, with 21 patients (84%) agreeing that they would use mPROS to report their symptoms to their health care team and 19 patients (76%) agreeing that they would recommend mPROS to others. Conclusions: The mPROS app is usable and feasible for facilitating the patient reporting of radiation therapy–related symptomatic toxicities. A revised version of mPROS that incorporates patient input and includes electronic health record integration is being developed and validated as part of a multicenter trial. %M 35412466 %R 10.2196/27775 %U https://formative.jmir.org/2022/4/e27775 %U https://doi.org/10.2196/27775 %U http://www.ncbi.nlm.nih.gov/pubmed/35412466 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e31901 %T Recruiting Black Men Who Have Sex With Men (MSM) Couples via Dating Apps: Pilot Study on Challenges and Successes %A Witkovic,Yong Darin %A Kim,Hyunjin Cindy %A Bright,Darius Jovon %A Tan,Judy Y %+ Division of Prevention Science, Center for AIDS Prevention Studies, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, United States, 1 415 514 7419, judy.tan@ucsf.edu %K African American %K sexual and gender minorities %K homosexuality, male %K HIV %K mHealth intervention %K mobile applications %K apps %K sexual partners %K investigative techniques %K community engagement %K MSM %K Black men %K mobile app %K LGBT %K research methods %K recruitment %K online dating %K social network %D 2022 %7 8.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV disproportionately impacts Black men who have sex with men (MSM), and targeting the primary relationship (ie, couples) using mobile technology for health holds promise for HIV prevention. Web-based recruitment of MSM is commonly employed in HIV prevention and intervention research. However, little known about recruiting Black MSM couples on the internet in the United States. Objective: This study describes the process of recruiting Black MSM couples over social networking and dating apps frequented by MSM. We describe the activities for recruiting, screening, and enrolling participants as part of a randomized trial employing a multipronged recruitment approach. Methods: Black MSM in couples were recruited via three apps (ie, Jack’d, Adam4Adam, and Growlr) between May 2020 and March 2021 during the COVID-19 pandemic in the United States. Black MSM couples were eligible if one or both partners are Black, MSM, and living with HIV, and if both partners were 18 years or older, and have been together for at least 2 months in what they both consider a primary relationship (ie, one in which both partners reported feeling most committed to over any other partner or relationship). Results: A total of 10 Black MSM couples (n=20) were enrolled via social networking apps. App recruitment activities were a combination of passive (eg, in-app advertisements) and active (eg, direct messaging of users) engagement. Recruitment approaches varied by the social networking app owing to differences in app features. A full-time recruiter experienced challenges such as bugs (ie, technical errors in computer program or system), navigating technical requirements specific to each app, and web-based harassment. Conclusions: Despite challenges, it was possible to recruit Black MSM couples virtually into research as part of a multipronged recruitment strategy. We identify tips for using web-based dating and other social networking apps as part of a recruitment strategy in future research with Black MSM couples. %M 35394432 %R 10.2196/31901 %U https://formative.jmir.org/2022/4/e31901 %U https://doi.org/10.2196/31901 %U http://www.ncbi.nlm.nih.gov/pubmed/35394432 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e30877 %T Prioritizing Support Offered to Caregivers by Examining the Status Quo and Opportunities for Enhancement When Using Web-Based Self-reported Health Questionnaires: Descriptive Qualitative Study %A Coles,Theresa %A Lucas,Nicole %A Daniell,Erin %A Sullivan,Caitlin %A Wang,Ke %A Olsen,Jennifer M %A Shepherd-Banigan,Megan %+ Department of Population Health Sciences, Duke University, 215 Morris St, Durham, NC, 27701, United States, 1 919 613 7994, theresa.coles@duke.edu %K caregiver %K web-based questionnaires %K self-report questionnaires %K caregiver outcomes %K intervention technology %K patient-reported outcome measures %D 2022 %7 8.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Rosalynn Carter Institute for Caregivers (RCI) offers evidence-based interventions to promote caregivers’ health and well-being. Trained coaches regularly meet with caregivers to offer education and instructions to improve caregiver health, build skill sets, and increase resilience. Two of these interventions, RCI Resources for Enhancing Alzheimer's Caregiver Health (REACH) and Operation Family Caregiver (OFC), use a set of caregiver-reported questionnaires to monitor caregivers’ health status and needs. Objective: This study aims to describe how web-based assessment questionnaires are used to identify and monitor caregiver status in the RCI REACH and OFC programs and outlines perceived enhancements to the web-based system that could support caregiver-coach encounters by directing priorities. Methods: This was a descriptive, qualitative study. Data were collected via semistructured interviews with caregivers and coaches in the RCI REACH and OFC programs from July 2020 to October 2020. During the interviews, participants were asked to describe how the assessment questionnaires were used to inform caregiver-coach encounters, perceived usefulness of enhancements to web-based display, and preference for the structure of score results. The interviews were recorded, transcribed, and coded using structural and interpretive codes from a structured codebook. Qualitative content analysis was used to identify themes and summarize the results. Results: A total of 25 caregivers (RCI REACH: 13/25, 52%; OFC: 12/25, 48%) and 11 coaches (RCI REACH: 5/11, 45%; OFC: 6/11, 55%) were interviewed. Most caregivers indicated that the assessment questions were relevant to their caregiving experience. Some caregivers and coaches indicated that they thought the assessment should be administered multiple times throughout the program to evaluate the caregiver progress. Overall, caregivers did not want their scores to be compared with those of other caregivers, and there was heterogeneity in how caregivers preferred to view their results at the question or topic level. Coaches were uncertain as to which and how much of the results from the self-reported questionnaires should be shared with caregivers. Overall, the results were very similar, regardless of program affiliation (RCI REACH vs OFC). Conclusions: Web-based and procedural enhancements were identified to enrich caregiver-coach encounters. New and enhanced strategies for using web-based assessment questionnaires to direct priorities in the caregiver-coach encounters included integrating figures showing caregiver progress at the individual caregiver level, ability to toggle results through different figures focused on individual versus aggregate results, and support for interpreting scores. The results of this qualitative study will drive the next steps for RCI’s web-based platform and expand on current standards for administering self-reported questionnaires in clinical practice settings. %M 35394436 %R 10.2196/30877 %U https://formative.jmir.org/2022/4/e30877 %U https://doi.org/10.2196/30877 %U http://www.ncbi.nlm.nih.gov/pubmed/35394436 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e30245 %T National Implementation of an Electronic Patient-Reported Outcome Measures Program for Joint Replacement Surgery: Pilot Study %A Heath,Emma L %A Ackerman,Ilana %A Lorimer,Michelle %A Rainbird,Sophia %A O'Donohue,Grace %A Brock,Andrew %A Graves,Stephen %A Harris,Ian %+ South Australian Health and Medical Research Institute, North Terrace, Adelaide, 5000, Australia, 61 881284358, emma.heath@sahmri.com %K cost %K cost-benefit %K online platform %K patient-reported outcome measure %K registry science %K electronic data collection %K electronic data %K capture %K joint replacement %K PROMs %K PROM %K outcome measure %K patient report %K data capture %K registry %K surgery %K operation %K postoperative %K surgical %K data reporting %K data collection %D 2022 %7 8.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a global emphasis on expanding data collection for joint replacement procedures beyond implant attributes and progression to revision surgery. Patient-reported outcome measures (PROMs) are increasingly considered as an important measure of surgical outcomes from a patient’s perspective. However, a major limitation preventing wider use of PROMs data in national data collection has been the inability to systematically collect and share electronic information with relevant stakeholders in a comprehensive and financially sustainable manner. Objective: This study reports on the development of an electronic data capture and reporting system by a national registry for the collection of PROMs and the processes used to identify and overcome barriers to implementation and uptake. The study also aims to provide a cost breakdown of establishing and maintaining a nationwide electronic PROMs program. Methods: Between 2018 and 2020, 3 governance and advisory committees were established to develop and implement a PROMs pilot program nested within a nationwide joint replacement registry. The program involved electronic collection of preoperative and 6-month postoperative data for hip, knee, or shoulder replacement surgery from 44 Australian hospitals. Resource requirements for the program included a project manager, software developers, data manager, and statistician. An online platform was tested, refined, and implemented for electronic PROMs collection with scalability considered for future expansion to all Australian hospitals and additional data fields. Technical capabilities included different access for multiple user types, patient registration, automatic reminders via SMS text messages and email, online consent, and patient outcome real-time dashboards accessible for different user groups (surgeons, patients, hospitals, and project stakeholders). Results: During the PROMs pilot period there were 19,699 primary procedures undertaken with 10,204 registered procedures in the electronic system. This equated to 51.80% of people who had a joint replacement at participating hospitals during this period. Patient registration and data collection were efficient (20-30 seconds and 10-12 minutes, respectively). Engagement with the reporting dashboards (as a proportion of those who viewed their dashboard) varied by user group: 197/277 (71.1%) hospital administrators, 68/129 (52.7%) project stakeholders, 177/391 (45.3%) surgeons, and 1138/8840 patients (12.9%). Cost analysis determined an overall cost per patient of Aus $7-15 (approximately US $5-12) for 2 PROMs collections per joint replacement procedure once the program was established. Conclusions: Successful implementation of an orthopedic PROMs program with planned scalability for a broader national rollout requires significant funding and staffing resources. However, this expenditure can be considered worthwhile, given that collection and reporting of PROMs can drive health care improvement processes. Further consideration of strategies to improve stakeholder engagement with electronic reporting dashboards (particularly for patients and surgeons) will be critical to the ongoing success of a national PROMs program. %M 35394439 %R 10.2196/30245 %U https://formative.jmir.org/2022/4/e30245 %U https://doi.org/10.2196/30245 %U http://www.ncbi.nlm.nih.gov/pubmed/35394439 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e31189 %T Student, Staff, and Faculty Perspectives on Intimate Partner and Sexual Violence on 3 Public University Campuses: Protocol for the UC Speaks Up Study and Preliminary Results %A Wagman,Jennifer A %A Amabile,Claire %A Sumstine,Stephanie %A Park,Eunhee %A Boyce,Sabrina %A Silverman,Jay %A Fielding-Miller,Rebecca %A Oaks,Laury %A Swendeman,Dallas %+ Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, 650 Charles E Young Dr S, Los Angeles, CA, 90095, United States, 1 310 825 5047, jennwagman@ucla.edu %K campus-based violence prevention %K intimate partner violence %K sexual violence %K mixed methods research %K public health approach %K prevention %K student-led %K trauma-informed research %K University of California %D 2022 %7 5.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Intimate partner and sexual violence are pervasive public health issues on college and university campuses in the United States. Research is recommended for creating and maintaining effective, relevant, and acceptable prevention programs and response services for student survivors. Objective: The University of California (UC) Speaks Up study aims to examine factors contributing to intimate partner and sexual violence on 3 UC campuses and use the findings to develop and test interventions and policies to prevent violence, promote health, and lay the groundwork for subsequent large-scale quantitative research. Methods: A mixed methods study was conducted at UC Los Angeles, UC San Diego, and UC Santa Barbara. Phase I (2017-2020) involved a resource audit; cultural consensus modeling of students’ perceptions of sexual consent; in-depth interviews (IDIs) and focus group discussions with students to understand perceptions of campus environment related to experiences as well as prevention of and responses to violence; and IDIs with faculty, staff, and community stakeholders to investigate institutional and community arrangements influencing students’ lives and experiences. Phase II (2020-ongoing) involves IDIs with student survivors to assess the use and perceptions of campus and community services. Qualitative content analysis is used to generate substantive codes and subthemes that emerge, using a thematic analysis approach. Results: In January 2019, we conducted 149 free-listing interviews and 214 web-based surveys with undergraduate and graduate and professional students for the cultural consensus modeling. Between February 2019 and June 2019, 179 IDIs were conducted with 86 (48%) undergraduate students, 21 (11.7%) graduate and professional students, 34 (19%) staff members, 27 (15.1%) faculty members, and 11 (6.1%) community stakeholders, and 35 focus group discussions (27/35, 77% with undergraduate students and 8/35, 23% with graduate and professional students) were conducted with 201 participants. Since September 2020, 50% (15/30) of the planned student survivor interviews have been conducted. This segment of data collection was disrupted by the COVID-19 pandemic. Recruitment is ongoing. Conclusions: Data analysis and phase II data collection are ongoing. The findings will be used to develop and test interventions for preventing violence, promoting health and well-being, and ensuring that survivor services are relevant and acceptable to and meet the needs of all individuals in the campus community, including those who are typically understudied. The findings will also be used to prepare for rigorous, UC–system-wide public health prevention research. International Registered Report Identifier (IRRID): DERR1-10.2196/31189 %M 35380114 %R 10.2196/31189 %U https://www.researchprotocols.org/2022/4/e31189 %U https://doi.org/10.2196/31189 %U http://www.ncbi.nlm.nih.gov/pubmed/35380114 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 1 %P e33213 %T Open-source Web Portal for Managing Self-reported Data and Real-world Data Donation in Diabetes Research: Platform Feasibility Study %A Cooper,Drew %A Ubben,Tebbe %A Knoll,Christine %A Ballhausen,Hanne %A O'Donnell,Shane %A Braune,Katarina %A Lewis,Dana %+ Department of Pediatric Endocrinology and Diabetes, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, 13353, Germany, 49 30450 ext 566261, drew.cooper@charite.de %K diabetes %K type 1 diabetes %K automated insulin delivery %K diabetes technology %K open-source %K patient-reported outcomes %K real-world data %K research methods %K mixed methods %K insulin %K digital health %K web portal %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: People with diabetes and their support networks have developed open-source automated insulin delivery systems to help manage their diabetes therapy, as well as to improve their quality of life and glycemic outcomes. Under the hashtag #WeAreNotWaiting, a wealth of knowledge and real-world data have been generated by users of these systems but have been left largely untapped by research; opportunities for such multimodal studies remain open. Objective: We aimed to evaluate the feasibility of several aspects of open-source automated insulin delivery systems including challenges related to data management and security across multiple disparate web-based platforms and challenges related to implementing follow-up studies. Methods: We developed a mixed methods study to collect questionnaire responses and anonymized diabetes data donated by participants—which included adults and children with diabetes and their partners or caregivers recruited through multiple diabetes online communities. We managed both front-end participant interactions and back-end data management with our web portal (called the Gateway). Participant questionnaire data from electronic data capture (REDCap) and personal device data aggregation (Open Humans) platforms were pseudonymously and securely linked and stored within a custom-built database that used both open-source and commercial software. Participants were later given the option to include their health care providers in the study to validate their questionnaire responses; the database architecture was designed specifically with this kind of extensibility in mind. Results: Of 1052 visitors to the study landing page, 930 participated and completed at least one questionnaire. After the implementation of health care professional validation of self-reported clinical outcomes to the study, an additional 164 individuals visited the landing page, with 142 completing at least one questionnaire. Of the optional study elements, 7 participant–health care professional dyads participated in the survey, and 97 participants who completed the survey donated their anonymized medical device data. Conclusions: The platform was accessible to participants while maintaining compliance with data regulations. The Gateway formalized a system of automated data matching between multiple data sets, which was a major benefit to researchers. Scalability of the platform was demonstrated with the later addition of self-reported data validation. This study demonstrated the feasibility of custom software solutions in addressing complex study designs. The Gateway portal code has been made available open-source and can be leveraged by other research groups. %M 35357312 %R 10.2196/33213 %U https://diabetes.jmir.org/2022/1/e33213 %U https://doi.org/10.2196/33213 %U http://www.ncbi.nlm.nih.gov/pubmed/35357312 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e28692 %T Statistical Methods for Item Reduction in a Representative Lifestyle Questionnaire: Pilot Questionnaire Study %A Staffini,Alessio %A Fujita,Kento %A Svensson,Akiko Kishi %A Chung,Ung-Il %A Svensson,Thomas %+ Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan, 81 358414737, kishi@bioeng.t.u-tokyo.ac.jp %K item reduction %K surveys and lifestyle questionnaires %K feedback measures %K questionnaire design %K variance inflation factor %K factor analysis %K mobile phone %D 2022 %7 18.3.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Reducing the number of items in a questionnaire while maintaining relevant information is important as it is associated with advantages such as higher respondent engagement and reduced response error. However, in health care, after the original design, an a posteriori check of the included items in a questionnaire is often overlooked or considered to be of minor importance. When conducted, this is often based on a single selected method. We argue that before finalizing any lifestyle questionnaire, a posteriori validation should always be conducted using multiple approaches to ensure the robustness of the results. Objective: The objectives of this study are to compare the results of two statistical methods for item reduction (variance inflation factor [VIF] and factor analysis [FA]) in a lifestyle questionnaire constructed by combining items from different sources and analyze the different results obtained from the 2 methods and the conclusions that can be made about the original items. Methods: Data were collected from 79 participants (heterogeneous in age and sex) with a high risk of metabolic syndrome working in a financial company based in Tokyo. The lifestyle questionnaire was constructed by combining items (asked with daily, weekly, and monthly frequency) from multiple validated questionnaires and other selected questions. Item reduction was conducted using VIF and exploratory FA. Adequacy tests were used to check the data distribution and sampling adequacy. Results: Among the daily and weekly questions, both VIF and FA identified redundancies in sleep-related items. Among the monthly questions, both approaches identified redundancies in stress-related items. However, the number of items suggested for reduction often differed: VIF suggested larger reductions than FA for daily questions but fewer reductions for weekly questions. Adequacy tests always confirmed that the structural detection was adequate for the considered items. Conclusions: As expected, our analyses showed that VIF and FA produced both similar and different findings, suggesting that questionnaire designers should consider using multiple methods for item reduction. Our findings using both methods indicate that many questions, especially those related to sleep, are redundant, indicating that the considered lifestyle questionnaire can be shortened. %M 35302507 %R 10.2196/28692 %U https://www.i-jmr.org/2022/1/e28692 %U https://doi.org/10.2196/28692 %U http://www.ncbi.nlm.nih.gov/pubmed/35302507 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31894 %T Testing Digital Methods of Patient-Reported Outcomes Data Collection: Prospective Cluster Randomized Trial to Test SMS Text Messaging and Mobile Surveys %A Agarwal,Anish K %A Ali,Zarina S %A Shofer,Frances %A Xiong,Ruiying %A Hemmons,Jessica %A Spencer,Evan %A Abdel-Rahman,Dina %A Sennett,Brian %A Delgado,Mucio K %+ Department of Emergency Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, United States, 1 6103042318, anish.agarwal@pennmedicine.upenn.edu %K patient-reported outcomes %K mobile surveys %K research methods %K text messaging %K mobile survey %K data collection %K patient engagement %K response rate %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Health care delivery continues to evolve, with an effort being made to create patient-centered care models using patient-reported outcomes (PROs) data. Collecting PROs has remained challenging and an expanding landscape of digital health offers a variety of methods to engage patients. Objective: The aim of this study is to prospectively investigate two common methods of remote PRO data collection. The study sought to compare response and engagement rates for bidirectional SMS text messaging and mobile surveys following orthopedic surgery. Methods: The study was a prospective, block randomized trial of adults undergoing elective orthopedic procedures over 6 weeks. The primary objective was to determine if the method of digital patient engagement would impact response and completion rates. The primary outcome was response rate and total completion of PRO questionnaires. Results: A total of 127 participants were block randomized into receiving a mobile survey (n=63) delivered as a hyperlink or responding to the same questions through an automated bidirectional SMS text messaging system (n=64). Gender, age, number of comorbidities, and opioid prescriptions were similar across messaging arms. Patients receiving the mobile survey were more likely to have had a knee-related surgery (n=50, 83.3% vs n=40, 62.5%; P=.02) but less likely to have had an invasive procedure (n=26, 41.3% vs n=39, 60.9%; P=.03). Overall engagement over the immediate postoperative period was similar. Prolonged engagement for patients taking opioids past postoperative day 4 was higher in the mobile survey arm at day 7 (18/19, 94.7% vs 9/16, 56.3%). Patients with more invasive procedures showed a trend toward being responsive at day 4 as compared to not responding (n=41, 59.4% vs n=24, 41.4%; P=.05). Conclusions: As mobile patient engagement becomes more common in health care, testing the various options to engage patients to gather data is crucial to inform future care and research. We found that bidirectional SMS text messaging and mobile surveys were comparable in response and engagement rates; however, mobile surveys may trend toward higher response rates over longer periods of time. Trial Registration: ClinicalTrials.gov NCT03532256; https://clinicaltrials.gov/ct2/show/NCT03532256 %M 35298394 %R 10.2196/31894 %U https://formative.jmir.org/2022/3/e31894 %U https://doi.org/10.2196/31894 %U http://www.ncbi.nlm.nih.gov/pubmed/35298394 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e29009 %T Comparing SF-36 Scores Collected Through Web-Based Questionnaire Self-completions and Telephone Interviews: An Ancillary Study of the SENTIPAT Multicenter Randomized Controlled Trial %A Açma,Ayşe %A Carrat,Fabrice %A Hejblum,Gilles %+ Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, 27 Rue Chaligny, Paris, 75012, France, gilles.hejblum@inserm.fr %K Bias, Epidemiologic %K Effect Modifier, Epidemiologic %K Forms as Topic %K Interviews, Telephone %K Internet %K Patient Reported Outcome Measures %K Patient Satisfaction %K Quality of Life %K Surveys and Questionnaires %D 2022 %7 10.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The 36-Item Short Form Health Survey (SF-36) is a popular questionnaire for measuring the self-perception of quality of life in a given population of interest. Processing the answers of a participant comprises the calculation of 10 scores corresponding to 8 scales measuring several aspects of perceived health and 2 summary components (physical and mental). Surprisingly, no study has compared score values issued from a telephone interview versus those from an internet-based questionnaire self-completion. Objective: This study aims to compare the SF-36 score values issued from a telephone interview versus those from an internet-based questionnaire self-completion. Methods: Patients with an internet connection and returning home after hospital discharge were enrolled in the SENTIPAT multicenter randomized trial on the day of discharge. They were randomized to either self-completing a set of questionnaires using a dedicated website (internet group) or providing answers to the same questionnaires administered during a telephone interview (telephone group). This ancillary study of the trial compared SF-36 data related to the posthospitalization period in these 2 groups. To anticipate the potential unbalanced characteristics of the responders in the 2 groups, the impact of the mode of administration of the questionnaire on score differences was investigated using a matched sample of individuals originating from the internet and telephone groups (1:1 ratio), in which the matching procedure was based on a propensity score approach. SF-36 scores observed in the internet and telephone groups were compared using the Wilcoxon-Mann-Whitney test, and the score differences between the 2 groups were also examined according to Cohen effect size. Results: Overall, 29.2% (245/840) and 75% (630/840) of SF-36 questionnaires were completed in the internet and telephone groups, respectively (P<.001). Globally, the score differences between groups before matching were similar to those observed in the matched sample. Mean scores observed in the telephone group were all above the corresponding values observed in the internet group. After matching, score differences in 6 out of the 8 SF-36 scales were statistically significant, with a mean difference greater than 5 for 4 scales and an associated mild effect size ranging from 0.22 to 0.29, and with a mean difference near this threshold for 2 other scales (4.57 and 4.56) and a low corresponding effect size (0.18 and 0.16, respectively). Conclusions: The telephone mode of administration of SF-36 involved an interviewer effect, increasing SF-36 scores. Questionnaire self-completion via the internet should be preferred, and surveys combining various administration methods should be avoided. Trial Registration: ClinicalTrials.gov NCT01769261; https://www.clinicaltrials.gov/ct2/show/record/NCT01769261 %M 35266869 %R 10.2196/29009 %U https://www.jmir.org/2022/3/e29009 %U https://doi.org/10.2196/29009 %U http://www.ncbi.nlm.nih.gov/pubmed/35266869 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e32694 %T The Transition of Social Isolation and Related Psychological Factors in 2 Mild Lockdown Periods During the COVID-19 Pandemic in Japan: Longitudinal Survey Study %A Sugaya,Nagisa %A Yamamoto,Tetsuya %A Suzuki,Naho %A Uchiumi,Chigusa %+ Graduate School of Technology, Industrial and Social Sciences, Tokushima University, 1-1, Minamijosanjima-cho, Tokushima, 770-8502, Japan, 81 88 656 7617, t.yamamoto@tokushima-u.ac.jp %K coronavirus disease 2019 %K mild lockdown %K social isolation %K longitudinal survey %K public health %K surveillance %K epidemiology %K COVID-19 %K pandemic %K lockdown %K psychological behavior %K social factors %K mental health %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Lockdowns and stay-at-home orders announced internationally for COVID-19 have led to physical and social distancing, with reports of many individuals experiencing social isolation (SI) and loneliness. Although the emergency declaration in Japan was declared as a “mild” lockdown requested by the government without penalties for violations, the lockdown measures, including SI, had several influences on people’s lives and mental health as in other countries. Furthermore, Japan declared a state of emergency multiple times; thus, it is necessary to examine the influence of the transition of SI caused by repeated emergency declarations and the deterioration of mental health associated with these changes. Objective: This study longitudinally investigated the transition of SI and its related factors during the mild lockdown under 2 declared states of emergency in Japan and analyzed psychosocial characteristics by extracting clusters where people with specific transition patterns of SI predominated. Methods: We collected data on 7893 inhabitants (3694 [46.8%] women, 49.6 [SD 13.7] years old) living in the 7 prefectures where the initial emergency declaration was applied. The investigations took place online in the final phase of the first and second states of emergency: phase 1 (between May 11 and 12, 2020) and phase 2 (between February 24 and 28, 2021). Nonparametric Bayesian coclustering was used to visualize the exhaustive interaction structure between the transition pattern of SI and the psychosocial variables. Results: There were no improvements in social networks and loneliness between the 2 phases, although psychological distress significantly improved and depression slightly decreased. Overall, 3868 (49%) of the 7893 participants remained socially isolated through phases 1 and 2, and 947 (12%) were socially isolated in phase 2, even though they were not socially isolated in phase 1. More participants experienced persistent SI in unmarried, childless, and low-household-income groups. The persistent-SI group had fewer cohabitants than other transition pattern groups. The nonparametric Bayesian coclustering results showed that most clusters, including participants without SI throughout phases 1 and 2, had healthy behaviors, more interactions, good relationships, and less loneliness and psychological stress. Furthermore, the cluster in which relationships deteriorated in phase 1 recovered in phase 2. Comparatively, the clusters with SI throughout phases 1 and 2 were divided into clusters with increased loneliness and psychological stress; clusters were close to participants’ average scores in this study. The clusters with increased loneliness and psychological stress were notable for deteriorating relationships and less online interaction. Conclusions: This study revealed the actual state of transition of SI and related psychological, social, and behavioral factors under repeated declarations of a state of emergency. These results should help construct intervention methods that fit individual characteristics of people in SI during a pandemic. %M 35107428 %R 10.2196/32694 %U https://publichealth.jmir.org/2022/3/e32694 %U https://doi.org/10.2196/32694 %U http://www.ncbi.nlm.nih.gov/pubmed/35107428 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e36026 %T HIV Surveillance and Research for Migrant Populations: Protocol Integrating Respondent-Driven Sampling, Case Finding, and Medicolegal Services for Venezuelans Living in Colombia %A Wirtz,Andrea L %A Page,Kathleen R %A Stevenson,Megan %A Guillén,José Rafael %A Ortíz,Jennifer %A López,Jhon Jairo %A Ramírez,Jhon Fredy %A Quijano,Cindy %A Vela,Alejandra %A Moreno,Yessenia %A Rigual,Francisco %A Case,James %A Hakim,Avi J %A Hladik,Wolfgang %A Spiegel,Paul B %+ Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 4109292881, awirtz1@jhu.edu %K HIV %K epidemiology %K migrant %K Venezuela %K Colombia %K respondent-driven sampling %K case finding %K HIV treatment %K HIV surveillance %K research %D 2022 %7 8.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Epidemiologic research among migrant populations is limited by logistical, methodological, and ethical challenges, but it is necessary for informing public health and humanitarian programming. Objective: We describe a methodology to estimate HIV prevalence among Venezuelan migrants in Colombia. Methods: Respondent-driven sampling, a nonprobability sampling method, was selected for attributes of reaching highly networked populations without sampling frames and analytic methods that permit estimation of population parameters. Respondent-driven sampling was modified to permit electronic referral of peers via SMS text messaging and WhatsApp. Participants complete sociobehavioral surveys and rapid HIV and syphilis screening tests with confirmatory testing. HIV treatment is not available for migrants who have entered Colombia through irregular pathways; thus, medicolegal services integrated into posttest counseling provide staff lawyers and legal assistance to participants diagnosed with HIV or syphilis for sustained access to treatment through the national health system. Case finding is integrated into respondent-driven sampling to allow partner referral. This study is implemented by a local community-based organization providing HIV support services and related legal services for Venezuelans in Colombia. Results: Data collection was launched in 4 cities in July and August 2021. As of November 2021, 3105 of the target 6100 participants were enrolled, with enrollment expected to end by February/March 2022. Conclusions: Tailored methods that combine community-led efforts with innovations in sampling and linkage to care can aid in advancing health research for migrant and displaced populations. Worldwide trends in displacement and migration underscore the value of improved methods for translation to humanitarian and public health programming. International Registered Report Identifier (IRRID): DERR1-10.2196/36026 %M 35258458 %R 10.2196/36026 %U https://www.researchprotocols.org/2022/3/e36026 %U https://doi.org/10.2196/36026 %U http://www.ncbi.nlm.nih.gov/pubmed/35258458 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e35984 %T Researching the Links Between Smartphone Behavior and Adolescent Well-being With the FUTURE-WP4 (Modeling the Future: Understanding the Impact of Technology on Adolescent’s Well-being Work Package 4) Project: Protocol for an Ecological Momentary Assessment Study %A Elavsky,Steriani %A Blahošová,Jana %A Lebedíková,Michaela %A Tkaczyk,Michał %A Tancos,Martin %A Plhák,Jaromír %A Sotolář,Ondřej %A Smahel,David %+ Faculty of Informatics, Masaryk University, Botanická 68A, Brno, 60200, Czech Republic, 420 549491814, elavsky@fi.muni.cz %K well-being %K adolescents %K smartphones %K intensive data %K ecological momentary assessment %D 2022 %7 8.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smartphone ownership has increased among teens within the last decade, with up to 89% of adolescents owning a smartphone and engaging daily with the online world through it. Although the results of recent meta-analyses suggest that engaging digital technology plays only a small role in adolescent well-being, parents, professionals, and policymakers remain concerned about the impact that the instant connectivity of smartphones has on adolescent well-being. Objective: Herein, we introduce the protocol of a research study investigating the associations between adolescent smartphone use and different facets of well-being (social, physical, and psychological), with the aim to apply innovative methods to address the limitations of existing empirical studies. Methods: This 12-month prospective study of adolescents uses a repeated measurement-burst design with the ecological momentary assessment methodology. Adolescents (N=203; age range 13-17 years) complete baseline assessments through online questionnaires, four 14-day intensive data collection bursts, and an online questionnaire at the end of the study. As part of the 4 measurement bursts, adolescent smartphone behavior is assessed objectively by passive data collection of smartphone data logs and through self-reports in short questionnaires administered via a custom-built Android app. Results: The protocol describes the study objectives, research tools (including the development of the Android app and specialized software), and process (including pilot studies, the main study, and targets for machine learning approaches). Two of the 203 enrolled participants provided no data during the first data collection burst of the main study. Preliminary analyses of the data from the first data collection burst indicated an acceptable level of compliance (72.25%) with the daily questionnaires. The design of the study will allow for the assessment of both within- and between-person variabilities in smartphone behavior, as well as short-term variation and long-term change in smartphone behavior and how it impacts the indicators of social, physical, and psychological well-being. Conclusions: The innovative methods applied in this study (objective smartphone logs, ecological momentary assessment, and machine learning) will allow for a more nuanced assessment of the links between smartphone use and well-being, informing strategies to help adolescents navigate the online world more constructively in terms of the development of their physical, social, and psychological well-being. International Registered Report Identifier (IRRID): DERR1-10.2196/35984 %M 35258467 %R 10.2196/35984 %U https://www.researchprotocols.org/2022/3/e35984 %U https://doi.org/10.2196/35984 %U http://www.ncbi.nlm.nih.gov/pubmed/35258467 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e27677 %T Smartphone App–Based Noncontact Ecological Momentary Assessment With Experienced and Naïve Older Participants: Feasibility Study %A Burke,Louise %A Naylor,Graham %+ Hearing Sciences - Scottish Section, School of Medicine, University of Nottingham, New Lister Building Level 3, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, G31 2ER, United Kingdom, 44 0141 242 9666, graham.naylor@nottingham.ac.uk %K ecological momentary assessment %K EMA %K smartphone %K mobile phone %K mHealth %K app %K noncontact EMA %K remote EMA %K hearing %K hearing loss %K feasibility %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphone app–based ecological momentary assessment (EMA) without face-to-face contact between researcher and participant (app-based noncontact EMA) potentially provides a valuable data collection tool when geographic, time, and situational factors (eg, COVID-19 restrictions) place constraints on in-person research. Nevertheless, little is known about the feasibility of this method, particularly in older and naïve EMA participants. Objective: This study aims to assess the feasibility of app-based noncontact EMA as a function of previous EMA experience, by recruiting and comparing a group of participants who had never participated in EMA before against a group of participants who had been part of an earlier in-person EMA study, and age, by recruiting middle-aged to older adults. Methods: Overall, 151 potential participants were invited via email; 46.4% (70/151) enrolled in the study by completing the baseline questionnaire set and were emailed instructions for the EMA phase. Of these participants, 67% (47/70) downloaded an EMA app and ran the survey sequence for 1 week. In total, 5 daytime surveys and 1 evening survey, each day, assessed participants’ listening environment, social activity, and conversational engagement. A semistructured exit telephone interview probed the acceptability of the method. As markers of feasibility, we assessed the enrollment rate, study completion rate, reason for noncompletion, EMA survey response rate, and likelihood of reporting an issue with survey alerts and requested assistance from researchers, family, or friends. Results: Enrollment rates among invitees (63.3% vs 38.2%; P=.004) and completion rates among enrollees (83.9% vs 53.8%; P<.001) were higher in the experienced than in the naïve EMA group. On average, experienced participants responded to 64.1% (SD 30.2%) of the daytime EMA surveys, and naïve participants responded to 54.3% (SD 29.5%) of the daytime EMA surveys (P=.27). Among participants who retrospectively reported issues with survey alerts, only 19% (3/16) requested researcher assistance during data collection. Older participants were more likely to report not being alerted to EMA surveys (P=.008), but age was unrelated to all other markers of feasibility. Post hoc analyses of the effect of the phone operating system on markers of feasibility revealed that response rates were higher among iOS users (mean 74.8%, SD 20.25%) than among Android users (mean 48.5%, SD 31.35%; P=.002). Conclusions: Smartphone app–based noncontact EMA appears to be feasible, although participants with previous EMA experience, younger participants, and iOS users performed better on certain markers of feasibility. Measures to increase feasibility may include extensive testing of the app with different phone types, encouraging participants to seek timely assistance for any issues experienced, and recruiting participants who have some previous EMA experience where possible. The limitations of this study include participants’ varying levels of existing relationship with the researcher and the implications of collecting data during the COVID-19 social restrictions. %M 35258471 %R 10.2196/27677 %U https://formative.jmir.org/2022/3/e27677 %U https://doi.org/10.2196/27677 %U http://www.ncbi.nlm.nih.gov/pubmed/35258471 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e35199 %T The Effects of Introducing a Mobile App–Based Procedural Logbook on Trainee Compliance to a Central Venous Catheter Insertion Accreditation Program: Before-and-After Study %A Tamblyn,Robert %A Brieva,Jorge %A Cain,Madeleine %A Martinez,F Eduardo %+ Division of Critical Care, John Hunter Hospital, Hunter New England Local Health District, Lookout Rd, New Lambton Heights, Newcastle, 2305, Australia, 61 432032151, robert.d.tamblyn@gmail.com %K logbook %K education %K training %K central venous catheter %K CVC %K intensive care %K smartphone %K mobile phone %K mobile apps %K mHealth %K mobile health %K accreditation program %K digital health %K digital record %D 2022 %7 7.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: To reduce complications associated with central venous catheter (CVC) insertions, local accreditation programs using a supervised procedural logbook are essential. To increase compliance with such a logbook, a mobile app could provide the ideal platform for training doctors in an adult intensive care unit (ICU). Objective: The aim of this paper was to compare trainee compliance with the completion of a logbook as part of a CVC insertion accreditation program, before and after the introduction of an app-based logbook. Methods: This is a retrospective observational study of logbook data, before and after the introduction of a purpose-built, app-based, electronic logbook to complement an existing paper-based logbook. Carried out over a 2-year period in the adult ICU of the John Hunter Hospital, Newcastle, NSW, Australia, the participants were ICU trainee medical officers completing a CVC insertion accreditation program. The primary outcome was the proportion of all CVC insertions documented in the patients’ electronic medical records appearing as logbook entries. To assess logbook entry quality, we measured and compared the proportion of logbook entries that were approved by a supervisor and contained a supervisor’s signature for the before and after periods. We also analyzed trainee participation before and after the intervention by comparing the total number of active logbook users, and the proportion of first-time users who logged 3 or more CVC insertions. Results: Of the 2987 CVC insertions documented in the electronic medical records between April 7, 2019, and April 6, 2021, 2161 (72%) were included and separated into cohorts before and after the app’s introduction. Following the introduction of the app-based logbook, the percentage of CVC insertions appearing as logbook entries increased from 3.6% (38/1059) to 20.5% (226/1102; P<.001). There was no difference in the proportion of supervisor-approved entries containing a supervisor’s signature before and after the introduction of the app, with 76.3% (29/38) and 83.2% (188/226), respectively (P=.31). After the introduction of the app, there was an increase in the percentage of active logbook users from 15.3% (13/85) to 62.8% (54/86; P<.001). Adherence to one’s logbook was similar in both groups with 60% (6/10) of first-time users in the before group and 79.5% (31/39) in the after group going on to log at least 3 or more CVCs during their time working in ICU. Conclusions: The addition of an electronic app-based logbook to a preexisting paper-based logbook was associated with a higher rate of logbook compliance in trainee doctors undertaking an accreditation program for CVC insertion in an adult ICU. There was a large increase in logbook use observed without a reduction in the quality of logbook entries. The overall trainee participation also improved with an observed increase in active logbook users and no reduction in the average number of entries per user following the introduction of the app. Further studies on app-based logbooks for ICU procedural accreditation programs are warranted. %M 35051900 %R 10.2196/35199 %U https://humanfactors.jmir.org/2022/1/e35199 %U https://doi.org/10.2196/35199 %U http://www.ncbi.nlm.nih.gov/pubmed/35051900 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 3 %P e25477 %T A Comparison of Census and Cohort Sampling Models for the Longitudinal Collection of User-Reported Data in the Maternity Care Pathway: Mixed Methods Study %A Jamieson Gilmore,Kendall %A Bonciani,Manila %A Vainieri,Milena %+ Management and Healthcare Laboratory, Department of Economics and Management in the era of Data Science, Institute of Management, Sant'Anna Scuola Superiore, 33 Piazza Martiri della Libertà, Pisa, 56127, Italy, 39 050 883111, k.jamiesongilmore@santannapisa.it %K longitudinal studies %K mothers %K pregnancy %K survival analysis %K patient-reported outcome measures %K patient-reported experience measures %K surveys %K maternity %K postpartum %K online %K digital health %K digital collection %D 2022 %7 4.3.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Typical measures of maternity performance remain focused on the technical elements of birth, especially pathological elements, with insufficient measurement of nontechnical measures and those collected pre- and postpartum. New technologies allow for patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) to be collected from large samples at multiple time points, which can be considered alongside existing administrative sources; however, such models are not widely implemented or evaluated. Since 2018, a longitudinal, personalized, and integrated user-reported data collection process for the maternal care pathway has been used in Tuscany, Italy. This model has been through two methodological iterations. Objective: The aim of this study was to compare and contrast two sampling models of longitudinal user-reported data for the maternity care pathway, exploring factors influencing participation, cost, and suitability of the models for different stakeholders. Methods: Data were collected by two modes: (1) “cohort” recruitment at the birth hospital of a predetermined sample size and (2) continuous, ongoing “census” recruitment of women at the first midwife appointment. Surveys were used to collect experiential and outcome data related to existing services. Women were included who passed 12 months after initial enrollment, meaning that they either received the surveys issued after that interval or dropped out in the intervening period. Data were collected from women in Tuscany, Italy, between September 2018 and July 2020. The total sample included 7784 individuals with 38,656 observations. The two models of longitudinal collection of user-reported data were analyzed using descriptive statistics, survival analysis, cost comparison, and a qualitative review. Results: Cohort sampling provided lower initial participation than census sampling, although very high subsequent response rates (87%) were obtained 1 year after enrollment. Census sampling had higher initial participation, but greater dropout (up to 45% at 1 year). Both models showed high response rates for online surveys. There were nonproportional dropout hazards over time. There were higher rates of dropout for women with foreign nationality (hazard ratio [HR] 1.88, P<.001), and lower rates of dropout for those who had a higher level of education (HR 0.77 and 0.61 for women completing high school and college, respectively; P<.001), were employed (HR 0.87, P=.01), in a relationship (HR 0.84, P=.04), and with previous pregnancies (HR 0.86, P=.002). The census model was initially more expensive, albeit with lower repeat costs and could become cheaper if repeated more than six times. Conclusions: The digital collection of user-reported data enables high response rates to targeted surveys in the maternity care pathway. The point at which pregnant women or mothers are recruited is relevant for response rates and sample bias. The census model of continuous enrollment and real-time data availability offers a wider set of potential benefits, but at an initially higher cost and with the requirement for more substantial data translation and managerial capacity to make use of such data. %M 35254268 %R 10.2196/25477 %U https://medinform.jmir.org/2022/3/e25477 %U https://doi.org/10.2196/25477 %U http://www.ncbi.nlm.nih.gov/pubmed/35254268 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30797 %T User-Centered Development and Testing of the Online Patient-Reported Outcomes, Burdens, and Experiences (PROBE) Survey and the myPROBE App and Integration With the Canadian Bleeding Disorder Registry: Mixed Methods Study %A Germini,Federico %A Borg Debono,Victoria %A Page,David %A Zuk,Victoria %A Kucher,Alexandra %A Cotoi,Chris %A Hobson,Nicholas %A Sevestre,Michael %A Skinner,Mark W %A Iorio,Alfonso %A , %+ Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, 2C Area, Hamilton, ON, L8S 4K1, Canada, 1 905 525 9140 ext 26771, germinif@mcmaster.ca %K health-related quality of life %K EQ-5D %K mobile app %K Patient-Reported Outcomes, Burdens, and Experiences (PROBE) %K hemophilia %K mobile health %K mHealth %K eHealth %K telehealth %K user-centered design %D 2022 %7 2.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The Patient-Reported Outcomes, Burdens, and Experiences (PROBE) questionnaire is a tool for assessing the quality of life and disease burden in people living with hemophilia. Objective: The objectives of our study were (1) to assess the needs of relevant stakeholders involved in the use of PROBE, (2) to develop the software infrastructure needed to meet these needs, and (3) to test the usability of the final product. Methods: We conducted a series of semistructured interviews of relevant stakeholders, including PROBE investigators, people with hemophilia, and representatives of the sponsor. Based on these, we developed an online survey and a mobile app for iOS and Android. A user group evaluated the final product using the System Usability Scale (SUS) and an open feedback framework. Results: The online survey was updated, and the myPROBE app for mobile devices and a new application programming interface were developed. The app was tested and modified according to user feedback over multiple cycles. The final version of the app was released in July 2019. Seventeen users aged 23 to 67 years evaluated the final version of the app using the SUS. The median (first, third quartile) SUS score for the app was 85 (68, 88) out of 100. The newly introduced functionalities were as follows: (1) capability to longitudinally track repeated fillings of the questionnaire at different time points by the same participant (as opposed to anonymous completion); (2) linking of the questionnaire with hemophilia registries, starting with the Canadian Bleeding Disorders Registry as a proof of concept; (3) removing or adding questions as needed; and (4) sending notifications to the users (eg, reminders). A new secure database was built for securely storing personal information separately from the questionnaire data. The PROBE online survey is currently available in 96 countries and 34 languages. Conclusions: The online survey was updated successfully, and the myPROBE app was developed, with a SUS score of 85 (out of 100). The app has been released in 81 countries and 34 languages. This will facilitate data collection for research and advocacy purposes, and the use of this tool in everyday clinical practice. %M 35234648 %R 10.2196/30797 %U https://humanfactors.jmir.org/2022/1/e30797 %U https://doi.org/10.2196/30797 %U http://www.ncbi.nlm.nih.gov/pubmed/35234648 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e34688 %T Island Study Linking Aging and Neurodegenerative Disease (ISLAND) Targeting Dementia Risk Reduction: Protocol for a Prospective Web-Based Cohort Study %A Bartlett,Larissa %A Doherty,Kathleen %A Farrow,Maree %A Kim,Sarang %A Hill,Edward %A King,Anna %A Alty,Jane %A Eccleston,Claire %A Kitsos,Alex %A Bindoff,Aidan %A Vickers,James C %+ Wicking Dementia Research and Education Centre, University of Tasmania, Medical Sciences Precinct, 17 Liverpool Street, Hobart, 7000, Australia, 1800 982 600, larissa.bartlett@utas.edu.au %K public health %K online %K prospective research cohort %K dementia %K aging %K older adult %K neurodegenerative %K modifiable risk factors %K risk reduction %K prevention %K lifestyle and behaviors %K lifestyle %K behavior change %K intervention %K risk %K cognition %K blood-based dementia biomarkers %K research translation %D 2022 %7 1.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Up to 40% of incident dementia is considered attributable to behavioral and lifestyle factors. Given the current lack of medical treatments and the projected increase in dementia prevalence, a focus on prevention through risk reduction is needed. Objective: We aim to increase dementia risk knowledge and promote changes in dementia risk behaviors at individual and population levels. Methods: The Island Study Linking Aging and Neurodegenerative Disease (ISLAND) is a long-term prospective, web-based cohort study with nested interventions that will be conducted over a 10-year period. Target participants (n=10,000) reside in Tasmania and are aged 50 years or over. Survey data on knowledge, attitudes, and behaviors related to modifiable dementia risk factors will be collected annually. After each survey wave, participants will be provided with a personalized dementia risk profile containing guidelines for reducing risk across 9 behavioral and lifestyle domains and with opportunities to engage in educational and behavioral interventions targeting risk reduction. Survey data will be modeled longitudinally with intervention engagement indices, cognitive function indices, and blood-based biomarkers, to measure change in risk over time. Results: In the initial 12 months (October 2019 to October 2020), 6410 participants have provided baseline data. The study is ongoing. Conclusions: Recruitment targets are feasible and efforts are ongoing to achieve a representative sample. Findings will inform future public health dementia risk reduction initiatives by showing whether, when, and how dementia risk can be lowered through educational and behavioral interventions, delivered in an uncontrolled real-world context. International Registered Report Identifier (IRRID): DERR1-10.2196/34688 %M 35230251 %R 10.2196/34688 %U https://www.researchprotocols.org/2022/3/e34688 %U https://doi.org/10.2196/34688 %U http://www.ncbi.nlm.nih.gov/pubmed/35230251 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e33636 %T A Smartphone-Based Information Communication Technology Solution for Primary Modifiable Risk Factors for Noncommunicable Diseases: Pilot and Feasibility Study in Norway %A Gram,Inger Torhild %A Skeie,Guri %A Oyeyemi,Sunday Oluwafemi %A Borch,Kristin Benjaminsen %A Hopstock,Laila Arnesdatter %A Løchen,Maja-Lisa %+ Norwegian Centre for E-health Research, University Hospital of North Norway, Forskningsparken i Breivika, 3rd floor, Sykehusvn. 23, Tromsø, 9019, Norway, 47 92401177, inger.gram@ehealthresearch.no %K eHealth %K feasibility study %K modifiable risk factor %K noncommunicable disease %K pilot study %K smartphone-based information communication technology solution %K short text message service %K feasibility %K risk %K factor %K information communication technology %K smartphone %K development %K monitoring %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes are the 4 main noncommunicable diseases. These noncommunicable diseases share 4 modifiable risk factors (tobacco use, harmful use of alcohol, physical inactivity, and unhealthy diet). Short smartphone surveys have the potential to identify modifiable risk factors for individuals to monitor trends. Objective: We aimed to pilot a smartphone-based information communication technology solution to collect nationally representative data, annually, on 4 modifiable risk factors. Methods: We developed an information communication technology solution with functionalities for capturing sensitive data from smartphones, receiving, and handling data in accordance with general data protection regulations. The main survey comprised 26 questions: 8 on socioeconomic factors, 17 on the 4 risk factors, and 1 about current or previous noncommunicable diseases. For answers to the continuous questions, a keyboard was displayed for entering numbers; there were preset upper and lower limits for acceptable response values. For categorical questions, pull-down menus with response options were displayed. The second survey comprised 9 yes-or-no questions. For both surveys, we used SMS text messaging. For the main survey, we invited 11,000 individuals, aged 16 to 69 years, selected randomly from the Norwegian National Population Registry (1000 from each of the 11 counties). For the second survey, we invited a random sample of 100 individuals from each county who had not responded to the main survey. All data, except county of residence, were self-reported. We calculated the distribution for socioeconomic background, tobacco use, diet, physical activity, and health condition factors overall and by sex. Results: The response rate was 21.9% (2303/11,000; women: 1397/2263; 61.7%, men: 866/2263, 38.3%; missing: 40/2303, 1.7%). The median age for men was 52 years (IQR 40-61); the median age for women was 48 years (IQR 35-58). The main reported reason for nonparticipation in the main survey was that the sender of the initial SMS was unknown. Conclusions: We successfully developed and piloted a smartphone-based information communication technology solution for collecting data on the 4 modifiable risk factors for the 4 main noncommunicable diseases. Approximately 1 in 5 invitees responded; thus, these data may not be nationally representative. The smartphone-based information communication technology solution should be further developed with the long-term goal to reduce premature mortality from the 4 main noncommunicable diseases. %M 35212636 %R 10.2196/33636 %U https://formative.jmir.org/2022/2/e33636 %U https://doi.org/10.2196/33636 %U http://www.ncbi.nlm.nih.gov/pubmed/35212636 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e31363 %T Effectiveness of Digital Forced-Choice Nudges for Voluntary Data Donation by Health Self-trackers in Germany: Web-Based Experiment %A Pilgrim,Katharina %A Bohnet-Joschko,Sabine %+ Department of Management and Entrepreneurship, Faculty of Management, Economics and Society, Witten Herdecke University, Alfred-Herrhausen-Str 50, Witten, 58455, Germany, 49 2302926475, katharina.pilgrim@uni-wh.de %K quantified self %K health self-tracking %K digital nudge %K data donation %K health data %K mobile phone %D 2022 %7 21.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Health self-tracking is an evidence-based approach to optimize health and well-being for personal self-improvement through lifestyle changes. At the same time, user-generated health-related data can be of particular value for (health care) research. As longitudinal data, these data can provide evidence for developing better and new medications, diagnosing rare diseases faster, or treating chronic diseases. Objective: This quantitative study aims to investigate the impact of digital forced-choice nudges on the willingness of German health self-trackers to donate self-tracked health-related data for research. This study contributes to the body of knowledge on the effectiveness of nonmonetary incentives. Our study enables a gender-specific statement on influencing factors on the voluntary donation of personal health data and, at the same time, on the effectiveness of digital forced-choice nudges within tracking apps. Methods: We implemented a digital experiment using a web-based questionnaire by graphical manipulation of the Runtastic tracking app interface. We asked 5 groups independently to indicate their willingness to donate tracked data for research. We used a digital forced-choice nudge via a pop-up window, which framed the data donation request with 4 different counter values. We generated the counter values according to the specific target group needs identified from the research literature. Results: A sample of 919 was generated, of which, 625 (68%) were women and 294 (32%) were men. By dividing the sample into male and female participants, we take into account research on gender differences in privacy tendencies on the web and offline, showing that female participants display higher privacy concerns than male participants. A statistical group comparison shows that with a small effect size (r=0.21), men are significantly more likely (P=.04) to donate their self-tracked data for research if the need to take on social responsibility is addressed (the prosocial counter value in this case—contributing to society) compared with the control group without counter value. Selfish or pseudoprosocial counter values had no significant effect on willingness to donate health data among male or female health self-trackers in Germany when presented as a forced-choice nudge within a tracking app. Conclusions: Although surveys regularly reveal an 80% to 95% willingness to donate data on average in the population, our results show that only 41% (377/919) of the health self-trackers would donate their self-collected health data to research. Although selfish motives do not significantly influence willingness to donate, linking data donation to added societal value could significantly increase the likelihood of donating among male self-trackers by 15.5%. Thus, addressing the need to contribute to society promotes the willingness to donate data among male health self-trackers. The implementation of forced-choice framing nudges within tracking apps presented in a pop-up window can add to the accessibility of user-generated health-related data for research. %M 35188472 %R 10.2196/31363 %U https://www.jmir.org/2022/2/e31363 %U https://doi.org/10.2196/31363 %U http://www.ncbi.nlm.nih.gov/pubmed/35188472 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e29821 %T Using Social Media to Engage Knowledge Users in Health Research Priority Setting: Scoping Review %A Sivaratnam,Surabhi %A Hwang,Kyobin %A Chee-A-Tow,Alyssandra %A Ren,Lily %A Fang,Geoffrey %A Jibb,Lindsay %+ Child Health Evaluative Sciences, Hospital for Sick Children, 686 Bay Street, Toronto, ON, Canada, 1 416 813 7654 ext 309160, lindsay.jibb@sickkids.ca %K social media %K research priority-setting %K knowledge user %K scoping review %D 2022 %7 21.2.2022 %9 Review %J J Med Internet Res %G English %X Background: The need to include individuals with lived experience (ie, patients, family members, caregivers, researchers, and clinicians) in health research priority setting is becoming increasingly recognized. Social media–based methods represent a means to elicit and prioritize the research interests of such individuals, but there remains sparse methodological guidance on how best to conduct these social media efforts and assess their effectiveness. Objective: This review aims to identify social media strategies that enhance participation in priority-setting research, collate metrics assessing the effectiveness of social media campaigns, and summarize the benefits and limitations of social media–based research approaches, as well as recommendations for prospective campaigns. Methods: We searched PubMed, Embase, Cochrane Library, Scopus, and Web of Science from database inception until September 2021. Two reviewers independently screened all titles and abstracts, as well as full texts for studies that implemented and evaluated social media strategies aimed at engaging knowledge users in research priority setting. We subsequently conducted a thematic analysis to aggregate study data by related codes and themes. Results: A total of 23 papers reporting on 22 unique studies were included. These studies used Facebook, Twitter, Reddit, websites, video-calling platforms, emails, blogs, e-newsletters, and web-based forums to engage with health research stakeholders. Priority-setting engagement strategies included paid platform–based advertisements, email-embedded survey links, and question-and-answer forums. Dissemination techniques for priority-setting surveys included snowball sampling and the circulation of participation opportunities via internal members’ and external organizations’ social media platforms. Social media campaign effectiveness was directly assessed as number of clicks and impressions on posts, frequency of viewed posts, volume of comments and replies, number of times individuals searched for a campaign page, and number of times a hashtag was used. Campaign effectiveness was indirectly assessed as numbers of priority-setting survey responses and visits to external survey administration sites. Recommendations to enhance engagement included the use of social media group moderators, opportunities for peer-to-peer interaction, and the establishment of a consistent tone and brand. Conclusions: Social media may increase the speed and reach of priority-setting participation opportunities leading to the development of research agendas informed by patients, family caregivers, clinicians, and researchers. Perceived limitations of the approach include underrepresentation of certain demographic groups and addressing such limitations will enhance the inclusion of diverse research priority opinions in future research agendas. %M 35188476 %R 10.2196/29821 %U https://www.jmir.org/2022/2/e29821 %U https://doi.org/10.2196/29821 %U http://www.ncbi.nlm.nih.gov/pubmed/35188476 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e25597 %T Acceptability of and Willingness to Take Digital Pills by Patients, the Public, and Health Care Professionals: Qualitative Content Analysis of a Large Online Survey %A Chevance,Astrid %A Fortel,Axel %A Jouannin,Adeline %A Denis,Faustine %A Mamzer,Marie-France %A Ravaud,Philippe %A Sidorkiewicz,Stephanie %+ Center for Research in Epidemiology and Statistics, Université de Paris-French National Institute for Health and Medical Research, 1, place du pravis de Notre Dame, Paris, 75004, France, 33 142348987, astrid.chevance@gmail.com %K acceptability %K health technology assessment %K clinical effectiveness research %K ethics %K digital pill %K digital health %K digital therapeutics %K ingestible sensor %K adherence %D 2022 %7 18.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital pills are pills combined with a sensor, which sends a signal to a patch connected to a smartphone when the pills are ingested. Health care professionals can access patient data from digital pills online via their own interface, thus allowing them to check whether a patient took the drug. Digital pills were developed for the stated goal of improving treatment adherence. The US Food and Drug Administration approved the first digital pills in November 2017, but the manufacturer withdrew its application to the European Medicines Agency in July 2020 because of insufficient evaluation. Objective: As recommended for the evaluation of health technologies, this study assesses the prospective acceptability of and willingness to take digital pills among patients, the public, and health care professionals. Methods: Participants were patients who were receiving long-term treatment for a chronic condition, public participants (both groups recruited from a representative sample), and health care professionals. Participants answered 5 open-ended questions regarding the acceptability of digital pills and 1 close-ended question regarding the willingness to take digital pills, which were developed in a preliminary qualitative study. We explored the 5 theoretical dimensions of acceptability by performing an abductive qualitative content analysis of all free-text responses. We assessed data saturation with mathematical models. We fitted a multivariate logistic regression model to identify the sociodemographic and health characteristics associated with the willingness to take digital pills. Results: Between January 29, 2020, and April 18, 2020, 767 patients, 1238 public participants, and 246 health care professionals provided 11,451 free-text responses. We identified 98 codes related to the acceptability of digital pills: 29 codes on perceived clinical effectiveness (eg, sensor safety cited by 66/2251 participants, 29.5%), 6 on perceived burden (eg, increased doctors’ workload, 164/2251 participants, 7.3%), 25 on perceived ethicality (eg, policing, 345/2251 participants, 15.3%), 30 codes on perceived opportunity (eg, exclusively negative perception, 690/2251 participants, 30.7%), and 8 on affective attitude (eg, anger, 541/2251, 24%). Overall, 271/767 (35.3%) patients, 376/1238 (30.4%) public participants, and 39/246 (15.8%) health care professionals reported willingness to take digital pills. This willingness was associated with male sex (odds ratio 1.98, 95% CI 1.62-2.43) and current use of a connected device to record health settings (with a dose–response relationship). Conclusions: The prospective acceptability of and willingness to take digital pills were limited by clinical and ethical concerns both at the individual and societal level. Our results suggest that digital pills should not be considered a mere change in the form of drug administration but a complex intervention requiring specific evaluation before extended use in clinical routine practice as well as an ethical and legal framework to ensure safe and ethical collection and use of health data through a patient-centered approach. %M 35179509 %R 10.2196/25597 %U https://www.jmir.org/2022/2/e25597 %U https://doi.org/10.2196/25597 %U http://www.ncbi.nlm.nih.gov/pubmed/35179509 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e31830 %T Identification of Social Engagement Indicators Associated With Autism Spectrum Disorder Using a Game-Based Mobile App: Comparative Study of Gaze Fixation and Visual Scanning Methods %A Varma,Maya %A Washington,Peter %A Chrisman,Brianna %A Kline,Aaron %A Leblanc,Emilie %A Paskov,Kelley %A Stockham,Nate %A Jung,Jae-Yoon %A Sun,Min Woo %A Wall,Dennis P %+ Department of Pediatrics and Biomedical Data Science, Stanford University, 1265 Welch Road, Stanford, CA, 94304, United States, 1 650 497 9214, dpwall@stanford.edu %K mobile health %K autism spectrum disorder %K social phenotyping %K computer vision %K gaze %K mobile diagnostics %K pattern recognition %K autism %K diagnostic %K pattern %K engagement %K gaming %K app %K insight %K vision %K video %D 2022 %7 15.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Autism spectrum disorder (ASD) is a widespread neurodevelopmental condition with a range of potential causes and symptoms. Standard diagnostic mechanisms for ASD, which involve lengthy parent questionnaires and clinical observation, often result in long waiting times for results. Recent advances in computer vision and mobile technology hold potential for speeding up the diagnostic process by enabling computational analysis of behavioral and social impairments from home videos. Such techniques can improve objectivity and contribute quantitatively to the diagnostic process. Objective: In this work, we evaluate whether home videos collected from a game-based mobile app can be used to provide diagnostic insights into ASD. To the best of our knowledge, this is the first study attempting to identify potential social indicators of ASD from mobile phone videos without the use of eye-tracking hardware, manual annotations, and structured scenarios or clinical environments. Methods: Here, we used a mobile health app to collect over 11 hours of video footage depicting 95 children engaged in gameplay in a natural home environment. We used automated data set annotations to analyze two social indicators that have previously been shown to differ between children with ASD and their neurotypical (NT) peers: (1) gaze fixation patterns, which represent regions of an individual’s visual focus and (2) visual scanning methods, which refer to the ways in which individuals scan their surrounding environment. We compared the gaze fixation and visual scanning methods used by children during a 90-second gameplay video to identify statistically significant differences between the 2 cohorts; we then trained a long short-term memory (LSTM) neural network to determine if gaze indicators could be predictive of ASD. Results: Our results show that gaze fixation patterns differ between the 2 cohorts; specifically, we could identify 1 statistically significant region of fixation (P<.001). In addition, we also demonstrate that there are unique visual scanning patterns that exist for individuals with ASD when compared to NT children (P<.001). A deep learning model trained on coarse gaze fixation annotations demonstrates mild predictive power in identifying ASD. Conclusions: Ultimately, our study demonstrates that heterogeneous video data sets collected from mobile devices hold potential for quantifying visual patterns and providing insights into ASD. We show the importance of automated labeling techniques in generating large-scale data sets while simultaneously preserving the privacy of participants, and we demonstrate that specific social engagement indicators associated with ASD can be identified and characterized using such data. %M 35166683 %R 10.2196/31830 %U https://www.jmir.org/2022/2/e31830 %U https://doi.org/10.2196/31830 %U http://www.ncbi.nlm.nih.gov/pubmed/35166683 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e33356 %T Predictors of Online Patient Portal Use Among a Diverse Sample of Emerging Adults: Cross-sectional Survey %A Wright,Julie A %A Volkman,Julie E %A Leveille,Suzanne G %A Amante,Daniel J %+ Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 368 Plantation St, Worcester, MA, 01605, United States, 1 5088568480, daniel.amante@umassmed.edu %K internet %K patient portal %K emerging adults %K portal %K predictor %K prediction %K sample %K cross-sectional %K survey %K usage %K young adult %K eHealth %K literacy %D 2022 %7 15.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Health self-management is increasingly being influenced by emerging health information technologies (IT), especially online patient portals. Patient portals provide patients with direct access to their health information, electronic tools to manage their health, and additional opportunities to engage with their care team. Previous studies have found that patient portal use is highest among patients with high eHealth literacy, the ability to find health information from electronic sources and apply the knowledge gained to solve a health problem. The role of eHealth literacy on patient portal use appears to be especially strong among older adults with chronic diseases. The use of patient portals among emerging adults (ages 18-29) is much less understood. Although generally healthy, emerging adults are more regular IT users and just beginning to independently navigate the health care system. A good understanding of how emerging adults are using online patient portals and what factors, including eHealth, impact portal use is lacking. Objective: The aim of this study is to describe patient portal use and explore the predictors of portal use among a diverse sample of emerging adults. Methods: A cross-sectional survey study that used convenience sampling was conducted at two universities. Data on demographics, health care encounters, eHealth literacy, patient engagement, and use of patient portal features (administrative and clinical) were obtained via self-report and summarized. Logistic regression models were used to examine factors associated with portal use. Results: Of the 340 emerging adults, 257 (76%) were female, 223 (65%) White, 156 (47%) low income, and 184 (54%) reported having patient portal access. Of those reporting access, 142 (77%) used at least 1 portal feature and 42 (23%) reported using none. Significant predictors were patient engagement (odds ratio [OR] 1.08, 95% CI 1.04-1.13, P=.001) and total encounters (OR 1.23, 95% CI 1.05-1.44, P=.009) but not eHealth literacy. Hispanic and Asian emerging adults were more likely to be frequent users of clinical portal features than White emerging adults (Hispanic: OR 2.97, 95% CI 1.03-8.52, P=.04; Asian: OR 4.28, 95% CI 1.08-16.89, P=.04). Conclusions: We found that about half of emerging adults had access to a patient portal. Among those with access, a majority reported using at least one portal feature. Factors associated with increased portal use included increased patient engagement and total clinical encounters. Self-reported eHealth literacy was not associated with patient portal use in this diverse sample of emerging adults. This may have been due to high overall eHealth literacy levels in this population of frequent IT users. There may also be racial/ethnic differences that are important to consider, as we found Hispanic and Asian emerging adults reported more frequent portal use than White emerging adults. Interventions to promote patient portal use among emerging adults should include strategies to increase awareness of portal access and engagement among patients with fewer clinical encounters, with a focus on preventative health management. %M 35166686 %R 10.2196/33356 %U https://formative.jmir.org/2022/2/e33356 %U https://doi.org/10.2196/33356 %U http://www.ncbi.nlm.nih.gov/pubmed/35166686 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e30941 %T Using a Patient Portal to Increase Enrollment in a Newborn Screening Research Study: Observational Study %A Gehtland,Lisa M %A Paquin,Ryan S %A Andrews,Sara M %A Lee,Adam M %A Gwaltney,Angela %A Duparc,Martin %A Pfaff,Emily R %A Bailey Jr,Donald B %+ RTI International, 3040 E. Cornwallis Road, Research Triangle Park, NC, 27709, United States, 1 919 541 8054, lgehtland@rti.org %K electronic health records %K patient portals %K patient selection %K research subject recruitment %K race factors %K racial disparities %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Many research studies fail to enroll enough research participants. Patient-facing electronic health record applications, known as patient portals, may be used to send research invitations to eligible patients. Objective: The first aim was to determine if receipt of a patient portal research recruitment invitation was associated with enrollment in a large ongoing study of newborns (Early Check). The second aim was to determine if there were differences in opening the patient portal research recruitment invitation and study enrollment by race and ethnicity, age, or rural/urban home address. Methods: We used a computable phenotype and queried the health care system’s clinical data warehouse to identify women whose newborns would likely be eligible. Research recruitment invitations were sent through the women’s patient portals. We conducted logistic regressions to test whether women enrolled their newborns after receipt of a patient portal invitation and whether there were differences by race and ethnicity, age, and rural/urban home address. Results: Research recruitment invitations were sent to 4510 women not yet enrolled through their patient portals between November 22, 2019, through March 5, 2020. Among women who received a patient portal invitation, 3.6% (161/4510) enrolled their newborns within 27 days. The odds of enrolling among women who opened the invitation was nearly 9 times the odds of enrolling among women who did not open their invitation (SE 3.24, OR 8.86, 95% CI 4.33-18.13; P<.001). On average, it took 3.92 days for women to enroll their newborn in the study, with 64% (97/161) enrolling their newborn within 1 day of opening the invitation. There were disparities by race and urbanicity in enrollment in the study after receipt of a patient portal research invitation but not by age. Black women were less likely to enroll their newborns than White women (SE 0.09, OR 0.29, 95% CI 0.16-0.55; P<.001), and women in urban zip codes were more likely to enroll their newborns than women in rural zip codes (SE 0.97, OR 3.03, 95% CI 1.62-5.67; P=.001). Black women (SE 0.05, OR 0.67, 95% CI 0.57-0.78; P<.001) and Hispanic women (SE 0.07, OR 0.73, 95% CI 0.60-0.89; P=.002) were less likely to open the research invitation compared to White women. Conclusions: Patient portals are an effective way to recruit participants for research studies, but there are substantial racial and ethnic disparities and disparities by urban/rural status in the use of patient portals, the opening of a patient portal invitation, and enrollment in the study. Trial Registration: ClinicalTrials.gov NCT03655223; https://clinicaltrials.gov/ct2/show/NCT03655223 %M 35142618 %R 10.2196/30941 %U https://pediatrics.jmir.org/2022/1/e30941 %U https://doi.org/10.2196/30941 %U http://www.ncbi.nlm.nih.gov/pubmed/35142618 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e16128 %T Implementation of an Electronic Patient-Reported Outcome App for Health-Related Quality of Life in Breast Cancer Patients: Evaluation and Acceptability Analysis in a Two-Center Prospective Trial %A Graf,Joachim %A Sickenberger,Nina %A Brusniak,Katharina %A Matthies,Lina Maria %A Deutsch,Thomas M %A Simoes,Elisabeth %A Plappert,Claudia %A Keilmann,Lucia %A Hartkopf,Andreas %A Walter,Christina Barbara %A Hahn,Markus %A Engler,Tobias %A Wallwiener,Stephanie %A Schuetz,Florian %A Fasching,Peter A %A Schneeweiss,Andreas %A Brucker,Sara Yvonne %A Wallwiener,Markus %+ Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Im Neuenheimer Feld 440, Heidelberg, 69120, Germany, 49 06221 ext 56, markus.wallwiener@gmail.com %K eHealth %K electronic patient-reported outcomes %K evaluation %K acceptability %K breast cancer %D 2022 %7 8.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: One in eight women is diagnosed with breast cancer in the course of their life. As systematic palliative treatment has only a limited effect on survival rates, the concept of health-related quality of life (HRQoL) was developed for measurement of patient-centered outcomes. Various studies have already demonstrated the reliability of paper-based patient-reported outcome (pPRO) and electronic patient-reported outcome (ePRO) surveys and that the 2 means of assessment are equally valid. Objective: The aim of this study was to analyze the acceptance and evaluation of a tablet-based ePRO app for breast cancer patients and to examine its suitability, effort, and difficulty in the context of HRQoL and sociodemographic factors. Methods: Overall, 106 women with adjuvant or advanced breast cancer were included in a 2-center study at 2 major university hospitals in Germany. Patients were asked to answer HRQoL and PRO questionnaires both on a tablet on-site using a specific eHealth assessment website and on paper. The suitability, effort, and difficulty of the app and self-reported technical skills were also assessed. Only the results of the electronically acquired data are presented here. The results of the reliability of the pPRO data have already been published elsewhere. Results: Patients regarded the ePRO assessment as more suitable (80/106, 75.5%), less stressful (73/106, 68.9%), and less difficult (69/106, 65.1%) than pPRO. The majority of patients stated that ePRO assessment improves health care in hospitals (87/106, 82.1%). However, evaluation of ePROs depended on the level of education (P=.003) in the dimensions of effort and difficulty (regression analysis). The app was rated highly in all categories. HRQoL data and therapy setting did not show significant correlations with the app’s evaluation parameters. Conclusions: The results indicate that ePRO surveys are feasible for measuring HRQoL in breast cancer patients and that those patients prefer ePRO assessment to pPRO assessment. It can also be seen that patients consider ePRO assessment to improve hospital health care. However, studies with larger numbers of patients are needed to develop apps that address the needs of patients with lower levels of education and technical skills. %M 35133288 %R 10.2196/16128 %U https://www.jmir.org/2022/2/e16128 %U https://doi.org/10.2196/16128 %U http://www.ncbi.nlm.nih.gov/pubmed/35133288 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e31877 %T Using Smartphones to Reduce Research Burden in a Neurodegenerative Population and Assessing Participant Adherence: A Randomized Clinical Trial and Two Observational Studies %A Beukenhorst,Anna L %A Burke,Katherine M %A Scheier,Zoe %A Miller,Timothy M %A Paganoni,Sabrina %A Keegan,Mackenzie %A Collins,Ella %A Connaghan,Kathryn P %A Tay,Anna %A Chan,James %A Berry,James D %A Onnela,Jukka-Pekka %+ Department of Biostatistics, Harvard T.H. Chan School of Public Health, 4th Floor, 677 Huntington Avenue, Boston, MA, MA 02115, United States, 1 (617) 4951000, beuk@hsph.harvard.edu %K digital phenotyping %K mobile health %K trial %K smartphones %K attrition %K mobile phone %D 2022 %7 4.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone studies provide an opportunity to collect frequent data at a low burden on participants. Therefore, smartphones may enable data collection from people with progressive neurodegenerative diseases such as amyotrophic lateral sclerosis at high frequencies for a long duration. However, the progressive decline in patients’ cognitive and functional abilities could also hamper the feasibility of collecting patient-reported outcomes, audio recordings, and location data in the long term. Objective: The aim of this study is to investigate the completeness of survey data, audio recordings, and passively collected location data from 3 smartphone-based studies of people with amyotrophic lateral sclerosis. Methods: We analyzed data completeness in three studies: 2 observational cohort studies (study 1: N=22; duration=12 weeks and study 2: N=49; duration=52 weeks) and 1 clinical trial (study 3: N=49; duration=20 weeks). In these studies, participants were asked to complete weekly surveys; weekly audio recordings; and in the background, the app collected sensor data, including location data. For each of the three studies and each of the three data streams, we estimated time-to-discontinuation using the Kaplan–Meier method. We identified predictors of app discontinuation using Cox proportional hazards regression analysis. We quantified data completeness for both early dropouts and participants who remained engaged for longer. Results: Time-to-discontinuation was shortest in the year-long observational study and longest in the clinical trial. After 3 months in the study, most participants still completed surveys and audio recordings: 77% (17/22) in study 1, 59% (29/49) in study 2, and 96% (22/23) in study 3. After 3 months, passively collected location data were collected for 95% (21/22), 86% (42/49), and 100% (23/23) of the participants. The Cox regression did not provide evidence that demographic characteristics or disease severity at baseline were associated with attrition, although it was somewhat underpowered. The mean data completeness was the highest for passively collected location data. For most participants, data completeness declined over time; mean data completeness was typically lower in the month before participants dropped out. Moreover, data completeness was lower for people who dropped out in the first study month (very few data points) compared with participants who adhered long term (data completeness fluctuating around 75%). Conclusions: These three studies successfully collected smartphone data longitudinally from a neurodegenerative population. Despite patients’ progressive physical and cognitive decline, time-to-discontinuation was higher than in typical smartphone studies. Our study provides an important benchmark for participant engagement in a neurodegenerative population. To increase data completeness, collecting passive data (such as location data) and identifying participants who are likely to adhere during the initial phase of a study can be useful. Trial Registration: ClinicalTrials.gov NCT03168711; https://clinicaltrials.gov/ct2/show/NCT03168711 %M 35119373 %R 10.2196/31877 %U https://mhealth.jmir.org/2022/2/e31877 %U https://doi.org/10.2196/31877 %U http://www.ncbi.nlm.nih.gov/pubmed/35119373 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e29691 %T Patients’ Perspectives on Transforming Clinical Trial Participation: Large Online Vignette-based Survey %A Nguyen,Van Thu %A Ravaud,Philippe %A Tran,Viet Thi %A Young,Bridget %A Boutron,Isabelle %+ Université de Paris, Centre of Research Epidemiology and Statistics, Inserm, 1 Parvis de Notre Dame, Paris, 75004, France, 33 605714478, nguyenthuvandkh@gmail.com %K randomized controlled trial %K remote trial %K telemedicine %K patient experience %K trial participation %K RCTs %K participation %K recruitment %K patient preferences %K remote medicine %K pharmacological treatments %D 2022 %7 1.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients’ participation is crucial to the success of randomized controlled trials (RCTs). However, recruiting and retaining patients in trials remain a challenge. Objective: This study aims to describe patients’ preferences for the organization of RCTs (visits on- site or remotely) and evaluate the potential impact of fulfilling preferences on their willingness to participate in a clinical trial. Methods: This was a vignette-based survey. Vignettes were case scenarios of real clinical trials assessing pharmacological treatments. These RCTs evaluated 6 prevalent chronic diseases (ie, osteoporosis, osteoarthritis, asthma, cardiovascular diseases, diabetes, and endometriosis). Each vignette described (1) the RCT and characteristics of the treatment tested (ie, doses, administration routes) and (2) the trial procedures and different options (on-site or remotely) for how the trial was organized for informed consent, follow-up visits, and communication of results when the trial was completed. We recruited 628 participants from ComPaRe (www.compare.aphp.fr), a French e-cohort of patients with chronic diseases. The outcomes were the participants’ preferences for the way the trial was organized (on-site or remotely) and their willingness to participate in the trial. Results: Of the 628 participants who answered the vignettes, 491 (78.2%) were female (median age 55 years), with different chronic diseases ranging from endometriosis in 59 of 491 (12%) patients to asthma in 133 of 628 (21.2%) patients. In addition, 38 (6.1%) participants wanted to provide informed consent and all trial visits on-site, 176 (28%) wished to participate in the trial entirely remotely, and 414 (65.9%) wanted to combine remote-based and hospital-based visits. Considering the trial as a whole, when the trial was organized in a way that the patients preferred, the median (Q1-Q3) likelihood of participation in the trial was 90% (80-100) versus 60% (30-80) if the trial followed the patients’ nonpreferred model. Furthermore, 256 (40.8%) patients responded to open-ended questions expressing their experience with trial participation and visits to the hospital and providing suggestions for improvement. The patients emphasized the need to personalize the way a trial is organized according to each patient’s needs and conditions. Conclusions: There was a significant diversity in the participants’ preferences. Most participants preferred hybrid organization involving both on-site and remote visits. Participants were more likely to participate in a trial organized according to their preferences. %M 35103603 %R 10.2196/29691 %U https://www.jmir.org/2022/2/e29691 %U https://doi.org/10.2196/29691 %U http://www.ncbi.nlm.nih.gov/pubmed/35103603 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e21341 %T Collaborative Research and Development of a Novel, Patient-Centered Digital Platform (MyEyeSite) for Rare Inherited Retinal Disease Data: Acceptability and Feasibility Study %A Gilbert,Rose M %A Sumodhee,Dayyanah %A Pontikos,Nikolas %A Hollyhead,Catherine %A Patrick,Angus %A Scarles,Samuel %A Van Der Smissen,Sabrina %A Young,Rodrigo M %A Nettleton,Nick %A Webster,Andrew R %A Cammack,Jocelyn %+ NIHR Moorfields Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, 2/12 Wolfson Building, 11-43 Bath Street, London, EC1V 9EL, United Kingdom, 44 020 7608 6800, rose.gilbert@gmail.com %K MyEyeSite %K inherited retinal diseases (IRD) %K rare diseases %K genetics %K ophthalmology %K digital health %K eye data %K GDPR %K subject access request (SAR) %K mobile phone %D 2022 %7 31.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Inherited retinal diseases (IRDs) are a leading cause of blindness in children and working age adults in the United Kingdom and other countries, with an appreciable socioeconomic impact. However, by definition, IRD data are individually rare, and as a result, this patient group has been underserved by research. Researchers need larger amounts of these rare data to make progress in this field, for example, through the development of gene therapies. The challenge has been how to find and make these data available to researchers in the most productive way. MyEyeSite is a research collaboration aiming to design and develop a digital platform (the MyEyeSite platform) for people with rare IRDs that will enable patients, doctors, and researchers to aggregate and share specialist eye health data. A crucial component of this platform is the MyEyeSite patient application, which will provide the means for patients with IRD to interact with the system and, in particular, to collate, manage, and share their personal specialist IRD data both for research and their own health care. Objective: This study aims to test the acceptability and feasibility of the MyEyeSite platform in the target IRD population through a collaborative patient-centered study. Methods: Qualitative data were generated through focus groups and workshops, and quantitative data were obtained through a survey of patients with IRD. Participants were recruited through clinics at Moorfields Eye Hospital National Health Service (NHS) Foundation Trust and the National Institute for Health Research (NIHR) Moorfields Biomedical Research Centre through their patient and public involvement databases. Results: Our IRD focus group sample (n=50) highlighted the following themes: frustration with the current system regarding data sharing within the United Kingdom’s NHS; positive expectations of the potential benefits of the MyEyeSite patient application, resulting from increased access to this specialized data; and concerns regarding data security, including potentially unethical use of the data outside the NHS. Of the surveyed 80 participants, 68 (85%) were motivated to have a more active role in their eye care and share their data for research purposes using a secure technology, such as a web application or mobile app. Conclusions: This study demonstrates that patients with IRD are highly motivated to be actively involved in managing their own data for research and their own eye care. It demonstrates the feasibility of involving patients with IRD in the detailed design of the MyEyeSite platform exemplar, with input from the patient with IRD workshops playing a key role in determining both the functionality and accessibility of the designs and prototypes. The development of a user-centered technological solution to the problem of rare health data has the potential to benefit not only the patient with IRD community but also others with rare diseases. %M 35099396 %R 10.2196/21341 %U https://formative.jmir.org/2022/1/e21341 %U https://doi.org/10.2196/21341 %U http://www.ncbi.nlm.nih.gov/pubmed/35099396 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e27719 %T Measuring Problematic Internet Use, Internet Gaming Disorder, and Social Media Addiction in Young Adults: Cross-sectional Survey Study %A Moreno,Megan %A Riddle,Karyn %A Jenkins,Marina C %A Singh,Ajay Paul %A Zhao,Qianqian %A Eickhoff,Jens %+ Department of Pediatrics, University of Wisconsin-Madison, 2870 University Ave, Suite 200, Madison, WI, 53705, United States, 1 6082632846, mamoreno@pediatrics.wisc.edu %K technology %K young adults %K addiction %K social media %K internet %K video games %K screening %K surveillance %K cross-sectional %K survey %K mobile phone %D 2022 %7 27.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Digital technology use is nearly ubiquitous among young adults; this use provides both benefits and risks. The risks of technology use include maladaptive technology use or technology addiction. Several conceptualizations of these addictions have emerged, each with its own assessment tools. These conditions include problematic internet use (PIU), internet gaming disorder (IGD), and social media addiction (SMA). These conditions have been associated with health outcomes such as problematic alcohol use, sleep disorders, and mental illness. These maladaptive technology conditions have been most commonly studied in isolation from each other. Objective: The aim of this study is to examine PIU, IGD, and SMA together to better inform future research approaches and provider screening practices for young adults. Methods: This cross-sectional survey study was conducted using Qualtrics panel-based recruitment and survey hosting. We recruited US young adults aged 18-25 years. The survey assessed PIU, IGD, and SMA. Survey measures also included assessments of problematic alcohol use, sleep, depression, and anxiety. We evaluated the frequency of and overlap in positive screening scores among PIU, IGD, and SMA and modeled each condition using multivariate logistic regression. Finally, we calculated sensitivity and specificity, as well as the positive predictive value and negative predictive value of the screening tools using the most prevalent maladaptive technology type. Results: Our 6000 participants had an average age of 21.7 (SD 2.5) years. Of these 6000 participants, 3062 (51.03%) were female, 3431 (57.18%) were Caucasian, 1686 (28.1%) were in a 4-year college program, and 2319 (38.65%) worked full time. The mean PIU score was 3.5 (SD 3.1), and 53.58% (3215/6000) of participants met the criteria for PIU. The mean IGD score was 2.7 (SD 2.6), and 24.33% (1460/6000) of participants met the criteria for IGD. The mean SMA score was 7.5 (SD 5.7), and 3.42% (205/6000) met the criteria for SMA. Across all 3 maladaptive technology use diagnoses, there were varied associations with demographic variables and similar overlap with health outcomes. The sensitivity of PIU screening to detect IGD was 82% and to detect SMA was 93%, whereas the specificity and positive predictive value were much lower (37%-54% specificity; 6%-37% positive predictive value). Conclusions: This cross-sectional survey screened a large national sample of adolescents and young adults for PIU, IGD, and SMA to determine prevalence and overlap, demographic associations with each, and associations between these technology-related conditions and health outcomes. There was overlap across PIU, IGD, and SMA in some associated demographic variables and health outcomes. However, the patterns in the associated variables demonstrated unique qualities of each of these conditions. %M 34081596 %R 10.2196/27719 %U https://publichealth.jmir.org/2022/1/e27719 %U https://doi.org/10.2196/27719 %U http://www.ncbi.nlm.nih.gov/pubmed/34081596 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e33059 %T Gaming Activity and Possible Changes in Gaming Behavior Among Young People During the COVID-19 Pandemic: Cross-sectional Online Survey Study %A Claesdotter-Knutsson,Emma %A André,Frida %A Håkansson,Anders %+ Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Barav. 1, Lund, 22185, Sweden, 46 768871765, emma.claesdotter-knutsson@med.lu.se %K COVID-19 pandemic %K gaming %K screen time %K psychological distress %D 2022 %7 25.1.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Young people’s daily lives and social interactions changed remarkably during the COVID-19 pandemic as schools and cinemas closed, leisure activities were cancelled, and gatherings were regulated. Questions have been raised by the media, schools, policy makers, and research communities about the effect on young people’s online behaviors. Objective: This cross-sectional study aimed to study self-reported changes in gaming, focusing on a younger section of the population during the COVID-19 pandemic in Sweden. We also wanted to look at potential risk factors behind problematic gaming during the pandemic, including gaming patterns, gambling behavior, psychological distress, certain sociodemographic characteristics, health factors, and school situation. Methods: This was an anonymous online survey study of web panel participants in Sweden (n=1501) to study changes in gaming behaviors during the COVID-19 pandemic. Self-reported increases in gaming were analyzed in logistic regression analyses against sociodemographic and health factors. Results: Within the study population that reported changes in gaming activity, we found significant differences in age, employment status, disposable income, whether they ever played on loot boxes, time spent at home, school attendance, psychological distress, and gambling and gaming problems, as well as significant differences in changes in alcohol consumption and exercise habits. When examining the 16–24-year-old age group who reported changes in gaming activity, we found significant differences within the group in disposable income, time at home, and school attendance. When examining the 25–39-year-old age group who reported changes in gaming activity, we found significant differences within the group in employment status, disposable income, time spent at home, whether the respondents were studying, school attendance level, psychological distress, and gaming problems, as well as significant differences in changes in alcohol consumption and exercise habits. Psychological distress (all age groups analyzed together; 25–39-year-old age group), drinking less alcohol (all age groups analyzed together), spending more time at home (all age groups analyzed together), gaming problems, and exercising less (25–39-year-old age group) were positively correlated with a self-reported increase in gaming activity. Being employed (25–39-year-old age group) and being over 40 years of age (all age groups analyzed together) were negatively correlated with increased gaming. We found no significant correlations in the 16–24-year-old age group. Conclusions: Those who reported increased gaming during the COVID-19 pandemic were more likely to be 16 years to 39 years old. In the age group of 25 years to 39 years old, the increase was associated with psychological distress, reporting less exercise, and being unemployed. COVID-19 may present as a risk factor of increased online gaming in a small but vulnerable group. More research and preferably longitudinal studies are needed in the field of gaming and effects of the COVID-19 pandemic. %M 34817386 %R 10.2196/33059 %U https://games.jmir.org/2022/1/e33059 %U https://doi.org/10.2196/33059 %U http://www.ncbi.nlm.nih.gov/pubmed/34817386 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e28647 %T Behavioral and Self-reported Data Collected From Smartphones for the Assessment of Depressive and Manic Symptoms in Patients With Bipolar Disorder: Prospective Observational Study %A Dominiak,Monika %A Kaczmarek-Majer,Katarzyna %A Antosik-Wójcińska,Anna Z %A Opara,Karol R %A Olwert,Anna %A Radziszewska,Weronika %A Hryniewicz,Olgierd %A Święcicki,Łukasz %A Wojnar,Marcin %A Mierzejewski,Paweł %+ Department of Pharmacology and Physiology of the Nervous System, Institute of Psychiatry and Neurology, Sobieskiego 9, Warsaw, 02-957, Poland, 48 507183375, mdominia@wp.pl %K bipolar disorder %K generalized linear model %K mixed-effects regression %K classification %K manic episodes %K depressive episodes %K smartphone %K behavioral markers %K mHealth %K remote monitoring %D 2022 %7 19.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphones allow for real-time monitoring of patients’ behavioral activities in a naturalistic setting. These data are suggested as markers for the mental state of patients with bipolar disorder (BD). Objective: We assessed the relations between data collected from smartphones and the clinically rated depressive and manic symptoms together with the corresponding affective states in patients with BD. Methods: BDmon, a dedicated mobile app, was developed and installed on patients’ smartphones to automatically collect the statistics about their phone calls and text messages as well as their self-assessments of sleep and mood. The final sample for the numerical analyses consisted of 51 eligible patients who participated in at least two psychiatric assessments and used the BDmon app (mean participation time, 208 [SD 132] days). In total, 196 psychiatric assessments were performed using the Hamilton Depression Rating Scale and the Young Mania Rating Scale. Generalized linear mixed-effects models were applied to quantify the strength of the relation between the daily statistics on the behavioral data collected automatically from smartphones and the affective symptoms and mood states in patients with BD. Results: Objective behavioral data collected from smartphones were found to be related with the BD states as follows: (1) depressed patients tended to make phone calls less frequently than euthymic patients (β=−.064, P=.01); (2) the number of incoming answered calls during depression was lower than that during euthymia (β=−.15, P=.01) and, concurrently, missed incoming calls were more frequent and increased as depressive symptoms intensified (β=4.431, P<.001; β=4.861, P<.001, respectively); (3) the fraction of outgoing calls was higher in manic states (β=2.73, P=.03); (4) the fraction of missed calls was higher in manic/mixed states as compared to that in the euthymic state (β=3.53, P=.01) and positively correlated to the severity of symptoms (β=2.991, P=.02); (5) the variability of the duration of the outgoing calls was higher in manic/mixed states (β=.0012, P=.045) and positively correlated to the severity of symptoms (β=.0017, P=.02); and (6) the number and length of the sent text messages was higher in manic/mixed states as compared to that in the euthymic state (β=.031, P=.01; β=.015, P=.01; respectively) and positively correlated to the severity of manic symptoms (β=.116, P<.001; β=.022, P<.001; respectively). We also observed that self-assessment of mood was lower in depressive (β=−1.452, P<.001) and higher in manic states (β=.509, P<.001). Conclusions: Smartphone-based behavioral parameters are valid markers for assessing the severity of affective symptoms and discriminating between mood states in patients with BD. This technology opens a way toward early detection of worsening of the mental state and thereby increases the patient’s chance of improving in the course of the illness. %M 34874015 %R 10.2196/28647 %U https://www.jmir.org/2022/1/e28647 %U https://doi.org/10.2196/28647 %U http://www.ncbi.nlm.nih.gov/pubmed/34874015 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e22113 %T Reasons for Nonuse, Discontinuation of Use, and Acceptance of Additional Functionalities of a COVID-19 Contact Tracing App: Cross-sectional Survey Study %A Walrave,Michel %A Waeterloos,Cato %A Ponnet,Koen %+ MIOS Research Group and GOVTRUST Centre of Excellence, Department of Communication Studies, Faculty of Social Sciences, University of Antwerp, Sint-Jacobstraat 2, Antwerp, 2000, Belgium, 32 475459785, michel.walrave@uantwerp.be %K COVID-19 %K SARS-CoV-2 %K coronavirus %K contact tracing %K proximity tracing %K mHealth %K mobile app %K user acceptability %K surveillance %K privacy %D 2022 %7 14.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In several countries, contact tracing apps (CTAs) have been introduced to warn users if they have had high-risk contacts that could expose them to SARS-CoV-2 and could, therefore, develop COVID-19 or further transmit the virus. For CTAs to be effective, a sufficient critical mass of users is needed. Until now, adoption of these apps in several countries has been limited, resulting in questions on which factors prevent app uptake or stimulate discontinuation of app use. Objective: The aim of this study was to investigate individuals’ reasons for not using, or stopping use of, a CTA, in particular, the Coronalert app. Users’ and nonusers’ attitudes toward the app’s potential impact was assessed in Belgium. To further stimulate interest and potential use of a CTA, the study also investigated the population’s interest in new functionalities. Methods: An online survey was administered in Belgium to a sample of 1850 respondents aged 18 to 64 years. Data were collected between October 30 and November 2, 2020. Sociodemographic differences were assessed between users and nonusers. We analyzed both groups’ attitudes toward the potential impact of CTAs and their acceptance of new app functionalities. Results: Our data showed that 64.9% (1201/1850) of our respondents were nonusers of the CTA under study; this included individuals who did not install the app, those who downloaded but did not activate the app, and those who uninstalled the app. While we did not find any sociodemographic differences between users and nonusers, attitudes toward the app and its functionalities seemed to differ. The main reasons for not downloading and using the app were a perceived lack of advantages (308/991, 31.1%), worries about privacy (290/991, 29.3%), and, to a lesser extent, not having a smartphone (183/991, 18.5%). Users of the CTA agreed more with the potential of such apps to mitigate the consequences of the pandemic. Overall, nonusers found the possibility of extending the CTA with future functionalities to be less acceptable than users. However, among users, acceptability also tended to differ. Among users, functionalities relating to access and control, such as digital certificates or “green cards” for events, were less accepted (358/649, 55.2%) than functionalities focusing on informing citizens about the spread of the virus (453/649, 69.8%) or making an appointment to get tested (525/649, 80.9%). Conclusions: Our results show that app users were more convinced of the CTA’s utility and more inclined to accept new app features than nonusers. Moreover, nonusers had more CTA-related privacy concerns. Therefore, to further stimulate app adoption and use, its potential advantages and privacy-preserving mechanisms need to be stressed. Building further knowledge on the forms of resistance among nonusers is important for responding to these barriers through the app’s further development and communication campaigns. %M 34794117 %R 10.2196/22113 %U https://publichealth.jmir.org/2022/1/e22113 %U https://doi.org/10.2196/22113 %U http://www.ncbi.nlm.nih.gov/pubmed/34794117 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e31759 %T Using Facebook Advertisements for Women’s Health Research: Methodology and Outcomes of an Observational Study %A Farr,Deeonna E %A Battle,Darian A %A Hall,Marla B %+ Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 2307 Carol G Belk Building, Mail Stop 529, Greenville, NC, 27858, United States, 1 2527375392, farrd17@ecu.edu %K social media %K surveys %K questionnaires %K advertising %K patient selection %K methodology %K ethnic groups %K health research %K healthcare %K health care %K women’s health %D 2022 %7 12.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Recruitment of diverse populations for health research studies remains a challenge. The COVID-19 pandemic has exacerbated these challenges by limiting in-person recruitment efforts and placing additional demands on potential participants. Social media, through the use of Facebook advertisements, has the potential to address recruitment challenges. However, existing reports are inconsistent with regard to the success of this strategy. Additionally, limited information is available about processes that can be used to increase the diversity of study participants. Objective: A Qualtrics survey was fielded to ascertain women’s knowledge of and health care experiences related to breast density. This paper describes the process of using Facebook advertisements for recruitment and the effectiveness of various advertisement strategies. Methods: Facebook advertisements were placed in 2 rounds between June and July 2020. During round 1, multiple combinations of headlines and interest terms were tested to determine the most cost-effective advertisement. The best performing advertisement was used in round 2 in combination with various strategies to enhance the diversity of the survey sample. Advertisement performance, cost, and survey respondent data were collected and examined. Results: In round 1, a total of 45 advertisements with 5 different headlines were placed, and the average cost per link click for each headline ranged from US $0.12 to US $0.79. Of the 164 women recruited in round 1, in total 91.62% were eligible to complete the survey. Advertisements used during recruitment in round 2 resulted in an average cost per link click of US $0.11. During the second round, 478 women attempted the survey, and 87.44% were eligible to participate. The majority of survey respondents were White (80.41%), over the age of 55 years (63.94%), and highly educated (63.71%). Conclusions: Facebook advertisements can be used to recruit respondents for health research quickly, but this strategy may yield participants who are less racially diverse, more educated, and older than the general population. Researchers should consider recruiting participants through other methods in addition to creating Facebook advertisements targeting underrepresented populations. %M 35019843 %R 10.2196/31759 %U https://formative.jmir.org/2022/1/e31759 %U https://doi.org/10.2196/31759 %U http://www.ncbi.nlm.nih.gov/pubmed/35019843 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e26563 %T Prioritization of Quality Principles for Health Apps Using the Kano Model: Survey Study %A Malinka,Christin %A von Jan,Ute %A Albrecht,Urs-Vito %+ Peter L Reichertz Institute for Medical Informatics, TU Braunschweig and Hannover Medical School, Carl-Neuberg-Str. 1, Hannover, 30625, Germany, 49 511 532 ext 4412, ute.von.jan@plri.de %K Kano %K quality principles %K mobile apps %K physicians %K surveys and questionnaires %K evaluation studies %K mHealth %K health apps %D 2022 %7 11.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health apps are often used without adequately taking aspects related to their quality under consideration. This may partially be due to inadequate awareness about necessary criteria and how to prioritize them when evaluating an app. Objective: The aim of this study was to introduce a method for prioritizing quality attributes in the mobile health context. To this end, physicians were asked about their assessment of nine app quality principles relevant in health contexts and their responses were used as a basis for designing a method for app prioritization. Ultimately, the goal was to aid in making better use of limited resources (eg, time) by assisting with the decision as to the specific quality principles that deserve priority in everyday medical practice and those that can be given lower priority, even in cases where the overall principles are rated similarly. Methods: A total of 9503 members of two German professional societies in the field of orthopedics were invited by email to participate in an anonymous online survey over a 1-month period. Participants were asked to rate a set of nine app quality principles using a Kano survey with functional and dysfunctional (ie, positively and negatively worded) questions. The evaluation was based on the work of Kano (baseline), supplemented by a self-designed approach. Results: Among the 9503 invited members, 382 completed relevant parts of the survey (return rate of 4.02%). These participants were equally and randomly assigned to two groups (test group and validation group, n=191 each). Demographic characteristics did not significantly differ between groups (all P>.05). Participants were predominantly male (328/382, 85.9%) and older than 40 years (290/382, 75.9%). Given similar ratings, common evaluation strategies for Kano surveys did not allow for conclusive prioritization of the principles, and the same was true when using the more elaborate approach of satisfaction and dissatisfaction indices following the work of Timko. Therefore, an extended, so-called “in-line-of-sight” method was developed and applied for this evaluation. Modified from the Timko method, this approach is based on a “point of view” (POV) metric, which generates a ranking coefficient. Although the principles were previously almost exclusively rated as must-be (with the exception of resource efficiency), which was not conducive to their prioritization, the new method applied from the must-be POV resulted in identical rankings for the test and validation groups: (1) legal conformity, (2) content validity, (3) risk adequacy, (4) practicality, (5) ethical soundness, (6) usability, (7) transparency, (8) technical adequacy, and (9) resource efficiency. Conclusions: Established survey methodologies based on the work of Kano predominantly seek to categorize the attributes to be evaluated. The methodology presented here is an interesting option for prioritization, and enables focusing on the most important criteria, thus saving valuable time when reviewing apps for use in the medical field, even with otherwise largely similar categorization results. The extent to which this approach is applicable beyond the scenario presented herein requires further investigation. %M 35014965 %R 10.2196/26563 %U https://mhealth.jmir.org/2022/1/e26563 %U https://doi.org/10.2196/26563 %U http://www.ncbi.nlm.nih.gov/pubmed/35014965 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e26299 %T Unit Response and Costs in Web Versus Face-To-Face Data Collection: Comparison of Two Cross-sectional Health Surveys %A Braekman,Elise %A Demarest,Stefaan %A Charafeddine,Rana %A Drieskens,Sabine %A Berete,Finaba %A Gisle,Lydia %A Van der Heyden,Johan %A Van Hal,Guido %+ Lifestyle and chronic diseases, Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, Brussels, Belgium, 32 2 642 57 06, elise.braekman@sciensano.be %K health interview surveys %K data collection mode %K face-to-face %K web %K unit response %K response rate %K nonresponse %K data collection costs %K web data %K health surveys %K internet penetration %K web survey %K costs %D 2022 %7 7.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Potential is seen in web data collection for population health surveys due to its combined cost-effectiveness, implementation ease, and increased internet penetration. Nonetheless, web modes may lead to lower and more selective unit response than traditional modes, and this may increase bias in the measured indicators. Objective: This research assesses the unit response and costs of a web study versus face-to-face (F2F) study. Methods: Alongside the Belgian Health Interview Survey by F2F edition 2018 (BHISF2F; net sample used: 3316), a web survey (Belgian Health Interview Survey by Web [BHISWEB]; net sample used: 1010) was organized. Sociodemographic data on invited individuals was obtained from the national register and census linkages. Unit response rates considering the different sampling probabilities of both surveys were calculated. Logistic regression analyses examined the association between mode system and sociodemographic characteristics for unit nonresponse. The costs per completed web questionnaire were compared with the costs for a completed F2F questionnaire. Results: The unit response rate is lower in BHISWEB (18.0%) versus BHISF2F (43.1%). A lower response rate was observed for the web survey among all sociodemographic groups, but the difference was higher among people aged 65 years and older (15.4% vs 45.1%), lower educated people (10.9% vs 38.0%), people with a non-Belgian European nationality (11.4% vs 40.7%), people with a non-European nationality (7.2% vs 38.0%), people living alone (12.6% vs 40.5%), and people living in the Brussels-Capital (12.2% vs 41.8%) region. The sociodemographic characteristics associated with nonresponse are not the same in the 2 studies. Having another European (OR 1.60, 95% CI 1.20-2.13) or non-European nationality (OR 2.57, 95% CI 1.79-3.70) compared to a Belgian nationality and living in the Brussels-Capital (OR 1.72, 95% CI 1.41-2.10) or Walloon (OR 1.47, 95% CI 1.15-1.87) regions compared to the Flemish region are associated with a higher nonresponse only in the BHISWEB study. In BHISF2F, younger people (OR 1.31, 95% CI 1.11-1.54) are more likely to be nonrespondents than older people, and this was not the case in BHISWEB. In both studies, lower educated people have a higher probability of being nonrespondent, but this effect is more pronounced in BHISWEB (low vs high education level: Web, OR 2.71, 95% CI 2.21-3.39 and F2F OR 1.70, 95% CI 1.48-1.95). The BHISWEB study had a considerable advantage; the cost per completed questionnaire was almost 3 times lower (€41 [US $48]) compared with F2F data collection (€111 [US $131]). Conclusions: The F2F unit response rate was generally higher, yet for certain groups the difference between web and F2F was more limited. Web data collection has a considerable cost advantage. It is therefore worth experimenting with adaptive mixed-mode designs to optimize financial resources without increasing selection bias (eg, only inviting sociodemographic groups who are keener to participate online for web surveys while continuing to focus on increasing F2F response rates for other groups). %M 34994701 %R 10.2196/26299 %U https://www.jmir.org/2022/1/e26299 %U https://doi.org/10.2196/26299 %U http://www.ncbi.nlm.nih.gov/pubmed/34994701 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e28368 %T A New Remote Guided Method for Supervised Web-Based Cognitive Testing to Ensure High-Quality Data: Development and Usability Study %A Leong,Victoria %A Raheel,Kausar %A Sim,Jia Yi %A Kacker,Kriti %A Karlaftis,Vasilis M %A Vassiliu,Chrysoula %A Kalaivanan,Kastoori %A Chen,S H Annabel %A Robbins,Trevor W %A Sahakian,Barbara J %A Kourtzi,Zoe %+ Psychology, School of Social Sciences, Nanyang Technological University, 48 Nanyang Avenue, Singapore, 639818, Singapore, 65 6514 1052, victorialeong@ntu.edu.sg %K web-based testing %K neurocognitive assessment %K COVID-19 %K executive functions %K learning %D 2022 %7 6.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The global COVID-19 pandemic has triggered a fundamental reexamination of how human psychological research can be conducted safely and robustly in a new era of digital working and physical distancing. Online web-based testing has risen to the forefront as a promising solution for the rapid mass collection of cognitive data without requiring human contact. However, a long-standing debate exists over the data quality and validity of web-based studies. This study examines the opportunities and challenges afforded by the societal shift toward web-based testing and highlights an urgent need to establish a standard data quality assurance framework for online studies. Objective: This study aims to develop and validate a new supervised online testing methodology, remote guided testing (RGT). Methods: A total of 85 healthy young adults were tested on 10 cognitive tasks assessing executive functioning (flexibility, memory, and inhibition) and learning. Tasks were administered either face-to-face in the laboratory (n=41) or online using remote guided testing (n=44) and delivered using identical web-based platforms (Cambridge Neuropsychological Test Automated Battery, Inquisit, and i-ABC). Data quality was assessed using detailed trial-level measures (missed trials, outlying and excluded responses, and response times) and overall task performance measures. Results: The results indicated that, across all data quality and performance measures, RGT data was statistically-equivalent to in-person data collected in the lab (P>.40 for all comparisons). Moreover, RGT participants out-performed the lab group on measured verbal intelligence (P<.001), which could reflect test environment differences, including possible effects of mask-wearing on communication. Conclusions: These data suggest that the RGT methodology could help ameliorate concerns regarding online data quality—particularly for studies involving high-risk or rare cohorts—and offer an alternative for collecting high-quality human cognitive data without requiring in-person physical attendance. %M 34989691 %R 10.2196/28368 %U https://www.jmir.org/2022/1/e28368 %U https://doi.org/10.2196/28368 %U http://www.ncbi.nlm.nih.gov/pubmed/34989691 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 1 %P e31679 %T Continuous User Experience Monitoring of a Patient-Completed Preoperative Assessment System in the United Kingdom: Cross-sectional Study %A Maramba,Inocencio Daniel %A Chatterjee,Arunangsu %+ Centre for Health Technology, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, United Kingdom, 44 1752 587484, inocencio.maramba@plymouth.ac.uk %K preoperative assessment %K self-completed patient questionnaires %K digital health %K usability %K user experience %K web-based %D 2022 %7 6.1.2022 %9 Original Paper %J JMIRx Med %G English %X Background: Anesthetic preoperative assessment (POA) is now a common part of the surgical care pathway, and guidelines support its routine use. MyPreOp (Ultramed Ltd) is a web-based POA system that enables remote assessments. Usability is a key factor in the success of digital health solutions. Objective: This study aims to assess the usability of the MyPreOp system through patient feedback, investigate the amount of time it took for patients to complete the POA questionnaire and the factors that influenced completion time, and explore the effect on completion times of implementing a validated eHealth usability scale, as compared to using a simple but unvalidated usability evaluation scale, and to test the feasibility of administering a more detailed usability evaluation scale in a staggered manner so as not to unduly increase completion times. Methods: In this cross-sectional study, anonymized data sets were extracted from the MyPreOp system. The participants were adults (aged ≥18 years), scheduled for nonurgent surgical procedures performed in hospitals in the United Kingdom, who gave consent for their anonymized data to be analyzed. Data collected included age, gender, American Society of Anesthesiology (ASA) physical classification status, and completion time. Two user experience evaluations were used: in Phase 1, 2 questions asking about overall experience and ease of use, and in Phase 2, a previously validated usability questionnaire, with its 20 questions equally distributed among 5 succeeding patient cohorts. There were 2593 respondents in total (Phase 1: n=1193; Phase 2: n=1400). The median age of the participants was 46 years, and 1520 (58.62%) of the 2593 respondents were female. End points measured were the median completion times in Phase I and Phase II. The data were collected by extracting a subset of records from the database and exported to a spreadsheet for analysis (Excel, Microsoft Corporation). The data were analyzed for differences in completion times between Phase I and Phase II, as well as for differences between age groups, genders, and ASA classifications. Results: MyPreOp scored well in usability in both phases. In Phase 1, 81.64% (974/1193) of respondents had a good or better experience, and 93.8% (1119/1193) found it easy to use. The usability rating in Phase 2 was 4.13 out of a maximum of 5, indicating high usability. The median completion time was 40.4 minutes. The implementation of the longer usability evaluation scale in Phase 2 did not negatively impact the completion times. Age and ASA physical status were found to be moderately associated with increased completion times. Conclusions: MyPreOp rates high in both user experience and usability. The method of dividing the questionnaire into 5 blocks is valid and does not negatively affect completion times. Further research into the factors affecting completion time is recommended. %M 37725545 %R 10.2196/31679 %U https://med.jmirx.org/2022/1/e31679 %U https://doi.org/10.2196/31679 %U http://www.ncbi.nlm.nih.gov/pubmed/37725545 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30027 %T Feasibility of Monitoring Health and Well-being in Emerging Adults: Pilot Longitudinal Cohort Study %A Lystad,Reidar P %A Fajardo Pulido,Diana %A Peters,Lorna %A Johnstone,Melissa %A Ellis,Louise A %A Braithwaite,Jeffrey %A Wuthrich,Viviana %A Amin,Janaki %A Cameron,Cate M %A Mitchell,Rebecca J %+ Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, 2109, Australia, 61 298502464, reidar.lystad@mq.edu.au %K young adult %K emerging adulthood %K health %K well-being %K health-related quality of life %K feasibility %K monitoring %K pilot study %K longitudinal %K cohort %K youth %K acceptability %K survey %K quality of life %D 2022 %7 6.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Emerging adulthood is a distinct segment of an individual’s life course. The defining features of this transitional period include identity exploration, instability, future possibilities, self-focus, and feeling in-between, all of which are thought to affect quality of life, health, and well-being. A longitudinal cohort study with a comprehensive set of measures would be a valuable resource for improving the understanding of the multifaceted elements and unique challenges that contribute to the health and well-being of emerging adults. Objective: The main aim of this pilot study was to evaluate the feasibility and acceptability of recruiting university graduates to establish a longitudinal cohort study to inform the understanding of emerging adulthood. Methods: This pilot study was conducted among graduates at a large university. It involved collecting web-based survey data at baseline (ie, graduation) and 12 months post baseline, and linking survey responses to health records from administrative data collections. The feasibility outcome measures of interest included the recruitment rate, response rate, retention rate, data linkage opt-out rate, and availability of linked health records. Descriptive statistics were used to evaluate the representativeness of the sample, completeness of the survey responses, and data linkage characteristics. Results: Only 2.8% of invited graduates (238/8532) agreed to participate in this pilot cohort study, of whom 59.7% (142/238) responded to the baseline survey. The retention rate between the baseline and follow-up surveys was 69.7% (99/142). The completeness of the surveys was excellent, with the proportion of answered questions in each survey domain ranging from 87.3% to 100% in both the baseline and follow-up surveys. The data linkage opt-out rate was 32.4% (77/238). Conclusions: The overall recruitment rate was poor, while the completeness of survey responses among respondents ranged from good to excellent. There was reasonable acceptability for conducting data linkage of health records from administrative data collections and survey responses. This pilot study offers insights and recommendations for future research aiming to establish a longitudinal cohort study to investigate health and well-being in emerging adults. Trial Registration: Australian New Zealand Clinical Trials Registry number ACTRN12618001364268; https://tinyurl.com/teec8wh International Registered Report Identifier (IRRID): RR2-10.2196/16108 %M 34989696 %R 10.2196/30027 %U https://formative.jmir.org/2022/1/e30027 %U https://doi.org/10.2196/30027 %U http://www.ncbi.nlm.nih.gov/pubmed/34989696 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e29288 %T Purpose Formulation, Coalition Building, and Evidence Use in Public–Academic Partnerships: Web-Based Survey Study %A Kang-Yi,Christina D %A Page,Amy %+ Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd Floor, Philadelphia, PA, 19104, United States, 1 215 746 6715, christina.kang-yi@pennmedicine.upenn.edu %K use of research evidence %K public care policy %K public–academic partnership %K partnership purpose formulation %K partnership coalition building %K youth mental health and well-being %D 2022 %7 5.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Partnerships between academic institutions and public care agencies (public–academic partnerships [PAPs]) can promote effective policy making and care delivery. Public care agencies are often engaged in PAPs for evidence-informed policy making in health care. Previous research has reported essential partnership contextual factors and mechanisms that promote evidence-based policy making and practice in health care. However, the studies have not yet informed whether public care agency leaders’ and academic researchers’ perceptions of partnership purpose formulation and coalition building evolve through the PAP life cycle and whether public care agency leaders’ use of research evidence differs through life cycle stages. Objective: This exploratory study aims to focus on PAPs designed to improve youth mental health and well-being outcomes. This study also aims to identify public care agency leaders’ and academic researchers’ perceptions of PAP purpose formulation (structure, goals, primary function, and agenda-setting process) and coalition building (mutual benefits, trust, convener’s role, member role clarity, and conflict management) by PAP life cycle stage and examine whether public care agency leaders’ use of research evidence differs according to the perception of PAP purpose formulation and coalition building through the PAP life cycle. Methods: A web-based survey of PAP experience was conducted by recruiting academic researchers (n=40) and public care agency leaders (n=26) who were engaged in PAPs for the past 10 years. Public care agency leaders additionally participated in the survey of the Structured Interview for Evidence Use scale (n=48). Results: Most public care agency leaders and academic researchers in PAPs formed, matured, and sustained perceived their PAP as having purpose formulation context well aligned with their organizational purpose formulation context, pursuing mutual benefits, having leadership representation and role clarity, having a higher level of trust, and knowing how to handle conflicts. Most PAPs across all life cycle stages crystallized another issue to focus, but not all PAPs with issue crystallization had purpose reformulation. Public care agency leaders who trusted academic researchers in their PAP had greater use of research evidence. Public care agency leaders in PAPs that had gone through new issue crystallization also showed greater use of research evidence compared with those that had not. Conclusions: To promote public care agency leaders’ use of research evidence, focusing on developing trusting partnerships and continuously crystallizing PAP issues are important. International Registered Report Identifier (IRRID): RR2-10.2196/14382 %M 34989678 %R 10.2196/29288 %U https://humanfactors.jmir.org/2022/1/e29288 %U https://doi.org/10.2196/29288 %U http://www.ncbi.nlm.nih.gov/pubmed/34989678 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e31126 %T The Future of Disability Research in Australia: Protocol for a Multiphase Research Agenda–Setting Study %A Smith-Merry,Jennifer %A O'Donovan,Mary-Ann %A Dew,Angela %A Hemsley,Bronwyn %A Imms,Christine %A Carey,Gemma %A Darcy,Simon %A Ellem,Kathy %A Gallego,Gisselle %A Gilroy,John %A Guastella,Adam %A Marella,Manjula %A McVilly,Keith %A Plumb,Jenny %+ Centre for Disability Research and Policy, Faculty of Medicine and Health, The University of Sydney, School of Health Sciences, Susan Wakil Health Building, Camperdown, 2006, Australia, 61 293519060, jennifer.smith-merry@sydney.edu.au %K disability studies %K disabled persons %K disability research %K consumer-driven community-based research %K research priorities %K mixed methods %K research design %D 2022 %7 3.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: For people with disabilities to live a good life, it is essential that funded research in health and social care addresses their interests, meets their needs, and fills gaps in our understanding of the impact that services, systems, and policies may have on them. Decisions about research funding should be based on an understanding of the research priorities of people with disabilities, their supporters and allies, disability researchers, service providers, and policy makers working in the field. Objective: The aim of this protocol is to describe the research design and methods of a large-scale, disability research agenda–setting exercise conducted in 2021 in Australia. Methods: The research agenda–setting exercise involves 3 integrated phases of work. In the first phase, a previous audit of disability research in Australia is updated to understand previous research and continuing gaps in the research. Building on this, the second phase involves consultation with stakeholders—people with disabilities and their supporters and family members, the disability workforce, and people working within services and connected sectors (eg, aging, employment, education, and housing), academia, and public policy. Data for the second phase will be gathered as follows: a national web-based survey; a consultation process undertaken through the government and nongovernment sector; and targeted consultation with Aboriginal and Torres Strait Islander people, children with disabilities and their families, people with cognitive disability, and people with complex communication needs. The third phase involves a web-based survey to develop a research agenda based on the outcomes of all phases. Results: We have started working on 2 parts of the research prioritization exercise. Through the research-mapping exercise we identified 1241 journal articles and book chapters (referred to as research papers) and 225 publicly available reports (referred to as research reports) produced over the 2018-2020 period. Data collection for the national survey has also been completed. We received 973 fully completed responses to the survey. Analysis of these data is currently underway. Conclusions: This multi-method research agenda–setting study will be the first to provide an indication of the areas of health and social research that people across the Australian disability community consider should be prioritized in disability research funding decisions. Project results from all phases will be made publicly available through reports, open-access journal publications, and Easy Read documents. International Registered Report Identifier (IRRID): DERR1-10.2196/31126 %M 34706859 %R 10.2196/31126 %U https://www.researchprotocols.org/2022/1/e31126 %U https://doi.org/10.2196/31126 %U http://www.ncbi.nlm.nih.gov/pubmed/34706859 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e26763 %T Assessing Physicians’ Recall Bias of Work Hours With a Mobile App: Interview and App-Recorded Data Comparison %A Wang,Hsiao-Han %A Lin,Yu-Hsuan %+ Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan Township, Miaoli County, 35053, Taiwan, 886 37 206 166 ext 36383, yuhsuanlin@nhri.edu.tw %K smartphone %K mobile app %K work hours %K recall bias %K time perception %K physicians %K labor policy %D 2021 %7 24.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous studies have shown inconsistencies in the accuracy of self-reported work hours. However, accurate documentation of work hours is fundamental for the formation of labor policies. Strict work-hour policies decrease medical errors, improve patient safety, and promote physicians’ well-being. Objective: The aim of this study was to estimate physicians’ recall bias of work hours with a mobile app, and to examine the association between the recall bias and physicians’ work hours. Methods: We quantified recall bias by calculating the differences between the app-recorded and self-reported work hours of the previous week and the penultimate week. We recruited 18 physicians to install the “Staff Hours” app, which automatically recorded GPS-defined work hours for 2 months, contributing 1068 person-days. We examined the association between work hours and two recall bias indicators: (1) the difference between self-reported and app-recorded work hours and (2) the percentage of days for which work hours were not precisely recalled during interviews. Results: App-recorded work hours highly correlated with self-reported counterparts (r=0.86-0.88, P<.001). Self-reported work hours were consistently significantly lower than app-recorded hours by –8.97 (SD 8.60) hours and –6.48 (SD 8.29) hours for the previous week and the penultimate week, respectively (both P<.001). The difference for the previous week was significantly correlated with work hours in the previous week (r=–0.410, P=.01), whereas the correlation of the difference with the hours in the penultimate week was not significant (r=–0.119, P=.48). The percentage of hours not recalled (38.6%) was significantly higher for the penultimate week (38.6%) than for the first week (16.0%), and the former was significantly correlated with work hours of the penultimate week (r=0.489, P=.002) Conclusions: Our study identified the existence of recall bias of work hours, the extent to which the recall was biased, and the influence of work hours on recall bias. %M 34951600 %R 10.2196/26763 %U https://www.jmir.org/2021/12/e26763 %U https://doi.org/10.2196/26763 %U http://www.ncbi.nlm.nih.gov/pubmed/34951600 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e30767 %T Perceptions of Older Men Using a Mobile Health App to Monitor Lower Urinary Tract Symptoms and Tamsulosin Side Effects: Mixed Methods Study %A Wang,Elizabeth Y %A Breyer,Benjamin N %A Lee,Austin W %A Rios,Natalie %A Oni-Orisan,Akinyemi %A Steinman,Michael A %A Sim,Ida %A Kenfield,Stacey A %A Bauer,Scott R %+ University of California San Francisco, 550 16th St, 6th floor, Box 1695, San Francisco, CA, 94121, United States, 1 4152214810 ext 24322, Scott.Bauer@ucsf.edu %K BPH %K mobile health %K mHealth %K telehealth %K telemedicine %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile health (mHealth) apps may provide an efficient way for patients with lower urinary tract symptoms (LUTS) to log and communicate symptoms and medication side effects with their clinicians. Objective: The aim of this study was to explore the perceptions of older men with LUTS after using an mHealth app to track their symptoms and tamsulosin side effects. Methods: Structured phone interviews were conducted after a 2-week study piloting the daily use of a mobile app to track the severity of patient-selected LUTS and tamsulosin side effects. Quantitative and qualitative data were considered. Results: All 19 (100%) pilot study participants completed the poststudy interviews. Most of the men (n=13, 68%) reported that the daily questionnaires were the right length, with 32% (n=6) reporting that the questionnaires were too short. Men with more severe symptoms were less likely to report changes in perception of health or changes in self-management; 47% (n=9) of the men reported improved awareness of symptoms and 5% (n=1) adjusted fluid intake based on the questionnaire. All of the men were willing to share app data with their clinicians. Thematic analysis of qualitative data yielded eight themes: (1) orientation (setting up app, format, symptom selection, and side-effect selection), (2) triggers (routine or habit and symptom timing), (3) daily questionnaire (reporting symptoms, reporting side effects, and tailoring), (4) technology literacy, (5) perceptions (awareness, causation or relevance, data quality, convenience, usefulness, and other apps), (6) self-management, (7) clinician engagement (communication and efficiency), and (8) improvement (reference materials, flexibility, language, management recommendations, and optimize clinician engagement). Conclusions: We assessed the perceptions of men using an mHealth app to monitor and improve management of LUTS and medication side effects. LUTS management may be further optimized by tailoring the mobile app experience to meet patients’ individual needs, such as tracking a greater number of symptoms and integrating the app with clinicians’ visits. mHealth apps are likely a scalable modality to monitor symptoms and improve care of older men with LUTS. Further study is required to determine the best ways to tailor the mobile app and to communicate data to clinicians or incorporate data into the electronical medical record meaningfully. %M 34951599 %R 10.2196/30767 %U https://humanfactors.jmir.org/2021/4/e30767 %U https://doi.org/10.2196/30767 %U http://www.ncbi.nlm.nih.gov/pubmed/34951599 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e25743 %T Methods to Generate Innovative Research Ideas and Improve Patient and Public Involvement in Modern Epidemiological Research: Review, Patient Viewpoint, and Guidelines for Implementation of a Digital Cohort Study %A Aguayo,Gloria A %A Goetzinger,Catherine %A Scibilia,Renza %A Fischer,Aurélie %A Seuring,Till %A Tran,Viet-Thi %A Ravaud,Philippe %A Bereczky,Tamás %A Huiart,Laetitia %A Fagherazzi,Guy %+ Deep Digital Phenotyping Research Unit, Department of Population Health, Luxembourg Institute of Health, 1 AB rue Thomas Edison, Strassen, 1445, Luxembourg, 352 26970770, gloria.aguayo@lih.lu %K patient and public involvement %K workshops %K surveys %K focus groups %K co-design %K digital cohort study %K digital epidemiology %K social media %K mobile phone %D 2021 %7 23.12.2021 %9 Review %J J Med Internet Res %G English %X Background: Patient and public involvement (PPI) in research aims to increase the quality and relevance of research by incorporating the perspective of those ultimately affected by the research. Despite these potential benefits, PPI is rarely included in epidemiology protocols. Objective: The aim of this study is to provide an overview of methods used for PPI and offer practical recommendations for its efficient implementation in epidemiological research. Methods: We conducted a review on PPI methods. We mirrored it with a patient advocate’s viewpoint about PPI. We then identified key steps to optimize PPI in epidemiological research based on our review and the viewpoint of the patient advocate, taking into account the identification of barriers to, and facilitators of, PPI. From these, we provided practical recommendations to launch a patient-centered cohort study. We used the implementation of a new digital cohort study as an exemplary use case. Results: We analyzed data from 97 studies, of which 58 (60%) were performed in the United Kingdom. The most common methods were workshops (47/97, 48%); surveys (33/97, 34%); meetings, events, or conferences (28/97, 29%); focus groups (25/97, 26%); interviews (23/97, 24%); consensus techniques (8/97, 8%); James Lind Alliance consensus technique (7/97, 7%); social media analysis (6/97, 6%); and experience-based co-design (3/97, 3%). The viewpoint of a patient advocate showed a strong interest in participating in research. The most usual PPI modalities were research ideas (60/97, 62%), co-design (42/97, 43%), defining priorities (31/97, 32%), and participation in data analysis (25/97, 26%). We identified 9 general recommendations and 32 key PPI-related steps that can serve as guidelines to increase the relevance of epidemiological studies. Conclusions: PPI is a project within a project that contributes to improving knowledge and increasing the relevance of research. PPI methods are mainly used for idea generation. On the basis of our review and case study, we recommend that PPI be included at an early stage and throughout the research cycle and that methods be combined for generation of new ideas. For e-cohorts, the use of digital tools is essential to scale up PPI. We encourage investigators to rely on our practical recommendations to extend PPI in future epidemiological studies. %M 34941554 %R 10.2196/25743 %U https://www.jmir.org/2021/12/e25743 %U https://doi.org/10.2196/25743 %U http://www.ncbi.nlm.nih.gov/pubmed/34941554 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30368 %T The Successful Synchronized Orchestration of an Investigator-Initiated Multicenter Trial Using a Clinical Trial Management System and Team Approach: Design and Utility Study %A Mudaranthakam,Dinesh Pal %A Brown,Alexandra %A Kerling,Elizabeth %A Carlson,Susan E %A Valentine,Christina J %A Gajewski,Byron %+ University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, United States, 1 9139456922, dmudaranthakam@kumc.edu %K data management %K data quality %K metrics %K trial execution %K clinical trials %K cost %K accrual %K accrual inequality %K rare diseases %K healthcare %K health care %K health operations %D 2021 %7 22.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As the cost of clinical trials continues to rise, novel approaches are required to ensure ethical allocation of resources. Multisite trials have been increasingly utilized in phase 1 trials for rare diseases and in phase 2 and 3 trials to meet accrual needs. The benefits of multisite trials include easier patient recruitment, expanded generalizability, and more robust statistical analyses. However, there are several problems more likely to arise in multisite trials, including accrual inequality, protocol nonadherence, data entry mistakes, and data integration difficulties. Objective: The Biostatistics & Data Science department at the University of Kansas Medical Center developed a clinical trial management system (comprehensive research information system [CRIS]) specifically designed to streamline multisite clinical trial management. Methods: A National Institute of Child Health and Human Development–funded phase 3 trial, the ADORE (assessment of docosahexaenoic acid [DHA] on reducing early preterm birth) trial fully utilized CRIS to provide automated accrual reports, centralize data capture, automate trial completion reports, and streamline data harmonization. Results: Using the ADORE trial as an example, we describe the utility of CRIS in database design, regulatory compliance, training standardization, study management, and automated reporting. Our goal is to continue to build a CRIS through use in subsequent multisite trials. Reports generated to suit the needs of future studies will be available as templates. Conclusions: The implementation of similar tools and systems could provide significant cost-saving and operational benefit to multisite trials. Trial Registration: ClinicalTrials.gov NCT02626299; https://tinyurl.com/j6erphcj %M 34941552 %R 10.2196/30368 %U https://formative.jmir.org/2021/12/e30368 %U https://doi.org/10.2196/30368 %U http://www.ncbi.nlm.nih.gov/pubmed/34941552 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31545 %T The Use of Multimode Data Collection in Random Digit Dialing Cell Phone Surveys for Young Adults: Feasibility Study %A Gundersen,Daniel Alexander %A Wivagg,Jonathan %A Young,William J %A Yan,Ting %A Delnevo,Cristine D %+ Survey and Qualitative Methods Core, Division of Population Sciences, Dana-Farber Cancer Institute, 450 Brookline Avenue, LW 686, Boston, MA, 02215, United States, 1 6176325827, DanielA_Gundersen@dfci.harvard.edu %K web mode %K web survey %K random digit dialing %K mixed mode surveys %K survey methodology %K data capture %K research methods %K recruitment %K survey %K feasibility %K smoking %D 2021 %7 20.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Young adults’ early adoption of new cell phone technologies have created challenges to survey recruitment but offer opportunities to combine random digit dialing (RDD) sampling with web mode data collection. The National Young Adult Health Survey was designed to test the feasibility of this methodology. Objective: In this study, we compared response rates across the telephone mode and web mode, assessed sample representativeness, examined design effects (DEFFs), and compared cigarette smoking prevalence to a gold standard national survey. Methods: We conducted a survey experiment where the sampling frame was randomized to single-mode telephone interviews, telephone-to-web sequential mixed mode, and single-mode web survey. A total of 831 respondents aged 18 to 34 years were recruited via RDD at baseline. A soft launch was conducted prior to main launch. We compared the web mode to the telephone modes (ie, single-mode and mixed mode) at wave 1 based on the American Association for Public Opinion Research response rate 3 for screening and extended surveys. Base-weighted demographic distributions were compared to the American Community Survey. The sample was calibrated to the US Census Bureau's American Community Survey to calculate DEFFs and to compare cigarette smoking prevalence to the National Health Interview Survey. Prevalence estimates are estimated with sampling weights and are presented with unweighted sample sizes. Consistency of estimates was judged by 95% CI. Results: The American Association for Public Opinion Research response rate 3 was higher in the telephone mode than in the web mode (24% and 30% vs 6.1% and 12.5%, for soft launch and main launch, respectively), which was reflected in response rate 3 for screening and extended surveys. During the soft launch, the extended survey and eligibility rate were low for respondents pushed to the web mode. To boost productivity and survey completes for the web condition, the main launch used cell phone numbers from the sampling frame where the sample vendor matched the number to auxiliary data, which suggested that the number likely belonged to an adult in the target age range. This increased the eligibility rate, but the screener response rate was lower. Compared to population distribution from the US Census Bureau, the telephone mode overrepresented men (57.1% [unweighted n=412] vs 50.9%) and those enrolled in college (40.3% [unweighted n=269] vs 23.8%); it also underrepresented those with a Bachelor of Arts or Science (34.4% [unweighted n=239] vs 55%). The web mode overrepresented White, non-Latinos (70.7% [unweighted n=90] vs 54.4%) and those with some college education (30.4% [unweighted n=40] vs 7.6%); it also underrepresented Latinos (13.6% [unweighted n=20] vs 20.7%) and those with a high school or General Education Development diploma (15.3% [unweighted n=20] vs 29.3%). The DEFF measure was 1.28 (subpopulation range 0.96-1.93). The National Young Adult Health Survey cigarette smoking prevalence was consistent with the National Health Interview Survey overall (15%, CI 12.4%-18% [unweighted 149/831] vs 13.5%, CI 12.3%-14.7% [unweighted 823/5552]), with notable deviation among 18- to 24-year-olds (15.6%, CI 11.3%-22.2% [unweighted 51/337] vs 8.7%, CI 7.1%-10.6% [unweighted 167/1647]), and those with education levels lower than Bachelor of Arts or Science (24%, CI 19.3%-29.4% [unweighted 123/524] vs 17.1%, CI 15.6%-18.7% [unweighted 690/3493]). Conclusions: RDD sampling for a web survey is not feasible for young adults due to its low response rate. However, combining this methodology with RDD telephone surveys may have a great potential for including media and collecting autophotographic data in population surveys. %M 34932017 %R 10.2196/31545 %U https://www.jmir.org/2021/12/e31545 %U https://doi.org/10.2196/31545 %U http://www.ncbi.nlm.nih.gov/pubmed/34932017 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e26611 %T Population Preferences for Performance and Explainability of Artificial Intelligence in Health Care: Choice-Based Conjoint Survey %A Ploug,Thomas %A Sundby,Anna %A Moeslund,Thomas B %A Holm,Søren %+ Department of Communication and Psychology, Aalborg University, A C Meyers Vænge 15, Copenhagen, 2450, Denmark, 45 99402533, ploug@hum.aau.dk %K artificial Intelligence %K performance %K transparency %K explainability %K population preferences %K public policy %D 2021 %7 13.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Certain types of artificial intelligence (AI), that is, deep learning models, can outperform health care professionals in particular domains. Such models hold considerable promise for improved diagnostics, treatment, and prevention, as well as more cost-efficient health care. They are, however, opaque in the sense that their exact reasoning cannot be fully explicated. Different stakeholders have emphasized the importance of the transparency/explainability of AI decision making. Transparency/explainability may come at the cost of performance. There is need for a public policy regulating the use of AI in health care that balances the societal interests in high performance as well as in transparency/explainability. A public policy should consider the wider public’s interests in such features of AI. Objective: This study elicited the public’s preferences for the performance and explainability of AI decision making in health care and determined whether these preferences depend on respondent characteristics, including trust in health and technology and fears and hopes regarding AI. Methods: We conducted a choice-based conjoint survey of public preferences for attributes of AI decision making in health care in a representative sample of the adult Danish population. Initial focus group interviews yielded 6 attributes playing a role in the respondents’ views on the use of AI decision support in health care: (1) type of AI decision, (2) level of explanation, (3) performance/accuracy, (4) responsibility for the final decision, (5) possibility of discrimination, and (6) severity of the disease to which the AI is applied. In total, 100 unique choice sets were developed using fractional factorial design. In a 12-task survey, respondents were asked about their preference for AI system use in hospitals in relation to 3 different scenarios. Results: Of the 1678 potential respondents, 1027 (61.2%) participated. The respondents consider the physician having the final responsibility for treatment decisions the most important attribute, with 46.8% of the total weight of attributes, followed by explainability of the decision (27.3%) and whether the system has been tested for discrimination (14.8%). Other factors, such as gender, age, level of education, whether respondents live rurally or in towns, respondents’ trust in health and technology, and respondents’ fears and hopes regarding AI, do not play a significant role in the majority of cases. Conclusions: The 3 factors that are most important to the public are, in descending order of importance, (1) that physicians are ultimately responsible for diagnostics and treatment planning, (2) that the AI decision support is explainable, and (3) that the AI system has been tested for discrimination. Public policy on AI system use in health care should give priority to such AI system use and ensure that patients are provided with information. %M 34898454 %R 10.2196/26611 %U https://www.jmir.org/2021/12/e26611 %U https://doi.org/10.2196/26611 %U http://www.ncbi.nlm.nih.gov/pubmed/34898454 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e32294 %T Examining the Impact of Question Construction on Reporting of Sexual Identity: Survey Experiment Among Young Adults %A Young,William J %A Bover Manderski,Michelle T %A Ganz,Ollie %A Delnevo,Cristine D %A Hrywna,Mary %+ Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, 303 George Street, Suite 500, New Brunswick, NJ, 08901, United States, 1 848 932 8054, william.j.young@rutgers.edu %K survey measurement %K sexual identity %K survey wording experiment %D 2021 %7 13.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Compared with heterosexuals, sexual minorities in the United States experience a higher incidence of negative physical and mental health outcomes. However, a variety of measurement challenges limit researchers’ ability to conduct meaningful survey research to understand these disparities. Despite the prevalence of additional identities, many national health surveys only offer respondents 3 substantive options for reporting their sexual identities (straight/heterosexual, gay or lesbian, and bisexual), which could lead to measurement error via misreporting and item nonresponse. Objective: This study compared the traditional 3-option approach to measuring sexual identity with an expanded approach that offered respondents 5 additional options. Methods: An online survey experiment conducted among New Jersey residents between March and June 2021 randomly assigned 1254 young adults (ages 18-21) to answer either the 3-response measure of sexual identity or the expanded item. Response distributions for each measure were compared as were the odds of item nonresponse. Results: The expanded version of the question appeared to result in more accurate reporting among some subgroups and induced less item nonresponse; 12% (77/642) of respondents in the expanded version selected a response that was not available in the shorter version. Females answering the expanded item were less likely to identify as gay or lesbian (2.1% [10/467] vs. 6.6% [30/457]). Females and Non-Hispanic Whites were slightly more likely to skip the shorter version than the longer version (1.1% [5/457 for females and 3/264 for Non-Hispanic Whites] vs. 0% [0/467 for females and 0/277 for Non-Hispanic Whites]). About 5% (32/642) of respondents answering the longer item were unsure of their sexual identity (a similar option was not available in the shorter version). Compared with respondents answering the longer version of the question, those answering the shorter version had substantially greater odds of skipping the question altogether (odds ratio 9.57, 95% CI 1.21-75.74; P=.03). Conclusions: Results favor the use of a longer, more detailed approach to measuring sexual identity in epidemiological research. Such a measure will likely allow researchers to produce more accurate estimates of health behaviors and outcomes among sexual minorities. %M 34898444 %R 10.2196/32294 %U https://publichealth.jmir.org/2021/12/e32294 %U https://doi.org/10.2196/32294 %U http://www.ncbi.nlm.nih.gov/pubmed/34898444 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e31053 %T Assessing the Views of Professionals, Patients, and Care Partners Concerning the Use of Computer Tools in Memory Clinics: International Survey Study %A van Gils,Aniek M %A Visser,Leonie NC %A Hendriksen,Heleen MA %A Georges,Jean %A Muller,Majon %A Bouwman,Femke H %A van der Flier,Wiesje M %A Rhodius-Meester,Hanneke FM %+ Department of Neurology, Alzheimer Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Location VUmc, De Boelelaan 1118, Amsterdam, 1081 HZ, Netherlands, 31 204440685, a.vangils@amsterdamumc.nl %K artificial intelligence %K clinical decision support systems %K dementia %K diagnostic testing %K diagnosis %K prognosis %K communication %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Computer tools based on artificial intelligence could aid clinicians in memory clinics in several ways, such as by supporting diagnostic decision-making, web-based cognitive testing, and the communication of diagnosis and prognosis. Objective: This study aims to identify the preferences as well as the main barriers and facilitators related to using computer tools in memory clinics for all end users, that is, clinicians, patients, and care partners. Methods: Between July and October 2020, we sent out invitations to a web-based survey to clinicians using the European Alzheimer’s Disease Centers network and the Dutch Memory Clinic network, and 109 clinicians participated (mean age 45 years, SD 10; 53/109, 48.6% female). A second survey was created for patients and care partners. They were invited via Alzheimer Europe, Alzheimer’s Society United Kingdom, Amsterdam Dementia Cohort, and Amsterdam Aging Cohort. A total of 50 patients with subjective cognitive decline, mild cognitive impairment, or dementia (mean age 73 years, SD 8; 17/34, 34% female) and 46 care partners (mean age 65 years, SD 12; 25/54, 54% female) participated in this survey. Results: Most clinicians reported a willingness to use diagnostic (88/109, 80.7%) and prognostic (83/109, 76.1%) computer tools. User-friendliness (71/109, 65.1%); Likert scale mean 4.5, SD 0.7), and increasing diagnostic accuracy (76/109, 69.7%; mean 4.3, SD 0.7) were reported as the main factors stimulating the adoption of a tool. Tools should also save time and provide clear information on reliability and validity. Inadequate integration with electronic patient records (46/109, 42.2%; mean 3.8, SD 1.0) and fear of losing important clinical information (48/109, 44%; mean 3.7, SD 1.2) were most frequently indicated as barriers. Patients and care partners were equally positive about the use of computer tools by clinicians, both for diagnosis (69/96, 72%) and prognosis (73/96, 76%). In addition, most of them thought favorably regarding the possibility of using the tools themselves. Conclusions: This study showed that computer tools in memory clinics are positively valued by most end users. For further development and implementation, it is essential to overcome the technical and practical barriers of a tool while paying utmost attention to its reliability and validity. %M 34870612 %R 10.2196/31053 %U https://formative.jmir.org/2021/12/e31053 %U https://doi.org/10.2196/31053 %U http://www.ncbi.nlm.nih.gov/pubmed/34870612 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e33125 %T Drinking and Social Media Use Among Workers During COVID-19 Pandemic Restrictions: Five-Wave Longitudinal Study %A Oksanen,Atte %A Oksa,Reetta %A Savela,Nina %A Celuch,Magdalena %A Savolainen,Iina %+ Tampere University, Faculty of Social Sciences, Kalevantie 5, Tampere, 33014, Finland, 358 503187279, atte.oksanen@tuni.fi %K excessive drinking %K alcohol %K COVID-19 %K social media %K remote work %K psychological distress %K distress %K pattern %K trend %K prediction %K survey %K app %K risk %D 2021 %7 2.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic restricted everyday life during 2020-2021 for many people worldwide. It also affected alcohol consumption patterns and leisure activities, including the use of social media. Objective: The aim of this study was to analyze whether social media use predicts increased risky drinking over time and during the COVID-19 pandemic restrictions in particular. Methods: This 5-wave longitudinal survey study, based on a nationwide sample of workers, was conducted in Finland in 2019-2021. A total of 840 respondents (male: 473/840, 56.31%; age range 18-64 years; mean age 43.90, SD 11.14 years) participated in all 5 waves of the study. The outcome variable was risky drinking, measured using the 3-item Alcohol Use Disorders Identification Test (AUDIT-C). Multilevel linear hybrid modeling enabled the investigation of both within-person and between-person effects. Predictors included social media use and communication, involvement in social media identity bubbles, psychological distress, and remote working. Controls included sociodemographic factors and the Big Five personality traits. Results: Increased involvement in social media identity bubbles was associated with an increase in risky drinking behavior. Of all social media platforms examined, online dating app use was associated with riskier use of alcohol over time during the COVID-19 crisis. Daily social media communication with colleagues about nonwork topics was associated with risky drinking. Female gender, younger age, university education, nonindustrial occupational field, conscientiousness, agreeableness, and neuroticism were associated with lower levels of risky drinking. Conclusions: Social media use during a pandemic carries some risks for alcohol consumption. Involvement in social media identity bubbles and online dating are risk factors for excessive drinking during the COVID-19 pandemic. %M 34662290 %R 10.2196/33125 %U https://www.jmir.org/2021/12/e33125 %U https://doi.org/10.2196/33125 %U http://www.ncbi.nlm.nih.gov/pubmed/34662290 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e27512 %T The Use of Food Images and Crowdsourcing to Capture Real-time Eating Behaviors: Acceptability and Usability Study %A Harrington,Katharine %A Zenk,Shannon N %A Van Horn,Linda %A Giurini,Lauren %A Mahakala,Nithya %A Kershaw,Kiarri N %+ Northwestern University Feinberg School of Medicine, 680 N Lake Shore, Suite 1400, Chicago, IL, 60611, United States, 1 312 503 4014, k-kershaw@northwestern.edu %K ecological momentary assessment %K eating behaviors %K crowdsourcing %K food consumption images %K food image processing %K mobile phone %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As poor diet quality is a significant risk factor for multiple noncommunicable diseases prevalent in the United States, it is important that methods be developed to accurately capture eating behavior data. There is growing interest in the use of ecological momentary assessments to collect data on health behaviors and their predictors on a micro timescale (at different points within or across days); however, documenting eating behaviors remains a challenge. Objective: This pilot study (N=48) aims to examine the feasibility—usability and acceptability—of using smartphone-captured and crowdsource-labeled images to document eating behaviors in real time. Methods: Participants completed the Block Fat/Sugar/Fruit/Vegetable Screener to provide a measure of their typical eating behavior, then took pictures of their meals and snacks and answered brief survey questions for 7 consecutive days using a commercially available smartphone app. Participant acceptability was determined through a questionnaire regarding their experiences administered at the end of the study. The images of meals and snacks were uploaded to Amazon Mechanical Turk (MTurk), a crowdsourcing distributed human intelligence platform, where 2 Workers assigned a count of food categories to the images (fruits, vegetables, salty snacks, and sweet snacks). The agreement among MTurk Workers was assessed, and weekly food counts were calculated and compared with the Screener responses. Results: Participants reported little difficulty in uploading photographs and remembered to take photographs most of the time. Crowdsource-labeled images (n=1014) showed moderate agreement between the MTurk Worker responses for vegetables (688/1014, 67.85%) and high agreement for all other food categories (871/1014, 85.89% for fruits; 847/1014, 83.53% for salty snacks, and 833/1014, 81.15% for sweet snacks). There were no significant differences in weekly food consumption between the food images and the Block Screener, suggesting that this approach may measure typical eating behaviors as accurately as traditional methods, with lesser burden on participants. Conclusions: Our approach offers a potentially time-efficient and cost-effective strategy for capturing eating events in real time. %M 34860666 %R 10.2196/27512 %U https://formative.jmir.org/2021/12/e27512 %U https://doi.org/10.2196/27512 %U http://www.ncbi.nlm.nih.gov/pubmed/34860666 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e31657 %T Comparing Social Media and In-Person Recruitment: Lessons Learned From Recruiting Substance-Using, Sexual and Gender Minority Adolescents and Young Adults for a Randomized Control Trial %A Parker,Jayelin N %A Hunter,Alexis S %A Bauermeister,Jose A %A Bonar,Erin E %A Carrico,Adam %A Stephenson,Rob %+ Center for Sexuality and Health Disparities, University of Michigan, 400 N Ingalls, Room 3340, Ann Arbor, MI, 48109, United States, 1 2488609446, jayelinp@umich.edu %K HIV testing %K substance use %K recruitment %K sexual and gender minorities %K youth %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Recruiting large samples of diverse sexual and gender minority adolescent and young adults (AYAs) into HIV intervention research is critical to the development and later dissemination of interventions that address the risk factors for HIV transmission among substance-using, sexual and gender minority AYAs. Objective: This paper aimed to describe the characteristics of the samples recruited via social media and in-person methods and makes recommendations for strategies to recruit substance-using, sexual and gender minority AYAs, a hardly reached population that is a priority for HIV prevention research. Methods: Using data from a randomized control trial of an HIV and substance use intervention with sexual and gender minority AYAs, aged 15 to 29 years in southeastern Michigan (n=414), we examined demographic and behavioral characteristics associated with successful recruitment from a range of virtual and physical venues. Results: We found that paid advertisements on Facebook, Instagram, and Grindr offered the largest quantity of eligible participants willing to enroll in the trial. Instagram offered the largest proportion of transgender masculine participants, and Grindr offered the largest proportion of Black/African American individuals. Although we attempted venue-based recruitment at clubs, bars, community centers, and AIDS service organizations, we found it to be unsuccessful for this specific hardly reached population. Social media and geobased dating applications offered the largest pool of eligible participants. Conclusions: Understanding factors associated with successful recruitment has the potential to inform effective and efficient strategies for HIV prevention research with substance-using, sexual and gender AYAs. Trial Registration: ClinicalTrials.gov NCT02945436; https://clinicaltrials.gov/ct2/show/NCT02945436 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9414 %M 34855613 %R 10.2196/31657 %U https://publichealth.jmir.org/2021/12/e31657 %U https://doi.org/10.2196/31657 %U http://www.ncbi.nlm.nih.gov/pubmed/34855613 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e29243 %T Evaluation of an Online System for Routine Outcome Monitoring: Cross-sectional Survey Study %A Wiebe,Deanna E %A Remers,Shannon %A Nippak,Pria %A Meyer,Julien %+ Department of Health Services Management, Ryerson University, 55 Dundas Street West, 8th floor, TRS 2-042, Toronto, ON, M5G 2C3, Canada, 1 416 979 5000 ext 6409, dwiebe@ryerson.ca %K routine outcome monitoring %K progress monitoring and feedback %K outcome measures %K web-based outcome monitoring %K routine outcome monitoring software %K outcome measurement questionnaire %K measurement-based care %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The use of routine outcome monitoring (ROM) in the treatment of mental health has emerged as a method of improving psychotherapy treatment outcomes. Despite this, very few clinicians regularly use ROM in clinical practice. Online ROM has been suggested as a solution to increase adoption. Objective: The aim of this study is to identify the influence of moving ROM online on client completion rates of self-reported outcome measures and to identify implementation and utilization barriers to online ROM by assessing clinicians’ views on their experience using the online system over previous paper-based methods. Methods: Client completion rates of self-reported outcome measures were compared pre- and postimplementation of an online system of ROM. In addition, a survey questionnaire was administered to 324 mental health service providers regarding their perception of the benefits with an online system of ROM. Results: Client completion rates of self-reported measures increased from 15.62% (427/2734) to 53.98% (1267/2347) after they were moved online. Furthermore, 57% (56/98) of service providers found the new system less time-consuming than the previous paper-based ROM, and 64% (63/98) found that it helped monitor clients. However, the perceived value of the system remains in doubt as only 23% (23/98) found it helped them identify clients at risk for treatment failure, and only 18% (18/98) found it strengthened the therapeutic alliance. Conclusions: Although the current study suggests mixed results regarding service providers’ views on their experience using an online system for ROM, it has identified barriers and challenges that are actionable for improvement. %M 34855615 %R 10.2196/29243 %U https://mental.jmir.org/2021/12/e29243 %U https://doi.org/10.2196/29243 %U http://www.ncbi.nlm.nih.gov/pubmed/34855615 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e28117 %T Relationship Between Illness Representations and Symptoms of Internet Gaming Disorder Among Young People: Cross-Lagged Model %A Yang,Xue %A Wong,Kei Man %A She,Rui %A Zhao,Chengjia %A Ding,Nani %A Xu,Huihui %A Tu,Xiaolian %A Lai,Xinyi %A Zhang,Guohua %+ Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Wenzhou Medical University, University Town, Chashan, Wenzhou, 325035, China, 86 +8613957764528, zghcnu@wmu.edu.cn %K illness representations %K internet gaming disorder %K youth %K cross-lagged model %D 2021 %7 30.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: The common-sense model of illness suggests that mental representations of health threats may affect one’s behavioral reactions to them and health status. Internet gaming disorder is a newly defined mental disorder. Illness representations of internet gaming disorder may affect one’s risk of internet gaming disorder. In turn, symptoms of internet gaming disorder may affect one’s perceptions of the disorder. Objective: This study aimed to investigate the relationships between illness representations and symptoms of internet gaming disorder in college students. Methods: A 1-year longitudinal study was conducted with a convenience sample of Chinese college students (n=591; 342/591, 57.9% female). Results: Of the participants, 10.1% (60/591) and 9.1% (54/591) were classified as having probable internet gaming disorder at baseline (T1) and follow-up (T2), respectively. The correlations between some dimensions of illness representations regarding internet gaming disorder (ie, consequence, timeline, personal control, treatment control, and concern) at T1 and symptoms of internet gaming disorder at T2 and between symptoms of internet gaming disorder at T1 and the dimensions of illness representations at T2 (ie, consequence, timeline, personal control, and emotional response) were statistically significant. The cross-lagged model fit the data well ((χ2/df=2.28, comparative fit index=.95, root mean square error of approximation=.06) and showed that internet gaming disorder at T1 was positively associated with unfavorable illness representations at T2. Conclusions: Individuals with more severe symptoms of internet gaming disorder had more pessimistic perceptions about the disorder. Such cognitive perceptions may affect one’s emotional and behavioral reactions towards the disorder (eg, greater levels of depression and low self-control intention) and should be modified by educational programs and psychological interventions. %M 34851298 %R 10.2196/28117 %U https://games.jmir.org/2021/4/e28117 %U https://doi.org/10.2196/28117 %U http://www.ncbi.nlm.nih.gov/pubmed/34851298 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e26743 %T Using Ecological Momentary Assessment to Study the Development of COVID-19 Worries in Sweden: Longitudinal Study %A Schulz,Peter Johannes %A Andersson,Elin M %A Bizzotto,Nicole %A Norberg,Margareta %+ Institute of Communication and Health, Università della Svizzera italiana, Via Giuseppe Buffi 13, Lugano, 6900, Switzerland, 41 58666 ext 4724, schulzp@usi.ch %K COVID-19 %K coronavirus %K longitudinal studies %K EMA %K worry %K fear %K pandemics %D 2021 %7 29.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The foray of COVID-19 around the globe has certainly instigated worries in many people, and lockdown measures may well have triggered more specific worries. Sweden, more than other countries, relied on voluntary measures to fight the pandemic. This provides a particularly interesting context to assess people’s reactions to the threat of the pandemic. Objective: The general aim of this study was to better understand the worried reactions to the virus and the associated lockdown measures. As there have been very few longitudinal studies in this area published to date, development of feelings of worry over time was analyzed over a longer range than in previous research. Affective variables, worry in particular, were included because most of the research in this field has focused on cognitive variables. To employ new methodology, ecological momentary assessment was used for data collection and a multilevel modeling approach was adopted for data analysis. Methods: Results were based on an unbalanced panel sample of 260 Swedish participants filling in 3226 interview questionnaires by smartphone over a 7-week period in 2020 during the rapid rise of cases in the early phase of the pandemic. Causal factors considered in this study included the perceived severity of an infection, susceptibility of a person to the threat posed by the virus, perceived efficacy of safeguarding measures, and assessment of government action against the spread of COVID-19. The effect of these factors on worries was traced in two analytical steps: the effects at the beginning of the study and the effect on the trend during the study. Results: The level of general worry related to COVID-19 was modest (mean 6.67, SD 2.54 on an 11-point Likert scale); the increase during the study period was small, but the interindividual variation of both the worry level and its increase over time was large. Findings confirmed that the hypothesized causal factors (severity of infection, susceptibility to the threat of the virus, efficacy of safeguarding, and assessment of government preventive action) did indeed affect the level of worry. Conclusions: The results confirmed earlier research in a very special case and demonstrated the usefulness of a different study design, which takes a longitudinal perspective, and a new type of data analysis borrowed from multilevel study design. %M 34847065 %R 10.2196/26743 %U https://www.jmir.org/2021/11/e26743 %U https://doi.org/10.2196/26743 %U http://www.ncbi.nlm.nih.gov/pubmed/34847065 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e31635 %T Impact of the COVID-19 Pandemic on the Health Status and Behaviors of Adults in Korea: National Cross-sectional Web-Based Self-report Survey %A Kang,EunKyo %A Lee,Hyejin %A Sohn,Jee Hoon %A Yun,Jieun %A Lee,Jin Yong %A Hong,Yun-Chul %+ Department of Preventive Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 2 740 8394, ychong1@snu.ac.kr %K COVID-19 %K health status %K health behavior %K self-reported online survey %K pandemic %K epidemiology %K public health %K sociodemographic factors %K health interventions %K lockdown %D 2021 %7 26.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has radically shifted living practices, thereby influencing changes in the health status and behaviors of every person. Objective: The aim of this study was to investigate the impact of COVID-19 on the self-reported health status and health behaviors along with any associated factors in adults in the Republic of Korea wherein no stringent lockdown measures were implemented during the pandemic. Methods: We conducted a web-based self-reported survey from November 2020 to December 2020. The study participants (N=2097) were identified through quota sampling by age, sex, and geographical regions among residents aged 19 years or older in Korea. The survey collected information on basic demographics, changes in self-reported health status, and health behaviors during the COVID-19 pandemic. Self-reported health status and health behaviors were categorized into 3 groups: unchanged, improved, or worsened. A chi-square test and logistic regression analyses were conducted. Results: With regard to changes in the self-reported health status, the majority (1478/2097, 70.5%) of the participants reported that their health was unchanged, while 20% (420/2097) of the participants reported having worser health after the COVID-19 outbreak. With regard to changes in health behaviors, the proportion of participants who increased tobacco consumption was similar to that of those who decreased tobacco consumption (110/545, 20.2% vs 106/545, 19.5%, respectively), while the proportion of those who decreased their drinking frequency was more than twice as many as those who increased their drinking frequency (578/1603, 36.1% vs 270/1603, 16.8%, respectively). Further, those who decreased their exercising frequency were more than those who increased their exercising frequency (333/823, 15.9% vs 211/823, 10%, respectively). The factor that had the greatest influence on lifestyle was age. In the subgroup analysis, the group aged 20-29 years had the highest number of individuals with both a worsened (100/377, 26.5%) and an improved (218/377, 15.7%) health status. Further, individuals aged 20-29 years had greater odds of increased smoking (6.44, 95% CI 2.15-19.32), increased alcohol use (4.64, 95% CI 2.60-8.28), and decreased moderate or higher intensity aerobic exercise (3.39, 95% CI 1.82-6.33) compared to individuals aged 60 years and older. Younger adults showed deteriorated health behaviors, while older adults showed improved health behaviors. Conclusions: The health status and the behavior of the majority of the Koreans were not found to be heavily affected by the COVID-19 outbreak. However, in some cases, changes in health status or health behavior were identified. This study highlighted that some groups were overwhelmingly affected by COVID-19 compared to others. Certain groups reported experiencing both worsening and improving health, while other groups reported unchanged health status. Age was the most influential factor for behavior change; in particular, the younger generation’s negative health behaviors need more attention in terms of public health. As COVID-19 prolongs, public health interventions for vulnerable groups may be needed. %M 34653017 %R 10.2196/31635 %U https://publichealth.jmir.org/2021/11/e31635 %U https://doi.org/10.2196/31635 %U http://www.ncbi.nlm.nih.gov/pubmed/34653017 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e33088 %T Assessing Values and Preferences Toward SARS-CoV-2 Self-testing Among the General Population and Their Representatives, Health Care Personnel, and Decision-Makers: Protocol for a Multicountry Mixed Methods Study %A Shilton,Sonjelle %A Ivanova Reipold,Elena %A Roca Álvarez,Albert %A Martínez-Pérez,Guillermo Z %+ FIND, the global alliance for diagnostics, Chemin des Mines 9, Geneva, 1202, Switzerland, 41 22 710 05 90, sonjelle.shilton@finddx.org %K COVID-19 %K SARS-CoV-2 %K diagnostic %K self-testing %K mixed methods %K testing %K protocol %K preference %K testing %K population %K health care worker %K decision-making %K accessibility %K transmission %K screening %D 2021 %7 26.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Accessible, safe, and client-centered SARS-CoV-2 testing services are an effective way to halt its transmission. Testing enables infected individuals to isolate or quarantine to prevent further transmission. In countries with limited health systems and laboratory capacity, it can be challenging to provide accessible and safe screening for COVID-19. Self-testing provides a convenient, private, and safe testing option; however, it also raises important concerns about lack of counseling and ensuring timely reporting of self-test results to national surveillance systems. Investigating community members’ views and perceptions regarding SARS-CoV-2 self-testing is crucial to inform the most effective and safe strategies for implementing said testing. Objective: We aimed to determine whether SARS-CoV-2 self-testing was useful to diagnose and prevent the spread of SARS-CoV-2 for populations in low-resource settings and under which circumstances it would be acceptable. Methods: This multisite, mixed methods, observational study will be conducted in 9 countries—Brazil, India, Indonesia, Kenya, Malawi, Nigeria, Peru, the Philippines, and South Africa—and will consists of 2 components: cross-sectional surveys and interviews (semistructured and group) among 4 respondent groupings: the general population, general population representatives, health care workers, and decision-makers. General population and health care worker survey responses will be analyzed separately from each other, using bivariate and multivariate inferential analysis and descriptive statistics. Semistructured interviews and group interviews will be audiorecorded, transcribed, and coded for thematic comparative analysis. Results: As of November 19, 2021, participant enrollment is ongoing; 4364 participants have been enrolled in the general population survey, and 2233 participants have been enrolled in the health care workers survey. In the qualitative inquiry, 298 participants have been enrolled. We plan to complete data collection by December 31, 2021 and publish results in 2022 via publications, presentations at conferences, and dissemination events specifically targeted at local decision-makers, civil society, and patient groups. Conclusions: The views and perceptions of local populations are crucial in the discussion of the safest strategies for implementing SARS-CoV-2 self-testing. We intend to identify sociocultural specificities that may hinder or accelerate the widespread utilization of SARS-CoV-2 self-testing. International Registered Report Identifier (IRRID): DERR1-10.2196/33088 %M 34726608 %R 10.2196/33088 %U https://www.researchprotocols.org/2021/11/e33088 %U https://doi.org/10.2196/33088 %U http://www.ncbi.nlm.nih.gov/pubmed/34726608 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e33124 %T Toward Automated Data Extraction According to Tabular Data Structure: Cross-sectional Pilot Survey of the Comparative Clinical Literature %A Holub,Karl %A Hardy,Nicole %A Kallmes,Kevin %+ Nested Knowledge, 1430 Avon Street N, St. Paul, MN, 55117, United States, 1 507 271 7051, kevinkallmes@supedit.com %K table structure %K systematic review %K automated data extraction %K data reporting conventions %K clinical comparative data %K data elements %K statistic formats %D 2021 %7 24.11.2021 %9 Review %J JMIR Form Res %G English %X Background: Systematic reviews depend on time-consuming extraction of data from the PDFs of underlying studies. To date, automation efforts have focused on extracting data from the text, and no approach has yet succeeded in fully automating ingestion of quantitative evidence. However, the majority of relevant data is generally presented in tables, and the tabular structure is more amenable to automated extraction than free text. Objective: The purpose of this study was to classify the structure and format of descriptive statistics reported in tables in the comparative medical literature. Methods: We sampled 100 published randomized controlled trials from 2019 based on a search in PubMed; these results were imported to the AutoLit platform. Studies were excluded if they were nonclinical, noncomparative, not in English, protocols, or not available in full text. In AutoLit, tables reporting baseline or outcome data in all studies were characterized based on reporting practices. Measurement context, meaning the structure in which the interventions of interest, patient arm breakdown, measurement time points, and data element descriptions were presented, was classified based on the number of contextual pieces and metadata reported. The statistic formats for reported metrics (specific instances of reporting of data elements) were then classified by location and broken down into reporting strategies for continuous, dichotomous, and categorical metrics. Results: We included 78 of 100 sampled studies, one of which (1.3%) did not report data elements in tables. The remaining 77 studies reported baseline and outcome data in 174 tables, and 96% (69/72) of these tables broke down reporting by patient arms. Fifteen structures were found for the reporting of measurement context, which were broadly grouped into: 1×1 contexts, where two pieces of context are reported in total (eg, arms in columns, data elements in rows); 2×1 contexts, where two pieces of context are given on row headers (eg, time points in columns, arms nested in data elements on rows); and 1×2 contexts, where two pieces of context are given on column headers. The 1×1 contexts were present in 57% of tables (99/174), compared to 20% (34/174) for 2×1 contexts and 15% (26/174) for 1×2 contexts; the remaining 8% (15/174) used unique/other stratification methods. Statistic formats were reported in the headers or descriptions of 84% (65/74) of studies. Conclusions: In this cross-sectional pilot review, we found a high density of information in tables, but with major heterogeneity in presentation of measurement context. The highest-density studies reported both baseline and outcome measures in tables, with arm-level breakout, intervention labels, and arm sizes present, and reported both the statistic formats and units. The measurement context formats presented here, broadly classified into three classes that cover 92% (71/78) of studies, form a basis for understanding the frequency of different reporting styles, supporting automated detection of the data format for extraction of metrics. %M 34821562 %R 10.2196/33124 %U https://formative.jmir.org/2021/11/e33124 %U https://doi.org/10.2196/33124 %U http://www.ncbi.nlm.nih.gov/pubmed/34821562 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e31678 %T Digital Instruments for Reporting of Gastrointestinal Symptoms in Clinical Trials: Comparison of End-of-Day Diaries Versus the Experience Sampling Method %A Beckers,Abraham B %A Snijkers,Johanna T W %A Weerts,Zsa Zsa R M %A Vork,Lisa %A Klaassen,Tim %A Smeets,Fabienne G M %A Masclee,Ad A M %A Keszthelyi,Daniel %+ Division of Gastroenterology-Hepatology, Department of Internal Medicine, Maastricht University Medical Center, Universiteitssingel 50, Maastricht, 6229 ER, Netherlands, 31 0433881844, ab.beckers@maastrichtuniversity.nl %K irritable bowel syndrome %K functional dyspepsia %K digital diary %K experience sampling method %K smartphone app %K mobile phone application %K mHealth %K eHealth %K compliance %K patient-reported outcome measures %D 2021 %7 24.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Questionnaires are necessary tools for assessing symptoms of disorders of the brain-gut interaction in clinical trials. We previously reported on the excellent adherence to a smartphone app used as symptom diary in a randomized clinical trial on irritable bowel syndrome (IBS). Other sampling methods, such as the experience sampling method (ESM), are better equipped to measure symptom variability over time and provide useful information regarding possible symptom triggers, and they are free of ecological and recall bias. The high frequency of measurements, however, could limit the feasibility of ESM in clinical trials. Objective: This study aimed to compare the adherence rates of a smartphone-based end-of-day diary and ESM for symptom assessment in IBS and functional dyspepsia (FD). Methods: Data from 4 separate studies were included. Patients with IBS participated in a randomized controlled trial, which involved a smartphone end-of-day diary for a 2+8-week (pretreatment + treatment) period, and an observational study in which patients completed ESM assessments using a smartphone app for 1 week. Patients with FD participated in a randomized controlled trial, which involved a smartphone end-of-day diary for a 2+12-week (pretreatment + treatment) period, and an observational study in which patients completed ESM assessments using a smartphone app for 1 week. Adherence rates were compared between these 2 symptom sampling methods. Results: In total, 25 patients with IBS and 15 patients with FD were included. Overall adherence rates for the end-of-day diaries were significantly higher than those for ESM (IBS: 92.7% vs 69.8%, FD: 90.1% vs 61.4%, respectively). Conclusions: This study demonstrates excellent adherence rates for smartphone app–based end-of-day diaries as used in 2 separate clinical trials. Overall adherence rates for ESM were significantly lower, rendering it more suitable for intermittent sampling periods rather than continuous sampling during longer clinical trials. %M 34821561 %R 10.2196/31678 %U https://formative.jmir.org/2021/11/e31678 %U https://doi.org/10.2196/31678 %U http://www.ncbi.nlm.nih.gov/pubmed/34821561 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e27873 %T Perceptions of Patients and Physicians on Teleconsultation at Home for Diabetes Mellitus: Survey Study %A Rego,Nazaré %A Pereira,Helena Silva %A Crispim,José %+ Escola de Economia e Gestão, Universidade do Minho, Campus de Gualtar, Braga, 4710 - ​057, Portugal, 351 253604565, nazare@eeg.uminho.pt %K teleconsultation %K diabetes mellitus %K telemedicine %K eHealth %K mobile phone %D 2021 %7 23.11.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Diabetes mellitus (DM) is one of the most challenging diseases in the 21st century and is the sixth leading cause of death. Telemedicine has increasingly been implemented in the care of patients with DM. Although teleconsultations at home have shown to be more effective for inducing HbA1c reduction than other telemedicine options, before the 2019 coronavirus disease crisis, their use had been lagging behind. Studies on physicians’ or patients’ perceptions about telemedicine have been performed independently of each other, and very few have focused on teleconsultations. In a time of great pressure for health systems and when an important portion of health care has to be assured at a distance, obtaining insights about teleconsultations at home from the stakeholders directly involved in the health care interaction is particularly important. Objective: The perceptions of patients and physicians about their intentions to use home synchronous teleconsultations for DM care are examined to identify drivers and barriers inherent to programs that involve home teleconsultations. Methods: Two identical questionnaires integrating the technology acceptance model and the unified theory of acceptance and use of technology and assessing the confidence in information and communication technology use of patients and physicians were developed. Responses by patients (n=75) and physicians (n=68) were analyzed using canonical correlation analysis. Results: Associations between predictor constructs (performance, effort, social influence, facilitating conditions, and attitude) and intention to use yielded significant functions, with a canonical R2 of 0.95 (for physicians) and 0.98 (patients). The main identified barriers to patient intention to use were the expected effort to explain the medical problem, and privacy and confidentiality issues. The major drivers were the facilitation of contact with the physician, which is beneficial to patient disease management and treatment, time savings, and reciprocity concerning physicians’ willingness to perform teleconsultations. Responses from physicians revealed an association between intention to use and the expected performance of home teleconsultations. The major barrier to intention to use expressed in physicians’ answers was doubts concerning the quality of patient examination. The major drivers were time savings, productivity increases, improvements in patient’s health and patient management, National Health System costs reduction, and reciprocity relative to patients’ willingness to engage in teleconsultations. Conclusions: To promote the use of home teleconsultations for DM, decision makers should improve patients’ health literacy so the physician–patient communication is more effective; explore information and communication technology developments to reduce current limitations of non–face-to-face examinations; ensure patient privacy and data confidentiality; and demonstrate the capabilities of home teleconsultations to physicians. %M 34817394 %R 10.2196/27873 %U https://humanfactors.jmir.org/2021/4/e27873 %U https://doi.org/10.2196/27873 %U http://www.ncbi.nlm.nih.gov/pubmed/34817394 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e32951 %T Digitization and Health in Germany: Cross-sectional Nationwide Survey %A De Santis,Karina Karolina %A Jahnel,Tina %A Sina,Elida %A Wienert,Julian %A Zeeb,Hajo %+ Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, Bremen, 28359, Germany, 49 42121856 ext 908, desantis@leibniz-bips.de %K digital health %K literacy %K survey %K attitude %K usage %K eHEALS %K COVID-19 %K physical activity %K general population %K misinformation %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Digital technologies are shaping medicine and public health. Objective: The aim of this study was to investigate the attitudes toward and the use of digital technologies for health-related purposes using a nationwide survey. Methods: We performed a cross-sectional study using a panel sample of internet users selected from the general population living in Germany. Responses to a survey with 28 items were collected using computer-assisted telephone interviews conducted in October 2020. The items were divided into four topics: (1) general attitudes toward digitization, (2) COVID-19 pandemic, (3) physical activity, and (4) perceived digital health (eHealth) literacy measured with the eHealth Literacy Scale (eHEALS; sum score of 8=lowest to 40=highest perceived eHealth literacy). The data were analyzed in IBM-SPSS24 using relative frequencies. Three univariate multiple regression analyses (linear or binary logistic) were performed to investigate the associations among the sociodemographic factors (age, gender, education, and household income) and digital technology use. Results: The participants included 1014 internet users (n=528, 52.07% women) aged 14 to 93 years (mean 54, SD 17). Among all participants, 66.47% (674/1014) completed up to tertiary (primary and secondary) education and 45.07% (457/1017) reported a household income of up to 3500 Euro/month (1 Euro=US $1.18). Over half (579/1014, 57.10%) reported having used digital technologies for health-related purposes. The majority (898/1014, 88.56%) noted that digitization will be important for therapy and health care, in the future. Only 25.64% (260/1014) reported interest in smartphone apps for health promotion/prevention and 42.70% (433/1014) downloaded the COVID-19 contact-tracing app. Although 52.47% (532/1014) reported that they come across inaccurate digital information on the COVID-19 pandemic, 78.01% (791/1014) were confident in their ability to recognize such inaccurate information. Among those who use digital technologies for moderate physical activity (n=220), 187 (85.0%) found such technologies easy to use and 140 (63.6%) reported using them regularly (at least once a week). Although the perceived eHealth literacy was high (eHEALS mean score 31 points, SD 6), less than half (43.10%, 400/928) were confident in using digital information for health decisions. The use of digital technologies for health was associated with higher household income (odds ratio [OR] 1.28, 95% CI 1.11-1.47). The use of digital technologies for physical activity was associated with younger age (OR 0.95, 95% CI 0.94-0.96) and more education (OR 1.22, 95% CI 1.01-1.46). A higher perceived eHealth literacy score was associated with younger age (β=–.22, P<.001), higher household income (β=.21, P<.001), and more education (β=.14, P<.001). Conclusions: Internet users in Germany expect that digitization will affect preventive and therapeutic health care in the future. The facilitators and barriers associated with the use of digital technologies for health warrant further research. A gap exists between high confidence in the perceived ability to evaluate digital information and low trust in internet-based information on the COVID-19 pandemic and health decisions. %M 34813493 %R 10.2196/32951 %U https://publichealth.jmir.org/2021/11/e32951 %U https://doi.org/10.2196/32951 %U http://www.ncbi.nlm.nih.gov/pubmed/34813493 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e33576 %T Digital SARS-CoV-2 Detection Among Hospital Employees: Participatory Surveillance Study %A Leal-Neto,Onicio %A Egger,Thomas %A Schlegel,Matthias %A Flury,Domenica %A Sumer,Johannes %A Albrich,Werner %A Babouee Flury,Baharak %A Kuster,Stefan %A Vernazza,Pietro %A Kahlert,Christian %A Kohler,Philipp %+ Department of Economics, University of Zurich, Schönberggasse 1, Zurich, 8001, Switzerland, 41 783242116, onicio@gmail.com %K digital epidemiology %K SARS-CoV-2 %K COVID-19 %K health care workers %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The implementation of novel techniques as a complement to traditional disease surveillance systems represents an additional opportunity for rapid analysis. Objective: The objective of this work is to describe a web-based participatory surveillance strategy among health care workers (HCWs) in two Swiss hospitals during the first wave of COVID-19. Methods: A prospective cohort of HCWs was recruited in March 2020 at the Cantonal Hospital of St. Gallen and the Eastern Switzerland Children’s Hospital. For data analysis, we used a combination of the following techniques: locally estimated scatterplot smoothing (LOESS) regression, Spearman correlation, anomaly detection, and random forest. Results: From March 23 to August 23, 2020, a total of 127,684 SMS text messages were sent, generating 90,414 valid reports among 1004 participants, achieving a weekly average of 4.5 (SD 1.9) reports per user. The symptom showing the strongest correlation with a positive polymerase chain reaction test result was loss of taste. Symptoms like red eyes or a runny nose were negatively associated with a positive test. The area under the receiver operating characteristic curve showed favorable performance of the classification tree, with an accuracy of 88% for the training data and 89% for the test data. Nevertheless, while the prediction matrix showed good specificity (80.0%), sensitivity was low (10.6%). Conclusions: Loss of taste was the symptom that was most aligned with COVID-19 activity at the population level. At the individual level—using machine learning–based random forest classification—reporting loss of taste and limb/muscle pain as well as the absence of runny nose and red eyes were the best predictors of COVID-19. %M 34727046 %R 10.2196/33576 %U https://publichealth.jmir.org/2021/11/e33576 %U https://doi.org/10.2196/33576 %U http://www.ncbi.nlm.nih.gov/pubmed/34727046 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e26480 %T Willingness of Chinese Men Who Have Sex With Men to Use Smartphone-Based Electronic Readers for HIV Self-testing: Web-Based Cross-sectional Study %A Marley,Gifty %A Fu,Gengfeng %A Zhang,Ye %A Li,Jianjun %A Tucker,Joseph D %A Tang,Weiming %A Yu,Rongbin %+ School of Public Health, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, China, 86 13851545125, rongbinyu@njmu.edu.cn %K smartphone-based electronic reader %K electronic readers %K HIV self-testing %K HIVST %K self-testing %K cellular phone–based readers %K mHealth %D 2021 %7 19.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The need for strategies to encourage user-initiated reporting of results after HIV self-testing (HIVST) persists. Smartphone-based electronic readers (SERs) have been shown capable of reading diagnostics results accurately in point-of-care diagnostics and could bridge the current gaps between HIVST and linkage to care. Objective: Our study aimed to assess the willingness of Chinese men who have sex with men (MSM) in the Jiangsu province to use an SER for HIVST through a web-based cross-sectional study. Methods: From February to April 2020, we conducted a convenience web-based survey among Chinese MSM by using a pretested structured questionnaire. Survey items were adapted from previous HIVST feasibility studies and modified as required. Prior to answering reader-related questions, participants watched a video showcasing a prototype SER. Statistical analysis included descriptive analysis, chi-squared test, and multivariable logistic regression. P values less than .05 were deemed statistically significant. Results: Of 692 participants, 369 (53.3%) were aged 26-40 years, 456 (65.9%) had ever self-tested for HIV, and 493 (71.2%) were willing to use an SER for HIVST. Approximately 98% (483/493) of the willing participants, 85.3% (459/538) of ever self-tested and never self-tested, and 40% (46/115) of unwilling participants reported that SERs would increase their HIVST frequency. Engaging in unprotected anal intercourse with regular partners compared to consistently using condoms (adjusted odds ratio [AOR] 3.04, 95% CI 1.19-7.74) increased the odds of willingness to use an SER for HIVST. Participants who had ever considered HIVST at home with a partner right before sex compared to those who had not (AOR 2.99, 95% CI 1.13-7.90) were also more willing to use an SER for HIVST. Playing receptive roles during anal intercourse compared to playing insertive roles (AOR 0.05, 95% CI 0.02-0.14) was associated with decreased odds of being willing to use an SER for HIVST. The majority of the participants (447/608, 73.5%) preferred to purchase readers from local Centers of Disease Control and Prevention offices and 51.2% (311/608) of the participants were willing to pay less than US $4.70 for a reader device. Conclusions: The majority of the Chinese MSM, especially those with high sexual risk behaviors, were willing to use an SER for HIVST. Many MSM were also willing to self-test more frequently for HIV with an SER. Further research is needed to ascertain the diagnostic and real-time data-capturing capacity of prototype SERs during HIVST. %M 34806988 %R 10.2196/26480 %U https://www.jmir.org/2021/11/e26480 %U https://doi.org/10.2196/26480 %U http://www.ncbi.nlm.nih.gov/pubmed/34806988 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 11 %P e29176 %T An Open-Source, Standard-Compliant, and Mobile Electronic Data Capture System for Medical Research (OpenEDC): Design and Evaluation Study %A Greulich,Leonard %A Hegselmann,Stefan %A Dugas,Martin %+ Institute of Medical Informatics, University of Münster, Albert-Schweitzer-Campus 1, Building A11, Münster, 48149, Germany, 49 15905368729, leonard.greulich@uni-muenster.de %K electronic data capture %K open science %K data interoperability %K metadata reuse %K mobile health %K data standard %K mobile phone %D 2021 %7 19.11.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Medical research and machine learning for health care depend on high-quality data. Electronic data capture (EDC) systems have been widely adopted for metadata-driven digital data collection. However, many systems use proprietary and incompatible formats that inhibit clinical data exchange and metadata reuse. In addition, the configuration and financial requirements of typical EDC systems frequently prevent small-scale studies from benefiting from their inherent advantages. Objective: The aim of this study is to develop and publish an open-source EDC system that addresses these issues. We aim to plan a system that is applicable to a wide range of research projects. Methods: We conducted a literature-based requirements analysis to identify the academic and regulatory demands for digital data collection. After designing and implementing OpenEDC, we performed a usability evaluation to obtain feedback from users. Results: We identified 20 frequently stated requirements for EDC. According to the International Organization for Standardization/International Electrotechnical Commission (ISO/IEC) 25010 norm, we categorized the requirements into functional suitability, availability, compatibility, usability, and security. We developed OpenEDC based on the regulatory-compliant Clinical Data Interchange Standards Consortium Operational Data Model (CDISC ODM) standard. Mobile device support enables the collection of patient-reported outcomes. OpenEDC is publicly available and released under the MIT open-source license. Conclusions: Adopting an established standard without modifications supports metadata reuse and clinical data exchange, but it limits item layouts. OpenEDC is a stand-alone web app that can be used without a setup or configuration. This should foster compatibility between medical research and open science. OpenEDC is targeted at observational and translational research studies by clinicians. %M 34806987 %R 10.2196/29176 %U https://medinform.jmir.org/2021/11/e29176 %U https://doi.org/10.2196/29176 %U http://www.ncbi.nlm.nih.gov/pubmed/34806987 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e30042 %T Use of Patient-Reported Outcome Measures and Patient-Reported Experience Measures Within Evaluation Studies of Telemedicine Applications: Systematic Review %A Knapp,Andreas %A Harst,Lorenz %A Hager,Stefan %A Schmitt,Jochen %A Scheibe,Madlen %+ Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstrasse 74, Dresden, 01307, Germany, 49 3514585665, andreas.knapp@uniklinikum-dresden.de %K telemedicine %K telehealth %K evaluation %K outcome %K patient-reported outcome measures %K patient-reported outcome %K patient-reported experience measures %K patient-reported experience %K measurement instrument %K questionnaire %D 2021 %7 17.11.2021 %9 Review %J J Med Internet Res %G English %X Background: With the rise of digital health technologies and telemedicine, the need for evidence-based evaluation is growing. Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are recommended as an essential part of the evaluation of telemedicine. For the first time, a systematic review has been conducted to investigate the use of PROMs and PREMs in the evaluation studies of telemedicine covering all application types and medical purposes. Objective: This study investigates the following research questions: in which scenarios are PROMs and PREMs collected for evaluation purposes, which PROM and PREM outcome domains have been covered and how often, which outcome measurement instruments have been used and how often, does the selection and quantity of PROMs and PREMs differ between study types and application types, and has the use of PROMs and PREMs changed over time. Methods: We conducted a systematic literature search of the MEDLINE and Embase databases and included studies published from inception until April 2, 2020. We included studies evaluating telemedicine with patients as the main users; these studies reported PROMs and PREMs within randomized controlled trials, controlled trials, noncontrolled trials, and feasibility trials in English and German. Results: Of the identified 2671 studies, 303 (11.34%) were included; of the 303 studies, 67 (22.1%) were feasibility studies, 70 (23.1%) were noncontrolled trials, 20 (6.6%) were controlled trials, and 146 (48.2%) were randomized controlled trials. Health-related quality of life (n=310; mean 1.02, SD 1.05), emotional function (n=244; mean 0.81, SD 1.18), and adherence (n=103; mean 0.34, SD 0.53) were the most frequently assessed outcome domains. Self-developed PROMs were used in 21.4% (65/303) of the studies, and self-developed PREMs were used in 22.3% (68/303). PROMs (n=884) were assessed more frequently than PREMs (n=234). As the evidence level of the studies increased, the number of PROMs also increased (τ=−0.45), and the number of PREMs decreased (τ=0.35). Since 2000, not only has the number of studies using PROMs and PREMs increased, but the level of evidence and the number of outcome measurement instruments used have also increased, with the number of PREMs permanently remaining at a lower level. Conclusions: There have been increasingly more studies, particularly high-evidence studies, which use PROMs and PREMs to evaluate telemedicine. PROMs have been used more frequently than PREMs. With the increasing maturity stage of telemedicine applications and higher evidence level, the use of PROMs increased in line with the recommendations of evaluation guidelines. Health-related quality of life and emotional function were measured in almost all the studies. Simultaneously, health literacy as a precondition for using the application adequately, alongside proper training and guidance, has rarely been reported. Further efforts should be pursued to standardize PROM and PREM collection in evaluation studies of telemedicine. %M 34523604 %R 10.2196/30042 %U https://www.jmir.org/2021/11/e30042 %U https://doi.org/10.2196/30042 %U http://www.ncbi.nlm.nih.gov/pubmed/34523604 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e28857 %T Understanding the Predictors of Missing Location Data to Inform Smartphone Study Design: Observational Study %A Beukenhorst,Anna L %A Sergeant,Jamie C %A Schultz,David M %A McBeth,John %A Yimer,Belay B %A Dixon,Will G %+ Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 2622757506, beuk@hsph.harvard.edu %K geolocation %K global positioning system %K smartphones %K mobile phone %K mobile health %K environmental exposures %K data analysis %K digital epidemiology %K missing data %K location data %K mobile application %D 2021 %7 16.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone location data can be used for observational health studies (to determine participant exposure or behavior) or to deliver a location-based health intervention. However, missing location data are more common when using smartphones compared to when using research-grade location trackers. Missing location data can affect study validity and intervention safety. Objective: The objective of this study was to investigate the distribution of missing location data and its predictors to inform design, analysis, and interpretation of future smartphone (observational and interventional) studies. Methods: We analyzed hourly smartphone location data collected from 9665 research participants on 488,400 participant days in a national smartphone study investigating the association between weather conditions and chronic pain in the United Kingdom. We used a generalized mixed-effects linear model with logistic regression to identify whether a successfully recorded geolocation was associated with the time of day, participants’ time in study, operating system, time since previous survey completion, participant age, sex, and weather sensitivity. Results: For most participants, the app collected a median of 2 out of a maximum of 24 locations (1760/9665, 18.2% of participants), no location data (1664/9665, 17.2%), or complete location data (1575/9665, 16.3%). The median locations per day differed by the operating system: participants with an Android phone most often had complete data (a median of 24/24 locations) whereas iPhone users most often had a median of 2 out of 24 locations. The odds of a successfully recorded location for Android phones were 22.91 times higher than those for iPhones (95% CI 19.53-26.87). The odds of a successfully recorded location were lower during weekends (odds ratio [OR] 0.94, 95% CI 0.94-0.95) and nights (OR 0.37, 95% CI 0.37-0.38), if time in study was longer (OR 0.99 per additional day in study, 95% CI 0.99-1.00), and if a participant had not used the app recently (OR 0.96 per additional day since last survey entry, 95% CI 0.96-0.96). Participant age and sex did not predict missing location data. Conclusions: The predictors of missing location data reported in our study could inform app settings and user instructions for future smartphone (observational and interventional) studies. These predictors have implications for analysis methods to deal with missing location data, such as imputation of missing values or case-only analysis. Health studies using smartphones for data collection should assess context-specific consequences of high missing data, especially among iPhone users, during the night and for disengaged participants. %M 34783661 %R 10.2196/28857 %U https://mhealth.jmir.org/2021/11/e28857 %U https://doi.org/10.2196/28857 %U http://www.ncbi.nlm.nih.gov/pubmed/34783661 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e27073 %T Suggested Modifications to the Management of Patients With Breast Cancer During the COVID-19 Pandemic: Web-Based Survey Study %A Elsamany,Shereef %A Elbaiomy,Mohamed %A Zeeneldin,Ahmed %A Tashkandi,Emad %A Hassanin,Fayza %A Abdelhafeez,Nafisa %A O Al-Shamsi,Humaid %A Bukhari,Nedal %A Elemam,Omima %+ Oncology Center, King Abdullah Medical City, Muzdalifah Rd, Al Mashair, Makkah, 24246, Saudi Arabia, 966 558357452, elemam.o@kamc.med.sa %K breast cancer %K COVID-19 %K pandemic %K web-based survey %K treatment modification %K oncology %K treatment %K modification %K risk %K infection %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Management of patients with cancer in the current era of the COVID-19 pandemic poses a significant challenge to health care systems. Breast cancer is the most common cancer internationally. Breast cancer is a disease that involves surgery, chemotherapy, hormonal therapy, targeted therapy, radiotherapy, and, more recently, immunotherapy in its management plan. The immune system requires months to recover from these medications, and this condition is even worse in patients with metastatic breast cancer who need ongoing treatment with these drugs. Some of these drugs, such as inhibitors of cyclin-dependent kinases 4 and 6, can cause rare but life-threating lung inflammation. Patients with breast cancer who have metastatic disease to the lungs can experience deterioration of disease symptoms with COVID-19 infection. Oncologists treating patients with breast cancer are facing a difficult situation regarding treatment choice. The impact that COVID-19 has had on breast cancer care is unknown, including how to provide the best care possible without compromising patient and community safety. Objective: The aim of this study was to explore the views of oncologists regarding the management of patients with breast cancer during the COVID-19 pandemic. Methods: A web-based SurveyMonkey questionnaire was submitted to licensed oncologists involved in breast cancer management in Saudi Arabia, Egypt, and United Arab Emirates. The survey focused on characteristics of the participants, infection risk among patients with cancer, and possible treatment modifications related to different types of breast cancer. Results: The survey was completed by 82 participants. For early hormone receptor (HR)–positive, human epidermal growth factor receptor 2 (HER2)–negative breast cancer, 61 of the 82 participants (74%) supported using neoadjuvant hormonal therapy in selected patients, and 58% (48/82) preferred giving 6 over 8 cycles of adjuvant chemotherapy when indicated. Only 43% (35/82) preferred inhibitors of cyclin-dependent kinases 4 and 6 with hormonal therapy as the first-line treatment in all patients with metastatic HR-positive disease. A total of 55 of the 82 participants (67%) supported using adjuvant trastuzumab for 6 instead of 12 months in selected patients with HER2-positive breast cancer. For metastatic HER2-positive, HR-positive breast cancer, 80% of participants (66/82) supported the use of hormonal therapy with dual anti-HER2 blockade in selected patients. The preferred choice of first-line treatment in metastatic triple negative patients with BRCA mutation and programmed cell death 1 ligand 1 (PD-L1) <1% was poly(adenosine diphosphate–ribose) polymerase inhibitor according to 41% (34/82) of the participants, and atezolizumab with nab-paclitaxel was preferred for PD-L1 >1% according to 71% (58/82) of the participants. Conclusions: Several modifications in breast cancer management were supported by the survey participants. These modifications need to be discussed on a local basis, taking into account the local infrastructure and available resources. %M 34726611 %R 10.2196/27073 %U https://cancer.jmir.org/2021/4/e27073 %U https://doi.org/10.2196/27073 %U http://www.ncbi.nlm.nih.gov/pubmed/34726611 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e32708 %T Acceptability, Feasibility, and Quality of Telehealth for Adolescent Health Care Delivery During the COVID-19 Pandemic: Cross-sectional Study of Patient and Family Experiences %A Wood,Sarah M %A Pickel,Julia %A Phillips,Alexis W %A Baber,Kari %A Chuo,John %A Maleki,Pegah %A Faust,Haley L %A Petsis,Danielle %A Apple,Danielle E %A Dowshen,Nadia %A Schwartz,Lisa A %+ Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, United States, 1 215 590 1000, woodsa@chop.edu %K telehealth %K telemedicine %K adolescent %K COVID-19 %K acceptability %K feasibility %K young adult %K teenager %K cross-sectional %K patient experience %K experience %K efficiency %K equity %K survey %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Data regarding the acceptability, feasibility, and quality of telehealth among adolescents and young adults (AYA) and their parents and caregivers (caregivers) are lacking. Objective: The aim of this study was to assess the noninferiority of telehealth versus in-person visits by comparing acceptability with respect to efficiency, effectiveness, equity, patient-centeredness, and confidentiality. Methods: Cross-sectional web-based surveys were sent to caregivers and AYA following video visits within an Adolescent Medicine subspecialty clinic in May-July 2020. Proportions of AYA and caregivers who rated telehealth as noninferior were compared using chi-squared tests. Feasibility was assessed via items measuring technical difficulties. Deductive thematic analysis using the Institute of Medicine dimensions of health care quality was used to code open-ended question responses. Results: Survey response rates were 20.5% (55/268) for AYA and 21.8% (123/563) for caregivers. The majority of the respondents were White cisgender females. Most AYA and caregivers rated telehealth as noninferior to in-person visits with respect to confidentiality, communication, medication management, and mental health care. A higher proportion of AYA compared to caregivers found telehealth inferior with respect to confidentiality (11/51, 22% vs 3/118, 2.5%, P<.001). One-quarter (14/55) of the AYA patients and 31.7% (39/123) of the caregivers reported technical difficulties. The dominant themes in the qualitative data included advantages of telehealth for efficiency and equity of health care delivery. However, respondents’ concerns included reduced safety and effectiveness of care, particularly for patients with eating disorders, owing to lack of hands-on examinations, collection of vital signs, and laboratory testing. Conclusions: Telehealth was highly acceptable among AYA and caregivers. Future optimization should include improving privacy, ameliorating technical difficulties, and standardizing at-home methods of obtaining patient data to assure patient safety. %M 34779782 %R 10.2196/32708 %U https://pediatrics.jmir.org/2021/4/e32708 %U https://doi.org/10.2196/32708 %U http://www.ncbi.nlm.nih.gov/pubmed/34779782 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e21462 %T The Online Patient Satisfaction Index for Patients With Low Back Pain: Development, Reliability, and Validation Study %A Afzali,Tamana %A Lauridsen,Henrik Hein %A Thomsen,Janus Laust %A Hartvigsen,Jan %A Jensen,Martin Bach %A Riis,Allan %+ Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Fyrkildevej 7, Aalborg, 9220, Denmark, 45 20823660, ariis@dcm.aau.dk %K data accuracy %K patient satisfaction %K rehabilitation %K low back pain %K internet-based intervention %K mobile phone %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Low back pain is highly prevalent, and most often, a specific causative factor cannot be identified. Therefore, for most patients, their low back pain is labeled as nonspecific. Patient education and information are recommended for all these patients. The internet is an accessible source of medical information on low back pain. Approximately 50% of patients with low back pain search the internet for health and medical advice. Patient satisfaction with education and information is important in relation to patients’ levels of inclination to use web-based information and their trust in the information they find. Although patients who are satisfied with the information they retrieve use the internet as a supplementary source of information, dissatisfied patients tend to avoid using the internet. Consumers’ loyalty to a product is often applied to evaluate their satisfaction. Consumers have been shown to be good ambassadors for a service when they are willing to recommend the service to a friend or colleague. When consumers are willing to recommend a service to a friend or colleague, they are also likely to be future users of the service. To the best of our knowledge, no multi-item instrument exists to specifically evaluate satisfaction with information delivered on the web for people with low back pain. Objective: This study aims to report on the development, reliability testing, and construct validity testing of the Online Patient Satisfaction Index to measure patients’ satisfaction with web-based information for low back pain. Methods: This is a cross-sectional validation study of the Online Patient Satisfaction Index. The index was developed with experts and assessed for face validity. It was subsequently administered to 150 adults with nonspecific low back pain. Of these, 46% (70/150) were randomly assigned to participate in a reliability test using an intraclass correlation coefficient of agreement. Construct validity was evaluated by hypothesis testing based on a web app (MyBack) and Wikipedia on low back pain. Results: The index includes 8 items. The median score (range 0-24) based on the MyBack website was 20 (IQR 18-22), and the median score for Wikipedia was 12 (IQR 8-15). The entire score range was used. Overall, 53 participants completed a retest, of which 39 (74%) were stable in their satisfaction with the home page and were included in the analysis for reliability. Intraclass correlation coefficient of agreement was estimated to be 0.82 (95% CI 0.68-0.90). Two hypothesized correlations for construct validity were confirmed through an analysis using complete data. Conclusions: The index had good face validity, excellent reliability, and good construct validity and can be used to measure satisfaction with the provision of web-based information regarding nonspecific low back pain among people willing to access the internet to obtain health information. Trial Registration: ClinicalTrials.gov NCT03449004; https://clinicaltrials.gov/ct2/show/NCT03449004 %M 34779785 %R 10.2196/21462 %U https://formative.jmir.org/2021/11/e21462 %U https://doi.org/10.2196/21462 %U http://www.ncbi.nlm.nih.gov/pubmed/34779785 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e21142 %T Recruiting Participants for Population Health Intervention Research: Effectiveness and Costs of Recruitment Methods for a Cohort Study %A Wasfi,Rania %A Poirier Stephens,Zoe %A Sones,Meridith %A Laberee,Karen %A Pugh,Caitlin %A Fuller,Daniel %A Winters,Meghan %A Kestens,Yan %+ Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada, 1 3435537356, rania.wasfi@phac-aspc.gc.ca %K recruitment methods %K Facebook recruitment %K cost-effectiveness %K built environment %K intervention research %K natural experiment %K mobile phone %D 2021 %7 12.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Public health research studies often rely on population-based participation and draw on various recruitment methods to establish samples. Increasingly, researchers are turning to web-based recruitment tools. However, few studies detail traditional and web-based recruitment efforts in terms of costs and potential biases. Objective: This study aims to report on and evaluate the cost-effectiveness, time effectiveness, and sociodemographic representation of diverse recruitment methods used to enroll participants in 3 cities of the Interventions, Research, and Action in Cities Team (INTERACT) study, a cohort study conducted in Canadian cities. Methods: Over 2017 and 2018 in Vancouver, Saskatoon, and Montreal, the INTERACT study used the following recruitment methods: mailed letters, social media (including sponsored Facebook advertisements), news media, partner communications, snowball recruitment, in-person recruitment, and posters. Participation in the study involved answering web-based questionnaires (at minimum), activating a smartphone app to share sensor data, and wearing a device for mobility and physical activity monitoring. We describe sociodemographic characteristics by the recruitment method and analyze performance indicators, including cost, completion rate, and time effectiveness. Effectiveness included calculating cost per completer (ie, a participant who completed at least one questionnaire), the completion rate of a health questionnaire, and the delay between completion of eligibility and health questionnaires. Cost included producing materials (ie, printing costs), transmitting recruitment messages (ie, mailing list rental, postage, and sponsored Facebook posts charges), and staff time. In Montreal, the largest INTERACT sample, we modeled the number of daily recruits through generalized linear models accounting for the distributed lagged effects of recruitment campaigns. Results: Overall, 1791 participants were recruited from 3 cities and completed at least one questionnaire: 318 in Vancouver, 315 in Saskatoon, and 1158 in Montreal. In all cities, most participants chose to participate fully (questionnaires, apps, and devices). The costs associated with a completed participant varied across recruitment methods and by city. Facebook advertisements generated the most recruits (n=687), at a cost of CAD $15.04 (US $11.57; including staff time) per completer. Mailed letters were the costliest, at CAD $108.30 (US $83.3) per completer but served to reach older participants. All methods resulted in a gender imbalance, with women participating more, specifically with social media. Partner newsletters resulted in the participation of younger adults and were cost-efficient (CAD $5.16 [US $3.97] per completer). A generalized linear model for daily Montreal recruitment identified 2-day lag effects on most recruitment methods, except for the snowball campaign (4 days), letters (15 days), and reminder cards (5 days). Conclusions: This study presents comprehensive data on the costs, effectiveness, and bias of population recruitment in a cohort study in 3 Canadian cities. More comprehensive documentation and reporting of recruitment efforts across studies are needed to improve our capacity to conduct inclusive intervention research. %M 34587586 %R 10.2196/21142 %U https://www.jmir.org/2021/11/e21142 %U https://doi.org/10.2196/21142 %U http://www.ncbi.nlm.nih.gov/pubmed/34587586 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e29020 %T Population Health Surveillance Using Mobile Phone Surveys in Low- and Middle-Income Countries: Methodology and Sample Representativeness of a Cross-sectional Survey of Live Poultry Exposure in Bangladesh %A Berry,Isha %A Mangtani,Punam %A Rahman,Mahbubur %A Khan,Iqbal Ansary %A Sarkar,Sudipta %A Naureen,Tanzila %A Greer,Amy L %A Morris,Shaun K %A Fisman,David N %A Flora,Meerjady Sabrina %+ Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada, 1 416 978 0901, isha.berry@mail.utoronto.ca %K mobile telephone survey %K health surveillance %K survey methodology %K Bangladesh %D 2021 %7 12.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Population-based health surveys are typically conducted using face-to-face household interviews in low- and middle-income countries (LMICs). However, telephone-based surveys are cheaper, faster, and can provide greater access to hard-to-reach or remote populations. The rapid growth in mobile phone ownership in LMICs provides a unique opportunity to implement novel data collection methods for population health surveys. Objective: This study aims to describe the development and population representativeness of a mobile phone survey measuring live poultry exposure in urban Bangladesh. Methods: A population-based, cross-sectional, mobile phone survey was conducted between September and November 2019 in North and South Dhaka City Corporations (DCC), Bangladesh, to measure live poultry exposure using a stratified probability sampling design. Data were collected using a computer-assisted telephone interview platform. The call operational data were summarized, and the participant data were weighted by age, sex, and education to the 2011 census. The demographic distribution of the weighted sample was compared with external sources to assess population representativeness. Results: A total of 5486 unique mobile phone numbers were dialed, with 1047 respondents completing the survey. The survey had an overall response rate of 52.2% (1047/2006) and a co-operation rate of 89.0% (1047/1176). Initial results comparing the sociodemographic profile of the survey sample to the census population showed that mobile phone sampling slightly underrepresented older individuals and overrepresented those with higher secondary education. After weighting, the demographic profile of the sample population matched well with the latest DCC census population profile. Conclusions: Probability-based mobile phone survey sampling and data collection methods produced a population-representative sample with minimal adjustment in DCC, Bangladesh. Mobile phone–based surveys can offer an efficient, economic, and robust way to conduct surveillance for population health outcomes, which has important implications for improving population health surveillance in LMICs. %M 34766914 %R 10.2196/29020 %U https://publichealth.jmir.org/2021/11/e29020 %U https://doi.org/10.2196/29020 %U http://www.ncbi.nlm.nih.gov/pubmed/34766914 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e26221 %T Dropout From an Internet-Delivered Cognitive Behavioral Therapy Intervention for Adults With Depression and Anxiety: Qualitative Study %A Lawler,Kate %A Earley,Caroline %A Timulak,Ladislav %A Enrique,Angel %A Richards,Derek %+ E-Mental Health Research Group, School of Psychology, Trinity College Dublin, College Green, Dublin, Ireland, 353 851510008, lawlerka@tcd.ie %K depression %K anxiety %K iCBT %K dropout %K internet interventions %D 2021 %7 12.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Treatment dropout continues to be reported from internet-delivered cognitive behavioral therapy (iCBT) interventions, and lower completion rates are generally associated with lower treatment effect sizes. However, evidence is emerging to suggest that completion of a predefined number of modules is not always necessary for clinical benefit or consideration of the needs of each individual patient. Objective: The aim of this study is to perform a qualitative analysis of patients’ experiences with an iCBT intervention in a routine care setting to achieve a deeper insight into the phenomenon of dropout. Methods: A total of 15 purposively sampled participants (female: 8/15, 53%) from a larger parent randomized controlled trial were interviewed via telephone using a semistructured interview schedule that was developed based on the existing literature and research on dropout in iCBT. Data were analyzed using a descriptive-interpretive approach. Results: The experience of treatment leading to dropout can be understood in terms of 10 domains: relationship to technology, motivation to start, background knowledge and attitudes toward iCBT, perceived change in motivation, usage of the program, changes due to the intervention, engagement with content, experience interacting with the supporter, experience of web-based communication, and termination of the supported period. Conclusions: Patients who drop out of treatment can be distinguished in terms of their change in motivation: those who felt ready to leave treatment early and those who had negative reasons for dropping out. These 2 groups of participants have different treatment experiences, revealing the potential attributes and nonattributes of dropout. The reported between-group differences should be examined further to consider those attributes that are strongly descriptive of the experience and regarded less important than those that have become loosely affiliated. %M 34766909 %R 10.2196/26221 %U https://formative.jmir.org/2021/11/e26221 %U https://doi.org/10.2196/26221 %U http://www.ncbi.nlm.nih.gov/pubmed/34766909 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e15220 %T Feasibility of Real-time Behavior Monitoring Via Mobile Technology in Czech Adults Aged 50 Years and Above: 12-Week Study With Ecological Momentary Assessment %A Elavsky,Steriani %A Klocek,Adam %A Knapova,Lenka %A Smahelova,Martina %A Smahel,David %A Cimler,Richard %A Kuhnova,Jitka %+ Department of Human Movement Studies, University of Ostrava, Varenska 40a, Ostrava, 70200, Czech Republic, 420 553462588, steriani.elavsky@osu.cz %K mHealth %K mobile phone %K older adults %K health behavior %K physical activity %K Fitbit %D 2021 %7 10.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Czech older adults have lower rates of physical activity than the average population and lag behind in the use of digital technologies, compared with their peers from other European countries. Objective: This study aims to assess the feasibility of intensive behavior monitoring through technology in Czech adults aged ≥50 years. Methods: Participants (N=30; mean age 61.2 years, SD 6.8 years, range 50-74 years; 16/30, 53% male; 7/30, 23% retired) were monitored for 12 weeks while wearing a Fitbit Charge 2 monitor and completed three 8-day bursts of intensive data collection through surveys presented on a custom-made mobile app. Web-based surveys were also completed before and at the end of the 12-week period (along with poststudy focus groups) to evaluate participants’ perceptions of their experience in the study. Results: All 30 participants completed the study. Across the three 8-day bursts, participants completed 1454 out of 1744 (83% compliance rate) surveys administered 3 times per day on a pseudorandom schedule, 451 out of 559 (81% compliance rate) end-of-day surveys, and 736 episodes of self-reported planned physical activity (with 29/736, 3.9% of the reports initiated but returned without data). The overall rating of using the mobile app and Fitbit was above average (74.5 out of 100 on the System Usability Scale). The majority reported that the Fitbit (27/30, 90%) and mobile app (25/30, 83%) were easy to use and rated their experience positively (25/30, 83%). Focus groups revealed that some surveys were missed owing to notifications not being noticed or that participants needed a longer time window for survey completion. Some found wearing the monitor in hot weather or at night uncomfortable, but overall, participants were highly motivated to complete the surveys and be compliant with the study procedures. Conclusions: The use of a mobile survey app coupled with a wearable device appears feasible for use among Czech older adults. Participants in this study tolerated the intensive assessment schedule well, but lower compliance may be expected in studies of more diverse groups of older adults. Some difficulties were noted with the pairing and synchronization of devices on some types of smartphones, posing challenges for large-scale studies. %M 34757317 %R 10.2196/15220 %U https://aging.jmir.org/2021/4/e15220 %U https://doi.org/10.2196/15220 %U http://www.ncbi.nlm.nih.gov/pubmed/34757317 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e28915 %T Data Quality of Longitudinally Collected Patient-Reported Outcomes After Thoracic Surgery: Comparison of Paper- and Web-Based Assessments %A Yu,Hongfan %A Yu,Qingsong %A Nie,Yuxian %A Xu,Wei %A Pu,Yang %A Dai,Wei %A Wei,Xing %A Shi,Qiuling %+ School of Public Health and Management, Chongqing Medical University, No 1, Medical College Road, Yuzhong District, Chonqqing, 400016, China, 86 18290585397, qshi@cqmu.edu.cn %K patient-reported outcome (PRO) %K data quality %K MDASI-LC %K postoperative care %K symptoms %D 2021 %7 9.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: High-frequency patient-reported outcome (PRO) assessments are used to measure patients' symptoms after surgery for surgical research; however, the quality of those longitudinal PRO data has seldom been discussed. Objective: The aim of this study was to determine data quality-influencing factors and to profile error trajectories of data longitudinally collected via paper-and-pencil (P&P) or web-based assessment (electronic PRO [ePRO]) after thoracic surgery. Methods: We extracted longitudinal PRO data with 678 patients scheduled for lung surgery from an observational study (n=512) and a randomized clinical trial (n=166) on the evaluation of different perioperative care strategies. PROs were assessed by the MD Anderson Symptom Inventory Lung Cancer Module and single-item Quality of Life Scale before surgery and then daily after surgery until discharge or up to 14 days of hospitalization. Patient compliance and data error were identified and compared between P&P and ePRO. Generalized estimating equations model and 2-piecewise model were used to describe trajectories of error incidence over time and to identify the risk factors. Results: Among 678 patients, 629 with at least 2 PRO assessments, 440 completed 3347 P&P assessments and 189 completed 1291 ePRO assessments. In total, 49.4% of patients had at least one error, including (1) missing items (64.69%, 1070/1654), (2) modifications without signatures (27.99%, 463/1654), (3) selection of multiple options (3.02%, 50/1654), (4) missing patient signatures (2.54%, 42/1654), (5) missing researcher signatures (1.45%, 24/1654), and (6) missing completion dates (0.30%, 5/1654). Patients who completed ePRO had fewer errors than those who completed P&P assessments (ePRO: 30.2% [57/189] vs. P&P: 57.7% [254/440]; P<.001). Compared with ePRO patients, those using P&P were older, less educated, and sicker. Common risk factors of having errors were a lower education level (P&P: odds ratio [OR] 1.39, 95% CI 1.20-1.62; P<.001; ePRO: OR 1.82, 95% CI 1.22-2.72; P=.003), treated in a provincial hospital (P&P: OR 3.34, 95% CI 2.10-5.33; P<.001; ePRO: OR 4.73, 95% CI 2.18-10.25; P<.001), and with severe disease (P&P: OR 1.63, 95% CI 1.33-1.99; P<.001; ePRO: OR 2.70, 95% CI 1.53-4.75; P<.001). Errors peaked on postoperative day (POD) 1 for P&P, and on POD 2 for ePRO. Conclusions: It is possible to improve data quality of longitudinally collected PRO through ePRO, compared with P&P. However, ePRO-related sampling bias needs to be considered when designing clinical research using longitudinal PROs as major outcomes. %M 34751657 %R 10.2196/28915 %U https://www.jmir.org/2021/11/e28915 %U https://doi.org/10.2196/28915 %U http://www.ncbi.nlm.nih.gov/pubmed/34751657 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e29319 %T Association of Substance Use With Behavioral Adherence to Centers for Disease Control and Prevention Guidelines for COVID-19 Mitigation: Cross-sectional Web-Based Survey %A Monnig,Mollie A %A Treloar Padovano,Hayley %A Sokolovsky,Alexander W %A DeCost,Grace %A Aston,Elizabeth R %A Haass-Koffler,Carolina L %A Szapary,Claire %A Moyo,Patience %A Avila,Jaqueline C %A Tidey,Jennifer W %A Monti,Peter M %A Ahluwalia,Jasjit S %+ Department of Behavioral and Social Sciences, Brown University, Box G-S121-5, Providence, RI, 02912, United States, 1 4018633491, mollie_monnig@brown.edu %K SARS-CoV-2 %K novel coronavirus %K COVID-19 %K alcohol use %K alcohol drinking %K opioid use %K stimulant use %K nicotine %K smoking %K survey %K substance abuse %K addiction %K mental health %K pandemic %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Substance use is a risk factor for COVID-19 infection and adverse outcomes. However, reasons for elevated risk for COVID-19 in substance users are not well understood. Objective: The aim of this study was to evaluate whether alcohol or other drug use is associated with adherence to Centers for Disease Control and Prevention (CDC) guidelines for COVID-19 mitigation. Preregistered analyses tested the hypothesis that greater use of alcohol and other drugs would be associated with lower CDC guideline adherence. A secondary objective was to determine whether substance use was associated with the likelihood of COVID-19 testing or outcome. Methods: A cross-sectional web-based survey was administered to a convenience sample recruited through Amazon’s Mechanical Turk platform from June 18 to July 19, 2020. Individuals aged 18 years or older and residing in Connecticut, Massachusetts, New Jersey, New York, or Rhode Island were eligible to participate. The exposure of interest was past 7-day use of alcohol, cigarettes, electronic cigarettes, cannabis, stimulants, and nonmedical opioids. The primary outcome was CDC guideline adherence measured using a scale developed from behaviors advised to reduce the spread of COVID-19. Secondary outcomes were likelihood of COVID-19 testing and a positive COVID-19 test result. All analyses accounted for the sociodemographic characteristics. Results: The sample consisted of 1084 individuals (mean age 40.9 [SD 13.4] years): 529 (48.8%) men, 543 (50.1%) women, 12 (1.1%) other gender identity, 742 (68.5%) White individuals, 267 (24.6%) Black individuals, and 276 (25.5%) Hispanic individuals. Daily opioid users reported lower CDC guideline adherence than nondaily users (B=–0.24, 95% CI –0.44 to –0.05) and nonusers (B=–0.57, 95% CI –0.76 to –0.38). Daily alcohol drinkers reported lower adherence than nondaily drinkers (B=–0.16, 95% CI –0.30 to –0.02). Nondaily alcohol drinkers reported higher adherence than nondrinkers (B=0.10, 95% CI 0.02-0.17). Daily opioid use was related to greater odds of COVID-19 testing, and daily stimulant use was related to greater odds of a positive COVID-19 test. Conclusions: In a regionally-specific, racially, and ethnically diverse convenience sample, adults who engaged in daily alcohol or opioid use reported lower CDC guideline adherence for COVID-19 mitigation. Any opioid use was associated with greater odds of COVID-19 testing, and daily stimulant use was associated with greater odds of COVID-19 infection. Cigarettes, electronic cigarettes, cannabis, or stimulant use were not statistically associated with CDC guideline adherence, after accounting for sociodemographic covariates and other substance use variables. Findings support further investigation into whether COVID-19 testing and vaccination should be expanded among individuals with substance-related risk factors. %M 34591780 %R 10.2196/29319 %U https://publichealth.jmir.org/2021/11/e29319 %U https://doi.org/10.2196/29319 %U http://www.ncbi.nlm.nih.gov/pubmed/34591780 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e29896 %T Psychosocial and Behavioral Effects of the COVID-19 Pandemic in the Indian Population: Protocol for a Cross-sectional Study %A Joshi,Megha %A Shah,Aangi %A Trivedi,Bhavi %A Trivedi,Jaahnavee %A Patel,Viral %A Parghi,Devam %A Thakkar,Manini %A Barot,Kanan %A Jadawala,Vivek %+ Department of Psychiatry, Shrimati Nathiba Hargovandas Lakhamichand Municipal Medical College, Gujarat University, Pritamrai cross road,, Ellisbridge, Paldi, Ahmedabad, 380006, India, 91 9909896196, joshimegha1@gmail.com %K COVID-19 %K mental health %K India %K lockdown %K isolation %K social isolation %K behavior %K psychology %K psychosocial effects %D 2021 %7 5.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: During the year 2020, the COVID-19 pandemic spread from China to the rest of the world, which prompted the world to implement a widespread mandated quarantine or social isolation. The impending uncertainty of the pandemic must have resulted in a variety of widespread mental health maladies. There has been documentation in the literature about a lot of these in small populations of the world but limited studies have been conducted in India, leading to limited evidence in the literature. Objective: The main objective of our study is to investigate the mental health effects that the COVID-19 pandemic has had on the general population in India both quantitatively and qualitatively. These results will help contribute to reducing the knowledge gap that is recognized in the literature, which is the result of the unprecedented and novel nature of the pandemic. Methods: We designed and validated our own questionnaire and used the method of circulating the questionnaire via WhatsApp (Facebook Inc). WhatsApp is a social media app that is very popularly used in India; hence, it turned out to be an effective medium for gathering pilot data. We analyzed the pilot data and used them to validate the questionnaire. This was done with the expertise of our mentor, Nilima Shah, MD (psychiatry). We gathered pilot data on 545 subjects and used the results to determine the changes that were needed for the questionnaire while simultaneously validating the questionnaire. Results: The study protocol was approved in September 2020 by the institutional review board at Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India. Conclusions: The following preliminary assumptions can be made about the study based on the pilot data: the majority of the survey respondents were male (289/545, 53%), most of them were educated and employed as health care workers (199/545, 36.5%). The majority of the responders were self-employed (185/545, 33.9%), single (297/545, 54.5%), and stayed with their families (427/541, 79%) for the lockdown, which helped them psychologically. Findings that are specific to mental health have been elaborated upon in the manuscript. It is evident from the data collected in previous literature that the pandemic has had significant detrimental effects on the mental health of a vast proportion of the Indian population. International Registered Report Identifier (IRRID): DERR1-10.2196/29896 %M 34519652 %R 10.2196/29896 %U https://www.researchprotocols.org/2021/11/e29896 %U https://doi.org/10.2196/29896 %U http://www.ncbi.nlm.nih.gov/pubmed/34519652 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e25329 %T Body Image Distress and Its Associations From an International Sample of Men and Women Across the Adult Life Span: Web-Based Survey Study %A Milton,Alyssa %A Hambleton,Ashlea %A Roberts,Anna %A Davenport,Tracey %A Flego,Anna %A Burns,Jane %A Hickie,Ian %+ Sydney School of Medicine, Faculty of Medicine and Health, University of Sydney, Professor Marie Bashir Centre, 67-73 Missenden Rd, Camperdown, 2050, Australia, 61 02 93510774, alyssa.milton@sydney.edu.au %K body image %K mental health %K well-being %K web-based survey %K sex differences %K age %D 2021 %7 4.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Previous research on body image distress mainly relied on samples that were small, generally homogeneous in age or sex, often limited to one geographical region, and were characterized by a lack of comprehensive analysis of multiple psychosocial domains. The research presented in this paper extends the international literature using the results of the web-based Global Health and Wellbeing Survey 2015. The survey included a large sample of both men and women aged ≥16 years from Australia, Canada, New Zealand, the United Kingdom, or the United States. Objective: The main objectives of this study are to examine body image distress across the adult life span (≥16 years) and sex and assess the association between body image distress and various psychosocial risk and protective factors. Methods: Data were extracted from the Global Health and Wellbeing Survey 2015, a web-based international self-report survey with 10,765 respondents, and compared with previous web-based surveys conducted in 2009 and 2012. Results: The body image distress of young Australians (aged 16-25 years) significantly rose by 33% from 2009 to 2015. In 2015, 75.19% (961/1278) of 16- to 25-year-old adults reported body image distress worldwide, and a decline in body image distress was noted with increasing age. More women reported higher levels of body image distress than men (1953/3338, 58.51% vs 853/2175, 39.22%). Sex, age, current dieting status, perception of weight, psychological distress, alcohol and other substance misuse, and well-being significantly explained 24% of the variance in body image distress in a linear regression (F15,4966=105.8; P<.001). Conclusions: This study demonstrates the significant interplay between body image distress and psychosocial factors across age and sex. %M 34734831 %R 10.2196/25329 %U https://formative.jmir.org/2021/11/e25329 %U https://doi.org/10.2196/25329 %U http://www.ncbi.nlm.nih.gov/pubmed/34734831 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e31483 %T Benefits, Problems, and Potential Improvements in a Nationwide Patient Portal: Cross-sectional Survey of Pharmacy Customers’ Experiences %A Sääskilahti,Maria %A Ojanen,Anna %A Ahonen,Riitta %A Timonen,Johanna %+ School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, PO Box 1627, Kuopio, 70211, Finland, 358 403552505, maria.saaskilahti@uef.fi %K benefit %K problem %K improvement need %K patient portal %K patient engagement %K experience %K survey %D 2021 %7 3.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient engagement is a worldwide trend in health care. Patient portals have the potential to increase patients’ knowledge about their health and care and therefore enhance patient engagement. Portal users’ experiences are needed to determine if these portals work appropriately and if there are barriers to achieving the aims that were set before their implementation. Objective: The aim of this study is to analyze pharmacy customers’ experiences of the Finnish nationwide patient portal My Kanta in terms of benefits, problems, and potential improvements. Methods: A questionnaire survey was conducted among pharmacy customers in the spring of 2019. The questionnaires (N=2866) were distributed from 18 community pharmacies across mainland Finland to customers aged ≥18 years who were purchasing prescription medicines for themselves or their children aged <18 years. Using open-ended questions, customers were asked about their experiences of the benefits and problems of My Kanta and what improvements could be made. Their responses were encoded and categorized using inductive content analysis, stored in SPSS Statistics for Windows, and analyzed using frequencies. Results: Of the 2866 questionnaires, a total of 994 (34.68%) questionnaires were included in the analysis. Most respondents were My Kanta users (820/994, 82.5%); of these 820 users, 667 (81.3%) reported at least one benefit, 311 (37.9%) reported at least one problem, and 327 (39.9%) reported at least one potential improvement when using My Kanta. The most commonly mentioned benefits were opportunities to view health data (290/667, 43.5%) and prescriptions (247/667, 37%) and to renew prescriptions (220/667, 33%). The most extensively reported problems with My Kanta were that the portal lacks health data (71/311, 22.8%), navigating the service and searching for information is difficult (68/311, 21.9%), and the delay before health data are incorporated into the service (41/311, 13.2%). The most frequently suggested potential improvements were that My Kanta needs more comprehensive health data (89/327, 27.2%); the service should be easier to navigate and information easier to access (71/327, 21.7%); the service should have more functions (51/327, 15.6%); and health data should be entered into the portal more promptly (47/327, 14.4%). Conclusions: Pharmacy customers reported more benefits than problems or potential improvements regarding the use of My Kanta. The service is useful for viewing health data and prescriptions and for renewing prescriptions. However, portal users would like to see more data and functions available in the portal and data searches to be made easier. These improvements could make the data and functions provided by the portal easier to view and use and hence promote patient engagement. %M 34730542 %R 10.2196/31483 %U https://www.jmir.org/2021/11/e31483 %U https://doi.org/10.2196/31483 %U http://www.ncbi.nlm.nih.gov/pubmed/34730542 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e30747 %T Changes in Self-Reported Web-Based Gambling Activity During the COVID-19 Pandemic: Cross-sectional Study %A Claesdotter-Knutsson,Emma %A Håkansson,Anders %+ Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Barav 1, Lund, 221 85, Sweden, 46 768871765, emma.claesdotter-knutsson@med.lu.se %K COVID-19 %K pandemic %K web-based gambling %K psychological distress %K gender %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: The COVID‑19 pandemic has affected not only somatic health with over 3.7 million deaths worldwide, but also has had a huge impact on psychological health, creating what amounts to a mental health crisis. The negative effect of the pandemic on traditional addictions is well described and concerning, and the same has been seen for gambling. Objective: This study explores self-reported web-based gambling behavior during the COVID‑19 pandemic in Sweden. We investigated overall changes, but also changes in specific web-based gambling types, and whether they are associated with certain risk factors or lifestyle changes. Methods: Our study is based on an anonymous web-based survey of web panel participants in Sweden (N=1501) designed to study a range of behavioral changes during the COVID‑19 pandemic. Increases in gambling were analyzed using logistic regression models against sociodemographic data and psychological distress. Results: The majority of the respondents who gambled reported no changes in their gambling habits during the COVID‑19 pandemic. We found significant associations with the problem gambling severity index (PGSI), the Kessler score (indicating psychological distress), employment status, changes in alcohol habits, and self-exclusion when looking at overall changes in gambling activity in the pandemic. In the subgroup that reported an increase in gambling activity, we found an association with both the PGSI and Kessler scores. The PGSI score was also an independent predictor for all specific web-based gambling (horses, sports, poker, and casino) whereas the Kessler score only had a significant impact on changes in casino gambling. In addition, male gender was an independent predictor for gambling on sports and casino gambling. Conclusions: The majority of respondents who gambled reported no changes in their gambling activity during the COVID‑19 pandemic. The group that reported an increase in overall gambling activity during the COVID-19 pandemic represent a group with gambling problems and psychological distress. The group that reported increased sports and casino gambling were often male, and this group seemed to experience more psychological distress. %M 34730540 %R 10.2196/30747 %U https://games.jmir.org/2021/4/e30747 %U https://doi.org/10.2196/30747 %U http://www.ncbi.nlm.nih.gov/pubmed/34730540 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e31649 %T Usability Evaluation of an Offline Electronic Data Capture App in a Prospective Multicenter Dementia Registry (digiDEM Bayern): Mixed Method Study %A Reichold,Michael %A Heß,Miriam %A Kolominsky-Rabas,Peter %A Gräßel,Elmar %A Prokosch,Hans-Ulrich %+ Department of Medical Informatics, Biometrics and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Wetterkreuz 15, Erlangen, 91058, Germany, 49 91318526720, michael.reichold@fau.de %K dementia %K usability %K evaluation %K mobile device %K registry %K electronic data collection %K offline %K mobile app %K digital health %K usability testing %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital registries have been shown to provide an efficient way of gaining a better understanding of the clinical complexity and long-term progression of diseases. The paperless method of electronic data capture (EDC) during a patient interview saves both time and resources. In the prospective multicenter project “Digital Dementia Registry Bavaria (digiDEM Bayern),” interviews are also performed on site in rural areas with unreliable internet connectivity. It must be ensured that EDC can still be performed in such a context and that there is no need to fall back on paper-based questionnaires. In addition to a web-based data collection solution, the EDC system REDCap (Research Electronic Data Capture) offers the option to collect data offline via an app and to synchronize it afterward. Objective: The aim of this study was to evaluate the usability of the REDCap app as an offline EDC option for a lay user group and to examine the necessary technology acceptance of using mobile devices for data collection. The feasibility of the app-based offline data collection in the digiDEM Bayern dementia registry project was then evaluated before going live. Methods: An exploratory mixed method design was employed in the form of an on-site usability test with the “Thinking Aloud” method combined with an online questionnaire including the System Usability Scale (SUS). The acceptance of mobile devices for data collection was surveyed based on five categories of the technology acceptance model. Results: Using the “Thinking Aloud” method, usability issues were identified and solutions were accordingly derived. Evaluation of the REDCap app resulted in a SUS score of 74, which represents “good” usability. After evaluating the technology acceptance questionnaire, it can be concluded that the lay user group is open to mobile devices as interview tools. Conclusions: The usability evaluation results show that a lay user group generally agree that data collecting partners in the digiDEM project can handle the REDCap app well. The usability evaluation provided statements about positive aspects and could also identify usability issues relating to the REDCap app. In addition, the current technology acceptance in the sample showed that heterogeneous groups of different ages with diverse experiences in handling mobile devices are also ready for the use of app-based EDC systems. Based on these results, it can be assumed that the offline use of an app-based EDC system on mobile devices is a viable solution for collecting data in a decentralized registry–based research project. %M 34730543 %R 10.2196/31649 %U https://formative.jmir.org/2021/11/e31649 %U https://doi.org/10.2196/31649 %U http://www.ncbi.nlm.nih.gov/pubmed/34730543 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28929 %T A Case Study of an SMS Text Message Community Panel Survey and Its Potential for Use During the COVID-19 Pandemic %A Chan,Lilian %A El-Haddad,Nouhad %A Freeman,Becky %A O'Hara,Blythe J %A Woodland,Lisa %A Harris-Roxas,Ben %+ Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, The University of Sydney, John Hopkins Drive, Camperdown, 2006, Australia, 61 286277554, lilian.chan@sydney.edu.au %K data collection %K mobile phone %K short message service %K tobacco %K COVID-19 %K survey %D 2021 %7 3.11.2021 %9 Viewpoint %J JMIR Form Res %G English %X During the COVID-19 pandemic many traditional methods of data collection, such as intercept surveys or focus groups, are not feasible. This paper proposes that establishing community panels through SMS text messages may be a useful method during the pandemic, by describing a case study of how an innovative SMS text message community panel was used for the “Shisha No Thanks” project to collect data from young adults of Arabic-speaking background about their attitudes on the harms of waterpipe smoking. Participants were asked to complete an initial recruitment survey, and then subsequently sent 1 survey question per week. The study recruited 133 participants to the SMS text message community panel and the mean response rate for each question was 73.0% (97.1/133) (range 76/133 [57.1%] to 112/133 [84.2%]). The SMS text message community panel approach is not suited for all populations, nor for all types of inquiry, particularly due to limitations of the type of responses that it allows and the required access to mobile devices. However, it is a rapid method for data collection, and therefore during the COVID-19 pandemic, it can provide service providers and policymakers with timely information to inform public health responses. In addition, this method negates the need for in-person interactions and allows for longitudinal data collection. It may be useful in supplementing other community needs assessment activities, and may be particularly relevant for people who are considered to be more difficult to reach, particularly young people, culturally and linguistically diverse communities, and other groups that might otherwise be missed by traditional methods. %M 34612824 %R 10.2196/28929 %U https://formative.jmir.org/2021/11/e28929 %U https://doi.org/10.2196/28929 %U http://www.ncbi.nlm.nih.gov/pubmed/34612824 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e27114 %T Understanding the Social Determinants of Mental Health of Undergraduate Students in Bangladesh: Interview Study %A Bhattacharjee,Ananya %A Haque,S M Taiabul %A Hady,Md Abdul %A Alam,S M Raihanul %A Rabbi,Mashfiqui %A Kabir,Muhammad Ashad %A Ahmed,Syed Ishtiaque %+ Department of Computer Science, University of Toronto, 40 St George Street, Toronto, ON, M5S 2E4, Canada, 1 6476196982, ananya@cs.toronto.edu %K Bangladesh %K global south %K social determinant %K students %K undergraduate %K religion %K women %K mobile phone %D 2021 %7 2.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The undergraduate student population has been actively studied in digital mental health research. However, the existing literature primarily focuses on students from high-income nations, and undergraduates from limited-income nations remain understudied. Objective: This study aims to identify the broader social determinants of mental health among undergraduate students in Bangladesh, a limited-income nation in South Asia; study the manifestation of these determinants in their day-to-day lives; and explore the feasibility of self-monitoring tools in helping them identify the specific factors or relationships that affect their mental health. Methods: We conducted a 21-day study with 38 undergraduate students from 7 universities in Bangladesh. We conducted 2 semistructured interviews: one prestudy and one poststudy. During the 21-day study, participants used an Android app to self-report and self-monitor their mood after each phone conversation. The app prompted participants to report their mood after each phone conversation and provided graphs and charts so that the participants could independently review their mood and conversation patterns. Results: Our results show that academics, family, job and economic condition, romantic relationship, and religion are the major social determinants of mental health among undergraduate students in Bangladesh. Our app helped the participants pinpoint the specific issues related to these factors, as the participants could review the pattern of their moods and emotions from past conversation history. Although our app does not provide any explicit recommendation, the participants took certain steps on their own to improve their mental health (eg, reduced the frequency of communication with certain persons). Conclusions: Although some of the factors (eg, academics) were reported in previous studies conducted in the Global North, this paper sheds light on some new issues (eg, extended family problems and religion) that are specific to the context of the Global South. Overall, the findings from this study would provide better insights for researchers to design better solutions to help the younger population from this part of the world. %M 34726609 %R 10.2196/27114 %U https://formative.jmir.org/2021/11/e27114 %U https://doi.org/10.2196/27114 %U http://www.ncbi.nlm.nih.gov/pubmed/34726609 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e31294 %T Public Attitudes to Digital Health Research Repositories: Cross-sectional International Survey %A Nunes Vilaza,Giovanna %A Coyle,David %A Bardram,Jakob Eyvind %+ Department of Health Technology, Technical University of Denmark, Ørsteds Plads 345B, Kongens Lyngby, 2800, Denmark, 45 45253724, gnvi@dtu.dk %K digital medicine %K health informatics %K health data repositories %K personal sensing %K technology acceptance %K willingness to share data %K human-centered computing %K ethics %D 2021 %7 29.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health research repositories propose sharing longitudinal streams of health records and personal sensing data between multiple projects and researchers. Motivated by the prospect of personalizing patient care (precision medicine), these initiatives demand broad public acceptance and large numbers of data contributors, both of which are challenging. Objective: This study investigates public attitudes toward possibly contributing to digital health research repositories to identify factors for their acceptance and to inform future developments. Methods: A cross-sectional online survey was conducted from March 2020 to December 2020. Because of the funded project scope and a multicenter collaboration, study recruitment targeted young adults in Denmark and Brazil, allowing an analysis of the differences between 2 very contrasting national contexts. Through closed-ended questions, the survey examined participants’ willingness to share different data types, data access preferences, reasons for concern, and motivations to contribute. The survey also collected information about participants’ demographics, level of interest in health topics, previous participation in health research, awareness of examples of existing research data repositories, and current attitudes about digital health research repositories. Data analysis consisted of descriptive frequency measures and statistical inferences (bivariate associations and logistic regressions). Results: The sample comprises 1017 respondents living in Brazil (1017/1600, 63.56%) and 583 in Denmark (583/1600, 36.44%). The demographics do not differ substantially between participants of these countries. The majority is aged between 18 and 27 years (933/1600, 58.31%), is highly educated (992/1600, 62.00%), uses smartphones (1562/1600, 97.63%), and is in good health (1407/1600, 87.94%). The analysis shows a vast majority were very motivated by helping future patients (1366/1600, 85.38%) and researchers (1253/1600, 78.31%), yet very concerned about unethical projects (1219/1600, 76.19%), profit making without consent (1096/1600, 68.50%), and cyberattacks (1055/1600, 65.94%). Participants’ willingness to share data is lower when sharing personal sensing data, such as the content of calls and texts (1206/1600, 75.38%), in contrast to more traditional health research information. Only 13.44% (215/1600) find it desirable to grant data access to private companies, and most would like to stay informed about which projects use their data (1334/1600, 83.38%) and control future data access (1181/1600, 73.81%). Findings indicate that favorable attitudes toward digital health research repositories are related to a personal interest in health topics (odds ratio [OR] 1.49, 95% CI 1.10-2.02; P=.01), previous participation in health research studies (OR 1.70, 95% CI 1.24-2.35; P=.001), and awareness of examples of research repositories (OR 2.78, 95% CI 1.83-4.38; P<.001). Conclusions: This study reveals essential factors for acceptance and willingness to share personal data with digital health research repositories. Implications include the importance of being more transparent about the goals and beneficiaries of research projects using and re-using data from repositories, providing participants with greater autonomy for choosing who gets access to which parts of their data, and raising public awareness of the benefits of data sharing for research. In addition, future developments should engage with and reduce risks for those unwilling to participate. %M 34714253 %R 10.2196/31294 %U https://www.jmir.org/2021/10/e31294 %U https://doi.org/10.2196/31294 %U http://www.ncbi.nlm.nih.gov/pubmed/34714253 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e28689 %T How Food Marketing on Instagram Shapes Adolescents’ Food Preferences: Online Randomized Trial %A Bragg,Marie %A Lutfeali,Samina %A Greene,Tenay %A Osterman,Jessica %A Dalton,Madeline %+ Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, 3rd Floor, New York City, NY, 10016, United States, 1 646 501 2717, Marie.Bragg@nyulangone.org %K food marketing %K traditional media %K social media %K adolescents %K Instagram %D 2021 %7 22.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Worldwide obesity rates have prompted 16 countries to enact policies to reduce children’s exposure to unhealthy food marketing, but few policies address online advertising practices or protect adolescents from being targeted. Given adolescents spend so much time online, it is critical to understand how persuasive Instagram food advertisements (ads) are compared with traditional food ads. To strengthen online food marketing policies, more evidence is needed on whether social media ads are more persuasive than other types of ads in shaping adolescents’ preferences. Objective: This study examined whether adolescents could identify food companies’ Instagram posts as ads, and the extent to which Instagram versus traditional food ads shape adolescents’ preferences. Methods: In Part 1, participants aged 13-17 years (N=832) viewed 8 pairs of ads and were asked to identify which ads originated from Instagram. One ad in each pair was selected from traditional sources (eg, print; online banner ad), and the other ad was selected from Instagram, but we removed the Instagram frame—which includes the logo, comments, and “likes.” In Part 2, participants were randomized to rate food ads that ostensibly originated from (1) Instagram (ie, we photoshopped the Instagram frame onto ads); or (2) traditional sources. Unbeknownst to participants, half of the ads in their condition originated from Instagram and half originated from traditional sources. Results: In Part 1, adolescents performed worse than chance when asked to identify Instagram ads (P<.001). In Part 2, there were no differences on 4 of 5 outcomes in the “labeled ad condition.” In the “unlabeled ad condition,” however, they preferred Instagram ads to traditional ads on 3 of 5 outcomes (ie, trendiness, P=.001; artistic appeal, P=.001; likeability, P=.001). Conclusions: Adolescents incorrectly identified traditional ads as Instagram posts, suggesting the artistic appearance of social media ads may not be perceived as marketing. Further, the mere presence of Instagram features caused adolescents to rate food ads more positively than ads without Instagram features. %M 34677136 %R 10.2196/28689 %U https://www.jmir.org/2021/10/e28689 %U https://doi.org/10.2196/28689 %U http://www.ncbi.nlm.nih.gov/pubmed/34677136 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e25489 %T High Work-Related Stress and Anxiety as a Response to COVID-19 Among Health Care Workers in South Korea: Cross-sectional Online Survey Study %A Ahn,Myung Hee %A Shin,Yong-Wook %A Suh,Sooyeon %A Kim,Jeong Hye %A Kim,Hwa Jung %A Lee,Kyoung-Uk %A Chung,Seockhoon %+ Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea, 82 2 3010 3411, schung@amc.seoul.kr %K COVID-19 %K health personnel %K occupational stress %K anxiety %K depression %K stress %K mental health %K South Korea %K health care worker %K assessment %K intervention %D 2021 %7 22.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 outbreak had a severe impact on health care workers' psychological health. It is important to establish a process for psychological assessment and intervention for health care workers during epidemics. Objective: We investigated risk factors associated with psychological impacts for each health care worker group, to help optimize psychological interventions for health care workers in countries affected by the COVID-19 pandemic. Methods: Respondents (n=1787) from 2 hospitals in Korea completed a web-based survey during the period from April 14 to 30, 2020. The web-based survey collected demographic information, psychiatric history, and responses to the 9-item Stress and Anxiety to Viral Epidemics (SAVE-9), 9-item Patient Health Questionnaire (PHQ-9), and 7-item Generalized Anxiety Disorder-7 (GAD-7) scales. We performed logistic regression to assess contributing factors as predictor variables, using health care workers’ depression as outcome variables. Results: Among 1783 health care workers, nursing professionals had significantly higher levels of depression (PHQ-9 score: meannurse 5.5, SD 4.6; meanother 3.8, SD 4.2; P<.001), general anxiety (GAD-7 score: meannurse 4.0, SD 4.1; meanother 2.7, SD 3.6; P<.001), and virus-related anxiety symptoms (SAVE-9 score: meannurse 21.6, SD 5.9; meanother 18.6, SD 6.3; P<.001). Among nursing professionals, single workers reported more severe depressive symptoms than married workers (PHQ-9 score ≥10; meannurse 20.3%; meanother 14.1%; P=.02), and junior (<40 years) workers reported more anxiety about the viral epidemic (SAVE-9 anxiety score; meannurse 15.6, SD 4.1; meanother 14.7, SD 4.4; P=.002). Logistic regression revealed that hospital (adjusted odds ratio [OR] 1.45, 95% CI 1.06-1.99), nursing professionals (adjusted OR 1.37, 95% CI 1.02-1.98), single workers (adjusted OR 1.51, 95% CI 1.05-2.16), higher stress and anxiety to the viral infection (high SAVE-9 score, adjusted OR 1.20, 95% CI 1.17-1.24), and past psychiatric history (adjusted OR 3.26, 95% CI 2.15-4.96) were positively associated with depression. Conclusions: Psychological support and interventions should be considered for health care workers, especially nursing professionals, those who are single, and those with high SAVE-9 scores. %M 34478401 %R 10.2196/25489 %U https://publichealth.jmir.org/2021/10/e25489 %U https://doi.org/10.2196/25489 %U http://www.ncbi.nlm.nih.gov/pubmed/34478401 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e32789 %T Understanding Adolescent and Young Adult 6-Mercaptopurine Adherence and mHealth Engagement During Cancer Treatment: Protocol for Ecological Momentary Assessment %A Psihogios,Alexandra M %A Rabbi,Mashfiqui %A Ahmed,Annisa %A McKelvey,Elise R %A Li,Yimei %A Laurenceau,Jean-Philippe %A Hunger,Stephen P %A Fleisher,Linda %A Pai,Ahna LH %A Schwartz,Lisa A %A Murphy,Susan A %A Barakat,Lamia P %+ Children's Hospital of Philadelphia, University of Pennsylvania, Abramson Pediatric Research Center, Room 1429C, 3615 Civic Center Blvd, Philadelphia, PA, 19104, United States, 1 267 314 0164, psihogiosa@email.chop.edu %K mHealth %K ecological momentary assessment %K adolescents %K young adults %K oncology %K cancer %K self-management %K mobile phone %D 2021 %7 22.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescents and young adults (AYAs) with cancer demonstrate suboptimal oral chemotherapy adherence, increasing their risk of cancer relapse. It is unclear how everyday time-varying contextual factors (eg, mood) affect their adherence, stalling the development of personalized mobile health (mHealth) interventions. Poor engagement is also a challenge across mHealth trials; an effective adherence intervention must be engaging to promote uptake. Objective: This protocol aims to determine the temporal associations between daily contextual factors and 6-mercaptopurine (6-MP) adherence and explore the proximal impact of various engagement strategies on ecological momentary assessment survey completion. Methods: At the Children’s Hospital of Philadelphia, AYAs with acute lymphoblastic leukemia or lymphoma who are prescribed prolonged maintenance chemotherapy that includes daily oral 6-MP are eligible, along with their matched caregivers. Participants will use an ecological momentary assessment app called ADAPTS (Adherence Assessments and Personalized Timely Support)—a version of an open-source app that was modified for AYAs with cancer through a user-centered process—and complete surveys in bursts over 6 months. Theory-informed engagement strategies will be microrandomized to estimate the causal effects on proximal survey completion. Results: With funding from the National Cancer Institute and institutional review board approval, of the proposed 30 AYA-caregiver dyads, 60% (18/30) have been enrolled; of the 18 enrolled, 15 (83%) have completed the study so far. Conclusions: This protocol represents an important first step toward prescreening tailoring variables and engagement components for a just-in-time adaptive intervention designed to promote both 6-MP adherence and mHealth engagement. International Registered Report Identifier (IRRID): DERR1-10.2196/32789 %M 34677129 %R 10.2196/32789 %U https://www.researchprotocols.org/2021/10/e32789 %U https://doi.org/10.2196/32789 %U http://www.ncbi.nlm.nih.gov/pubmed/34677129 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e31582 %T Health Care Providers’ Acceptance of a Personal Health Record: Cross-sectional Study %A Yousef,Consuela Cheriece %A Salgado,Teresa M %A Farooq,Ali %A Burnett,Keisha %A McClelland,Laura E %A Abu Esba,Laila Carolina %A Alhamdan,Hani Solaiman %A Khoshhal,Sahal %A Aldossary,Ibrahim Fahad %A Alyas,Omar Anwar %A DeShazo,Jonathan P %+ Pharmaceutical Care Department, Ministry of National Guard Health Affairs, P.O. Box 4616, Dammam, 31412, Saudi Arabia, 966 8532555, consuela_73@hotmail.com %K personal health records %K patient portals %K Ministry of National Guard Health Affairs %K UTAUT %K eHealth %K Middle East %D 2021 %7 21.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Personal health records (PHRs) are eHealth tools designed to support patient engagement, patient empowerment, and patient- and person-centered care. Endorsement of a PHR by health care providers (HCPs) facilitates patient acceptance. As health care organizations in the Kingdom of Saudi Arabia begin to adopt PHRs, understanding the perspectives of HCPs is important because it can influence patient adoption. However, no studies evaluated HCPs’ acceptance of PHRs in the Kingdom of Saudi Arabia. Objective: The aim of this study was to identify predictors of HCPs’ acceptance of PHRs using behavioral intention to recommend as a proxy for adoption. Methods: This cross-sectional study was conducted among HCPs (physicians, pharmacists, nurses, technicians, others) utilizing a survey based on the Unified Theory of Acceptance and Use of Technology. The main theory constructs of performance expectancy, effort expectancy, social influence, facilitating conditions, and positive attitude were considered independent variables. Behavioral intention was the dependent variable. Age, years of experience, and professional role were tested as moderators between the main theory constructs and behavioral intention using partial least squares structural equation modeling. Results: Of the 291 participants, 246 were included in the final analysis. Behavioral intention to support PHR use among patients was significantly influenced by performance expectancy (β=.17, P=.03) and attitude (β=.61, P<.01). No moderating effects were present. Conclusions: This study identified performance expectancy and attitude as predictors of HCPs’ behavioral intention to recommend PHR to patients. To encourage HCPs to endorse PHRs, health care organizations should involve HCPs in the implementation and provide training on the features available as well as expected benefits. Future studies should be conducted in other contexts and include other potential predictors. %M 34569943 %R 10.2196/31582 %U https://www.jmir.org/2021/10/e31582 %U https://doi.org/10.2196/31582 %U http://www.ncbi.nlm.nih.gov/pubmed/34569943 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e19789 %T Willingness to Share Wearable Device Data for Research Among Mechanical Turk Workers: Web-Based Survey Study %A Taylor,Casey Overby %A Flaks-Manov,Natalie %A Ramesh,Shankar %A Choe,Eun Kyoung %+ Departments of Medicine and Biomedical Engineering, Johns Hopkins University School of Medicine, 217D Hackerman Hall, 3101 Wyman Park Dr, Baltimore, MD, 21218, United States, 1 4432876657, cot@jhu.edu %K wearables %K personal data %K research participation %K crowdsourcing %D 2021 %7 21.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Wearable devices that are used for observational research and clinical trials hold promise for collecting data from study participants in a convenient, scalable way that is more likely to reach a broad and diverse population than traditional research approaches. Amazon Mechanical Turk (MTurk) is a potential resource that researchers can use to recruit individuals into studies that use data from wearable devices. Objective: This study aimed to explore the characteristics of wearable device users on MTurk that are associated with a willingness to share wearable device data for research. We also aimed to determine whether compensation was a factor that influenced the willingness to share such data. Methods: This was a secondary analysis of a cross-sectional survey study of MTurk workers who use wearable devices for health monitoring. A 19-question web-based survey was administered from March 1 to April 5, 2018, to participants aged ≥18 years by using the MTurk platform. In order to identify characteristics that were associated with a willingness to share wearable device data, we performed logistic regression and decision tree analyses. Results:  A total of 935 MTurk workers who use wearable devices completed the survey. The majority of respondents indicated a willingness to share their wearable device data (615/935, 65.8%), and the majority of these respondents were willing to share their data if they received compensation (518/615, 84.2%). The findings from our logistic regression analyses indicated that Indian nationality (odds ratio [OR] 2.74, 95% CI 1.48-4.01, P=.007), higher annual income (OR 2.46, 95% CI 1.26-3.67, P=.02), over 6 months of using a wearable device (OR 1.75, 95% CI 1.21-2.29, P=.006), and the use of heartbeat and pulse tracking monitoring devices (OR 1.60, 95% CI 0.14-2.07, P=.01) are significant parameters that influence the willingness to share data. The only factor associated with a willingness to share data if compensation is provided was Indian nationality (OR 0.47, 95% CI 0.24-0.9, P=.02). The findings from our decision tree analyses indicated that the three leading parameters associated with a willingness to share data were the duration of wearable device use, nationality, and income. Conclusions: Most wearable device users indicated a willingness to share their data for research use (with or without compensation; 615/935, 65.8%). The probability of having a willingness to share these data was higher among individuals who had used a wearable for more than 6 months, were of Indian nationality, or were of American (United States of America) nationality and had an annual income of more than US $20,000. Individuals of Indian nationality who were willing to share their data expected compensation significantly less often than individuals of American nationality (P=.02). %M 34673528 %R 10.2196/19789 %U https://www.jmir.org/2021/10/e19789 %U https://doi.org/10.2196/19789 %U http://www.ncbi.nlm.nih.gov/pubmed/34673528 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e32542 %T Associations Between Online Pornography Consumption and Sexual Dysfunction in Young Men: Multivariate Analysis Based on an International Web-Based Survey %A Jacobs,Tim %A Geysemans,Björn %A Van Hal,Guido %A Glazemakers,Inge %A Fog-Poulsen,Kristian %A Vermandel,Alexandra %A De Wachter,Stefan %A De Win,Gunter %+ Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Antwerp, 2610, Belgium, 32 3 821 33 68, gunter.dewin@uza.be %K erectile dysfunction %K ED %K pornography %K pornography-induced erectile dysfunction %K PIED %K sexual health %K young adults %D 2021 %7 21.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Expanding access to the internet has resulted in more and earlier consumption of online pornography. At the same time, a higher prevalence of erectile dysfunction (ED) among young men is seen. Increased pornography consumption has been suggested as a possible explanation for this rise. Objective: The aim of this study was to better understand associations between problematic pornography consumption (PPC) and ED. Methods: A 118-item survey was published online, and data collection took place between April 2019 and May 2020. Of the 5770 men who responded, the responses from 3419 men between 18 years old and 35 years old were analyzed. The survey used validated questionnaires such as the Cyber Pornography Addiction Test (CYPAT), International Index of Erectile Function (IIEF-5), and Alcohol Use Disorders Identification Test-Concise (AUDIT-C). The estimated amount of porn watching was calculated. Univariable and multivariable analyses were performed. For the multivariable analysis, a logistic regression model using a directed acyclic graph was used. Results: According to their IIEF-5 scores, 21.48% (444/2067) of our sexually active participants (ie, those who attempted penetrative sex in the previous 4 weeks) had some degree of ED. Higher CYPAT scores indicating problematic online pornography consumption resulted in a higher probability of ED, while controlling for covariates. Masturbation frequency seemed not to be a significant factor when assessing ED. Conclusions: This prevalence of ED in young men is alarmingly high, and the results of this study suggest a significant association with PPC. Trial Registration: Research Registry researchregistry5111; https://tinyurl.com/m45mcaa2 %M 34534092 %R 10.2196/32542 %U https://publichealth.jmir.org/2021/10/e32542 %U https://doi.org/10.2196/32542 %U http://www.ncbi.nlm.nih.gov/pubmed/34534092 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e28071 %T Psychological Impact of the COVID-19 Pandemic and Social Determinants on the Portuguese Population: Protocol for a Web-Based Cross-sectional Study %A Aguiar,A %A Pinto,M %A Duarte,R %+ EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, Porto, 4050-600, Portugal, 351 222061820, ana.aguiar@ispup.up.pt %K COVID-19 %K public health %K mental health %K study protocol %K psychological impact %K anxiety %K depression %K grief %K behavior change %D 2021 %7 19.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 outbreak and consequent physical distance measures implemented worldwide have caused significant stress, anxiety, and mental health implications among the general population. Unemployment, working from home, and day-to-day changes may lead to a greater risk of poor mental health outcomes. Objective: This paper describes the protocol for a web-based cross-sectional study that aims to address the impact of the COVID-19 pandemic on mental health. Methods: Individuals from the general population aged 18 years or more and living in Portugal were included in this study. Data collection took place between November 10, 2020, and February 10, 2021. An exponential, nondiscriminative, snowball sampling method was applied to recruit participants. A web-based survey was developed and shared on social media platforms (eg, Facebook, Instagram, Twitter, LinkedIn, and WhatsApp groups) and through e-mail lists for recruitment of the seeds. Results: Data analysis will be performed in accordance with the different variables and outcomes of interest by using quantitative methods, qualitative methods, or mixed methods, as applicable. A total of 929 individuals had completed the web-based survey during the 3-month period; thus, our final sample comprised 929 participants. Results of the survey will be disseminated in national and international scientific journals in 2021-2022. Conclusions: We believe that the findings of this study will have broad implications for understanding the psychological impact of the COVID-19 pandemic on Portuguese residents, as well as aspects related to the informal economy. We also hope that the findings of this study are able to provide insights and guidelines for the Portuguese government to implement action. Finally, we expect this protocol to provide a roadmap for other countries and researchers that would like to implement a similar questionnaire considering the related conclusions. International Registered Report Identifier (IRRID): DERR1-10.2196/28071 %M 34516387 %R 10.2196/28071 %U https://www.researchprotocols.org/2021/10/e28071 %U https://doi.org/10.2196/28071 %U http://www.ncbi.nlm.nih.gov/pubmed/34516387 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e29764 %T Digital Health Literacy in Bipolar Disorder: International Web-Based Survey %A Morton,Emma %A Ho,Kendall %A Barnes,Steven J %A Michalak,Erin E %+ Department of Psychiatry, University of British Columbia, 420-5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada, 1 604 827 3393, erin.michalak@ubc.ca %K eHealth %K health literacy %K bipolar disorder %K self-management %D 2021 %7 19.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Web-based resources can support people with bipolar disorder (BD) to improve their knowledge and self-management. However, publicly available resources are heterogeneous in terms of their quality and ease of use. Characterizing digital health literacy (the skillset that enable people to navigate and make use of health information in a web-based context) in BD will support the development of educational resources. Objective: The aim of this study was to develop understanding of digital health literacy and its predictors in people with BD. Methods: A web-based survey was used to explore self-reported digital health literacy (as measured by the e-Health Literacy Scale [eHEALS]) in people with BD. Multiple regression analysis was used to evaluate potential predictors, including demographic/clinical characteristics and technology use. Results: A total of 919 respondents (77.9% female; mean age 36.9 years) completed the survey. Older age (β=0.09; P=.01), postgraduate education (β=0.11; P=.01), and current use of self-management apps related to BD (β=0.13; P<.001) were associated with higher eHEALS ratings. Conclusions: Levels of self-reported digital health literacy were comparable or higher than other studies in the general population and specific physical/mental health conditions. However, individuals with BD who are younger, have completed less education, or are less familiar with mental health apps may require extra support to safely and productively navigate web-based health resources. Relevant educational initiatives are discussed. Future studies should evaluate skill development interventions for less digitally literate groups. %M 34665143 %R 10.2196/29764 %U https://mental.jmir.org/2021/10/e29764 %U https://doi.org/10.2196/29764 %U http://www.ncbi.nlm.nih.gov/pubmed/34665143 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e19307 %T Examining the Trends in Online Health Information–Seeking Behavior About Chronic Obstructive Pulmonary Disease in Singapore: Analysis of Data From Google Trends and the Global Burden of Disease Study %A Fang,Yang %A Shepherd,Thomas A %A Smith,Helen E %+ Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Clinical Sciences Building, Singapore, 308232, Singapore, 65 6513 8572, fang.yang@ntu.edu.sg %K online health information seeking %K infodemiology %K Google Trends %K Global Burden of Disease study %K chronic obstructive pulmonary disease %K respiratory health %D 2021 %7 18.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally, and timely health care seeking is imperative for its prevention, early detection, and management. While online health information–seeking behavior (OHISB) is increasingly popular due to widespread internet connectivity, little is known about how OHISB for COPD has changed in comparison with the COPD disease burden, particularly at a country-specific level. Objective: This study aimed to examine the trends in OHISB for COPD and how that compared with the estimates of COPD disease burden in Singapore, a highly wired country with a steadily increasing COPD disease burden. Methods: To examine the trends in OHISB for COPD, we performed Prais-Winsten regression analyses on monthly search volume data for COPD from January 2004 to June 2020 downloaded from Google Trends. We then conducted cross-correlational analyses to examine the relationship between annualized search volume on COPD topics and estimates of COPD morbidity and mortality reported in the Global Burden of Disease study from 2004 to 2017. Results: From 2004 to 2020, the trend in COPD search volume was curvilinear (β=1.69, t194=6.64, P<.001), with a slope change around the end of 2006. There was a negative linear trend (β=–0.53, t33=–3.57, P=.001) from 2004 to 2006 and a positive linear trend (β=0.51, t159=7.43, P<.001) from 2007 to 2020. Cross-correlation analyses revealed positive associations between COPD search volume and COPD disease burden indicators: positive correlations between search volume and prevalence, incidence, years living with disability (YLD) at lag 0, and positive correlations between search volume and prevalence, YLD at lag 1. Conclusions: Google search volume on COPD increased from 2007 to 2020; this trend correlated with the upward trajectory of several COPD morbidity estimates, suggesting increasing engagement in OHISB for COPD in Singapore. These findings underscore the importance of making high-quality, web-based information accessible to the public, particularly COPD patients and their carers. %M 34661539 %R 10.2196/19307 %U https://www.jmir.org/2021/10/e19307 %U https://doi.org/10.2196/19307 %U http://www.ncbi.nlm.nih.gov/pubmed/34661539 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e29615 %T Validity and Reliability of the Self-administered Psycho-TherApy-SystemS (SELFPASS) Item Pool for the Daily Mood Tracking of Depressive Symptoms: Cross-sectional Web-Based Survey %A Mayer,Gwendolyn %A Hummel,Svenja %A Gronewold,Nadine %A Oetjen,Neele %A Hilbel,Thomas %A Schultz,Jobst-Hendrik %+ Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 130 3, Heidelberg, 69120, Germany, 49 6221 56 35685, gwendolyn.mayer@med.uni-heidelberg.de %K self-management %K mood tracking %K validity %K reliability %K item pool %K questionnaire %K depression %K anxiety %K mood assessment %D 2021 %7 18.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: e-Mental health apps targeting depression have gained increased attention in mental health care. Daily self-assessment is an essential part of e-mental health apps. The Self-administered Psycho-TherApy-SystemS (SELFPASS) app is a self-management app to manage depressive and comorbid anxiety symptoms of patients with a depression diagnosis. A self-developed item pool with 40 depression items and 12 anxiety items is included to provide symptom-specific suggestions for interventions. However, the psychometric properties of the item pool have not yet been evaluated. Objective: The aim of this study is to investigate the validity and reliability of the SELFPASS item pool. Methods: A weblink with the SELFPASS item pool and validated mood assessment scales was distributed to healthy subjects and patients who had received a diagnosis of a depressive disorder within the last year. Two scores were derived from the SELFPASS item pool: SELFPASS depression (SP-D) and SELFPASS anxiety (SP-A). Reliability was examined using Cronbach α. Construct validity was assessed through Pearson correlations with the Patient Health Questionnaire-9 (PHQ-9), the General Anxiety Disorder Scale-7 (GAD-7), and the WHO-5-Wellbeing-Scale (WHO-5). Logistic regression analysis was performed as an indicator for concurrent criterion validity of SP-D and SP-A. Factor analysis was performed to provide information about the underlying factor structure of the item pool. Item-scale correlations were calculated in order to determine item quality. Results: A total of 284 participants were included, with 192 (67.6%) healthy subjects and 92 (32.4%) patients. Cronbach α was set to .94 for SP-D and α=.88 for SP-A. We found significant positive correlations between SP-D and PHQ-9 scores (r=0.87; P<.001) and between SP-A and GAD-7 scores (r=0.80; P<.001), and negative correlations between SP-D and WHO-5 scores (r=–0.80; P<.001) and between SP-A and WHO-5 scores (r=–0.69; P<.001). Increasing scores of SP-D and SP-A led to increased odds of belonging to the patient group (SP-D: odds ratio 1.03, 95% CI 1.01-1.05; P<.001; SP-A: 1.05, 1.05-1.01; P=.01). The item pool yielded 2 factors: one that consisted of mood-related items and another with somatic-related items. Conclusions: The SELFPASS item pool showed good psychometric properties in terms of reliability, construct, and criterion validity. The item pool is an appropriate source for daily mood tracking in future e-mental health apps among patients with depression. Our study provides general recommendations for future developments as well as recommendations within the item pool. %M 34661547 %R 10.2196/29615 %U https://mental.jmir.org/2021/10/e29615 %U https://doi.org/10.2196/29615 %U http://www.ncbi.nlm.nih.gov/pubmed/34661547 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e29426 %T Passive Sensing of Preteens’ Smartphone Use: An Adolescent Brain Cognitive Development (ABCD) Cohort Substudy %A Wade,Natasha E %A Ortigara,Joseph M %A Sullivan,Ryan M %A Tomko,Rachel L %A Breslin,Florence J %A Baker,Fiona C %A Fuemmeler,Bernard F %A Delrahim Howlett,Katia %A Lisdahl,Krista M %A Marshall,Andrew T %A Mason,Michael J %A Neale,Michael C %A Squeglia,Lindsay M %A Wolff-Hughes,Dana L %A Tapert,Susan F %A Bagot,Kara S %A , %+ University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, United States, 1 (858) 280 6398, nwade@health.ucsd.edu %K preadolescents %K smartphone use %K passive sensing %K screen use %K screen time %K mobile phone %D 2021 %7 18.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Concerns abound regarding childhood smartphone use, but studies to date have largely relied on self-reported screen use. Self-reporting of screen use is known to be misreported by pediatric samples and their parents, limiting the accurate determination of the impact of screen use on social, emotional, and cognitive development. Thus, a more passive, objective measurement of smartphone screen use among children is needed. Objective: This study aims to passively sense smartphone screen use by time and types of apps used in a pilot sample of children and to assess the feasibility of passive sensing in a larger longitudinal sample. Methods: The Adolescent Brain Cognitive Development (ABCD) study used passive, objective phone app methods for assessing smartphone screen use over 4 weeks in 2019-2020 in a subsample of 67 participants (aged 11-12 years; 31/67, 46% female; 23/67, 34% White). Children and their parents both reported average smartphone screen use before and after the study period, and they completed a questionnaire regarding the acceptability of the study protocol. Descriptive statistics for smartphone screen use, app use, and protocol feasibility and acceptability were reviewed. Analyses of variance were run to assess differences in categorical app use by demographics. Self-report and parent report were correlated with passive sensing data. Results: Self-report of smartphone screen use was partly consistent with objective measurement (r=0.49), although objective data indicated that children used their phones more than they reported. Passive sensing revealed the most common types of apps used were for streaming (mean 1 hour 57 minutes per day, SD 1 hour 32 minutes), communication (mean 48 minutes per day, SD 1 hour 17 minutes), gaming (mean 41 minutes per day, SD 41 minutes), and social media (mean 36 minutes per day, SD 1 hour 7 minutes). Passive sensing of smartphone screen use was generally acceptable to children (43/62, 69%) and parents (53/62, 85%). Conclusions: The results of passive, objective sensing suggest that children use their phones more than they self-report. Therefore, use of more robust methods for objective data collection is necessary and feasible in pediatric samples. These data may then more accurately reflect the impact of smartphone screen use on behavioral and emotional functioning. Accordingly, the ABCD study is implementing a passive sensing protocol in the full ABCD cohort. Taken together, passive assessment with a phone app provided objective, low-burden, novel, informative data about preteen smartphone screen use. %M 34661541 %R 10.2196/29426 %U https://mental.jmir.org/2021/10/e29426 %U https://doi.org/10.2196/29426 %U http://www.ncbi.nlm.nih.gov/pubmed/34661541 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e22199 %T Acceptance and Use of Telepsychology From the Clients’ Perspective: Questionnaire Study to Document Perceived Advantages and Barriers %A Sora,Beatriz %A Nieto,Rubén %A Montesano del Campo,Adrian %A Armayones,Manuel %+ Department of Psychology, Rovira i Virgili University, Campus Sescelades. Carretera Valls, s/n, Tarragona, 43007, Spain, 34 977558097 ext 8097, beatriz.sora@urv.cat %K telepsychology %K telepsychology advantages %K telepsychology barriers %K telepsychology use %K telepsychology usefulness %K intention to use telepsychology %D 2021 %7 15.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Telepsychology is increasingly being incorporated in clinical practice, being offered in many psychotherapy centers, especially after the impact of the pandemic. However, there seems to be a remarkable discrepancy between the offer, or interest in, and real-world uptake of e-mental health interventions among the population. A critical precondition is clients’ willingness to accept and use telepsychology, although this issue has thus far been overlooked in research. Objective: The aim of this study was to examine people’s acceptance and use of telepsychology by adopting an extended model of the unified theory of acceptance and use of technology (UTAUT) that integrates perceived telepsychology advantages and barriers, usefulness perceptions, behavioral intention, and telepsychology use. Methods: An online survey was conducted with a convenience sample of 514 participants. Structural equation models were computed to test a mediation model. Results: Results supported the UTAUT model to explain participants’ acceptance and use of telepsychology. They showed a causal chain in which perceived telepsychology advantages and barriers were related to telepsychology use through the perceived usefulness of and intention to use telepsychology. Conclusions: Telepsychology use may be explained according to the UTAUT model when coupled with participants’ perceptions of telepsychology advantages and barriers. Mental health stakeholders could consider these factors in order to increase the acceptance and use of telepsychology. %M 34652276 %R 10.2196/22199 %U https://mental.jmir.org/2021/10/e22199 %U https://doi.org/10.2196/22199 %U http://www.ncbi.nlm.nih.gov/pubmed/34652276 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e27723 %T National-Level Disparities in Internet Access Among Low-Income and Black and Hispanic Youth: Current Population Survey %A Dolcini,M Margaret %A Canchola,Jesse A %A Catania,Joseph A %A Song Mayeda,Marissa M %A Dietz,Erin L %A Cotto-Negrón,Coral %A Narayanan,Vasudha %+ Hallie Ford Center for Healthy Children and Families, College of Public Health and Human Sciences, Oregon State University, 2631 SW Campus Way, Corvallis, OR, 97331, United States, 1 541 737 3829, Peggy.Dolcini@oregonstate.edu %K internet access %K smartphone use %K Black youth %K Hispanic youth %K low-income youth %K disparities %K mobile phone %D 2021 %7 12.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet access is increasingly critical for adolescents with regard to obtaining health information and resources, participating in web-based health promotion, and communicating with health practitioners. However, past work demonstrates that access is not uniform among youth in the United States, with lower access found among groups with higher health-related needs. Population-level data yield important insights about access and internet use in the United States. Objective: The aim of this study is to examine internet access and mode of access by social class and race and ethnicity among youth (aged 14-17 years) in the United States. Methods: Using the Current Population Survey, we examined internet access, cell phone or smartphone access, and modes of connecting to the internet for adolescents in 2015 (unweighted N=6950; expanded weights N=17,103,547) and 2017 (unweighted N=6761; expanded weights N=17,379,728). Results: Internet access increased from 2015 to 2017, but socioeconomic status (SES) and racial and ethnic disparities remained. In 2017, the greatest disparities were found for youth in low-income households (no home access=23%) and for Black youth (no home access=18%) and Hispanic youth (no home access=14%). Low-income Black and Hispanic youth were the most likely to lack home internet access (no home access, low SES Black youth=29%; low SES Hispanic youth=21%). The mode of access (eg, from home and smartphone) and smartphone-only analyses also revealed disparities. Conclusions: Without internet access, web-based dissemination of information, health promotion, and health care will not reach a significant segment of youth. Currently, SES and racial and ethnic disparities in access prolong health inequalities. Moreover, the economic impact of COVID-19 on Black, Hispanic, and low-income communities may lead to losses in internet access for youth that will further exacerbate disparities. %M 34636728 %R 10.2196/27723 %U https://www.jmir.org/2021/10/e27723 %U https://doi.org/10.2196/27723 %U http://www.ncbi.nlm.nih.gov/pubmed/34636728 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e29963 %T Attitudes About COVID-19 and Health (ATTACH): Online Survey and Mixed Methods Study %A Hood,Anna M %A Stotesbury,Hanne %A Murphy,Jennifer %A Kölbel,Melanie %A Slee,April %A Springall,Charlie %A Paradis,Matthew %A Corral-Frías,Nadia Saraí %A Reyes-Aguilar,Azalea %A Cuellar Barboza,Alfredo B %A Noser,Amy E %A Gomes,Stacey %A Mitchell,Monica %A Watkins,Sharon M %A Butsch Kovacic,Melinda %A Kirkham,Fenella J %A Crosby,Lori E %+ Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom, 44 02079052744, a.hood@ucl.ac.uk %K COVID-19 %K mental health %K international %K mitigation strategies %K deprivation %D 2021 %7 7.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Behavioral mitigation strategies to slow the spread of COVID-19 have resulted in sweeping lifestyle changes, with short- and long-term psychological, well-being, and quality of life implications. The Attitudes About COVID-19 and Health (ATTACH) study focuses on understanding attitudes and beliefs while considering the impact on mental and physical health and the influence of broader demographic and geographic factors on attitudes, beliefs, and mental health burden. Objective: In this assessment of our first wave of data collection, we provide baseline cohort description of the ATTACH study participants in the United Kingdom, the United States, and Mexico. Additionally, we assess responses to daily poll questions related to COVID-19 and conduct a cross-sectional analysis of baseline assessments collected in the UK between June 26 and October 31, 2020. Methods: The ATTACH study uses smartphone app technology and online survey data collection. Participants completed poll questions related to COVID-19 2 times daily and a monthly survey assessing mental health, social isolation, physical health, and quality of life. Poll question responses were graphed using 95% Clopper–Pearson (exact) tests with 95% CIs. Pearson correlations, hierarchical linear regression analyses, and generalized linear models assessed relationships, predictors of self-reported outcomes, and group differences, respectively. Results: By October 31, 2020, 1405, 80, and 90 participants had consented to participate in the UK, United States, and Mexico, respectively. Descriptive data for the UK daily poll questions indicated that participants generally followed social distancing measures, but worry and negative impacts on families increased as the pandemic progressed. Although participants generally reported feeling that the reasons for current measures had been made clear, there was low trust that the government was doing everything in its power to meet public needs. In the UK, 1282 participants also completed a monthly survey (94.99% [1326/1396] White, 72.22% [1014/1404] female, and 20.12% [277/1377] key or essential workers); 18.88% (242/1282) of UK participants reported a preexisting mental health disorder, 31.36% (402/1282) reported a preexisting chronic medical illness, and 35.11% (493/1404) were aged over 65; 57.72% (740/1282) of participants reported being more sedentary since the pandemic began, and 41.89% (537/1282) reported reduced access to medical care. Those with poorer mental health outcomes lived in more deprived neighborhoods, in larger households (Ps<.05), had more preexisting mental health disorders and medical conditions, and were younger than 65 years (all Ps<.001). Conclusions: Communities who have been exposed to additional harm during the COVID-19 pandemic were experiencing worse mental outcomes. Factors including having a medical condition, or living in a deprived neighborhood or larger household were associated with heightened risk. Future longitudinal studies should investigate the link between COVID-19 exposure, mental health, and sociodemographic and residential characteristics. %M 34357877 %R 10.2196/29963 %U https://mental.jmir.org/2021/10/e29963 %U https://doi.org/10.2196/29963 %U http://www.ncbi.nlm.nih.gov/pubmed/34357877 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29558 %T Multiple Sclerosis Progression Discussion Tool Usability and Usefulness in Clinical Practice: Cross-sectional, Web-Based Survey %A Ziemssen,Tjalf %A Giovannoni,Gavin %A Alvarez,Enrique %A Bhan,Virender %A Hersh,Carrie %A Hoffmann,Olaf %A Oreja-Guevara,Celia %A Robles-Cedeño,Rene R %A Trojano,Maria %A Vermersch,Patrick %A Dobay,Pamela %A Khwaja,Mudeer %A Stadler,Bianca %A Rauser,Benedict %A Hach,Thomas %A Piani-Meier,Daniela %A Burton,Jason %+ Center of Clinical Neuroscience, Neurological University Clinic Carl-Gustav Carus, Dresden University of Technology, Helmholtzstr. 10, Dresden, 01069, Germany, 49 3514584465, Ziemssen@web.de %K multiple sclerosis %K relapsing remitting multiple sclerosis %K secondary progressive multiple sclerosis %K transition %K progression %K digital %K usability %D 2021 %7 6.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: A digital tool, Multiple Sclerosis Progression Discussion Tool (MSProDiscuss), was developed to facilitate discussions between health care professionals (HCPs) and patients in evaluating early, subtle signs of multiple sclerosis (MS) disease progression. Objective: The aim of this study is to report the findings on the usability and usefulness of MSProDiscuss in a real-world clinical setting. Methods: In this cross-sectional, web-based survey, HCPs across 34 countries completed an initial individual questionnaire (comprising 7 questions on comprehensibility, usability, and usefulness after using MSProDiscuss during each patient consultation) and a final questionnaire (comprising 13 questions on comprehensibility, usability, usefulness, and integration and adoption into clinical practice to capture the HCPs’ overall experience of using the tool). The responses were provided on a 5-point Likert scale. All analyses were descriptive, and no statistical comparisons were made. Results: In total, 301 HCPs tested the tool in 6974 people with MS, of whom 77% (5370/6974) had relapsing-remitting MS, including those suspected to be transitioning to secondary progressive MS. The time taken to complete MSProDiscuss was reported to be in the range of 1 to 4 minutes in 97.3% (6786/6974; initial) to 98.2% (269/274; final) of the cases. In 93.54% (6524/6974; initial) to 97.1% (266/274; final) of the cases, the HCPs agreed (4 or 5 on the Likert scale) that patients were able to comprehend the questions in the tool. The HCPs were willing to use the tool again in the same patient, 90.47% (6310/6974; initial) of the cases. The HCPs reported MSProDiscuss to be useful in discussing MS symptoms and their impact on daily activities (6121/6974, 87.76% initial and 252/274, 92% final) and cognitive function (5482/6974, 78.61% initial and 271/274, 79.2% final), as well as in discussing progression in general (6102/6974, 87.49% initial and 246/274, 89.8% final). While completing the final questionnaire, 94.9% (260/274) of the HCPs agreed that the questions were similar to those asked in regular consultation, and the tool helped to better understand the impact of MS symptoms on daily activities (249/274, 90.9%) and cognitive function (220/274, 80.3%). Overall, 92% (252/274) of the HCPs reported that they would recommend MSProDiscuss to a colleague, and 85.8% (235/274) were willing to integrate it into their clinical practice. Conclusions: MSProDiscuss is a usable and useful tool to facilitate a physician-patient discussion on MS disease progression in daily clinical practice. Most of the HCPs agreed that the tool is easy to use and were willing to integrate MSProDiscuss into their daily clinical practice. %M 34612826 %R 10.2196/29558 %U https://www.jmir.org/2021/10/e29558 %U https://doi.org/10.2196/29558 %U http://www.ncbi.nlm.nih.gov/pubmed/34612826 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e24200 %T Sharing Government Health Data With the Private Sector: Community Attitudes Survey %A Braunack-Mayer,Annette %A Fabrianesi,Belinda %A Street,Jackie %A O'Shaughnessy,Pauline %A Carter,Stacy M %A Engelen,Lina %A Carolan,Lucy %A Bosward,Rebecca %A Roder,David %A Sproston,Kylie %+ Australian Centre for Health Engagement, Evidence and Values, School of Health and Society, University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia, 61 2 4298 1228, abmayer@uow.edu.au %K big data %K health information systems %K health data %K private sector %K data linkage %K public opinion %K consent %K trust %K public interest %K social license %D 2021 %7 1.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of government health data for secondary purposes, such as monitoring the quality of hospital services, researching the health needs of populations, and testing how well new treatments work, is increasing. This increase in the secondary uses of health data has led to increased interest in what the public thinks about data sharing, in particular, the possibilities of sharing with the private sector for research and development. Although international evidence demonstrates broad public support for the secondary use of health data, this support does not extend to sharing health data with the private sector. If governments intend to share health data with the private sector, knowing what the public thinks will be important. This paper reports a national survey to explore public attitudes in Australia toward sharing health data with private companies for research on and development of therapeutic drugs and medical devices. Objective: This study aims to explore public attitudes in Australia toward sharing government health data with the private sector. Methods: A web-based survey tool was developed to assess attitudes about sharing government health data with the private sector. A market research company was employed to administer the web-based survey in June 2019. Results: The survey was completed by 2537 individuals residing in Australia. Between 51.8% and 57.98% of all participants were willing to share their data, with slightly fewer in favor of sharing to improve health services (51.99%) and a slightly higher proportion in favor of sharing for research and development (57.98%). There was a preference for opt-in consent (53.44%) and broad support for placing conditions on sharing health information with private companies (62% to 91.99%). Wide variability was also observed in participants’ views about the extent to which the private sector could be trusted and how well they would behave if entrusted with people’s health information. In their qualitative responses, the participants noted concerns about private sector corporate interests, corruption, and profit making and expressed doubt about the Australian government’s capacity to manage data sharing safely. The percentages presented are adjusted against the Australian population. Conclusions: This nationally representative survey provides preliminary evidence that Australians are uncertain about sharing their health data with the private sector. Although just over half of all the respondents supported sharing health data with the private sector, there was also strong support for strict conditions on sharing data and for opt-in consent and significant concerns about how well the private sector would manage government health data. Addressing public concern about sharing government health data with the private sector will require more and better engagement to build community understanding about how agencies can collect, share, protect, and use their personal data. %M 34596573 %R 10.2196/24200 %U https://www.jmir.org/2021/10/e24200 %U https://doi.org/10.2196/24200 %U http://www.ncbi.nlm.nih.gov/pubmed/34596573 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e24005 %T Evaluation of the Acceptability of a Proposed, Instagram-Based, Randomized Controlled Trial for People With Asthma: Survey Study %A Spitzer,Kerry A %A Heineman,Brent %A Jewell,Marcella %A Moran,Michael %A Lindenauer,Peter K %+ Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, 3rd Fl, 3601 Main St, Springfield, MA, 01199, United States, 1 413 794 7909, kerry.spitzer@baystatehealth.org %K asthma %K social media %K Instagram %K social support %K digital storytelling %K young adult %D 2021 %7 30.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Asthma is a chronic lung disease that affects nearly 25 million individuals in the United States. More research is needed into the potential for health care providers to leverage existing social media platforms to improve healthy behaviors and support individuals living with chronic health conditions. Objective: In this study, we assessed the willingness of Instagram users with poorly controlled asthma to participate in a pilot randomized controlled trial that will use Instagram as a means of providing social and informational support. In addition, we explored the potential for adapting the principles of photovoice and digital storytelling to Instagram. Methods: We conducted a survey study of Instagram users aged 18-40 years with poorly controlled asthma in the United States. Results: Over 3 weeks of recruitment, 457 individuals completed the presurvey screener; 347 (75.9%) were excluded and 110 (24.1%) were eligible and agreed to participate in the study. Of the 110 individuals, 82 (74.5%) completed the study survey. The mean age of the respondents was 21 (SD 5.3) years. Among respondents, 56% (46/82) were female, 65% (53/82) were non-Hispanic White, and 72% (59/82) had at least some college education. The majority of respondents (67/82, 82%) indicated that they would be willing to participate in the proposed study. Conclusions: Among young adult Instagram users with asthma, there is substantial interest in participating in a pilot randomized controlled trial that will use Instagram to connect participants with peers and a health coach to share information about self-management of asthma and build social connection. %M 34591019 %R 10.2196/24005 %U https://formative.jmir.org/2021/9/e24005 %U https://doi.org/10.2196/24005 %U http://www.ncbi.nlm.nih.gov/pubmed/34591019 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27741 %T Emotional Analysis of Twitter Posts During the First Phase of the COVID-19 Pandemic in Greece: Infoveillance Study %A Geronikolou,Styliani %A Drosatos,George %A Chrousos,George %+ Biomedical Research Foundation of the Academy of Athens, Soranou Ephessiou 4, Athens, 11527, Greece, 30 2106597403, sgeronik@gmail.com %K emotional analysis %K COVID-19 %K Twitter %K Greece %K infodemics %K emotional contagion %K epidemiology %K pandemic %K mental health %D 2021 %7 29.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The effectiveness of public health measures depends upon a community’s compliance as well as on its positive or negative emotions. Objective: The purpose of this study was to perform an analysis of the expressed emotions in English tweets by Greek Twitter users during the first phase of the COVID-19 pandemic in Greece. Methods: The period of this study was from January 25, 2020 to June 30, 2020. Data collection was performed by using appropriate search words with the filter-streaming application programming interface of Twitter. The emotional analysis of the tweets that satisfied the inclusion criteria was achieved using a deep learning approach that performs better by utilizing recurrent neural networks on sequences of characters. Emotional epidemiology tools such as the 6 basic emotions, that is, joy, sadness, disgust, fear, surprise, and anger based on the Paul Ekman classification were adopted. Results: The most frequent emotion that was detected in the tweets was “surprise” at the emerging contagion, while the imposed isolation resulted mostly in “anger” (odds ratio 2.108, 95% CI 0.986-4.506). Although the Greeks felt rather safe during the first phase of the COVID-19 pandemic, their positive and negative emotions reflected a masked “flight or fight” or “fear versus anger” response to the contagion. Conclusions: The findings of our study show that emotional analysis emerges as a valid tool for epidemiology evaluations, design, and public health strategy and surveillance. %M 34469328 %R 10.2196/27741 %U https://formative.jmir.org/2021/9/e27741 %U https://doi.org/10.2196/27741 %U http://www.ncbi.nlm.nih.gov/pubmed/34469328 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e23237 %T Introducing an Integrated Model of Adults’ Wearable Activity Tracker Use and Obesity Information–Seeking Behaviors From a National Quota Sample Survey %A Kim,Bokyung %A Hong,Seoyeon %A Kim,Sungwook %+ Department of Public Relations & Advertising, Ric Edelman College of Communication & Creative Arts, Rowan University, 301 High St, Room 322, Glassboro, NJ, 08028, United States, 1 8562564293, kimb@rowan.edu %K wearable activity tracker %K wearable health technology %K obesity %K health belief %K health belief model %K Technology Acceptance Model %K online information seeking %D 2021 %7 29.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Research from multiple perspectives to investigate adults’ use of wearable activity-tracking devices is limited. We offer a multiperspective model and provide empirical evidence of what leads to frequent usage of wearable health technologies from a large, nationally representative survey sample. Objective: This study aims to explore factors affecting the use of wearable activity-tracking devices among health consumers from the perspectives of individual health beliefs (perceived severity, perceived susceptibility, perceived benefits, and self-efficacy) and information-seeking behaviors. Methods: Our Integrated Model of Wearable Activity Tracker (IMWAT) use and proposed hypotheses were validated and tested with data collected from a telephone survey with a national quota sample. The data were analyzed using a variety of statistical techniques, including structural equation analysis. Results: The sample comprised 2006 participants. Our results showed that the perceived benefits of physical activity, perceived susceptibility, and self-efficacy toward obesity were significant predictors of information-seeking behaviors, which, in turn, mediated their effects on the use of wearable activity trackers. Perceptions of obesity severity directly promoted wearable device usage. Conclusions: This study provided a new and powerful theoretical model that combined the health beliefs and information-seeking behaviors behind the use of wearable activity trackers in the adult population. The findings provide meaningful implications for developers and designers of wearable health technology products and will assist health informatics practitioners and obesity prevention communicators. %M 34586076 %R 10.2196/23237 %U https://formative.jmir.org/2021/9/e23237 %U https://doi.org/10.2196/23237 %U http://www.ncbi.nlm.nih.gov/pubmed/34586076 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e31421 %T Patterns of Missing Data With Ecological Momentary Assessment Among People Who Use Drugs: Feasibility Study Using Pilot Study Data %A Markowski,Kelly L %A Smith,Jeffrey A %A Gauthier,G Robin %A Harcey,Sela R %+ Rural Drug Addiction Research Center, University of Nebraska-Lincoln, 660 N 12th St, Lincoln, NE, 68508, United States, 1 8153536605, kmarkowski2@unl.edu %K EMA %K ecological momentary assessment %K PWUD %K people who use drugs %K noncompliance %K missing data %K mobile phone %D 2021 %7 24.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Ecological momentary assessment (EMA) is a set of research methods that capture events, feelings, and behaviors as they unfold in their real-world setting. Capturing data in the moment reduces important sources of measurement error but also generates challenges for noncompliance (ie, missing data). To date, EMA research has only examined the overall rates of noncompliance. Objective: In this study, we identify four types of noncompliance among people who use drugs and aim to examine the factors associated with the most common types. Methods: Data were obtained from a recent pilot study of 28 Nebraskan people who use drugs who answered EMA questions for 2 weeks. We examined questions that were not answered because they were skipped, they expired, the phone was switched off, or the phone died after receiving them. Results: We found that the phone being switched off and questions expiring comprised 93.34% (1739/1863 missing question-instances) of our missing data. Generalized structural equation model results show that participant-level factors, including age (relative risk ratio [RRR]=0.93; P=.005), gender (RRR=0.08; P=.006), homelessness (RRR=3.80; P=.04), personal device ownership (RRR=0.14; P=.008), and network size (RRR=0.57; P=.001), are important for predicting off missingness, whereas only question-level factors, including time of day (ie, morning compared with afternoon, RRR=0.55; P<.001) and day of week (ie, Tuesday-Saturday compared with Sunday, RRR=0.70, P=.02; RRR=0.64, P=.005; RRR=0.58, P=.001; RRR=0.55, P<.001; and RRR=0.66, P=.008, respectively) are important for predicting expired missingness. The week of study is important for both (ie, week 2 compared with week 1, RRR=1.21, P=.03, for off missingness and RRR=1.98, P<.001, for expired missingness). Conclusions: We suggest a three-pronged strategy to preempt missing EMA data with high-risk populations: first, provide additional resources for participants likely to experience phone charging problems (eg, people experiencing homelessness); second, ask questions when participants are not likely to experience competing demands (eg, morning); and third, incentivize continued compliance as the study progresses. Attending to these issues can help researchers ensure maximal data quality. %M 34464327 %R 10.2196/31421 %U https://formative.jmir.org/2021/9/e31421 %U https://doi.org/10.2196/31421 %U http://www.ncbi.nlm.nih.gov/pubmed/34464327 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 3 %P e28501 %T Examining How Internet Users Trust and Access Electronic Health Record Patient Portals: Survey Study %A Yin,Rong %A Law,Katherine %A Neyens,David %+ Department of Industrial Engineering, Clemson University, 100 Freeman Hall, Clemson, SC, United States, 1 8646564719, dneyens@clemson.edu %K internet %K consumer health informatics %K patient portal %K participatory medicine %K electronic health records %K logistic model %K surveys %K questionnaires %D 2021 %7 21.9.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Electronic health record (EHR) patient portals are designed to provide medical health records to patients. Using an EHR portal is expected to contribute to positive health outcomes and facilitate patient-provider communication. Objective: Our objective was to examine how portal users report using their portals and the factors associated with obtaining health information from the internet. We also examined the desired portal features, factors impacting users’ trust in portals, and barriers to using portals. Methods: An internet-based survey study was conducted using Amazon Mechanical Turk. All the participants were adults in the United States who used patient portals. The survey included questions about how the participants used their portals, what factors acted as barriers to using their portals, and how they used and how much they trusted other web-based health information sources as well as their portals. A logistic regression model was used to examine the factors influencing the participants’ trust in their portals. Additionally, the desired features and design characteristics were identified to support the design of future portals. Results: A total of 394 participants completed the survey. Most of the participants were less than 35 years old (212/394, 53.8%), with 36.3% (143/394) aged between 35 and 55 years, and 9.9% (39/394) aged above 55 years. Women accounted for 48.5% (191/394) of the survey participants. More than 78% (307/394) of the participants reported using portals at least monthly. The most common portal features used were viewing lab results, making appointments, and paying bills. Participants reported some barriers to portal use including data security and limited access to the internet. The results of a logistic regression model used to predict the trust in their portals suggest that those comfortable using their portals (odds ratio [OR] 7.97, 95% CI 1.11-57.32) thought that their portals were easy to use (OR 7.4, 95% CI 1.12-48.84), and frequent internet users (OR 43.72, 95% CI 1.83-1046.43) were more likely to trust their portals. Participants reporting that the portals were important in managing their health (OR 28.13, 95% CI 5.31-148.85) and that their portals were a valuable part of their health care (OR 6.75, 95% CI 1.51-30.11) were also more likely to trust their portals. Conclusions: There are several factors that impact the trust of EHR patient portal users in their portals. Designing easily usable portals and considering these factors may be the most effective approach to improving trust in patient portals. The desired features and usability of portals are critical factors that contribute to users’ trust in EHR portals. %M 34546182 %R 10.2196/28501 %U https://humanfactors.jmir.org/2021/3/e28501 %U https://doi.org/10.2196/28501 %U http://www.ncbi.nlm.nih.gov/pubmed/34546182 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e31052 %T Associations Between the Perceived Severity of the COVID-19 Pandemic, Cyberchondria, Depression, Anxiety, Stress, and Lockdown Experience: Cross-sectional Survey Study %A Han,Lei %A Zhan,Yanru %A Li,Weizi %A Xu,Yuqing %A Xu,Yan %A Zhao,Jinzhe %+ Faculty of Psychology, Beijing Normal University, 19 Xinjiekouwai Street Haidian District, Beijing, 100875, China, 86 19800356013, sszbjz@163.com %K COVID-19 %K cyberchondria %K depression %K anxiety %K stress %K ABC theory of emotions %K lockdown experience %K perceived severity %K cross-sectional %K online health information %D 2021 %7 16.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The outbreak of the COVID-19 pandemic has caused great panic among the public, with many people suffering from adverse stress reactions. To control the spread of the pandemic, governments in many countries have imposed lockdown policies. In this unique pandemic context, people can obtain information about pandemic dynamics on the internet. However, searching for health-related information on the internet frequently increases the possibility of individuals being troubled by the information that they find, and consequently, experiencing symptoms of cyberchondria. Objective: We aimed to examine the relationships between people’s perceived severity of the COVID-19 pandemic and their depression, anxiety, and stress to explore the role of cyberchondria, which, in these relationship mechanisms, is closely related to using the internet. In addition, we also examined the moderating role of lockdown experiences. Methods: In February 2020, a total of 486 participants were recruited through a web-based platform from areas in China with a large number of infections. We used questionnaires to measure participants’ perceived severity of the COVID-19 pandemic, to measure the severity of their cyberchondria, depression, anxiety, and stress symptoms, and to assess their lockdown experiences. Confirmatory factor analysis, exploratory factor analysis, common method bias, descriptive statistical analysis, and correlation analysis were performed, and moderated mediation models were examined. Results: There was a positive association between perceived severity of the COVID-19 pandemic and depression (β=0.36, t=8.51, P<.001), anxiety (β=0.41, t=9.84, P<.001), and stress (β=0.46, t=11.45, P<.001), which were mediated by cyberchondria (β=0.36, t=8.59, P<.001). The direct effects of perceived severity of the COVID-19 pandemic on anxiety (β=0.07, t=2.01, P=.045) and stress (β=0.09, t=2.75, P=.006) and the indirect effects of cyberchondria on depression (β=0.10, t=2.59, P=.009) and anxiety (β=0.10, t=2.50, P=.01) were moderated by lockdown experience. Conclusions: The higher the perceived severity of the COVID-19 pandemic, the more serious individuals’ symptoms of depression, anxiety, and stress. In addition, the associations were partially mediated by cyberchondria. Individuals with higher perceived severity of the COVID-19 pandemic were more likely to develop cyberchondria, which aggravated individuals’ depression, anxiety, and stress symptoms. Negative lockdown experiences exacerbated the COVID-19 pandemic’s impact on mental health. %M 34478402 %R 10.2196/31052 %U https://publichealth.jmir.org/2021/9/e31052 %U https://doi.org/10.2196/31052 %U http://www.ncbi.nlm.nih.gov/pubmed/34478402 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26207 %T Young Sexual Minority Adolescent Experiences of Self-expression and Isolation on Social Media: Cross-sectional Survey Study %A Charmaraman,Linda %A Hodes,Rachel %A Richer,Amanda M %+ Wellesley Centers for Women, Wellesley College, 106 Central Street, Wellesley, MA, 02481, United States, 1 7812832542, lcharmar@wellesley.edu %K social media %K social networking sites %K sexual minorities %K cyberbullying %K depression %K loneliness %K self-harm %K social support %K adolescents %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Early adolescent years are marked by pervasive self- and peer-regulation regarding gender and sexuality norms, which can affect the mental well-being of sexual minority youth. During this developmental period, social media use is also emerging as a dominant mode of communication with peers, allowing for both risk and resilient behaviors that can impact well-being. Objective: This exploratory study aims to examine how sexual minorities in middle school use social media, who they are connected to and for what purposes, and the associations between these behaviors and mental well-being compared with their heterosexual peers. Methods: In our cross-sectional survey study of 1033 early adolescents aged between 10 and 16 years (average age 12.7, SD 1.21 years) from 4 middle school sites in the Northeastern United States, we conducted an exploratory study comparing sexual minorities (212/873, 24.3% of sample with known sexual orientation) with their heterosexual peers (n=661), obtaining an 84.46% (1033/1223; total possible) response rate. Results: Sexual minorities reported having smaller networks on their favorite social media website (β=−.57; P<.001), less often responded positively when friends shared good news (β=−.35; P=.002), and less often tried to make friends feel better when they shared bad news (β=−.30; P=.01). However, sexual minorities more often reported joining a group or web-based community to make themselves feel less alone (β=.28; P=.003), unlike heterosexual youth. Sexual minorities had higher averages of loneliness and social isolation (β=.19; P<.001) than heterosexual students. Sexual minorities were also twice as likely to have tried to harm themselves in the past (β=.81; odds ratio [OR] 2.24, 95% CI 1.64-3.06; P<.001) and were more likely to have symptoms that reached the Center for Epidemiological Studies-Depression definition of depression (β=.15; OR 1.16, 95% CI 1.08-1.25; P<.001). About 39.1% (83/212) of sexual minorities had no one to talk to about their sexual orientation. Sexual minorities were 1.5 times more likely to have joined a social media website their parents would disapprove (β=.41; OR 1.50, 95% CI 1.14-1.97; P=.004) and more likely to report seeing videos related to self-harm (β=.33; OR 1.39, 95% CI 1.06-1.83; P=.02) on the web than heterosexual youth. Conclusions: Given previous reports of supportive and safe web-based spaces for sexual minority youth, our findings demonstrated that sexual minority youth prefer to maintain small, close-knit web-based communities (apart from their families) to express themselves, particularly when reaching out to web-based communities to reduce loneliness. Future longitudinal studies could determine any bidirectional influences of mental well-being and social media use in sexual minorities during this difficult developmental period. %M 34524107 %R 10.2196/26207 %U https://mental.jmir.org/2021/9/e26207 %U https://doi.org/10.2196/26207 %U http://www.ncbi.nlm.nih.gov/pubmed/34524107 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 3 %P e28989 %T A Sociodemographic Profile of Mask Use During the COVID-19 Outbreak Among Young and Elderly Individuals in Brazil: Online Survey Study %A Vancini,Rodrigo L %A Camargo-Neto,Luiz %A Andrade,Marilia S %A de Lira,Claudio A %A dos Santos,Rafaela G %A Nikolaidis,Pantelis T %A Knechtle,Beat %A Piacezzi,Luiz HV %A Teixeira-Lopes,Maria CB %A Assayag-Batista,Ruth E %A Pinto-Okuno,Meiry F %A Vancini-Campanharo,Cássia R %+ Institute of Primary Care, University of Zurich, Pestalozzistrasse 24, Zürich, 8091, Switzerland, 41 44 255 98 55, beat.knechtle@hispeed.ch %K aging %K older adults %K COVID-19 %K pandemic %K sociodemographic profile %K face mask %K social media %K online media %K adolescents %D 2021 %7 14.9.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Sociodemographic variables may impact decision making regarding safety measures. The use and selection of adequate face masks is a safety and health measure that could help minimize the spread of COVID-19 infection. Objective: This study aims to examine sociodemographic variables and factors relating to COVID-19 that could impact decision making or the choice to use or not use face masks in the prevention and care of a possible COVID-19 infection among a large sample of younger and older Brazilian people. Methods: An online survey composed of 14 closed-ended questions about sociodemographic variables and COVID-19 was used. A total of 2673 participants consisted of Brazilian people (aged ≥18 years) from different states of Brazil and were grouped according to age (≤59 years and ≥60 years). To compare the variables of interest (associated with wearing a face mask or not), chi-square and likelihood ratio tests were used (with P<.05 being significant). Results: Most of the participants in both groups were women from the southeast region who had postgraduate degrees. Approximately 61% (1452/2378) of individuals aged ≤59 years and 67.8% (200/295) of those aged ≥60 years were not health professionals. In the group aged ≤59 years, 83.4% (1983/2378) did not show COVID-19 signs and symptoms, and 97.3% (2314/2378) were not diagnosed with COVID-19. In the older adult group, 92.5% (273/295) did not show signs and symptoms of COVID-19, and 98.3% (290/295) were not diagnosed with the disease. The majority of the participants in both groups reported using face masks, and their decision to use face masks was influenced by the level of education and their occupation as a health professional. Conclusions: Younger and older adults have worn face masks during the COVID-19 outbreak. It is difficult to measure how much of a positive impact this attitude, habit, and behavior could have on the degree of infection and spread of the disease. However, it can be a positive indicator of adherence to the population’s security and safety measures during the pandemic. %M 34253508 %R 10.2196/28989 %U https://aging.jmir.org/2021/3/e28989 %U https://doi.org/10.2196/28989 %U http://www.ncbi.nlm.nih.gov/pubmed/34253508 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26608 %T Exploring Test-Retest Reliability and Longitudinal Stability of Digital Biomarkers for Parkinson Disease in the m-Power Data Set: Cohort Study %A Sahandi Far,Mehran %A Eickhoff,Simon B %A Goni,Maria %A Dukart,Juergen %+ Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Wilhelm-Johnen-Strasse, Jülich, 52425, Germany, 49 1632874330, juergen.dukart@gmail.com %K health sciences %K medical research %K biomarkers %K diagnostic markers %K neurological disorders %K Parkinson disease %K mobile phone %D 2021 %7 13.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital biomarkers (DB), as captured using sensors embedded in modern smart devices, are a promising technology for home-based sign and symptom monitoring in Parkinson disease (PD). Objective: Despite extensive application in recent studies, test-retest reliability and longitudinal stability of DB have not been well addressed in this context. We utilized the large-scale m-Power data set to establish the test-retest reliability and longitudinal stability of gait, balance, voice, and tapping tasks in an unsupervised and self-administered daily life setting in patients with PD and healthy controls (HC). Methods: Intraclass correlation coefficients were computed to estimate the test-retest reliability of features that also differentiate between patients with PD and healthy volunteers. In addition, we tested for longitudinal stability of DB measures in PD and HC, as well as for their sensitivity to PD medication effects. Results: Among the features differing between PD and HC, only a few tapping and voice features had good to excellent test-retest reliabilities and medium to large effect sizes. All other features performed poorly in this respect. Only a few features were sensitive to medication effects. The longitudinal analyses revealed significant alterations over time across a variety of features and in particular for the tapping task. Conclusions: These results indicate the need for further development of more standardized, sensitive, and reliable DB for application in self-administered remote studies in patients with PD. Motivational, learning, and other confounders may cause variations in performance that need to be considered in DB longitudinal applications. %M 34515645 %R 10.2196/26608 %U https://www.jmir.org/2021/9/e26608 %U https://doi.org/10.2196/26608 %U http://www.ncbi.nlm.nih.gov/pubmed/34515645 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e24624 %T Domestic Violence and Mental Health During the COVID-19 Pandemic in Bangladesh %A Rashid Soron,Tanjir %A Ashiq,Md Ashiqur Rahman %A Al-Hakeem,Marzia %A Chowdhury,Zaid Farzan %A Uddin Ahmed,Helal %A Afrooz Chowdhury,Chaman %+ Telepsychiatry Research and Innovation Network Ltd, 3D, 2nd Floor, Rupayan Trade Center, Bangla Motor, Dhaka, 1205, Bangladesh, 880 1718827138, tanjirsoron@gmail.com %K domestic violence %K COVID-19 %K mental health %K violence %K Bangladesh %K lockdown %K isolation %K anxiety %K stress %K telemental health %K telepsychiatry %K web-based survey %D 2021 %7 13.9.2021 %9 Viewpoint %J JMIR Form Res %G English %X Background: The COVID-19 lockdown, the advent of working from home, and other unprecedent events have resulted in multilayer and multidimensional impacts on our personal, social, and occupational lives. Mental health conditions are deteriorating, financial crises are increasing in prevalence, and the need to stay at home has resulted in the increased prevalence of domestic violence. In Bangladesh, where domestic violence is already prevalent, the lockdown period and stay-at-home orders could result in more opportunities and increased scope for perpetrators of domestic violence. Objective: In this study, we aimed to determine the prevalence and pattern of domestic violence during the initial COVID-19 lockdown period in Bangladesh and the perceptions of domestic violence survivors with regard to mental health care. Methods: We conducted this cross-sectional web-based study among the Bangladeshi population and used a semistructured self-reported questionnaire to understand the patterns of domestic violence and perceptions on mental health care from August to September 2020. The questionnaire was disseminated on different organizational websites and social media pages (ie, those of organizations that provide mental health and domestic violence services). Data were analyzed by using IBM SPSS (version 22.0; IBM Corporation). Results: We found that 36.8% (50/136) of respondents had faced domestic violence at some point in their lives; psychological abuse was the most common type of violence. However, the prevalence of the economical abuse domestic violence type increased after the COVID-19 lockdown was enforced. Although 96.3% (102/136) of the participants believed that domestic violence survivors need mental health support, only 25% (34/136) of the respondents had an idea about the mental health services that are available for domestic violence survivors in Bangladesh and how and where they could avail mental health services. Conclusions: Domestic violence is one of the most well-known stressors that have direct impacts on physical and mental health. However, the burden of domestic violence is often underreported, and its impact on mental health is neglected in Bangladesh. The burden of this problem has increased during the COVID-19 crisis, and the cry for mental health support is obvious in the country. However, it is necessary to provide information about available support services; telepsychiatry can be good option for providing immediate mental health support in a convenient and cost-effective manner. %M 34346893 %R 10.2196/24624 %U https://formative.jmir.org/2021/9/e24624 %U https://doi.org/10.2196/24624 %U http://www.ncbi.nlm.nih.gov/pubmed/34346893 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e30237 %T Using the Think-Aloud Method to Assess the Feasibility and Acceptability of Network Canvas Among Black Men Who Have Sex With Men and Transgender Persons: Qualitative Analysis %A Crawford,Natalie D %A Josma,Dorie %A Harrington,Kristin R V %A Morris,Joseph %A Quamina,Alvan %A Birkett,Michelle %A Phillips II,Gregory %+ Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Grace Crum Rollins Building, 1518 Clifton Rd, Atlanta, GA, 30322, United States, 1 404 712 9445, ndcrawford@emory.edu %K think-aloud %K egocentric networks %K sociogram %K social networks %K MSM %K transgender %K network canvas %K black MSM %K infectious disease transmission %K stigma %D 2021 %7 9.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Characteristics of an individual’s social network have been important factors in understanding infectious disease transmission patterns. Social network data collection is generally time and resource intensive, yet it is crucial to our understanding of the complex epidemiologic landscape of human behaviors among stigmatized social groups. Objective: We sought to evaluate the feasibility and acceptability of a self-administered social network data collection tool, Network Canvas, among Black men who have sex with men (BMSM) and transgender persons using the think-aloud method, which is a robust and flexible research technique used to perform usability testing. Methods: We piloted a self-administered network interview within the Network Canvas Software Suite. Participants aged 18 years and older were recruited through a community-based organization in Atlanta, GA, and were included based upon their willingness to share information on sexual behaviors and drug use for themselves and their social networks. A semistructured interview guide was used to document cognitive decision-making processes while using the tool. Recorded interviews were transcribed verbatim, and thematic analyses were performed. Results: Among 7 BMSM and transgender participants, three main themes were identified from cognitive processes: (1) the utility, (2) navigation, and (3) intuitive design of Network Canvas. Overall, Network Canvas was described as “easy to use,” with suggestions mainly directed toward improving navigation tools and implementing an initial tutorial on the program prior to use. Participants were willing to use Network Canvas to document their social networks and characteristics. In general, observed verbal responses from participants matched their behavior, although there were some discrepancies between verbal affirmations of use and understanding versus external observation. Conclusions: We found Network Canvas to be a useful new tool to capture social network data. Self-administration allowed participants the opportunity to provide sensitive information about themselves and their social networks. Furthermore, automated name generation and visualization of an individuals’ social network in the app has the potential to reduce cognitive burden during data collection. More efficient methods of social network data collection have the potential to provide epidemiologic information to guide prevention efforts for populations with stigmatized health conditions or behaviors. %M 34499040 %R 10.2196/30237 %U https://formative.jmir.org/2021/9/e30237 %U https://doi.org/10.2196/30237 %U http://www.ncbi.nlm.nih.gov/pubmed/34499040 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e26503 %T Assessing the Electronic Evidence System Needs of Canadian Public Health Professionals: Cross-sectional Study %A Dhaliwal,Bandna %A Neil-Sztramko,Sarah E %A Boston-Fisher,Nikita %A Buckeridge,David L %A Dobbins,Maureen %+ National Collaborating Centre for Methods and Tools, McMaster University, 175 Longwood Road South, Suite 210a, Hamilton, ON, L8P 0A1, Canada, 1 905 525 9140 ext 20450, dobbinsm@mcmaster.ca %K population surveillance %K evidence-informed decision-making %K needs assessment %K public health %K precision public health %D 2021 %7 7.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: True evidence-informed decision-making in public health relies on incorporating evidence from a number of sources in addition to traditional scientific evidence. Lack of access to these types of data as well as ease of use and interpretability of scientific evidence contribute to limited uptake of evidence-informed decision-making in practice. An electronic evidence system that includes multiple sources of evidence and potentially novel computational processing approaches or artificial intelligence holds promise as a solution to overcoming barriers to evidence-informed decision-making in public health. Objective: This study aims to understand the needs and preferences for an electronic evidence system among public health professionals in Canada. Methods: An invitation to participate in an anonymous web-based survey was distributed via listservs of 2 Canadian public health organizations in February 2019. Eligible participants were English- or French-speaking individuals currently working in public health. The survey contained both multiple-choice and open-ended questions about the needs and preferences relevant to an electronic evidence system. Quantitative responses were analyzed to explore differences by public health role. Inductive and deductive analysis methods were used to code and interpret the qualitative data. Ethics review was not required by the host institution. Results: Respondents (N=371) were heterogeneous, spanning organizations, positions, and areas of practice within public health. Nearly all (364/371, 98.1%) respondents indicated that an electronic evidence system would support their work. Respondents had high preferences for local contextual data, research and intervention evidence, and information about human and financial resources. Qualitative analyses identified several concerns, needs, and suggestions for the development of such a system. Concerns ranged from the personal use of such a system to the ability of their organization to use such a system. Recognized needs spanned the different sources of evidence, including local context, research and intervention evidence, and resources and tools. Additional suggestions were identified to improve system usability. Conclusions: Canadian public health professionals have positive perceptions toward an electronic evidence system that would bring together evidence from the local context, scientific research, and resources. Elements were also identified to increase the usability of an electronic evidence system. %M 34491205 %R 10.2196/26503 %U https://publichealth.jmir.org/2021/9/e26503 %U https://doi.org/10.2196/26503 %U http://www.ncbi.nlm.nih.gov/pubmed/34491205 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e21348 %T Investigation of the Effects of an Online Support Group for Mental Health Problems on Stigma and Help-Seeking Among Japanese Adults: Cross-sectional Study %A Kobori,Osamu %A Yoshinaga,Naoki %+ Department of Psychology, International University of Health and Welfare, 4-1-26 Akasaka, Minato-ku, Tokyo, 1078402, Japan, 81 3 5574 3900, O.Kobori@iuhw.ac.jp %K online support group %K mental health %K depression %K stigma %K help-seeking %D 2021 %7 7.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Online support groups vary widely in both goals and structures owing to the rapid development of social networking services. Several studies have shown the potential effectiveness of online support groups, such as reducing psychological distress (eg, depression) among individuals with mental health problems. However, online support groups often do not aim at effectiveness regarding distress relief–related outcomes. Objective: This study aims to examine whether the use frequency of online support group platform functions (U2plus) is associated with lower stigma and higher consumer activation. Methods: A total of 350 U2plus users participated in a web-based survey. They were asked what therapy they had received in the past and how often they logged on to it, used each of its functions, and completed the following questionnaires: the Patient Health Questionnaire-9, the Devaluation-Discrimination Scale, and the General Help-Seeking Questionnaire. Results: Regarding the therapy received, 88% (308/350) of participants had taken medication for mental health problems, and 66.6% (233/350) had received psychotherapy or mental health counseling. Regarding use frequency, 21.7% (74/341) of the participants signed in to U2plus and used its functions more than once a week. The use frequency of U2plus functions was not correlated with perceived stigma, but the use frequency of some functions was weakly correlated with help-seeking intentions from formal sources (eg, doctors and psychologists). However, multiple regression analyses revealed that the use frequency of those functions did not uniquely predict help-seeking intentions. Conclusions: It was suggested that online support groups may serve as an alternative treatment option for those who are already undergoing pharmacological treatment and are willing to seek help from whatever source they deem helpful. %M 34491206 %R 10.2196/21348 %U https://formative.jmir.org/2021/9/e21348 %U https://doi.org/10.2196/21348 %U http://www.ncbi.nlm.nih.gov/pubmed/34491206 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e29310 %T COVID-19 Data Utilization in North Carolina: Qualitative Analysis of Stakeholder Experiences %A Patterson,Jenny Rees %A Shaw,Donna %A Thomas,Sharita R %A Hayes,Julie A %A Daley,Christopher R %A Knight,Stefania %A Aikat,Jay %A Mieczkowska,Joanna O %A Ahalt,Stanley C %A Krishnamurthy,Ashok K %+ University of Iowa, 145 N. Riverside Drive, Iowa City, IA, 52242, United States, 1 3147490050, jennifer-patterson@uiowa.edu %K qualitative research %K interview %K COVID-19 %K SARS-CoV-2 %K pandemic %K data collection %K data reporting %K data %K public health %K coronavirus disease 2019 %D 2021 %7 2.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As the world faced the pandemic caused by the novel coronavirus disease 2019 (COVID-19), medical professionals, technologists, community leaders, and policy makers sought to understand how best to leverage data for public health surveillance and community education. With this complex public health problem, North Carolinians relied on data from state, federal, and global health organizations to increase their understanding of the pandemic and guide decision-making. Objective: We aimed to describe the role that stakeholders involved in COVID-19–related data played in managing the pandemic in North Carolina. The study investigated the processes used by organizations throughout the state in using, collecting, and reporting COVID-19 data. Methods: We used an exploratory qualitative study design to investigate North Carolina’s COVID-19 data collection efforts. To better understand these processes, key informant interviews were conducted with employees from organizations that collected COVID-19 data across the state. We developed an interview guide, and open-ended semistructured interviews were conducted during the period from June through November 2020. Interviews lasted between 30 and 45 minutes and were conducted by data scientists by videoconference. Data were subsequently analyzed using qualitative data analysis software. Results: Results indicated that electronic health records were primary sources of COVID-19 data. Often, data were also used to create dashboards to inform the public or other health professionals, to aid in decision-making, or for reporting purposes. Cross-sector collaboration was cited as a major success. Consistency among metrics and data definitions, data collection processes, and contact tracing were cited as challenges. Conclusions: Findings suggest that, during future outbreaks, organizations across regions could benefit from data centralization and data governance. Data should be publicly accessible and in a user-friendly format. Additionally, established cross-sector collaboration networks are demonstrably beneficial for public health professionals across the state as these established relationships facilitate a rapid response to evolving public health challenges. %M 34298500 %R 10.2196/29310 %U https://publichealth.jmir.org/2021/9/e29310 %U https://doi.org/10.2196/29310 %U http://www.ncbi.nlm.nih.gov/pubmed/34298500 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e27304 %T Using Machine Learning Techniques to Predict Factors Contributing to the Incidence of Metabolic Syndrome in Tehran: Cohort Study %A Hosseini-Esfahani,Firoozeh %A Alafchi,Behnaz %A Cheraghi,Zahra %A Doosti-Irani,Amin %A Mirmiran,Parvin %A Khalili,Davood %A Azizi,Fereidoun %+ Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Shahid Fahmideh Ave, Hamadan, 65157835129, Iran, 98 9183177990, cheraghiz@ymail.com %K metabolic syndrome %K Tehran Lipid and Glucose Study %K data mining %D 2021 %7 2.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Metabolic syndrome (MetS), a major contributor to cardiovascular disease and diabetes, is considered to be among the most common public health problems worldwide. Objective: We aimed to identify and rank the most important nutritional and nonnutritional factors contributing to the development of MetS using a data-mining method. Methods: This prospective study was performed on 3048 adults (aged ≥20 years) who participated in the fifth follow-up examination of the Tehran Lipid and Glucose Study, who were followed for 3 years. MetS was defined according to the modified definition of the National Cholesterol Education Program/Adult Treatment Panel III. The importance of variables was obtained by the training set using the random forest model for determining factors with the greatest contribution to developing MetS. Results: Among the 3048 participants, 701 (22.9%) developed MetS during the study period. The mean age of the participants was 44.3 years (SD 11.8). The total incidence rate of MetS was 229.9 (95% CI 278.6-322.9) per 1000 person-years and the mean follow-up time was 40.5 months (SD 7.3). The incidence of MetS was significantly (P<.001) higher in men than in women (27% vs 20%). Those affected by MetS were older, married, had diabetes, with lower levels of education, and had a higher BMI (P<.001). The percentage of hospitalized patients was higher among those with MetS than among healthy people, although this difference was only statistically significant in women (P=.02). Based on the variable importance and multiple logistic regression analyses, the most important determinants of MetS were identified as history of diabetes (odds ratio [OR] 6.3, 95% CI 3.9-10.2, P<.001), BMI (OR 1.2, 95% CI 1.0-1.2, P<.001), age (OR 1.0, 95% CI 1.0-1.03, P<.001), female gender (OR 0.5, 95% CI 0.38-0.63, P<.001), and dietary monounsaturated fatty acid (OR 0.97, 95% CI 0.94-0.99, P=.04). Conclusions: Based on our findings, the incidence rate of MetS was significantly higher in men than in women in Tehran. The most important determinants of MetS were history of diabetes, high BMI, older age, male gender, and low dietary monounsaturated fatty acid intake. %M 34473070 %R 10.2196/27304 %U https://publichealth.jmir.org/2021/9/e27304 %U https://doi.org/10.2196/27304 %U http://www.ncbi.nlm.nih.gov/pubmed/34473070 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e28075 %T Scoping the Need for a Tailored mHealth App to Improve Health and Well-being Behavioral Transformation in the Police: Exploring the Views of UK Police Workers via Web-Based Surveys and Client Meetings %A Swanston,Emma %A Pulman,Andy %A Dogan,Huseyin %A Murphy,Jane %A Bitters,Fiona %+ Faculty of Science and Technology, Bournemouth University, Poole House, Talbot Campus,, Fern Barrow, Poole, BH12 5BB, United Kingdom, 44 1202 961047, apulman@bournemouth.ac.uk %K nutrition %K food %K behavior change %K mobile health %K police %K lifestyle management %K well-being %K mobile phone %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Police officers often work long, unsocial hours in a highly pressurized environment and may experience difficulties in managing their health and well-being. Their jobs can be highly stressful and feature unusual working hours and multiple shift patterns. When considering the policing environment of 2021, many roles that were previously the domain of warranted officers are now being carried out by nonwarranted police staff equivalents. These police staff roles are relatively new to policing but put staff under some of the same stresses as police officers. A UK police force requested help to investigate technologies that could be used to improve health and well-being and research how these technologies could be used to measure and track health behavior change. Objective: Historical research studies need to be appraised in light of this new policing environment, and new research also needs to include this shift in dynamics when considering aspects of policing, including their health and well-being. This study explores police officer and staff attitudes toward and their use of existing health-related technology, highlights existing practices, and gathers views about how technology could be used more effectively. Methods: A web-based survey was completed by police officers and staff (N=213) during the initial period of the UK lockdown in 2020. The survey was designed to find the solutions that participants used outside of those supplied by their employer, identify issues or problems, and find what they would like a hypothetical app to focus on. Additional requirements data were captured through client meetings, including discussions concerning previously attempted solutions and those currently in place. Thematic analysis was undertaken to identify the key themes. Results: Attitudes toward and uses of existing health-related technology were captured, and existing practices were highlighted. Participants identified a need for an app to consider that a user was on shift—an important point, as many issues and problems with elements of their health and well-being involved shift work. Data also highlighted that a multifunctional tool would be more beneficial to participants than focusing on just 1 element. The key features and four domains were identified for app coverage. The prioritized order of importance of the four domains was activity, food and diet, sleep, and fluid intake. Conclusions: For police officers and staff, research data suggest that there is a previously unidentified requirement for a mobile app that could provide an easily accessible platform for them to use, regardless of the current location; one that could provide guidelines on diet, lifestyle habits, and health behavior to help the user make informed decisions to assist in personalized behavior change. Notably, one which is multifunctional and which also aligns effectively with the irregular shift patterns of its users. %M 34463625 %R 10.2196/28075 %U https://formative.jmir.org/2021/8/e28075 %U https://doi.org/10.2196/28075 %U http://www.ncbi.nlm.nih.gov/pubmed/34463625 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e27713 %T Cross-Canada Release of the Post-Secondary Student Stressors Index (PSSI): Protocol for a Cross-sectional, Repeated Measures Study %A Linden,Brooke %+ Health Services and Policy Research Institute, Queen's University, 99 University Avenue, Kingston, ON, K7L 3P5, Canada, 1 613 533 2000, brooke.linden@queensu.ca %K stress %K mental health %K health promotion %K postsecondary %K higher education %K measurement tool %K study protocol %D 2021 %7 31.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The prevalence of mental health–related problems, including stress, psychological distress, and symptoms of mental illnesses, continues to increase among Canadian postsecondary student populations. Excessive stress in this population has been linked to a number of negative academic and health outcomes. Despite attempts to improve mental health at postsecondary institutions, a persistent gap exists in the evaluation of the specific sources of stress for students within the postsecondary setting. Objective: The purpose of this paper is to report the study protocol for a cross-Canada, multisite launch of the Post-Secondary Student Stressors Index (PSSI), which will engage postsecondary institutions across the country as partners and facilitate improved measurement of the sources of student stress, in addition to contributing toward improved tailoring of upstream mental health services and support. Methods: Created in collaboration with students, the PSSI is a validated 46-item tool assessing stressors across five domains: academics, learning environment, campus culture, interpersonal, and personal stressors. The tool is designed to be applicable to students at all years, levels, and areas of study. Data will be collected longitudinally at multiple time points over the course of each academic year. Results: We recruited 15 postsecondary institutions across Canada for the first year, inviting students to participate in an online survey including questions concerning sociodemographic characteristics, stress, mental health, and resiliency. Analyses, including appropriate data visualization, will be conducted to determine the impact of specific stressors on mental health, linking responses over time to allow for the observation of changes in trends. Conclusions: The PSSI is an intuitive and evidence-informed tool that can aid postsecondary institutions in evaluating the sources of student stress on their campuses. This multisite project will make a substantial contribution to the current literature regarding postsecondary student stress and allow institutions across the country to improve the tailoring of upstream mental health services in order to directly support the unique needs of their student body. Opportunities for knowledge translation and exchange are discussed. International Registered Report Identifier (IRRID): DERR1-10.2196/27713 %M 34463632 %R 10.2196/27713 %U https://www.researchprotocols.org/2021/8/e27713 %U https://doi.org/10.2196/27713 %U http://www.ncbi.nlm.nih.gov/pubmed/34463632 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e30987 %T Advancing Intersectional Discrimination Measures for Health Disparities Research: Protocol for a Bilingual Mixed Methods Measurement Study %A Scheim,Ayden I %A Bauer,Greta R %A Bastos,João L %A Poteat,Tonia %+ Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, United States, 1 2673596359, drascheim@gmail.com %K stigma %K discrimination %K racism %K measurement %K health disparities %K survey research %K psychometrics %D 2021 %7 30.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Guided by intersectionality frameworks, researchers have documented health disparities at the intersection of multiple axes of social status and position, particularly race and ethnicity, gender, and sexual orientation. To advance from identifying to intervening in such intersectional health disparities, studies that examine the underlying mechanisms are required. Although much research demonstrates the negative health impacts of perceived discrimination along single axes, quantitative approaches to assessing the role of discrimination in generating intersectional health disparities remain in their infancy. Members of our team recently introduced the Intersectional Discrimination Index (InDI) to address this gap. The InDI comprises three measures of enacted (day-to-day and major) and anticipated discrimination. These attribution-free measures ask about experiences of mistreatment because of who you are. These measures show promise for intersectional health disparities research but require further validation across intersectional groups and languages. In addition, the proposal to remove attributions is controversial, and no direct comparison has ever been conducted. Objective: This study aims to cognitively and psychometrically evaluate the InDI in English and Spanish and determine whether attributions should be included. Methods: The study will draw on a preliminary validation data set and three original sequentially collected sources of data: qualitative cognitive interviews in English and Spanish with a sample purposively recruited across intersecting social status and position (gender, sexual orientation, race and ethnicity, socioeconomic status, age, and nativity); a Spanish quantitative survey (n=500; 250/500, 50% sexual and gender minorities); and an English quantitative survey (n=3000), with quota sampling by race and ethnicity (Black, Latino/a/x, and White), sexual or gender minority status, and gender. Results: The study was funded by the National Institute on Minority Health and Health Disparities in May 2021, and data collection began in July 2021. Conclusions: The key deliverables of the study will be bilingual measures of anticipated, day-to-day, and major discrimination validated for multiple health disparity populations using qualitative, quantitative, and mixed methods. International Registered Report Identifier (IRRID): PRR1-10.2196/30987 %M 34459747 %R 10.2196/30987 %U https://www.researchprotocols.org/2021/8/e30987 %U https://doi.org/10.2196/30987 %U http://www.ncbi.nlm.nih.gov/pubmed/34459747 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e27247 %T Lateralization and Bodily Patterns of Segmental Signs and Spontaneous Pain in Acute Visceral Disease: Observational Study %A Shaballout,Nour %A Aloumar,Anas %A Manuel,Jorge %A May,Marcus %A Beissner,Florian %+ Insula Institute for Integrative Therapy Research, Brabeckstraße 177e, Hannover, 30539, Germany, 49 16095543423, f.beissner@insula-institut.org %K digital pain drawings %K visceral referred pain %K referred pain %K head zones %K mydriasis %K chest pain %K clinical examination %K differential diagnosis %K digital health %K digital drawings %K pain %K health technology %K image analysis %D 2021 %7 27.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The differential diagnosis of acute visceral diseases is a challenging clinical problem. Older literature suggests that patients with acute visceral problems show segmental signs such as hyperalgesia, skin resistance, or muscular defense as manifestations of referred visceral pain in somatic or visceral tissues with overlapping segmental innervation. According to these sources, the lateralization and segmental distribution of such signs may be used for differential diagnosis. Segmental signs and symptoms may be accompanied by spontaneous (visceral) pain, which, however, shows a nonsegmental distribution. Objective: This study aimed to investigate the lateralization (ie, localization on one side of the body, in preference to the other) and segmental distribution (ie, surface ratio of the affected segments) of spontaneous pain and (referred) segmental signs in acute visceral diseases using digital pain drawing technology. Methods: We recruited 208 emergency room patients that were presenting for acute medical problems considered by triage as related to internal organ disease. All patients underwent a structured 10-minute bodily examination to test for various segmental signs and spontaneous visceral pain. They were further asked their segmental symptoms such as nausea, meteorism, and urinary retention. We collected spontaneous pain and segmental signs as digital drawings and segmental symptoms as binary values on a tablet PC. After the final diagnosis, patients were divided into groups according to the organ affected. Using statistical image analysis, we calculated mean distributions of pain and segmental signs for the heart, lungs, stomach, liver/gallbladder, and kidneys/ureters, analyzing the segmental distribution of these signs and the lateralization. Results: Of the 208 recruited patients, 110 (52.9%) were later diagnosed with a single-organ problem. These recruited patients had a mean age of 57.3 (SD 17.2) years, and 40.9% (85/208) were female. Of these 110 patients, 85 (77.3%) reported spontaneous visceral pain. Of the 110, 81 (73.6%) had at least 1 segmental sign, and the most frequent signs were hyperalgesia (46/81, 57%), and muscle resistance (39/81, 48%). While pain was distributed along the body midline, segmental signs for the heart, stomach, and liver/gallbladder appeared mostly ipsilateral to the affected organ. An unexpectedly high number of patients (37/110, 33.6%) further showed ipsilateral mydriasis. Conclusions: This study underlines the usefulness of including digitally recorded segmental signs in bodily examinations of patients with acute medical problems. %M 34448718 %R 10.2196/27247 %U https://www.jmir.org/2021/8/e27247 %U https://doi.org/10.2196/27247 %U http://www.ncbi.nlm.nih.gov/pubmed/34448718 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e26223 %T Factors That Help and Hinder the Implementation of Digital Depression Prevention Programs: School-Based Cross-sectional Study %A Beames,Joanne R %A Johnston,Lara %A O'Dea,Bridianne %A Torok,Michelle %A Christensen,Helen %A Boydell,Katherine M %A Werner-Seidler,Aliza %+ Black Dog Institute, University of New South Wales, Hospital Road, Randwick, 2031, Australia, 61 2 9382 ext 8776, j.beames@blackdog.org.au %K secondary school %K depression %K prevention %K digital %K barrier %K facilitator %K teacher %K counselor %K principal %K student %D 2021 %7 27.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital prevention programs that are delivered in a school environment can inoculate young people against depression. However, little is known about the school-based factors that help and hinder the implementation of these programs. Staff members are integral for supporting mental health programs in schools and are likely to have a wealth of expertise and knowledge about the factors that affect implementation. Objective: The primary objective of this study was to explore the barriers and facilitators to implementing a digital depression prevention program in Australian secondary schools with teachers, counselors, and principals. The secondary objective was to explore variations in these factors across different school contexts, including the school type (government or nongovernment), location (capital city, regional/or rural areas), and socioeconomic status (SES) (low, medium, high). Methods: This quantitative cross-sectional survey study assessed the barriers and facilitators to implementing a hypothetical digital prevention program in Australian schools. The survey was taken by 97 teachers (average age 38.3 years), 93 counselors (average age 39.5 years), and 11 principals (average age 50.9 years) across Australia between November 2017 and July 2018. Results: A range of barriers and facilitators relating to logistics and resources, staff support, and program factors were endorsed by the surveyed staff. Consistent with prior research, common barriers included a lack of time and resources (ie, staff and rooms). These barriers were particularly evident in government, rural/regional, and low socioeconomic schools. Other barriers were specific to digital delivery, including privacy issues and a lack of clarity around staff roles and responsibilities. Facilitators included upskilling staff through training, embedding the program into the curriculum, and other program factors including universal delivery, screening of students’ mental health, and clear referral pathways. Knowledge about the program efficacy was also perceived as important by a large proportion of the respondents. Conclusions: The digital depression prevention program was perceived as suitable for use within different schools in Australia, although certain factors need to be considered to enable effective implementation. Logistics and resources, support, and program factors were identified as particularly important for school-based implementation. To maximize the effectiveness in delivering digital programs, implementation may need to be tailored to the staff roles and school types. %M 34448701 %R 10.2196/26223 %U https://www.jmir.org/2021/8/e26223 %U https://doi.org/10.2196/26223 %U http://www.ncbi.nlm.nih.gov/pubmed/34448701 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e24408 %T Image Processing for Public Health Surveillance of Tobacco Point-of-Sale Advertising: Machine Learning–Based Methodology %A English,Ned %A Anesetti-Rothermel,Andrew %A Zhao,Chang %A Latterner,Andrew %A Benson,Adam F %A Herman,Peter %A Emery,Sherry %A Schneider,Jordan %A Rose,Shyanika W %A Patel,Minal %A Schillo,Barbara A %+ NORC at the University of Chicago, 55 E Monroe St, Ste 3100, Chicago, IL, 60603, United States, 1 3127594010, english-ned@norc.org %K machine learning %K image classification %K convolutional neural network %K object detection %K crowdsourcing %K tobacco point of sale %K public health surveillance %D 2021 %7 27.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: With a rapidly evolving tobacco retail environment, it is increasingly necessary to understand the point-of-sale (POS) advertising environment as part of tobacco surveillance and control. Advances in machine learning and image processing suggest the ability for more efficient and nuanced data capture than previously available. Objective: The study aims to use machine learning algorithms to discover the presence of tobacco advertising in photographs of tobacco POS advertising and their location in the photograph. Methods: We first collected images of the interiors of tobacco retailers in West Virginia and the District of Columbia during 2016 and 2018. The clearest photographs were selected and used to create a training and test data set. We then used a pretrained image classification network model, Inception V3, to discover the presence of tobacco logos and a unified object detection system, You Only Look Once V3, to identify logo locations. Results: Our model was successful in identifying the presence of advertising within images, with a classification accuracy of over 75% for 8 of the 42 brands. Discovering the location of logos within a given photograph was more challenging because of the relatively small training data set, resulting in a mean average precision score of 0.72 and an intersection over union score of 0.62. Conclusions: Our research provides preliminary evidence for a novel methodological approach that tobacco researchers and other public health practitioners can apply in the collection and processing of data for tobacco or other POS surveillance efforts. The resulting surveillance information can inform policy adoption, implementation, and enforcement. Limitations notwithstanding, our analysis shows the promise of using machine learning as part of a suite of tools to understand the tobacco retail environment, make policy recommendations, and design public health interventions at the municipal or other jurisdictional scale. %M 34448700 %R 10.2196/24408 %U https://www.jmir.org/2021/8/e24408 %U https://doi.org/10.2196/24408 %U http://www.ncbi.nlm.nih.gov/pubmed/34448700 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e30861 %T Comparison of the Differences Between Web-Based and Traditional Questionnaire Surveys in Pediatrics: Comparative Survey Study %A Fang,Heping %A Xian,Ruoling %A Ma,Zhuoying %A Lu,Mingyue %A Hu,Yan %+ Department of Child Health Care, Children’s Hospital of Chongqing Medical University, No.136, 2nd Zhongshan Road, Yuzhong District, Chongqing, , China, 86 023 63622764, hy420@126.com %K pediatrics %K survey %K questionnaire %K web survey %K comparative study %D 2021 %7 26.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: A web-based survey is a novel method for data capture. Some studies have applied web-based surveys in pediatrics, but few of them have reported data on the differences between web-based and traditional questionnaire surveys. Objective: The objective of our study was to evaluate the internal consistency of a web-based survey and compare it with a traditional questionnaire survey in pediatrics. Methods: A convenience sample of caregivers was invited to participate in the survey on feeding patterns and their children’s eating behaviors if their children were aged 2 to 7 years. A web-based survey and a traditional questionnaire survey were carried out between October 2018 and July 2019. A total of 1085 caregivers were involved in this study, and they were divided into the following three groups based on methods and sources: (1) web-based survey from a web source, (2) web-based survey from a hospital source, and (3) traditional questionnaire survey from a hospital source. The data were then compared and analyzed. Results: A total of 735 caregivers participated in the web-based survey and 350 caregivers participated in the traditional questionnaire survey, and 816 cases were then included in the analyses after data processing. The effective rate of the web-based survey was 70.1% (515/735), and the completeness rate of the traditional questionnaire survey was 86.0% (301/350). There were no significant differences between web-based surveys from different sources. However, demographic characteristics were significantly different between the web-based and traditional questionnaire surveys, mainly in terms of age and caregivers (χ²4=16.509, P=.002 and χ²4=111.464, P<.001, respectively). Caregivers of children aged 2 to 3 years and grandparents were more likely to respond to the web-based survey. Age-specific stratified analysis showed that the score of “monitoring” and the reporting rate of “poor appetite” in children aged 2 to 3 years were significantly higher in the web-based survey compared to the traditional questionnaire survey after adjusting for demographic characteristics. Conclusions: A web-based survey could be a feasible tool in pediatric studies. However, differences in demographic characteristics and their possible impacts on the results should be considered in the analyses. %M 34319240 %R 10.2196/30861 %U https://www.jmir.org/2021/8/e30861 %U https://doi.org/10.2196/30861 %U http://www.ncbi.nlm.nih.gov/pubmed/34319240 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e18502 %T Digital Patient-Reported Outcome Measures for Monitoring of Patients on Cancer Treatment: Cross-sectional Questionnaire Study %A Sivanandan,Mayuran Ananth %A Sharma,Catherine %A Bullard,Pippa %A Christian,Judith %+ Department of Oncology and Radiotherapy, Nottingham University Hospitals NHS Trust, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, United Kingdom, 44 07859877635, ananthsiva@doctors.org.uk %K patient-reported outcome measures %K patient-reported outcomes %K remote monitoring %K toxicity %K outpatients %K digital technology %K digital health %K mobile health %K oncology %K chemotherapy %K immunotherapy %K radiotherapy %D 2021 %7 13.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Oncology has been facing increasing outpatient activity associated with higher cancer incidence, better survival rates, and more treatment options. Innovative technological solutions could help deal with this increasing demand. Using digital patient-reported outcome measures (PROMs) to identify patients who need a face-to-face (FTF) appointment is a potential approach. Objective: This study aims to assess the feasibility of digital PROM questionnaires to enable remote symptom monitoring for patients undergoing cancer treatment and their ability to highlight the requirement for an FTF appointment. Methods: This study was performed at a tertiary oncology center between December 2018 and February 2019. The Common Terminology Criteria for Adverse Events were adapted into patient-friendly language to form the basis of treatment-specific digital questionnaires covering specific cancer drugs and radiotherapy treatments. These treatment-specific digital PROM questionnaires were scored by both patients and their clinicians during FTF appointments. Patients and clinicians did not see each other’s scored PROMs. Agreement between patients and clinicians was assessed using descriptive statistics. Patient and staff feedback was also obtained. Results: In total, 90 patients participated in the study across 10 different treatment pathways. By comparing paired patient and clinician responses, the sensitivity of the patient-completed questionnaires in correctly highlighting the need for FTF review was 94% (44/47), and all patients with severe or grade 3+ symptoms were identified (6/6, 100%). Patient-completed PROMs appropriately revealed that 29% (26/90) of the participating patients did not need FTF review based on their symptoms alone. Certain oncological treatment pathways, such as immunotherapy, were found to have a larger proportion of patients with minimal symptoms than others, such as conventional chemotherapy. Patient and staff feedback showed high approval of digital PROMs and their potential for use in remote monitoring. Conclusions: Digital PROM questionnaires can feasibly highlight the need for FTF review in oncology clinics for treatment. Their use with specific treatments could safely reduce the requirement for FTF care, and future work should evaluate their application in the remote monitoring of patients. %M 34398785 %R 10.2196/18502 %U https://formative.jmir.org/2021/8/e18502 %U https://doi.org/10.2196/18502 %U http://www.ncbi.nlm.nih.gov/pubmed/34398785 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e27477 %T Informed Decision-making for Health Insurance Enrollment: Survey Study %A Colón-Morales,Coralys M %A Giang,Wayne C W %A Alvarado,Michelle %+ Department of Industrial and Systems Engineering, University of Florida, 303 Weil Hall, Gainesville, FL, 32603, United States, 1 (352) 392 1464, ccolonmorales@ufl.edu %K health insurance %K information %K sources %K survey %K literacy %D 2021 %7 12.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Health insurance enrollment is a difficult financial decision with large health impacts. Challenges such as low health insurance literacy and lack of knowledge about choosing a plan further complicate this decision-making process. Therefore, to support consumers in their choice of a health insurance plan, it is essential to understand how individuals go about making this decision. Objective: This study aims to understand the sources of information used by individuals to support their employer-provided health insurance enrollment decisions. It seeks to describe how individual descriptive factors lead to choosing a particular type of information source. Methods: An introduction was presented on health insurance plan selection and the sources of information used to support these decisions from the 1980s to the present. Subsequently, an electronic survey of 151 full-time faculty and staff members was conducted. The survey consisted of four sections: demographics, sources of information, health insurance literacy, and technology acceptance. Descriptive statistics were used to show the demographic characteristics of the 126 eligible respondents and to study the response behaviors in the remaining survey sections. Proportion data analysis was performed using the Cochran-Armitage trend test to understand the strength of the association between our variables and the types of sources used by the respondents. Results: In terms of demographics, most of the respondents were women (103/126, 81.7%), represented a small household (1-2 persons; 87/126, 69%), and used their insurance 3-12 times a year (52/126, 41.3%). They assessed themselves as having moderate to high health insurance literacy and high acceptance of technology. The most selected and top-ranked sources were Official employer or state websites and Official Human Resources Virtual Benefits Counselor Alex. From our data analysis, we found that the use of official primary sources was constant across age groups and health insurance use groups. Meanwhile, the use of friends or family as a primary source slightly decreased as age and use increased. Conclusions: In this exploratory study, we identified the main sources of health insurance information among full-time employees from a large state university and found that most of the respondents needed 2-3 sources to gather all the information that they desired. We also studied and identified the relationships between individual factors (such as age, gender, and literacy) and 2 dependent variables on the types of primary sources of information. We encountered several limitations, which will be addressed in future studies. %M 34387555 %R 10.2196/27477 %U https://formative.jmir.org/2021/8/e27477 %U https://doi.org/10.2196/27477 %U http://www.ncbi.nlm.nih.gov/pubmed/34387555 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 3 %P e30265 %T Improving Electronic Survey Response Rates Among Cancer Center Patients During the COVID-19 Pandemic: Mixed Methods Pilot Study %A Hathaway,Cassandra A %A Chavez,Melody N %A Kadono,Mika %A Ketcher,Dana %A Rollison,Dana E %A Siegel,Erin M %A Peoples,Anita R %A Ulrich,Cornelia M %A Penedo,Frank J %A Tworoger,Shelley S %A Gonzalez,Brian D %+ Department of Cancer Epidemiology, Moffitt Cancer Center, 13131 USF Magnolia Drive, MRC 2nd Floor, Tampa, FL, 33612, United States, 1 813 745 1810, Shelley.Tworoger@moffitt.org %K response rates %K electronic survey %K cancer %K COVID-19 %K pandemic %K surveillance %K cancer patients %K health promotion %K digital health %K patient experience %K health outcomes %D 2021 %7 6.8.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Surveys play a vital role in cancer research. During the COVID-19 pandemic, the use of electronic surveys is crucial to improve understanding of the patient experience. However, response rates to electronic surveys are often lower compared with those of paper surveys. Objective: The aim of this study was to determine the best approach to improve response rates for an electronic survey administered to patients at a cancer center during the COVID-19 pandemic. Methods: We contacted 2750 patients seen at Moffitt Cancer Center in the prior 5 years via email to complete a survey regarding their experience during the COVID-19 pandemic, with patients randomly assigned to a series of variations of prenotifications (ie, postcard, letter) or incentives (ie, small gift, modest gift card). In total, eight combinations were evaluated. Qualitative interviews were conducted to understand the level of patient understanding and burden with the survey, and quantitative analysis was used to evaluate the response rates between conditions. Results: A total of 262 (9.5%) patients completed the survey and 9 participated in a qualitative interview. Interviews revealed minimal barriers in understanding or burden, which resulted in minor survey design changes. Compared to sending an email only, sending a postcard or letter prior to the email improved response rates from 3.7% to 9.8%. Similarly, inclusion of an incentive significantly increased the response rate from 5.4% to 16.7%, especially among racial (3.0% to 12.2%) and ethnic (6.4% to 21.0%) minorities, as well as among patients with low socioeconomic status (3.1% to 14.9%). Conclusions: Strategies to promote effective response rates include prenotification postcards or letters as well as monetary incentives. This work can inform future survey development to increase response rates for electronic surveys, particularly among hard-to-reach populations. %M 34156965 %R 10.2196/30265 %U https://cancer.jmir.org/2021/3/e30265 %U https://doi.org/10.2196/30265 %U http://www.ncbi.nlm.nih.gov/pubmed/34156965 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e28360 %T Mental Health and the Perceived Usability of Digital Mental Health Tools Among Essential Workers and People Unemployed Due to COVID-19: Cross-sectional Survey Study %A Mata-Greve,Felicia %A Johnson,Morgan %A Pullmann,Michael D %A Friedman,Emily C %A Griffith Fillipo,Isabell %A Comtois,Katherine A %A Arean,Patricia %+ Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, United States, 1 206 616 2129, parean@uw.edu %K digital health %K COVID-19 %K essential worker %K unemployed %K usability %K user burden %K mental health %K e-mental health %K survey %K distress %D 2021 %7 5.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: COVID-19 has created serious mental health consequences for essential workers or people who have become unemployed as a result of the pandemic. Digital mental health tools have the potential to address this problem in a timely and efficient manner. Objective: The purpose of this study was to document the extent of digital mental health tool (DMHT) use by essential workers and those unemployed due to COVID-19, including asking participants to rate the usability and user burden of the DMHT they used most to cope. We also explored which aspects and features of DMHTs were seen as necessary for managing stress during a pandemic by having participants design their own ideal DMHT. Methods: A total of 2000 people were recruited from an online research community (Prolific) to complete a one-time survey about mental health symptoms, DMHT use, and preferred digital mental health features. Results: The final sample included 1987 US residents that identified as either an essential worker or someone who was unemployed due to COVID-19. Almost three-quarters of the sample (1479/1987, 74.8%) reported clinically significant emotional distress. Only 14.2% (277/1957) of the sample used a DMHT to cope with stress associated with COVID-19. Of those who used DMHTs to cope with COVID-19, meditation apps were the most common (119/261, 45.6%). Usability was broadly in the acceptable range, although participants unemployed due to COVID-19 were less likely to report user burden with DMHTs than essential workers (t198.1=–3.89, P<.001). Individuals with emotional distress reported higher financial burden for their DMHT than nondistressed individuals (t69.0=–3.21, P=.01). When the sample was provided the option to build their own DMHT, the most desired features were a combination of mindfulness/meditation (1271/1987, 64.0%), information or education (1254/1987, 63.1%), distraction tools (1170/1987, 58.9%), symptom tracking for mood and sleep (1160/1987, 58.4%), link to mental health resources (1140/1987, 57.4%), and positive psychology (1131/1986, 56.9%). Subgroups by employment, distress, and previous DMHT use status had varied preferences. Of those who did not use a DMHT to cope with COVID-19, most indicated that they did not consider looking for such a tool to help with coping (1179/1710, 68.9%). Conclusions: Despite the potential need for DMHTs, this study found that the use of such tools remains similar to prepandemic levels. This study also found that regardless of the level of distress or even past experience using an app to cope with COVID-19, it is possible to develop a COVID-19 coping app that would appeal to a majority of essential workers and unemployed persons. %M 34081592 %R 10.2196/28360 %U https://mental.jmir.org/2021/8/e28360 %U https://doi.org/10.2196/28360 %U http://www.ncbi.nlm.nih.gov/pubmed/34081592 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e26412 %T Recursive Partitioning vs Computerized Adaptive Testing to Reduce the Burden of Health Assessments in Cleft Lip and/or Palate: Comparative Simulation Study %A Harrison,Conrad J %A Sidey-Gibbons,Chris J %A Klassen,Anne F %A Wong Riff,Karen W Y %A Furniss,Dominic %A Swan,Marc C %A Rodrigues,Jeremy N %+ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, The Botnar Research Centre, Old Road, Oxford, OX3 7LD, United Kingdom, 44 1865 227 374, conrad.harrison@medsci.ox.ac.uk %K cleft Lip %K cleft palate %K patient-reported outcome measures %K outcome assessment %K CLEFT-Q %K computerized adaptive test %K machine learning %K decision tree %K regression tree %D 2021 %7 30.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Computerized adaptive testing (CAT) has been shown to deliver short, accurate, and personalized versions of the CLEFT-Q patient-reported outcome measure for children and young adults born with a cleft lip and/or palate. Decision trees may integrate clinician-reported data (eg, age, gender, cleft type, and planned treatments) to make these assessments even shorter and more accurate. Objective: We aimed to create decision tree models incorporating clinician-reported data into adaptive CLEFT-Q assessments and compare their accuracy to traditional CAT models. Methods: We used relevant clinician-reported data and patient-reported item responses from the CLEFT-Q field test to train and test decision tree models using recursive partitioning. We compared the prediction accuracy of decision trees to CAT assessments of similar length. Participant scores from the full-length questionnaire were used as ground truth. Accuracy was assessed through Pearson’s correlation coefficient of predicted and ground truth scores, mean absolute error, root mean squared error, and a two-tailed Wilcoxon signed-rank test comparing squared error. Results: Decision trees demonstrated poorer accuracy than CAT comparators and generally made data splits based on item responses rather than clinician-reported data. Conclusions: When predicting CLEFT-Q scores, individual item responses are generally more informative than clinician-reported data. Decision trees that make binary splits are at risk of underfitting polytomous patient-reported outcome measure data and demonstrated poorer performance than CATs in this study. %M 34328443 %R 10.2196/26412 %U https://www.jmir.org/2021/7/e26412 %U https://doi.org/10.2196/26412 %U http://www.ncbi.nlm.nih.gov/pubmed/34328443 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e27885 %T Perspectives and Preferences of Adult Smartphone Users Regarding Nutrition and Diet Apps: Web-Based Survey Study %A Vasiloglou,Maria F %A Christodoulidis,Stergios %A Reber,Emilie %A Stathopoulou,Thomai %A Lu,Ya %A Stanga,Zeno %A Mougiakakou,Stavroula %+ ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, 3008, Bern, Switzerland, 41 316327592, stavroula.mougiakakou@artorg.unibe.ch %K dietary assessment %K end-users %K mHealth %K mobile apps %K smartphone %K survey %K apps %K nutrition %K diet %K mobile health %K users %K behavior %K behavior change %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital technologies have evolved dramatically in recent years, finding applications in a variety of aspects of everyday life. Smartphones and mobile apps are being used for a steadily increasing number of tasks, including health monitoring. A large number of nutrition and diet apps are available, and some of them are very popular in terms of user downloads, highlighting a trend toward diet monitoring and assessment. Objective: We sought to explore the perspectives of end users on the features, current use, and acceptance of nutrition and diet mHealth apps with a survey. We expect that this study can provide user insights to assist researchers and developers in achieving innovative dietary assessments. Methods: A multidisciplinary team designed and compiled the survey. Before its release, it was pilot-tested by 18 end users. A 19-question survey was finally developed and was translated into six languages: English, German, French, Spanish, Italian, and Greek. The participants were mainly recruited via social media platforms and mailing lists of universities, university hospitals, and patient associations. Results: A total of 2382 respondents (1891 female, 79.4%; 474 male, 19.9%; and 17 neither, 0.7%) with a mean age of 27.2 years (SD 8.5) completed the survey. Approximately half of the participants (1227/2382, 51.5%) had used a nutrition and diet app. The primary criteria for selecting such an app were ease of use (1570/2382, 65.9%), free cost (1413/2382, 59.3%), and ability to produce automatic readings of caloric content (1231/2382, 51.7%) and macronutrient content (1117/2382, 46.9%) (ie, food type and portion size are estimated by the system without any contribution from the user). An app was less likely to be selected if it incorrectly estimated portion size, calories, or nutrient content (798/2382, 33.5%). Other important limitations included the use of a database that does not include local foods (655/2382, 27.5%) or that may omit major foods (977/2382, 41%). Conclusions: This comprehensive study in a mostly European population assessed the preferences and perspectives of potential nutrition and diet app users. Understanding user needs will benefit researchers who develop tools for innovative dietary assessment as well as those who assist research on behavioral changes related to nutrition. %M 34328425 %R 10.2196/27885 %U https://mhealth.jmir.org/2021/7/e27885 %U https://doi.org/10.2196/27885 %U http://www.ncbi.nlm.nih.gov/pubmed/34328425 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e31013 %T Practitioners’ and Policymakers’ Successes, Challenges, Innovations, and Learning in Promoting Children’s Well-being During COVID-19: Protocol for a Multinational Smartphone App Survey %A Davidson,Jennifer C %A Karadzhov,Dimitar %A Wilson,Graham %+ Institute for Inspiring Children's Futures, School of Social Work and Social Policy, University of Strathclyde, Curran Building, Level 6, 94 Cathedral Street, Glasgow, G4 0LG, United Kingdom, 44 141 444 8513, jennifer.davidson@strath.ac.uk %K mobile phones %K smartphone app %K qualitative %K mixed method %K international %K survey %K service providers %K policy %K practice %K children’s rights %K well-being %K COVID-19 %K pandemic %K app %K mHealth %K children %D 2021 %7 29.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The advent of COVID-19 abruptly thrust the health and safety of children and families into greater risk around the world. As regional and local governments, nongovernmental organizations, communities, families, and children grapple with the immediate public health impact of COVID-19, the rights and well-being of children, especially those who are already marginalized, have been overlooked. Those working with children have likely encountered unprecedented challenges and responded in innovative ways in efforts to address the needs and rights of all children. Objective: This paper presents a protocol for a large-scale, multinational study using a new smartphone app to capture the real-time experiences and perspectives of practitioners and policymakers supporting children and families during the COVID-19 pandemic around the globe in relation to a children’s human rights 4P framework of protection, provision, prevention, and participation. Methods: This protocol describes a mixed methods survey utilizing a custom-built iOS and Android smartphone app called the COVID 4P Log for Children’s Wellbeing, which was developed in close consultation with 17 international key partner organizations. Practitioners and policymakers working with and for children’s well-being across 29 countries and 5 continents were invited to download the app and respond to questions over the course of 8 weeks. The anticipated large amount of qualitative and quantitative response data will be analyzed using content analysis, descriptive statistics, and word frequencies. Results: Formal data collection took place from October 2020 until March 2021. Data analysis was completed in July 2021. Conclusions: The findings will directly inform the understanding of the ways in which COVID-19 has impacted practitioners’, managers’, and policymakers’ efforts to support children’s well-being in their practices, services, and policies, respectively. Innovative and ambitious in its scope and use of smartphone technology, this project also aims to inform and inspire future multinational research using app-based methodologies—the demand for which is likely to continue to dramatically rise in the COVID-19 era. Mitigating the risks of longitudinal remote data collection will help maximize the acceptability of the app, respondents’ sustained engagement, and data quality. International Registered Report Identifier (IRRID): DERR1-10.2196/31013 %M 34323850 %R 10.2196/31013 %U https://www.researchprotocols.org/2021/7/e31013 %U https://doi.org/10.2196/31013 %U http://www.ncbi.nlm.nih.gov/pubmed/34323850 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e29952 %T Measuring the Impact of COVID-19 on Siyan Mental Health Patients Using the Epidemic-Pandemic Impacts Inventory: Survey Study %A Shah,Anish %A Darling,Michele %A Arstein-Kerslake,Olivia %A Morgan,Tiffany %A Vance Tovrea,Aubreen %A Young,James %A Laines,Helen %+ Siyan Clinical Corporation, 480 Tesconi Cir B, Santa Rosa, CA, 95401, United States, 1 707 206 7273, ashah@siyanclinical.com %K COVID-19 %K coronavirus %K pandemic %K mental health %K social isolation %K wellness %D 2021 %7 29.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Recent research has shown that the impacts of the COVID-19 pandemic and social isolation on people’s mental health are quite extensive, but there are limited studies on the effects of the pandemic on patients with mental health disorders. Objective: The objective of this study was to assess the negative impacts of the COVID-19 pandemic on individuals who have previously sought treatment for a mental health disorder. Methods: This study uses the newly developed Epidemic-Pandemic Impacts Inventory (EPII) survey. This tool was designed to assess tangible impacts of epidemics and pandemics across personal and social life domains. From November 9, 2020, to February 18, 2021, a total of 245 adults recruited from a mental health clinic completed the consent form and responded to the survey link from the Siyan Clinical Corporation and Siyan Clinical Research practices located in Santa Rosa, California, USA. Results: We found that the least affected age group included individuals aged 75 years or older. This was followed closely by the 65- to 75-year-old age group. People with children under the age of 18 years also reported both more negative indicators associated with the pandemic and more positive indicators compared to those without children at home. Gender queer, nonconforming, and transgender individuals may also be at higher risk for more negative impacts associated with the pandemic. When respondents were assessed with regard to their mental health diagnosis, no differences were noted. Substance use also increased during the pandemic. Conclusions: In conclusion, the data collected here may serve as foundational research in the prevention, care, and treatment of mental health disorders during pandemics such as COVID-19. Populations such as those with previously diagnosed mental health disorders are particularly at risk for negative effects of pandemic-related stressors such as social isolation, especially if they have children in the household, are part of a younger age group, or have substance use disorder. Gender may also be a factor. Further, the EPII survey may prove to be a useful tool in understanding these effects. Overall, these data may be a critical step toward understanding the effects of the COVID-19 pandemic on populations with a mental health diagnosis, which may aid mental health practitioners in understanding the consequences of pandemics on their patients’ overall well-being. Trial Registration: ClinicalTrials.gov NCT04568135; https://clinicaltrials.gov/ct2/show/NCT04568135 %M 34323851 %R 10.2196/29952 %U https://formative.jmir.org/2021/7/e29952 %U https://doi.org/10.2196/29952 %U http://www.ncbi.nlm.nih.gov/pubmed/34323851 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e25973 %T Turn on, Tune in, and Drop out: Predictors of Attrition in a Prospective Observational Cohort Study on Psychedelic Use %A Hübner,Sebastian %A Haijen,Eline %A Kaelen,Mendel %A Carhart-Harris,Robin Lester %A Kettner,Hannes %+ Centre for Psychedelic Research, Imperial College London, Du Cane Rd, Burlington Danes Building, London, W12 0TY, United Kingdom, 44 020 7589 5111, hannes.kettner17@imperial.ac.uk %K attrition %K digital data %K dropout %K educational level %K personality %K psychedelics %K web-based research %K web-based survey %D 2021 %7 28.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The resurgence of research and public interest in the positive psychological effects of psychedelics, together with advancements in digital data collection techniques, have brought forth a new type of research design, which involves prospectively gathering large-scale naturalistic data from psychedelic users; that is, before and after the use of a psychedelic compound. A methodological limitation of such studies is their high attrition rate, particularly owing to participants who stop responding after initial study enrollment. Importantly, study dropout can introduce systematic biases that may affect the interpretability of results. Objective: Based on a previously collected sample (baseline n=654), here we investigated potential determinants of study attrition in web-based prospective studies on psychedelic use. Methods: Logistic regression models were used to examine demographic, psychological trait and state, and psychedelic-specific predictors of dropout. Predictors were assessed 1 week before, 1 day after, and 2 weeks after psychedelic use, with attrition being defined as noncompletion of the key endpoint 4 weeks post experience. Results: Predictors of attrition were found among demographic variables including age (β=0.024; P=.007) and educational levels, as well as personality traits, specifically conscientiousness (β=–0.079; P=.02) and extraversion (β=0.082; P=.01). Contrary to prior hypotheses, neither baseline attitudes toward psychedelics nor the intensity of acute challenging experiences were predictive of dropout. Conclusions: The baseline predictors of attrition identified here are consistent with those reported in longitudinal studies in other scientific disciplines, suggesting their transdisciplinary relevance. Moreover, the lack of an association between attrition and psychedelic advocacy or negative drug experiences in our sample contextualizes concerns about problematic biases in these and related data. %M 34319246 %R 10.2196/25973 %U https://www.jmir.org/2021/7/e25973 %U https://doi.org/10.2196/25973 %U http://www.ncbi.nlm.nih.gov/pubmed/34319246 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e26297 %T Development of a Mobile App for Ecological Momentary Assessment of Circadian Data: Design Considerations and Usability Testing %A Woolf,Thomas B %A Goheer,Attia %A Holzhauer,Katherine %A Martinez,Jonathan %A Coughlin,Janelle W %A Martin,Lindsay %A Zhao,Di %A Song,Shanshan %A Ahmad,Yanif %A Sokolinskyi,Kostiantyn %A Remayeva,Tetyana %A Clark,Jeanne M %A Bennett,Wendy %A Lehmann,Harold %+ Department of Physiology, Johns Hopkins University School of Medicine, 725 N Wolfe St, Baltimore, MD, 21205, United States, 1 410 416 2643, twoolf@jhu.edu %K mhealth %K circadian %K sleep %K ecological momentary assessment %K timing of eating %K mobile applications %K habits %K body weight %K surveys and questionnaires %D 2021 %7 23.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Collecting data on daily habits across a population of individuals is challenging. Mobile-based circadian ecological momentary assessment (cEMA) is a powerful frame for observing the impact of daily living on long-term health. Objective: In this paper, we (1) describe the design, testing, and rationale for specifications of a mobile-based cEMA app to collect timing of eating and sleeping data and (2) compare cEMA and survey data collected as part of a 6-month observational cohort study. The ultimate goal of this paper is to summarize our experience and lessons learned with the Daily24 mobile app and to highlight the pros and cons of this data collection modality. Methods: Design specifications for the Daily24 app were drafted by the study team based on the research questions and target audience for the cohort study. The associated backend was optimized to provide real-time data to the study team for participant monitoring and engagement. An external 8-member advisory board was consulted throughout the development process, and additional test users recruited as part of a qualitative study provided feedback through in-depth interviews. Results: After ≥4 days of at-home use, 37 qualitative study participants provided feedback on the app. The app generally received positive feedback from test users for being fast and easy to use. Test users identified several bugs and areas where modifications were necessary to in-app text and instructions and also provided feedback on the engagement strategy. Data collected through the mobile app captured more variability in eating windows than data collected through a one-time survey, though at a significant cost. Conclusions: Researchers should consider the potential uses of a mobile app beyond the initial data collection when deciding whether the time and monetary expenditure are advisable for their situation and goals. %M 34296999 %R 10.2196/26297 %U https://formative.jmir.org/2021/7/e26297 %U https://doi.org/10.2196/26297 %U http://www.ncbi.nlm.nih.gov/pubmed/34296999 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e27891 %T Associations Between Physiological Signals Captured Using Wearable Sensors and Self-reported Outcomes Among Adults in Alcohol Use Disorder Recovery: Development and Usability Study %A Alinia,Parastoo %A Sah,Ramesh Kumar %A McDonell,Michael %A Pendry,Patricia %A Parent,Sara %A Ghasemzadeh,Hassan %A Cleveland,Michael John %+ Department of Human Development, Washington State University, 501 Johnson Tower, Pullman, WA, 99164, United States, 1 509 335 2870, michael.cleveland@wsu.edu %K alcohol relapse prevention %K stress markers %K alcohol consumption %K electrodermal activity %K heart rate variability %K emotion %K mobile phone %D 2021 %7 21.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Previous research has highlighted the role of stress in substance misuse and addiction, particularly for relapse risk. Mobile health interventions that incorporate real-time monitoring of physiological markers of stress offer promise for delivering tailored interventions to individuals during high-risk states of heightened stress to prevent alcohol relapse. Before such interventions can be developed, measurements of these processes in ambulatory, real-world settings are needed. Objective: This research is a proof-of-concept study to establish the feasibility of using a wearable sensor device to continuously monitor stress in an ambulatory setting. Toward that end, we first aimed to examine the quality of 2 continuously monitored physiological signals—electrodermal activity (EDA) and heart rate variability (HRV)—and show that the data follow standard quality measures according to the literature. Next, we examined the associations between the statistical features extracted from the EDA and HRV signals and self-reported outcomes. Methods: Participants (N=11; female: n=10) were asked to wear an Empatica E4 wearable sensor for continuous unobtrusive physiological signal collection for up to 14 days. During the same time frame, participants responded to a daily diary study using ecological momentary assessment of self-reported stress, emotions, alcohol-related cravings, pain, and discomfort via a web-based survey, which was conducted 4 times daily. Participants also participated in structured interviews throughout the study to assess daily alcohol use and to validate self-reported and physiological stress markers. In the analysis, we first used existing artifact detection methods and physiological signal processing approaches to assess the quality of the physiological data. Next, we examined the descriptive statistics for self-reported outcomes. Finally, we investigated the associations between the features of physiological signals and self-reported outcomes. Results: We determined that 87.86% (1,032,265/1,174,898) of the EDA signals were clean. A comparison of the frequency of skin conductance responses per minute with previous research confirmed that the physiological signals collected in the ambulatory setting were successful. The results also indicated that the statistical features of the EDA and HRV measures were significantly correlated with the self-reported outcomes, including the number of stressful events marked on the sensor device, positive and negative emotions, and experienced pain and discomfort. Conclusions: The results demonstrated that the physiological data collected via an Empatica E4 wearable sensor device were consistent with previous literature in terms of the quality of the data and that features of these physiological signals were significantly associated with several self-reported outcomes among a sample of adults diagnosed with alcohol use disorder. These results suggest that ambulatory assessment of stress is feasible and can be used to develop tailored mobile health interventions to enhance sustained recovery from alcohol use disorder. %M 34287205 %R 10.2196/27891 %U https://formative.jmir.org/2021/7/e27891 %U https://doi.org/10.2196/27891 %U http://www.ncbi.nlm.nih.gov/pubmed/34287205 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 3 %P e30730 %T Strategies for the Identification and Prevention of Survey Fraud: Data Analysis of a Web-Based Survey %A Pratt-Chapman,Mandi %A Moses,Jenna %A Arem,Hannah %+ GW Cancer Center, The George Washington University, 2600 Virginia Ave, #300, Washington, DC, 20037, United States, 1 202 994 5502, mandi@email.gwu.edu %K cancer survivors %K pandemic %K COVID-19 %K fraudulent responses %K survey %K research methods %K cancer patients %K fraud %K CAPTCHA %K data integrity %K online surveys %D 2021 %7 16.7.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: To assess the impact of COVID-19 on cancer survivors, we fielded a survey promoted via email and social media in winter 2020. Examination of the data showed suspicious patterns that warranted serious review. Objective: The aim of this paper is to review the methods used to identify and prevent fraudulent survey responses. Methods: As precautions, we included a Completely Automated Public Turing test to tell Computers and Humans Apart (CAPTCHA), a hidden question, and instructions for respondents to type a specific word. To identify likely fraudulent data, we defined a priori indicators that warranted elimination or suspicion. If a survey contained two or more suspicious indicators, the survey was eliminated. We examined differences between the retained and eliminated data sets. Results: Of the total responses (N=1977), nearly three-fourths (n=1408) were dropped and one-fourth (n=569) were retained after data quality checking. Comparisons of the two data sets showed statistically significant differences across almost all demographic characteristics. Conclusions: Numerous precautions beyond the inclusion of a CAPTCHA are needed when fielding web-based surveys, particularly if a financial incentive is offered. %M 34269685 %R 10.2196/30730 %U https://cancer.jmir.org/2021/3/e30730 %U https://doi.org/10.2196/30730 %U http://www.ncbi.nlm.nih.gov/pubmed/34269685 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e23959 %T Recruitment and Retention Strategies Among Racial and Ethnic Minorities in Web-Based Intervention Trials: Retrospective Qualitative Analysis %A Hwang,DaSol Amy %A Lee,Alex %A Song,Jae Min %A Han,Hae-Ra %+ Johns Hopkins University School of Nursing, 525 N Wolfe St, Room 533, Baltimore, MD, 21205, United States, 1 410 614 2669, hhan3@jh.edu %K recruitment and retention %K web-based intervention %K clinical trial %K Korean American %K racial/ethnic minority %D 2021 %7 12.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Racial and ethnic minority groups are underrepresented in health research, contributing to persistent health disparities in the United States. Identifying effective recruitment and retention strategies among minority groups and their subpopulations is an important research agenda. Web-based intervention approaches are becoming increasingly popular with the ubiquitous use of the internet. However, it is not completely clear which recruitment and retention strategies have been successful in web-based intervention trials targeting racial and ethnic minorities. Objective: This study aims to describe lessons learned in recruiting and retaining one of the understudied ethnic minority women—Korean Americans—enrolled in a web-based intervention trial and to compare our findings with the strategies reported in relevant published web-based intervention trials. Methods: Multiple sources of data were used to address the objectives of this study, including the study team’s meeting minutes, participant tracking and contact logs, survey reports, and postintervention interviews. In addition, an electronic search involving 2 databases (PubMed and CINAHL) was performed to identify published studies using web-based interventions. Qualitative analysis was then performed to identify common themes addressing recruitment and retention strategies across the trials using web-based intervention modalities. Results: A total of 9 categories of recruitment and retention strategies emerged: authentic care; accommodation of time, place, and transportation; financial incentives; diversity among the study team; multiple, yet standardized modes of communication; mobilizing existing community relationships with efforts to build trust; prioritizing features of web-based intervention; combined use of web-based and direct recruitment; and self-directed web-based intervention with human support. Although all the studies included in the analysis combined multiple strategies, prioritizing features of web-based intervention or use of human support were particularly relevant for promoting recruitment and retention of racial and ethnic minorities in web-based intervention trials. Conclusions: The growing prevalence of internet use among racial and ethnic minority populations represents an excellent opportunity to design and deliver intervention programs via the internet. Future research should explore and compare successful recruitment and retention methods among race and ethnic groups for web-based interventions. Trial Registration: ClinicalTrials.gov NCT03726619; https://clinicaltrials.gov/ct2/show/NCT03726619. %M 34255658 %R 10.2196/23959 %U https://www.jmir.org/2021/7/e23959 %U https://doi.org/10.2196/23959 %U http://www.ncbi.nlm.nih.gov/pubmed/34255658 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e28656 %T Social Media as a Platform for Recruitment to a National Survey During the COVID-19 Pandemic: Feasibility and Cost Analysis %A Green,Heidi %A Fernandez,Ritin %A MacPhail,Catherine %+ School of Nursing, University of Wollongong, Northfields Ave, 2522, Wollongong, Australia, 61 0412108532, Heidi.Lord@health.nsw.gov.au %K social media %K survey %K online recruitment %K COVID-19 %K pandemic %K methodology %D 2021 %7 6.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: With improved accessibility to social media globally, health researchers are capitalizing on social media platforms to recruit participants for research studies. This has particularly been the case during the COVID-19 pandemic, when researchers were not able to use traditional methods of recruitment. Nevertheless, there is limited evidence on the feasibility of social media for recruiting a national sample. Objective: This paper describes the use of social media as a tool for recruiting a national sample of adults to a web-based survey during the COVID-19 pandemic. Methods: Between August and October 2020, participants were recruited through Facebook via two advertisement campaigns (paid option and no-cost option) into a web-based survey exploring the relationship between social determinants of health and well-being of adults during the COVID-19 pandemic. Data were analyzed using SPSS software and Facebook metrics that were autogenerated by Facebook Ads Manager. Poststratification weights were calculated to match the Australian population on the basis of gender, age, and state or territory based on the 2016 Australian census data. Results: In total, 9594 people were reached nationally with the paid option and potentially 902,000 people were reached through the no-cost option, resulting in a total of 1211 survey responses. The total cost of the advertisement campaign was Aus $649.66 (US $489.23), resulting in an overall cost per click of Aus $0.25 (US $0.19). Conclusions: Facebook is a feasible and cost-effective method of recruiting participants for a web-based survey, enabling recruitment of population groups that are considered hard to reach or marginalized. Recruitment through Facebook facilitated diversity, with participants varying in socioeconomic status, geographical location, educational attainment, and age. %M 34133315 %R 10.2196/28656 %U https://formative.jmir.org/2021/7/e28656 %U https://doi.org/10.2196/28656 %U http://www.ncbi.nlm.nih.gov/pubmed/34133315 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e27502 %T Chemotherapy-Induced Peripheral Neuropathy Detection via a Smartphone App: Cross-sectional Pilot Study %A Chen,Ciao-Sin %A Kim,Judith %A Garg,Noemi %A Guntupalli,Harsha %A Jagsi,Reshma %A Griggs,Jennifer J %A Sabel,Michael %A Dorsch,Michael P %A Callaghan,Brian C %A Hertz,Daniel L %+ Department of Clinical Pharmacy, University of Michigan College of Pharmacy, 428 Church St., Room 2560C, Ann Arbor, MI, 48109-1065, United States, 1 7347630015, dlhertz@med.umich.edu %K chemotherapy-induced peripheral neuropathy %K smartphone %K mobile health %K gait %K balance %K 9-Hole Peg Test %D 2021 %7 5.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Severe chemotherapy-induced peripheral neuropathy (CIPN) can cause long-term dysfunction of the hands and feet, interfere with activities of daily living, and diminish the quality of life. Monitoring to identify CIPN and adjust treatment before it progressing to a life-altering severity relies on patients self-reporting subjective symptoms to their clinical team. Objective assessment is not a standard component of CIPN monitoring due to the requirement for specially trained health care professionals and equipment. Smartphone apps have the potential to conveniently collect both subjective and objective CIPN data directly from patients, which could improve CIPN monitoring. Objective: The objective of this cross-sectional pilot study was to assess the feasibility of functional CIPN assessment via a smartphone app in patients with cancer that have received neurotoxic chemotherapy. Methods: A total of 26 patients who had completed neurotoxic chemotherapy were enrolled and classified as CIPN cases (n=17) or controls (n=9) based on self-report symptoms. All participants completed CIPN assessments within the NeuroDetect app a single time, including patient-reported surveys (CIPN20 [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Chemotherapy-induced Peripheral Neuropathy 20-item scale] and PRO-CTCAE [Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events]) and functional assessments (Gait and Balance and 9-Hole Peg Test). Functional assessment data were decomposed into features. The primary analysis was done to identify features indicative of the difference between CIPN cases and controls using partial least squares analyses. Exploratory analyses were performed to test if any features were associated with specific symptom subtypes or patient-reported survey scores. Patient interviews were also conducted to understand the challenges they experienced with the app. Results: Comparisons between CIPN cases and controls indicate that CIPN cases had shorter step length (P=.007), unique swaying acceleration patterns during a walking task, and shorter hand moving distance in the dominant hands during a manual dexterity task (variable importance in projection scores ≥2). Exploratory analyses showed similar signatures associated with symptoms subtypes, CIPN20, and PRO-CTCAE. The interview results showed that some patients had difficulties due to technical issues, which indicated a need for additional training or oversight during the initial app download. Conclusions: Our results supported the feasibility of remote CIPN assessment via a smartphone app and suggested that functional assessments may indicate CIPN manifestations in the hands and feet. Additional work is needed to determine which functional assessments are most indicative of CIPN and could be used for CIPN monitoring within clinical care. %M 36260403 %R 10.2196/27502 %U https://mhealth.jmir.org/2021/7/e27502 %U https://doi.org/10.2196/27502 %U http://www.ncbi.nlm.nih.gov/pubmed/36260403 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e25850 %T Studying Microtemporal, Within-Person Processes of Diet, Physical Activity, and Related Factors Using the APPetite-Mobile-App: Feasibility, Usability, and Validation Study %A Ruf,Alea %A Koch,Elena Doris %A Ebner-Priemer,Ulrich %A Knopf,Monika %A Reif,Andreas %A Matura,Silke %+ Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Heinrich-Hoffmann-Straße 10, Frankfurt, 60528, Germany, 49 69 6301 83348, alea.ruf@kgu.de %K diet %K physical activity %K microtemporal processes %K within-person factors %K ecological momentary assessment %K smartphone-app %K mobile phone %K mHealth %K dietary assessment %K feasibility %K usability %K validity %D 2021 %7 5.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Diet and physical activity (PA) have a major impact on physical and mental health. However, there is a lack of effective strategies for sustaining these health-protective behaviors. A shift to a microtemporal, within-person approach is needed to capture dynamic processes underlying eating behavior and PA, as they change rapidly across minutes or hours and differ among individuals. However, a tool that captures these microtemporal, within-person processes in daily life is currently not present. Objective: The APPetite-mobile-app is developed for the ecological momentary assessment of microtemporal, within-person processes of complex dietary intake, objectively recorded PA, and related factors. This study aims to evaluate the feasibility and usability of the APPetite-mobile-app and the validity of the incorporated APPetite-food record. Methods: The APPetite-mobile-app captures dietary intake event-contingently through a food record, captures PA continuously through accelerometers, and captures related factors (eg, stress) signal-contingently through 8 prompts per day. Empirical data on feasibility (n=157), usability (n=84), and validity (n=44) were collected within the Eat2beNICE-APPetite-study. Feasibility and usability were examined in healthy participants and psychiatric patients. The relative validity of the APPetite-food record was assessed with a subgroup of healthy participants by using a counterbalanced crossover design. The reference method was a 24-hour recall. In addition, the energy intake was compared with the total energy expenditure estimated from accelerometry. Results: Good feasibility, with compliance rates above 80% for prompts and the accelerometer, as well as reasonable average response and recording durations (prompt: 2.04 min; food record per day: 17.66 min) and latencies (prompts: 3.16 min; food record: 58.35 min) were found. Usability was rated as moderate, with a score of 61.9 of 100 on the System Usability Scale. The evaluation of validity identified large differences in energy and macronutrient intake between the two methods at the group and individual levels. The APPetite-food record captured higher dietary intakes, indicating a lower level of underreporting, compared with the 24-hour recall. Energy intake was assessed fairly accurately by the APPetite-food record at the group level on 2 of 3 days when compared with total energy expenditure. The comparison with mean total energy expenditure (2417.8 kcal, SD 410) showed that the 24-hour recall (1909.2 kcal, SD 478.8) underestimated habitual energy intake to a larger degree than the APPetite-food record (2146.4 kcal, SD 574.5). Conclusions: The APPetite-mobile-app is a promising tool for capturing microtemporal, within-person processes of diet, PA, and related factors in real time or near real time and is, to the best of our knowledge, the first of its kind. First evidence supports the good feasibility and moderate usability of the APPetite-mobile-app and the validity of the APPetite-food record. Future findings in this context will build the foundation for the development of personalized lifestyle modification interventions, such as just-in-time adaptive interventions. %M 34342268 %R 10.2196/25850 %U https://www.jmir.org/2021/7/e25850 %U https://doi.org/10.2196/25850 %U http://www.ncbi.nlm.nih.gov/pubmed/34342268 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e26571 %T A Data-Free Digital Platform to Reach Families With Young Children During the COVID-19 Pandemic: Online Survey Study %A Richter,Linda Marleine %A Naicker,Sara Naomi %+ DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Office 154 First Floor East Wing, Wits School of Public Health, Education Campus, 27 St Andrews Road, Parktown, Johannesburg, 2193, South Africa, 27 117172382, linda.richter@wits.ac.za %K families %K parenting %K children %K COVID-19 %K digital %K survey %K data-free %D 2021 %7 28.6.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The COVID-19 pandemic and containment measures have severely affected families around the world. It is frequently assumed that digital technologies can supplement and perhaps even replace services for families. This is challenging in conditions of high device and data costs as well as poor internet provision and access, raising concerns about widening inequalities in availability of support and consequent effects on child and family outcomes. Very few studies have examined these issues, including in low- and middle-income countries. Objective: The study objectives were two-fold. The first objective was to gather data on the impact of the COVID-19 pandemic on families of young children using an online survey. The second objective was to assess the feasibility of using a data-free online platform to conduct regular surveys and, potentially, to provide support for parents and families of young children in South Africa. Methods: We used a data-free mobile messenger platform to conduct a short digital survey of the impact of the COVID-19 pandemic on caring for young children in South Africa. We report on the methodological processes and preliminary findings of the online survey. Results: More than 44,000 individuals accessed the survey link and 16,217 consented to the short survey within 96 hours of its launch. Respondents were predominantly from lower classes and lower-middle classes, representing the majority of the population, with urban residential locations roughly proportionate to national patterns and some underrepresentation of rural households. Mothers comprised 70.2% (11,178/15,912) of respondents and fathers comprised 29.8% (4734/15,912), representing 18,672 children 5 years of age and younger. Response rates per survey item ranged from 74.8% (11,907/15,912) at the start of the survey to 50.3% (8007/15,912) at completion. A total of 82.0% (12,729/15,912) of parents experienced at least one challenge during the pandemic, and 32.4% (2737/8441) did not receive help when needed from listed sources. Aggregate and individual findings in the form of bar graphs were made available to participants to view and download once they had completed the survey. Participants were also able to download contact details for support and referral services at no data cost. Conclusions: Data-free survey methodology breaks new ground and demonstrates potential not previously considered. Reach is greater than achieved through phone surveys and some social media platforms, men are not usually included in parent surveys, costs are lower than phone surveys, and the technology allows for immediate feedback to respondents. These factors suggest that zero-rated, or no-cost, services could provide a feasible, sustainable, and equitable basis for ongoing interactions with families of young children. %M 33852414 %R 10.2196/26571 %U https://pediatrics.jmir.org/2021/2/e26571 %U https://doi.org/10.2196/26571 %U http://www.ncbi.nlm.nih.gov/pubmed/33852414 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e29733 %T The Impact of COVID-19 Vaccine Communication, Acceptance, and Practices (CO-VIN-CAP) on Vaccine Hesitancy in an Indian Setting: Protocol for a Cross-sectional Study %A Surapaneni,Krishna Mohan %A Kaur,Mahima %A Kaur,Ritika %A Grover,Ashoo %A Joshi,Ashish %+ Panimalar Medical College Hospital & Research Institute, Varadharajapuram, Poonamallee, Tamil Nadu, Chennai, 600123, India, 91 9789099989, krishnamohan.surapaneni@gmail.com %K COVID-19 vaccine %K vaccine hesitancy %K vaccine acceptance %K unintended consequences %K vaccination %K COVID-19 %K pandemic %K coronavirus %K infectious disease %K protocol %K vaccine %D 2021 %7 24.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: COVID-19 vaccines are considered to be a key to limiting and eliminating the infectious disease. However, the success of the vaccination program will rely on the rates of vaccine acceptance among the population. Objective: This study aims to examine the factors that influence vaccine hesitancy and vaccine acceptance, and to explore the unintended consequences of COVID-19 infections. The study will further explore the association between sociodemographic characteristics; health status; COVID-19–related knowledge, attitude, and practices; and its influence on vaccine hesitancy and acceptance among individuals living in urban and rural settings of Chennai, Tamil Nadu in the southern state of India. Methods: A cross-sectional study will be conducted between January 2021 and January 2023. A sample of approximately 25,000 individuals will be recruited and enrolled using a nonprobability complete enumeration sampling method from 11 selected urban and rural settings of Chennai. The data will be collected at one time point by administering the questionnaire to the eligible study participants. The collected data will be used to assess the rates of vaccine acceptance; hesitancy; and knowledge, attitudes, practices, and beliefs regarding COVID-19 and COVID-19 vaccines. Lastly, the study questionnaire will be used to assess the unintended consequences of COVID-19 infection. Results: A pilot of 2500 individuals has been conducted to pretest the survey questionnaire. The data collection was initiated on March 1, 2021, and the initial results are planned for publication by June 2021. Descriptive analysis of the gathered data will be performed using SAS v9.1, and reporting of the results will be done at 95% CIs and P=.049. The study will help explore the burden of vaccine acceptance and hesitancy among individuals living in urban and rural settings of Chennai. Further, it will help to examine the variables that influence vaccine acceptance and hesitancy. Lastly, the findings will help to design and develop a user-centered informatics platform that can deliver multimedia-driven health education modules tailored to facilitate vaccine uptake in varied settings. Conclusions: The proposed study will help in understanding the rate and determinants of COVID-19 vaccine acceptance and hesitancy among the population of Chennai. The findings of the study would further facilitate the development of a multifaceted intervention to enhance vaccine acceptance among the population. International Registered Report Identifier (IRRID): DERR1-10.2196/29733 %R 10.2196/29733 %U https://www.researchprotocols.org/2021/6/e29733/ %U https://doi.org/10.2196/29733 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 6 %P e27140 %T Indications of Depressive Symptoms During the COVID-19 Pandemic in Germany: Comparison of National Survey and Twitter Data %A Cohrdes,Caroline %A Yenikent,Seren %A Wu,Jiawen %A Ghanem,Bilal %A Franco-Salvador,Marc %A Vogelgesang,Felicitas %+ Mental Health Research Unit, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, Berlin, 12101, Germany, 49 30 18754 2692, CohrdesC@rki.de %K depressive symptoms %K GEDA/EHIS survey %K Twitter %K COVID-19 %K pandemic %K social contact ban %K temporal progression %K data correspondence %K public mental health surveillance %K depression %K survey %K social media %K data %K infodemiology %K infoveillance %K twitter %K mental health %K public health %K surveillance %K monitoring %K symptom %D 2021 %7 18.6.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The current COVID-19 pandemic is associated with extensive individual and societal challenges, including challenges to both physical and mental health. To date, the development of mental health problems such as depressive symptoms accompanying population-based federal distancing measures is largely unknown, and opportunities for rapid, effective, and valid monitoring are currently a relevant matter of investigation. Objective: In this study, we aim to investigate, first, the temporal progression of depressive symptoms during the COVID-19 pandemic and, second, the consistency of the results from tweets and survey-based self-reports of depressive symptoms within the same time period. Methods: Based on a cross-sectional population survey of 9011 German adolescents and adults (n=4659, 51.7% female; age groups from 15 to 50 years and older) and a sample of 88,900 tweets (n=74,587, 83.9% female; age groups from 10 to 50 years and older), we investigated five depressive symptoms (eg, depressed mood and energy loss) using items from the Patient Health Questionnaire (PHQ-8) before, during, and after relaxation of the first German social contact ban from January to July 2020. Results: On average, feelings of worthlessness were the least frequently reported symptom (survey: n=1011, 13.9%; Twitter: n=5103, 5.7%) and fatigue or loss of energy was the most frequently reported depressive symptom (survey: n=4472, 51.6%; Twitter: n=31,005, 34.9%) among both the survey and Twitter respondents. Young adult women and people living in federal districts with high COVID-19 infection rates were at an increased risk for depressive symptoms. The comparison of the survey and Twitter data before and after the first contact ban showed that German adolescents and adults had a significant decrease in feelings of fatigue and energy loss over time. The temporal progression of depressive symptoms showed high correspondence between both data sources (ρ=0.76-0.93; P<.001), except for diminished interest and depressed mood, which showed a steady increase even after the relaxation of the contact ban among the Twitter respondents but not among the survey respondents. Conclusions: Overall, the results indicate relatively small differences in depressive symptoms associated with social distancing measures during the COVID-19 pandemic and highlight the need to differentiate between positive (eg, energy level) and negative (eg, depressed mood) associations and variations over time. The results also underscore previous suggestions of Twitter data’s potential to help identify hot spots of declining and improving public mental health and thereby help provide early intervention measures, especially for young and middle-aged adults. Further efforts are needed to investigate the long-term consequences of recurring lockdown phases and to address the limitations of social media data such as Twitter data to establish real-time public mental surveillance approaches. %M 34142973 %R 10.2196/27140 %U https://mental.jmir.org/2021/6/e27140 %U https://doi.org/10.2196/27140 %U http://www.ncbi.nlm.nih.gov/pubmed/34142973 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e23976 %T A Rapid Assessment of the Impact of COVID-19 on Asian Americans: Cross-sectional Survey Study %A Quach,Thu %A Ðoàn,Lan N %A Liou,Julia %A Ponce,Ninez A %+ Asian Health Services, 101 8th Street, Suite 100, Oakland, CA, 94607, United States, 1 510 735 3179, tquach@ahschc.org %K COVID-19 %K Asian American %K testing %K mental health %K barrier %K behavior %K impact %K discrimination %K inequality %K disparity %K experience %K COVID %K violence %K culture %K stress %K anti-Asian violence %D 2021 %7 11.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The diverse Asian American population has been impacted by the COVID-19 pandemic, but due to limited data and other factors, disparities experienced by this population are hidden. Objective: This study aims to describe the Asian American community’s experiences during the COVID-19 pandemic, focusing on the Greater San Francisco Bay Area, California, and to better inform a Federally Qualified Health Center’s (FQHC) health care services and response to challenges faced by the community. Methods: We conducted a cross-sectional survey between May 20 and June 23, 2020, using a multipronged recruitment approach, including word-of-mouth, FQHC patient appointments, and social media posts. The survey was self-administered online or administered over the phone by FQHC staff in English, Cantonese, Mandarin, and Vietnamese. Survey question topics included COVID-19 testing and preventative behaviors, economic impacts of COVID-19, experience with perceived mistreatment due to their race/ethnicity, and mental health challenges. Results: Among 1297 Asian American respondents, only 3.1% (39/1273) had previously been tested for COVID-19, and 46.6% (392/841) stated that they could not find a place to get tested. In addition, about two-thirds of respondents (477/707) reported feeling stressed, and 22.6% (160/707) reported feeling depressed. Furthermore, 5.6% (72/1275) of respondents reported being treated unfairly because of their race/ethnicity. Among respondents who experienced economic impacts from COVID-19, 32.2% (246/763) had lost their regular jobs and 22.5% (172/763) had reduced hours or reduced income. Additionally, 70.1% (890/1269) of respondents shared that they avoid leaving their home to go to public places (eg, grocery stores, church, and school). Conclusions: We found that Asian Americans had lower levels of COVID-19 testing and limited access to testing, a high prevalence of mental health issues and economic impacts, and a high prevalence of risk-avoidant behaviors (eg, not leaving the house) in the early months of the COVID-19 pandemic. These findings provide preliminary insights into the impact of the COVID-19 pandemic on Asian American communities served by an FQHC and underscore the longstanding need for culturally and linguistically appropriate approaches to providing mental health, outreach, and education services. These findings led to the establishment of the first Asian multilingual and multicultural COVID-19 testing sites in the local area where the study was conducted, and laid the groundwork for subsequent COVID-19 programs, specifically contact tracing and vaccination programs. %M 34019478 %R 10.2196/23976 %U https://publichealth.jmir.org/2021/6/e23976 %U https://doi.org/10.2196/23976 %U http://www.ncbi.nlm.nih.gov/pubmed/34019478 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e27280 %T Development of the 12-Item Social Media Disinformation Scale and its Association With Social Media Addiction and Mental Health Related to COVID-19 in Tunisia: Survey-Based Pilot Case Study %A Guelmami,Noomen %A Ben Khalifa,Maher %A Chalghaf,Nasr %A Kong,Jude Dzevela %A Amayra,Tannoubi %A Wu,Jianhong %A Azaiez,Fairouz %A Bragazzi,Nicola Luigi %+ Department of Mathematics and Statistics, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 2818392210, robertobragazzi@gmail.com %K COVID-19 pandemic %K media disinformation %K social media addiction %K mental health %K scale validation %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, online disinformation has increased. Fake news has been spreading about the COVID-19 pandemic. Since January 2020, the culprits and antidotes to disinformation have been digital media and social media. Objective: Our study aimed to develop and test the psychometric properties of the 12-item Social Media Disinformation Scale (SMDS-12), which assesses the consumption, confidence, and sharing of information related to COVID-19 by social media users. Methods: A total of 874 subjects were recruited over two phases: the exploratory phase group had a mean age of 28.39 years (SD 9.32) and the confirmatory phase group had a mean age of 32.84 years (SD 12.72). Participants completed the SMDS-12, the Internet Addiction Test, the COVID-19 Fear Scale, and the 10-item Perceived Stress Scale. The SMDS-12 was initially tested by exploratory factor analysis and was subsequently tested by confirmatory factor analysis. Results: The test supported the three-factor structure. In addition, no items were removed from the measurement scale, with three factors explaining up to 73.72% of the total variance, and the items had a lambda factor loading ranging from 0.73 to 0.85. Subsequently, confirmatory factor analysis confirmed the robustness of the measure by referring to a wide range of goodness-of-fit indices that met the recommended standards. The construct validity of the scale was supported by its convergent and discriminant validity. The reliability of the instrument examined by means of three internal consistency indices, and the corrected item-total correlation, demonstrated that the three dimensions of the instrument were reliable: Cronbach α values were .89, .88, and .88 for the consumption, confidence, and sharing subscales, respectively. The corrected item-total correlation ranged from 0.70 to 0.78. The correlation of the instrument’s dimensions with internet addiction and mental health factors showed positive associations. Conclusions: The SMDS-12 can be reliably utilized to measure the credibility of social media disinformation and can be adapted to measure the credibility of disinformation in other contexts. %M 34021742 %R 10.2196/27280 %U https://formative.jmir.org/2021/6/e27280 %U https://doi.org/10.2196/27280 %U http://www.ncbi.nlm.nih.gov/pubmed/34021742 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e24235 %T Factors Influencing Clinicians’ Willingness to Prescribe Pre-exposure Prophylaxis for Persons at High Risk of HIV in China: Cross-sectional Online Survey Study %A Cui,Sitong %A Ding,Haibo %A Huang,Xiaojie %A Wang,Hui %A Tang,Weiming %A Leuba,Sequoia I %A Ye,Zehao %A Jiang,Yongjun %A Geng,Wenqing %A Xu,Junjie %A Shang,Hong %+ NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang, Liaoning Province, 110001, China, 86 8328 2634, hongshang100@hotmail.com %K WeChat %K pre-exposure prophylaxis %K clinicians %K willingness to prescribe %K HIV prevention %K China %D 2021 %7 4.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Pre-exposure prophylaxis (PrEP) is an effective HIV prevention measure. Clinicians play a crucial role in PrEP implementation, and their knowledge, attitudes, and career experience may affect their willingness to prescribe PrEP. However, little is known about the attitudes and willingness of clinicians to prescribe PrEP in countries without PrEP-specific guidelines. Objective: We aimed to determine the factors associated with clinicians being willing to prescribe PrEP in China. Methods: Between May and June 2019, we conducted an online cross-sectional survey of clinicians in 31 provinces across the six administrative regions in China on the WeChat smartphone app platform. Multivariable logistic regression was used to determine factors associated with willingness to prescribe PrEP. Results: Overall, 777 HIV clinicians completed the survey. Most of the respondents had heard of PrEP (563/777, 72.5%), 31.9% (248/777) thought that PrEP was extremely effective for reducing the risk of HIV infection, and 47.2% (367/777) thought that it was necessary to provide PrEP to high-risk groups. After adjusting for age, gender, ethnicity, and educational background of the clinicians, the following factors significantly increased the odds of the clinicians being willing to prescribe PrEP: having worked for more than 10 years, compared to 5 years or less (adjusted odds ratio [aOR] 2.82, 95% CI 1.96-4.05); having treated more than 100 patients living with HIV per month, compared to 50 patients or fewer (aOR 4.16, 95% CI 2.85-6.08); and having heard of PrEP (aOR 7.32, 95% CI 4.88-10.97). Clinicians were less likely to be willing to prescribe PrEP if they were concerned about poor adherence to PrEP (aOR 0.66, 95% CI 0.50-0.88), the lack of PrEP clinical guidelines (aOR 0.47, 95% CI 0.32-0.70), and the lack of drug indications for PrEP (aOR 0.49, 95% CI 0.32-0.76). Conclusions: About half of all clinicians surveyed were willing to prescribe PrEP, but most surveyed had a low understanding of PrEP. Lack of PrEP clinical guidelines, lack of drug indications, and less than 11 years of work experience were the main barriers to the surveyed clinicians’ willingness to prescribe PrEP. Development of PrEP clinical guidelines and drug indications, as well as increasing the availability of PrEP training, could help improve understanding of PrEP among clinicians and, thus, increase the number willing to prescribe PrEP. %M 34085941 %R 10.2196/24235 %U https://publichealth.jmir.org/2021/6/e24235 %U https://doi.org/10.2196/24235 %U http://www.ncbi.nlm.nih.gov/pubmed/34085941 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e23118 %T Expanding the Reach of Research: Quantitative Evaluation of a Web-Based Approach for Remote Recruitment of People Who Hear Voices %A Buck,Benjamin %A Chander,Ayesha %A Brian,Rachel M %A Wang,Weichen %A Campbell,Andrew T %A Ben-Zeev,Dror %+ Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, United States, 1 206 221 8518, buckbe@uw.edu %K digital health %K research procedures %K recruitment %K mobile phone %D 2021 %7 3.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Similar to other populations with highly stigmatized medical or psychiatric conditions, people who hear voices (ie, experience auditory verbal hallucinations [AVH]) are often difficult to identify and reach for research. Technology-assisted remote research strategies reduce barriers to research recruitment; however, few studies have reported on the efficiency and effectiveness of these approaches. Objective: This study introduces and evaluates the efficacy of technology-assisted remote research designed for people who experience AVH. Methods: Our group developed an integrated, automated and human complementary web-based recruitment and enrollment apparatus that incorporated Google Ads, web-based screening, identification verification, hybrid automation, and interaction with live staff. We examined the efficacy of that apparatus by examining the number of web-based advertisement impressions (ie, number of times the web-based advertisement was viewed); clicks on that advertisement; engagement with web-based research materials; and the extent to which it succeeded in representing a broad sample of individuals with AVH, assessed through the self-reported AVH symptom severity and demographic representativeness (relative to the US population) of the sample recruited. Results: Over an 18-month period, our Google Ads advertisement was viewed 872,496 times and clicked on 11,183 times. A total amount of US $4429.25 was spent on Google Ads, resulting in 772 individuals who experience AVH providing consent to participate in an entirely remote research study (US $0.40 per click on the advertisement and US $5.73 per consented participant) after verifying their phone number, passing a competency screening questionnaire, and providing consent. These participants reported high levels of AVH frequency (666/756, 88.1% daily or more), distress (689/755, 91.3%), and functional interference (697/755, 92.4%). They also represented a broad sample of diversity that mirrored the US population demographics. Approximately one-third (264/756, 34.9%) of the participants had never received treatment for their AVH and, therefore, were unlikely to be identified via traditional clinic-based research recruitment strategies. Conclusions: Web-based procedures allow for time saving, cost-efficient, and representative recruitment of individuals with AVH and can serve as a model for future studies focusing on hard-to-reach populations. %M 34081011 %R 10.2196/23118 %U https://formative.jmir.org/2021/6/e23118 %U https://doi.org/10.2196/23118 %U http://www.ncbi.nlm.nih.gov/pubmed/34081011 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e27185 %T Acceptability of Research and Health Care Visits During the COVID-19 Pandemic: Cross-sectional Survey Study %A Ross,Kathryn M %A Hong,Young-Rock %A Krukowski,Rebecca A %A Miller,Darci R %A Lemas,Dominick J %A Cardel,Michelle I %+ Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, PO Box 10065, Gainesville, FL, 32610, United States, 1 3522948433, kmross@phhp.ufl.edu %K COVID-19 %K health care access %K telehealth %K research recruitment %K telemedicine %K belief %K access %K willingness %K cross-sectional %K survey %D 2021 %7 2.6.2021 %9 Short Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has had a widespread impact on attendance in biomedical research and health care visits. Objective: This study aimed to identify when and how American adults might feel comfortable about resuming in-person research and health care visits. Methods: Cross-sectional questionnaire data were collected from 135 adults (age: median 48 years; women: n=113, 83.7%; White participants: n=92, 68.2%) who were engaged in health-related research. Results: More than half of the respondents (65/122, 53.3%) felt that the COVID-19 pandemic positively affected their desire to participate in research. Although 73.6% (95/129) of respondents also indicated a willingness to attend in-person health care visits while Centers for Disease Control and Prevention (CDC) guidelines are implemented, 85.8% (109/127) indicated a willingness to attend in-person, outdoor visits, and 92.2% (118/128) reported a willingness to attend drive-through visits (with CDC guidelines implemented during both visit types). Videoconferencing was the most preferred format for intervention visits; however, adults over the age of 65 years preferred this format less than younger adults (P=.001). Conclusions: Researchers and clinicians should continue to provide opportunities for continuing the conduction of remote-based interventions while enforcing CDC guidelines during in-person visits. %M 34033577 %R 10.2196/27185 %U https://formative.jmir.org/2021/6/e27185 %U https://doi.org/10.2196/27185 %U http://www.ncbi.nlm.nih.gov/pubmed/34033577 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e23630 %T Health Perceptions and Adopted Lifestyle Behaviors During the COVID-19 Pandemic: Cross-National Survey %A Manjunath,Nandi Krishnamurthy %A Majumdar,Vijaya %A Rozzi,Antonietta %A Huiru,Wang %A Mishra,Avinash %A Kimura,Keishin %A Nagarathna,Raghuram %A Nagendra,Hongasandra Ramarao %+ Swami Vivekananda Yoga Anusandhana Samsthana University, #19, Eknath Bhavan, Gavipuram Circle, KG Naga, Bengaluru, 560019, India, 91 08026995163, vijaya.majumdar@svyasa.edu.in %K health behavior %K self-report %K cross-national survey %K COVID-19 %K behavior %K perception %K lifestyle %K nutrition %K real-time %D 2021 %7 1.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Social isolation measures are requisites to control viral spread during the COVID-19 pandemic. However, if these measures are implemented for a long period of time, they can result in adverse modification of people’s health perceptions and lifestyle behaviors. Objective: The aim of this cross-national survey was to address the lack of adequate real-time data on the public response to changes in lifestyle behavior during the crisis of the COVID-19 pandemic. Methods: A cross-national web-based survey was administered using Google Forms during the month of April 2020. The settings were China, Japan, Italy, and India. There were two primary outcomes: (1) response to the health scale, defined as perceived health status, a combined score of health-related survey items; and (2) adoption of healthy lifestyle choices, defined as the engagement of the respondent in any two of three healthy lifestyle choices (healthy eating habits, engagement in physical activity or exercise, and reduced substance use). Statistical associations were assessed with linear and logistic regression analyses. Results: We received 3371 responses; 1342 were from India (39.8%), 983 from China (29.2%), 669 from Italy (19.8%), and 377 (11.2%) from Japan. A differential countrywise response was observed toward perceived health status; the highest scores were obtained for Indian respondents (9.43, SD 2.43), and the lowest were obtained for Japanese respondents (6.81, SD 3.44). Similarly, countrywise differences in the magnitude of the influence of perceptions on health status were observed; perception of interpersonal relationships was most pronounced in the comparatively old Italian and Japanese respondents (β=.68 and .60, respectively), and the fear response was most pronounced in Chinese respondents (β=.71). Overall, 78.4% of the respondents adopted at least two healthy lifestyle choices amid the COVID-19 pandemic. Unlike health status, the influence of perception of interpersonal relationships on the adoption of lifestyle choices was not unanimous, and it was absent in the Italian respondents (odds ratio 1.93, 95% CI 0.65-5.79). The influence of perceived health status was a significant predictor of lifestyle change across all the countries, most prominently by approximately 6-fold in China and Italy. Conclusions: The overall consistent positive influence of increased interpersonal relationships on health perceptions and adopted lifestyle behaviors during the pandemic is the key real-time finding of the survey. Favorable behavioral changes should be bolstered through regular virtual interpersonal interactions, particularly in countries with an overall middle-aged or older population. Further, controlling the fear response of the public through counseling could also help improve health perceptions and lifestyle behavior. However, the observed human behavior needs to be viewed within the purview of cultural disparities, self-perceptions, demographic variances, and the influence of countrywise phase variations of the pandemic. The observations derived from a short lockdown period are preliminary, and real insight could only be obtained from a longer follow-up. %M 33900928 %R 10.2196/23630 %U https://formative.jmir.org/2021/6/e23630 %U https://doi.org/10.2196/23630 %U http://www.ncbi.nlm.nih.gov/pubmed/33900928 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 5 %P e24567 %T Using Digital Tools to Engage Patients With Psychosis and Their Families in Research: Survey Recruitment and Completion in an Early Psychosis Intervention Program %A Polillo,Alexia %A Voineskos,Aristotle N %A Foussias,George %A Kidd,Sean A %A Sav,Andreea %A Hawley,Steve %A Soklaridis,Sophie %A Stergiopoulos,Vicky %A Kozloff,Nicole %+ Centre for Addiction and Mental Health, 1025 Queen Street West, B1-4345, Toronto, ON, M6J 1H1, Canada, 1 416 535 8501, n.kozloff@mail.utoronto.ca %K digital %K online %K psychosis %K schizophrenia %K early psychosis intervention %K surveys %D 2021 %7 31.5.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Barriers to recruiting and retaining people with psychosis and their families in research are well-established, potentially biasing clinical research samples. Digital research tools, such as online platforms, mobile apps, and text messaging, have the potential to address barriers to research by facilitating remote participation. However, there has been limited research on leveraging these technologies to engage people with psychosis and their families in research. Objective: The objective of this study was to assess the uptake of digital tools to engage patients with provisional psychosis and their families in research and their preferences for different research administration methods. Methods: This study used Research Electronic Data Capture (REDCap)—a secure web-based platform with built-in tools for data collection and storage—to send web-based consent forms and surveys on service engagement via text message or email to patients and families referred to early psychosis intervention services; potential participants were also approached or reminded about the study in person. We calculated completion rates and timing using remote and in-person methods and compensation preferences. Results: A total of 447 patients with provisional psychosis and 187 of their family members agreed to receive the web-based consent form, and approximately half of the patients (216/447, 48.3%) and family members (109/187, 58.3%) consented to participate in the survey. Most patients (182/229, 79.5%) and family members (75/116, 64.7%) who completed the consent form did so remotely, with more family members (41/116, 35.3%) than patients (47/229, 20.5%) completing it in person. Of those who consented, 77.3% (167/216) of patients and 72.5% (79/109) of family members completed the survey, and most did the survey remotely. Almost all patients (418/462, 90.5%) and family members (174/190, 91.6%) requested to receive the consent form and survey by email, and only 4.1% (19/462) and 3.2% (6/190), respectively, preferred text message. Just over half of the patients (91/167, 54.5%) and family members (42/79, 53.2%) preferred to receive electronic gift cards from a coffee shop as study compensation. Most surveys were completed on weekdays between 12 PM and 6 PM. Conclusions: When offered the choice, most participants with psychosis and their families chose remote administration methods, suggesting that digital tools may enhance research recruitment and participation in this population, particularly in the context of the COVID-19 global pandemic. %M 34057421 %R 10.2196/24567 %U https://mental.jmir.org/2021/5/e24567 %U https://doi.org/10.2196/24567 %U http://www.ncbi.nlm.nih.gov/pubmed/34057421 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e28007 %T The Effect of Training on Participant Adherence With a Reporting Time Frame for Momentary Subjective Experiences in Ecological Momentary Assessment: Cognitive Interview Study %A Wen,Cheng K Fred %A Junghaenel,Doerte U %A Newman,David B %A Schneider,Stefan %A Mendez,Marilyn %A Goldstein,Sarah E %A Velasco,Sarah %A Smyth,Joshua M %A Stone,Arthur A %+ Dornsife Center for Self-Report Science, University of Southern California, 635 Downey Way, Verna and Peter Dauterive Hall 405H, Los Angeles, CA, 90089, United States, 1 2138212894, chengkuw@usc.edu %K ecological momentary assessment %K EMA %K cognitive interview %K participant training %K reporting period %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Ecological momentary assessment (EMA) has the potential to minimize recall bias by having people report on their experiences in the moment (momentary model) or over short periods (coverage model). This potential hinges on the assumption that participants provide their ratings based on the reporting time frame instructions prescribed in the EMA items. However, it is unclear what time frames participants actually use when answering the EMA questions and whether participant training improves participants’ adherence to the reporting instructions. Objective: This study aims to investigate the reporting time frames participants used when answering EMA questions and whether participant training improves participants’ adherence to the EMA reporting timeframe instructions. Methods: Telephone-based cognitive interviews were used to investigate the research questions. In a 2×2 factorial design, participants (n=100) were assigned to receive either basic or enhanced EMA training and randomized to rate their experiences using a momentary (at the moment you were called) or a coverage (since the last phone call) model. Participants received five calls over the course of a day to provide ratings; after each rating, participants were immediately interviewed about the time frame they used to answer the EMA questions. A total of 2 raters independently coded the momentary interview responses into time frame categories (Cohen κ=0.64, 95% CI 0.55-0.73). Results: The results from the momentary conditions showed that most of the calls referred to the period during the call (57/199, 28.6%) or just before the call (98/199, 49.2%) to provide ratings; the remainder were from longer reporting periods. Multinomial logistic regression results indicated a significant training effect (χ21=16.6; P<.001) in which the enhanced training condition yielded more reports within the intended reporting time frames for momentary EMA reports. Cognitive interview data from the coverage model did not lend themselves to reliable coding and were not analyzed. Conclusions: The results of this study provide the first evidence about adherence to EMA instructions to reporting periods and that enhanced participant training improves adherence to the time frame specified in momentary EMA studies. %M 34037524 %R 10.2196/28007 %U https://formative.jmir.org/2021/5/e28007 %U https://doi.org/10.2196/28007 %U http://www.ncbi.nlm.nih.gov/pubmed/34037524 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e18771 %T Exploring Canadian Children’s Social Media Use, Digital Literacy, and Quality of Life: Pilot Cross-sectional Survey Study %A Donelle,Lorie %A Facca,Danica %A Burke,Shauna %A Hiebert,Bradley %A Bender,Emma %A Ling,Stephen %+ Arthur Labatt Family School of Nursing, The University of Western Ontario, 1151 Richmond Street, London, ON, N6A3K7, Canada, 1 5198688675, dfacca2@uwo.ca %K child %K children %K internet %K social media %K digital literacy %K digital inclusion %K quality of life %K mobile phone %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Understanding social media use and digital literacy among young Canadian children is an increasing area of concern, given the importance of digital inclusion for full and informed participation in evolving educational, civic, corporate, social, and economic spaces. Objective: The aim of this study was to explore internet and social media knowledge as well as social media use among Canadian children aged between 6 and 10 years. Methods: We conducted interview surveys with 42 children aged between 6 and 10 years who participated in an after-school health promotion program in an urban community in Southwestern Ontario to understand their digital literacy skills and social media use. The data were analyzed using both quantitative and qualitative methods. Results: Of the 42 children who participated in this study, 24 (57%) reported that they used social media, specifically YouTube (19/24, 79% reported use), Snapchat (16/24, 67% reported use), and Facebook (8/24, 33% reported use). While using social media, children reported sharing personal information, including videos or pictures of themselves (12/24, 50%), videos or pictures of others (8/24, 33%), and their birthday (12/24, 50%), whereas only one-third (9/24, 38%) of the children believed that only close family and friends had access to the content they shared. When reporting on the quality of life in the context of using social media, most (17/24, 71%) children never felt sad, half (12/24, 50%) never had difficulty making new friends, and nearly one-third (7/24, 30%) indicated that they never had difficulty wanting to play outside. Conclusions: Owing to the rapidly evolving uptake and use of social media among young Canadians, the implementation of childhood digital health literacy education is vital to best support digital inclusion and well-being in Canada. The findings of our study highlight the need for future research to understand where children receive their digital literacy knowledge from and whether this knowledge is gained through self-directed social media use or observation from other actors, such as parents, siblings, or friends. %M 34037525 %R 10.2196/18771 %U https://formative.jmir.org/2021/5/e18771 %U https://doi.org/10.2196/18771 %U http://www.ncbi.nlm.nih.gov/pubmed/34037525 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e24742 %T Capturing COVID-19–Like Symptoms at Scale Using Banner Ads on an Online News Platform: Pilot Survey Study %A Dixon,Brian E %A Mukherjee,Sumit %A Wiensch,Ashley %A Gray,Mary L %A Ferres,Juan M Lavista %A Grannis,Shaun J %+ Department of Epidemiology, Richard M Fairbanks School of Public Health, Indiana University, 1050 Wishard Boulevard, Floors 5 and 6, Indianapolis, IN, 46202, United States, 1 317 278 3072, bedixon@regenstrief.org %K COVID-19 %K coronavirus %K epidemiology %K research subject recruitment %K signs and symptoms %D 2021 %7 20.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Identifying new COVID-19 cases is challenging. Not every suspected case undergoes testing, because testing kits and other equipment are limited in many parts of the world. Yet populations increasingly use the internet to manage both home and work life during the pandemic, giving researchers mediated connections to millions of people sheltering in place. Objective: The goal of this study was to assess the feasibility of using an online news platform to recruit volunteers willing to report COVID-19–like symptoms and behaviors. Methods: An online epidemiologic survey captured COVID-19–related symptoms and behaviors from individuals recruited through banner ads offered through Microsoft News. Respondents indicated whether they were experiencing symptoms, whether they received COVID-19 testing, and whether they traveled outside of their local area. Results: A total of 87,322 respondents completed the survey across a 3-week span at the end of April 2020, with 54.3% of the responses from the United States and 32.0% from Japan. Of the total respondents, 19,631 (22.3%) reported at least one symptom associated with COVID-19. Nearly two-fifths of these respondents (39.1%) reported more than one COVID-19–like symptom. Individuals who reported being tested for COVID-19 were significantly more likely to report symptoms (47.7% vs 21.5%; P<.001). Symptom reporting rates positively correlated with per capita COVID-19 testing rates (R2=0.26; P<.001). Respondents were geographically diverse, with all states and most ZIP Codes represented. More than half of the respondents from both countries were older than 50 years of age. Conclusions: News platforms can be used to quickly recruit study participants, enabling collection of infectious disease symptoms at scale and with populations that are older than those found through social media platforms. Such platforms could enable epidemiologists and researchers to quickly assess trends in emerging infections potentially before at-risk populations present to clinics and hospitals for testing and/or treatment. %M 33872190 %R 10.2196/24742 %U https://www.jmir.org/2021/5/e24742 %U https://doi.org/10.2196/24742 %U http://www.ncbi.nlm.nih.gov/pubmed/33872190 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e25273 %T Changes in Perceptions and Use of Mobile Technology and Health Communication in South Africa During the COVID-19 Lockdown: Cross-sectional Survey Study %A Fischer,Alex Emilio %A Van Tonder,Tanya %A Gumede,Siphamandla B %A Lalla-Edward,Samanta T %+ Ezintsha, Faculty of Health Sciences, University of Witwatersrand, Sunnyside Office Park, 31 Princess of Wales Terrace Parktown, Johannesburg, 2193, South Africa, 27 073 776 2705, fischermHealth@gmail.com %K coronavirus %K SARS-CoV-2 %K COVID-19 %K technology %K mHealth %K app %D 2021 %7 17.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In late March 2020, South Africa implemented a 5-stage COVID-19 Risk Adjusted Strategy, which included a lockdown that required all residents to remain home to prevent the spread of COVID-19. Due to this lockdown, individuals have been forced to find and use alternatives for accomplishing tasks including shopping, socializing, working, and finding information, and many have turned to the internet and their mobile devices. Objective: This study aimed to describe how South Africans consume and internalize information surrounding the COVID-19 outbreak in order to determine whether the COVID-19 lockdown and social isolation have influenced technology behavior, particularly in terms of health communication and information. Methods: From June 24 to August 24, 2020, people in South Africa were invited to complete a survey through the Upinion mobile app, an online data collection resource. The survey collected information on demographics, and technology use during the lockdown, and COVID-19 knowledge. Results: There were 405 participants, of which 296 (73.06%) were female. A total of 320 (79.01%) participants had a tertiary school education, 242 (59.75%) were single, and 173 (42.72%) had full-time employment. The lockdown forced 363 (89.63%) participants to use more technology, especially for work (n=140, 24.05%) and social media/communication (n=133, 22.85%). Security or privacy issues (n=46, 38.98%) and unfamiliarity with technology (n=32, 27.12%) were identified as the most common issues faced by the 127 (31.36%) participants who were unsure about using technology prior to the lockdown. Almost all participants (n=392, 96.79%) stated that they would continue using technology after the lockdown. Multimedia (n=215, 53.09%), mobile phone content (n=99, 24.44%), and health organizations and professionals (n=91, 22.47%) were the main sources of COVID-19 information. Most participants (n=282, 69.63%) felt that they had enough information. Two-thirds (n=275, 67.90%) of participants stated that they had used their mobile phones for health information before the lockdown, with web searches (n=109, 26.91%), social media (n=58, 14.32%), and government and institutional websites (n=52; 12.84%) serving as their main sources of information. Overall, the mean COVID-19 knowledge score was 8.8 (out of 10), and 335 (82.72%) had adequate knowledge (scored ≥8). Males were less likely to identify the correct transmission routes, and single participants were less likely to identify the signs and symptoms of the coronavirus. Tertiary school graduates were 4 times more likely to correctly identify the routes and 2 times more likely to identify how to stop the spread of the virus. People aged 43-56 years were 4 times more likely to identify how the coronavirus can be prevented, and participants ≥57 years were 2.6 times more likely to obtain a knowledge score of 10 when compared to those under 29 years of age. Conclusions: This study has shown that the COVID-19 lockdown has forced people to increase technology use, and people plan to continue using technology after the lockdown is lifted. Increased technology use was seen across a variety of fields; however, barriers including privacy, unfamiliarity, and data costs were identified. This population showed high COVID-19 knowledge, although the use of web searches and social media, instead of government and institutional websites, increases the potential for health misinformation to be spread. %M 33956640 %R 10.2196/25273 %U https://formative.jmir.org/2021/5/e25273 %U https://doi.org/10.2196/25273 %U http://www.ncbi.nlm.nih.gov/pubmed/33956640 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e25577 %T Using a Multisectoral Approach to Advance Health Equity in Rural Arizona: Community-Engaged Survey Development and Implementation Study %A Remiker,Mark %A Sabo,Samantha %A Jiménez,Dulce %A Samarron Longorio,Alexandra %A Chief,Carmenlita %A Williamson,Heather %A Teufel-Shone,Nicolette %+ Center for Health Equity Research, Northern Arizona University, 1395 Knoles Dr., Flagstaff, AZ, 86011, United States, 1 2627487095, mark.remiker@nau.edu %K health equity %K community-engaged %K multisector %K survey development %D 2021 %7 12.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Over the past decade, public health research and practice sectors have shifted their focus away from identifying health disparities and toward addressing the social, environmental, and economic determinants of health equity. Given the complex and interrelated nature of these determinants, developing policies that will advance health equity requires collaboration across sectors outside of health. However, engaging various stakeholder groups, tapping into their unique knowledge systems, and identifying common objectives across sectors is difficult and time consuming and can impede collaborative efforts. Objective: The Southwest Health Equity Research Collaborative at Northern Arizona University, in partnership with an 11-member community advisory council, is addressing this need with a joint community-campus effort to develop and implement a Regional Health Equity Survey (RHES) designed to generate an interdisciplinary body of knowledge, which will be used to guide future multisectoral action for improving community health and well-being. Methods: Researchers and community partners used facilitated discussions and free listing techniques to generate survey items. The community partners pilot tested the survey instrument to evaluate its feasibility and duration before survey administration. Respondent-driven sampling was used to ensure that participants included leadership from across all sectors and regions of northern Arizona. Results: Over the course of 6 months, 206 participants representing 13 sectors across the 5 counties of northern Arizona were recruited to participate in an RHES. Survey response rates, completion percentage, and sector representation were used to assess the effectiveness and feasibility of using a community-engaged apporach for survey development and participant recruitment. The findings describe the current capacity to impact health equity by using a multisectoral approach in northern Arizona. Conclusions: The Southwest Health Equity Research Collaborative effectively engaged community members to assist with the development and implementation of an RHES aimed at understanding and promoting multisectoral action on the root causes of health inequity. The results will help to build research and evaluation capacity to address the social, economic, and environmental conditions of health inequity in the region. %M 33978596 %R 10.2196/25577 %U https://formative.jmir.org/2021/5/e25577 %U https://doi.org/10.2196/25577 %U http://www.ncbi.nlm.nih.gov/pubmed/33978596 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e23009 %T Learning From the Experiences of COVID-19 Survivors: Web-Based Survey Study %A Prioleau,Temiloluwa %+ Dartmouth College, 9 Maynard Street, Hanover, NH, 03755, United States, 1 6036468730, tprioleau@dartmouth.edu %K patient-reported outcomes %K coronavirus %K COVID-19 %K outcome %K crowdsourcing %K social media %K internet %K survivor %K experience %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There are still many unanswered questions about the novel coronavirus; however, a largely underutilized source of knowledge is the millions of people who have recovered after contracting the virus. This includes a majority of undocumented cases of COVID-19, which were classified as mild or moderate and received little to no clinical care during the course of illness. Objective: This study aims to document and glean insights from the experiences of individuals with a first-hand experience in dealing with COVID-19, especially the so-called mild-to-moderate cases that self-resolved while in isolation. Methods: This web-based survey study called C19 Insider Scoop recruited adult participants aged 18 years or older who reside in the United States and had tested positive for COVID-19 or antibodies. Participants were recruited through various methods, including online support groups for COVID-19 survivors, advertisement in local news outlets, as well as through professional and other networks. The main outcomes measured in this study included knowledge of contraction or transmission of the virus, symptoms, and personal experiences on the road to recovery. Results: A total of 72 participants (female, n=53; male, n=19; age range: 18-73 years; mean age: 41 [SD 14] years) from 22 US states were enrolled in this study. The top known source of how people contracted SARS-CoV-2, the virus known to cause COVID-19, was through a family or household member (26/72, 35%). This was followed by essential workers contracting the virus through the workplace (13/72, 18%). Participants reported up to 27 less-documented symptoms that they experienced during their illness, such as brain or memory fog, palpitations, ear pain or discomfort, and neurological problems. In addition, 47 of 72 (65%) participants reported that their symptoms lasted longer than the commonly cited 2-week period even for mild cases of COVID-19. The mean recovery time of the study participants was 4.5 weeks, and exactly one-half of participants (50%) still experienced lingering symptoms of COVID-19 after an average of 65 days following illness onset. Additionally, 37 (51%) participants reported that they experienced stigma associated with contracting COVID-19. Conclusions: This study presents preliminary findings suggesting that emphasis on family or household spread of COVID-19 may be lacking and that there is a general underestimation of the recovery time even for mild cases of illness with the virus. Although a larger study is needed to validate these results, it is important to note that as more people experience COVID-19, insights from COVID-19 survivors can enable a more informed public, pave the way for others who may be affected by the virus, and guide further research. %M 33878012 %R 10.2196/23009 %U https://formative.jmir.org/2021/5/e23009 %U https://doi.org/10.2196/23009 %U http://www.ncbi.nlm.nih.gov/pubmed/33878012 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e24277 %T Effects of Age, Gender, Health Status, and Political Party on COVID-19–Related Concerns and Prevention Behaviors: Results of a Large, Longitudinal Cross-sectional Survey %A Naeim,Arash %A Baxter-King,Ryan %A Wenger,Neil %A Stanton,Annette L %A Sepucha,Karen %A Vavreck,Lynn %+ Center for SMART Health, Departments of Medicine and Bioengineering, David Geffen School of Medicine at UCLA and Samueli School of Engineering and Applied Science, 10911 Weyburn Avenue, Los Angeles, CA, 90095, United States, 1 3103670148, anaeim@mednet.ucla.edu %K COVID-19 %K prevention %K behavior %K advice %K health care provider %K economy %K health information %K concern %K survey %D 2021 %7 28.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: With conflicting information about COVID-19, the general public may be uncertain about how to proceed in terms of precautionary behavior and decisions about whether to return to activity. Objective: The aim of this study is to determine the factors associated with COVID-19–related concerns, precautionary behaviors, and willingness to return to activity. Methods: National survey data were obtained from the Democracy Fund + UCLA Nationscape Project, an ongoing cross-sectional weekly survey. The sample was provided by Lucid, a web-based market research platform. Three outcomes were evaluated: (1) COVID-19–related concerns, (2) precautionary behaviors, and (3) willingness to return to activity. Key independent variables included age, gender, race or ethnicity, education, household income, political party support, religion, news consumption, number of medication prescriptions, perceived COVID-19 status, and timing of peak COVID-19 infections by state. Results: The data included 125,508 responses from web-based surveys conducted over 20 consecutive weeks during the COVID-19 pandemic (comprising approximately 6250 adults per week), between March 19 and August 5, 2020, approved by the University of California, Los Angeles (UCLA) Institutional Review Board for analysis. A substantial number of participants were not willing to return to activity even after the restrictions were lifted. Weighted multivariate logistic regressions indicated the following groups had different outcomes (all P<.001): individuals aged ≥65 years (COVID-19–related concerns: OR 2.05, 95% CI 1.93-2.18; precautionary behaviors: OR 2.38, 95% CI 2.02-2.80; return to activity: OR 0.41, 95% CI 0.37-0.46 vs 18-40 years); men (COVID-19–related concerns: OR 0.73, 95% CI 0.70-0.75; precautionary behaviors: OR 0.74, 95% CI 0.67-0.81; return to activity: OR 2.00, 95% CI 1.88-2.12 vs women); taking ≥4 medications (COVID-19–related concerns: OR 1.47, 95% CI 1.40-1.54; precautionary behaviors: OR 1.36, 95% CI 1.20-1.555; return to activity: OR 0.75, 95% CI 0.69-0.81 vs <3 medications); Republicans (COVID-19–related concerns: OR 0.40, 95% CI 0.38-0.42; precautionary behaviors: OR 0.45, 95% CI 0.40-0.50; return to activity: OR 2.22, 95% CI 2.09-2.36 vs Democrats); and adults who reported having COVID-19 (COVID-19–related concerns: OR 1.24, 95% CI 1.12-1.39; precautionary behaviors: OR 0.65, 95% CI 0.52-0.81; return to activity: OR 3.99, 95% CI 3.48-4.58 vs those who did not). Conclusions: Participants’ age, party affiliation, and perceived COVID-19 status were strongly associated with their COVID-19–related concerns, precautionary behaviors, and willingness to return to activity. Future studies need to develop and test targeted messaging approaches and consider political partisanship to encourage preventative behaviors and willingness to return to activities. %M 33908887 %R 10.2196/24277 %U https://publichealth.jmir.org/2021/4/e24277 %U https://doi.org/10.2196/24277 %U http://www.ncbi.nlm.nih.gov/pubmed/33908887 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e27091 %T Association Between Smoking and SARS-CoV-2 Infection: Cross-sectional Study of the EPICOVID19 Internet-Based Survey %A Prinelli,Federica %A Bianchi,Fabrizio %A Drago,Gaspare %A Ruggieri,Silvia %A Sojic,Aleksandra %A Jesuthasan,Nithiya %A Molinaro,Sabrina %A Bastiani,Luca %A Maggi,Stefania %A Noale,Marianna %A Galli,Massimo %A Giacomelli,Andrea %A Antonelli Incalzi,Raffaele %A Adorni,Fulvio %A Cibella,Fabio %A , %+ Institute of Biomedical Technologies, National Research Council, Via Fratelli 93, Segrate (MI), 20090, Italy, 39 0226422629, federica.prinelli@cnr.it %K SARS-CoV-2 %K COVID-19 %K smoking habit %K dose-response relationship %K nasopharyngeal swab testing %K infection severity %K web-based survey %K self-reported %K cross-sectional design %D 2021 %7 28.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Several studies have reported a low prevalence of current smoking among hospitalized COVID-19 cases; however, no definitive conclusions can be drawn. Objective: We investigated the association of tobacco smoke exposure with nasopharyngeal swab (NPS) test results for SARS-CoV-2 infection and disease severity accounting for possible confounders. Methods: The nationwide, self-administered, cross-sectional web-based Italian National Epidemiological Survey on COVID-19 (EPICOVID19) was administered to an Italian population of 198,822 adult volunteers who filled in an online questionnaire between April 13 and June 2, 2020. For this study, we analyzed 6857 individuals with known NPS test results. The associations of smoking status and the dose-response relationship with a positive NPS test result and infection severity were calculated as odds ratios (ORs) with 95% CIs by means of logistic and multinomial regression models adjusting for sociodemographic, clinical, and behavioral characteristics. Results: Out of the 6857 individuals (mean age 47.9 years, SD 14.1; 4516/6857, 65.9% female), 63.2% (4334/6857) had never smoked, 21.3% (1463/6857) were former smokers, and 15.5% (1060/6857) were current smokers. Compared to nonsmokers, current smokers were younger, were more educated, were less affected by chronic diseases, reported COVID-19–like symptoms less frequently, were less frequently hospitalized, and less frequently tested positive for COVID-19. In multivariate analysis, current smokers had almost half the odds of a positive NPS test result (OR 0.54, 95% CI 0.45-0.65) compared to nonsmokers. We also found a dose-dependent relationship with tobacco smoke: mild smokers (adjusted OR [aOR] 0.76, 95% CI 0.55-1.05), moderate smokers (aOR 0.56, 95% CI 0.42-0.73), and heavy smokers (aOR 0.38, 95% CI 0.27-0.53). This inverse association also persisted when considering the severity of the infection. Current smokers had a statistically significantly lower probability of having asymptomatic (aOR 0.50, 95% CI 0.27-0.92), mild (aOR 0.65, 95% CI 0.53-0.81), and severe infections (aOR 0.27, 95% CI 0.17-0.42) compared to those who never smoked. Conclusions: Current smoking was negatively associated with SARS-CoV-2 infection with a dose-dependent relationship. Ad hoc experimental studies are needed to elucidate the mechanisms underlying this association. Trial Registration: ClinicalTrials.gov NCT04471701; https://clinicaltrials.gov/ct2/show/NCT04471701 %M 33668011 %R 10.2196/27091 %U https://publichealth.jmir.org/2021/4/e27091 %U https://doi.org/10.2196/27091 %U http://www.ncbi.nlm.nih.gov/pubmed/33668011 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e26955 %T Estimating the Proportion of COVID-19 Contacts Among Households Based on Individuals With Myocardial Infarction History: Cross-sectional Telephone Survey %A Fraticelli,Laurie %A Freyssenge,Julie %A Claustre,Clément %A Martinez,Mikaël %A Redjaline,Abdesslam %A Serre,Patrice %A Bochaton,Thomas %A El Khoury,Carlos %+ RESCUe-RESUVal, Lucien Hussel Hospital, Montée du Docteur Maurice Chapuis, Vienne, 38200, France, 33 4 37 02 10 59, l.fraticelli@resuval.fr %K COVID-19 %K survey %K myocardial infarction %K cases %K contacts %K household %K estimate %K cross-sectional %K cardiovascular %K risk %K symptom %D 2021 %7 27.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Adults with cardiovascular diseases were disproportionately associated with an increased risk of a severe form of COVID-19 and all-cause mortality. Objective: The aims of this study are to report the associated symptoms for COVID-19 cases, to estimate the proportion of contacts, and to describe the clinical signs and behaviors among individuals with and without myocardial infarction history among cases and contacts. Methods: A 2-week cross-sectional telephone survey was conducted during the first lockdown period in France, from May 4 to 15, 2020. A total of 668 households participated, representing 703 individuals with pre-existing cardiovascular disease in the past 2 years and 849 individuals without myocardial infarction history. Results: High rates of compliance with health measures were self-reported, regardless of age or risk factors. There were 4 confirmed COVID-19 cases that were registered from 4 different households. Based on deductive assumptions of the 1552 individuals, 9.73% (n=151) were identified as contacts, of whom 71.52% (108/151) were asymptomatic. Among individuals with a myocardial infarction history, 2 were COVID-19 cases, and the estimated proportion of contacts was 8.68% (61/703), of whom 68.85% (42/61) were asymptomatic. The cases and contacts presented different symptoms, with more respiratory signs in those with a myocardial infarction history. Conclusions: The telephone survey could be a relevant tool for reporting the number of contacts during a limited period and in a limited territory based on the presence of associated symptoms and COVID-19 cases in the households. This study advanced our knowledge to better prepare for future crises. %M 33855968 %R 10.2196/26955 %U https://formative.jmir.org/2021/4/e26955 %U https://doi.org/10.2196/26955 %U http://www.ncbi.nlm.nih.gov/pubmed/33855968 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e24180 %T Mobile Sensing Apps and Self-management of Mental Health During the COVID-19 Pandemic: Web-Based Survey %A Suruliraj,Banuchitra %A Bessenyei,Kitti %A Bagnell,Alexa %A McGrath,Patrick %A Wozney,Lori %A Orji,Rita %A Meier,Sandra %+ Department of Psychiatry, Dalhousie University, 5850/5980 University Avenue, PO Box 970, Halifax, NS, B3K 6R8, Canada, 1 782 414 8054, sandra.m.meier@gmail.com %K app %K awareness %K behavior %K COVID-19 %K helpfulness %K mobile health %K mobile sensing %K self-management %K sensing %K web-based survey %D 2021 %7 26.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, people had to adapt their daily life routines to the currently implemented public health measures, which is likely to have resulted in a lack of in-person social interactions, physical activity, or sleep. Such changes can have a significant impact on mental health. Mobile sensing apps can passively record the daily life routines of people, thus making them aware of maladaptive behavioral adjustments to the pandemic. Objective: This study aimed to explore the views of people on mobile sensing apps that passively record behaviors and their potential to increase awareness and helpfulness for self-managing mental health during the pandemic. Methods: We conducted an anonymous web-based survey including people with and those without mental disorders, asking them to rate the helpfulness of mobile sensing apps for the self-management of mental health during the COVID-19 pandemic. The survey was conducted in May 2020. Results: The majority of participants, particularly those with a mental disorder (n=106/148, 72%), perceived mobile sensing apps as very or extremely helpful for managing their mental health by becoming aware of maladaptive behaviors. The perceived helpfulness of mobile sensing apps was also higher among people who experienced a stronger health impact of the COVID-19 pandemic (β=.24; 95% CI 0.16-0.33; P<.001), had a better understanding of technology (β=.17; 95% CI 0.08-0.25; P<.001), and had a higher education (β=.1; 95% CI 0.02-0.19; P=.02). Conclusions: Our findings highlight the potential of mobile sensing apps to assist in mental health care during the pandemic. %M 33872181 %R 10.2196/24180 %U https://formative.jmir.org/2021/4/e24180 %U https://doi.org/10.2196/24180 %U http://www.ncbi.nlm.nih.gov/pubmed/33872181 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24716 %T Multimodal Recruitment to Study Ovulation and Menstruation Health: Internet-Based Survey Pilot Study %A Mahalingaiah,Shruthi %A Cheng,J Jojo %A Winter,Michael R %A Rodriguez,Erika %A Fruh,Victoria %A Williams,Anna %A Nguyen,MyMy %A Madhavan,Rashmi %A Karanja,Pascaline %A MacRae,Jill %A Konanki,Sai Charan %A Lane,Kevin J %A Aschengrau,Ann %+ Department of Environmental Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Building 1, Floor 14, Boston, MA, 02115, United States, 1 6174324381, shruthi@hsph.harvard.edu %K polycystic ovary syndrome %K PCOS %K menstrual cycle %K multimodal recruitment strategy %K epidemiology %K recruitment %K pilot %K strategy %K women %K feasibility %K online survey %K ovulation %K menstrual %D 2021 %7 16.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Multimodal recruitment strategies are a novel way to increase diversity in research populations. However, these methods have not been previously applied to understanding the prevalence of menstrual disorders such as polycystic ovary syndrome. Objective: The purpose of this study was to test the feasibility of recruiting a diverse cohort to complete a web-based survey on ovulation and menstruation health. Methods: We conducted the Ovulation and Menstruation Health Pilot Study using a REDCap web-based survey platform. We recruited 200 women from a clinical population, a community fair, and the internet. Results: We recruited 438 women over 29 weeks between September 2017 and March 2018. After consent and eligibility determination, 345 enrolled, 278 started (clinic: n=43; community fair: n=61; internet: n=174), and 247 completed (clinic: n=28; community fair: n=60; internet: n=159) the survey. Among all participants, the median age was 25.0 (SD 6.0) years, mean BMI was 26.1 kg/m2 (SD 6.6), 79.7% (216/271) had a college degree or higher, and 14.6% (37/254) reported a physician diagnosis of polycystic ovary syndrome. Race and ethnicity distributions were 64.7% (176/272) White, 11.8% (32/272) Black/African American, 7.7% (21/272) Latina/Hispanic, and 5.9% (16/272) Asian individuals; 9.9% (27/272) reported more than one race or ethnicity. The highest enrollment of Black/African American individuals was in clinic (17/42, 40.5%) compared to 1.6% (1/61) in the community fair and 8.3% (14/169) using the internet. Survey completion rates were highest among those who were recruited from the internet (159/174, 91.4%) and community fairs (60/61, 98.4%) compared to those recruited in clinic (28/43, 65.1%). Conclusions: Multimodal recruitment achieved target recruitment in a short time period and established a racially diverse cohort to study ovulation and menstruation health. There were greater enrollment and completion rates among those recruited via the internet and community fair. %M 33861203 %R 10.2196/24716 %U https://www.jmir.org/2021/4/e24716 %U https://doi.org/10.2196/24716 %U http://www.ncbi.nlm.nih.gov/pubmed/33861203 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e24617 %T Effects of Participating in a Research Project During the COVID-19 Pandemic on Medical Students’ Educational Routines and Mental Health: Protocol for a Web-Based Survey Study %A Calderaro,Débora Cerqueira %A Kahlow,Barbara Stadler %A Munhoz,Gabriela Araújo %A Dias,Samuel Elias Basualto %A Lopes,João Vitor Ziroldo %A Borges,Aline Rizzo %A Mariz,Henrique De Ataíde %A Gomes,Kirla Wagner Poti %A Valadares,Lilian David De Azevedo %A Araújo,Nafice Costa %A Ribeiro,Sandra Lucia Euzébio %A Kakehasi,Adriana Maria %A Reis,Ana Paula Monteiro Gomides %A Marques,Cláudia %A Reis-Neto,Edgard Torres %A Paiva,Eduardo Dos Santos %A Pileggi,Gecilmara Salviato %A Ferreira,Gilda Aparecida %A Provenza,José Roberto %A Mota,Licia Maria Henrique %A Xavier,Ricardo Machado %A Teodoro,Maycoln Leôni Martins %A Pinheiro,Marcelo De Medeiros %A , %+ Universidade Federal de Minas Gerais, 190 Professor Alfredo Balena Avenue, Belo Horizonte, 30130-100, Brazil, 55 3134099757, dccalderaro@gmail.com %K SARS-CoV-2 %K COVID-19 %K medical education %K observational %K cross-sectional %K case-control study %K voluntary %K mental health %K rheumatic disease %K medical student %K protocol %K survey %D 2021 %7 9.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has resulted in social isolation, which has a potential negative impact on the educational routines (eg, the suspension of face-to-face appointments) and mental health of medical students. The Mario Pinotti II (MPII) study is a 24-week observational study that conducted scheduled telephone calls every 2 weeks to verify the occurrence of COVID-19 in patients with rheumatic diseases on chronic hydroxychloroquine therapy (from March 29, 2020, to September 30, 2020). The effects of voluntarily participating in a research project (ie, one that involves interactions via telephone contact with patients, professors, rheumatologists, and colleagues) on the daily lives and mental health of medical students requires evaluation. Objective: As medical students are professionals in training and have a high level of responsibility in terms of handling the emotional and physical aspects of several diseases, this study aims to evaluate the impacts of the COVID-19 pandemic and participation in the MPII study on the educational routines and mental health of medical students. Methods: A web-based survey was carried out to perform a cross-sectional comparative assessment of medical students who participated in the MPII study and their colleagues who were not involved in the MPII study. Participants from both groups were matched based on sex, age, and medical school. The web questionnaire was developed by a panel composed of graduate medical students, rheumatologists, medical school professors, and a psychology professor. The questionnaire included details on demographic and life habits data and evaluated participants' impressions of the MPII study and the impact of the COVID-19 pandemic on their educational routines and medical training. In addition, depression, anxiety, and stress were evaluated using the Brazilian version of the Depression, Anxiety, and Stress Scale (DASS)-21, and currently, the DASS-21 scores are grouped as those that indicate a low, moderate, or high risk of mental distress. This project was approved by the Federal University of São Paulo Ethics Committee (CAAE: 34034620.0.0000.5505). Results: Data were collected from both medical student groups from July 20 to August 31, 2020. Data extraction was completed in September 2020. The data analysis is ongoing. We expect the results to be published in the first semester of 2021. Conclusions: This study will provide insight into the effects of participating in a research project on depression, anxiety, and stress, which will be determined by applying the DASS-21 to a large sample of Brazilian undergraduate medical students. We will also evaluate the impact of the COVID-19 pandemic on medical students’ educational routines and medical training. International Registered Report Identifier (IRRID): DERR1-10.2196/24617 %M 33735094 %R 10.2196/24617 %U https://www.researchprotocols.org/2021/4/e24617 %U https://doi.org/10.2196/24617 %U http://www.ncbi.nlm.nih.gov/pubmed/33735094 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e19022 %T Facebook Ads Manager as a Recruitment Tool for a Health and Safety Survey of Farm Mothers: Pilot Study %A Burke,Richard R %A Weichelt,Bryan P %A Namkoong,Kang %+ National Farm Medicine Center, Marshfield Clinic Research Institute, 1000 N Oak Avenue, Marshfield, WI, 54449, United States, 1 715 389 3789, burke.richard@marshfieldresearch.org %K Facebook %K recruitment %K advertisement %K agriculture %K health %K safety %K survey %K online %D 2021 %7 7.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media platforms have experienced unprecedented levels of growth and usage over the past decade, with Facebook hosting 2.7 billion active users worldwide, including over 200 million users in the United States. Facebook users have been underutilized and understudied by the academic community as a resource for participant recruitment. Objective: We performed a pilot study to explore the efficacy and cost-effectiveness of Facebook advertisements for the recruitment of an online agricultural health and safety survey. Methods: We undertook a 1-week advertising campaign utilizing the integrated, targeted advertising platform of Facebook Ads Manager with a target-spending limit of US $294. We created and posted three advertisements depicting varying levels of agricultural safety adoption leading to a brief survey on farm demographics and safety attitudes. We targeted our advertisements toward farm mothers aged 21-50 years in the United States and determined cost-effectiveness and potential biases. No participant incentive was offered. Results: We reached 40,024 users and gathered 318 advertisement clicks. Twenty-nine participants consented to the survey with 24 completions. Including personnel costs, the cost per completed survey was US $17.42. Compared to the distribution of female producers in the United States, our advertisements were unexpectedly overrepresented in the eastern United States and were underrepresented in the western United States. Conclusions: Facebook Ads Manager represents a potentially cost-effective and timely method to recruit participants for online health and safety research when targeting a specific population. However, social media recruitment mirrors traditional recruitment methods in its limitations, exhibiting geographic, response, and self-selection biases that need to be addressed. %M 33825686 %R 10.2196/19022 %U https://formative.jmir.org/2021/4/e19022 %U https://doi.org/10.2196/19022 %U http://www.ncbi.nlm.nih.gov/pubmed/33825686 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e26214 %T Structure and Functioning of Acute Inpatient Psychiatric Units in Spain: Qualitative Study %A Rodriguez-Jimenez,Roberto %A Corripio,Iluminada %A Campos,Ricardo %A Páramo,Mario %A Franco-Martin,Manuel %A Segura,Estefanía %A González,Sergio %A Martínez-Raga,José %+ Department of Psychiatry, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Av de Córdoba km 5,400, Madrid, 28041, Spain, 34 91 390 85 36, roberto.rodriguez.jimenez@gmail.com %K acute inpatient psychiatric units %K organization %K resources %K scorecard %K Spain %D 2021 %7 7.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: As a consequence of the decentralization of health care provision to the different Regions (called Autonomous Communities) in Spain, different health care models and resources have been developed for psychiatric patients. It would be very useful to obtain comprehensive and comparative data on health care models, resources, and activity of acute inpatient psychiatric units (AIPUs) as a key part of mental health systems. Objective: The aim of this study was to determine the current state of AIPUs in Spain through a national scorecard that allows the current situation to be visualized in terms of resources, processes, and outputs. Methods: A 104-item online questionnaire was sent to all the AIPUs of the different Regions in Spain. It was divided into 11 sections, including data on the resources, processes, and outputs of the AIPUs plus general data, an indicator dashboard, and good practices. Results: The questionnaire was completed by 60.0% (117/195) of the AIPUs invited to participate. The information collected has allowed us to obtain a detailed snapshot of the current situation of AIPUs in Spain at the levels of infrastructure and material resources, staffing, organization and activity of the units, coordination with other units, guidelines, processes and protocols used, participation and communication with patients and their families, teaching activity, and research linked to the units. Conclusions: This project aimed to help understand the general situation of AIPUs in Spain and its different Regions, contribute to enhancing the benchmarking and harmonization among Spanish Regions, and provide data for future comparisons with other countries. International Registered Report Identifier (IRRID): RR1-10.2196/26214 %M 33729167 %R 10.2196/26214 %U https://www.researchprotocols.org/2021/4/e26214 %U https://doi.org/10.2196/26214 %U http://www.ncbi.nlm.nih.gov/pubmed/33729167 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23984 %T HOPES: An Integrative Digital Phenotyping Platform for Data Collection, Monitoring, and Machine Learning %A Wang,Xuancong %A Vouk,Nikola %A Heaukulani,Creighton %A Buddhika,Thisum %A Martanto,Wijaya %A Lee,Jimmy %A Morris,Robert JT %+ Office for Healthcare Transformation, Ministry of Health, 1 Maritime Square, #12-10 Harbourfront Centre, Singapore, 099253, Singapore, 65 66793209, creighton.heaukulani@moht.com.sg %K digital phenotyping %K eHealth %K mHealth %K mobile phone %K phenotype %K data collection %K outpatient monitoring %K machine learning %D 2021 %7 15.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X The collection of data from a personal digital device to characterize current health conditions and behaviors that determine how an individual’s health will evolve has been called digital phenotyping. In this paper, we describe the development of and early experiences with a comprehensive digital phenotyping platform: Health Outcomes through Positive Engagement and Self-Empowerment (HOPES). HOPES is based on the open-source Beiwe platform but adds a wider range of data collection, including the integration of wearable devices and further sensor collection from smartphones. Requirements were partly derived from a concurrent clinical trial for schizophrenia that required the development of significant capabilities in HOPES for security, privacy, ease of use, and scalability, based on a careful combination of public cloud and on-premises operation. We describe new data pipelines to clean, process, present, and analyze data. This includes a set of dashboards customized to the needs of research study operations and clinical care. A test use case for HOPES was described by analyzing the digital behavior of 22 participants during the SARS-CoV-2 pandemic. %M 33720028 %R 10.2196/23984 %U https://www.jmir.org/2021/3/e23984 %U https://doi.org/10.2196/23984 %U http://www.ncbi.nlm.nih.gov/pubmed/33720028 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e19461 %T Parents’ Perspectives on Using Artificial Intelligence to Reduce Technology Interference During Early Childhood: Cross-sectional Online Survey %A Glassman,Jill %A Humphreys,Kathryn %A Yeung,Serena %A Smith,Michelle %A Jauregui,Adam %A Milstein,Arnold %A Sanders,Lee %+ Clinical Excellence Research Center, School of Medicine, Stanford University, 365 Lasuen Street, #308, Stanford, CA, 94305, United States, 1 8314195302, jill.r.glassman@stanford.edu %K parenting %K digital technology %K mobile phone %K child development %K artificial intelligence %D 2021 %7 15.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Parents’ use of mobile technologies may interfere with important parent-child interactions that are critical to healthy child development. This phenomenon is known as technoference. However, little is known about the population-wide awareness of this problem and the acceptability of artificial intelligence (AI)–based tools that help with mitigating technoference. Objective: This study aims to assess parents’ awareness of technoference and its harms, the acceptability of AI tools for mitigating technoference, and how each of these constructs vary across sociodemographic factors. Methods: We administered a web-based survey to a nationally representative sample of parents of children aged ≤5 years. Parents’ perceptions that their own technology use had risen to potentially problematic levels in general, their perceptions of their own parenting technoference, and the degree to which they found AI tools for mitigating technoference acceptable were assessed by using adaptations of previously validated scales. Multiple regression and mediation analyses were used to assess the relationships between these scales and each of the 6 sociodemographic factors (parent age, sex, language, ethnicity, educational attainment, and family income). Results: Of the 305 respondents, 280 provided data that met the established standards for analysis. Parents reported that a mean of 3.03 devices (SD 2.07) interfered daily in their interactions with their child. Almost two-thirds of the parents agreed with the statements “I am worried about the impact of my mobile electronic device use on my child” and “Using a computer-assisted coach while caring for my child would help me notice more quickly when my device use is interfering with my caregiving” (187/281, 66.5% and 184/282, 65.1%, respectively). Younger age, Hispanic ethnicity, and Spanish language spoken at home were associated with increased technoference awareness. Compared to parents’ perceived technoference and sociodemographic factors, parents’ perceptions of their own problematic technology use was the factor that was most associated with the acceptance of AI tools. Conclusions: Parents reported high levels of mobile device use and technoference around their youngest children. Most parents across a wide sociodemographic spectrum, especially younger parents, found the use of AI tools to help mitigate technoference during parent-child daily interaction acceptable and useful. %M 33720026 %R 10.2196/19461 %U https://www.jmir.org/2021/3/e19461 %U https://doi.org/10.2196/19461 %U http://www.ncbi.nlm.nih.gov/pubmed/33720026 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24590 %T Commencement of and Retention in Web-Based Interventions and Response to Prompts and Reminders: Longitudinal Observational Study Based on Two Randomized Controlled Trials %A Andriopoulos,Athanasios %A Olsson,Erik M G %A Hägg Sylvén,Ylva %A Sjöström,Jonas %A Johansson,Birgitta %A von Essen,Louise %A Grönqvist,Helena %+ Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, Uppsala, 75185, Sweden, 46 736236500, helena.gronqvist@kbh.uu.se %K log data analysis %K use pattern %K retention %K dropout %K attrition %K online intervention %K online data %D 2021 %7 12.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based interventions are effective for several psychological problems. However, recruitment, adherence, and missing data are challenges when evaluating these interventions. Objective: This study aimed to describe the use patterns during the commencement phase, possible retention patterns (continuation of data provision), and responses to prompts and reminders among participants in 2 randomized controlled trials (RCTs) evaluating web-based interventions. Methods: Data on use patterns logged in 2 RCTs aiming to reduce symptoms of anxiety and depression among adult patients recently diagnosed with cancer (AdultCan RCT) and patients with a recent myocardial infarction (Heart RCT) were analyzed. The web-based intervention in the AdultCan trial consisted of unguided self-help and psychoeducation and that in the Heart trial consisted of therapist-supported cognitive behavioral therapy. In total, 2360 participants’ use patterns at first log-in, including data collection at baseline (ie, commencement) and at 2 follow-ups, were analyzed. Both the intervention and comparison groups were analyzed. Results: At commencement, 70.85% (909/1283) and 86.82% (935/1077) of the participants in AdultCan and Heart RCTs, respectively, logged in and completed baseline data collection after receiving a welcome email with log-in credentials. The median duration of the first log-in was 44 minutes and 38 minutes in AdultCan and Heart RCTs, respectively. Slightly less than half of the participants’ first log-ins were completed outside standard office hours. More than 80% (92/114 and 103/111) of the participants in both trials explored the intervention within 2 weeks of being randomized to the treatment group, with a median duration of 7 minutes and 47 minutes in AdultCan and Heart RCTs, respectively. There was a significant association between intervention exploration time during the first 2 weeks and retention in the Heart trial but not in the AdultCan trial. However, the control group was most likely to retain and provide complete follow-up data. Across the 3 time points of data collection explored in this study, the proportion of participants responding to all questionnaires within 1 week from the prompt, without a reminder, varied between 35.45% (413/1165) and 66.3% (112/169). After 2 reminders, up to 97.6% (165/169) of the participants responded. Conclusions: Most participants in both RCTs completed the baseline questionnaires within 1 week of receiving the welcome email. Approximately half of them answered questions at baseline data collection outside office hours, suggesting that the time flexibility inherent in web-based interventions contributes to commencement and use. In contrast to what was expected, the intervention groups generally had lower completion rates than the comparison groups. About half of the participants completed the questionnaires without a reminder, but thereafter, reminders contributed to both baseline and follow-up retention, suggesting they were effective. Strategies to increase commencement of and retention in eHealth interventions are important for the future development of effective interventions and relevant research. %M 33709937 %R 10.2196/24590 %U https://www.jmir.org/2021/3/e24590 %U https://doi.org/10.2196/24590 %U http://www.ncbi.nlm.nih.gov/pubmed/33709937 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24638 %T Acceptance and Use of Home-Based Electronic Symptom Self-Reporting Systems in Patients With Cancer: Systematic Review %A Cho,Youmin %A Zhang,Huiting %A Harris,Marcelline Ruth %A Gong,Yang %A Smith,Ellen Lavoie %A Jiang,Yun %+ University of Michigan School of Nursing, 400 North Ingalls, Ann Arbor, MI, 48109, United States, 1 734 763 3705, jiangyu@umich.edu %K symptom %K self report %K telemedicine %K technology %K internet %K mobile phone %K patient preference %K cancer %K patient-reported outcomes %D 2021 %7 12.3.2021 %9 Review %J J Med Internet Res %G English %X Background: Electronic symptom self-reporting systems (e-SRS) have been shown to improve symptoms and survival in patients with cancer. However, patient engagement in using e-SRS for voluntary symptom self-reporting is less optimal. Multiple factors can potentially affect patients’ acceptance and engagement in using home-based e-SRS. However, such factors have not been fully explored in cancer populations. Objective: The aim of this study is to understand the acceptance and use of home-based e-SRS by patients with cancer and identify associated facilitators and barriers. Methods: PubMed, CINAHL, Scopus, and PsycINFO (January 2010 to March 2020) were searched using a combination of Medical Subject Headings (MeSH) terms and keywords such as symptom self-reporting, electronic/technology, cancer, and their synonyms. Included studies focused on the use of home-based e-SRS by patients with cancer and their families. Studies on patients’ use of e-SRS in clinical settings only were excluded. Of the 3740 papers retrieved, 33 were included in the final review. Factors associated with patient acceptance and use of e-SRS were extracted and synthesized. Results: Most e-SRS were web based (22/33, 66%) or mobile app based (9/33, 27%). The e-SRS initial acceptance, represented by patient enrollment rates, ranged from 40% (22/55) to 100% (100/100). High e-SRS acceptance was rated by 69% (59/85) to 77.6% (337/434) of the patients after they used the system. The e-SRS use, measured by patients’ response rates to questionnaires (ranging from 1596/3521, 45.33% to 92%) or system log-on rates (ranging from 4/12, 33% to 99/100, 99%), declined over time in general patterns. Few studies (n=7) reported e-SRS use beyond 6 months, with the response rates ranging from 62% (40/64) to 85.1% (541/636) and the log-on rates ranging from 63.6% (103/162) to 77% (49/64). The availability of compatible devices and technical support, interactive system features, information accessibility, privacy, questionnaire quality, patient physical/psychosocial status, and age were associated with patient acceptance and use of home-based e-SRS. Conclusions: Acceptance and use of home-based e-SRS by patients with cancer varied significantly across studies, as assessed by a variety of approaches. The lack of access to technology has remained a barrier to e-SRS adoption. Interactive system features and personalized questionnaires may increase patient engagement. More studies are needed to further understand patients’ long-term use of home-based e-SRS behavior patterns to develop personalized interventions to support symptom self-management and self-reporting of patients with cancer for optimal health outcomes. %M 33709929 %R 10.2196/24638 %U https://www.jmir.org/2021/3/e24638 %U https://doi.org/10.2196/24638 %U http://www.ncbi.nlm.nih.gov/pubmed/33709929 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25173 %T Guidelines for Conducting Virtual Cognitive Interviews During a Pandemic %A Shepperd,James A %A Pogge,Gabrielle %A Hunleth,Jean M %A Ruiz,Sienna %A Waters,Erika A %+ Department of Psychology, University of Florida, 945 Center Drive, Gainesville, FL, 32611, United States, 1 352 273 2165, shepperd@ufl.edu %K cognitive interview %K COVID-19 %K guidelines %K teleresearch %K pandemic %K tablet computer %K telehealth %K training %D 2021 %7 11.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X The COVID-19 pandemic has challenged researchers working in physical contact with research participants. Cognitive interviews examine whether study components (most often questionnaire items) are worded or structured in a manner that allows study participants to interpret the items in a way intended by the researcher. We developed guidelines to conduct cognitive interviews virtually to accommodate interviewees who have limited access to the internet. The guidelines describe the essential communication and safety equipment requirements and outline a procedure for collecting responses while maintaining the safety of the participants and researchers. Furthermore, the guidelines provide suggestions regarding training of participants to use the technology, encouraging them to respond aloud (a potential challenge given that the researcher is not physically present with the participant), and testing and deploying the equipment prior to the interview. Finally, the guidelines emphasize the need to adapt the interview to the circumstances and anticipate potential problems that might arise. %M 33577464 %R 10.2196/25173 %U https://www.jmir.org/2021/3/e25173 %U https://doi.org/10.2196/25173 %U http://www.ncbi.nlm.nih.gov/pubmed/33577464 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e25123 %T Internet Access and Usage Among Stroke Survivors and Their Informal Caregivers: Cross-sectional Study %A Naqvi,Imama Ali %A Montiel,Tahani Casameni %A Bittar,Yazan %A Hunter,Norma %A Okpala,Munachi %A Johnson,Constance %A Weiner,Mark G %A Savitz,Sean %A Sharrief,Anjail %A Beauchamp,Jennifer Elizabeth Sanner %+ Division of Stroke and Cerebrovascular Diseases, Department of Neurology, Columbia University Irving Medical Center, 710 W 168th St, 6th Fl, Ste 650, New York, NY, 10032, United States, 1 212 305 8253, ian2108@cumc.columbia.edu %K internet access %K stroke %K caregivers %K surveys %K questionnaires %K mobile phone %D 2021 %7 8.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based interventions have shown promise for chronic disease management but have not been widely applied to populations with stroke. Existing barriers may inhibit the adoption of web-based interventions among stroke survivors and necessitate the involvement of informal caregivers. However, limited information is available on internet accessibility and usability among stroke survivors and their caregivers. Objective: This study aims to investigate internet access and usage in a cohort of stroke survivors and their caregivers. Methods: A cross-sectional survey was conducted with 375 participants (248 stroke survivors and 127 caregivers). Descriptive statistics were generated using cross-tabulation. Comparisons with categorical data were conducted using the chi-square test, whereas the Mann-Whitney U test was used for comparisons involving ordinal variables. Results: Overall, 86.1% (323/375) of the participants reported having internet access. Caregivers were more likely than stroke survivors to access the internet (N=375, χ21=18.5, P<.001) and used text messaging (n=321, χ21=14.7, P<.001). Stroke survivors and caregivers with internet access were younger than stroke survivors and caregivers without internet access. The highest number of participants who reported internet access were non-Hispanic White. Smartphones were the most common devices used to access the internet. Email was the most common type of internet usage reported. Patients who survived for >12 months after a stroke reported higher internet access than those who survived <3 months (P<.001). The number of hours per week spent using the internet was higher for caregivers than for stroke survivors (P<.001). Conclusions: Future feasibility and acceptability studies should consider the role of the informal caregiver, participant age, race and ethnicity, the use of smartphone apps, email and text correspondence, and the amount of time elapsed since the stroke event in the design and implementation of web-based interventions for populations with stroke. %M 33683206 %R 10.2196/25123 %U https://formative.jmir.org/2021/3/e25123 %U https://doi.org/10.2196/25123 %U http://www.ncbi.nlm.nih.gov/pubmed/33683206 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e22732 %T Text Messaging and Web-Based Survey System to Recruit Patients With Low Back Pain and Collect Outcomes in the Emergency Department: Observational Study %A Amorim,Anita Barros %A Coombs,Danielle %A Richards,Bethan %A Maher,Chris G %A Machado,Gustavo C %+ Discipline of Physiotherapy, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Level 7 East, Susan Wakil Health Building D18, Camperdown, Sydney, 2006, Australia, 61 0401399572, anita.amorim@sydney.edu.au %K emergency department %K clinical trial %K low back pain %K acute pain %K data collection %K patient recruitment %K short message service %K patient reported outcome measures %K mobile phone %D 2021 %7 4.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Low back pain (LBP) is a frequent reason for emergency department (ED) presentations, with a global prevalence of 4.4%. Despite being common, the number of clinical trials investigating LBP in the ED is low. Recruitment of patients in EDs can be challenging because of the fast-paced and demanding ED environment. Objective: The aim of this study is to describe the recruitment and response rates using an SMS text messaging and web-based survey system supplemented by telephone calls to recruit patients with LBP and collect health outcomes in the ED. Methods: An automated SMS text messaging system was integrated into Research Electronic Data Capture and used to collect patient-reported outcomes for an implementation trial in Sydney, Australia. We invited patients with nonserious LBP who presented to participating EDs at 1, 2, and 4 weeks after ED discharge. Patients who did not respond to the initial SMS text message invitation were sent a reminder SMS text message or contacted via telephone. The recruitment rate was measured as the proportion of patients who agreed to participate, and the response rate was measured as the proportion of participants completing the follow-up surveys at weeks 2 and 4. Regression analyses were used to explore factors associated with response rates. Results: In total, 807 patients with nonserious LBP were invited to participate and 425 (53.0%) agreed to participate. The week 1 survey was completed by 51.5% (416/807) of participants. At week 2, the response rate was 86.5% (360/416), and at week 4, it was 84.4% (351/416). Overall, 60% of the surveys were completed via SMS text messaging and on the web and 40% were completed via telephone. Younger participants and those from less socioeconomically disadvantaged areas were more likely to respond to the survey via the SMS text messaging and web-based system. Conclusions: Using an SMS text messaging and web-based survey system supplemented by telephone calls is a viable method for recruiting patients with LBP and collecting health outcomes in the ED. This hybrid system could potentially reduce the costs of using traditional recruitment and data collection methods (eg, face-to-face, telephone calls only). International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2017-019052 %M 33661125 %R 10.2196/22732 %U https://mhealth.jmir.org/2021/3/e22732 %U https://doi.org/10.2196/22732 %U http://www.ncbi.nlm.nih.gov/pubmed/33661125 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e24302 %T Educational Needs and Preferences for Patient-Centered Outcomes Research in the Cystic Fibrosis Community: Mixed Methods Study %A Godfrey,Emily M %A Kazmerski,Traci M %A Brown,Georgia %A Thayer,Erin K %A Mentch,Laura %A Pam,Molly %A Al Achkar,Morhaf %+ Department of Family Medicine, University of Washington School of Medicine, 4311 11th Ave NE, Suite 210, Box 354982, Seattle, WA, 98105, United States, 1 206 685 4895, godfreye@uw.edu %K cystic fibrosis %K needs assessment %K patient-centered outcomes research %K training %K education %K team building %K patient engagement %D 2021 %7 4.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Cystic fibrosis (CF) is a rare, life-shortening, multiorgan disease, the treatment of which has seen significant increases in the life expectancy of those with CF. Many advances in CF care are thanks to the dedicated and active participation of people with CF as research participants. Unfortunately, most CF research teams still do not fully partner with people with CF or their caregivers. Objective: The aim of this study was to determine the interest, knowledge gaps, and desired format for patient-centered outcomes research (PCOR) training in the CF community. Methods: We surveyed patients, caregivers, researchers, research staff, and diverse health care providers via list servers and social media outreach about their knowledge of, experience with, and preferences for PCOR training components. We followed the survey with 3 small-group discussion sessions with 22 participants who completed the survey to establish consensus and prioritize key learning components of a PCOR training program. We summarized results using descriptive statistics. Results: A total of 170 participants completed the survey (patients/caregivers: 96/170, 56.5%; researchers/health care providers: 74/170, 43.5%). Among providers, 26% (19/74) were physicians/advanced practice providers, 20% (15/74) were nurses, and 54% (40/74) were from other disciplines. Among all participants, 86.5% (147/170) expressed interest in learning about PCOR, although training topics and training format differed between the patient/caregiver and researcher/health care provider groups. Before participating in PCOR, patients/caregivers wanted to understand more about expectations of them as partners on PCOR research teams (82/96, 85%). Meanwhile, researchers/health care providers desired information on how to include outcomes important to patients/caregivers (55/74, 74%) and the quality and impact of PCOR research (52/74, 70% and 51/74, 69%, respectively). Patients/caregivers were most interested in learning about the time commitment as a PCOR team member (75/96, 78%). Researchers/health care providers wanted to receive training about how to establish trust (47/74, 64%) and maintain confidentiality (47/74, 64%) when including patient or caregiver partners on the PCOR team. During follow-up discussions, participants emphasized the importance of addressing the traditional patient/caregiver and researchers/health care provider hierarchy by teaching about transparency, appreciation, creating a common language between the groups, and providing specific training on “how” to do PCOR. Conclusions: Our findings suggest CF community members are interested in PCOR. A high-quality training program would fill a current deficit in methodological research. This assessment identified the topics and formats desired and can be used to develop targeted training to enhance meaningful PCOR in CF. %M 33661127 %R 10.2196/24302 %U https://formative.jmir.org/2021/3/e24302 %U https://doi.org/10.2196/24302 %U http://www.ncbi.nlm.nih.gov/pubmed/33661127 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 3 %P e18269 %T Comparative Analysis of Paper-Based and Web-Based Versions of the National Comprehensive Cancer Network-Functional Assessment of Cancer Therapy-Breast Cancer Symptom Index (NFBSI-16) Questionnaire in Breast Cancer Patients: Randomized Crossover Study %A Ma,Jinfei %A Zou,Zihao %A Pazo,Emmanuel Eric %A Moutari,Salissou %A Liu,Ye %A Jin,Feng %+ Department of Breast Surgery, The First Affiliated Hospital of China Medical University, No 155 Nanjing Road, Heping District, Shenyang, 110001, China, 86 18040031101, jinfeng@cmu.edu.cn %K breast cancer %K NFBSI-16 %K patient-reported outcome %K reproducibility %K test-retest reliability %K web-based questionnaire %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Breast cancer remains the most common neoplasm diagnosed among women in China and globally. Health-related questionnaire assessments in research and clinical oncology settings have gained prominence. The National Comprehensive Cancer Network–Functional Assessment of Cancer Therapy–Breast Cancer Symptom Index (NFBSI-16) is a rapid and powerful tool to help evaluate disease- or treatment-related symptoms, both physical and emotional, in patients with breast cancer for clinical and research purposes. Prevalence of individual smartphones provides a potential web-based approach to administrating the questionnaire; however, the reliability of the NFBSI-16 in electronic format has not been assessed. Objective: This study aimed to assess the reliability of a web-based NFBSI-16 questionnaire in breast cancer patients undergoing systematic treatment with a prospective open-label randomized crossover study design. Methods: We recruited random patients with breast cancer under systematic treatment from the central hospital registry to complete both paper- and web-based versions of the questionnaires. Both versions of the questionnaires were self-assessed. Patients were randomly assigned to group A (paper-based first and web-based second) or group B (web-based first and paper-based second). A total of 354 patients were included in the analysis (group A: n=177, group B: n=177). Descriptive sociodemographic characteristics, reliability and agreement rates for single items, subscales, and total score were analyzed using the Wilcoxon test. The Lin concordance correlation coefficient (CCC) and Spearman and Kendall τ rank correlations were used to assess test-retest reliability. Results: Test-retest reliability measured with CCCs was 0.94 for the total NFBSI-16 score. Significant correlations (Spearman ρ) were documented for all 4 subscales—Disease-Related Symptoms Subscale–Physical (ρ=0.93), Disease-Related Symptoms Subscale–Emotional (ρ=0.85), Treatment Side Effects Subscale (ρ=0.95), and Function and Well-Being Subscale (ρ=0.91)—and total NFBSI-16 score (ρ=0.94). Mean differences of the test and retest were all close to zero (≤0.06). The parallel test-retest reliability of subscales with the Wilcoxon test comparing individual items found GP3 (item 5) to be significantly different (P=.02). A majority of the participants in this study (255/354, 72.0%) preferred the web-based over the paper-based version. Conclusions: The web-based version of the NFBSI-16 questionnaire is an excellent tool for monitoring individual breast cancer patients under treatment, with the majority of participants preferring it over the paper-based version. %M 33650978 %R 10.2196/18269 %U https://medinform.jmir.org/2021/3/e18269 %U https://doi.org/10.2196/18269 %U http://www.ncbi.nlm.nih.gov/pubmed/33650978 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e19074 %T Assessment of Patients’ Ability to Review Electronic Health Record Information to Identify Potential Errors: Cross-sectional Web-Based Survey %A Freise,Lisa %A Neves,Ana Luisa %A Flott,Kelsey %A Harrison,Paul %A Kelly,John %A Darzi,Ara %A Mayer,Erik K %+ Patient Safety Translational Research Centre, Institute of Global Health Innovation, Imperial College London, St Mary’s Campus Queen, Elizabeth Queen Mother Wing, London, W2 1NY, United Kingdom, 44 (0)20 7589 5111, ana.luisa.neves14@ic.ac.uk %K patient portals %K electronic health records %K patient participation %K medical errors %K patient safety %D 2021 %7 26.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Sharing personal health information positively impacts quality of care across several domains, and particularly, safety and patient-centeredness. Patients may identify and flag up inconsistencies in their electronic health records (EHRs), leading to improved information quality and patient safety. However, in order to identify potential errors, patients need to be able to understand the information contained in their EHRs. Objective: The aim of this study was to assess patients’ perceptions of their ability to understand the information contained in their EHRs and to analyze the main barriers to their understanding. Additionally, the main types of patient-reported errors were characterized. Methods: A cross-sectional web-based survey was undertaken between March 2017 and September 2017. A total of 682 registered users of the Care Information Exchange, a patient portal, with at least one access during the time of the study were invited to complete the survey containing both structured (multiple choice) and unstructured (free text) questions. The survey contained questions on patients’ perceived ability to understand their EHR information and therefore, to identify errors. Free-text questions allowed respondents to expand on the reasoning for their structured responses and provide more detail about their perceptions of EHRs and identifying errors within them. Qualitative data were systematically reviewed by 2 independent researchers using the framework analysis method in order to identify emerging themes. Results: A total of 210 responses were obtained. The majority of the responses (123/210, 58.6%) reported understanding of the information. The main barriers identified were information-related (medical terminology and knowledge and interpretation of test results) and technology-related (user-friendliness of the portal, information display). Inconsistencies relating to incomplete and incorrect information were reported in 12.4% (26/210) of the responses. Conclusions: While the majority of the responses affirmed the understanding of the information contained within the EHRs, both technology and information-based barriers persist. There is a potential to improve the system design to better support opportunities for patients to identify errors. This is with the aim of improving the accuracy, quality, and timeliness of the information held in the EHRs and a mechanism to further engage patients in their health care. %M 33635277 %R 10.2196/19074 %U https://formative.jmir.org/2021/2/e19074 %U https://doi.org/10.2196/19074 %U http://www.ncbi.nlm.nih.gov/pubmed/33635277 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e22854 %T Comparison of Facebook, Google Ads, and Reddit for the Recruitment of People Who Considered but Did Not Obtain Abortion Care in the United States: Cross-sectional Survey %A Moseson,Heidi %A Wollum,Alexandra %A Seymour,Jane W %A Zuniga,Carmela %A Thompson,Terri-Ann %A Gerdts,Caitlin %+ Ibis Reproductive Health, 1736 Franklin Street, Suite 600, Oakland, CA, 94612, United States, 1 5108222696, hmoseson@gmail.com %K abortion, induced %K abortion seekers %K abortion surveys %K bias, selection %K pregnancy, unplanned %K research subject recruitment %K reproductive health %K social media %K social stigma %D 2021 %7 24.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, abortion access is restricted by numerous logistical, financial, social, and policy barriers. Most studies on abortion-seeking experiences in the United States have recruited participants from abortion clinics. However, clinic-based recruitment strategies fail to capture the experiences of people who consider an abortion but do not make it to an abortion clinic. Research indicates that many people search for abortion information on the web; however, web-based recruitment remains underutilized in abortion research. Objective: This study aims to establish the feasibility of using Facebook, Google Ads, and Reddit as recruitment platforms for a study on abortion-seeking experiences in the United States. Methods: From August to September 2018, we posted recruitment advertisements for a survey about abortion-seeking experiences through Facebook, Google Ads, and Reddit. Eligible participants were US residents aged 15-49 years who had been pregnant in the past 5 years and had considered abortion for a pregnancy in this period but did not abort. For each platform, we recorded staff time to develop advertisements and manage recruitment, as well as costs related to advertisement buys and social marketing firm support. We summarized the number of views and clicks for each advertisement where possible, and we calculated metrics related to cost per recruited participant and recruitment rate by week for each platform. We assessed differences across platforms using the chi-square and Kruskal-Wallis tests. Results: Overall, study advertisements received 77,464 views in the 1-month period (from Facebook and Google; information not available for Reddit) and 2808 study page views. After clicking on the advertisements, there were 1254 initiations of the eligibility screening survey, which resulted in 98 eligible survey participants (75 recruited from Facebook, 14 from Google Ads, and 9 from Reddit). The cost for each eligible participant in each platform was US $49.48 for Facebook, US $265.93 for Google Ads, and US $182.78 for Reddit. A total of 84% (66/79) of those who screened eligible from Facebook completed the short survey compared with 73% (8/11) of those who screened eligible from Reddit and 13% (7/53) of those who screened eligible from Google Ads. Conclusions: These results suggest that Facebook advertisements may be the most time- and cost-effective strategy to recruit people who considered but did not obtain an abortion in the United States. Adapting and implementing Facebook-based recruitment strategies for research on abortion access could facilitate a more complete understanding of the barriers to abortion care in the United States. %M 33625368 %R 10.2196/22854 %U https://formative.jmir.org/2021/2/e22854 %U https://doi.org/10.2196/22854 %U http://www.ncbi.nlm.nih.gov/pubmed/33625368 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25125 %T Differences in Basic Life Support Knowledge Between Junior Medical Students and Lay People: Web-Based Questionnaire Study %A Sturny,Ludovic %A Regard,Simon %A Larribau,Robert %A Niquille,Marc %A Savoldelli,Georges Louis %A Sarasin,François %A Schiffer,Eduardo %A Suppan,Laurent %+ Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, Geneva, 1211, Switzerland, 41 795532579, laurent.suppan@hcuge.ch %K basic life support %K cardiopulmonary resuscitation %K medical students %K undergraduate medical education %K out-of-hospital cardiac arrest %K life support %K cardiopulmonary %K medical education %D 2021 %7 23.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Early cardiopulmonary resuscitation and prompt defibrillation markedly increase the survival rate in the event of out-of-hospital cardiac arrest (OHCA). As future health care professionals, medical students should be trained to efficiently manage an unexpectedly encountered OHCA. Objective: Our aim was to assess basic life support (BLS) knowledge in junior medical students at the University of Geneva Faculty of Medicine (UGFM) and to compare it with that of the general population. Methods: Junior UGFM students and lay people who had registered for BLS classes given by a Red Cross–affiliated center were sent invitation links to complete a web-based questionnaire. The primary outcome was the between-group difference in a 10-question score regarding cardiopulmonary resuscitation knowledge. Secondary outcomes were the differences in the rate of correct answers for each individual question, the level of self-assessed confidence in the ability to perform resuscitation, and a 6-question score, “essential BLS knowledge,” which only contains key elements of the chain of survival. Continuous variables were first analyzed using the Student t test, then by multivariable linear regression. Fisher exact test was used for between-groups comparison of binary variables. Results: The mean score was higher in medical students than in lay people for both the 10-question score (mean 5.8, SD 1.7 vs mean 4.2, SD 1.7; P<.001) and 6-question score (mean 3.0, SD 1.1 vs mean 2.0, SD 1.0; P<.001). Participants who were younger or already trained scored consistently better. Although the phone number of the emergency medical dispatch center was well known in both groups (medical students, 75/80, 94% vs lay people, 51/62, 82%; P=.06), most participants were unable to identify the criteria used to recognize OHCA, and almost none were able to correctly reorganize the BLS sequence. Medical students felt more confident than lay people in their ability to perform resuscitation (mean 4.7, SD 2.2 vs mean 3.1, SD 2.1; P<.001). Female gender and older age were associated with lower confidence, while participants who had already attended a BLS course prior to taking the questionnaire felt more confident. Conclusions: Although junior medical students were more knowledgeable than lay people regarding BLS procedures, the proportion of correct answers was low in both groups, and changes in BLS education policy should be considered. %M 33620322 %R 10.2196/25125 %U https://www.jmir.org/2021/2/e25125 %U https://doi.org/10.2196/25125 %U http://www.ncbi.nlm.nih.gov/pubmed/33620322 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25118 %T Efficiency and Quality of Data Collection Among Public Mental Health Surveys Conducted During the COVID-19 Pandemic: Systematic Review %A Lin,Yu-Hsuan %A Chen,Chung-Yen %A Wu,Shiow-Ing %+ Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 35053, Taiwan, 886 37 206166 ext 36383, yuhsuanlin@nhri.edu.tw %K COVID-19 %K mental health %K Newcastle-Ottawa Scale %K review %K data collection %K survey %K surveillance %K literature %K research %D 2021 %7 10.2.2021 %9 Review %J J Med Internet Res %G English %X Background: The World Health Organization has recognized the importance of assessing population-level mental health during the COVID-19 pandemic. During a global crisis such as the COVID-19 pandemic, a timely surveillance method is urgently needed to track the impact on public mental health. Objective: This brief systematic review focused on the efficiency and quality of data collection of studies conducted during the COVID-19 pandemic. Methods: We searched the PubMed database using the following search strings: ((COVID-19) OR (SARS-CoV-2)) AND ((Mental health) OR (psychological) OR (psychiatry)). We screened the titles, abstracts, and texts of the published papers to exclude irrelevant studies. We used the Newcastle-Ottawa Scale to evaluate the quality of each research paper. Results: Our search yielded 37 relevant mental health surveys of the general public that were conducted during the COVID-19 pandemic, as of July 10, 2020. All these public mental health surveys were cross-sectional in design, and the journals efficiently made these articles available online in an average of 18.7 (range 1-64) days from the date they were received. The average duration of recruitment periods was 9.2 (range 2-35) days, and the average sample size was 5137 (range 100-56,679). However, 73% (27/37) of the selected studies had Newcastle-Ottawa Scale scores of <3 points, which suggests that these studies are of very low quality for inclusion in a meta-analysis. Conclusions: The studies examined in this systematic review used an efficient data collection method, but there was a high risk of bias, in general, among the existing public mental health surveys. Therefore, following recommendations to avoid selection bias, or employing novel methodologies considering both a longitudinal design and high temporal resolution, would help provide a strong basis for the formation of national mental health policies. %M 33481754 %R 10.2196/25118 %U http://www.jmir.org/2021/2/e25118/ %U https://doi.org/10.2196/25118 %U http://www.ncbi.nlm.nih.gov/pubmed/33481754 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e22980 %T Conducting Virtual, Synchronous Focus Groups Among Black Sexual Minority Men: Qualitative Study %A Dangerfield II,Derek T %A Wylie,Charleen %A Anderson,Janeane N %+ Johns Hopkins School of Nursing, 855 N Wolfe St, Baltimore, MD, 21205, United States, 1 4109553757, ddanger2@jhu.edu %K engagement %K recruitment %K sexual health %K telehealth %D 2021 %7 8.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Focus groups are useful to support HIV prevention research among US subpopulations, such as Black gay, Black bisexual, and other Black sexual minority men (BSMM). Virtual synchronous focus groups provide an electronic means to obtain qualitative data and are convenient to implement; however, the protocols and acceptability for conducting virtual synchronous focus groups in HIV prevention research among BSMM are lacking. Objective: This paper describes the protocols and acceptability of conducting virtual synchronous focus groups in HIV prevention research among BSMM Methods: Data for this study came from 8 virtual synchronous focus groups examined in 2 studies of HIV-negative BSMM in US cities, stratified by age (N=39): 2 groups of BSMM ages 18-24 years, 5 groups of BSMM ages 25-34 years, and 1 group of BSMM 35 years and older. Virtual synchronous focus groups were conducted via Zoom, and participants were asked to complete an electronic satisfaction survey distributed to their email via Qualtrics. Results: The age of participants ranged from 18 to 44 years (mean 28.3, SD 6.0). All participants “strongly agreed” or “agreed” that they were satisfied participating in an online focus group. Only 17% (5/30) preferred providing written informed consent versus oral consent. Regarding privacy, most (30/30,100%) reported “strongly agree” or “agree” that their information was safe to share with other participants in the group. Additionally, 97% (29/30) reported being satisfied with the incentive. Conclusions: Conducting virtual synchronous focus groups in HIV prevention research among BSMM is feasible. However, thorough oral informed consent with multiple opportunities for questions, culturally relevant facilitation procedures, and appropriate incentives are needed for optimal focus group participation. %M 33427671 %R 10.2196/22980 %U http://publichealth.jmir.org/2021/2/e22980/ %U https://doi.org/10.2196/22980 %U http://www.ncbi.nlm.nih.gov/pubmed/33427671 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e24382 %T Using Information Technology to Assess Patient Risk Factors in Primary Care Clinics: Pragmatic Evaluation %A Kosowan,Leanne %A Katz,Alan %A Halas,Gayle %A LaBine,Lisa %A Singer,Alexander %+ Rady Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave, Winnipeg, MB, R3E 3P5, Canada, 1 204 789 3442, Alan.katz@umanitoba.ca %K risk factors %K information technology %K primary health care %K primary prevention %D 2021 %7 2.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Tobacco use, physical inactivity, and poor diet are associated with morbidity and premature death. Health promotion and primary prevention counseling, advice, and support by a primary care provider lead to behavior change attempts among patients. However, although physicians consider preventative health important, there is often a larger focus on symptom presentation, acute care, and medication review. Objective: This study evaluated the feasibility, adoption, and integration of the tablet-based Risk Factor Identification Tool (RFIT) that uses algorithmic information technology to support obtainment of patient risk factor information in primary care clinics. Methods: This is a pragmatic developmental evaluation. Each clinic developed a site-specific implementation plan adapted to their workflow. The RFIT was implemented in 2 primary care clinics located in Manitoba. Perceptions of 10 clinic staff and 8 primary care clinicians informed this evaluation. Results: Clinicians reported a smooth and fast transfer of RFIT responses to an electronic medical record encounter note. The RFIT was used by 207 patients, with a completion rate of 86%. Clinic staff reported that approximately 3%-5% of patients declined the use of the RFIT or required assistance to use the tablet. Among the 207 patients that used the RFIT, 22 (12.1%) smoked, 39 (21.2%) felt their diet could be improved, 20 (12.0%) reported high alcohol consumption, 103 (56.9%) reported less than 150 minutes of physical activity a week, and 6 (8.2%) patients lived in poverty. Clinicians suggested that although a wide variety of patients were able to use the tablet-based RFIT, implemented surveys should be tailored to patient subgroups. Conclusions: Clinicians and clinic staff positively reviewed the use of information technology in primary care. Algorithmic information technology can collect, organize, and synthesize individual health information to inform and tailor primary care counseling to the patients’ context and readiness to change. The RFIT is a user-friendly tool that provides an effective method for obtaining risk factor information from patients. It is particularly useful for subsets of patients lacking continuity in the care they receive. When implemented within a context that can support practical interventions to address identified risk factors, the RFIT can inform brief interventions within primary care. %M 33528376 %R 10.2196/24382 %U https://formative.jmir.org/2021/2/e24382 %U https://doi.org/10.2196/24382 %U http://www.ncbi.nlm.nih.gov/pubmed/33528376 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e21382 %T Data Quality and Cost-effectiveness Analyses of Electronic and Paper-Based Interviewer-Administered Public Health Surveys: Systematic Review %A Zeleke,Atinkut Alamirrew %A Naziyok,Tolga %A Fritz,Fleur %A Christianson,Lara %A Röhrig,Rainer %+ Medical Informatics, Institute for Community Medicine, University Medicine Greifswald, Ellernholzstraße 1-2, Greifswald, D-17487, Germany, 49 3834 86 7548, atinkut.zeleke@uni-greifswald.de %K electronic data collection %K demographic and health survey %K tablet computer %K smartphone %K mobile phone %D 2021 %7 22.1.2021 %9 Review %J J Med Internet Res %G English %X Background: A population-level survey (PLS) is an essential and standard method used in public health research that supports the quantification of sociodemographic events, public health policy development, and intervention designs. Data collection mechanisms in PLS seem to be a significant determinant in avoiding mistakes. Using electronic devices such as smartphones and tablet computers improves the quality and cost-effectiveness of public health surveys. However, there is a lack of systematic evidence to show the potential impact of electronic data collection tools on data quality and cost reduction in interviewer-administered surveys compared with the standard paper-based data collection system. Objective: This systematic review aims to evaluate the impact of the interviewer-administered electronic data collection methods on data quality and cost reduction in PLS compared with traditional methods. Methods: We conducted a systematic search of MEDLINE, CINAHL, PsycINFO, the Web of Science, EconLit, Cochrane CENTRAL, and CDSR to identify relevant studies from 2008 to 2018. We included randomized and nonrandomized studies that examined data quality and cost reduction outcomes, as well as usability, user experience, and usage parameters. In total, 2 independent authors screened the title and abstract, and extracted data from selected papers. A third author mediated any disagreements. The review authors used EndNote for deduplication and Rayyan for screening. Results: Our search produced 3817 papers. After deduplication, we screened 2533 papers, and 14 fulfilled the inclusion criteria. None of the studies were randomized controlled trials; most had a quasi-experimental design, for example, comparative experimental evaluation studies nested on other ongoing cross-sectional surveys. A total of 4 comparative evaluations, 2 pre-post intervention comparative evaluations, 2 retrospective comparative evaluations, and 4 one-arm noncomparative studies were included. Meta-analysis was not possible because of the heterogeneity in study designs, types, study settings, and level of outcome measurements. Individual paper synthesis showed that electronic data collection systems provided good quality data and delivered faster compared with paper-based data collection systems. Only 2 studies linked cost and data quality outcomes to describe the cost-effectiveness of electronic data collection systems. Field data collectors reported that an electronic data collection system was a feasible, acceptable, and preferable tool for their work. Onsite data error prevention, fast data submission, and easy-to-handle devices were the comparative advantages offered by electronic data collection systems. Challenges during implementation included technical difficulties, accidental data loss, device theft, security concerns, power surges, and internet connection problems. Conclusions: Although evidence exists of the comparative advantages of electronic data collection compared with paper-based methods, the included studies were not methodologically rigorous enough to combine. More rigorous studies are needed to compare paper and electronic data collection systems in public health surveys considering data quality, work efficiency, and cost reduction. International Registered Report Identifier (IRRID): RR2-10.2196/10678 %M 33480859 %R 10.2196/21382 %U http://www.jmir.org/2021/1/e21382/ %U https://doi.org/10.2196/21382 %U http://www.ncbi.nlm.nih.gov/pubmed/33480859 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e17691 %T Possibilities, Problems, and Perspectives of Data Collection by Mobile Apps in Longitudinal Epidemiological Studies: Scoping Review %A Fischer,Florian %A Kleen,Sina %+ Institut of Public Health, Charité - Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 751 501 9441, florian.fischer1@charite.de %K apps %K questionnaire %K survey %K epidemiology %K healthcare %D 2021 %7 22.1.2021 %9 Review %J J Med Internet Res %G English %X Background: The broad availability of smartphones and the number of health apps in app stores have risen in recent years. Health apps have benefits for individuals (eg, the ability to monitor one’s health) as well as for researchers (eg, the ability to collect data in population-based, clinical, and observational studies). Although the number of health apps on the global app market is huge and the associated potential seems to be great, app-based questionnaires for collecting patient-related data have not played an important role in epidemiological studies so far. Objective: This study aims to provide an overview of studies that have collected patient data using an app-based approach, with a particular focus on longitudinal studies. This literature review describes the current extent to which smartphones have been used for collecting (patient) data for research purposes, and the potential benefits and challenges associated with this approach. Methods: We conducted a scoping review of studies that used data collection via apps. PubMed was used to identify studies describing the use of smartphone app questionnaires for collecting data over time. Overall, 17 articles were included in the summary. Results: Based on the results of this scoping review, there are only a few studies that integrate smartphone apps into data-collection approaches. Studies dealing with the collection of health-related data via smartphone apps have mainly been developed with regard to psychosomatic, neurodegenerative, respiratory, and cardiovascular diseases, as well as malign neoplasm. Among the identified studies, the duration of data collection ranged from 4 weeks to 12 months, and the participants’ mean ages ranged from 7 to 69 years. Potential can be seen for real-time information transfer, fast data synchronization (which saves time and increases effectivity), and the possibility of tracking responses longitudinally. Furthermore, smartphone-based data-collection techniques might prevent biases, such as reminder bias or mistakes occurring during manual data transfers. In chronic diseases, real-time communication with physicians and early detection of symptoms enables rapid modifications in disease management. Conclusions: The results indicate that using mobile technologies can help to overcome challenges linked with data collection in epidemiological research. However, further feasibility studies need to be conducted in the near future to test the applicability and acceptance of these mobile apps for epidemiological research in various subpopulations. %M 33480850 %R 10.2196/17691 %U http://www.jmir.org/2021/1/e17691/ %U https://doi.org/10.2196/17691 %U http://www.ncbi.nlm.nih.gov/pubmed/33480850 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e24773 %T Adherence of Mobile App-Based Surveys and Comparison With Traditional Surveys: eCohort Study %A Pathiravasan,Chathurangi H %A Zhang,Yuankai %A Trinquart,Ludovic %A Benjamin,Emelia J %A Borrelli,Belinda %A McManus,David D %A Kheterpal,Vik %A Lin,Honghuang %A Sardana,Mayank %A Hammond,Michael M %A Spartano,Nicole L %A Dunn,Amy L %A Schramm,Eric %A Nowak,Christopher %A Manders,Emily S %A Liu,Hongshan %A Kornej,Jelena %A Liu,Chunyu %A Murabito,Joanne M %+ Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Crosstown 2, 201 Massachusetts Ave, Boston, MA, 02118, United States, 1 508 935 3461, murabito@bu.edu %K eCohort %K mobile health %K mHealth %K smartphone %K survey %K app %K Framingham Heart Study %K adherence %K agreement %K cardiovascular disease %D 2021 %7 20.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: eCohort studies offer an efficient approach for data collection. However, eCohort studies are challenged by volunteer bias and low adherence. We designed an eCohort embedded in the Framingham Heart Study (eFHS) to address these challenges and to compare the digital data to traditional data collection. Objective: The aim of this study was to evaluate adherence of the eFHS app-based surveys deployed at baseline (time of enrollment in the eCohort) and every 3 months up to 1 year, and to compare baseline digital surveys with surveys collected at the research center. Methods: We defined adherence rates as the proportion of participants who completed at least one survey at a given 3-month period and computed adherence rates for each 3-month period. To evaluate agreement, we compared several baseline measures obtained in the eFHS app survey to those obtained at the in-person research center exam using the concordance correlation coefficient (CCC). Results: Among the 1948 eFHS participants (mean age 53, SD 9 years; 57% women), we found high adherence to baseline surveys (89%) and a decrease in adherence over time (58% at 3 months, 52% at 6 months, 41% at 9 months, and 40% at 12 months). eFHS participants who returned surveys were more likely to be women (adjusted odds ratio [aOR] 1.58, 95% CI 1.18-2.11) and less likely to be smokers (aOR 0.53, 95% CI 0.32-0.90). Compared to in-person exam data, we observed moderate agreement for baseline app-based surveys of the Physical Activity Index (mean difference 2.27, CCC=0.56), and high agreement for average drinks per week (mean difference 0.54, CCC=0.82) and depressive symptoms scores (mean difference 0.03, CCC=0.77). Conclusions: We observed that eFHS participants had a high survey return at baseline and each 3-month survey period over the 12 months of follow up. We observed moderate to high agreement between digital and research center measures for several types of surveys, including physical activity, depressive symptoms, and alcohol use. Thus, this digital data collection mechanism is a promising tool to collect data related to cardiovascular disease and its risk factors. %M 33470944 %R 10.2196/24773 %U http://www.jmir.org/2021/1/e24773/ %U https://doi.org/10.2196/24773 %U http://www.ncbi.nlm.nih.gov/pubmed/33470944 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e18214 %T The Acceptability and Efficacy of Electronic Data Collection in a Hospital Neurodevelopmental Clinic: Pilot Questionnaire Study %A Patel,Shrujna %A Boulton,Kelsie Ann %A Redoblado-Hodge,Marie Antoinette %A Papanicolaou,Angela %A Barnett,Diana %A Bennett,Beverley %A Drevensek,Suzi %A Cramsie,Jane %A Ganesalingam,Kalaichelvi %A Ong,Natalie %A Rozsa,Magdalen %A Sutherland,Rebecca %A Williamsz,Marcia %A Pokorski,Izabella %A Song,Yun Ju Christine %A Silove,Natalie %A Guastella,Adam John %+ Autism Clinic for Translational Research, Brain and Mind Centre, Children’s Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 100 Mallett Street, Camperdown, 2050, Australia, 61 2 9351 0539, adam.guastella@sydney.edu.au %K electronic data collection %K family-centered care %K hospital-based data collection %D 2021 %7 19.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a growing need for cost-efficient and patient-centered approaches to support families in hospital- and community-based neurodevelopmental services. For such purposes, electronic data collection (EDC) may hold advantages over paper-based data collection. Such EDC approaches enable automated data collection for scoring and interpretation, saving time for clinicians and services and promoting more efficient service delivery. Objective: This pilot study evaluated the efficacy of EDC for the Child Development Unit, a hospital-based diagnostic assessment clinic in the Sydney Children’s Hospital Network. Caregiver response rates and preference for EDC or paper-based methods were evaluated as well as the moderating role of demographic characteristics such as age, level of education, and ethnic background. Methods: Families were sent either a paper-based questionnaire via post or an electronic mail link for completion before attending their first on-site clinic appointment for assessment. A total of 62 families were provided a paper version of the questionnaire, while 184 families were provided the online version of the same questionnaire. Results: Completion rates of the questionnaire before the first appointment were significantly higher for EDC (164/184, 89.1%) in comparison to paper-based methods (24/62, 39%; P<.001). Within the EDC group, a vast majority of respondents indicated a preference for completing the questionnaire online (151/173, 87.3%), compared to paper completion (22/173, 12.7%; P<.001). Of the caregiver demographic characteristics, only the respondent’s level of education was associated with modality preference, such that those with a higher level of education reported a greater preference for EDC (P=.04). Conclusions: These results show that EDC is feasible in hospital-based clinics and has the potential to offer substantial benefits in terms of centralized data collation, time and cost savings, efficiency of service, and resource allocation. The results of this study therefore support the continued use of electronic methods to improve family-centered care in clinical practices. %M 33464217 %R 10.2196/18214 %U http://formative.jmir.org/2021/1/e18214/ %U https://doi.org/10.2196/18214 %U http://www.ncbi.nlm.nih.gov/pubmed/33464217 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e21240 %T Differences in Mode Preferences, Response Rates, and Mode Effect Between Automated Email and Phone Survey Systems for Patients of Primary Care Practices: Cross-Sectional Study %A Johnston,Sharon %A Hogg,William %A Wong,Sabrina T %A Burge,Fred %A Peterson,Sandra %+ Department of Family Medicine, University of Ottawa, 43 Bruyere St, Ottawa, ON, K1N5C8, Canada, 1 613 562 6262 ext 2931, sjohnston@bruyere.org %K response rates %K primary care %K mixed-mode survey %D 2021 %7 11.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: A growing number of health care practices are adopting software systems that link with their existing electronic medical records to generate outgoing phone calls, emails, or text notifications to patients for appointment reminders or practice updates. While practices are adopting this software technology for service notifications to patients, its use for collection of patient-reported measures is still nascent. Objective: This study assessed the mode preferences, response rates, and mode effect for a practice-based automated patient survey using phone and email modalities to patients of primary care practices. Methods: This cross-sectional study analyzed responses and respondent demographics for a short, fully automated, telephone or email patient survey sent to individuals within 72 hours of a visit to their regular primary care practice. Each survey consisted of 5 questions drawn from a larger study’s patient survey that all respondents completed in the waiting room at the time of their visit. Automated patient survey responses were linked to self-reported sociodemographic information provided on the waiting room survey including age, sex, reported income, and health status. Results: A total of 871 patients from 87 primary care practices in British Columbia, Ontario, and Nova Scotia, Canada, agreed to the automated patient survey and 470 patients (45.2%) completed all 5 questions on the automated survey. Email administration of the follow-up survey was preferred over phone-based administration, except among patients aged 75 years and older (P<.001). Overall, response rates for those who selected an emailed survey (369/606, 60.9%) were higher (P<.001) than those who selected the phone survey (101/265, 38.1%). This held true irrespective of age, sex, or chronic disease status of individuals. Response rates were also higher for email (range 57.4% [58/101] to 66.3% [108/163]) compared with phone surveys (range 36% [23/64] to 43% [10/23]) for all income groups except the lowest income quintile, which had similar response rates (email: 29/63, 46%; phone: 23/50, 46%) for phone and email modes. We observed moderate (range 64.6% [62/96] to 78.8% [282/358]) agreement between waiting room survey responses and those obtained in the follow-up automated survey. However, overall agreement in responses was poor (range 45.3% [43/95] to 46.2% [43/93]) for 2 questions relating to care coordination. Conclusions: An automated practice-based patient experience survey achieved significantly different response rates between phone and email and increased response rates for email as income group rose. Potential mode effects for the different survey modalities may limit multimodal survey approaches. An automated minimal burden patient survey could facilitate the integration of patient-reported outcomes into care planning and service organization, supporting the move of our primary care practices toward a more responsive, patient-centered, continual learning system. However, practices must be attentive to furthering inequities in health care by underrepresenting the experience of certain groups in decision making based on the reach of different survey modes. %M 33427675 %R 10.2196/21240 %U https://www.jmir.org/2021/1/e21240 %U https://doi.org/10.2196/21240 %U http://www.ncbi.nlm.nih.gov/pubmed/33427675 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 1 %P e24618 %T Development of Social Support Networks by Patients With Depression Through Online Health Communities: Social Network Analysis %A Lu,Yingjie %A Luo,Shuwen %A Liu,Xuan %+ School of Business, East China University of Science and Technology, Meilong Road 130, Shanghai, 200237, China, 86 2164252489, xuanliu@ecust.edu.cn %K online depression community %K social support network %K exponential random graph model %K informational support %K emotional support %K mental health %K depression %K social network %D 2021 %7 7.1.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: In recent years, people with mental health problems are increasingly using online social networks to receive social support. For example, in online depression communities, patients can share their experiences, exchange valuable information, and receive emotional support to help them cope with their disease. Therefore, it is critical to understand how patients with depression develop online social support networks to exchange informational and emotional support. Objective: Our aim in this study was to investigate which user attributes have significant effects on the formation of informational and emotional support networks in online depression communities and to further examine whether there is an association between the two social networks. Methods: We used social network theory and constructed exponential random graph models to help understand the informational and emotional support networks in online depression communities. A total of 74,986 original posts were retrieved from 1077 members in an online depression community in China from April 2003 to September 2017 and the available data were extracted. An informational support network of 1077 participant nodes and 6557 arcs and an emotional support network of 1077 participant nodes and 6430 arcs were constructed to examine the endogenous (purely structural) effects and exogenous (actor-relation) effects on each support network separately, as well as the cross-network effects between the two networks. Results: We found significant effects of two important structural features, reciprocity and transitivity, on the formation of both the informational support network (r=3.6247, P<.001, and r=1.6232, P<.001, respectively) and the emotional support network (r=4.4111, P<.001, and r=0.0177, P<.001, respectively). The results also showed significant effects of some individual factors on the formation of the two networks. No significant effects of homophily were found for gender (r=0.0783, P=.20, and r=0.1122, P=.25, respectively) in the informational or emotional support networks. There was no tendency for users who had great influence (r=0.3253, P=.05) or wrote more posts (r=0.3896, P=.07) or newcomers (r=–0.0452, P=.66) to form informational support ties more easily. However, users who spent more time online (r=0.6680, P<.001) or provided more replies to other posts (r=0.5026, P<.001) were more likely to form informational support ties. Users who had a big influence (r=0.8325, P<.001), spent more time online (r=0.5839, P<.001), wrote more posts (r=2.4025, P<.001), or provided more replies to other posts (r=0.2259, P<.001) were more likely to form emotional support ties, and newcomers (r=–0.4224, P<.001) were less likely than old-timers to receive emotional support. In addition, we found that there was a significant entrainment effect (r=0.7834, P<.001) and a nonsignificant exchange effect (r=–0.2757, P=.32) between the two networks. Conclusions: This study makes several important theoretical contributions to the research on online depression communities and has important practical implications for the managers of online depression communities and the users involved in these communities. %M 33279878 %R 10.2196/24618 %U http://medinform.jmir.org/2021/1/e24618/ %U https://doi.org/10.2196/24618 %U http://www.ncbi.nlm.nih.gov/pubmed/33279878 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e19046 %T Examining the Correlation Between Depression and Social Behavior on Smartphones Through Usage Metadata: Empirical Study %A Wang,Yameng %A Ren,Xiaotong %A Liu,Xiaoqian %A Zhu,Tingshao %+ CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing, 100101, China, 86 15010965509, tszhu@psych.ac.cn %K depression %K digital phenotyping %K social behavior %K smartphone usage %K mobile sensing %D 2021 %7 6.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As smartphone has been widely used, understanding how depression correlates with social behavior on smartphones can be beneficial for early diagnosis of depression. An enormous amount of research relied on self-report questionnaires, which is not objective. Only recently the increased availability of rich data about human behavior in digital space has provided new perspectives for the investigation of individual differences. Objective: The objective of this study was to explore depressed Chinese individuals’ social behavior in digital space through metadata collected via smartphones. Methods: A total of 120 participants were recruited to carry a smartphone with a metadata collection app (MobileSens). At the end of metadata collection, they were instructed to complete the Center for Epidemiological Studies-Depression Scale (CES-D). We then separated participants into nondepressed and depressed groups based on their scores on CES-D. From the metadata of smartphone usage, we extracted 44 features, including traditional social behaviors such as making calls and sending SMS text messages, and the usage of social apps (eg, WeChat and Sina Weibo, 2 popular social apps in China). The 2-way ANOVA (nondepressed vs depressed × male vs female) and multiple logistic regression analysis were conducted to investigate differences in social behaviors on smartphones among users. Results: The results found depressed users received less calls from contacts (all day: F1,116=3.995, P=.048, η2=0.033; afternoon: F1,116=5.278, P=.02, η2=0.044), and used social apps more frequently (all day: F1,116=6.801, P=.01, η2=0.055; evening: F1,116=6.902, P=.01, η2=0.056) than nondepressed ones. In the depressed group, females used Weibo more frequently than males (all day: F1,116=11.744, P=.001, η2=0.092; morning: F1,116=9.105, P=.003, η2=0.073; afternoon: F1,116=14.224, P<.001, η2=0.109; evening: F1,116=9.052, P=.003, η2=0.072). Moreover, usage of social apps in the evening emerged as a predictor of depressive symptoms for all participants (odds ratio [OR] 1.007, 95% CI 1.001-1.013; P=.02) and male (OR 1.013, 95% CI 1.003-1.022; P=.01), and usage of Weibo in the morning emerged as a predictor for female (OR 1.183, 95% CI 1.015-1.378; P=.03). Conclusions: This paper finds that there exists a certain correlation between depression and social behavior on smartphones. The result may be useful to improve social interaction for depressed individuals in the daily lives and may be insightful for early diagnosis of depression. %M 33404512 %R 10.2196/19046 %U https://mhealth.jmir.org/2021/1/e19046 %U https://doi.org/10.2196/19046 %U http://www.ncbi.nlm.nih.gov/pubmed/33404512 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e18655 %T Digital Monitoring and Management of Patients With Advanced or Metastatic Non-Small Cell Lung Cancer Treated With Cancer Immunotherapy and Its Impact on Quality of Clinical Care: Interview and Survey Study Among Health Care Professionals and Patients %A Schmalz,Oliver %A Jacob,Christine %A Ammann,Johannes %A Liss,Blasius %A Iivanainen,Sanna %A Kammermann,Manuel %A Koivunen,Jussi %A Klein,Alexander %A Popescu,Razvan Andrei %+ Medical Affairs (Personalised Healthcare and Patient Access), F Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Basel, 4070 Basel, Switzerland, 41 792 921 758, johannes.ammann@roche.com %K advanced or metastatic non-small cell lung cancer %K cancer immunotherapy %K digital patient monitoring %K drug- and indication-specific cancer immunotherapy module %K eHealth %K mHealth %K quality of patient care %K patient-reported outcomes %K real-time symptom reporting %K user experience %D 2020 %7 21.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Cancer immunotherapy (CIT), as a monotherapy or in combination with chemotherapy, has been shown to extend overall survival in patients with locally advanced or metastatic non-small cell lung cancer (NSCLC). However, patients experience treatment-related symptoms that they are required to recall between hospital visits. Digital patient monitoring and management (DPMM) tools may improve clinical practice by allowing real-time symptom reporting. Objective: This proof-of-concept pilot study assessed patient and health care professional (HCP) adoption of our DPMM tool, which was designed specifically for patients with advanced or metastatic NSCLC treated with CIT, and the tool’s impact on clinical care. Methods: Four advisory boards were assembled in order to co-develop a drug- and indication-specific CIT (CIT+) module, based on a generic CIT DPMM tool from Kaiku Health, Helsinki, Finland. A total of 45 patients treated with second-line single-agent CIT (ie, atezolizumab or otherwise) for advanced or metastatic NSCLC, as well as HCPs, whose exact number was decided by the clinics, were recruited from 10 clinics in Germany, Finland, and Switzerland between February and May 2019. All clinics were provided with the Kaiku Health generic CIT DPMM tool, including our CIT+ module. Data on user experience, overall satisfaction, and impact of the tool on clinical practice were collected using anonymized surveys—answers ranged from 1 (low agreement) to 5 (high agreement)—and HCP interviews; surveys and interviews consisted of closed-ended Likert scales and open-ended questions, respectively. The first survey was conducted after 2 months of DPMM use, and a second survey and HCP interviews were conducted at study end (ie, after ≥3 months of DPMM use); only a subgroup of HCPs from each clinic responded to the surveys and interviews. Survey data were analyzed quantitatively; interviews were recorded, transcribed verbatim, and translated into English, where applicable, for coding and qualitative thematic analysis. Results: Among interim survey respondents (N=51: 13 [25%] nurses, 11 [22%] physicians, and 27 [53%] patients), mean rankings of the tool’s seven usability attributes ranged from 3.2 to 4.4 (nurses), 3.7 to 4.5 (physicians), and 3.7 to 4.2 (patients). At the end-of-study survey (N=48: 19 [40%] nurses, 8 [17%] physicians, and 21 [44%] patients), most respondents agreed that the tool facilitated more efficient and focused discussions between patients and HCPs (nurses and patients: mean rating 4.2, SD 0.8; physicians: mean rating 4.4, SD 0.8) and allowed HCPs to tailor discussions with patients (mean rating 4.35, SD 0.65). The standalone tool was well integrated into HCP daily clinical workflow (mean rating 3.80, SD 0.75), enabled workflow optimization between physicians and nurses (mean rating 3.75, SD 0.80), and saved time by decreasing phone consultations (mean rating 3.75, SD 1.00) and patient visits (mean rating 3.45, SD 1.20). Workload was the most common challenge of tool use among respondents (12/19, 63%). Conclusions: Our results demonstrate high user satisfaction and acceptance of DPMM tools by HCPs and patients, and highlight the improvements to clinical care in patients with advanced or metastatic NSCLC treated with CIT monotherapy. However, further integration of the tool into the clinical information technology data flow is required. Future studies or registries using our DPMM tool may provide insights into significant effects on patient quality of life or health-economic benefits. %M 33346738 %R 10.2196/18655 %U http://www.jmir.org/2020/12/e18655/ %U https://doi.org/10.2196/18655 %U http://www.ncbi.nlm.nih.gov/pubmed/33346738 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e15524 %T An Interactive Text Message Survey as a Novel Assessment for Bedtime Routines in Public Health Research: Observational Study %A Kitsaras,George %A Goodwin,Michaela %A Allan,Julia %A Kelly,Michael %A Pretty,Iain %+ University of Manchester, Dental Health Unit, Williams House Manchester Science Park, Manchester, M15 6SE, United Kingdom, 44 01612261211, georgios.kitsaras@manchester.ac.uk %K digital technologies %K mobile health %K child %K well-being %K development %K assessment %K bedtime routines %K P4 health care %K text survey %D 2020 %7 21.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Traditional research approaches, especially questionnaires and paper-based assessments, limit in-depth understanding of the fluid dynamic processes associated with child well-being and development. This includes bedtime routine activities such as toothbrushing and reading a book before bed. The increase in innovative digital technologies alongside greater use and familiarity among the public creates unique opportunities to use these technical developments in research. Objective: This study aimed to (1) examine the best way of assessing bedtime routines in families and develop an automated, interactive, text message survey assessment delivered directly to participants’ mobile phones and (2) test the assessment within a predominately deprived sociodemographic sample to explore retention, uptake, feedback, and effectiveness. Methods: A public and patient involvement project showed clear preference for interactive text surveys regarding bedtime routines. The developed interactive text survey included questions on bedtime routine activities and was delivered for seven consecutive nights to participating parents’ mobile phones. A total of 200 parents participated. Apart from the completion of the text survey, feedback was provided by participants, and data on response, completion, and retention rates were captured. Results: There was a high retention rate (185/200, 92.5%), and the response rate was high (160/185, 86.5%). In total, 114 participants provided anonymized feedback. Only a small percentage (5/114, 4.4%) of participants reported problems associated with completing the assessment. The majority (99/114, 86.8%) of participants enjoyed their participation in the study, with an average satisfaction score of 4.6 out of 5. Conclusions: This study demonstrated the potential of deploying SMS text message–based surveys to capture and quantify real-time information on recurrent dynamic processes in public health research. Changes and adaptations based on recommendations are crucial next steps in further exploring the diagnostic and potential intervention properties of text survey and text messaging approaches. %M 33346734 %R 10.2196/15524 %U http://publichealth.jmir.org/2020/4/e15524/ %U https://doi.org/10.2196/15524 %U http://www.ncbi.nlm.nih.gov/pubmed/33346734 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e20653 %T Addressing Public Health Emergencies via Facebook Surveys: Advantages, Challenges, and Practical Considerations %A Grow,André %A Perrotta,Daniela %A Del Fava,Emanuele %A Cimentada,Jorge %A Rampazzo,Francesco %A Gil-Clavel,Sofia %A Zagheni,Emilio %+ Laboratory of Digital and Computational Demography, Max Planck Institute for Demographic Research, Konrad-Zuse-Str 1, Rostock, 18057, Germany, 49 3812081142, grow@demogr.mpg.de %K Facebook %K web-based surveys %K public health emergency %K COVID-19 %D 2020 %7 14.12.2020 %9 Viewpoint %J J Med Internet Res %G English %X Surveys of the general population can provide crucial information for designing effective nonpharmaceutical interventions to tackle public health emergencies, such as the COVID-19 pandemic. Yet, conducting such surveys can be difficult, especially when timely data collection is required. In this viewpoint paper, we discuss our experiences with using targeted Facebook advertising campaigns to address these difficulties in relation to the COVID-19 pandemic. We describe central advantages, challenges, and practical considerations. This includes a discussion of potential sources of bias and how they can be addressed. %M 33284782 %R 10.2196/20653 %U http://www.jmir.org/2020/12/e20653/ %U https://doi.org/10.2196/20653 %U http://www.ncbi.nlm.nih.gov/pubmed/33284782 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 12 %P e21982 %T User Experience of a Chatbot Questionnaire Versus a Regular Computer Questionnaire: Prospective Comparative Study %A te Pas,Mariska E %A Rutten,Werner G M M %A Bouwman,R Arthur %A Buise,Marc P %+ Anesthesiology Department, Catharina Hospital, Michelangelolaan 2, Eindhoven, 5623 EJ, Netherlands, 31 627624857, mariska.t.pas@catharinaziekenhuis.nl %K chatbot %K user experience %K questionnaires %K response rates %K value-based health care %D 2020 %7 7.12.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Respondent engagement of questionnaires in health care is fundamental to ensure adequate response rates for the evaluation of services and quality of care. Conventional survey designs are often perceived as dull and unengaging, resulting in negative respondent behavior. It is necessary to make completing a questionnaire attractive and motivating. Objective: The aim of this study is to compare the user experience of a chatbot questionnaire, which mimics intelligent conversation, with a regular computer questionnaire. Methods: The research took place at the preoperative outpatient clinic. Patients completed both the standard computer questionnaire and the new chatbot questionnaire. Afterward, patients gave their feedback on both questionnaires by the User Experience Questionnaire, which consists of 26 terms to score. Results: The mean age of the 40 included patients (25 [63%] women) was 49 (SD 18-79) years; 46.73% (486/1040) of all terms were scored positive for the chatbot. Patients preferred the computer for 7.98% (83/1040) of the terms and for 47.88% (498/1040) of the terms there were no differences. Completion (mean time) of the computer questionnaire took 9.00 minutes by men (SD 2.72) and 7.72 minutes by women (SD 2.60; P=.148). For the chatbot, completion by men took 8.33 minutes (SD 2.99) and by women 7.36 minutes (SD 2.61; P=.287). Conclusions: Patients preferred the chatbot questionnaire over the computer questionnaire. Time to completion of both questionnaires did not differ, though the chatbot questionnaire on a tablet felt more rapid compared to the computer questionnaire. This is an important finding because it could lead to higher response rates and to qualitatively better responses in future questionnaires. %M 33284125 %R 10.2196/21982 %U http://medinform.jmir.org/2020/12/e21982/ %U https://doi.org/10.2196/21982 %U http://www.ncbi.nlm.nih.gov/pubmed/33284125 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e21671 %T User Perceptions and Experiences of an Interactive Voice Response Mobile Phone Survey Pilot in Uganda: Qualitative Study %A Tweheyo,Raymond %A Selig,Hannah %A Gibson,Dustin G %A Pariyo,George William %A Rutebemberwa,Elizeus %+ Department of Health Policy Planning and Management, Makerere University School of Public Health, Mulago Hill Road, P O Box, 7072, Kampala, 256, Uganda, 256 772466695, rtweheyo@musph.ac.ug %K interactive voice response %K noncommunicable diseases %K qualitative %K Uganda %D 2020 %7 3.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: With the growing burden of noncommunicable diseases in low- and middle- income countries, the World Health Organization recommended a stepwise approach of surveillance for noncommunicable diseases. This is expensive to conduct on a frequent basis and using interactive voice response mobile phone surveys has been put forth as an alternative. However, there is limited evidence on how to design and deliver interactive voice response calls that are robust and acceptable to respondents. Objective: This study aimed to explore user perceptions and experiences of receiving and responding to an interactive voice response call in Uganda in order to adapt and refine the instrument prior to national deployment. Methods: A qualitative study design was used and comprised a locally translated audiorecorded interactive voice response survey delivered in 4 languages to 59 purposively selected participants' mobile phones in 5 survey rounds guided by data saturation. The interactive voice response survey had modules on sociodemographic characteristics, physical activity, fruit and vegetable consumption, diabetes, and hypertension. After the interactive voice response survey, study staff called participants back and used a semistructured interview to collect information on the participant’s perceptions of interactive voice response call audibility, instruction clarity, interview pace, language courtesy and appropriateness, the validity of questions, and the lottery incentive. Descriptive statistics were used for the interactive voice response survey, while a framework analysis was used to analyze qualitative data. Results: Key findings that favored interactive voice response survey participation or completion included preference for brief surveys of 10 minutes or shorter, preference for evening calls between 6 PM and 10 PM, preference for courteous language, and favorable perceptions of the lottery-type incentive. While key findings curtailing participation were suspicion about the caller’s identity, unclear voice, confusing skip patterns, difficulty with the phone interface such as for selecting inappropriate digits for both ordinary and smartphones, and poor network connectivity for remote and rural participants. Conclusions: Interactive voice response surveys should be as brief as possible and considerate of local preferences to increase completion rates. Caller credibility needs to be enhanced through either masking the caller or prior community mobilization. There is need to evaluate the preferred timing of interactive voice response calls, as the finding of evening call preference is inconclusive and might be contextual. %M 33270037 %R 10.2196/21671 %U https://formative.jmir.org/2020/12/e21671 %U https://doi.org/10.2196/21671 %U http://www.ncbi.nlm.nih.gov/pubmed/33270037 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e18588 %T Web-Based Data Collection for Older Adults Living With HIV in a Clinical Research Setting: Pilot Observational Study %A Tassiopoulos,Katherine %A Roberts-Toler,Carla %A Fichtenbaum,Carl J %A Koletar,Susan L %+ Department of Epidemiology, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Kresge 817B, Boston, MA, 02115, United States, 1 617 432 3265, ktassiop@hsph.harvard.edu %K HIV %K aging %K web-based data collection %K longitudinal follow-up %K mobile phone %D 2020 %7 11.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Longitudinal follow-up of older persons living with HIV is essential for the ascertainment of aging-related clinical and behavioral outcomes, and self-administered questionnaires are necessary for collecting behavioral information in research involving persons living with HIV. Web-based self-reported data collection results in higher data quality than paper-and-pencil questionnaires in a wide range of populations. The option of remote web-based surveys may also increase retention in long-term research studies. However, the acceptability and feasibility of web-based data collection in clinical research involving older persons living with HIV have never been studied. Objective: This study aims to assess the acceptability and feasibility of a web-based survey to collect information on sexual, substance use, and physical activity behaviors; compare the data quality of the web-based survey with that of a paper-and-pencil questionnaire; and summarize web-based survey metrics. Methods: This pilot study took place within the AIDS Clinical Trials Group A5322 study, a longitudinal cohort of men and women living with HIV (aged ≥40 years), followed at 32 clinical sites in the United States and Puerto Rico. A total of 4 sites participated in this study. A web-based survey was created using self-administered questionnaires typically completed in A5322 via paper and pencil. Pilot study participants completed these questionnaires via web-based survey at one research visit in lieu of paper-and-pencil administration. Two questions were added to assess feasibility, defined as participants’ perception of the ease of web-based survey completion (very hard, hard, easy, very easy), and their preferred format (computer or tablet, paper and pencil, no preference) for completing the questions in the future (acceptability). Feasibility and acceptability were summarized overall and by demographic and clinical characteristics; the proportion of evaluable data by web-based survey versus previously administered paper-and-pencil questionnaires (data quality) was compared for each question. Results: Acceptability and feasibility were high overall: 50.0% (79/158) preferred computer or tablet, 38.0% (60/158) reported no preference, and 12.0% (19/158) preferred paper and pencil; 93.0% (147/158) reported survey completion easy or very easy. Older age was associated with lower odds of preferring computer or tablet to paper and pencil (odds ratio per 1-year increase in age: 0.91, 95% CI 0.85-0.98). Individuals who found the survey hard or very hard had a lower median neurocognitive test score than those who found it easy or very easy. Data quality with web-based survey administration was similar to or higher than that with paper-and-pencil administration for most questions. Conclusions: Web-based survey administration was acceptable and feasible in this cohort of older adults living with HIV, and data quality was high. Web-based surveys can be a useful tool for valid data collection and can potentially improve retention in long-term follow-up studies. %M 33174854 %R 10.2196/18588 %U https://www.jmir.org/2020/11/e18588 %U https://doi.org/10.2196/18588 %U http://www.ncbi.nlm.nih.gov/pubmed/33174854 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e21684 %T Exploring the Role of Media Sources on COVID-19–Related Discrimination Experiences and Concerns Among Asian People in the United States: Cross-Sectional Survey Study %A Yu,Nan %A Pan,Shuya %A Yang,Chia-chen %A Tsai,Jiun-Yi %+ School of Journalism and Communication, Renmin University of China, 59 Zhongguancun St, Beijing, 100082, China, 86 1082500855, shuya@ruc.edu.cn %K COVID-19 %K discrimination %K Asians %K Asian Americans %K media source %K social media %K prejudice  %D 2020 %7 6.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Media coverage and scholarly research have reported that Asian people who reside in the United States have been the targets of racially motivated incidents during the COVID-19 pandemic. Objective: This study aimed to examine the types of discrimination and worries experienced by Asians and Asian Americans living in the United States during the pandemic, as well as factors that were associated with everyday discrimination experience and concerns about future discrimination that the Asian community may face. Methods: A cross-sectional online survey was conducted. A total of 235 people who identified themselves as Asian or Asian American and resided in the United States completed the questionnaire. Results: Our study suggested that up to a third of Asians surveyed had experienced some type of discrimination. Pooling the responses “very often,” “often,” and “sometimes,” the percentages for each experienced discrimination type ranged between 14%-34%. In total, 49%-58% of respondents expressed concerns about discrimination in the future. The most frequently experienced discrimination types, as indicated by responses “very often” and “often,” were “people act as if they think you are dangerous” (25/235, 11%) and “being treated with less courtesy or respect” (24/235, 10%). About 14% (32/235) of individuals reported very often, often, or sometimes being threatened or harassed. In addition, social media use was significantly associated with a higher likelihood of experiencing discrimination (β=.18, P=.01) and having concerns about future episodes of discrimination the community may face (β=.20, P=.005). Use of print media was also positively associated with experiencing discrimination (β=.31, P<.001). Conclusions: Our study provided important empirical evidence regarding the various types of discrimination Asians residing in the United States experienced or worried about during the COVID-19 pandemic. The relationship between media sources and the perception of racial biases in this group was also identified. We noted the role of social media in reinforcing the perception of discrimination experience and concerns about future discrimination among Asians during this outbreak. Our results indicate several practical implications for public health agencies. To reduce discrimination against Asians during the pandemic, official sources and public health professionals should be cognizant of the possible impacts of stigmatizing cues in media reports on activating racial biases. Furthermore, Asians or Asian Americans could also be informed that using social media to obtain COVID-19 information is associated with an increase in concerns about future discrimination, and thus they may consider approaching this media source with caution. %M 33108307 %R 10.2196/21684 %U http://www.jmir.org/2020/11/e21684/ %U https://doi.org/10.2196/21684 %U http://www.ncbi.nlm.nih.gov/pubmed/33108307 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21475 %T Digital Pain Mapping and Tracking in Patients With Chronic Pain: Longitudinal Study %A Galve Villa,Maria %A S Palsson,Thorvaldur %A Cid Royo,Albert %A R Bjarkam,Carsten %A Boudreau,Shellie A %+ Center for Neuroplasticity and Pain, Center for Sensory Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Frederik Bajers Vej 7D, Aalborg, 9200, Denmark, 45 99409829, sboudreau@hst.aau.dk %K eHealth %K medical illustrations %K pain perception %K mHealth %K pain measurement %K disease progression %K patient-reported outcome measures %K musculoskeletal pain %K mobile phone %K surveys and questionnaires %K pain management %D 2020 %7 26.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital pain mapping allows for remote and ecological momentary assessment in patients over multiple time points spanning days to months. Frequent ecological assessments may reveal tendencies and fluctuations more clearly and provide insights into the trajectory of a patient’s pain. Objective: The primary aim of this study is to remotely map and track the intensity and distribution of pain and discomfort (eg, burning, aching, and tingling) in patients with nonmalignant spinal referred pain over 12 weeks using a web-based app for digital pain mapping. The secondary aim is to explore the barriers of use by determining the differences in clinical and user characteristics between patients with good (regular users) and poor (nonregular users) reporting compliance. Methods: Patients (N=91; n=53 women) with spinal referred pain were recruited using web-based and traditional in-house strategies. Patients were asked to submit weekly digital pain reports for 12 weeks. Each pain report consisted of digital pain drawings on a pseudo–three-dimensional body chart and pain intensity ratings. The pain drawings captured the distribution of pain and discomfort (pain quality descriptors) expressed as the total extent and location. Differences in weekly pain reports were explored using the total extent (pixels), current and usual pain intensity ratings, frequency of quality descriptor selection, and Jaccard similarity index. Validated e-questionnaires were completed at baseline to determine the patients’ characteristics (adapted Danish National Spine Register), disability (Oswestry Disability Index and Neck Disability Index), and pain catastrophizing (Pain Catastrophizing Scale) profiles. Barriers of use were assessed at 6 weeks using a health care–related usability and acceptance e-questionnaire and a self-developed technology-specific e-questionnaire to assess the accessibility and ease of access of the pain mapping app. Associations between total extent, pain intensity, disability, and catastrophizing were explored to further understand pain. Differences between regular and nonregular users were assessed to understand the pain mapping app reporting compliance. Results: Fluctuations were identified in pain reports for total extent and pain intensity ratings (P<.001). However, quality descriptor selection (P=.99) and pain drawing (P=.49), compared using the Jaccard index, were similar over time. Interestingly, current pain intensity was greater than usual pain intensity (P<.001), suggesting that the timing of pain reporting coincided with a more intense pain experience than usual. Usability and acceptance were similar between regular and nonregular users. Regular users were younger (P<.001) and reported a larger total extent of pain than nonregular users (P<.001). Conclusions: This is the first study to examine digital reports of pain intensity and distribution in patients with nonmalignant spinal referred pain remotely for a sustained period and barriers of use and compliance using a digital pain mapping app. Differences in age, pain distribution, and current pain intensity may influence reporting behavior and compliance. %M 33104012 %R 10.2196/21475 %U http://www.jmir.org/2020/10/e21475/ %U https://doi.org/10.2196/21475 %U http://www.ncbi.nlm.nih.gov/pubmed/33104012 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e15430 %T Occurrence of and Reasons for “Missing Events” in Mobile Dietary Assessments: Results From Three Event-Based Ecological Momentary Assessment Studies %A Ziesemer,Katrin %A König,Laura Maria %A Boushey,Carol Jo %A Villinger,Karoline %A Wahl,Deborah Ronja %A Butscher,Simon %A Müller,Jens %A Reiterer,Harald %A Schupp,Harald Thomas %A Renner,Britta %+ Psychological Assessment & Health Psychology, Department of Psychology, University of Konstanz, PO Box 47, Konstanz, 78457, Germany, 49 7531884679, britta.renner@uni-konstanz.de %K dietary assessment %K diet records %K mobile phone %K mobile applications %K technology %K adherence %K compliance %K missing events %K Ecological Momentary Assessment %K mHealth %D 2020 %7 14.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Establishing a methodology for assessing nutritional behavior comprehensively and accurately poses a great challenge. Mobile technologies such as mobile image-based food recording apps enable eating events to be assessed in the moment in real time, thereby reducing memory biases inherent in retrospective food records. However, users might find it challenging to take images of the food they consume at every eating event over an extended period, which might lead to incomplete records of eating events (missing events). Objective: Analyzing data from 3 studies that used mobile image-based food recording apps and varied in their technical enrichment, this study aims to assess how often eating events (meals and snacks) were missed over a period of 8 days in a naturalistic setting by comparing the number of recorded events with the number of normative expected events, over time, and with recollections of missing events. Methods: Participants in 3 event-based Ecological Momentary Assessment (EMA) studies using mobile image-based dietary assessments were asked to record all eating events (study 1, N=38, 1070 eating events; study 2, N=35, 934 eating events; study 3, N=110, 3469 eating events). Study 1 used a basic app; study 2 included 1 fixed reminder and the possibility to add meals after the actual eating events occurred instead of in the moment (addendum); and study 3 included 2 fixed reminders, an addendum feature, and the option to record skipped meals. The number of recalled missed events and their reasons were assessed by semistructured interviews after the EMA period (studies 1 and 2) and daily questionnaires (study 3). Results: Overall, 183 participants reported 5473 eating events. Although the momentary adherence rate as indexed by a comparison with normative expected events was generally high across all 3 studies, a differential pattern of results emerged with a higher rate of logged meals in the more technically intensive study 3. Multilevel models for the logging trajectories of reported meals in all 3 studies showed a significant, albeit small, decline over time (b=−.11 to −.14, Ps<.001, pseudo-R²=0.04-0.06), mainly because of a drop in reported snacks between days 1 and 2. Intraclass coefficients indicated that 38% or less of the observed variance was because of individual differences. The most common reasons for missing events were competing activities and technical issues, whereas situational barriers were less important. Conclusions: Three different indicators (normative, time stability, and recalled missing events) consistently indicated missing events. However, given the intensive nature of diet EMA protocols, the effect sizes were rather small and the logging trajectories over time were remarkably stable. Moreover, the individual’s actual state and context seemed to exert a greater influence on adherence rates than stable individual differences, which emphasizes the need for a more nuanced understanding of the factors that affect momentary adherence. %M 33052123 %R 10.2196/15430 %U https://mhealth.jmir.org/2020/10/e15430 %U https://doi.org/10.2196/15430 %U http://www.ncbi.nlm.nih.gov/pubmed/33052123 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e19474 %T Barriers and Enablers to Using a Patient-Facing Electronic Questionnaire: A Qualitative Theoretical Domains Framework Analysis %A Yamada,Janet %A Kouri,Andrew %A Simard,Sarah-Nicole %A Segovia,Stephanie A %A Gupta,Samir %+ Department of Medicine, University of Toronto, Division of Respirology, St. Michael's Hospital, Unity Health Toronto, Bond Wing, Suite 6042, 30 Bond St, Toronto, ON, M5B 1W8, Canada, 1 416 864 6026, samir.gupta@unityhealth.to %K asthma %K electronic questionnaire %K patients %K barriers %K enablers %K mobile phone %D 2020 %7 8.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic patient questionnaires are becoming ubiquitous in health care. To address care gaps that contribute to poor asthma management, we developed the Electronic Asthma Management System, which includes a previsit electronic patient questionnaire linked to a computerized clinical decision support system. Objective: This study aims to identify the determinants (barriers and enablers) of patient uptake and completion of a previsit mobile health questionnaire. Methods: We conducted semistructured interviews with adult patients with asthma in Toronto, Canada. After demonstrating the questionnaire, participants completed the questionnaire using their smartphones and were then interviewed regarding perceived barriers and enablers to using and completing the questionnaire. Interview questions were based on the Theoretical Domains Framework to identify the determinants of health-related behavior. We generated themes that addressed the enablers and barriers to the uptake and completion of the questionnaire. Results: In total, 12 participants were interviewed for saturation. Key enablers were as follows: the questionnaire was easy to complete without additional knowledge or skills and was perceived as a priority and responsibility for patients, use could lead to more efficient and personalized care, completion on one’s own time would be convenient, and uptake and completion could be optimized through patient reminders. Concerns about data security, the usefulness of questionnaire data, the stress of completing it accurately and on time, competing priorities, and preferences to complete the questionnaire on other devices were the main barriers. Conclusions: The barriers and enablers identified by patients should be addressed by developing implementation strategies to enhance e-questionnaire use and completion by patients. As the use of e-questionnaires grows, our findings will contribute to implementation efforts across settings and diseases. %M 33030437 %R 10.2196/19474 %U http://www.jmir.org/2020/10/e19474/ %U https://doi.org/10.2196/19474 %U http://www.ncbi.nlm.nih.gov/pubmed/33030437 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e23021 %T Threats of Bots and Other Bad Actors to Data Quality Following Research Participant Recruitment Through Social Media: Cross-Sectional Questionnaire %A Pozzar,Rachel %A Hammer,Marilyn J %A Underhill-Blazey,Meghan %A Wright,Alexi A %A Tulsky,James A %A Hong,Fangxin %A Gundersen,Daniel A %A Berry,Donna L %+ Phyllis F Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, 450 Brookline Ave, LW517, Boston, MA, , United States, 1 857 215 0743, rachel_pozzar@dfci.harvard.edu %K social media %K internet %K methods %K data accuracy %K fraud %D 2020 %7 7.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Recruitment of health research participants through social media is becoming more common. In the United States, 80% of adults use at least one social media platform. Social media platforms may allow researchers to reach potential participants efficiently. However, online research methods may be associated with unique threats to sample validity and data integrity. Limited research has described issues of data quality and authenticity associated with the recruitment of health research participants through social media, and sources of low-quality and fraudulent data in this context are poorly understood. Objective: The goal of the research was to describe and explain threats to sample validity and data integrity following recruitment of health research participants through social media and summarize recommended strategies to mitigate these threats. Our experience designing and implementing a research study using social media recruitment and online data collection serves as a case study. Methods: Using published strategies to preserve data integrity, we recruited participants to complete an online survey through the social media platforms Twitter and Facebook. Participants were to receive $15 upon survey completion. Prior to manually issuing remuneration, we reviewed completed surveys for indicators of fraudulent or low-quality data. Indicators attributable to respondent error were labeled suspicious, while those suggesting misrepresentation were labeled fraudulent. We planned to remove cases with 1 fraudulent indicator or at least 3 suspicious indicators. Results: Within 7 hours of survey activation, we received 271 completed surveys. We classified 94.5% (256/271) of cases as fraudulent and 5.5% (15/271) as suspicious. In total, 86.7% (235/271) provided inconsistent responses to verifiable items and 16.2% (44/271) exhibited evidence of bot automation. Of the fraudulent cases, 53.9% (138/256) provided a duplicate or unusual response to one or more open-ended items and 52.0% (133/256) exhibited evidence of inattention. Conclusions: Research findings from several disciplines suggest studies in which research participants are recruited through social media are susceptible to data quality issues. Opportunistic individuals who use virtual private servers to fraudulently complete research surveys for profit may contribute to low-quality data. Strategies to preserve data integrity following research participant recruitment through social media are limited. Development and testing of novel strategies to prevent and detect fraud is a research priority. %M 33026360 %R 10.2196/23021 %U http://www.jmir.org/2020/10/e23021/ %U https://doi.org/10.2196/23021 %U http://www.ncbi.nlm.nih.gov/pubmed/33026360 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e18556 %T Research Participants’ Perspectives on Using an Electronic Portal for Engagement and Data Collection: Focus Group Results From a Large Epidemiologic Cohort %A Rees-Punia,Erika %A Patel,Alpa V %A Beckwitt,Asher %A Leach,Corinne R %A Gapstur,Susan M %A Smith,Tenbroeck G %+ American Cancer Society, 250 Williams St, Atlanta, GA, 30303, United States, 1 4049823684, erika.rees-punia@cancer.org %K focus groups %K health information technology %K epidemiologic studies %D 2020 %7 1.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Epidemiologic cohort studies have begun to leverage electronic research participant portals to facilitate data collection, integrate wearable technologies, lower costs, and engage participants. However, little is known about the acceptability of portal use by research participants. Objective: The aim of this study is to conduct focus groups among a sample of Cancer Prevention Study-3 (CPS-3) participants to better understand their preferences and concerns about research portals. Methods: CPS-3 participants were stratified based on sex, race and ethnicity, age, and cancer status, and randomly invited to participate. Focus groups used an exploratory case design with semistructured guides to prompt discussion. Using a constant comparison technique, transcripts were assigned codes to identify themes. Results: Participants (31/59, 52% women; 52/59, 88% White/non-Latinx) were favorably disposed toward using a research participant portal to take surveys, communicate with the study staff, and upload data. Most participants indicated that a portal would be beneficial and convenient but expressed concerns over data safety. Participants stressed the importance of an easy-to-use and trustworthy portal that is compatible with mobile devices. Conclusions: In addition to being beneficial to researchers, portals may also benefit participants as long as the portals are secure and simple. Participants believe that portals can provide convenient ways to report data and remain connected to the study. %M 33001033 %R 10.2196/18556 %U https://www.jmir.org/2020/10/e18556 %U https://doi.org/10.2196/18556 %U http://www.ncbi.nlm.nih.gov/pubmed/33001033 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e19138 %T Phone Calls to Retain Research Participants and Determinants of Reachability in an African Setting: Observational Study %A Draaijer,Melvin %A Lalla-Edward,Samanta Tresha %A Venter,Willem Daniel Francois %A Vos,Alinda %+ Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, Utrecht, , Netherlands, 31 0887577136, A.G.Vos-8@umcutrecht.nl %K retention %K loss to follow-up %K phone %K mobile phones %K HIV %K ART %K South Africa %D 2020 %7 30.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Long-term retention of research participants in studies is challenging. In research in sub-Saharan Africa, phone calls are the most frequently used method to distantly engage with participants. Objective: We aimed to get insight into the effectiveness of phone calls to retain contact with participants and evaluated determinants of reachability. Methods: A cross-sectional study was performed using the databases of two randomized controlled trials investigating different kinds of antiretroviral therapy in HIV-positive patients. One trial finished in 2018 (study 1), and the other finished in 2015 (study 2). A random sample size of 200 participants per study was obtained. There were up to 3 phone numbers available per participant collected during the studies. Participants received a maximum of 3 phone calls on every available number on different days and at different times. Voicemails were left, and emails sent wherever possible. We documented how many calls were answered, who answered, as well as after how many attempts participants were reached. To further increase our understanding of reachability, we conducted a short questionnaire assessing factors contributing to reachability. The study was approved by the Research Ethics Committee of the University of Witwatersrand, Johannesburg, South Africa (reference number M1811107). Results: In our sample size of n=200 per study, study 1, with a median time of 11 months since the last visit at the research site, had a response rate of 70.5% (141/200) participants while study 2, with a median duration of 55 months since the last visit, had a response rate of 50.0% (100/200; P<.001). In study 1, 61.5% (123/200) of calls were answered directly by the participant while this was 36.0% (72/200) in study 2 (P=.003). The likelihood of reaching a participant decreased with time (odds ratio [OR] 0.73, 95% CI 0.63 to 0.84) for every year since the last face-to-face visit. Having more phone numbers per participant increased reachability (OR 2.32, 95% CI 1.24 to 4.36 for 2 phone numbers and OR 3.03, 95% CI 1.48 to 6.22 for 3 phone numbers compared with 1 number). A total of 141 of 241 reached participants responded to the questionnaire. Of the 93 participants who had changed phone numbers, 5% (50/93) had changed numbers because their phone was stolen. The most preferred method of being contacted was direct calling (128/141) with participants naming this method followed by WhatsApp (69/141). Conclusions: Time since last visit and the number of phone numbers listed were the only determinants of reachability. Longer follow-up time is accompanied with a decrease in reachability by phone while more listed phone numbers increases the likelihood that someone can be reached. Trial Registration: ClinicalTrials.gov NCT02671383; https://clinicaltrials.gov/ct2/show/NCT02671383 and ClinicalTrials.gov NCT02670772; https://clinicaltrials.gov/ct2/show/NCT02670772 %M 32996891 %R 10.2196/19138 %U http://formative.jmir.org/2020/9/e19138/ %U https://doi.org/10.2196/19138 %U http://www.ncbi.nlm.nih.gov/pubmed/32996891 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e18234 %T A Rapid Electronic Cognitive Assessment Measure for Multiple Sclerosis: Validation of Cognitive Reaction, an Electronic Version of the Symbol Digit Modalities Test %A Middleton,Rod M %A Pearson,Owen R %A Ingram,Gillian %A Craig,Elaine M %A Rodgers,William J %A Downing-Wood,Hannah %A Hill,Joseph %A Tuite-Dalton,Katherine %A Roberts,Christopher %A Watson,Lynne %A Ford,David V %A Nicholas,Richard %A , %+ Population Data Science, Swansea University Medical School, Swansea University, Data Science Building, Singleton Park, Swansea, SA2 8PP, United Kingdom, 44 1792606760, r.m.middleton@swansea.ac.uk %K cognition %K multiple sclerosis %K eHealth %K electronic assessment %K patient reported outcomes %K neurology %D 2020 %7 23.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Incorporating cognitive testing into routine clinical practice is a challenge in multiple sclerosis (MS), given the wide spectrum of both cognitive and physical impairments people can have and the time that testing requires. Shortened paper and verbal assessments predominate but still are not used routinely. Computer-based tests are becoming more widespread; however, changes in how a paper test is implemented can impact what exactly is being assessed in an individual. The Symbol Digit Modalities Test (SDMT) is one validated test that forms part of the cognitive batteries used in MS and has some computer-based versions. We developed a tablet-based SDMT variant that has the potential to be ultimately deployed to patients’ own devices. Objective: This paper aims to develop, validate, and deploy a computer-based SDMT variant, the Cognition Reaction (CoRe) test, that can reliably replicate the characteristics of the paper-based SDMT. Methods: We carried out analysis using Pearson and intraclass correlations, as well as a Bland-Altman comparison, to examine consistency between the SDMT and CoRe tests and for test-retest reliability. The SDMT and CoRe tests were evaluated for sensitivity to disability levels and age. A novel metric in CoRe was found: question answering velocity could be calculated. This was evaluated in relation to disability levels and age for people with MS and compared with a group of healthy control volunteers. Results: SDMT and CoRe test scores were highly correlated and consistent with 1-month retest values. Lower scores were seen in patients with higher age and some effect was seen with increasing disability. There was no learning effect evident. Question answering velocity demonstrated a small increase in speed over the 90-second duration of the test in people with MS and healthy controls. Conclusions: This study validates a computer-based alternative to the SDMT that can be used in clinics and beyond. It enables accurate recording of elements of cognition relevant in MS but offers additional metrics that may offer further value to clinicians and people with MS. %M 32965240 %R 10.2196/18234 %U http://www.jmir.org/2020/9/e18234/ %U https://doi.org/10.2196/18234 %U http://www.ncbi.nlm.nih.gov/pubmed/32965240 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e19219 %T Evaluation of the Sexual Health Behaviors of Black Male Adolescents and Young Adults Through Social Media Platforms: Web-Based Survey Study %A Burns,Jade %A Johnstone,Keith %A Chavanduka,Tanaka %A Jamison,Cornelius %A Pena,Valery %A Stephenson,Rob %A Darbes,Lynae %+ Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 N. Ingalls, Room 3175, Ann Arbor, MI, 48109, United States, 1 734 936 5311, curryj@umich.edu %K social media %K survey %K adolescent %K young adult %K Black %K males %K sexual health %K service delivery %D 2020 %7 22.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media platforms such as Facebook, Instagram, and Twitter, which have millions of users who interact and communicate every day, have been effective in promoting sexual health interventions and in disseminating reproductive health education. They have also been shown to be useful in health promotion and have been used to track several key metrics (eg, comments, posts) among users of all demographics. However, there is a lack of research on the impact and reach of these social media platforms as a community-based tool for disseminating sexual health information and for increasing engagement among Black adolescents and young adults, which is a targeted high-risk population. Objective: The purpose of this study was to determine the social media platforms and banner advertisements that affected engagement among Black male adolescents and young adults in participating in web-based health surveys. Methods: A web-based survey was conducted from March 2019 to July 2019 to assess sexual health and health behaviors in a convenience sample of Black male adolescents and young adults in the age range of 18-24 years (N=170). Social media metrics from Facebook, Instagram, and Twitter were monitored. This cross-sectional survey comprised several categories, including basic personal information, drug-related risk behaviors, health care, sexual reproductive health questions, attitudes, norms, and perceived control, mental health, violence-related risk behaviors, and social media preferences. Results: Social media advertisements on the Black Male Opinion survey reached approximately 146,412 individuals. Our primary finding of the web-based survey engagement was that referral (eg, group chat, indirect social media sharing) led to as the greatest proportion of recruitment, with Twitter and YouTube as the preferred sites to receive sexual health information. Conclusions: Recognizing the variety of technologies being used among Black male young adults and adolescents can help the community, researchers, and health care providers understand the web-based engagement of this high-risk population. This information may also promote culturally sensitive, customized marketing on sexual health information for this population. %M 32693387 %R 10.2196/19219 %U http://publichealth.jmir.org/2020/3/e19219/ %U https://doi.org/10.2196/19219 %U http://www.ncbi.nlm.nih.gov/pubmed/32693387 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e21866 %T Self-Reported Symptoms of SARS-CoV-2 Infection in a Nonhospitalized Population in Italy: Cross-Sectional Study of the EPICOVID19 Web-Based Survey %A Adorni,Fulvio %A Prinelli,Federica %A Bianchi,Fabrizio %A Giacomelli,Andrea %A Pagani,Gabriele %A Bernacchia,Dario %A Rusconi,Stefano %A Maggi,Stefania %A Trevisan,Caterina %A Noale,Marianna %A Molinaro,Sabrina %A Bastiani,Luca %A Fortunato,Loredana %A Jesuthasan,Nithiya %A Sojic,Aleksandra %A Pettenati,Carla %A Tavio,Marcello %A Andreoni,Massimo %A Mastroianni,Claudio %A Antonelli Incalzi,Raffaele %A Galli,Massimo %+ Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Via G.B. Grassi 74, Milan, 20157, Italy, 39 02 50319761, massimo.galli@unimi.it %K SARS-CoV-2 %K COVID-19 %K voluntary respondents %K web-based survey %K self-reported symptom %K nasopharyngeal swab testing %K cross-sectional %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Understanding the occurrence of symptoms resembling those of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a large nonhospitalized population at the peak of the epidemic in Italy is of paramount importance; however, data are currently scarce. Objective: The aims of this study were to evaluate the association of self-reported symptoms with SARS-CoV-2 nasopharyngeal swab (NPS) test results in nonhospitalized individuals and to estimate the occurrence of symptoms associated with coronavirus disease (COVID-19) in a larger nontested population. Methods: EPICOVID19 is a self-administered cross-sectional voluntary web-based survey of adults throughout Italy who completed an anonymous questionnaire in the period of April 13 to 21, 2020. The associations between symptoms potentially related to SARS-CoV-2 infection and NPS results were calculated as adjusted odds ratios (aORs) with 95% CIs by multiple logistic regression analysis controlling for age, sex, education, smoking habits, and number of comorbidities. Thereafter, for each symptom and for combinations of the symptoms, we calculated the sensitivity, specificity, accuracy, and areas under the curve (AUCs) in a receiver operating characteristic (ROC) analysis to estimate the occurrence of COVID-19–like infection in the nontested population. Results: A total of 171,310 people responded to the survey, of whom 102,543 (59.9%) were women; mean age 47.4 years. Out of the 4785 respondents with known NPS test results, 4392 were not hospitalized. Among the 4392 nonhospitalized respondents, those with positive NPS tests (856, 19.5%) most frequently reported myalgia (527, 61.6%), olfactory and taste disorders (507, 59.2%), cough (466, 54.4%), and fever (444, 51.9%), whereas 7.7% were asymptomatic. Multiple regression analysis showed that olfactory and taste disorders (aOR 10.3, 95% CI 8.4-12.7), fever (aOR 2.5, 95% CI 2.0-3.1), myalgia (aOR 1.5, 95% CI 1.2-1.8), and cough (aOR 1.3, 95% CI 1.0-1.6) were associated with NPS positivity. Having two to four of these symptoms increased the aOR from 7.4 (95% CI 5.6-9.7) to 35.5 (95% CI 24.6-52.2). The combination of the four symptoms showed an AUC of 0.810 (95% CI 0.795-0.825) in classifying positive NPS test results and then was applied to the nonhospitalized and nontested sample (n=165,782). We found that 7739 to 20,103 of these 165,782 respondents (4.4% to 12.1%) had experienced symptoms suggestive of COVID-19 infection. Conclusions: Our results suggest that self-reported symptoms are reliable indicators of SARS-CoV-2 infection in a pandemic context. A nonnegligible number of symptomatic respondents (up to 12.1%) were undiagnosed and potentially contributed to the spread of the infection. Trial Registration: ClinicalTrials.gov NCT04471701; https://clinicaltrials.gov/ct2/show/NCT04471701 %M 32650305 %R 10.2196/21866 %U http://publichealth.jmir.org/2020/3/e21866/ %U https://doi.org/10.2196/21866 %U http://www.ncbi.nlm.nih.gov/pubmed/32650305 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e19630 %T Global Changes and Factors of Increase in Caloric/Salty Food Intake, Screen Use, and Substance Use During the Early COVID-19 Containment Phase in the General Population in France: Survey Study %A Rolland,Benjamin %A Haesebaert,Frédéric %A Zante,Elodie %A Benyamina,Amine %A Haesebaert,Julie %A Franck,Nicolas %+ Service Universitaire d'Addictologie de Lyon, CH Le Vinatier, Hospices Civils de Lyon, Bâtiment 502, Bron, 69500, France, 33 0437915075, benjrolland@gmail.com %K COVID-19 %K containment %K eating behaviors %K screen use %K internet use %K substance use %K public health %K mental health %K pandemic %K lifestyle %K online survey %K addiction %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The international outbreak of coronavirus disease (COVID-19) has led many countries to enforce drastic containment measures. It has been suggested that this abrupt lockdown of populations will foster addiction-related habits such as caloric/salty food intake, screen use, and substance use. Objective: Our aim was to assess the global changes and factors of increase in addiction-related habits during the early COVID-19 containment phase in France. Methods: A web-based survey was provided from day 8 to day 13 of the containment and was completed by 11,391 participants. The questions explored sociodemographic features, psychiatric/addiction history, material conditions of lockdown, general stress, mental well-being, and reported changes in several addiction-related behaviors. Global changes were described and factors of increase were explored using population-weighted and adjusted logistic regression models, providing adjusted odds ratios (aORs) and their 95% confidence intervals. Results: Overall, the respondents reported more increases in addiction-related habits than decreases, specifically 28.4% (caloric/salty food intake), 64.6% (screen use), 35.6% (tobacco use), 24.8% (alcohol use), and 31.2% (cannabis use). Reduced well-being scores and increased stress scores were general factors of increase in addiction-related habits (P<.001 for all habits). Factors of increase in caloric/salty food intake (n=10,771) were female gender (aOR 1.62, 95% CI 1.48-1.77), age less than 29 years (P<.001), having a partner (aOR 1.19, 95% CI 1.06-1.35), being locked down in a more confined space (per 1 square meter/person decrease: aOR 1.02, 95% CI 1.01-1.03), being locked down alone (aOR 1.29, 95% CI 1.11-1.49), and reporting current (aOR 1.94, 95% CI 1.62-2.31) or past (aOR 1.27, 95% CI 1.09-1.47) psychiatric treatment. Factors of increase in screen use (n=11,267) were female gender (aOR 1.31, 95% CI 1.21-1.43), age less than 29 years (P<.001), having no partner (aOR 1.18, 95% CI 1.06-1.32), being employed (P<.001), intermediate/high education level (P<.001), being locked down with no access to an outdoor space (aOR 1.16, 95% CI 1.05-1.29), being locked down alone (aOR 1.15, 95% CI 1.01-1.32), living in an urban environment (P<.01), and not working (P<.001). Factors of increase in tobacco use (n=2787) were female gender (aOR 1.31, 95% CI 1.11-1.55), having no partner (aOR 1.30, 95% CI 1.06-1.59), intermediate/low education level (P<.01), and still working in the workplace (aOR 1.47, 95% CI 1.17-1.86). Factors of increase in alcohol use (n=7108) were age 30-49 years (P<.05), a high level of education (P<.001), and current psychiatric treatment (aOR 1.44, 95% CI 1.10-1.88). The only significant factor of increase in cannabis use (n=620) was intermediate/low level of education (P<.001). Conclusions: The early phase of COVID-19 containment in France led to widespread increases in addiction-related habits in the general population. Reduced well-being and increased stress were universal factors of increase. More specific factors were associated with increases in each of the explored habits. %M 32589149 %R 10.2196/19630 %U http://publichealth.jmir.org/2020/3/e19630/ %U https://doi.org/10.2196/19630 %U http://www.ncbi.nlm.nih.gov/pubmed/32589149 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19358 %T Primary Care Pre-Visit Electronic Patient Questionnaire for Asthma: Uptake Analysis and Predictor Modeling %A Kouri,Andrew %A Yamada,Janet %A Sale,Joanna E M %A Straus,Sharon E %A Gupta,Samir %+ Division of Respirology, Department of Medicine, St. Michael’s Hospital, Unity Health Toronto, Bond Wing, Suite 6042, 30 Bond St., Toronto, ON, M5B 1W8, Canada, 1 416 864 6026, samir.gupta@unityhealth.to %K electronic questionnaire %K tablet %K mHealth uptake %K asthma %K modeling %D 2020 %7 18.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: mHealth tablet-based interventions are increasingly being studied and deployed in various health care settings, yet little knowledge exists regarding patient uptake and acceptance or how patient demographics influence these important implementation metrics. Objective: To determine which factors influence the uptake and successful completion of an mHealth tablet questionnaire by analyzing its implementation in a primary care setting. Methods: We prospectively studied a patient-facing electronic touch-tablet asthma questionnaire deployed as part of the Electronic Asthma Management System. We describe tablet uptake and completion rates and corresponding predictor models for these behaviors. Results: The tablet was offered to and accepted by patients in 891/1715 (52.0%) visits. Patients refused the tablet in 33.0% (439/1330) visits in which it was successfully offered. Patients aged older than 65 years of age (odds ratio [OR] 2.30, 95% CI 1.33-3.95) and with concurrent chronic obstructive pulmonary disease (OR 2.22, 95% CI 1.05-4.67) were more likely to refuse the tablet, and those on an asthma medication (OR 0.55, 95% CI 0.30-0.99) were less likely to refuse it. Once accepted, the questionnaire was completed in 784/891 (88.0%) instances, with those on an asthma medication (OR 0.53, 95% CI 0.32-0.88) being less likely to leave it incomplete. Conclusions: Older age predicted initial tablet refusal but not tablet questionnaire completion, suggesting that perceptions of mHealth among older adults may negatively impact uptake, independent of usability. The influence of being on an asthma medication suggests that disease severity may also mediate mHealth acceptance. Although use of mHealth questionnaires is growing rapidly across health care settings and diseases, few studies describe their real-world acceptance and its predictors. Our results should be complemented by qualitative methods to identify barriers and enablers to uptake and may inform technological and implementation strategies to drive successful usage. %M 32945779 %R 10.2196/19358 %U http://www.jmir.org/2020/9/e19358/ %U https://doi.org/10.2196/19358 %U http://www.ncbi.nlm.nih.gov/pubmed/32945779 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19517 %T Sociodemographic Representativeness in a Nationwide Web-Based Survey of the View of Men on Involvement in Health Care Decision-Making: Cross-Sectional Questionnaire Study %A Birkeland,Søren F %A Haakonsson,Anders K %A Pedersen,Susanne S %A Rottmann,Nina %A Barry,Michael J %A Möller,Sören %+ Open Patient Data Explorative Network (OPEN), Odense University Hospital and Department of Clinical Medicine, University of Southern Denmark, J. B. Winsløws Vej 9 a, 3. floor, Odense, DK-5000, Denmark, 45 29166730, sbirkeland@health.sdu.dk %K research methodology %K electronic data capture %K internet-based survey %K representativeness %K generalizability %K user involvement %K patient satisfaction %K bioethics %K medical law %K cancer %D 2020 %7 2.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Being able to generalize research findings to a broader population outside of the study sample is an important goal in surveys on the internet. We conducted a nationwide, cross-sectional, web-based survey with vignettes illustrating different levels of patient involvement to investigate men’s preferences regarding participation in health care decision-making. Following randomization into vignette variants, we distributed the survey among men aged 45 to 70 years through the state-authorized digital mailbox provided by the Danish authorities for secure communication with citizens. Objective: This study aimed to investigate the sociodemographic representativeness of our sample of men obtained in a nationwide web-based survey using the digital mailbox. Methods: Response rate estimates were established, and comparisons were made between responders and nonresponders in terms of age profiles (eg, average age) and municipality-level information on sociodemographic characteristics. Results: Among 22,288 men invited during two waves, a total of 6756 (30.31%) participants responded to the survey. In adjusted analyses, responders’ characteristics mostly resembled those of nonresponders. Response rates, however, were significantly higher in older men (odds ratio [OR] 2.83 for responses among those aged 65-70 years compared with those aged 45-49 years, 95% CI 2.58-3.11; P<.001) and in rural areas (OR 1.10 compared with urban areas, 95% CI 1.03-1.18; P=.005). Furthermore, response rates appeared lower in areas with a higher tax base (OR 0.89 in the highest tertile, 95% CI 0.81-0.98; P=.02). Conclusions: Overall, the general population of men aged 45 to 70 years was represented very well by the responders to our web-based survey. However, the imbalances identified highlight the importance of supplementing survey findings with studies of the representativeness of other characteristics of the sample like trait and preference features, so that proper statistical corrections can be made in upcoming analyses of survey responses whenever needed. %M 32663149 %R 10.2196/19517 %U https://www.jmir.org/2020/9/e19517 %U https://doi.org/10.2196/19517 %U http://www.ncbi.nlm.nih.gov/pubmed/32663149 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e15284 %T Comparing a Mobile Phone Automated System With a Paper and Email Data Collection System: Substudy Within a Randomized Controlled Trial %A Bond,Diana M %A Hammond,Jeremy %A Shand,Antonia W %A Nassar,Natasha %+ Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Level 2, Charles Perkins Centre D17, Sydney, 2006, Australia, 61 2 9036 7006, diana.bond@sydney.edu.au %K mobile phones %K text messaging %K data collection methods %K clinical trial %K breastfeeding %K maternal health %D 2020 %7 25.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Traditional data collection methods using paper and email are increasingly being replaced by data collection using mobile phones, although there is limited evidence evaluating the impact of mobile phone technology as part of an automated research management system on data collection and health outcomes. Objective: The aim of this study is to compare a web-based mobile phone automated system (MPAS) with a more traditional delivery and data collection system combining paper and email data collection (PEDC) in a cohort of breastfeeding women. Methods: We conducted a substudy of a randomized controlled trial in Sydney, Australia, which included women with uncomplicated term births who intended to breastfeed. Women were recruited within 72 hours of giving birth. A quasi-randomized number of women were recruited using the PEDC system, and the remainder were recruited using the MPAS. The outcomes assessed included the effectiveness of data collection, impact on study outcomes, response rate, acceptability, and cost analysis between the MPAS and PEDC methods. Results: Women were recruited between April 2015 and December 2016. The analysis included 555 women: 471 using the MPAS and 84 using the PEDC. There were no differences in clinical outcomes between the 2 groups. At the end of the 8-week treatment phase, the MPAS group showed an increased response rate compared with the PEDC group (56% vs 37%; P<.001), which was also seen at the 2-, 6-, and 12-month follow-ups. At the 2-month follow-up, the MPAS participants also showed an increased rate of self-reported treatment compliance (70% vs 56%; P<.001) and a higher recommendation rate for future use (95% vs 64%; P<.001) as compared with the PEDC group. The cost analysis between the 2 groups was comparable. Conclusions: MPAS is an effective and acceptable method for improving the overall management, treatment compliance, and methodological quality of clinical research to ensure the validity and reliability of findings. %M 32763873 %R 10.2196/15284 %U http://mhealth.jmir.org/2020/8/e15284/ %U https://doi.org/10.2196/15284 %U http://www.ncbi.nlm.nih.gov/pubmed/32763873 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17504 %T Patients’ and Health Care Professionals’ Perceptions of the Potential of Using the Digital Diabetes Questionnaire to Prepare for Diabetes Care Meetings: Qualitative Focus Group Interview Study %A Eeg-Olofsson,Katarina %A Johansson,Unn-Britt %A Linder,Ebba %A Leksell,Janeth %+ Sahlgrenska University Hospital, Blå Stråket 5, Gothenburg, 413 45, Sweden, 46 313421000, katarina.eeg-olofsson@vgregion.se %K Digital questionnaire %K health care professionals %K diabetes care %K focus group interview %K qualitative research %K eHealth  %D 2020 %7 19.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In effective diabetes management, it is important that providers and health care systems prioritize the delivery of patient-centered care and that they are respectful of and responsive to individual patient preferences and barriers. Objective: The objective of the study was to conduct focus group interviews to capture patients’ and health care professionals’ perceptions and attitudes regarding digital technology and to explore how the digital Diabetes Questionnaire can be used to support patient participation in diabetes care, as a basis for an implementation study. Methods: A qualitative study was conducted with six focus group discussions with diabetes specialist nurses and medical doctors (n=29) and four focus group discussions with individuals with diabetes (n=23). A semistructured focus group interview guide was developed, including probing questions. The data were transcribed verbatim, and qualitative content analysis was performed using an inductive approach. Results: Two main categories were revealed by the qualitative analysis: perceptions of digital technology and the digital questionnaire in diabetes management and care and perceptions of participation in diabetes care. An overarching theme that emerged from the focus group interviews was patients’ and professionals’ involvement in diabetes care using digital tools. Conclusions: The analysis identified important factors to consider when introducing the digital Diabetes Questionnaire in clinical use. Both professionals and patients need support and training in the practical implementation of the digital questionnaire, as well as the opportunity to provide feedback on the questionnaire answers. %M 32812884 %R 10.2196/17504 %U https://www.jmir.org/2020/8/e17504 %U https://doi.org/10.2196/17504 %U http://www.ncbi.nlm.nih.gov/pubmed/32812884 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e16778 %T Capturing Relevant Patient Data in Clinical Encounters Through Integration of an Electronic Patient-Reported Outcome System Into Routine Primary Care in a Boston Community Health Center: Development and Implementation Study %A Loo,Stephanie %A Grasso,Chris %A Glushkina,Jessica %A McReynolds,Justin %A Lober,William %A Crane,Heidi %A Mayer,Kenneth H %+ The Fenway Institute, 1340 Boylston St, Boston, MA, 02215, United States, 1 857 313 6582, sloo@fenwayhealth.org %K information technology in health %K primary care %K technology adoption %K technology diffusion %D 2020 %7 19.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic patient-reported outcome (ePRO) systems can improve health outcomes by detecting health issues or risk behaviors that may be missed when relying on provider elicitation. Objective: This study aimed to implement an ePRO system that administers key health questionnaires in an urban community health center in Boston, Massachusetts. Methods: An ePRO system that administers key health questionnaires was implemented in an urban community health center in Boston, Massachusetts. The system was integrated with the electronic health record so that medical providers could review and adjudicate patient responses in real-time during the course of the patient visit. This implementation project was accomplished through careful examination of clinical workflows and a graduated rollout process that was mindful of patient and clinical staff time and burden. Patients responded to questionnaires using a tablet at the beginning of their visit. Results: Our program demonstrates that implementation of an ePRO system in a primary care setting is feasible, allowing for facilitation of patient-provider communication and care. Other community health centers can learn from our model in terms of applying technological innovation to streamline clinical processes and improve patient care. Conclusions: Our program demonstrates that implementation of an ePRO system in a primary care setting is feasible, allowing for facilitation of patient-provider communication and care. Other community health centers can learn from our model for application of technological innovation to streamline clinical processes and improve patient care. %M 32554372 %R 10.2196/16778 %U http://www.jmir.org/2020/8/e16778/ %U https://doi.org/10.2196/16778 %U http://www.ncbi.nlm.nih.gov/pubmed/32554372 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e16792 %T Comparing Web-Based and Lab-Based Cognitive Assessment Using the Cambridge Neuropsychological Test Automated Battery: A Within-Subjects Counterbalanced Study %A Backx,Rosa %A Skirrow,Caroline %A Dente,Pasquale %A Barnett,Jennifer H %A Cormack,Francesca K %+ Cambridge Cognition Ltd, Tunbridge Court, Tunbridge Ln, Bottisham, Cambridge, CB25 9TU, United Kingdom, 44 (0)1223 810 700, caroline.skirrow@camcog.com %K reliability %K mobile health %K neuropsychological tests %K CANTAB %K cognition %D 2020 %7 4.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Computerized assessments are already used to derive accurate and reliable measures of cognitive function. Web-based cognitive assessment could improve the accessibility and flexibility of research and clinical assessment, widen participation, and promote research recruitment while simultaneously reducing costs. However, differences in context may influence task performance. Objective: This study aims to determine the comparability of an unsupervised, web-based administration of the Cambridge Neuropsychological Test Automated Battery (CANTAB) against a typical in-person lab-based assessment, using a within-subjects counterbalanced design. The study aims to test (1) reliability, quantifying the relationship between measurements across settings using correlational approaches; (2) equivalence, the extent to which test results in different settings produce similar overall results; and (3) agreement, by quantifying acceptable limits to bias and differences between measurement environments. Methods: A total of 51 healthy adults (32 women and 19 men; mean age 36.8, SD 15.6 years) completed 2 testing sessions, which were completed on average 1 week apart (SD 4.5 days). Assessments included equivalent tests of emotion recognition (emotion recognition task [ERT]), visual recognition (pattern recognition memory [PRM]), episodic memory (paired associate learning [PAL]), working memory and spatial planning (spatial working memory [SWM] and one touch stockings of Cambridge), and sustained attention (rapid visual information processing [RVP]). Participants were randomly allocated to one of the two groups, either assessed in-person in the laboratory first (n=33) or with unsupervised web-based assessments on their personal computing systems first (n=18). Performance indices (errors, correct trials, and response sensitivity) and median reaction times were extracted. Intraclass and bivariate correlations examined intersetting reliability, linear mixed models and Bayesian paired sample t tests tested for equivalence, and Bland-Altman plots examined agreement. Results: Intraclass correlation (ICC) coefficients ranged from ρ=0.23-0.67, with high correlations in 3 performance indices (from PAL, SWM, and RVP tasks; ρ≥0.60). High ICC values were also seen for reaction time measures from 2 tasks (PRM and ERT tasks; ρ≥0.60). However, reaction times were slower during web-based assessments, which undermined both equivalence and agreement for reaction time measures. Performance indices did not differ between assessment settings and generally showed satisfactory agreement. Conclusions: Our findings support the comparability of CANTAB performance indices (errors, correct trials, and response sensitivity) in unsupervised, web-based assessments with in-person and laboratory tests. Reaction times are not as easily translatable from in-person to web-based testing, likely due to variations in computer hardware. The results underline the importance of examining more than one index to ascertain comparability, as high correlations can present in the context of systematic differences, which are a product of differences between measurement environments. Further work is now needed to examine web-based assessments in clinical populations and in larger samples to improve sensitivity for detecting subtler differences between test settings. %M 32749999 %R 10.2196/16792 %U https://www.jmir.org/2020/8/e16792 %U https://doi.org/10.2196/16792 %U http://www.ncbi.nlm.nih.gov/pubmed/32749999 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17238 %T Worldwide Prevalence of Hearing Loss Among Smartphone Users: Cross-Sectional Study Using a Mobile-Based App %A Masalski,Marcin %A Morawski,Krzysztof %+ Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine, Wroclaw Medical University, Wybrzeze Ludwika Pasteura 1, Wroclaw, 50-367, Poland, 48 515086252, marcin.masalski@pwr.edu.pl %K hearing loss %K epidemiology %K mobile-based %K hearing test %K pure-tone audiometry %D 2020 %7 23.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In addition to the aging process, risk factors for hearing loss in adults include, among others, exposure to noise, use of ototoxic drugs, genetics, and limited access to medical care. Differences in exposure to these factors are bound to be reflected in the prevalence of hearing loss. Assessment of hearing loss can easily be carried out on a large scale and at low cost using mobile apps. Objective: This study aimed to conduct a worldwide assessment of the differences in hearing loss prevalence between countries in a group of mobile device users. Methods: Hearing tests were conducted using the open-access Android-based mobile app Hearing Test. The app is available free of charge in the Google Play store, provided that consent to the use of the results for scientific purposes is given. This study included hearing tests carried out on device models supported by the app with bundled headphones in the set. Calibration factors for supported models were determined using the biological method. The tests consisted of self-determining the quietest audible tone in the frequency range from 250 Hz to 8 kHz by adjusting its intensity using the buttons. The ambient noise level was optionally monitored using a built-in microphone. Following the test, the user could compare his hearing threshold against age norms by providing his or her age. The user's location was identified based on the phone’s IP address. Results: From November 23, 2016 to November 22, 2019, 733,716 hearing tests were conducted on 236,716 mobile devices across 212 countries. After rejecting the tests that were incomplete, performed with disconnected headphones, not meeting the time criterion, repeated by the same user, or carried out regularly on one device, 116,733 of 733,716 tests (15.9%) were qualified for further analysis. The prevalence of hearing loss, defined as the average threshold at frequencies 0.5 kHz, 1 kHz, 2 kHz, and 4 kHz above 25 dB HL in the better ear, was calculated at 15.6% (95% CI 15.4-15.8). Statistically significant differences were found between countries (P<.001), with the highest prevalences for Bangladesh, Pakistan, and India (>28%) and the lowest prevalences for Taiwan, Finland, and South Korea (<11%). Conclusions: Hearing thresholds measured by means of mobile devices were congruent with the literature data on worldwide hearing loss prevalence. Uniform recruitment criteria simplify the comparison of the hearing loss prevalence across countries. Hearing testing on mobile devices may be a valid tool in epidemiological studies carried out on a large scale. %M 32706700 %R 10.2196/17238 %U http://www.jmir.org/2020/7/e17238/ %U https://doi.org/10.2196/17238 %U http://www.ncbi.nlm.nih.gov/pubmed/32706700 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17231 %T Clinical Characteristics of an Internet-Based Cohort of Patient-Reported Diagnosis of Granulomatosis With Polyangiitis and Microscopic Polyangiitis: Observational Study %A Springer,Jason Michael %A Kermani,Tanaz A %A Sreih,Antoine %A Shaw,Dianne G %A Young,Kalen %A Burroughs,Cristina M %A Merkel,Peter A %+ University of Kansas Medical Center, 3901 Rainbow Blvd MS 2026, Kansas City, KS, 66160, United States, 1 913 588 6009, jspringer2@kumc.edu %K granulomatosis with polyangiitis %K microscopic polyangiitis %K vasculitis %K patient-reported outcomes %K patient registry %K electronic health records %K questionnaire %K online cohort %D 2020 %7 20.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Utilizing the traditional centers of excellence approach to conduct clinical trials involving rare diseases remains challenging. Patient-based registries have been shown to be both feasible and valid in several other diseases. Objective: This report outlines the clinical characteristics of a large internet registry cohort of participants with a self-reported diagnosis of granulomatosis with polyangiitis or microscopic polyangiitis. Methods: Patients with a self-reported diagnosis of granulomatosis with polyangiitis or microscopic polyangiitis in an internet-based prospective longitudinal cohort (from the Vasculitis Patient-Powered Research Network) were included. Data on symptoms, diagnostic testing, and treatment were collected using standardized questionnaires. Results: The study compared patients with granulomatosis with polyangiitis (n=762) and patients with microscopic polyangiitis (n=164). Of the cohort, 97.7% (904/925) reported the diagnosis had been confirmed by a physician. Compared to microscopic polyangiitis, patients with granulomatosis with polyangiitis reported significantly more ear, nose, and throat manifestations (granulomatosis with polyangiitis: 641/723, 88.7%; microscopic polyangiitis: 89/164, 54.3%; z=10.42, P<.001), fevers (granulomatosis with polyangiitis: 325/588, 55.3%; microscopic polyangiitis: 64/139, 46.0%; z=1.96, P=.05), joint involvement (granulomatosis with polyangiitis: 549/688, 79.8%; microscopic polyangiitis: 106/154, 68.8%; z=2.96, P=.003), and pulmonary involvement (granulomatosis with polyangiitis: 523/734, 71.3%; microscopic polyangiitis: 90/154, 58.4%; z=3.13, P=.002). Compared to microscopic polyangiitis, patients with granulomatosis with polyangiitis reported significantly less renal involvement (granulomatosis with polyangiitis: 457/743, 61.5%; microscopic polyangiitis: 135/163, 82.8%; z=–5.18, P<.001) and renal transplantation (granulomatosis with polyangiitis: 10/721, 1.4%; microscopic polyangiitis: 7/164, 4.3%; z=–2.43, P=.02). Antineutrophil cytoplasmic antibody positivity was reported in 94.2% (652/692) of patients with granulomatosis with polyangiitis and 96.1% (147/153) of patients with microscopic polyangiitis. A biopsy showing vasculitis was reported in 77.0% (562/730) of patients with granulomatosis with polyangiitis and 81.9% (131/160) of patients with microscopic polyangiitis. Conclusions: In this large, internet-based cohort of patients with a self-reported diagnosis of granulomatosis with polyangiitis or microscopic polyangiitis, disease manifestations were consistent with expectations for each type of vasculitis. Given the rarity of these and other vasculitides, conducting some types of research through internet-based registries may provide an efficient alternative to inperson, center-of-excellence clinical trials. %M 32459634 %R 10.2196/17231 %U https://www.jmir.org/2020/7/e17231 %U https://doi.org/10.2196/17231 %U http://www.ncbi.nlm.nih.gov/pubmed/32459634 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e18446 %T Recruiting and Retaining Youth and Young Adults in the Policy and Communication Evaluation (PACE) Vermont Study: Randomized Controlled Trial of Participant Compensation %A Villanti,Andrea C %A Vallencourt,Christie P %A West,Julia C %A Peasley-Miklus,Catherine %A LePine,S Elisha %A McCluskey,Caitlin %A Klemperer,Elias %A Priest,Jeffrey S %A Logan,Alison %A Patton,Bill %A Erickson,Nancy %A Hicks,Jennifer %A Horton,Kathleen %A Livingston,Shayla %A Roemhildt,Maria %A Singer,Erin %A Trutor,Megan %A Williams,Rhonda %+ Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont Larner College of Medicine, 1 South Prospect Street, MS 482, Burlington, VT, 05401, United States, 1 8026561187, avillant@uvm.edu %K recruitment %K retention %K adolescents %K young adults %K prevention %D 2020 %7 20.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The standard approach for evaluating the effects of population-level substance use prevention efforts on youth and young adult perceptions and behaviors has been to compare outcomes across states using national surveillance data. Novel surveillance methods that follow individuals over shorter time intervals and capture awareness of substance use prevention policy and communication efforts may provide a stronger basis for their evaluation than annual cross-sectional studies. Objective: This study aimed to identify a combination of strategies to recruit a sample of youth and young adults sufficiently representative of the Vermont population and determine how best to retain a web-based panel of youth and young adults over a 6-month period. Methods: Eligible participants were Vermont residents aged 12 to 25 years who were willing to complete three 10 to 15-minute web-based surveys over a 6-month period. Recruitment was conducted via the following three main mechanisms: (1) web-based recruitment (paid and unpaid), (2) community-based recruitment through partners, and (3) participant referrals via a personalized link. Upon completion of the baseline survey, participants were randomly assigned to one of the following three retention incentive conditions: (1) guaranteed incentive (US $10), (2) lottery incentive (US $50 weekly lottery drawing), and (3) preferred method (guaranteed or lottery). Analyses examined cost per survey start by recruitment source, distribution of demographic characteristics across incentive conditions, and retention by study condition at 3-month and 6-month follow-ups. Results: Over a 10-week period in 2019, we recruited 480 eligible youth (aged 12-17 years) and 1037 eligible young adults (aged 18-25 years) to the Policy and Communication Evaluation (PACE) Vermont Study. Facebook and Instagram advertising produced the greatest number of survey starts (n=2013), followed by posts to a state-wide web-based neighborhood forum (n=822) and Google advertisements (n=749). Retention was 78.11% (1185/1517) at 3 months and 72.18% (1095/1517) at 6 months. Retention was equivalent across all incentive study conditions at both waves, despite a strong stated preference among study participants for the guaranteed payment at baseline. Youth had greater retention than young adults at both waves (wave 2: 395/480, 82.3% vs 790/1037, 76.18%; wave 3: 366/480, 76.3% vs 729/1037, 70.30%). Substance use prevalence in this cohort was similar to national and state-level surveillance estimates for young adults, but was lower than state-level surveillance estimates for youth. Most participants retained at wave 3 provided positive qualitative feedback on their experience. Conclusions: Our study supports the feasibility of recruiting a web-based cohort of youth and young adults with representation across an entire state to evaluate substance use prevention efforts. Findings suggest that a guaranteed payment immediately upon survey completion coupled with a bonus for completing all survey waves and weekly survey reminders may facilitate retention in a cohort of youth and young adults. %M 32706681 %R 10.2196/18446 %U http://www.jmir.org/2020/7/e18446/ %U https://doi.org/10.2196/18446 %U http://www.ncbi.nlm.nih.gov/pubmed/32706681 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e19354 %T Association of Search Query Interest in Gastrointestinal Symptoms With COVID-19 Diagnosis in the United States: Infodemiology Study %A Rajan,Anjana %A Sharaf,Ravi %A Brown,Robert S %A Sharaiha,Reem Z %A Lebwohl,Benjamin %A Mahadev,SriHari %+ Department of Gastroenterology and Hepatology, Weill Cornell Medicine, 1305 York Ave, 4th Floor, New York, NY, 10065, United States, 1 646 962 2382, srm9005@med.cornell.edu %K COVID-19 %K diarrhea %K internet search queries %K Google Trends %K gastrointestinal %K symptom %K health information %K pandemic %K infectious disease %K virus %D 2020 %7 17.7.2020 %9 Short Paper %J JMIR Public Health Surveill %G English %X Background: Coronavirus disease (COVID-19) is a novel viral illness that has rapidly spread worldwide. While the disease primarily presents as a respiratory illness, gastrointestinal symptoms such as diarrhea have been reported in up to one-third of confirmed cases, and patients may have mild symptoms that do not prompt them to seek medical attention. Internet-based infodemiology offers an approach to studying symptoms at a population level, even in individuals who do not seek medical care. Objective: This study aimed to determine if a correlation exists between internet searches for gastrointestinal symptoms and the confirmed case count of COVID-19 in the United States. Methods: The search terms chosen for analysis in this study included common gastrointestinal symptoms such as diarrhea, nausea, vomiting, and abdominal pain. Furthermore, the search terms fever and cough were used as positive controls, and constipation was used as a negative control. Daily query shares for the selected symptoms were obtained from Google Trends between October 1, 2019 and June 15, 2020 for all US states. These shares were divided into two time periods: pre–COVID-19 (prior to March 1) and post–COVID-19 (March 1-June 15). Confirmed COVID-19 case numbers were obtained from the Johns Hopkins University Center for Systems Science and Engineering data repository. Moving averages of the daily query shares (normalized to baseline pre–COVID-19) were then analyzed against the confirmed disease case count and daily new cases to establish a temporal relationship. Results: The relative search query shares of many symptoms, including nausea, vomiting, abdominal pain, and constipation, remained near or below baseline throughout the time period studied; however, there were notable increases in searches for the positive control symptoms of fever and cough as well as for diarrhea. These increases in daily search queries for fever, cough, and diarrhea preceded the rapid rise in number of cases by approximately 10 to 14 days. The search volumes for these terms began declining after mid-March despite the continued rises in cumulative cases and daily new case counts. Conclusions: Google searches for symptoms may precede the actual rises in cases and hospitalizations during pandemics. During the current COVID-19 pandemic, this study demonstrates that internet search queries for fever, cough, and diarrhea increased prior to the increased confirmed case count by available testing during the early weeks of the pandemic in the United States. While the search volumes eventually decreased significantly as the number of cases continued to rise, internet query search data may still be a useful tool at a population level to identify areas of active disease transmission at the cusp of new outbreaks. %M 32640418 %R 10.2196/19354 %U http://publichealth.jmir.org/2020/3/e19354/ %U https://doi.org/10.2196/19354 %U http://www.ncbi.nlm.nih.gov/pubmed/32640418 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e18059 %T Characterization and Correction of Bias Due to Nonparticipation and the Degree of Loyalty in Large-Scale Finnish Loyalty Card Data on Grocery Purchases: Cohort Study %A Vuorinen,Anna-Leena %A Erkkola,Maijaliisa %A Fogelholm,Mikael %A Kinnunen,Satu %A Saarijärvi,Hannu %A Uusitalo,Liisa %A Näppilä,Turkka %A Nevalainen,Jaakko %+ Faculty of Social Sciences (Health Sciences), Tampere University, Arvo Ylpön katu 34, FI-33014, Tampere, , Finland, 358 408485966, anna-leena.vuorinen@vtt.fi %K loyalty card data %K diet %K selection bias %K weighting %K raking %K food %D 2020 %7 15.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: To date, the evaluation of diet has mostly been based on questionnaires and diaries that have their limitations in terms of being time and resource intensive, and a tendency toward social desirability. Loyalty card data obtained in retailing provides timely and objective information on diet-related behaviors. In Finland, the market is highly concentrated, which provides a unique opportunity to investigate diet through grocery purchases. Objective: The aims of this study were as follows: (1) to investigate and quantify the selection bias in large-scale (n=47,066) loyalty card (LoCard) data and correct the bias by developing weighting schemes and (2) to investigate how the degree of loyalty relates to food purchases. Methods: Members of a loyalty card program from a large retailer in Finland were contacted via email and invited to take part in the study, which involved consenting to the release of their grocery purchase data for research purposes. Participants’ sociodemographic background was obtained through a web-based questionnaire and was compared to that of the general Finnish adult population obtained via Statistics Finland. To match the distributions of sociodemographic variables, poststratification weights were constructed by using the raking method. The degree of loyalty was self-estimated on a 5-point rating scale. Results: On comparing our study sample with the general Finnish adult population, in our sample, there were more women (65.25%, 30,696/47,045 vs 51.12%, 2,273,139/4,446,869), individuals with higher education (56.91%, 20,684/36,348 vs 32.21%, 1,432,276/4,446,869), and employed individuals (60.53%, 22,086/36,487 vs 52.35%, 2,327,730/4,446,869). Additionally, in our sample, there was underrepresentation of individuals aged under 30 years (14.44%, 6,791/47,045 vs 18.04%, 802,295/4,446,869) and over 70 years (7.94%, 3,735/47,045 vs 18.20%, 809,317/4,446,869), as well as retired individuals (23.51%, 8,578/36,487 vs 31.82%, 1,414,785/4,446,869). Food purchases differed by the degree of loyalty, with higher shares of vegetable, red meat & processed meat, and fat spread purchases in the higher loyalty groups. Conclusions: Individuals who consented to the use of their loyalty card data for research purposes tended to diverge from the general Finnish adult population. However, the high volume of data enabled the inclusion of sociodemographically diverse subgroups and successful correction of the differences found in the distributions of sociodemographic variables. In addition, it seems that food purchases differ according to the degree of loyalty, which should be taken into account when researching loyalty card data. Despite the limitations, loyalty card data provide a cost-effective approach to reach large groups of people, including hard-to-reach population subgroups. %M 32459633 %R 10.2196/18059 %U http://www.jmir.org/2020/7/e18059/ %U https://doi.org/10.2196/18059 %U http://www.ncbi.nlm.nih.gov/pubmed/32459633 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17891 %T Automated and Interviewer-Administered Mobile Phone Surveys in Burkina Faso: Sociodemographic Differences Among Female Mobile Phone Survey Respondents and Nonrespondents %A Greenleaf,Abigail R %A Gadiaga,Aliou %A Choi,Yoonjoung %A Guiella,Georges %A Turke,Shani %A Battle,Noelle %A Ahmed,Saifuddin %A Moreau,Caroline %+ ICAP at Columbia University, 722 W 168th St, New York, NY, 10032, United States, 1 4439553694, arg2177@cumc.columbia.edu %K cell phone %K mHealth %K Africa South of the Sahara %K Burkina Faso %K methodology, survey, nonrespondents, survey methods, interviews, telephone %D 2020 %7 14.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The remarkable growth of cell phone ownership in low- and middle-income countries has generated significant interest in using cell phones for conducting surveys through computer-assisted telephone interviews, live interviewer-administered surveys, or automated surveys (ie, interactive voice response). Objective: This study aimed to compare, by mode, the sociodemographic characteristics of cell phone owners who completed a follow-up phone survey with those who did not complete the survey. Methods: The study was based on a nationally representative sample of women aged 15 to 49 years who reported cell phone ownership during a household survey in Burkina Faso in 2016. Female cell phone owners were randomized to participate in a computer-assisted telephone interview or hybrid interactive voice response follow-up phone survey 11 months after baseline interviews. Completion of the phone survey was defined as participants responding to more than 50% of questions in the phone survey. We investigated sociodemographic characteristics associated with cell phone survey completion using multivariable logistic regression models, stratifying the analysis by survey mode and by directly comparing computer-assisted telephone interview and hybrid interactive voice response respondents. Results: A total of 1766 women were called for the phone survey between November 5 and 17, 2017. In both the computer-assisted telephone interview and hybrid interactive voice response samples, women in urban communities and women with secondary education or higher were more likely to complete the survey than their rural and less-educated counterparts. Compared directly, women who completed the hybrid interactive voice response survey had higher odds of having a secondary education than those who completed computer-assisted telephone interviews (odds ratio 1.7, 95% CI 1.1-2.6). Conclusions: In Burkina Faso, computer-assisted telephone interviews are the preferred method of conducting cell phone surveys owing to less sample distortion and a higher response rate compared with a hybrid interactive voice response survey. %M 32673250 %R 10.2196/17891 %U https://mhealth.jmir.org/2020/7/e17891 %U https://doi.org/10.2196/17891 %U http://www.ncbi.nlm.nih.gov/pubmed/32673250 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17451 %T The Potential of Smartphone Apps in Informing Protobacco and Antitobacco Messaging Efforts Among Underserved Communities: Longitudinal Observational Study %A Lee,Edmund WJ %A Bekalu,Mesfin Awoke %A McCloud,Rachel %A Vallone,Donna %A Arya,Monisha %A Osgood,Nathaniel %A Li,Xiaoyan %A Minsky,Sara %A Viswanath,Kasisomayajula %+ Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, United States, 1 6178587988, Edmund_Lee@dfci.harvard.edu %K mobile health %K mobile phone %K tobacco use %K big data %K spatial analysis %K data science %D 2020 %7 7.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: People from underserved communities such as those from lower socioeconomic positions or racial and ethnic minority groups are often disproportionately targeted by the tobacco industry, through the relatively high levels of tobacco retail outlets (TROs) located in their neighborhood or protobacco marketing and promotional strategies. It is difficult to capture the smoking behaviors of individuals in actual locations as well as the extent of exposure to tobacco promotional efforts. With the high ownership of smartphones in the United States—when used alongside data sources on TRO locations—apps could potentially improve tobacco control efforts. Health apps could be used to assess individual-level exposure to tobacco marketing, particularly in relation to the locations of TROs as well as locations where they were most likely to smoke. To date, it remains unclear how health apps could be used practically by health promotion organizations to better reach underserved communities in their tobacco control efforts. Objective: This study aimed to demonstrate how smartphone apps could augment existing data on locations of TROs within underserved communities in Massachusetts and Texas to help inform tobacco control efforts. Methods: Data for this study were collected from 2 sources: (1) geolocations of TROs from the North American Industry Classification System 2016 and (2) 95 participants (aged 18 to 34 years) from underserved communities who resided in Massachusetts and Texas and took part in an 8-week study using location tracking on their smartphones. We analyzed the data using spatial autocorrelation, optimized hot spot analysis, and fitted power-law distribution to identify the TROs that attracted the most human traffic using mobility data. Results: Participants reported encountering protobacco messages mostly from store signs and displays and antitobacco messages predominantly through television. In Massachusetts, clusters of TROs (Dorchester Center and Jamaica Plain) and reported smoking behaviors (Dorchester Center, Roxbury Crossing, Lawrence) were found in economically disadvantaged neighborhoods. Despite the widespread distribution of TROs throughout the communities, participants overwhelmingly visited a relatively small number of TROs in Roxbury and Methuen. In Texas, clusters of TROs (Spring, Jersey Village, Bunker Hill Village, Sugar Land, and Missouri City) were found primarily in Houston, whereas clusters of reported smoking behaviors were concentrated in West University Place, Aldine, Jersey Village, Spring, and Baytown. Conclusions: Smartphone apps could be used to pair geolocation data with self-reported smoking behavior in order to gain a better understanding of how tobacco product marketing and promotion influence smoking behavior within vulnerable communities. Public health officials could take advantage of smartphone data collection capabilities to implement targeted tobacco control efforts in these strategic locations to reach underserved communities in their built environment. %M 32673252 %R 10.2196/17451 %U https://www.jmir.org/2020/7/e17451 %U https://doi.org/10.2196/17451 %U http://www.ncbi.nlm.nih.gov/pubmed/32673252 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 6 %P e15609 %T Using Electronic Data Collection Platforms to Assess Complementary and Integrative Health Patient-Reported Outcomes: Feasibility Project %A Haun,Jolie N %A Alman,Amy C %A Melillo,Christine %A Standifer,Maisha %A McMahon-Grenz,Julie %A Shin,Marlena %A Lapcevic,W A %A Patel,Nitin %A Elwy,A Rani %+ Research Service, James A. Haley VA Medical Center, 8900 Grand Oak Circle, Tampa, FL, 33637, United States, 1 813 558 7622, Jolie.Haun@va.gov %K integrative medicine %K health information technology %K health services research %K mobile phone %K patient-reported outcomes %K veteran %D 2020 %7 26.6.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: The Veteran Administration (VA) Office of Patient-Centered Care and Cultural Transformation is invested in improving veteran health through a whole-person approach while taking advantage of the electronic resources suite available through the VA. Currently, there is no standardized process to collect and integrate electronic patient-reported outcomes (ePROs) of complementary and integrative health (CIH) into clinical care using a web-based survey platform. This quality improvement project enrolled veterans attending CIH appointments within a VA facility and used web-based technologies to collect ePROs. Objective: This study aimed to (1) determine a practical process for collecting ePROs using patient email services and a web-based survey platform and (2) conduct analyses of survey data using repeated measures to estimate the effects of CIH on patient outcomes. Methods: In total, 100 veterans from one VA facility, comprising 11 cohorts, agreed to participate. The VA patient email services (Secure Messaging) were used to manually send links to a 16-item web-based survey stored on a secure web-based survey storage platform (Qualtrics). Each survey included questions about patient outcomes from CIH programs. Each cohort was sent survey links via Secure Messaging (SM) at 6 time points: weeks 1 through 4, week 8, and week 12. Process evaluation interviews were conducted with five primary care providers to assess barriers and facilitators to using the patient-reported outcome survey in usual care. Results: This quality improvement project demonstrated the usability of SM and Qualtrics for ePRO collection. However, SM for ePROs was labor intensive for providers. Descriptive statistics on health competence (2-item Perceived Health Competence Scale), physical and mental health (Patient-Reported Outcomes Measurement Information System Global-10), and stress (4-item Perceived Stress Scale) indicated that scores did not significantly change over time. Survey response rates varied (18/100, 18.0%-42/100, 42.0%) across each of the 12 weekly survey periods. In total, 74 of 100 participants provided ≥1 survey, and 90% (66/74) were female. The majority, 62% (33/53) of participants, who reported the use of any CIH modality, reported the use of two or more unique modalities. Primary care providers highlighted specific challenges with SM and offered solutions regarding staff involvement in survey implementation. Conclusions: This quality improvement project informs our understanding of the processes currently available for using SM and web-based data platforms to collect ePROs. The study results indicate that although it is possible to use SM and web-based survey platforms for ePROs, automating scheduled administration will be necessary to reduce provider burden. The lack of significant change in ePROs may be due to standard measures taking a biomedical approach to wellness. Future work should focus on identifying ideal ePRO processes that would include standardized, whole-person measures of wellness. %M 32589163 %R 10.2196/15609 %U http://medinform.jmir.org/2020/6/e15609/ %U https://doi.org/10.2196/15609 %U http://www.ncbi.nlm.nih.gov/pubmed/32589163 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e16480 %T Electronic Data Capture Versus Conventional Data Collection Methods in Clinical Pain Studies: Systematic Review and Meta-Analysis %A Jibb,Lindsay A %A Khan,James S %A Seth,Puneet %A Lalloo,Chitra %A Mulrooney,Lauren %A Nicholson,Kathryn %A Nowak,Dominik A %A Kaur,Harneel %A Chee-A-Tow,Alyssandra %A Foster,Joel %A Stinson,Jennifer N %+ Child Health Evaluative Sciences, Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G 0A4, Canada, 1 416 813 7654 ext 309160, lindsay.jibb@sickkids.ca %K electronic %K data collection %K pain %K efficiency %K systematic review %K meta-analysis %D 2020 %7 16.6.2020 %9 Review %J J Med Internet Res %G English %X Background: The most commonly used means to assess pain is by patient self-reported questionnaires. These questionnaires have traditionally been completed using paper-and-pencil, telephone, or in-person methods, which may limit the validity of the collected data. Electronic data capture methods represent a potential way to validly, reliably, and feasibly collect pain-related data from patients in both clinical and research settings. Objective: The aim of this study was to conduct a systematic review and meta-analysis to compare electronic and conventional pain-related data collection methods with respect to pain score equivalence, data completeness, ease of use, efficiency, and acceptability between methods. Methods: We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica Database (EMBASE), and Cochrane Central Register of Controlled Trials (CENTRAL) from database inception until November 2019. We included all peer-reviewed studies that compared electronic (any modality) and conventional (paper-, telephone-, or in-person–based) data capture methods for patient-reported pain data on one of the following outcomes: pain score equivalence, data completeness, ease of use, efficiency, and acceptability. We used random effects models to combine score equivalence data across studies that reported correlations or measures of agreement between electronic and conventional pain assessment methods. Results: A total of 53 unique studies were included in this systematic review, of which 21 were included in the meta-analysis. Overall, the pain scores reported electronically were congruent with those reported using conventional modalities, with the majority of studies (36/44, 82%) that reported on pain scores demonstrating this relationship. The weighted summary correlation coefficient of pain score equivalence from our meta-analysis was 0.92 (95% CI 0.88-0.95). Studies on data completeness, patient- or provider-reported ease of use, and efficiency generally indicated that electronic data capture methods were equivalent or superior to conventional methods. Most (19/23, 83%) studies that directly surveyed patients reported that the electronic format was the preferred data collection method. Conclusions: Electronic pain-related data capture methods are comparable with conventional methods in terms of score equivalence, data completeness, ease, efficiency, and acceptability and, if the appropriate psychometric evaluations are in place, are a feasible means to collect pain data in clinical and research settings. %M 32348259 %R 10.2196/16480 %U https://www.jmir.org/2020/6/e16480 %U https://doi.org/10.2196/16480 %U http://www.ncbi.nlm.nih.gov/pubmed/32348259 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19855 %T Epidemiological Observations on the Association Between Anosmia and COVID-19 Infection: Analysis of Data From a Self-Assessment Web Application %A Denis,Fabrice %A Galmiche,Simon %A Dinh,Aurélien %A Fontanet,Arnaud %A Scherpereel,Arnaud %A Benezit,Francois %A Lescure,François-Xavier %+ Inter-regional Cancer Institut Jean Bernard, 9, rue Beauverger, Le Mans, 72100, France, 33 243475810, f.denis@cjb72.org %K COVID-19 %K anosmia %K epidemiological surveillance %K self-assessment %K web application %K outbreak %K symptoms %K self-assessment %K surveillance %K epidemiology %D 2020 %7 11.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: We developed a self-assessment and participatory surveillance web application for coronavirus disease (COVID-19), which was launched in France in March 2020. Objective: Our objective was to determine if self-reported symptoms could help monitor the dynamics of the COVID-19 outbreak in France. Methods: Users were asked questions about underlying conditions, sociodemographic status, zip code, and COVID-19 symptoms. Depending on the symptoms reported and the presence of coexisting disorders, users were told to either stay at home, contact a general practitioner (GP), or call an emergency phone number. Data regarding COVID-19–related hospitalizations were retrieved from the Ministry of Health. Results: As of March 29, 2020, the application was opened 4,126,789 times; 3,799,535 electronic questionnaires were filled out; and 2,477,174 users had at least one symptom. In total, 34.8% (n=1,322,361) reported no symptoms. The remaining users were directed to self-monitoring (n=858,878, 22.6%), GP visit or teleconsultation (n=1,033,922, 27.2%), or an emergency phone call (n=584,374, 15.4%). Emergency warning signs were reported by 39.1% of participants with anosmia, a loss of the sense of smell (n=127,586) versus 22.7% of participants without anosmia (n=1,597,289). Anosmia and fever and/or cough were correlated with hospitalizations for COVID-19 (Spearman correlation coefficients=0.87 and 0.82, respectively; P<.001 for both). Conclusions: This study suggests that anosmia may be strongly associated with COVID-19 and its severity. Despite a lack of medical assessment and virological confirmation, self-checking application data could be a relevant tool to monitor outbreak trends. Trial Registration: ClinicalTrials.gov NCT04331171; https://clinicaltrials.gov/ct2/show/NCT04331171 %M 32496206 %R 10.2196/19855 %U http://www.jmir.org/2020/6/e19855/ %U https://doi.org/10.2196/19855 %U http://www.ncbi.nlm.nih.gov/pubmed/32496206 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17446 %T Active Surveillance of Adverse Events Following Human Papillomavirus Vaccination: Feasibility Pilot Study Based on the Regional Health Care Information Platform in the City of Ningbo, China %A Liu,Zhike %A Zhang,Liang %A Yang,Yu %A Meng,Ruogu %A Fang,Ting %A Dong,Ying %A Li,Ning %A Xu,Guozhang %A Zhan,Siyan %+ Department of Epidemiology and Biostatistics, Peking University Health Science Center, 38 Xueyuan Road, Haidian District, Beijing, 100191, China, 86 13641084052, siyan-zhan@bjmu.edu.cn %K safety %K HPV %K human papillomavirus %K vaccine %K active surveillance %D 2020 %7 1.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Comprehensive safety data for vaccines from post-licensure surveillance, especially active surveillance, could guide administrations and individuals to make reasonable decisions on vaccination. Therefore, we designed a pilot study to assess the capability of a regional health care information platform to actively monitor the safety of a newly licensed vaccine. Objective: This study aimed to conduct active surveillance of human papillomavirus (HPV) vaccine safety based on this information platform. Methods: In 2017, one of China’s most mature information platforms with superior data linkage was selected. A structured questionnaire and open-ended interview guidelines were developed to investigate the feasibility of active surveillance following HPV vaccination using the regional health care information platform in Ningbo. The questionnaire was sent to participants via email, and a face-to-face interview was conducted to confirm details or resolve discrepancies. Results: Five databases that could be considered essential to active surveillance of vaccine safety were integrated into the platform starting in 2015. Except for residents' health records, which had a coverage rate of 87%, the data sources covered more than 95% of the records that were documented in Ningbo. All the data could be inherently linked using the national identity card. There were 19,328 women who received the HPV vaccine, and 37,988 doses were administered in 2017 and 2018. Women aged 30-40 years accounted for the largest proportion. Quadrivalent vaccination accounted for 73.1% of total vaccination, a much higher proportion than that of bivalent vaccination. Of the first doses, 60 (60/19,328, 0.31%) occurred outside Ningbo. There were no missing data for vaccination-relevant variables, such as identity card, vaccine name, vaccination doses, vaccination date, and manufacturer. ICD-10 coding could be used to identify 9,180 cases using a predefined list of the outcomes of interest, and 1.88% of these cases were missing the identity card. During the 90 days following HPV vaccination, 4 incident cases were found through the linked vaccination history and electronic medical records. The combined incident rate of rheumatoid arthritis, optic neuritis, and Henoch-Schonlein purpura was 8.84/100,000 doses of bivalent HPV, and the incidence rate of rheumatoid arthritis was 3.75/100,000 doses of quadrivalent HPV. Conclusions: This study presents an available approach to initiate an active surveillance system for adverse events following HPV vaccination, based on a regional health care information platform in China. An extended observation period or the inclusion of additional functional sites is warranted to conduct future hypothesis-generating and hypothesis-confirming studies for vaccine safety concerns. %M 32234696 %R 10.2196/17446 %U https://www.jmir.org/2020/6/e17446 %U https://doi.org/10.2196/17446 %U http://www.ncbi.nlm.nih.gov/pubmed/32234696 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e15815 %T Reliability, Feasibility, and Patient Acceptance of an Electronic Version of a Multidimensional Health Assessment Questionnaire for Routine Rheumatology Care: Validation and Patient Preference Study %A Pincus,Theodore %A Castrejon,Isabel %A Riad,Mariam %A Obreja,Elena %A Lewis,Candice %A Krogh,Niels Steen %+ Rush University Medical Center, 1611 West Harrison, Suite 510, Chicago, IL, United States, 1 3129428268, tedpincus@gmail.com %K patient reported outcomes %K health status measures %K electronic version %K rapid3 %K mdhaq %D 2020 %7 27.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: A multidimensional health assessment questionnaire (MDHAQ) that was developed primarily for routine rheumatology care has advanced clinical research concerning disease burden, disability, and mortality in rheumatic diseases. Routine Assessment of Patient Index Data 3 (RAPID3), an index within the MDHAQ, is the most widely used index to assess rheumatoid arthritis (RA) in clinical care in the United States, and it recognizes clinical status changes in all studied rheumatic diseases. MDHAQ physical function scores are far more significant in the prognosis of premature RA mortality than laboratory or imaging data. However, electronic medical records (EMRs) generally do not include patient questionnaires. An electronic MDHAQ (eMDHAQ), linked by fast healthcare interoperability resources (FIHR) to an EMR, can facilitate clinical and research advances. Objective: This study analyzed the reliability, feasibility, and patient acceptance of an eMDHAQ. Methods: Since 2006, all Rush University Medical Center rheumatology patients with all diagnoses have been asked to complete a paper MDHAQ at each routine care encounter. In April 2019, patients were invited to complete an eMDHAQ at the conclusion of the encounter. Analyses were conducted to determine the reliability of eMDHAQ versus paper MDHAQ scores, arithmetically and by intraclass correlation coefficient (ICC). The feasibility of the eMDHAQ was analyzed based on the time for patient completion. The patient preference for the electronic or paper version was analyzed through a patient paper questionnaire. Results: The 98 study patients were a typical routine rheumatology patient group. Seven paper versus eMDHAQ scores were within 2%, differences neither clinically nor statistically significant. ICCs of 0.86-0.98 also indicated good to excellent reliability. Mean eMDHAQ completion time was a feasible 8.2 minutes. The eMDHAQ was preferred by 72% of patients; preferences were similar according to age and educational level. Conclusions: The results on a paper MDHAQ versus eMDHAQ were similar. Most patients preferred an eMDHAQ. %M 32459182 %R 10.2196/15815 %U http://formative.jmir.org/2020/5/e15815/ %U https://doi.org/10.2196/15815 %U http://www.ncbi.nlm.nih.gov/pubmed/32459182 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15909 %T A Questionnaire for Assessing User Satisfaction With Mobile Health Apps: Development Using Rasch Measurement Theory %A Melin,Jeanette %A Bonn,Stephanie Erika %A Pendrill,Leslie %A Trolle Lagerros,Ylva %+ Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Eugeniahemmet T2, Stockholm, 171 76, Sweden, 46 46 851779183, ylva.trolle@ki.se %K cell phone %K healthy lifestyle %K methods %K mobile applications %K psychometrics %K smartphone %K telemedicine %K mobile phone %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps offer great opportunities to deliver large-scale, cost-efficient digital solutions for implementing lifestyle changes. Furthermore, many mHealth apps act as medical devices. Yet, there is little research on how to assess user satisfaction with an mHealth solution. Objective: This study presents the development of the mHealth Satisfaction Questionnaire and evaluates its measurement properties. Methods: Respondents who took part in the Health Integrator Study and were randomized to use the Health Integrator smartphone app for lifestyle changes (n=112), with and without additional telephone coaching, rated their satisfaction with the app using the new 14-item mHealth Satisfaction Questionnaire. The ratings were given on a 5-point Likert scale and measurement properties were evaluated using Rasch measurement theory (RMT). Results: Optimal scoring was reached when response options 2, 3, and 4 were collapsed, giving three response categories. After omitting two items that did not fit into the scale, fit residuals were within, or close to, the recommended range of ±2.5. There was no differential item functioning between intervention group, age group, or sex. The Person Separation Index was 0.79, indicating that the scale’s ability to discriminate correctly between person leniency was acceptable for group comparisons but not for individual evaluations. The scale did not meet the criterion of unidimensionality; 16.1% (18/112) of the respondents were outside the desired range of −1.96 to 1.96. In addition, several items showed local dependency and three underlying dimensions emerged: negative experiences, positive experiences, and lifestyle consequences of using the mHealth solution. Conclusions: In times where mHealth apps and digital solutions are given more attention, the mHealth Satisfaction Questionnaire provides a new possibility to measure user satisfaction to ensure usability and improve development of new apps. Our study is one of only a few cases where RMT has been used to evaluate the usability of such an instrument. There is, though, a need for further development of the mHealth Satisfaction Questionnaire, including the addition of more items and consideration of further response options. The mHealth Satisfaction Questionnaire should also be evaluated in a larger sample and with other mHealth apps and in other contexts. Trial Registration: ClinicalTrials.gov NCT03579342; http://clinicaltrials.gov/ct2/show/NCT03579342. %M 32452817 %R 10.2196/15909 %U http://mhealth.jmir.org/2020/5/e15909/ %U https://doi.org/10.2196/15909 %U http://www.ncbi.nlm.nih.gov/pubmed/32452817 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e17129 %T Paper Versus Digital Data Collection Methods for Road Safety Observations: Comparative Efficiency Analysis of Cost, Timeliness, Reliability, and Results %A Taber,Niloufer %A Mehmood,Amber %A Vedagiri,Perumal %A Gupta,Shivam %A Pinto,Rachel %A Bachani,Abdulgafoor M %+ International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 410 955 3934, ntaber1@jhu.edu %K information technology %K public health informatics %K mHealth %K risk factors %K population surveillance %K traffic accidents %K data collection %D 2020 %7 22.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Roadside observational studies play a fundamental role in designing evidence-informed strategies to address the pressing global health problem of road traffic injuries. Paper-based data collection has been the standard method for such studies, although digital methods are gaining popularity in all types of primary data collection. Objective: This study aims to understand the reliability, productivity, and efficiency of paper vs digital data collection based on three different road user behaviors: helmet use, seatbelt use, and speeding. It also aims to understand the cost and time efficiency of each method and to evaluate potential trade-offs among reliability, productivity, and efficiency. Methods: A total of 150 observational sessions were conducted simultaneously for each risk factor in Mumbai, India, across two rounds of data collection. We matched the simultaneous digital and paper observation periods by date, time, and location, and compared the reliability by subgroups and the productivity using Pearson correlations (r). We also conducted logistic regressions separately by method to understand how similar results of inferential analyses would be. The time to complete an observation and the time to obtain a complete dataset were also compared, as were the total costs in US dollars for fieldwork, data entry, management, and cleaning. Results: Productivity was higher in paper than digital methods in each round for each risk factor. However, the sample sizes across both methods provided a precision of 0.7 percentage points or smaller. The gap between digital and paper data collection productivity narrowed across rounds, with correlations improving from r=0.27-0.49 to 0.89-0.96. Reliability in risk factor proportions was between 0.61 and 0.99, improving between the two rounds for each risk factor. The results of the logistic regressions were also largely comparable between the two methods. Differences in regression results were largely attributable to small sample sizes in some variable levels or random error in variables where the prevalence of the outcome was similar among variable levels. Although data collectors were able to complete an observation using paper more quickly, the digital dataset was available approximately 9 days sooner. Although fixed costs were higher for digital data collection, variable costs were much lower, resulting in a 7.73% (US $3011/38,947) lower overall cost. Conclusions: Our study did not face trade-offs among time efficiency, cost efficiency, statistical reliability, and descriptive comparability when deciding between digital and paper, as digital data collection proved equivalent or superior on these domains in the context of our project. As trade-offs among cost, timeliness, and comparability—and the relative importance of each—could be unique to every data collection project, researchers should carefully consider the questionnaire complexity, target sample size, implementation plan, cost and logistical constraints, and geographical contexts when making the decision between digital and paper. %M 32348273 %R 10.2196/17129 %U http://www.jmir.org/2020/5/e17129/ %U https://doi.org/10.2196/17129 %U http://www.ncbi.nlm.nih.gov/pubmed/32348273 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e15665 %T Internet Narratives Focused on Health Travelers’ Experiences in India: Qualitative Analysis %A Brown,Joseph %A Johnson,James %A Ozan-Rafferty,Margaret E %A Sharma,Manoj %A Barbera,Salvatore %+ The Herbert H & Grace A Dow College of Health Professions, Central Michigan University, 1280 E Campus Dr, Mount Pleasant, MI, 48859, United States, 1 9897744000, brown7jc@cmich.edu %K medical tourism %K India %K global health %K personal narratives %K travel-related illness %K qualitative research %K patient satisfaction %K delivery of health care %K travel %K data collection %D 2020 %7 14.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The medical tourism industry is currently popular in India, but there is no confirmation of the common perspectives among the country’s medical travelers. Objective: This qualitative research study analyzed web-based narratives from health travelers visiting India and described the themes of their experiences. This study aimed to answer the following primary question: What can we learn about health travelers’ experiences in India from an analysis of their web-based narratives? The secondary questions were as follows: (1) What are the primary health care reasons for which patients in the examined narratives traveled to India? (2) What can be derived from the narratives regarding medical tourists’ satisfaction with the outcome and result of the treatment they received in India? (3) What are some positive and negative factors influencing medical tourists’ perceptions and overall experiences about their health travel to India? (4) What are the characteristics of medical tourists who write web-based narratives regarding their health experiences in India? Methods: Publicly available narratives written by medical tourists who visited India were obtained from a Google search. The narratives included blog posts and discussion board posts by medical tourists. The analysis process consisted of initial open coding being conducted on the narratives to create initial codes and identify common themes with a focus on the primary research question and subquestions. Results: Although Mumbai, Chennai, and New Delhi were not the only destination cities mentioned, these were the most popular cities patients visited for care. The medical tourists, who stated their origin country, came from one of the following continents: Africa, Europe, North America, and Oceania. Dental care, Ayurveda treatment, and eye care were the most popular types of care that medical tourists sought. The results showed that most of the medical tourists were happy with the overall experience of receiving care in India. The most popular themes with regard to the patients’ satisfaction were low costs, good customer service, and services being offered that were unavailable in their home country. When negative feedback was provided, it was mainly concentrated on the overall environment of India being unorganized and unsanitary. Conclusions: Primarily, the study’s findings can benefit health care providers and patients. Providers hosting medical tourists in India can use negative feedback to improve their services; similarly, providers who are losing patients to medical tourism can identify opportunities for improvement (ie, why are we losing patients). Indian providers hosting medical tourists should keep their prices competitive and continue to provide exceptional service; however, they should do their best to lessen the crowdedness of their facilities while making sure they are esthetically pleasing. Providers losing patients to medical tourism need to identify ways to ensure their services match the benefits that their international counterparts are providing, such as competitive pricing and expansion on the services provided. %M 32406860 %R 10.2196/15665 %U https://www.jmir.org/2020/5/e15665 %U https://doi.org/10.2196/15665 %U http://www.ncbi.nlm.nih.gov/pubmed/32406860 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19161 %T Knowledge and Behaviors Toward COVID-19 Among US Residents During the Early Days of the Pandemic: Cross-Sectional Online Questionnaire %A Clements,John M %+ Master of Public Health Program, Division of Public Health, College of Human Medicine, Michigan State University, 130 E 2nd Street, Suite 202, Flint, MI, 48502, United States, 1 989 708 6338, clemen69@msu.edu %K public health %K surveillance %K COVID-19 %K knowledge %K behavior %K outbreak %K infectious disease %K health information %D 2020 %7 8.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The early days of the coronavirus disease (COVID-19) pandemic in the United States brought uncertainty in the knowledge about COVID-19 and what to do about it. It is necessary to understand public knowledge and behaviors if we are to effectively address the pandemic. Objective: The aim of this study is to test the hypothesis that knowledge about COVID-19 influences participation in different behaviors including self-reports of purchasing more goods than usual, attending large gatherings, and using medical masks. Methods: This study was funded and approved by the Institutional Review Board on March 17, 2020. The cross-sectional online survey of 1034 US residents aged 18 years or older was conducted on March 17, 2020. Results: For every point increase in knowledge, the odds of participation in purchasing more goods (odds ratio [OR] 0.88, 95% CI 0.81-0.95), attending large gatherings (OR 0.87, 95% CI 0.81-0.93), and using medical masks (OR 0.56, 95% CI 0.50-0.62) decreased by 12%, 13%, and 44%, respectively. Gen X and millennial participants had 56% and 76% higher odds, respectively, of increased purchasing behavior compared to baby boomers. The results suggest that there is a politicization of response recommendations. Democrats had 30% lower odds of attending large gatherings (OR 0.70, 95% CI 0.50-0.97) and 48% lower odds of using medical masks (OR 0.52, 95% CI 0.34-0.78) compared to Republicans. Conclusions: This survey is one of the first attempts to study determinants of knowledge and behaviors in response to the COVID-19 pandemic in the United States. A national, coordinated effort toward a pandemic response may ensure better compliance with behavioral recommendations to address this public health emergency. %M 32369759 %R 10.2196/19161 %U http://publichealth.jmir.org/2020/2/e19161/ %U https://doi.org/10.2196/19161 %U http://www.ncbi.nlm.nih.gov/pubmed/32369759 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18576 %T Surveillance of COVID-19 in the General Population Using an Online Questionnaire: Report From 18,161 Respondents in China %A Luo,Hongxing %A Lie,Yongchan %A Prinzen,Frits W %+ Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Welsdaal 150 C, Maastricht, 6228JG, Netherlands, 31 685704703, h.luo@maastrichtuniversity.nl %K coronavirus %K surveillance %K syndromic surveillance %K participatory surveillance %K online questionnaire %K Wuhan %K COVID-19 %D 2020 %7 27.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The recent outbreak of the coronavirus disease (COVID-19) has become an international pandemic. So far, little is known about the role of an internet approach in COVID-19 participatory surveillance. Objective: The aim of this study is to investigate whether an online survey can provide population-level information for observing prevalence trends during the early phase of an outbreak and identifying potential risk factors of COVID-19 infection. Methods: A 10-item online questionnaire was developed according to medical guidelines and relevant publications. It was distributed between January 24 and February 17, 2020. The characteristics of respondents and temporal changes of various questionnaire-derived indicators were analyzed. Results: A total of 18,161 questionnaires were returned, including 6.45% (n=1171) from Wuhan City. Geographical distributions of the respondents were consistent with the population per province (R2=0.61, P<.001). History of contact significantly decreased with time, both outside Wuhan City (R2=0.35, P=.002) and outside Hubei Province (R2=0.42, P<.001). The percentage of respondents reporting a fever peaked around February 8 (R2=0.57, P<.001) and increased with a history of contact in the areas outside Wuhan City (risk ratio 1.31, 95% CI 1.13-1.52, P<.001). Male sex, advanced age, and lung diseases were associated with a higher risk of fever in the general population with a history of contact. Conclusions: This study shows the usefulness of an online questionnaire for the surveillance of outbreaks like COVID-19 by providing information about trends of the disease and aiding the identification of potential risk factors. %M 32319956 %R 10.2196/18576 %U http://publichealth.jmir.org/2020/2/e18576/ %U https://doi.org/10.2196/18576 %U http://www.ncbi.nlm.nih.gov/pubmed/32319956 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e15561 %T Developing Mental or Behavioral Health Mobile Apps for Pilot Studies by Leveraging Survey Platforms: A Do-it-Yourself Process %A Chow,Philip I %+ Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, 560 Ray C. Hunt Dr., Charlottesville, VA, 22908, United States, 1 434 924 5401, philip.i.chow@gmail.com %K app %K mental health %K mHealth %D 2020 %7 20.4.2020 %9 Tutorial %J JMIR Mhealth Uhealth %G English %X Background: Behavioral health researchers are increasingly recognizing the potential of mobile phone apps to deliver empirically supported treatments. However, current options for developing apps typically require large amounts of expertise or money. Objective: This paper aims to describe a pragmatic do-it-yourself approach for researchers to create and pilot an Android mobile phone app using existing survey software (eg, Qualtrics survey platform). Methods: This study was conducted at an academic research center in the United States focused on developing and evaluating behavioral health technologies. The process outlined in this paper was derived and condensed from the steps to building an existing app intervention, iCanThrive, which was developed to enhance mental well-being in women cancer survivors. Results: This paper describes an inexpensive, practical process that uses a widely available survey software, such as Qualtrics, to create and pilot a mobile phone intervention that is presented to participants as a Web viewer app that is downloaded from the Google Play store. Health researchers who are interested in using this process to pilot apps are encouraged to inquire about the survey platforms available to them, the level of security those survey platforms provide, and the regulatory guidelines set forth by their institution. Conclusions: As app interventions continue to gain interest among researchers and consumers alike, it is important to find new ways to efficiently develop and pilot app interventions before committing a large amount of resources. Mobile phone app interventions are an important component to discovering new ways to reach and support individuals with behavioral or mental health disorders. %M 32310143 %R 10.2196/15561 %U https://mhealth.jmir.org/2020/4/e15561 %U https://doi.org/10.2196/15561 %U http://www.ncbi.nlm.nih.gov/pubmed/32310143 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e18790 %T Use of Rapid Online Surveys to Assess People's Perceptions During Infectious Disease Outbreaks: A Cross-sectional Survey on COVID-19 %A Geldsetzer,Pascal %+ Division of Primary Care and Population Health, Department of Medicine, Stanford University, 1265 Welch Road, Stanford, CA, 94035, United States, 1 6507238596, pgeldsetzer@stanford.edu %K rapid online surveys %K perceptions %K knowledge %K coronavirus %K SARS-CoV-2 %K pandemic %K infectious disease %K outbreak %K survey %K COVID-19 %K public health %D 2020 %7 2.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the extensive time needed to conduct a nationally representative household survey and the commonly low response rate of phone surveys, rapid online surveys may be a promising method to assess and track knowledge and perceptions among the general public during fast-moving infectious disease outbreaks. Objective: This study aimed to apply rapid online surveying to determine knowledge and perceptions of coronavirus disease 2019 (COVID-19) among the general public in the United States and the United Kingdom. Methods: An online questionnaire was administered to 3000 adults residing in the United States and 3000 adults residing in the United Kingdom who had registered with Prolific Academic to participate in online research. Prolific Academic established strata by age (18-27, 28-37, 38-47, 48-57, or ≥58 years), sex (male or female), and ethnicity (white, black or African American, Asian or Asian Indian, mixed, or “other”), as well as all permutations of these strata. The number of participants who could enroll in each of these strata was calculated to reflect the distribution in the US and UK general population. Enrollment into the survey within each stratum was on a first-come, first-served basis. Participants completed the questionnaire between February 23 and March 2, 2020. Results: A total of 2986 and 2988 adults residing in the United States and the United Kingdom, respectively, completed the questionnaire. Of those, 64.4% (1924/2986) of US participants and 51.5% (1540/2988) of UK participants had a tertiary education degree, 67.5% (2015/2986) of US participants had a total household income between US $20,000 and US $99,999, and 74.4% (2223/2988) of UK participants had a total household income between £15,000 and £74,999. US and UK participants’ median estimate for the probability of a fatal disease course among those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was 5.0% (IQR 2.0%-15.0%) and 3.0% (IQR 2.0%-10.0%), respectively. Participants generally had good knowledge of the main mode of disease transmission and common symptoms of COVID-19. However, a substantial proportion of participants had misconceptions about how to prevent an infection and the recommended care-seeking behavior. For instance, 37.8% (95% CI 36.1%-39.6%) of US participants and 29.7% (95% CI 28.1%-31.4%) of UK participants thought that wearing a common surgical mask was “highly effective” in protecting them from acquiring COVID-19, and 25.6% (95% CI 24.1%-27.2%) of US participants and 29.6% (95% CI 28.0%-31.3%) of UK participants thought it was prudent to refrain from eating at Chinese restaurants. Around half (53.8%, 95% CI 52.1%-55.6%) of US participants and 39.1% (95% CI 37.4%-40.9%) of UK participants thought that children were at an especially high risk of death when infected with SARS-CoV-2. Conclusions: The distribution of participants by total household income and education followed approximately that of the US and UK general population. The findings from this online survey could guide information campaigns by public health authorities, clinicians, and the media. More broadly, rapid online surveys could be an important tool in tracking the public’s knowledge and misperceptions during rapidly moving infectious disease outbreaks. %M 32240094 %R 10.2196/18790 %U http://www.jmir.org/2020/4/e18790/ %U https://doi.org/10.2196/18790 %U http://www.ncbi.nlm.nih.gov/pubmed/32240094 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16680 %T Use of Telephone and Digital Channels to Engage Socioeconomically Disadvantaged Adults in Health Disparities Research Within a Social Service Setting: Cross-Sectional Study %A Alcaraz,Kassandra I %A Vereen,Rhyan N %A Burnham,Donna %+ Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams Street NW, Atlanta, GA, 30303, United States, 1 4044178019, kassandra.alcaraz@cancer.org %K cross-sectional studies %K electronic mail %K health status disparities %K health care disparities %K internet %K mobile phone %K telephone %K text messaging %K social services %D 2020 %7 1.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Engaging socioeconomically disadvantaged populations in health research is vital to understanding and, ultimately, eliminating health-related disparities. Digital communication channels are increasingly used to recruit study participants, and recent trends indicate a growing need to partner with the social service sector to improve population health. However, few studies have recruited participants from social service settings using multiple digital channels. Objective: This study aimed to recruit and survey 3791 adult clients of a social service organization via telephone and digital channels. This paper aimed to describe recruitment outcomes across five channels and compare participant characteristics by recruitment channel type. Methods: The Cancer Communication Channels in Context Study recruited and surveyed adult clients of 2-1-1, a social service–focused information and referral system, using five channels: telephone, website, text message, web-based live chat, and email. Participants completed surveys administered either by phone (if recruited by phone) or on the web (if recruited from digital channels, ie, website, text message, Web-based live chat, or email). Measures for the current analysis included demographic and health characteristics. Results: A total of 3293 participants were recruited, with 1907 recruited by phone and 1386 recruited from digital channels. Those recruited by phone had a moderate study eligibility rate (42.23%) and the highest survey completion rate (91.24%) of all channels. Individuals recruited by text message had a high study eligibility rate (94.14%) yet the lowest survey completion rate (74.0%) of all channels. Sample accrual goals were achieved for phone, text message, and website recruitment. Multivariable analyses found differences in participant characteristics by recruitment channel type. Compared with participants recruited by phone, those recruited from digital channels were younger (adjusted odds ratio [aOR] 0.96, 95% CI 0.96-0.97) and more likely to be female (aOR 1.52, 95% CI 1.23-1.88), married (aOR 1.52, 95% CI 1.22-1.89), and other than non-Hispanic black (aOR 1.48, 95% CI 1.22-1.79). Those recruited via phone also were more likely to have more than a high school education (aOR 2.17, 95% CI 1.67-2.82), have a household income ≥US $25,000 a year (aOR 2.02, 95% CI 1.56-2.61), and have children living in the home (aOR 1.26, 95% CI 1.06-1.51). Additionally, participants recruited from digital channels were less likely than those recruited by phone to have public health insurance (aOR 0.75, 95% CI 0.62-0.90) and more likely to report better overall health (aOR 1.52, 95% CI 1.27-1.83 for good-to-excellent health). Conclusions: Findings indicate the feasibility and utility of recruiting socioeconomically disadvantaged adults from the social service sector using multiple communication channels, including digital channels. As social service–based health research evolves, strategic recruitment using a combination of traditional and digital channels may be warranted to avoid underrepresentation of highly medically vulnerable individuals, which could exacerbate disparities in health. %M 32234699 %R 10.2196/16680 %U https://www.jmir.org/2020/4/e16680 %U https://doi.org/10.2196/16680 %U http://www.ncbi.nlm.nih.gov/pubmed/32234699 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e12689 %T Utilizing Digital Health to Collect Electronic Patient-Reported Outcomes in Prostate Cancer: Single-Arm Pilot Trial %A Tran,Christine %A Dicker,Adam %A Leiby,Benjamin %A Gressen,Eric %A Williams,Noelle %A Jim,Heather %+ Thomas Jefferson University, Sidney Kimmel Medical College and Cancer Center, Jefferson Center for Digital Health & Data Science, 4201 Henry Ave, Philadelphia, PA, United States, 1 216 955 6700, adam.dicker@jefferson.edu %K eHealth %K mHealth %K smartphone %K mobile phone %K mobile apps %K health promotion %K chronic disease %K health-related quality of life %K cancer %K patient-reported outcome measures %K health information technology %K patient-centered care %D 2020 %7 25.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Measuring patient-reported outcomes (PROs) requires an individual’s perspective on their symptoms, functional status, and quality of life. Digital health enables remote electronic PRO (ePRO) assessments as a clinical decision support tool to facilitate meaningful provider interactions and personalized treatment. Objective: This study explored the feasibility and acceptability of collecting ePROs using validated health-related quality of life (HRQoL) questionnaires for prostate cancer. Methods: Using Apple ResearchKit software, the Strength Through Insight app was created with content from validated HRQoL tools 26-item Expanded Prostate Cancer Index Composite (EPIC) or EPIC for Clinical Practice and 8-item Functional Assessment of Cancer Therapy Advanced Prostate Symptom Index. In a single-arm pilot study with patients receiving prostate cancer treatment at Thomas Jefferson University Hospital and affiliates, participants were recruited, and instructed to download Strength Through Insight and complete ePROs once a week over 12 weeks. A mixed methods approach, including qualitative pre- and poststudy interviews, was used to evaluate the feasibility and acceptability of Strength Through Insight for the collection and care management of cancer treatment. Results: Thirty patients consented to the study; 1 patient failed to complete any of the questionnaires and was left out of the analysis of the intervention. Moreover, 86% (25/29) reached satisfactory questionnaire completion (defined as completion of 60% of weekly questions over 12 weeks). The lower bound of the exact one-sided 95% CI was 71%, exceeding the 70% feasibility threshold. Most participants self-identified with having a high digital literacy level (defined as the ability to use, understand, evaluate, and analyze information from multiple formats from a variety of digital sources), and only a few participants identified with having a low digital literacy level (defined as only having the ability to gather information on the Web). Interviews were thematically analyzed to reveal the following: (1) value of emotional support and wellness in cancer treatment, (2) rise of social patient advocacy in online patient communities and networks, (3) patient concerns over privacy, and (4) desire for personalized engagement tools. Conclusions: Strength Through Insight was demonstrated as a feasible and acceptable method of data collection for ePROs. A high compliance rate confirmed the app as a reliable tool for patients with localized and advanced prostate cancer. Nearly all participants reported that using the smartphone app is easier than or equivalent to the traditional paper-and-pen approach, providing evidence of acceptability and support for the use of remote PRO monitoring. This study expands on current research involving the value of digital health, as a social and behavioral science, augmented with technology, can begin to contribute to population health management, as it shapes psychographic segmentation by demographic, socioeconomic, health condition, or behavioral factors to group patients by their distinct personalities and motivations, which influence their choices. Trial Registration: ClinicalTrials.gov NC03197948; http://clinicaltrials.gov/ct2/show/NC03197948 %M 32209536 %R 10.2196/12689 %U https://www.jmir.org/2020/3/e12689 %U https://doi.org/10.2196/12689 %U http://www.ncbi.nlm.nih.gov/pubmed/32209536 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e17921 %T The Multiple Sclerosis Health Resource Utilization Survey (MS-HRS): Development and Validation Study %A Ness,Nils-Henning %A Haase,Rocco %A Kern,Raimar %A Schriefer,Dirk %A Ettle,Benjamin %A Cornelissen,Christian %A Akguen,Katja %A Ziemssen,Tjalf %+ University Hospital Carl Gustav Carus, Fetscherstr. 74, Dresden, 01307, Germany, 49 3514584465, tjalf.ziemssen@uniklinikum-dresden.de %K multiple sclerosis %K patient-reported outcome measures %K resource utilization %K validation %K questionnaire development %D 2020 %7 17.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Survey-based studies are frequently used to describe the economic impact of multiple sclerosis (MS). However, there is no validated health resource survey available, preventing comparison of study results and meaningful conclusions regarding the efficiency of long-term treatments. Objective: The aim of this study was to develop and validate a tablet- and paper-based MS health resource utilization survey. Methods: We developed and validated the Multiple Sclerosis Health Resource Utilization Survey (MS-HRS), consisting of 24 cost items for paper and tablet users. Data for validation came from two large German observational studies. Survey practicability was assessed according to the response rate. Reliability was described using test-retest reliability as well as Guttman lambda. Construct validity was assessed as convergent and discriminant validity via correlations with associated patient-reported outcomes and known-group analyses. Results: In total, 2207 out of 2388 (response rate: 92.4%) patients completed the survey and were included to determine psychometric properties. The test-retest reliability had an intraclass correlation coefficient of 0.828 over a course of 3 months. Convergent validity analyses showed that total costs correlated positively with increased disability (r=0.411, P<.001). For discriminant validity, correlations of total costs with the Treatment Satisfaction Questionnaire for Medication ranged from −0.006 (convenience) to −0.216 (effectiveness). The mean annual cost was €28,203 (SD €14,808) (US $39,203; SD US $20,583) with disease-modifying therapies. Conclusions: The MS-HRS is a multilingual, reliable, valid, electronically available, and easy-to-administer questionnaire providing a holistic cross-sectional and longitudinal assessment of resource utilization in patients with MS. %M 32181745 %R 10.2196/17921 %U http://www.jmir.org/2020/3/e17921/ %U https://doi.org/10.2196/17921 %U http://www.ncbi.nlm.nih.gov/pubmed/32181745 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e17695 %T Identifying Lung Cancer Risk Factors in the Elderly Using Deep Neural Networks: Quantitative Analysis of Web-Based Survey Data %A Chen,Songjing %A Wu,Sizhu %+ Institute of Medical Information and Library, Chinese Academy of Medical Sciences / Peking Union Medical College, No 3, Yabao Road, Chaoyang District, Beijing, China, 86 01052328761, chen.songjing@imicams.ac.cn %K deep learning %K lung cancer %K risk factors %K aged %K primary prevention %D 2020 %7 17.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Lung cancer is one of the most dangerous malignant tumors, with the fastest-growing morbidity and mortality, especially in the elderly. With a rapid growth of the elderly population in recent years, lung cancer prevention and control are increasingly of fundamental importance, but are complicated by the fact that the pathogenesis of lung cancer is a complex process involving a variety of risk factors. Objective: This study aimed at identifying key risk factors of lung cancer incidence in the elderly and quantitatively analyzing these risk factors’ degree of influence using a deep learning method. Methods: Based on Web-based survey data, we integrated multidisciplinary risk factors, including behavioral risk factors, disease history factors, environmental factors, and demographic factors, and then preprocessed these integrated data. We trained deep neural network models in a stratified elderly population. We then extracted risk factors of lung cancer in the elderly and conducted quantitative analyses of the degree of influence using the deep neural network models. Results: The proposed model quantitatively identified risk factors based on 235,673 adults. The proposed deep neural network models of 4 groups (age ≥65 years, women ≥65 years old, men ≥65 years old, and the whole population) achieved good performance in identifying lung cancer risk factors, with accuracy ranging from 0.927 (95% CI 0.223-0.525; P=.002) to 0.962 (95% CI 0.530-0.751; P=.002) and the area under curve ranging from 0.913 (95% CI 0.564-0.803) to 0.931(95% CI 0.499-0.593). Smoking frequency was the leading risk factor for lung cancer in men 65 years and older. Time since quitting and smoking at least 100 cigarettes in their lifetime were the main risk factors for lung cancer in women 65 years and older. Men 65 years and older had the highest lung cancer incidence among the stratified groups, particularly non–small cell lung cancer incidence. Lung cancer incidence decreased more obviously in men than in women with smoking rate decline. Conclusions: This study demonstrated a quantitative method to identify risk factors of lung cancer in the elderly. The proposed models provided intervention indicators to prevent lung cancer, especially in older men. This approach might be used as a risk factor identification tool to apply in other cancers and help physicians make decisions on cancer prevention. %M 32181751 %R 10.2196/17695 %U http://www.jmir.org/2020/3/e17695/ %U https://doi.org/10.2196/17695 %U http://www.ncbi.nlm.nih.gov/pubmed/32181751 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e16853 %T Locating Medical and Recreational Cannabis Outlets for Research Purposes: Online Methods and Observational Study %A Pedersen,Eric R %A Firth,Caislin %A Parker,Jennifer %A Shih,Regina A %A Davenport,Steven %A Rodriguez,Anthony %A Dunbar,Michael S %A Kraus,Lisa %A Tucker,Joan S %A D'Amico,Elizabeth J %+ RAND Corporation, 1776 Main Street, Santa Monica, CA, 90047, United States, 1 3103930411, ericp@rand.org %K marijuana %K cannabis %K dispensaries %K retailers %K Los Angeles %K tobacco %D 2020 %7 26.2.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: An increasing number of states have laws for the legal sale of recreational and medical cannabis out of brick-and-mortar storefront locations. Given the proliferation of cannabis outlets and their potential for impact on local economies, neighborhood structures, and individual patterns of cannabis use, it is essential to create practical and thorough methods to capture the location of such outlets for research purposes. However, methods used by researchers vary greatly between studies and often do not include important information about the retailer’s license status and storefront signage. Objective: The aim of this study was to find methods for locating and observing cannabis outlets in Los Angeles County after the period when recreational cannabis retailers were granted licenses and allowed to be open for business. Methods: The procedures included searches of online cannabis outlet databases, followed by methods to verify each outlet’s name, address, license information, and open status. These procedures, conducted solely online, resulted in a database of 531 outlets. To further verify each outlet’s information and collect signage data, we conducted direct observations of the 531 identified outlets. Results: We found that 80.9% (430/531) of these outlets were open for business, of which 37.6% (162/430) were licensed to sell cannabis. Unlicensed outlets were less likely to have signage indicating the store sold cannabis, such as a green cross, which was the most prevalent form of observed signage. Co-use of cannabis and tobacco/nicotine has been found to be a substantial health concern, and we observed that 40.6% (175/430) of cannabis outlets had a tobacco/nicotine outlet within sight of the cannabis outlet. Most (350/430, 81.4%) cannabis outlets were located within the City of Los Angeles, and these outlets were more likely to be licensed than outlets outside the city. Conclusions: The findings of this study suggest that online searches and observational methods are both necessary to best capture accurate and detailed information about cannabis outlets. The methods described here can be applied to other metropolitan areas to more accurately capture the availability of cannabis in an area. %M 32130141 %R 10.2196/16853 %U https://www.jmir.org/2020/2/e16853 %U https://doi.org/10.2196/16853 %U http://www.ncbi.nlm.nih.gov/pubmed/32130141 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e16105 %T Evaluating the Effect of Daily Diary Instructional Phrases on Respondents’ Recall Time Frames: Survey Experiment %A Stone,Arthur A %A Wen,Cheng K Fred %A Schneider,Stefan %A Junghaenel,Doerte U %+ Center for Self-Report Science and Center for Economic and Social Research, University of Southern California, 635 Downey Way 405H, Los Angeles, CA, 90089, United States, 1 2138212894, chengkuw@usc.edu %K end-of-day dairy %K daily diary study %K recall time frame %D 2020 %7 21.2.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Daily diaries are extensively used for examining participants’ daily experience in behavioral and medical science. However, little attention is paid to whether participants recall their experiences within the time frames prescribed by the task. Objective: This study aimed to describe survey respondents’ self-reported recall time frames and to evaluate the impact of different daily diary items on respondents’ reported affective states. Methods: In this study, 577 participants completed a mood survey with one of the following 4 time frame instructions: (1) today, (2) since waking up today, (3) during the last 24 hours, or (4) in the last day. They were also asked to indicate the periods they considered when answering these items and to recall the instructional phrases associated with the items. Results: Almost all participants in the today (141/146, 96.6%) and since waking up today (136/145, 93.8%) conditions reported using periods consistent with our expectations, whereas a lower proportion was observed in the during the last 24 hours (100/145, 69.0%) condition. A diverse range of responses was observed in the in the last day condition. Furthermore, the instructions influenced the levels of some self-reported affects, although exploratory analyses were not able to identify the mechanism underlying this finding. Conclusions: Overall, these results indicate that today and since waking up today are the most effective instructional phrases for inquiring about daily experience and that investigators should use caution when using the other 2 instructional phrases. %M 32130129 %R 10.2196/16105 %U http://www.jmir.org/2020/2/e16105/ %U https://doi.org/10.2196/16105 %U http://www.ncbi.nlm.nih.gov/pubmed/32130129 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e13266 %T Progressive 24-Hour Recall: Usability Study of Short Retention Intervals in Web-Based Dietary Assessment Surveys %A Osadchiy,Timur %A Poliakov,Ivan %A Olivier,Patrick %A Rowland,Maisie %A Foster,Emma %+ Open Lab, School of Computing, Newcastle University, Floor 1, Urban Sciences Building, Newcastle Helix, Newcastle upon Tyne, NE4 5TG, United Kingdom, 44 1912084642, timurosadchiy@gmail.com %K computer systems %K nutrition surveys %K diet records %K nutrition assessment %K epidemiologic methods %D 2020 %7 3.2.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Under-reporting because of the limitations of human memory is one of the key challenges in dietary assessment surveys that use the multiple-pass 24-hour recall. Research indicates that shortening a retention interval (ie, the time between the eating event and recall) reduces the burden on memory and may increase the accuracy of the assessment. Objective: This study aimed to explore the accuracy and acceptability of Web-based dietary assessment surveys based on a progressive recall, where a respondent is asked to record multiple recalls throughout a 24-hour period using the multiple-pass protocol and portion size estimation methods of the 24-hour recall. Methods: The experiment was conducted with a dietary assessment system, Intake24, that typically implements the multiple-pass 24-hour recall method where respondents record all meals they had for the previous day on a single occasion. We modified the system to allow respondents to add multiple recalls throughout the day using the multiple-pass protocol and portion size estimation methods of the 24-hour recall (progressive recall). We conducted a dietary assessment survey with 33 participants, where they were asked to record dietary intake using both 24-hour and progressive recall methods for weekdays only. We compared mean retention intervals (ie, the time between eating event and recall) for the 2 methods. To examine accuracy, we compared mean energy estimates and the mean number of reported foods. Of these participants, 23 were interviewed to examine the acceptability of the progressive recall. Results: Retention intervals were found to be, on average, 15.2 hours (SD 7.8) shorter during progressive recalls than those during 24-hour recalls. We found that the mean number of foods reported for evening meals for progressive recalls (5.2 foods) was significantly higher (P=.001) than that for 24-hour recalls (4.2 foods). The number of foods and the amount of energy reported for other meals remained similar across the 2 methods. In interviews, 65% (15/23) of participants said that the 24-hour recall is more convenient in terms of fitting in with their daily lifestyles, and 65% (15/23) of respondents indicated that they remembered meal content and portion sizes better with the progressive recall. Conclusions: The analysis of interviews and data from our study indicate that progressive recalls provide minor improvements to the accuracy of dietary assessment in Intake24. Additional work is needed to improve the acceptability of progressive recalls in this system. %M 32012055 %R 10.2196/13266 %U https://www.jmir.org/2020/2/e13266 %U https://doi.org/10.2196/13266 %U http://www.ncbi.nlm.nih.gov/pubmed/32012055 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e12509 %T Classification and Regression Tree and Computer Adaptive Testing in Cardiac Rehabilitation: Instrument Validation Study %A Peute,Linda %A Scheeve,Thom %A Jaspers,Monique %+ Center of Human Factors Engineering of Health Information Technology, Department of Medical Informatics, Amsterdam Institute of Public Health, Amsterdam University Medical Centers, J1b-116, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 640120422, m.w.jaspers@amsterdamumc.nl %K psychometrics %K computing methodologies %K mHealth %K internet %K cardiac rehabilitation %K needs assessment %D 2020 %7 30.1.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a need for shorter-length assessments that capture patient questionnaire data while attaining high data quality without an undue response burden on patients. Computerized adaptive testing (CAT) and classification and regression tree (CART) methods have the potential to meet these needs and can offer attractive options to shorten questionnaire lengths. Objective: The objective of this study was to test whether CAT or CART was best suited to reduce the number of questionnaire items in multiple domains (eg, anxiety, depression, quality of life, and social support) used for a needs assessment procedure (NAP) within the field of cardiac rehabilitation (CR) without the loss of data quality. Methods: NAP data of 2837 CR patients from a multicenter Cardiac Rehabilitation Decision Support System (CARDSS) Web-based program was used. Patients used a Web-based portal, MyCARDSS, to provide their data. CAT and CART were assessed based on their performances in shortening the NAP procedure and in terms of sensitivity and specificity. Results: With CAT and CART, an overall reduction of 36% and 72% of NAP questionnaire length, respectively, was achieved, with a mean sensitivity and specificity of 0.765 and 0.817 for CAT, 0.777 and 0.877 for classification trees, and 0.743 and 0.40 for regression trees, respectively. Conclusions: Both CAT and CART can be used to shorten the questionnaires of the NAP used within the field of CR. CART, however, showed the best performance, with a twice as large overall decrease in the number of questionnaire items of the NAP compared to CAT and the highest sensitivity and specificity. To our knowledge, our study is the first to assess the differences in performance between CAT and CART for shortening questionnaire lengths. Future research should consider administering varied assessments of patients over time to monitor their progress in multiple domains. For CR professionals, CART integrated with MyCARDSS would provide a feedback loop that informs the rehabilitation progress of their patients by providing real-time patient measurements. %M 32012065 %R 10.2196/12509 %U https://www.jmir.org/2020/1/e12509 %U https://doi.org/10.2196/12509 %U http://www.ncbi.nlm.nih.gov/pubmed/32012065 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e14111 %T Challenges and Lessons Learned From a Mobile Health, Web-Based Human Papillomavirus Intervention for Female Korean American College Students: Feasibility Experimental Study %A Kim,Minjin %A Lee,Haeok %A Allison,Jeroan %+ University of Massachusetts Medical School, Department of Population and Quantitative Health Sciences, 368 Plantation Street, Worcester, MA, 01605, United States, 1 7202095559, minjin.kim2@umassmed.edu %K mHealth %K Web-based intervention %K fraud %K experimental design %D 2020 %7 29.1.2020 %9 Short Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) and Web-based research methods are becoming more commonplace for researchers. However, there is a lack of mHealth and Web-based human papillomavirus (HPV) prevention experimental studies that discuss potential issues that may arise. Objective: This study aimed to assess the feasibility of research procedures and discuss the challenges and lessons learned from an mHealth and Web-based HPV prevention experimental study targeting female Korean American college students in the United States. Methods: A pilot randomized controlled trial (RCT) was conducted in an mHealth and Web-based platform with 104 female Korean American college students aged 18-26 years between September 2016 and December 2016. Participants were randomized to either the experimental group (a storytelling video intervention) or the comparison group (a nonnarrative, information-based intervention). Outcomes included the feasibility of research procedures (recruitment, eligibility, randomization, and retention). Results: From September 2016 to October 2016, we recorded 225 entries in our initial eligibility survey. The eligibility rate was 54.2% (122/225). This study demonstrated a high recruitment rate (95.6%, 111/122) and retention rate (83.7%, 87/104) at the 2-month follow-up. Conclusions: Findings from this study demonstrated sufficient feasibility in terms of research procedures to justify a full-scale RCT. Given the increased possibility of invalid or misrepresentative entries in mHealth and Web-based studies, strategies for detection and prevention are critical. Trial Registration: ISRCTN Registry ISRCTN12175285; http://www.isrctn.com/ISRCTN12175285 %M 32012036 %R 10.2196/14111 %U http://formative.jmir.org/2020/1/e14111/ %U https://doi.org/10.2196/14111 %U http://www.ncbi.nlm.nih.gov/pubmed/32012036 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 1 %P e14535 %T Screening University Students for Health Checks With an Electronic Health Questionnaire in Finland: Protocol for a Retrospective, Register-Based Cohort Study %A Paldanius,Susanna %A Seilo,Noora %A Kunttu,Kristina %A Autio,Reija %A Kaila,Minna %+ Faculty of Medicine and Health Technology, Tampere University, PL 100, Tampere, 33014, Finland, 358 443220385, susanna.paldanius@tuni.fi %K electronic health questionnaire %K health check %K screening %K students %K student health services %K digitalization %K register study %K preventive health services %D 2020 %7 29.1.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health questionnaires and health checks are an established part of preventive health care services in Finland. However, only very limited research of these has been conducted. The Finnish Student Health Service (FSHS) provides primary health care services to all bachelor’s and master’s degree university students (approximately 134,500 students) in Finland. FSHS’s statutory health examination process of university entrants includes an electronic health questionnaire (eHQ) and, based on the students’ eHQ responses, a subsequent health check if necessary. To our knowledge, no previous studies have been published on the use of questionnaires for screening students for general health checks. Objective: The general aim of the study is to evaluate the health examination process of university entrants. The objectives are to determine how students’ self-reported health in the eHQ and participation in the health examination process are associated with graduation, mental health problems, and the use of student health care services. Methods: This is an ongoing, nationwide, retrospective, register-based cohort study with a 6-year follow-up. The study population is the cohort of university entrants (N=15,723) from the 2011-2012 academic year. These students were sent the eHQ, which consisted of 26 questions about health, health habits, social relations, and studying. Based on the eHQ responses, students were referred to one of the following interventions: (1) a health check, (2) an appointment other than a health check (eg, physiotherapy), or (3) electronic feedback to support a healthy lifestyle, when the other interventions were not necessary. Multiple comparisons will be made within these groups using logistic regression. The primary outcome variables are graduation, having a mental health problem, and attending a health check. The use of FSHS health care services will be studied with the cluster analysis method. The data have been obtained from three nationwide registers: the eHQ register, the medical records of FSHS, and the Higher education achievement register. The data have been linked using personal identity codes. Results: As of August 2019, the data collection and processing are complete and the statistical analyses are in progress. Preliminary results are expected in autumn 2019. Further publications are expected in 2020, and two PhD theses are expected to be completed by the end of 2022. Conclusions: Studying practical procedures in primary health care is highly important for resource allocation and the development of evidence-based processes. This study will be the first to assess the usage of a health questionnaire in screening students for health checks. The findings of this study will contribute to the field of preventive health care. The main practical implication is the development of the FSHS’s health examination process. We hypothesize that participation in the health examination process enhances academic achievement and the detection of university students’ mental health problems early on in their studies. International Registered Report Identifier (IRRID): DERR1-10.2196/14535 %M 32012093 %R 10.2196/14535 %U https://www.researchprotocols.org/2020/1/e14535 %U https://doi.org/10.2196/14535 %U http://www.ncbi.nlm.nih.gov/pubmed/32012093 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e17077 %T Development of a National Caregiver Health Survey for Hematopoietic Stem Cell Transplant: Qualitative Study of Cognitive Interviews and Verbal Probing %A Kedroske,Jacob %A Koblick,Sarah %A Chaar,Dima %A Mazzoli,Amanda %A O'Brien,Maureen %A Yahng,Lilian %A Vue,Rebecca %A Chappell,Grant %A Shin,Ji Youn %A Hanauer,David A %A Choi,Sung Won %+ Blood and Marrow Transplantation Program, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, United States, 1 7346155707, sungchoi@med.umich.edu %K hematopoietic stem cell transplantation %K caregivers %K mobile applications %K qualitative research %D 2020 %7 23.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Roadmap 1.0 is a mobile health app that was previously developed for caregivers of patients who have undergone hematopoietic stem cell transplantation (HSCT). Formative research targeted toward its end users (caregivers) can help inform app design and development, allowing additional components to be incorporated into the app, which can then be tested in a future randomized controlled trial. Objective: This study aimed to create a methodologically rigorous national survey that would help inform the development of Roadmap 2.0. Methods: We conducted a prospective, qualitative research study that took place between November 18, 2018, and February 7, 2019, in a blood and marrow transplant unit within a large academic medical institution in the midwestern part of the United States. Cognitive interviews, including think-aloud and verbal probing techniques, were conducted in 10 adult caregivers (≥18 years) of patients who had undergone HSCT. Results: Most participants were female (9/10, 90%), white (9/10, 90%), married (9/10, 90%), employed at least part time (6/10, 60%), caregivers of adult patients (7/10, 70%), and had some college education (9/10, 90%) and an annual household income of $60,000 or higher (6/10, 60%). All but one interview was audio-recorded, with permission. Overall, participants were engaged in the cognitive interview process of the draft survey, which included 7 topics. The interviews highlighted areas wherein survey items could be further refined, such as offering more response choices (eg, “NA”) or clarifying the type of transplant (eg, autologous or allogeneic) or context of transplant care (eg, pre-HSCT, during HSCT, post-HSCT, inpatient, and outpatient). Apart from these findings, the items in demographics, caregiving experiences, technology, positive activities, and mood were generally interpreted as intended. On the basis of the transcript data and field notes by the interviewer, items within self-efficacy (Caregiver Self-Efficacy Scale) and coping (Brief Coping Orientation to Problems Experienced inventory) questionnaires generated more confusion among interviewer and participants, reflecting difficulties in interpreting the meaning of some survey items. Conclusions: This study incorporated the four cognitive aspects of survey methodology that describe the question-answering process—(1) comprehension, (2) information retrieval, (3) judgment and decision making, and (4) responding—by using the think-aloud and probing techniques in cognitive interviews. We conclude that this methodologically rigorous process informed revisions and improved our final questionnaire design. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.49188 %M 32012037 %R 10.2196/17077 %U http://formative.jmir.org/2020/1/e17077/ %U https://doi.org/10.2196/17077 %U http://www.ncbi.nlm.nih.gov/pubmed/32012037 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e14204 %T Detecting Lifestyle Risk Factors for Chronic Kidney Disease With Comorbidities: Association Rule Mining Analysis of Web-Based Survey Data %A Peng,Suyuan %A Shen,Feichen %A Wen,Andrew %A Wang,Liwei %A Fan,Yadan %A Liu,Xusheng %A Liu,Hongfang %+ The Second Medical College, Guangzhou University of Chinese Medicine, No 111 Dade Road, Guangzhou, , China, 86 13503078703, liuxusheng@gzucm.edu.cn %K chronic kidney disease %K association rule mining %K Behavioral Risk Factor Surveillance System %K noncommunicable diseases %D 2019 %7 10.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The rise in the number of patients with chronic kidney disease (CKD) and consequent end-stage renal disease necessitating renal replacement therapy has placed a significant strain on health care. The rate of progression of CKD is influenced by both modifiable and unmodifiable risk factors. Identification of modifiable risk factors, such as lifestyle choices, is vital in informing strategies toward renoprotection. Modification of unhealthy lifestyle choices lessens the risk of CKD progression and associated comorbidities, although the lifestyle risk factors and modification strategies may vary with different comorbidities (eg, diabetes, hypertension). However, there are limited studies on suitable lifestyle interventions for CKD patients with comorbidities. Objective: The objectives of our study are to (1) identify the lifestyle risk factors for CKD with common comorbid chronic conditions using a US nationwide survey in combination with literature mining, and (2) demonstrate the potential effectiveness of association rule mining (ARM) analysis for the aforementioned task, which can be generalized for similar tasks associated with noncommunicable diseases (NCDs). Methods: We applied ARM to identify lifestyle risk factors for CKD progression with comorbidities (cardiovascular disease, chronic pulmonary disease, rheumatoid arthritis, diabetes, and cancer) using questionnaire data for 450,000 participants collected from the Behavioral Risk Factor Surveillance System (BRFSS) 2017. The BRFSS is a Web-based resource, which includes demographic information, chronic health conditions, fruit and vegetable consumption, and sugar- or salt-related behavior. To enrich the BRFSS questionnaire, the Semantic MEDLINE Database was also mined to identify lifestyle risk factors. Results: The results suggest that lifestyle modification for CKD varies among different comorbidities. For example, the lifestyle modification of CKD with cardiovascular disease needs to focus on increasing aerobic capacity by improving muscle strength or functional ability. For CKD patients with chronic pulmonary disease or rheumatoid arthritis, lifestyle modification should be high dietary fiber intake and participation in moderate-intensity exercise. Meanwhile, the management of CKD patients with diabetes focuses on exercise and weight loss predominantly. Conclusions: We have demonstrated the use of ARM to identify lifestyle risk factors for CKD with common comorbid chronic conditions using data from BRFSS 2017. Our methods can be generalized to advance chronic disease management with more focused and optimized lifestyle modification of NCDs. %M 31821152 %R 10.2196/14204 %U https://www.jmir.org/2019/12/e14204 %U https://doi.org/10.2196/14204 %U http://www.ncbi.nlm.nih.gov/pubmed/31821152 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e14475 %T Compliance and Retention With the Experience Sampling Method Over the Continuum of Severe Mental Disorders: Meta-Analysis and Recommendations %A Vachon,Hugo %A Viechtbauer,Wolfgang %A Rintala,Aki %A Myin-Germeys,Inez %+ Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Kapucijnenvoer 33 bus 7001 (blok h), Leuven, 3000, Belgium, 32 0492087694, hugo.vachon@eortc.org %K experience sampling %K ecological momentary assessment %K compliance %K retention %K severe mental disorders %D 2019 %7 6.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the growing interest in the experience sampling method (ESM) as a data collection tool for mental health research, the absence of methodological guidelines related to its use has resulted in a large heterogeneity of designs. Concomitantly, the potential effects of the design on the response behavior of the participants remain largely unknown. Objective: The objective of this meta-analysis was to investigate the associations between various sample and design characteristics and the compliance and retention rates of studies using ESM in mental health research. Methods: ESM studies investigating major depressive disorder, bipolar disorder, and psychotic disorder were considered for inclusion. Besides the compliance and retention rates, a number of sample and design characteristics of the selected studies were collected to assess their potential relationships with the compliance and retention rates. Multilevel random/mixed effects models were used for the analyses. Results: Compliance and retention rates were lower for studies with a higher proportion of male participants (P<.001) and individuals with a psychotic disorder (P<.001). Compliance was positively associated with the use of a fixed sampling scheme (P=.02), higher incentives (P=.03), higher time intervals between successive evaluations (P=.02), and fewer evaluations per day (P=.008), while no significant associations were observed with regard to the mean age of the sample, the study duration, or other design characteristics. Conclusions: The findings demonstrate that ESM studies can be carried out in mental health research, but the quality of the data collection depends upon a number of factors related to the design of ESM studies and the samples under study that need to be considered when designing such protocols. %M 31808748 %R 10.2196/14475 %U https://www.jmir.org/2019/12/e14475 %U https://doi.org/10.2196/14475 %U http://www.ncbi.nlm.nih.gov/pubmed/31808748 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e15830 %T An Online Survey for Pharmacoepidemiological Investigation (Survey of Non-Medical Use of Prescription Drugs Program): Validation Study %A Black,Joshua Curtis %A Rockhill,Karilynn %A Forber,Alyssa %A Amioka,Elise %A May,K Patrick %A Haynes,Colleen M %A Dasgupta,Nabarun %A Dart,Richard C %+ Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, 1391 N Speer Blvd, #600, M/C 0180, Denver, CO, , United States, 1 303 389 1652, joshua.black@rmpds.org %K nonprobability methods %K general population survey %K drug abuse %K calibration weights %D 2019 %7 25.10.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: In rapidly changing fields such as the study of drug use, the need for accurate and timely data is paramount to properly inform policy and intervention decisions. Trends in drug use can change rapidly by month, and using study designs with flexible modules could present advantages. Timely data from online panels can inform proactive interventions against emerging trends, leading to a faster public response. However, threats to validity from using online panels must be addressed to create accurate estimates. Objective: The objective of this study was to demonstrate a comprehensive methodological approach that optimizes a nonprobability, online opt-in sample to provide timely, accurate national estimates on prevalence of drug use. Methods: The Survey of Non-Medical Use of Prescription Drugs Program from the Researched Abuse, Diversion and Addiction Related Surveillance (RADARS) System is an online, cross-sectional survey on drug use in the United States, and several best practices were implemented. To optimize final estimates, two best practices were investigated in detail: exclusion of respondents showing careless or improbable responding patterns and calibration of weights. The approach in this work was to cumulatively implement each method, which improved key estimates during the third quarter 2018 survey launch. Cutoffs for five exclusion criteria were tested. Using a series of benchmarks, average relative bias and changes in bias were calculated for 33 different weighting variable combinations. Results: There were 148,274 invitations sent to panelists, with 40,021 who initiated the survey (26.99%). After eligibility assessment, 20.23% (29,998/148,274) of the completed questionnaires were available for analysis. A total of 0.52% (157/29,998) of respondents were excluded based on careless or improbable responses; however, these exclusions had larger impacts on lower volume drugs. Number of exclusions applied were negatively correlated to total dispensing volume by drug (Spearman ρ=–.88, P<.001). A weighting scheme including three demographic and two health characteristics reduced average relative bias by 31.2%. After weighting, estimates of drug use decreased, reflecting a weighted sample that had healthier benchmarks than the unweighted sample. Conclusions: Our study illustrates a new approach to using nonprobability online panels to achieve national prevalence estimates for drug abuse. We were able to overcome challenges with using nonprobability internet samples, including misclassification due to improbable responses. Final drug use and health estimates demonstrated concurrent validity to national probability-based drug use and health surveys. Inclusion of multiple best practices cumulatively improved the estimates generated. This method can bridge the information gap when there is a need for prompt, accurate national data. %M 31654568 %R 10.2196/15830 %U http://www.jmir.org/2019/10/e15830/ %U https://doi.org/10.2196/15830 %U http://www.ncbi.nlm.nih.gov/pubmed/31654568 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e14791 %T Participant-Centered Online Active Surveillance for Adverse Events Following Vaccination in a Large Clinical Trial: Feasibility and Usability Study %A Munnoch,Sally-Anne %A Cashman,Patrick %A Peel,Roseanne %A Attia,John %A Hure,Alexis %A Durrheim,David N %+ Hunter New England Local Health District, Locked Mail Bag 10, Wallsend, NSW, 2287, Australia, 61 429231908, sally.munnoch@health.nsw.gov.au %K clinical trials %K active surveillance %K adverse events following immunization %K technology %K vaccination %D 2019 %7 23.10.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Active participant monitoring of adverse events following immunization (AEFI) is a recent development to improve the speed and transparency of vaccine safety postmarketing. Vaxtracker, an online tool used to monitor vaccine safety, has successfully demonstrated its usefulness in postmarketing surveillance of newly introduced childhood vaccines. However, its use in older participants, or for monitoring patients participating in large clinical trials, has not been evaluated. Objective: The objective of this study was to monitor AEFIs in older participants enrolled in the Australian Study for the Prevention through the Immunisation of Cardiovascular Events (AUSPICE) trial, and to evaluate the usefulness and effectiveness of Vaxtracker in this research setting. Methods: AUSPICE is a multicenter, randomized, placebo-controlled, double-blinded trial in which participants aged 55 to 61 years were given either the pneumococcal polysaccharide vaccine (23vPPV) or 0.9% saline placebo. Vaxtracker was used to monitor AEFIs in participants in either treatment arm through the administration of two online questionnaires. A link to each questionnaire was sent to participants via email or short message service (SMS) text message 7 and 28 days following vaccination. Data were collated and analyzed in near-real time to identify any possible safety signals indicating problems with the vaccine or placebo. Results: All 4725 AUSPICE participants were enrolled in Vaxtracker. Participant response rates for the first and final survey were 96.47% (n=4558) and 96.65% (n=4525), respectively. The online survey was completed by 90.23% (4083/4525) of Vaxtracker participants within 3 days of receiving the link. AEFIs were reported by 34.40% (805/2340) of 23vPPV recipients and 10.29% (240/2332) of placebo recipients in the 7 days following vaccination. Dominant symptoms for vaccine and placebo recipients were pain at the injection site (587/2340, 25.09%) and fatigue (103/2332, 4.42%), respectively. Females were more likely to report symptoms following vaccination with 23vPPV compared with males (433/1138, 38.05% versus 372/1202, 30.95%; P<.001). Conclusions: Vaxtracker is an effective tool for monitoring AEFIs in the 55 to 61 years age group. Participant response rates were high for both surveys, in both treatment arms and for each method of sending the survey. This study indicates that administration of 23vPPV was well-tolerated in this cohort. Vaxtracker has successfully demonstrated its application in the monitoring of adverse events in near-real time following vaccination in people participating in a national clinical trial. Trial Registration: Australian New Zealand Trial Registry Number (ACTRN) 12615000536561; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368506 %M 31647470 %R 10.2196/14791 %U https://www.jmir.org/2019/10/e14791 %U https://doi.org/10.2196/14791 %U http://www.ncbi.nlm.nih.gov/pubmed/31647470 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e14080 %T Youth Study Recruitment Using Paid Advertising on Instagram, Snapchat, and Facebook: Cross-Sectional Survey Study %A Ford,Kelsey Lynett %A Albritton,Tashuna %A Dunn,Tara A %A Crawford,Kacy %A Neuwirth,Jessica %A Bull,Sheana %+ Anschutz Medical Campus, University of Colorado, 13001 E 17th Pl, Aurora, CO, 80045, United States, 1 303724 5000, kelsey.ford@cuanschutz.edu %K social media %K youth %K surveys and questionnaires %D 2019 %7 9.10.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The use of paid social media advertising for targeted study recruitment is an effective strategy in health research and evaluation, specifically to reach diverse youth participants. Although the literature adequately describes the utility of Facebook in recruitment, limited information exists for social media platforms that are more popular with youth, specifically Instagram and Snapchat. Objective: This paper outlines a paid advertising approach using Instagram, Snapchat, and Facebook to evaluate a statewide youth marijuana prevention campaign. The objective of this study was to compare recruitment metrics across Instagram, Snapchat, and Facebook for two surveys documenting youth knowledge, attitudes, and behaviors related to retail marijuana in Colorado post legalization. In addition, the study assessed the feasibility of using Instagram and Snapchat as effective additions to Facebook for youth study recruitment. Methods: A social media recruitment strategy was used to conduct two cross-sectional surveys of youth, aged 13 to 20 years, in Colorado. Geographically targeted ads across 3 social media platforms encouraged the completion of a Web-based self-administered survey. Ad Words and Snap Ads were used to deploy and manage advertising campaigns, including ad design, placement, and analysis. Ad costs and recruitment metrics (ie, impressions, link clicks, and conversion rates) were calculated across the three social media platforms. Results: Over two 1-month periods, 763,613 youth were reached (ie, impressions), 6089 of them clicked survey links (ie, clicks), and 828 eligible youth completed surveys about knowledge, attitudes, and behaviors related to retail marijuana. Instagram converted 36.13% (803/2222) of impressions to clicks (ie, conversion rate) in the first survey and 0.87% (864/98982) in the second survey. Snapchat generated the most impressions and link clicks, but it did so with the lowest conversion rate for both surveys, with a 1.40% (1600/114,200) conversion rate in the first survey and a 0.36% (1818/504700) conversion rate in the second survey. Facebook maintained a consistent conversion rate of roughly 2% across both surveys, despite reductions in budget for the second survey. The cost-per-click ranged between US $0.25 and $0.37 across the three platforms, with Snapchat as both the most cost-effective platform in the first survey and the most expensive platform in the second survey. Conclusions: Recruitment and enrollment outcomes indicate the use of Instagram and Snapchat, in addition to Facebook, may be a modern, useful, and cost-effective approach to reach youth with surveys on sensitive health topics. As the use of Facebook declines among youth, the use of more popular social media platforms can augment study recruitment for health research and evaluation efforts. %M 31599739 %R 10.2196/14080 %U https://publichealth.jmir.org/2019/4/e14080 %U https://doi.org/10.2196/14080 %U http://www.ncbi.nlm.nih.gov/pubmed/31599739 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e11997 %T Paper-Based Versus Web-Based Versions of Self-Administered Questionnaires, Including Food-Frequency Questionnaires: Prospective Cohort Study %A Zazpe,Itziar %A Santiago,Susana %A De la Fuente-Arrillaga,Carmen %A Nuñez-Córdoba,Jorge M %A Bes-Rastrollo,Maira %A Martínez-González,Miguel Angel %+ School of Medicine, Department of Preventive Medicine and Public Health, University of Navarra, C/ Irunlarrea s/n, Pamplona, 31080, Spain, 34 948 42 56 00 ext 806463, mamartinez@unav.es %K epidemiologic studies %K cohort studies %K surveys and questionnaires %D 2019 %7 1.10.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Web-based questionnaires allow collecting data quickly, with minimal costs from large sample groups and through Web-based self-administered forms. Until recently, there has been a lack of evidence from large-scale epidemiological studies and nutrition surveys that have evaluated the comparison between traditional and new technologies to measure dietary intake. Objective: This study aimed to compare results from the general baseline questionnaire (Q_0) and the 10-year follow-up questionnaire (Q_10) in the Seguimiento Universidad de Navarra (SUN) prospective cohort, obtained from different subjects, some of whom used a paper-based version, and others used a Web-based version. Both baseline and 10-year assessments included a validated 136-item semiquantitative food-frequency questionnaire (FFQ), used to collect dietary intake. Methods: The SUN project is a prospective cohort study (with continuous open recruitment and many participants who were recently recruited). All participants were university graduates. Participants who completed the validated FFQ at baseline (FFQ_0, n=22,564) were selected. The variables analyzed were classified into 6 groups of questions: (1) FFQ (136 items), (2) healthy eating attitudes (10 items), (3) alcohol consumption (3 items), (4) physical activity during leisure time (17 items), (5) other activities (24 items), and (6) personality traits (3 items). Multiple linear and logistic regression models were used to assess the adjusted differences between the mean number of missing values and the risk of having apparently incorrect values for FFQ items or mismatches and inconsistencies in dietary variables. Results: Only 1.5% (339/22564) and 60.71% (6765/11144) participants reported their information using the Web-based version for Q_0 and Q_10, respectively, and 51.40 % (11598/22564) and 100.00% (11144/11144) of participants who completed the Q_0 and Q_10, respectively, had the option of choosing the Web-based version. Sociodemographic, lifestyle, health characteristics, food consumption, and energy and nutrient intakes were similar among participants, according to the type of questionnaire used in Q_10. Less than 0.5% of values were missing for items related to healthy eating attitudes, alcohol consumption, and personality traits in the Web-based questionnaires. The proportion of missing data in FFQ, leisure time physical activity, and other activities was higher in paper-based questionnaires than Web-based questionnaires. In Web-based questionnaires, a high degree of internal consistency was found when comparing answers that should not be contradictory, such as the frequency of fruit as dessert versus total fruit consumption and the frequency of fried food consumptions versus oil consumption. Conclusions: Incorporating a Web-based version for a baseline and 10-year questionnaire has not implicated a loss of data quality in this cohort of highly educated adults. Younger participants showed greater preference for Web-based questionnaires. Web-based questionnaires were filled out to a greater extent and with less missing items than paper-based questionnaires. Further research is needed to optimize data collection and response rate in Web-based questionnaires. %M 31573924 %R 10.2196/11997 %U https://publichealth.jmir.org/2019/4/e11997 %U https://doi.org/10.2196/11997 %U http://www.ncbi.nlm.nih.gov/pubmed/31573924 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 2 %N 2 %P e10728 %T Listening to the HysterSisters: A Retrospective Keyword Frequency Analysis of Conversations About Hysterectomy Recovery %A Dave,Arpit %A Yi,Johnny %A Boothe,Andy %A Brashear,Helene %A Byrne,Jeffrey %A Gad,Yash %+ Mayo Clinic Arizona, Department of Gynecology, 5777 E Mayo Blvd, Phoenix, AZ, 85054, United States, 1 480 301 8000, amdave@gmail.com %K hysterectomy %K gynecology %K social media %K perceived recovery %D 2019 %7 26.9.2019 %9 Original Paper %J JMIR Perioper Med %G English %X Background: In the postoperative period, individual patient experiences vary widely and are based on a diverse set of input variables influenced by all stakeholders in and throughout the surgical process. Although clinical research has primarily focused on clinical and administrative datasets to characterize the postoperative recovery experience, there is increasing interest in patient-reported outcome measures (PROMs). The growth of online communities in which patients themselves participate provides a venue to study PROMs directly. One such forum-based community is HysterSisters, dedicated to helping individuals through the experience of hysterectomy, a major surgery which removes the uterus. The surgery can be performed by a variety of methods such as minimally invasive approaches or the traditional abdominal approach using a larger incision. The community offers support for “medical and emotional issues [...] from diagnosis, to treatment, to recovery.” Users can specify when and what type of hysterectomy they underwent. They can discuss their shared experience of hysterectomy and provide, among other interactions, feedback, reassurance, sympathy, or advice, thus providing a unique view into conversations surrounding the hysterectomy experience. Objective: We aimed to characterize conversations about hysterectomy recovery as experienced by users of the HysterSisters online community. Methods: A retrospective keyword frequency analysis of the HysterSisters Hysterectomy Recovery forum was performed. Results: Within the Hysterectomy Recovery forum, 33,311 unique users declared their hysterectomy date and type and posted during the first 12 weeks postsurgery. A taxonomy of 8 primary symptom groups was created using a seed list of keywords generated from a term frequency analysis of these threads. Pain and bleeding were the two most mentioned symptom groups and account for almost half of all symptom mentions (19,965/40,127). For symptoms categories such as pain and hormones and emotions, there was no difference in the proportion of users mentioning related keywords, regardless of the type of hysterectomy, whereas bleeding-related or intimacy-related keywords were mentioned more frequently by users undergoing certain minimally invasive approaches when compared with those undergoing abdominal hysterectomy. Temporal patterns in symptom mentions were noted as well. The majority of all posting activity occurred in the first 3 weeks. Across all keyword groups, individuals reporting minimally invasive procedures ceased forum use of these keywords significantly earlier than those reporting abdominal hysterectomy. Peaks in conversation volume surrounding particular symptom categories were also identified at 1, 3, and 6 weeks postoperatively. Conclusions: The HysterSisters Hysterectomy Recovery forum and other such forums centered on users’ health care experience can provide novel actionable insights that can improve patient-centered care during the postoperative period. This study adds another dimension to the utility of social media analytics by demonstrating that measurement of post volumes and distribution of symptom mentions over time reveal key opportunities for beneficial symptom-specific patient engagement. %M 33393919 %R 10.2196/10728 %U http://periop.jmir.org/2019/2/e10728/ %U https://doi.org/10.2196/10728 %U http://www.ncbi.nlm.nih.gov/pubmed/33393919 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e12811 %T Identifying Attrition Phases in Survey Data: Applicability and Assessment Study %A Hochheimer,Camille J %A Sabo,Roy T %A Perera,Robert A %A Mukhopadhyay,Nitai %A Krist,Alex H %+ Department of Biostatistics, Virginia Commonwealth University, PO Box 980032, Richmond, VA, 23298-0032, United States, 1 804 828 9824, hochheimercj@vcu.edu %K patient dropouts %K surveys and questionnaires %K survival analyses %K statistical models %D 2019 %7 23.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Although Web-based questionnaires are an efficient, increasingly popular mode of data collection, their utility is often challenged by high participant dropout. Researchers can gain insight into potential causes of high participant dropout by analyzing the dropout patterns. Objective: This study proposed the application of and assessed the use of user-specified and existing hypothesis testing methods in a novel setting—survey dropout data—to identify phases of higher or lower survey dropout. Methods: First, we proposed the application of user-specified thresholds to identify abrupt differences in the dropout rate. Second, we proposed the application of 2 existing hypothesis testing methods to detect significant differences in participant dropout. We assessed these methods through a simulation study and through application to a case study, featuring a questionnaire addressing decision-making surrounding cancer screening. Results: The user-specified method set to a low threshold performed best at accurately detecting phases of high attrition in both the simulation study and test case application, although all proposed methods were too sensitive. Conclusions: The user-specified method set to a low threshold correctly identified the attrition phases. Hypothesis testing methods, although sensitive at times, were unable to accurately identify the attrition phases. These results strengthen the case for further development of and research surrounding the science of attrition. %M 31444875 %R 10.2196/12811 %U http://www.jmir.org/2019/8/e12811/ %U https://doi.org/10.2196/12811 %U http://www.ncbi.nlm.nih.gov/pubmed/31444875 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 3 %P e14519 %T The Presence of Physical Symptoms in Patients With Tinnitus: International Web-Based Survey %A Michiels,Sarah %A Harrison,Stephen %A Vesala,Markku %A Schlee,Winfried %+ Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk, 2610, Belgium, 32 485840758, sarah.michiels@uantwerpen.be %K tinnitus %K self report %K surveys %D 2019 %7 30.07.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Tinnitus, or ringing in the ears, is a phantom perception of sound in the absence of overt acoustic stimulation. Many patients indicate that the perception of their tinnitus is not constant and can vary from moment to moment. This tinnitus fluctuation is one of the diagnostic criteria for somatosensory tinnitus (ST), a tinnitus subtype that is influenced by cervical spine or temporomandibular dysfunctions, although various factors have been reported to cause fluctuations in tinnitus, such as stress, anxiety, and physical activity. Objective: The aim of this study was twofold: (1) to investigate the presence of physical symptoms in a large group of participants with tinnitus and (2) to investigate if these physical symptoms are more frequently present in a subgroup of participants with ST. Methods: A Web-based survey, questioning the presence of physical symptoms in a convenience sample of participants with tinnitus, was launched on the online forum, Tinnitus Talk, managed by Tinnitus Hub. After a general analysis of the physical symptoms present in our survey population, we further analyzed the group of participants who were diagnosed by a physician (n=1262). This subgroup was divided into 2 groups, one group diagnosed with ST and another group diagnosed with other types of tinnitus. Results: In total, 6115 participants with a mean age of 54.08 years (SD 13.8) completed the survey. Physical symptoms were frequently present in our sample of participants with tinnitus: 4221 participants (69.02%) reported some form of neck pain, 429 (7.01%) were diagnosed with temporomandibular disorders, 2730 (44.64%) indicated they have bruxism, and between 858 and 1419 (14.03%-23.20%) participants were able to modulate their tinnitus by voluntary movements. ST was diagnosed in 154 out of 1262 (12.20%) participants whose tinnitus cause was diagnosed by a physician. Symptoms referring to the known diagnostic criteria were evidently more present in the ST group than in the non-ST group. Additionally, participants with ST more often indicated a negative effect of a bad night’s sleep (P=.01) and light intensity exercise (P=.01). Conclusions: Physical activity and movement (disorders) frequently affect tinnitus severity. Head-neck related symptoms are more frequently reported in the ST group, as is the ability to modulate the tinnitus by head or jaw movements. Additionally, participants with ST more often report fluctuations of their tinnitus and reaction to sleeping difficulties and low intensity exercise. %M 31364603 %R 10.2196/14519 %U http://www.i-jmr.org/2019/3/e14519/ %U https://doi.org/10.2196/14519 %U http://www.ncbi.nlm.nih.gov/pubmed/31364603 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e13798 %T Audience Response Systems and Missingness Trends: Using Interactive Polling Systems to Gather Sensitive Health Information From Youth %A Toscos,Tammy %A Drouin,Michelle %A Flanagan,Mindy %A Carpenter,Maria %A Kerrigan,Connie %A Carpenter,Colleen %A Mere,Cameron %A Haaff,Marcia %+ Parkview Research Center, 10622 Parkview Plaza Dr, Fort Wayne, IN, 46845, United States, 1 260 266 5586, Tammy.Toscos@parkview.com %K mental health %K youth %K surveys and questionnaires %K health care %K software %D 2019 %7 16.07.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The widespread availability and cost-effectiveness of new-wave software-based audience response systems (ARSs) have expanded the possibilities of collecting health data from hard-to-reach populations, including youth. However, with all survey methods, biases in the data may exist because of participant nonresponse. Objective: The aims of this study were to (1) examine the extent to which an ARS could be used to gather health information from youths within a large-group school setting and (2) examine individual- and survey-level response biases stemming from this Web-based data collection method. Methods: We used an ARS to deliver a mental health survey to 3418 youths in 4 high schools in the Midwestern United States. The survey contained demographic questions, depression, anxiety, and suicidality screeners, and questions about their use of offline resources (eg, parents, peers, and counselors) and Web-based resources (ie, telemental health technologies) when they faced stressful life situations. We then examined the response rates for each survey item, focusing on the individual- and survey-level characteristics that related to nonresponse. Results: Overall, 25.39% (868/3418) of youths answered all 38 survey questions; however, missingness analyses showed that there were some survey structure factors that led to higher rates of nonresponse (eg, questions at the end of survey, sensitive questions, and questions for which precise answers were difficult to provide). There were also some personal characteristics that were associated with nonresponse (eg, not identifying as either male or female, nonwhite ethnicity, and higher levels of depression). Specifically, a multivariate model showed that male students and students who reported their gender as other had significantly higher numbers of missed items compared with female students (B=.30 and B=.47, respectively, P<.001). Similarly, nonwhite race (B=.39, P<.001) and higher depression scores (B=.39, P<.001) were positively related to the number of missing survey responses. Conclusions: Although our methodology-focused study showed that it is possible to gather sensitive mental health data from youths in large groups using ARSs, we also suggest that these nonresponse patterns need to be considered and controlled for when using ARSs for gathering population health data. %M 31313658 %R 10.2196/13798 %U https://formative.jmir.org/2019/3/e13798/ %U https://doi.org/10.2196/13798 %U http://www.ncbi.nlm.nih.gov/pubmed/31313658 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e13222 %T Paper Versus Digital Data Collection for Road Safety Risk Factors: Reliability Comparative Analysis From Three Cities in Low- and Middle-Income Countries %A Mehmood,Amber %A Taber,Niloufer %A Bachani,Abdulgafoor M %A Gupta,Shivam %A Paichadze,Nino %A Hyder,Adnan A %+ International Injury Research Unit, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E-8644, Baltimore, MD, 21205, United States, 1 443 287 2763, amehmoo2@jhu.edu %K information technology %K public health informatics %K mHealth %K risk factors %K population surveillance %D 2019 %7 28.05.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Rapid advances in mobile technologies and applications and the continued growth in digital network coverage have the potential to transform data collection in low- and middle-income countries. A common perception is that digital data collection (DDC) is faster and quickly adaptable. Objective: The objective of this study was to test whether DDC is faster and more adaptable in a roadside environment. We conducted a reliability study comparing digital versus paper data collection in 3 cities in Ghana, Vietnam, and Indonesia observing road safety risk factors in real time. Methods: Roadside observation of helmet use among motorcycle passengers, seat belt use among 4-wheeler passengers, and speeding was conducted in Accra, Ghana; Ho Chi Minh City (HCMC), Vietnam; and Bandung, Indonesia. Two independent data collection teams were deployed to the same sites on the same dates and times, one using a paper-based data collection tool and the other using a digital tool. All research assistants were trained on paper-based data collection and DDC. A head-to-head analysis was conducted to compare the volume of observations, as well as the prevalence of each risk factor. Correlations (r) for continuous variables and kappa for categorical variables are reported with their level of statistical significance. Results: In Accra, there were 119 observation periods (90-min each) identical by date, time, and location during the helmet and seat belt use risk factor data collection and 118 identical periods observing speeding prevalence. In Bandung, there were 150 observation periods common to digital and paper data collection methods, whereas in HCMC, there were 77 matching observation periods for helmet use, 82 for seat belt use, and 84 for speeding. Data collectors using paper tools were more productive than their DDC counterparts during the study. The highest mean volume per session was recorded for speeding, with Bandung recording over 1000 vehicles on paper (paper: mean 1092 [SD 435]; digital: mean 807 [SD 261]); whereas the lowest volume per session was from HCMC for seat belts (paper: mean 52 [SD 28]; digital: mean 62 [SD 30]). Accra and Bandung showed good-to-high correlation for all 3 risk factors (r=0.52 to 0.96), with higher reliability in speeding and helmet use over seat belt use; HCMC showed high reliability for speeding (r=0.99) but lower reliability for helmet and seat belt use (r=0.08 to 0.32). The reported prevalence of risk factors was comparable in all cities regardless of the data collection method. Conclusions: DDC was convenient and reliable during roadside observational data collection. There was some site-related variability in implementing DDC methods, and generally the productivity was higher using the more familiar paper-based method. Even with low correlations between digital and paper data collection methods, the overall reported population prevalence was similar for all risk factors. %M 31140431 %R 10.2196/13222 %U http://www.jmir.org/2019/5/e13222/ %U https://doi.org/10.2196/13222 %U http://www.ncbi.nlm.nih.gov/pubmed/31140431 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e13870 %T A New Tool for Public Health Opinion to Give Insight Into Telemedicine: Twitter Poll Analysis %A Vidal-Alaball,Josep %A Fernandez-Luque,Luis %A Marin-Gomez,Francesc X %A Ahmed,Wasim %+ Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Carrer Pica d'Estats, 36, Sant Fruitós de Bages, 08272, Spain, 34 936 93 00 40, jvidal.cc.ics@gencat.cat %K telemedicine %K Twitter messaging %K health care surveys %D 2019 %7 28.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine draws on information technologies in order to enable the delivery of clinical health care from a distance. Twitter is a social networking platform that has 316 million monthly active users with 500 million tweets per day; its potential for real-time monitoring of public health has been well documented. There is a lack of empirical research that has critically examined the potential of Twitter polls for providing insight into public health. One of the benefits of utilizing Twitter polls is that it is possible to gain access to a large audience that can provide instant and real-time feedback. Moreover, Twitter polls are completely anonymized. Objective: The overall aim of this study was to develop and disseminate Twitter polls based on existing surveys to gain real-time feedback on public views and opinions toward telemedicine. Methods: Two Twitter polls were developed utilizing questions from previously used questionnaires to explore acceptance of telemedicine among Twitter users. The polls were placed on the Twitter timeline of one of the authors, which had more than 9300 followers, and the account followers were asked to answer the poll and retweet it to reach a larger audience. Results: In a population where telemedicine was expected to enjoy big support, a significant number of Twitter users responding to the poll felt that telemedicine was not as good as traditional care. Conclusions: Our results show the potential of Twitter polls for gaining insight into public health topics on a range of health issues not just limited to telemedicine. Our study also sheds light on how Twitter polls can be used to validate and test survey questions. %M 31140442 %R 10.2196/13870 %U http://formative.jmir.org/2019/2/e13870/ %U https://doi.org/10.2196/13870 %U http://www.ncbi.nlm.nih.gov/pubmed/31140442 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e13241 %T Social Inequity and Structural Barriers to Completion of Ecological Momentary Assessments for Young Men Who Have Sex With Men and Trans Women Living With HIV in San Francisco %A Turner,Caitlin M %A Arayasirikul,Sean %A Trujillo,Dillon %A Lê,Victory %A Wilson,Erin C %+ San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 500, San Francisco, CA, 94102, United States, 1 4155549018, caitlin.turner@sfdph.org %K ecological momentary assessment %K EMA %K MSM %K trans women %K people living with HIV %K feasibility %K acceptability %D 2019 %7 08.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Ecological momentary assessments (EMAs) administered via text messaging facilitate real-time data collection. With widespread cell phone access, EMAs are becoming more available to even the most disenfranchised communities, such as those living with HIV. However, structural barriers disproportionately burden young men who have sex with men (MSM) and trans women (TW) living with HIV and threaten participation in HIV research. Objective: We aim to identify structural barriers to completing EMA text surveys nested within a digital HIV care intervention for young MSM and TW living with HIV in San Francisco. Methods: A total of 10,800 EMA text messages were delivered daily over 90 days to 120 participants enrolled in the Health eNav intervention (2017-2018) at the San Francisco Department of Public Health. EMA surveys inquired about participants’ daily affect, sexual behaviors, substance use, and treatment adherence. Survey completion was calculated after 30, 60, and 90 days of follow-up. We described characteristics of nonstarters (those who provided less than four complete responses to the first seven EMA surveys) and analyzed structural correlates of days to first weeklong or more EMA survey noncompletion using multivariable Cox proportional hazards regression. Qualitative interviews were used to evaluate the acceptability of EMA surveys. Results: Participants completed 4384 of 10,800 (40.59%) EMA surveys. Completion of 70% or more of EMA surveys was attained by 56 of 120 participants (46.7%) at 30 days of follow-up, 40/120 (33.3%) at 60 days of follow-up, and 30/120 (25.0%) by the end of the 90-day study period. Twenty-eight participants (23.3%) were identified as nonstarters, and were more likely to be recently incarcerated (prevalence ratio [PR] 2.3, 95% CI 1.3-4.4), forego basic needs for HIV medications (PR 2.4, 95% CI 1.3-4.5), and be diagnosed with HIV in the last year (PR 2.2, 95% CI 1.1-4.1). Adjusting for nonstarters, young MSM and TW living in temporary/transitional housing (adjusted hazard ratio [aHR] 1.8, 95% CI 1.1-3.0), foregoing HIV medications to afford basic needs (aHR 1.7, 95% CI 1.1-2.7), and having less than a college education (aHR 3.5, 95% CI 1.4-9.0) had greater hazard of weeklong or more EMA survey noncompletion. Overall, there was high acceptability of the EMA surveys. Conclusions: Although access to and use of technology is increasingly ubiquitous, this analysis demonstrates persisting gaps in EMA completion by socioeconomic factors such as incarceration, education level, housing, and competing needs for young MSM and TW living with HIV in San Francisco. Moreover, those recently diagnosed with HIV were more likely to experience an immediate drop-off in completing EMA surveys. EMAs are feasible for individuals not experiencing social inequity and structural barriers. HIV prevention technologies addressing these barriers and leveraging similar methodology may prove effective for young MSM and TW living with HIV. %M 31066714 %R 10.2196/13241 %U https://mhealth.jmir.org/2019/5/e13241/ %U https://doi.org/10.2196/13241 %U http://www.ncbi.nlm.nih.gov/pubmed/31066714 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e11855 %T Predictors of Postal or Online Response Mode and Associations With Patient Experience and Satisfaction in the English Cancer Patient Experience Survey %A Pham,Tra My %A Abel,Gary A %A Gomez-Cano,Mayam %A Lyratzopoulos,Georgios %+ Epidemiology of Cancer Healthcare and Outcomes Group, Department of Behavioural Science and Health, University College London, , London,, United Kingdom, 44 2076791719, y.lyratzopoulos@ucl.ac.uk %K cancer %K patient survey %K satisfaction %K experience %K online response %K Web %K internet %D 2019 %7 02.05.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient experience surveys are important tools for improving the quality of cancer services, but the representativeness of responders is a concern. Increasingly, patient surveys that traditionally used postal questionnaires are incorporating an online response option. However, the characteristics and experience ratings of online responders are poorly understood. Objective: We sought to examine predictors of postal or online response mode, and associations with patient experience in the (English) Cancer Patient Experience Survey. Methods: We analyzed data from 71,186 patients with cancer recently treated in National Health Service hospitals who responded to the Cancer Patient Experience Survey 2015. Using logistic regression, we explored patient characteristics associated with greater probability of online response and whether, after adjustment for patient characteristics, the online response was associated with a more or less critical evaluation of cancer care compared to the postal response. Results: Of the 63,134 patients included in the analysis, 4635 (7.34%) responded online. In an adjusted analysis, male (women vs men: odds ratio [OR] 0.50, 95% confidence interval [CI] 0.46-0.54), younger (<55 vs 65-74 years: OR 3.49, 95% CI 3.21-3.80), least deprived (most vs least deprived quintile: OR 0.57, 95% CI 0.51-0.64), and nonwhite (nonwhite vs white ethnic group: OR 1.37, 95% CI 1.24-1.51) patients were more likely to respond online. Compared to postal responders, after adjustment for patient characteristics, online responders had a higher likelihood of reporting an overall satisfied experience of care (OR 1.24, 95% CI 1.16-1.32). For 34 of 49 other items, online responders more frequently reported a less than positive experience of care (8 reached statistical significance), and the associations were positive for the remaining 15 of 49 items (2 reached statistical significance). Conclusions: In the context of a national survey of patients with cancer, online and postal responders tend to differ in their characteristics and rating of satisfaction. Associations between online response and reported experience were generally small and mostly nonsignificant, but with a tendency toward less than positive ratings, although not consistently. Whether the observed associations between response mode and reported experience were causal needs to be examined using experimental survey designs. %M 31045503 %R 10.2196/11855 %U https://www.jmir.org/2019/5/e11855/ %U https://doi.org/10.2196/11855 %U http://www.ncbi.nlm.nih.gov/pubmed/31045503 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 4 %P e12173 %T Development of a Phone Survey Tool to Measure Respectful Maternity Care During Pregnancy and Childbirth in India: Study Protocol %A LeFevre,Amnesty E %A Scott,Kerry %A Mohan,Diwakar %A Shah,Neha %A Bhatnagar,Aarushi %A Labrique,Alain %A Dhar,Diva %A Chamberlain,Sara %A Ved,Rajani %+ Division of Epidemiology and Biostatistics , School of Public Health and Family Medicine, University of Cape Town, 5th Floor Falmouth Building Uct, Anzio Road, Observatory, Cape Town,, South Africa, 27 0767828704, aelefevre@gmail.com %K maternal care %K text messages %K phone surveys %K India %D 2019 %7 25.04.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Respectful maternity care (RMC) is a key barometer of the underlying quality of care women receive during pregnancy and childbirth. Efforts to measure RMC have largely been qualitative, although validated quantitative tools are emerging. Available tools have been limited to the measurement of RMC during childbirth and confined to observational and face-to-face survey modes. Phone surveys are less invasive, low cost, and rapid alternatives to traditional face-to-face methods, yet little is known about their validity and reliability. Objective: The primary objective of this study was to develop validated face-to-face and phone survey tools for measuring RMC during pregnancy and childbirth for use in India and other low resource settings. The secondary objective was to optimize strategies for improving the delivery of phone surveys for use in measuring RMC. Methods: To develop face-to-face and phone surveys for measuring RMC, we describe procedures for assessing content, criterion, and construct validity as well as reliability analyses. To optimize the delivery of phone surveys, we outline plans for substudies, which aim to assess the effect of survey modality, and content on survey response, completion, and attrition rates. Results: Data collection will be carried out in 4 districts of Madhya Pradesh, India, from July 2018 to March 2019. Conclusions: To our knowledge, this is the first RMC phone survey tool developed for India, which may provide an opportunity for the rapid, routine collection of data essential for improving the quality of care during pregnancy and childbirth. Elsewhere, phone survey tools are emerging; however, efforts to develop these surveys are often not inclusive of rigorous pretesting activities essential for ensuring quality data, including cognitive, reliability, and validity testing. In the absence of these activities, emerging data could overestimate or underestimate the burden of disease and health care practices under assessment. In the context of RMC, poor quality data could have adverse consequences including the naming and shaming of providers. By outlining a blueprint of the minimum activities required to generate reliable and valid survey tools, we hope to improve efforts to develop and deploy face-to-face and phone surveys in the health sector. International Registered Report Identifier (IRRID): DERR1-10.2196/12173 %M 31021329 %R 10.2196/12173 %U https://www.researchprotocols.org/2019/4/e12173/ %U https://doi.org/10.2196/12173 %U http://www.ncbi.nlm.nih.gov/pubmed/31021329 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 4 %P e12170 %T Exploring Associations Between the Self-Reported Values, Well-Being, and Health Behaviors of Finnish Citizens: Cross-Sectional Analysis of More Than 100,000 Web-Survey Responses %A Honka,Anita Marianne %A Helander,Elina %A Pavel,Misha %A Jimison,Holly %A Mustonen,Pekka %A Korhonen,Ilkka %A Ermes,Miikka %+ Smart Health, VTT Technical Research Centre of Finland Ltd, PO Box 1300, Tampere, 33101, Finland, 358 20722111, anita.honka@vtt.fi %K value orientation %K happiness %K health behavior %K healthy lifestyle %K cross-sectional survey %D 2019 %7 22.04.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Understanding the relationship between personal values, well-being, and health-related behavior could facilitate the development of engaging, effective digital interventions for promoting well-being and the healthy lifestyles of citizens. Although the associations between well-being and values have been quite extensively studied, the knowledge about the relationship between health behaviors and values is less comprehensive. Objective: The aim of this study was to assess retrospectively the associations between self-reported values and commitment to values combined with self-reported well-being and health behaviors from a large cross-sectional dataset. Methods: We analyzed 101,130 anonymous responses (mean age 44.78 years [SD 13.82]; 78.88%, 79,770/101,130 women) to a Finnish Web survey, which were collected as part of a national health promotion campaign. The data regarding personal values were unstructured, and the self-reported value items were classified into value types based on the Schwartz value theory and by applying principal component analysis. Logistic and multiple linear regression were used to explore the associations of value types and commitment to values with well-being factors (happiness, communal social activity, work, and family-related distress) and health behaviors (exercise, eating, smoking, alcohol consumption, and sleep). Results: Commitment to personal values was positively related to happiness (part r2=0.28), communal social activity (part r2=0.09), and regular exercise (part r2=0.06; P<.001 for all). Health, Power (social status and dominance), and Mental balance (self-acceptance) values had the most extensive associations with health behaviors. Regular exercise, healthy eating, and nonsmoking increased the odds of valuing Health by 71.7%, 26.8%, and 40.0%, respectively (P<.001 for all). Smoking, unhealthy eating, irregular exercise, and increased alcohol consumption increased the odds of reporting Power values by 27.80%, 27.78%, 24.66%, and 17.35%, respectively (P<.001 for all). Smoking, unhealthy eating, and irregular exercise increased the odds of reporting Mental balance values by 20.79%, 16.67%, and 15.37%, respectively (P<.001 for all). In addition, lower happiness levels increased the odds of reporting Mental balance and Power values by 24.12% and 20.69%, respectively (P<.001 for all). Conclusions: The findings suggest that commitment to values is positively associated with happiness and highlight various, also previously unexplored, associations between values and health behaviors. %M 31008710 %R 10.2196/12170 %U http://mental.jmir.org/2019/4/e12170/ %U https://doi.org/10.2196/12170 %U http://www.ncbi.nlm.nih.gov/pubmed/31008710 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e12223 %T Postvaccination Fever Response Rates in Children Derived Using the Fever Coach Mobile App: A Retrospective Observational Study %A Ahn,Sang Hyun %A Zhiang,Jooho %A Kim,Hyery %A Chang,Seyun %A Shin,Jaewon %A Kim,Myeongchan %A Lee,Yura %A Lee,Jae-Ho %A Park,Yu Rang %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2228 2493, yurangpark@yuhs.ac %K patient-generated health data %K vaccination %K postvaccination fever %K digital health care %K mobile app %D 2019 %7 22.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Postvaccination fever is a mild adverse event that naturally improves without complications, but is highly prevalent and can be accompanied by febrile convulsions in some cases. These adverse effects may cause parents to delay or avoid vaccinating their children. Objective: This study aimed to identify postvaccination fever patterns and the ability of antipyretics to affect changes in these patterns from data collected from a mobile app named Fever Coach. Methods: Data provided by parents of feverish children derived from a mobile app, Fever Coach, were used to identify postvaccination fever patterns according to vaccinations and the use of antipyretic drugs. We selected single vaccination records that contained five or more body temperature readings performed within 48 hours of vaccination, and we analyzed postvaccination fever onset, offset, duration, and maximum body temperature. Through observing the postvaccination fever response to vaccination, we identified the effects of antipyretic drugs on postvaccination fever onset, offset, and duration times; the extent of fever; and the rate of decline. We also performed logistic regression analysis to determine demographic variables (age, weight, and sex) involved in relatively high fevers (body temperature ≥39°C). Results: The total number of Fever Coach users was 25,037, with 3834 users having entered single vaccination records, including 4448 vaccinations and 55,783 body temperature records. Most records were obtained from children receiving the following vaccinations: pneumococcus (n=2069); Japanese encephalitis (n=911); influenza (n=669); diphtheria, tetanus, and pertussis (n=403); and hepatitis A (n=252). According to the 4448 vaccination records, 3427 (77.05%) children had taken antipyretic drugs, and 3238 (89.15%) children took antibiotics at body temperatures above 38°C. The number of children taking antipyretics at a body temperature of 38°C was more than four times that of those taking antipyretics at 37.9°C (307 vs 67 cases). The number of instances in which this temperature threshold was reached was more than four times greater than the number when the temperature was 37.9°C. A comparative analysis of antipyretic and nonantipyretic cases showed there was no difference in onset time; however, offset and duration times were significantly shorter in nonantipyretic cases than in antipyretic cases (P<.001). In nonantipyretic cases, offset times and duration times were 9.9 and 10.1 hours shorter, respectively, than in antipyretic cases. Body temperatures also decreased faster in nonantipyretic cases. Influenza vaccine-associated fevers lasted relatively longer, whereas pneumococcus vaccine-associated fevers were relatively short-lived. Conclusions: These findings suggest that postvaccination fever has its own fever pattern, which is dependent on vaccine type and the presence of antipyretic drugs, and that postvaccination temperature monitoring may ease fever phobia and reduce the unnecessary use of antipyretics in medical care. %M 31008712 %R 10.2196/12223 %U http://mhealth.jmir.org/2019/4/e12223/ %U https://doi.org/10.2196/12223 %U http://www.ncbi.nlm.nih.gov/pubmed/31008712 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 4 %P e11865 %T Socioeconomic Status and Racial or Ethnic Differences in Participation: Web-Based Survey %A Jang,Myoungock %A Vorderstrasse,Allison %+ University of Wisconsin-Madison, 701 Highland Ave, 4165 Cooper Hall, Madison, WI, 53705, United States, 1 6082634711, mjang7@wisc.edu %K survey %K technology %K race %K socioeconomic status %D 2019 %7 10.04.2019 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Web-based survey data collection has been widely used because of its advantages, although attaining and retaining participants can be challenging. There are several factors associated with successful Web-based survey participation; yet little is known regarding racial or ethnic and socioeconomic differences in the progress of a Web-based survey. Objective: This study aimed to examine racial or ethnic and socioeconomic status (SES) differences in participation in a Web-based survey. Methods: We conducted a secondary data analysis of a study dataset containing information on parents of preschool children. We used 2 phases of Web-based surveys: (1) screening questions including race or ethnicity information and (2) full survey with a consent form. Once potential participants submitted the screening questions, including their racial or ethnic information, the team sent the full survey link to potential participants who met study eligibility criteria. We calculated the proportion of racial or ethnic groups in each of the following areas: consent, partial survey completion, and total survey completion. Results: A total of 487 participants (236 non-Hispanic white, 44 Hispanic, 137 black, and 70 Asian) completed initial screening questions, and a total of 458 participants met study eligibility criteria. Compared with black participants, non-Hispanic white and Asian participants were more likely to consent to participate in the study (odds ratio [OR] 1.73, 95% CI 1.08-2.78, P=.02; OR 2.07, 95% CI 1.04-4.13, P=.04, respectively). There was no racial or ethnic difference with respect to the completion of demographic questions or completion of a partial survey. Finally, compared with black participants, non-Hispanic white participants were more likely to complete the entire survey (OR 3.36, 95% CI 1.51-7.06, P<.001). With respect to SES, less educated non-Hispanic white participants were less likely to complete the survey compared with their counterparts with more education (OR 0.15, 95% CI 0.50-1.48, P<.001). Conclusions: We found a significant difference among racial or ethnic groups as well as different education levels in Web-based survey participation. Survey researchers need to consider the SES and racial or ethnic differences in Web-based survey participation and develop strategies to address this bias in participation and completion in their research. %M 30969173 %R 10.2196/11865 %U https://www.researchprotocols.org/2019/4/e11865/ %U https://doi.org/10.2196/11865 %U http://www.ncbi.nlm.nih.gov/pubmed/30969173 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e11387 %T Identification of Anxiety and Depression Symptoms in Patients With Cancer: Comparison Between Short and Long Web-Based Questionnaires %A Mattsson,Susanne %A Olsson,Erik Martin Gustaf %A Carlsson,Maria %A Johansson,Birgitta Beda Kristina %+ Lifestyle and Rehabilitation in long term illness, Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, 75122, Sweden, 46 184710000 ext 6637, susanne.mattsson@pubcare.uu.se %K screening %K cancer %K depression %K anxiety %K internet %K eHealth %D 2019 %7 05.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Physicians and nurses in cancer care easily fail to detect symptoms of psychological distress because of barriers such as lack of time, training on screening methods, and knowledge about how to diagnose anxiety and depression. National guidelines in several countries recommend routine screening for emotional distress in patients with cancer, but in many clinics, this is not implemented. By inventing screening methods that are time-efficient, such as digitalized and automatized screenings with short instruments, we can alleviate the burden on patients and staff. Objective: The aim of this study was to compare Web-based versions of the ultrashort electronic Visual Analogue Scale (eVAS) anxiety and eVAS depression and the short Hospital Anxiety and Depression Scale (HADS) with Web-based versions of the longer Montgomery Åsberg Depression Rating Scale-Self-report (MADRS-S) and the State Trait Anxiety Inventory- State (STAI-S) with regard to their ability to identify symptoms of anxiety and depression in patients with cancer. Methods: Data were obtained from a consecutive sample of patients with newly diagnosed (<6 months) breast, prostate, or colorectal cancer or with recurrence of colorectal cancer (N=558). The patients were recruited at 4 hospitals in Sweden between April 2013 and September 2015, as part of an intervention study administered via the internet. All questionnaires were completed on the Web at the baseline assessment in the intervention study. Results: The ultrashort and short Web-based-delivered eVAS anxiety, eVAS depression and HADS were found to have an excellent ability to discriminate between persons with and without clinical levels of symptoms of anxiety and depression compared with recommended cutoffs of the longer instruments MADRS-S and STAI-S (area under the curve: 0.88-0.94). Cutoffs of >6 on HADS anxiety and >7 hundredths (hs) on eVAS anxiety identified patients with anxiety symptoms with high accuracy. For HADS depression, at a cutoff of >5 and eVAS depression at a cutoff of >7 hs, the accuracy was very high likewise. Conclusions: The use of the short and ultrashort tools, eVAS and HADS, may be a suitable initial method of Web-based screening in busy clinical settings. However, there are still a proportion of patients who lack access to the internet or the ability to use it. There is a need to find solutions for this group to find all the patients with psychological distress. %M 30950804 %R 10.2196/11387 %U https://www.jmir.org/2019/4/e11387/ %U https://doi.org/10.2196/11387 %U http://www.ncbi.nlm.nih.gov/pubmed/30950804 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e12569 %T Computer-Mediated Communication to Facilitate Synchronous Online Focus Group Discussions: Feasibility Study for Qualitative HIV Research Among Transgender Women Across the United States %A Wirtz,Andrea L %A Cooney,Erin E %A Chaudhry,Aeysha %A Reisner,Sari L %A , %+ Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E7644, Baltimore, MD, 21205, United States, 1 4105020800, awirtz1@jhu.edu %K transgender %K qualitative research %K formative research %K technology %D 2019 %7 29.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Novel, technology-based methods are rapidly increasing in popularity across multiple facets of quantitative research. Qualitative research, however, has been slower to integrate technology into research methodology. One method, computer-mediated communication (CMC), has been utilized to a limited extent for focus group discussions. Objective: This study aimed to assess feasibility of an online video conferencing system to further adapt CMC to facilitate synchronous focus group discussions among transgender women living in six cities in eastern and southern United States. Methods: Between August 2017 and January 2018, focus group discussions with adult transgender women were conducted in English and Spanish by research teams based in Boston, MA, and Baltimore, MD. Participants were sampled from six cities: Baltimore, MD; Boston, MA; New York, NY; Washington, DC; Atlanta, GA; and Miami, FL. This was formative research to inform a technology-enhanced cohort study to assess HIV acquisition among transgender women. This analysis focused on the methodologic use of CMC focus groups conducted synchronously using online software that enabled video or phone discussion. Findings were based on qualitative observations of attendance and study team debriefing on topics of individual, social, technical, and logistical challenges encountered. Results: A total of 41 transgender women from all six cities participated in seven online focus group discussions—five English and two Spanish. There was equal racial distribution of black/African American (14/41, 34%) and white (14/41, 34%) attendees, with 29% (12/41) identifying as Hispanic/Latina ethnicity. Overall, 29 of 70 (41%) eligible and scheduled transgender women failed to attend the focus group discussions. The most common reason for nonattendance was forgetting or having a scheduling conflict (16/29, 55%). A total of 14% (4/29) reported technical challenges associated with accessing the CMC focus group discussion. CMC focus group discussions were found to facilitate geographic diversity; allow participants to control anonymity and privacy (eg, use of pseudonyms and option to use video); ease scheduling by eliminating challenges related to travel to a data collection site; and offer flexibility to join via a variety of devices. Challenges encountered were related to overlapping conversations; variable audio quality in cases where Internet or cellular connection was poor; and distribution of incentives (eg, cash versus gift cards). As with all focus group discussions, establishment of ground rules and employing both a skilled facilitator and a notetaker who could troubleshoot technology issues were critical to the success of CMC focus group discussions. Conclusions: Synchronous CMC focus group discussions provide a secure opportunity to convene participants across geographic space with minimal time burden and without losing the standardized approach that is expected of focus group discussions. This method may provide an optimal alternative to engaging hard-to-reach participants in focus group discussions. Participants with limited technological literacy or inconsistent access to a phone and/or cellular data or service, as well as circumstances necessitating immediate cash incentives may, however, require additional support and accommodation when participating in CMC focus group discussions. %M 30924782 %R 10.2196/12569 %U http://www.jmir.org/2019/3/e12569/ %U https://doi.org/10.2196/12569 %U http://www.ncbi.nlm.nih.gov/pubmed/30924782 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e11286 %T Factors Influencing Web-Based Survey Response for a Longitudinal Cohort of Young Women Born Between 1989 and 1995 %A Loxton,Deborah %A Harris,Melissa L %A Forder,Peta %A Powers,Jennifer %A Townsend,Natalie %A Byles,Julie %A Mishra,Gita %+ Research Centre for Generational Health and Ageing, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 240420621, melissa.harris@newcastle.edu.au %K retention %K attrition %K young adult %K Web-based survey %K social media %K women’s health %D 2019 %7 25.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: With health research practices shifting toward rapid recruitment of samples through the use of online approaches, little is known about the impact of these recruitment methods on continued participation in cohort studies. Objective: This study aimed to report on the retention of a cohort of young women who were recruited using an open recruitment strategy. Methods: Women from the 1989-95 cohort of the Australian Longitudinal Study on Women’s Health, recruited in 2012 and 2013 were followed up annually via Web-based surveys in 2014, 2015, and 2016. Prevalence ratios for survey response were calculated using log-binomial models with generalized estimating equations including demographic, health-related, and recruitment method characteristics examined as explanatory factors. Results: Of the 17,012 women who completed the baseline survey (Survey 1) in 2012 to 2013, approximately two-thirds completed Survey 2 (2014), and just over half completed Surveys 3 (2015) and 4 (2016). Women demonstrated transient patterns of responding with 38.21% (6501/17,012) of women completing all 4 surveys. Although retention of young women was associated with older age, higher education, higher self-rated health status, and low engagement with adverse health behaviors, the method of recruitment was a key determinant of study participation in the multivariate model. Although women were more likely to be recruited into the cohort via social media (eg, Facebook), retention over time was higher for women recruited through traditional media and referral approaches. Conclusions: A balance must be obtained between achieving representativeness, achieving rapid cohort recruitment, and mitigating the pitfalls of attrition based on recruitment method in the new era of cohort studies, where traditional recruitment methods are no longer exclusively viable options. %M 30907739 %R 10.2196/11286 %U http://www.jmir.org/2019/3/e11286/ %U https://doi.org/10.2196/11286 %U http://www.ncbi.nlm.nih.gov/pubmed/30907739 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e10335 %T A Web-Based Form With Interactive Charts Used to Collect and Analyze Data on Home Births in Italy %A Zanetti,Michele %A Campi,Rita %A Olivieri,Paola %A Campiotti,Marta %A Faggianelli,Alice %A Bonati,Maurizio %+ Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri, 19 Via G La Masa, Milan, 20156, Italy, 39 0239014249, michele.zanetti@marionegri.it %K Web-based form %K home birth %K interactive charts %K internet %K survey methods %D 2019 %7 22.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of Web-based forms and data analysis can improve the collection and visualization of data in clinical research. In Italy, no register exists that collects clinical data concerning home births. Objective: The purpose of this study was (1) to develop a Web portal to collect, through a Web-based form, data on home births in Italy and (2) to provide those interested with a graphic visualization of the analyses and data collected. Methods: Following the World Health Organization’s guidelines, and adding questions based on scientific evidence, the case report form (CRF) on the online form was drafted by midwives of the National Association of Out-of-Hospital Birth Midwives. During an initial phase, a group of midwives (n=10) tested the CRF, leading to improvements and adding the necessary questions to achieve a CRF that would allow a more complete collection of data. After the test phase, the entire group of midwives (n=166) registered themselves on the system and began filling out birth questionnaires. In a subsequent phase, the administrators of the portal were able to view the completed forms in a graphic format through the use of interactive maps and graphs. Results: From 2014 to 2016, 58 midwives included 599 birth questionnaires via the Web portal; of these, 443 were home-based, 76% (321/424) of which were performed at home and 24% (103/424) at a midwifery unit. Most of the births assisted (79%, 335/424) were in northern Italy, and the average ages of the mother and father were 33.6 (SD 4.7) years and 37.0 (SD 5.6) years, respectively. Conclusions: We developed an innovative Web-based form that allows, for the first time in Italy, the collection of data on home births and births in the midwifery unit. Furthermore, the data collected are viewable online by the midwives through interactive maps and graphs that allow them to have a general and continuously updated view of the situation of out-of-hospital births performed by the National Association of Out-of-Hospital Birth Midwives. The future goal is to be able to expand this data collection to all out-of-hospital births throughout the national territory. With an increase in the number of enrolled midwives, it would be possible to use the portal as a Web-based form and also as a portal for sharing resources that would help midwives in their clinical practice. %M 30900993 %R 10.2196/10335 %U https://www.jmir.org/2019/3/e10335/ %U https://doi.org/10.2196/10335 %U http://www.ncbi.nlm.nih.gov/pubmed/30900993 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e9922 %T What Is Being Used and Who Is Using It: Barriers to the Adoption of Smartphone Patient Experience Surveys %A Ng,Denise %A McMurray,Josephine %A Wallace,James %A Morita,Plinio %+ Business Technology Management, Lazaridis School of Business & Economics, Wilfrid Laurier University, 73 George Street, Brantford, ON, N3T3Y3, Canada, 1 5192427477, jmcmurray@wlu.ca %K quality of healthcare %K surveys and questionnaires %K patient satisfaction %K data collection %K smartphone %K mobile phone %K risk %K privacy %D 2019 %7 18.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphones are positioned to transform the way health care services gather patient experience data through advanced mobile survey apps which we refer to as smart surveys. In comparison with traditional methods of survey data capture, smartphone sensing survey apps have the capacity to elicit multidimensional, in situ user experience data in real time with unprecedented detail, responsiveness, and accuracy. Objective: This study aimed to explore the context and circumstances under which patients are willing to use their smartphones to share data on their service experiences. Methods: We conducted in-person, semistructured interviews (N=24) with smartphone owners to capture their experiences, perceptions, and attitudes toward smart surveys. Results: Analysis examining perceived risk revealed a few barriers to use; however, major potential barriers to adoption were the identity of recipients, reliability of the communication channel, and potential for loss of agency. The results demonstrate that the classical dimensions of perceived risk raised minimal concerns for the use of smartphones to collect patient service experience feedback. However, trust in the doctor-patient relationship, the reliability of the communication channel, the altruistic motivation to contribute to health service quality for others, and the risk of losing information agency were identified as determinants in the patients’ adoption of smart surveys. Conclusions: On the basis of these findings, we provide recommendations for the design of smart surveys in practice and suggest a need for privacy design tools for voluntary, health-related technologies. %M 30882354 %R 10.2196/formative.9922 %U http://formative.jmir.org/2019/1/e9922/ %U https://doi.org/10.2196/formative.9922 %U http://www.ncbi.nlm.nih.gov/pubmed/30882354 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e10672 %T Use of Online or Paper Surveys by Australian Women: Longitudinal Study of Users, Devices, and Cohort Retention %A Fitzgerald,David %A Hockey,Richard %A Jones,Mark %A Mishra,Gita %A Waller,Michael %A Dobson,Annette %+ Centre for Longitudinal and Life Course Research, School of Public Health, University of Queensland, Herston, Brisbane,, Queensland 4006, Australia, 61 7 3365 5346, a.dobson@sph.uq.edu.au %K online survey %K paper survey %K longitudinal study %K participant retention %D 2019 %7 14.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: There is increasing use of online surveys to improve data quality and timeliness and reduce costs. While there have been numerous cross-sectional studies comparing responses to online or paper surveys, there is little research from a longitudinal perspective. Objective: In the context of the well-established Australian Longitudinal Study on Women’s Health, we examined the patterns of responses to online or paper surveys across the first two waves of the study in which both modes were offered. We compared the following: differences between women born between 1946 and 1951 and between 1973 and 1978; types of device used for online completion; sociodemographic, behavioral, and health characteristics of women who responded online or using mailed paper surveys; and associations between mode of completion in the first survey and participation and mode of completion in the second survey. Methods: Participants in this study, who had responded to regular mailed surveys since 1996, were offered a choice of completing surveys using paper questionnaires or Web-based electronic questionnaires starting in 2012. Two groups of women were involved: an older cohort born between 1946 and 1951 aged in their 60s and a younger cohort born between 1973 and 1978 aged in their 30s when the online surveys were first introduced. We compared women who responded online on both occasions, women who responded online at the first survey and used the paper version of the second survey, women who changed from paper to online, and those who used paper for both surveys. Results: Of the 9663 women in their 60s who responded to one or both surveys, more than 50% preferred paper surveys (5290/9663, 54.74%, on the first survey and 5373/8621, 62.32%, on the second survey). If they chose the online version, most used computers. In contrast, of the 8628 women in their 30s, 56.04% (4835/8628) chose the online version at the first survey. While most favored computers to phones or tablets, many did try these alternatives on the subsequent survey. Many women who completed the survey online the first time preferred the paper version on the subsequent survey. In fact, for women in their 60s, the number who went from online to paper (1151/3851, 29.89%) exceeded the number who went from paper to online (734/5290, 13.88%). The online option was more likely to be chosen by better educated and healthier women. In both cohorts, women who completed paper surveys were more likely than online completers to become nonrespondents on the next survey. Due to the large sample size, almost all differences were statistically significant, with P<.001. Conclusions: Despite the cost-saving advantages of online compared to paper surveys, paper surveys are likely to appeal to a different population of potential respondents with different sociodemographic, behavioral, and health characteristics and greater likelihood of attrition from the study. Not offering a paper version is therefore likely to induce bias in the distribution of responses unless weighting for respondent characteristics (relative to the target population) is employed. Therefore, if mixed mode (paper or online) options are feasible, they are highly likely to produce more representative results than if only the less costly online option is offered. %M 30869647 %R 10.2196/10672 %U http://www.jmir.org/2019/3/e10672/ %U https://doi.org/10.2196/10672 %U http://www.ncbi.nlm.nih.gov/pubmed/30869647 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e11206 %T Using Paid and Free Facebook Methods to Recruit Australian Parents to an Online Survey: An Evaluation %A Bennetts,Shannon K %A Hokke,Stacey %A Crawford,Sharinne %A Hackworth,Naomi J %A Leach,Liana S %A Nguyen,Cattram %A Nicholson,Jan M %A Cooklin,Amanda R %+ Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Level 3, George Singer Building, Bundoora, 3086, Australia, 61 03 9479 ext 8763, s.bennetts@latrobe.edu.au %K parents %K research subject recruitment %K retention %K social media %K cost effectiveness %K sampling bias %K fathers %K mothers %K survey %D 2019 %7 06.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The prevalence of social media makes it a potential alternative to traditional offline methods of recruiting and engaging participants in health research. Despite burgeoning use and interest, few studies have rigorously evaluated its effectiveness and feasibility in terms of recruitment rates and costs, sample representativeness, and retention. Objective: This study aimed to determine the feasibility of using Facebook to recruit employed Australian parents to an online survey about managing work and family demands, specifically to examine (1) recruitment rates and costs; (2) sample representativeness, compared with a population-based cohort of parents; and (3) retention, including demographic and health characteristics of parents who returned to complete a follow-up survey 6 weeks later. Methods: Recruitment was conducted using 20 paid Facebook advertising campaigns, supplemented with free advertising approaches such as posts on relevant Facebook pages and requests for professional networks to circulate the survey link via Facebook. Recruitment rates and costs were evaluated using the Checklist for Reporting Results of Internet E-Surveys, including view rate, participation rate, completion rate, cost per consent, and cost per completer. Sample representativeness was evaluated by comparing demographic and outcome variables with a comparable sample from the Longitudinal Study of Australian Children including educational attainment, marital status, country of birth, neighborhood disadvantage, work-family conflict, and psychological distress. Retention was evaluated by comparing the number and demographic characteristics of participants at recruitment and at 6-week follow-up. Results: Recruitment strategies together resulted in 6653 clicks on the survey link, from which 5378 parents consented to participate and 4665 (86.74%) completed the survey. Of those who completed the survey, 85.94% (4009/4665) agreed to be recontacted, with 57.79% (2317/4009) completing the follow-up survey (ie, 43.08% [2317/5378] of parents who consented to the initial survey). Paid Facebook advertising recruited nearly 75% of the sample at Aus $2.32 per completed survey (Aus $7969 spent, 3440 surveys completed). Compared with a population-based sample, participants at baseline were more likely to be university educated (P<.001), experience greater work-family conflict (P<.001) and psychological distress (P<.001), and were less likely to be born outside Australia (P<.001) or live in a disadvantaged neighborhood (P<.001). Conclusions: Facebook provided a feasible, rapid method to recruit a large national sample of parents for health research. However, some sample biases were observed and should be considered when recruiting participants via Facebook. Retention of participants at 6- to 8-week follow-up was less than half the initial sample; this may reflect limited ongoing participant engagement for those recruited through social media, compared with face-to-face. %M 30839282 %R 10.2196/11206 %U https://www.jmir.org/2019/3/e11206/ %U https://doi.org/10.2196/11206 %U http://www.ncbi.nlm.nih.gov/pubmed/30839282 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e12143 %T Design and Preliminary Findings From a New Electronic Cohort Embedded in the Framingham Heart Study %A McManus,David D %A Trinquart,Ludovic %A Benjamin,Emelia J %A Manders,Emily S %A Fusco,Kelsey %A Jung,Lindsey S %A Spartano,Nicole L %A Kheterpal,Vik %A Nowak,Christopher %A Sardana,Mayank %A Murabito,Joanne M %+ Boston University's and National Heart, Lung, and Blood Institute's Framingham Heart Study, 73 Mount Wayte Ave, Framingham, MA, 01701, United States, 1 508 935 3400, murabito@bu.edu %K smartphone %K tele-medicine %K blood pressure monitoring %K ambulatory %K cohort studies %D 2019 %7 01.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: New models of scalable population-based data collection that integrate digital and mobile health (mHealth) data are necessary. Objective: The aim of this study was to describe a cardiovascular digital and mHealth electronic cohort (e-cohort) embedded in a traditional longitudinal cohort study, the Framingham Heart Study (FHS). Methods: We invited eligible and consenting FHS Generation 3 and Omni participants to download the electronic Framingham Heart Study (eFHS) app onto their mobile phones and co-deployed a digital blood pressure (BP) cuff. Thereafter, participants were also offered a smartwatch (Apple Watch). Participants are invited to complete surveys through the eFHS app, to perform weekly BP measurements, and to wear the smartwatch daily. Results: Up to July 2017, we enrolled 790 eFHS participants, representing 76% (790/1044) of potentially eligible FHS participants. eFHS participants were, on average, 53±8 years of age and 57% were women. A total of 85% (675/790) of eFHS participants completed all of the baseline survey and 59% (470/790) completed the 3-month survey. A total of 42% (241/573) and 76% (306/405) of eFHS participants adhered to weekly digital BP and heart rate (HR) uploads, respectively, over 12 weeks. Conclusions: We have designed an e-cohort focused on identifying novel cardiovascular disease risk factors using a new smartphone app, a digital BP cuff, and a smartwatch. Despite minimal training and support, preliminary findings over a 3-month follow-up period show that uptake is high and adherence to periodic app-based surveys, weekly digital BP assessments, and smartwatch HR measures is acceptable. %M 30821691 %R 10.2196/12143 %U http://www.jmir.org/2019/3/e12143/ %U https://doi.org/10.2196/12143 %U http://www.ncbi.nlm.nih.gov/pubmed/30821691 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 1 %P e9317 %T The Usability of Electronic Medical Record Systems Implemented in Sub-Saharan Africa: A Literature Review of the Evidence %A Kavuma,Michael %+ Department of Tele-Health, College of Health Sciences, University of KwaZulu-Natal, Nelson R Mandela School of Medicine, 719 Umbilo Road 4001, Congella 4013, Durban,, South Africa, 27 782632775, mikavs@gmail.com %K review %K computer systems %K delivery of health care %K sub-Saharan Africa %D 2019 %7 25.02.2019 %9 Review %J JMIR Hum Factors %G English %X Background: Electronic medical record (EMR) systems hold the exciting promise of accurate, real-time access to patient health care data and great potential to improve the quality of patient care through decision support to clinicians. This review evaluated the usability of EMR systems implemented in sub-Saharan Africa based on a usability evaluation criterion developed by the Healthcare Information and Management Systems Society (HIMSS). Objective: This review aimed to evaluate EMR system implementations in sub-Saharan Africa against a well-defined evaluation methodology and assess their usability based on a defined set of metrics. In addition, the review aimed to identify the extent to which usability has been an enabling or hindering factor in the implementation of EMR systems in sub-Saharan Africa. Methods: Five key metrics for evaluating EMR system usability were developed based on the methodology proposed by HIMSS. These were efficiency, effectiveness, ease of learning, cognitive load, and user satisfaction. A 5-point rating system was developed for the review. EMR systems in 19 reviewed publications were scored based on this rating system. It awarded 5 points per metric to any EMR system that was identified as excellent, 4 points for good, 3 points for fair, 2 points for poor, and 1 point for bad. In addition, each of the 5 key metrics carried a maximum weighted score of 20. The percentage scores for each metric were then computed from the weighted scores from which the final overall usability score was derived. Results: In possibly contributing to the usability of implemented EMR systems, ease of learning obtained the highest percentage score of 71% (SD 1.09) followed by cognitive load in second place with a score of 68% (SD 1.62). Effectiveness followed closely in third place at 67% (SD 1.47) and efficiency was in fourth place at 64% (SD 1.04). User satisfaction came in last at 63% (SD 1.70). The overall usability score for all systems was calculated to be 66%. Conclusions: The usability of EMR systems implemented in sub-Saharan Africa has been good with ease of learning possibly being the biggest positive contributor to this rating. Cognitive load and effectiveness have also possibly positively influenced the usability of EMR systems, whereas efficiency and user satisfaction have perhaps contributed least to positively influencing EMR system usability. %M 30801251 %R 10.2196/humanfactors.9317 %U http://humanfactors.jmir.org/2019/1/e9317/ %U https://doi.org/10.2196/humanfactors.9317 %U http://www.ncbi.nlm.nih.gov/pubmed/30801251 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e10995 %T Evaluation of Electronic and Paper-Pen Data Capturing Tools for Data Quality in a Public Health Survey in a Health and Demographic Surveillance Site, Ethiopia: Randomized Controlled Crossover Health Care Information Technology Evaluation %A Zeleke,Atinkut Alamirrew %A Worku,Abebaw Gebeyehu %A Demissie,Adina %A Otto-Sobotka,Fabian %A Wilken,Marc %A Lipprandt,Myriam %A Tilahun,Binyam %A Röhrig,Rainer %+ Division of Medical Informatics, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Building V04-1-133, Ammerländer Heerstraße 140, Oldenburg, 26129, Germany, 49 1732587251, atinkut.alamirrew.zeleke@uni-oldenburg.de %K public health %K maternal health %K surveillance %K survey %K data collection %K data quality %K tablet computer %K mHealth %K Ethiopia %D 2019 %7 11.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Periodic demographic health surveillance and surveys are the main sources of health information in developing countries. Conducting a survey requires extensive use of paper-pen and manual work and lengthy processes to generate the required information. Despite the rise of popularity in using electronic data collection systems to alleviate the problems, sufficient evidence is not available to support the use of electronic data capture (EDC) tools in interviewer-administered data collection processes. Objective: This study aimed to compare data quality parameters in the data collected using mobile electronic and standard paper-based data capture tools in one of the health and demographic surveillance sites in northwest Ethiopia. Methods: A randomized controlled crossover health care information technology evaluation was conducted from May 10, 2016, to June 3, 2016, in a demographic and surveillance site. A total of 12 interviewers, as 2 individuals (one of them with a tablet computer and the other with a paper-based questionnaire) in 6 groups were assigned in the 6 towns of the surveillance premises. Data collectors switched the data collection method based on computer-generated random order. Data were cleaned using a MySQL program and transferred to SPSS (IBM SPSS Statistics for Windows, Version 24.0) and R statistical software (R version 3.4.3, the R Foundation for Statistical Computing Platform) for analysis. Descriptive and mixed ordinal logistic analyses were employed. The qualitative interview audio record from the system users was transcribed, coded, categorized, and linked to the International Organization for Standardization 9241-part 10 dialogue principles for system usability. The usability of this open data kit–based system was assessed using quantitative System Usability Scale (SUS) and matching of qualitative data with the isometric dialogue principles. Results: From the submitted 1246 complete records of questionnaires in each tool, 41.89% (522/1246) of the paper and pen data capture (PPDC) and 30.89% (385/1246) of the EDC tool questionnaires had one or more types of data quality errors. The overall error rates were 1.67% and 0.60% for PPDC and EDC, respectively. The chances of more errors on the PPDC tool were multiplied by 1.015 for each additional question in the interview compared with EDC. The SUS score of the data collectors was 85.6. In the qualitative data response mapping, EDC had more positive suitability of task responses with few error tolerance characteristics. Conclusions: EDC possessed significantly better data quality and efficiency compared with PPDC, explained with fewer errors, instant data submission, and easy handling. The EDC proved to be a usable data collection tool in the rural study setting. Implementation organization needs to consider consistent power source, decent internet connection, standby technical support, and security assurance for the mobile device users for planning full-fledged implementation and integration of the system in the surveillance site. %M 30741642 %R 10.2196/10995 %U http://mhealth.jmir.org/2019/2/e10995/ %U https://doi.org/10.2196/10995 %U http://www.ncbi.nlm.nih.gov/pubmed/30741642 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e11398 %T What Affects the Completion of Ecological Momentary Assessments in Chronic Pain Research? An Individual Patient Data Meta-Analysis %A Ono,Masakatsu %A Schneider,Stefan %A Junghaenel,Doerte U %A Stone,Arthur A %+ Center for Self-Report Science, Center for Economic and Social Research, University of Southern California, 635 Downey Way, Los Angeles, CA, 90089, United States, 1 213 821 8862, masakatsu.ono@manchester.ac.uk %K chronic pain %K completion rate %K compliance rate %K ecological momentary assessment %K experience sampling %K IPD meta-analysis %D 2019 %7 05.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Ecological momentary assessment (EMA) involves repeated sampling of people’s current experiences in real time in their natural environments, which offers a granular perspective on patients’ experience of pain and other symptoms. However, EMA can be burdensome to patients, and its benefits depend upon patients’ engagement in the assessments. Objective: The goal of this study was to investigate factors affecting EMA-completion rates among patients with chronic pain. Methods: This individual patient data meta-analysis was based on 12 EMA datasets that examined patients with chronic noncancer-related pain (n=701). The EMA-completion rates were calculated on a daily basis for each patient. Multilevel models were used to test the following predictors of completion rates at different levels: within-patient factors (days into the study and daily pain level), between-patient factors (age, sex, pain diagnosis, and average pain level per person), and between-study EMA design factors (study duration, sampling density, and survey length). Results: Across datasets, an EMA-completion rate of 85% was observed. The strongest results were found for the between-patient factor age: Younger respondents reported lower completion rates than older respondents (P=.002). One within-patient factor, study day, was associated with completion rates (P<.001): over the course of the studies, the completion rates declined. The two abovementioned factors interacted with each other (P=.02) in that younger participants showed a more rapid decline in EMA completion over time. In addition, none of the other hypothesized factors including gender, chronic pain diagnoses, pain intensity levels, or measures of study burden showed any significant effects. Conclusion: Many factors thought to influence the EMA-completion rates in chronic pain studies were not confirmed. However, future EMA research in chronic pain should note that study length and young age can impact the quality of the momentary data and devise strategies to maximize completion rates across different age groups and study days. %M 30720437 %R 10.2196/11398 %U https://www.jmir.org/2019/2/e11398/ %U https://doi.org/10.2196/11398 %U http://www.ncbi.nlm.nih.gov/pubmed/30720437 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 1 %P e10678 %T Data Quality and Cost-Effectiveness Analyses of Electronic and Paper-Based Interviewer-Administered Public Health Surveys: Protocol for a Systematic Review %A Zeleke,Atinkut Alamirrew %A Naziyok,Tolga %A Fritz,Fleur %A Röhrig,Rainer %+ Division of Medical Informatics, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Bldg V04-1-133, Ammerländer Heerstraße 140, Oldenburg, 26129, Germany, 49 441 798 2871, atinkut.alamirrew.zeleke@uni-oldenburg.de %K data collection %K demographic and health surveys %K tablet computers %K smartphone %K mobile phone %K data quality %K cost comparison %D 2019 %7 30.01.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Population-level survey is an essential standard method used in public health research to quantify sociodemographic events and support public health policy development and intervention designs with evidence. Although all steps in the survey can contribute to the data quality parameters, data collection mechanisms seem the most determinant, as they can avoid mistakes before they happen. The use of electronic devices such as smartphones and tablet computers improve the quality and cost-effectiveness of public health surveys. However, there is lack of systematically analyzed evidence to show the potential impact on data quality and cost reduction of electronic-based data collection tools in interviewer-administered surveys. Objective: This systematic review aims to evaluate the impact of interviewer-administered electronic device data collection methods concerning data quality and cost reduction in population-level surveys compared with the traditional paper-based methods. Methods: We will conduct a systematic search on Medical Literature Analysis and Retrieval System Online, PubMed, CINAHL, PsycINFO, Global Health, Trip, ISI Web of Science, and Cochrane Library for studies from 2007 to 2018 to identify relevant studies. The review will include randomized and nonrandomized studies that examine data quality and cost reduction outcomes. Moreover, usability, user experience, and usage parameters from the same study will be summarized. Two independent authors will screen the title and abstract. A third author will mediate in cases of disagreement. If the studies are considered to be combinable with minimal heterogeneity, we will perform a meta-analysis. Results: The preliminary search in PubMed and Web of Science showed 1491 and 979 resulting hits of articles, respectively. The review protocol is registered in the International Prospective Register of Systematic Reviews (CRD42018092259). We anticipate January 30, 2019, to be the finishing date. Conclusions: This systematic review will inform policymakers, investors, researchers, and technologists about the impact of an electronic-based data collection system on data quality, work efficiency, and cost reduction. Trial Registration: PROSPERO CRD42018092259; http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID= CRD42018092259 International Registered Report Identifier (IRRID): PRR1-10.2196/10678 %M 30698530 %R 10.2196/10678 %U http://www.researchprotocols.org/2019/1/e10678/ %U https://doi.org/10.2196/10678 %U http://www.ncbi.nlm.nih.gov/pubmed/30698530 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11898 %T Physical Activity Surveillance Through Smartphone Apps and Wearable Trackers: Examining the UK Potential for Nationally Representative Sampling %A Strain,Tessa %A Wijndaele,Katrien %A Brage,Søren %+ MRC Epidemiology Unit, Institute of Metabolic Science, School of Clinical Medicine, University of Cambridge, Addenbrookes Biomedical Campus, Cambridge, CB2 0QQ, United Kingdom, 44 1223 330315, tessa.strain@mrc-epid.cam.ac.uk %K adult %K exercise %K fitness trackers %K health surveys %K smartphone %K surveys and questionnaires %K United Kingdom %K mobile phone %D 2019 %7 29.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphones and wearable activity trackers present opportunities for large-scale physical activity (PA) surveillance that overcome some limitations of questionnaires or researcher-administered devices. However, it remains unknown whether current users of such technologies are representative of the UK population. Objective: The objective of this study was to investigate potential sociodemographic biases in individuals using, or with the potential to use, smartphone apps or wearable activity trackers for PA surveillance in the United Kingdom. Methods: We used data of adults (aged ≥16 years) from two nationally representative surveys. Using the UK-wide 2018 Ofcom Technology Tracker (unweighted N=3688), we derived mutually adjusted odds ratios (ORs; 95% CI) of personal use or household ownership of a smartwatch or fitness tracker and personal use of a smartphone by age, sex, social grade, activity- or work-limiting disability, urban or rural, and home nation. Using the 2016 Health Survey for England (unweighted N=4539), we derived mutually adjusted ORs of the use of wearable trackers or websites or smartphone apps for weight management. The explanatory variables were age, sex, PA, deprivation, and body mass index (BMI). Furthermore, we stratified these analyses by BMI, as these questions were asked in the context of weight management. Results: Smartphone use was the most prevalent of all technology outcomes, with 79.01% (weighted 2085/2639) of the Technology Tracker sample responding affirmatively. All other outcomes were <30% prevalent. Age ≥65 years was the strongest inverse correlate of all outcomes (eg, OR 0.03, 95% CI 0.02-0.05 for smartphone use compared with those aged 16-44 years). In addition, lower social grade and activity- or work-limiting disability were inversely associated with all Technology Tracker outcomes. Physical inactivity and male sex were inversely associated with both outcomes assessed in the Health Survey for England; higher levels of deprivation were only inversely associated with websites or phone apps used for weight management. The conclusions did not differ meaningfully in the BMI-stratified analyses, except for deprivation that showed stronger inverse associations with website or phone app use in the obese. Conclusions: The sole use of PA data from wearable trackers or smartphone apps for UK national surveillance is premature, as those using these technologies are more active, younger, and more affluent than those who do not. %M 30694198 %R 10.2196/11898 %U http://mhealth.jmir.org/2019/1/e11898/ %U https://doi.org/10.2196/11898 %U http://www.ncbi.nlm.nih.gov/pubmed/30694198 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e10861 %T A Web-Based Application to Improve Data Collection in an Interventional Study Targeting Childhood Obesity: Pre-Post Analysis %A Hanbury,Meagan M %A Sadeghi,Banafsheh %A Tseregounis,Iraklis Erik %A Gomez-Camacho,Rosa %A Manzo,Rosa D %A Rangel,Maria Isabel %A Alexandrescu,Bogdan %A de la Torre,Adela %+ Center for Transnational Health, University of California, Davis, 328 D Street, Davis, CA, 95616, United States, 1 617 877 6795, mhanbury@ucdavis.edu %K data collection %K internet %K rural population %K efficiency %D 2019 %7 16.01.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Although participatory action research (PAR) studies have proliferated in recent years, the development of technological resources to manage these types of projects has not kept pace. Few studies show how Web-based applications can be used to efficiently manage the data collection process. Objective: This study described the development, use, and impact of a Web-based application to facilitate data management in Niños Sanos, Familia Sana (Healthy Children, Healthy Family), an interventional multifaceted PAR field study. Methods: We described the transformation of the data management process and evaluated the impact of the application in terms of time efficiency of data collection and engagement of community-based data collectors. We defined time efficiency as the total number of days it took to collect 3 main surveys, per year of data collection. The engagement of data collectors was assessed based on qualitative reports. Results: The amount of time it took to perform a round of data collection was reduced after implementation of the field team application (between 382 and 383 days and 198 and 233 days). Secondary data were also collected in a tighter time frame around collection of the primary outcome, and communication among data collectors, the field staff, and the research team was streamlined. In focus groups, community-based data collectors reported feeling more empowered and engaged in the data collection process after implementation of the application. Conclusions: A Web-based management application was successful in improving data collection time efficiency and engagement among data collectors. %M 30664465 %R 10.2196/10861 %U http://www.jmir.org/2019/1/e10861/ %U https://doi.org/10.2196/10861 %U http://www.ncbi.nlm.nih.gov/pubmed/30664465 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 6 %N 1 %P e11127 %T Global Consensus From Clinicians Regarding Low Back Pain Outcome Indicators for Older Adults: Pairwise Wiki Survey Using Crowdsourcing %A Wong,Arnold YL %A Lauridsen,Henrik H %A Samartzis,Dino %A Macedo,Luciana %A Ferreira,Paulo H %A Ferreira,Manuela L %+ Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Room ST512, 5/F, Ng Wing Hong Building, 11 Yuk Choi Road, Hong Kong,, China (Hong Kong), 852 2766 6741, arnold.wong@polyu.edu.hk %K crowdsourcing %K wiki survey %K low back pain %K older people %K outcome indicators %D 2019 %7 15.01.2019 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Low back pain (LBP) is one of the most debilitating conditions among older adults. Unfortunately, existing LBP outcome questionnaires are not adapted for specific circumstances related to old age, which may make these measures less than ideal for evaluating LBP in older adults. Objective: To explore the necessity of developing age-specific outcome measures, crowdsourcing was conducted to solicit opinions from clinicians globally. Methods: Clinicians around the world voted and/or prioritized various LBP outcome indicators for older adults on a pairwise wiki survey website. Seven seed outcome indicators were posted for voting while respondents were encouraged to suggest new indicators for others to vote/prioritize. The website was promoted on the social media of various health care professional organizations. An established algorithm calculated the mean scores of all ideas. A score >50 points means that the idea has >50% probability of beating another randomly presented indicator. Results: Within 42 days, 128 respondents from 6 continents cast 2466 votes and proposed 14 ideas. Indicators pertinent to improvements of physical functioning and age-related social functioning scored >50 while self-perceived reduction of LBP scored 32. Conclusions: This is the first crowdsourcing study to address LBP outcome indicators for older adults. The study noted that age-specific outcome indicators should be integrated into future LBP outcome measures for older adults. Future research should solicit opinions from older patients with LBP to develop age-specific back pain outcome measures that suit clinicians and patients alike. %M 30664493 %R 10.2196/11127 %U http://rehab.jmir.org/2019/1/e11127/ %U https://doi.org/10.2196/11127 %U http://www.ncbi.nlm.nih.gov/pubmed/30664493 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e9076 %T Evaluating Digital Maturity and Patient Acceptability of Real-Time Patient Experience Feedback Systems: Systematic Review %A Khanbhai,Mustafa %A Flott,Kelsey %A Darzi,Ara %A Mayer,Erik %+ Centre for Health Policy, Imperial College London, 10th Floor QEQM Building, Centre for Health Policy, London, W2 1NY, United Kingdom, 44 02033126428, m.khanbhai@imperial.ac.uk %K digital maturity %K digital technology %K feedback %K patient experience %K real time %D 2019 %7 14.01.2019 %9 Review %J J Med Internet Res %G English %X Background: One of the essential elements of a strategic approach to improving patients’ experience is to measure and report on patients’ experiences in real time. Real-time feedback (RTF) is increasingly being collected using digital technology; however, there are several factors that may influence the success of the digital system. Objective: The aim of this review was to evaluate the digital maturity and patient acceptability of real-time patient experience feedback systems. Methods: We systematically searched the following databases to identify papers that used digital systems to collect RTF: The Cochrane Library, Global Health, Health Management Information Consortium, Medical Literature Analysis and Retrieval System Online, EMBASE, PsycINFO, Web of Science, and CINAHL. In addition, Google Scholar and gray literature were utilized. Studies were assessed on their digital maturity using a Digital Maturity Framework on the basis of the following 4 domains: capacity/resource, usage, interoperability, and impact. A total score of 4 indicated the highest level of digital maturity. Results: RTF was collected primarily using touchscreens, tablets, and Web-based platforms. Implementation of digital systems showed acceptable response rates and generally positive views from patients and staff. Patient demographics according to RTF responses varied. An overrepresentation existed in females with a white predominance and in patients aged ≥65 years. Of 13 eligible studies, none had digital systems that were deemed to be of the highest level of maturity. Three studies received a score of 3, 2, and 1, respectively. Four studies scored 0 points. While 7 studies demonstrated capacity/resource, 8 demonstrated impact. None of the studies demonstrated interoperability in their digital systems. Conclusions: Patients and staff alike are willing to engage in RTF delivered using digital technology, thereby disrupting previous paper-based feedback. However, a lack of emphasis on digital maturity may lead to ineffective RTF, thwarting improvement efforts. Therefore, given the potential benefits of RTF, health care services should ensure that their digital systems deliver across the digital maturity continuum. %M 31344680 %R 10.2196/jmir.9076 %U https://www.jmir.org/2019/1/e9076/ %U https://doi.org/10.2196/jmir.9076 %U http://www.ncbi.nlm.nih.gov/pubmed/31344680 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e11683 %T Use of In-Game Rewards to Motivate Daily Self-Report Compliance: Randomized Controlled Trial %A Taylor,Sara %A Ferguson,Craig %A Peng,Fengjiao %A Schoeneich,Magdalena %A Picard,Rosalind W %+ Affective Computing Group, Department of Media Arts and Sciences, Massachusetts Institute of Technology, 77 Massachusetts Avenue, E14-348V, Cambridge, MA, 02142, United States, 1 6128608622, sataylor@mit.edu %K self-reports %K protocol compliance %K recreational games %D 2019 %7 03.01.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Encouraging individuals to report daily information such as unpleasant disease symptoms, daily activities and behaviors, or aspects of their physical and emotional state is difficult but necessary for many studies and clinical trials that rely on patient-reported data as primary outcomes. Use of paper diaries is the traditional method of completing daily diaries, but digital surveys are becoming the new standard because of their increased compliance; however, they still fall short of desired compliance levels. Objective: Mobile games using in-game rewards offer the opportunity to increase compliance above the rates of digital diaries and paper diaries. We conducted a 5-week randomized control trial to compare the completion rates of a daily diary across 3 conditions: a paper-based participant-reported outcome diary (Paper PRO), an electronic-based participant-reported outcome diary (ePRO), and a novel ePRO diary with in-game rewards (Game-Motivated ePRO). Methods: We developed a novel mobile game that is a combination of the idle and pet collection genres to reward individuals who complete a daily diary with an in-game reward. Overall, 197 individuals aged 6 to 24 years (male: 100 and female: 97) were enrolled in a 5-week study after being randomized into 1 of the 3 methods of daily diary completion. Moreover, 157 participants (male: 84 and female: 69) completed at least one diary and were subsequently included in analysis of compliance rates. Results: We observed a significant difference (F2,124=6.341; P=.002) in compliance to filling out daily diaries, with the Game-Motivated ePRO group having the highest compliance (mean completion 86.4%, SD 19.6%), followed by the ePRO group (mean completion 77.7%, SD 24.1%), and finally, the Paper PRO group (mean completion 70.6%, SD 23.4%). The Game-Motivated ePRO (P=.002) significantly improved compliance rates above the Paper PRO. In addition, the Game-Motivated ePRO resulted in higher compliance rates than the rates of ePRO alone (P=.09). Equally important, even though we observed significant differences in completion of daily diaries between groups, we did not observe any statistically significant differences in association between the responses to a daily mood question and study group, the average diary completion time (P=.52), or the System Usability Scale score (P=.88). Conclusions: The Game-Motivated ePRO system encouraged individuals to complete the daily diaries above the compliance rates of the Paper PRO and ePRO without altering the participants’ responses. Trial Registration: ClinicalTrials.gov NCT03738254; http://clinicaltrials.gov/ct2/show/NCT03738254 (Archived by WebCite at http://www.webcitation.org/74T1p8u52) %M 30609986 %R 10.2196/11683 %U https://www.jmir.org/2019/1/e11683/ %U https://doi.org/10.2196/11683 %U http://www.ncbi.nlm.nih.gov/pubmed/30609986 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e11046 %T Questionnaire Breakoff and Item Nonresponse in Web-Based Questionnaires: Multilevel Analysis of Person-Level and Item Design Factors in a Birth Cohort %A Blumenberg,Cauane %A Zugna,Daniela %A Popovic,Maja %A Pizzi,Costanza %A Barros,Aluisio J D %A Richiardi,Lorenzo %+ Center for Epidemiological Research, Post-Graduate Program in Epidemiology, Federal University of Pelotas, 1160 Marechal Deodoro Street, 3rd Floor, Pelotas, 96020-220, Brazil, 55 53 32841300, cauane.epi@gmail.com %K epidemiology %K internet %K surveys and questionnaires %K epidemiologic research design %K data collection %D 2018 %7 07.12.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based questionnaires are increasingly used in epidemiologic studies, as traditional methods are facing a decrease in response rates and an increase in costs. However, few studies have investigated factors related to the level of completion of internet-based epidemiologic questionnaires. Objective: Our objective was to identify person-level characteristics and item design factors associated with breakoff (not finishing the questionnaire) and item nonresponse in a Web-based questionnaire. Methods: This study was a cross-sectional analysis of the baseline questionnaire, applied from 2005 to 2016, of the Italian NINFEA (Nascita e Infanzia: gli Effetti dell’Ambiente) birth cohort. The baseline questionnaire was administered to enrolled women, who could register at any time during pregnancy. We used logistic regression to analyze the influence of person-level factors on questionnaire breakoff, and a logistic multilevel model (first level: items of the questionnaire; second level: sections of the questionnaire; third level: study participants) to analyze the influence of person-level and item design factors on item nonresponse. Since the number of applicable items depended on the respondent’s characteristics and breakoff, we used inverse probability weighting to deal with missing by design. Results: Of 5970 women, 519 (8.69%) did not finish the questionnaire. Older age (adjusted odds ratio 1.40, 95% CI 1.05-1.88), lower educational level (adjusted odds ratio [OR] 1.53, 95% CI 1.23-1.90), and earlier stage of pregnancy (adjusted OR 3.01, 95% CI 2.31-3.92) were positively associated with questionnaire breakoff. Of the 1,062,519 applicable items displayed for the participants, 22,831 were not responded to (overall prevalence of item nonresponse 2.15%). Item nonresponse was positively associated with older age (adjusted OR 1.25, 95% CI 1.14-1.38), being in the first trimester of pregnancy (adjusted OR 1.18, 95% CI 1.06-1.31), and lower educational level (adjusted OR 1.23, 95% CI 1.14-1.33). Dropdown menu items (adjusted OR 1.77, 95% CI 1.56-2.00) and items organized in grids (adjusted OR 1.69, 95% CI 1.49-1.91) were positively associated with item nonresponse. Conclusions: It is important to use targeted strategies to keep participants motivated to respond. Item nonresponse in internet-based questionnaires is affected by person-level and item design factors. Some item types should be limited to reduce item nonresponse. %M 30530454 %R 10.2196/11046 %U https://www.jmir.org/2018/12/e11046/ %U https://doi.org/10.2196/11046 %U http://www.ncbi.nlm.nih.gov/pubmed/30530454 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 11 %P e11050 %T A Practical Do-It-Yourself Recruitment Framework for Concurrent eHealth Clinical Trials: Identification of Efficient and Cost-Effective Methods for Decision Making (Part 2) %A Lattie,Emily G %A Kaiser,Susan M %A Alam,Nameyeh %A Tomasino,Kathryn N %A Sargent,Elizabeth %A Rubanovich,Caryn Kseniya %A Palac,Hannah L %A Mohr,David C %+ Center for Behavioral Intervention Technologies, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 10th Floor, 750 North Lake Shore Drive, Chicago, IL, 60611, United States, 1 3125033741, emily.lattie@northwestern.edu %K eHealth %K mHealth %K mental health %K recruitment %D 2018 %7 29.11.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The ability to successfully recruit participants for electronic health (eHealth) clinical trials is largely dependent on the use of efficient and effective recruitment strategies. Determining which types of recruitment strategies to use presents a challenge for many researchers. Objective: The aim of this study was to present an analysis of the time-efficiency and cost-effectiveness of recruitment strategies for eHealth clinical trials, and it describes a framework for cost-effective trial recruitment. Methods: Participants were recruited for one of 5 eHealth trials of interventions for common mental health conditions. A multipronged recruitment approach was used, including digital (eg, social media and Craigslist), research registry-based, print (eg, flyers and posters on public transportation), clinic-based (eg, a general internal medicine clinic within an academic medical center and a large nonprofit health care organization), a market research recruitment firm, and traditional media strategies (eg, newspaper and television coverage in response to press releases). The time costs and fees for each recruitment method were calculated, and the participant yield on recruitment costs was calculated by dividing the number of enrolled participants by the total cost for each method. Results: A total of 777 participants were enrolled across all trials. Digital recruitment strategies yielded the largest number of participants across the 5 clinical trials and represented 34.0% (264/777) of the total enrolled participants. Registry-based recruitment strategies were in second place by enrolling 28.0% (217/777) of the total enrolled participants across trials. Research registry-based recruitment had a relatively high conversion rate from potential participants who contacted our center for being screened to be enrolled, and it was also the most cost-effective for enrolling participants in this set of clinical trials with a total cost per person enrolled at US $8.99. Conclusions: On the basis of these results, a framework is proposed for participant recruitment. To make decisions on initiating and maintaining different types of recruitment strategies, the resources available and requirements of the research study (or studies) need to be carefully examined. %M 30497997 %R 10.2196/11050 %U https://www.jmir.org/2018/11/e11050/ %U https://doi.org/10.2196/11050 %U http://www.ncbi.nlm.nih.gov/pubmed/30497997 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 11 %P e11049 %T A Practical Do-It-Yourself Recruitment Framework for Concurrent eHealth Clinical Trials: Simple Architecture (Part 1) %A Palac,Hannah L %A Alam,Nameyeh %A Kaiser,Susan M %A Ciolino,Jody D %A Lattie,Emily G %A Mohr,David C %+ Center for Behavioral Intervention Technologies, Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 10th Floor, 750 North Lake Shore Drive, Chicago, IL, 60611, United States, 1 3125033741, emily.lattie@northwestern.edu %K eHealth %K mHealth %K online recruitment %K REDCap %K referral management %D 2018 %7 01.11.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The ability to identify, screen, and enroll potential research participants in an efficient and timely manner is crucial to the success of clinical trials. In the age of the internet, researchers can be confronted with large numbers of people contacting the program, overwhelming study staff and frustrating potential participants. Objective: This paper describes a “do-it-yourself” recruitment support framework (DIY-RSF) that uses tools readily available in many academic research settings to support remote participant recruitment, prescreening, enrollment, and management across multiple concurrent eHealth clinical trials. Methods: This work was conducted in an academic research center focused on developing and evaluating behavioral intervention technologies. A needs assessment consisting of unstructured individual and group interviews was conducted to identify barriers to recruitment and important features for the new system. Results: We describe a practical and adaptable recruitment management architecture that used readily available software, such as REDCap (Research Electronic Data Capture) and standard statistical software (eg, SAS, R), to create an automated recruitment framework that supported prescreening potential participants, consent to join a research registry, triaging for management of multiple trials, capture of eligibility information for each phase of a recruitment pipeline, and staff management tools including monitoring of participant flow and task assignment/reassignment features. The DIY-RSF was launched in July 2015. As of July 2017, the DIY-RSF has supported the successful recruitment efforts for eight trials, producing 14,557 participant records in the referral tracking database and 5337 participants in the center research registry. The DIY-RSF has allowed for more efficient use of staff time and more rapid processing of potential applicants. Conclusions: Using tools already supported at many academic institutions, we describe the architecture and utilization of an adaptable referral management framework to support recruitment for multiple concurrent clinical trials. The DIY-RSF can serve as a guide for leveraging common technologies to improve clinical trial recruitment procedures. %M 30389650 %R 10.2196/11049 %U https://www.jmir.org/2018/11/e11049/ %U https://doi.org/10.2196/11049 %U http://www.ncbi.nlm.nih.gov/pubmed/30389650 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 2 %P e10529 %T Association Between Adherence to Cancer Screening and Knowledge of Screening Guidelines: Feasibility Study Linking Self-Reported Survey Data With Medical Records %A Lofters,Aisha K %A Telner,Deanna %A Kalia,Sumeet %A Slater,Morgan %+ Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 30 Bond Street, Toronto, ON,, Canada, 1 416 864 6060, aisha.lofters@utoronto.ca %K cancer screening %K electronic medical records %K electronic survey %K health literacy %K self-reported data %D 2018 %7 01.11.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: It is possible that patients who are more aware of cancer screening guidelines may be more likely to adhere to them. Objective: The aim of this study was to determine whether screening knowledge was associated with the documented screening participation. We also assessed the feasibility and acceptability of linking electronic survey data with clinical data in the primary care setting. Methods: We conducted an electronic survey at 2 sites in Toronto, Canada. At one site, eligible patients were approached in the waiting room to complete the survey; at the second site, eligible patients were sent an email inviting them to participate. All participants were asked to consent to the linkage of their survey results with their electronic medical record. Results: Overall, 1683 participants responded to the survey—247 responded in the waiting room (response rate, 247/366, 67.5%), whereas 1436 responded through email (response rate, 1436/5779, 24.8%). More than 80% (199/247 and 1245/1436) of participants consented to linking their survey data to their medical record. Knowledge of cancer screening guidelines was generally low. Although the majority of participants were able to identify the recommended tests for breast and cervical screening, very few participants correctly identified the recommended age and frequency of screening, with a maximum of 22% (21/95) of screen-eligible women correctly answering all 3 questions for breast cancer screening. However, this low level of knowledge among patients was not significantly associated with screening uptake, particularly after adjustment for sociodemographic characteristics. Conclusions: Although knowledge of screening guidelines was low among patients in our study, this was not associated with screening participation. Participants were willing to link self-reported data with their medical record data, which has substantial implications for future research. %M 30389655 %R 10.2196/10529 %U http://cancer.jmir.org/2018/2/e10529/ %U https://doi.org/10.2196/10529 %U http://www.ncbi.nlm.nih.gov/pubmed/30389655 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e11168 %T The Impact of Disease-Modifying Therapy Access Barriers on People With Multiple Sclerosis: Mixed-Methods Study %A Simacek,Kristina F %A Ko,John J %A Moreton,Debbie %A Varga,Stefan %A Johnson,Kristen %A Katic,Bozena J %+ Research and Development, PatientsLikeMe, 160 2nd Street, Cambridge, MA, 02142, United States, 1 617 499 4003, ksimacek@patientslikeme.com %K cost sharing %K insurance %K mixed methods %K multiple sclerosis %K out-of-pocket costs %K patient adherence %K pharmaceutical services %K self-report %K surveys and questionnaires %D 2018 %7 30.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: In the United States, people with relapsing-remitting multiple sclerosis (RRMS) can face difficulty accessing disease-modifying therapies (DMTs) because of insurance, pharmacy, or provider policies. These barriers have been associated with poor adherence and negative health outcomes. Objective: The goals of this study were to describe the overall occurrence of difficulties and delays associated with gaining access to DMTs among people with RRMS, to assess DMT adherence during periods of reduced access, and to contextualize the patients’ journey from receipt of a prescription for DMT to obtaining and taking their medication when faced with access barriers. Methods: We recruited US-based adults self-reporting RRMS from a Web-based health data-sharing social network, PatientsLikeMe. Individuals were invited to complete a Web-based survey if they reported a diagnosis of RRMS and were prescribed a DMT for MS. Follow-up phone interviews were conducted with 10 respondents who reported experiencing an MS-related relapse during the time they had experienced challenges accessing DMTs. Results: Among 507 survey completers, nearly half were either currently experiencing an issue related to DMT assess or had difficulty accessing a DMT in the past (233/507, 46.0%). The most frequently reported reasons for access difficulty were authorization requirements by insurance companies (past issues: 78/182, 42.9%; current issues: 9/42, 21%) and high out-of-pocket costs (past issues: 54/182, 29.7%; current issues: 13/42, 31%). About half (20/39, 51%) of participants with current access issues and over a third (68/165, 41.2%) of those with past issues went without their medication until they could access their prescribed DMT. Relapses were reported during periods of reduced DMT access for almost half (56/118, 47.5%) of those with past issues and nearly half (22/45, 49%) of those with current issues. Resolving access issues involved multiple stakeholder agents often coordinated in a patient-led effort. Among those who had resolved issues, about half (57/119, 47.9%) reported that doctors or office staff were involved, under half (48/119, 40.3%) were involved themselves, and about a third (39/119, 32.8%) reported the drug manufacturer was involved in resolving the issue. Follow-up interviews revealed that the financial burden associated with obtaining a prescribed DMT led to nonadherence. Additionally, participants felt that DMT treatment delays and stress associated with obtaining the DMT triggered relapses or worsened their MS. Conclusions: This study expands current research by using a patient-centered, mixed-methods approach to describe barriers to MS treatment, the process to resolve barriers, and the perceived impact of treatment barriers on outcomes. Issues related to DMT access occur frequently, with individuals often serving as their own agents when navigating access difficulties to obtain their medication(s). Support for resolution of DMT access is needed to prevent undue stress and nonadherence. %M 30377144 %R 10.2196/11168 %U http://www.jmir.org/2018/10/e11168/ %U https://doi.org/10.2196/11168 %U http://www.ncbi.nlm.nih.gov/pubmed/30377144 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e12094 %T The Use of Web-Based Technologies in Health Research Participation: Qualitative Study of Consumer and Researcher Experiences %A Pang,Patrick Cheong-Iao %A Chang,Shanton %A Verspoor,Karin %A Clavisi,Ornella %+ School of Computing and Information Systems, The University of Melbourne, Doug McDonell Building (Building 168), The University of Melbourne, Parkville, 3010, Australia, 61 3 9035 6066, mail@patrickpang.net %K research subjects %K consumer behavior %K research design %K social networking %K patient portals %K registries %D 2018 %7 30.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Health consumers are often targeted for their involvement in health research including randomized controlled trials, focus groups, interviews, and surveys. However, as reported by many studies, recruitment and engagement of consumers in academic research remains challenging. In addition, there is scarce literature describing what consumers look for and want to achieve by participating in research. Objective: Understanding and responding to the needs of consumers is crucial to the success of health research projects. In this study, we aim to understand consumers’ needs and investigate the opportunities for addressing these needs with Web-based technologies, particularly in the use of Web-based research registers and social networking sites (SNSs). Methods: We undertook a qualitative approach, interviewing both consumer and medical researchers in this study. With the help from an Australian-based organization supporting people with musculoskeletal conditions, we successfully interviewed 23 consumers and 10 researchers. All interviews were transcribed and analyzed with thematic analysis methodology. Data collection was stopped after the data themes reached saturation. Results: We found that consumers perceive research as a learning opportunity and, therefore, expect high research transparency and regular updates. They also consider the sources of the information about research projects, the trust between consumers and researchers, and the mobility of consumers before participating in any research. Researchers need to be aware of such needs when designing a campaign for recruitment for their studies. On the other hand, researchers have attempted to establish a rapport with consumer participants, design research for consumers’ needs, and use technologies to reach out to consumers. A systematic approach to integrating a variety of technologies is needed. Conclusions: On the basis of the feedback from both consumers and researchers, we propose 3 future directions to use Web-based technologies for addressing consumers’ needs and engaging with consumers in health research: (1) researchers can make use of consumer registers and Web-based research portals, (2) SNSs and new media should be frequently used as an aid, and (3) new technologies should be adopted to remotely collect data and reduce administrative work for obtaining consumers’ consent. %M 30377139 %R 10.2196/12094 %U https://www.jmir.org/2018/10/e12094/ %U https://doi.org/10.2196/12094 %U http://www.ncbi.nlm.nih.gov/pubmed/30377139 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e272 %T Responsiveness, Reliability, and Minimally Important and Minimal Detectable Changes of 3 Electronic Patient-Reported Outcome Measures for Low Back Pain: Validation Study %A Froud,Robert %A Fawkes,Carol %A Foss,Jonathan %A Underwood,Martin %A Carnes,Dawn %+ Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, United Kingdom, 44 024 7657 4221, r.froud@warwick.ac.uk %K electronic patient-reported outcome measures %K validation %K responsiveness %K reliability %K minimally important change %K minimal detectable change %K Roland Morris Disability Questionnaire %K visual analog scale %K numerical rating scale %D 2018 %7 24.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The Roland Morris Disability Questionnaire (RMDQ), visual analog scale (VAS) of pain intensity, and numerical rating scale (NRS) are among the most commonly used outcome measures in trials of interventions for low back pain. Their use in paper form is well established. Few data are available on the metric properties of electronic counterparts. Objective: The goal of our research was to establish responsiveness, minimally important change (MIC) thresholds, reliability, and minimal detectable change at a 95% level (MDC95) for electronic versions of the RMDQ, VAS, and NRS as delivered via iOS and Android apps and Web browser. Methods: We recruited adults with low back pain who visited osteopaths. We invited participants to complete the eRMDQ, eVAS, and eNRS at baseline, 1 week, and 6 weeks along with a health transition question at 1 and 6 weeks. Data from participants reporting recovery were used in MIC and responsiveness analyses using receiver operator characteristic (ROC) curves and areas under the ROC curves (AUCs). Data from participants reporting stability were used for analyses of reliability (intraclass correlation coefficient [ICC] agreement) and MDC95. Results: We included 442 participants. At 1 and 6 weeks, ROC AUCs were 0.69 (95% CI 0.59 to 0.80) and 0.67 (95% CI 0.46 to 0.87) for the eRMDQ, 0.69 (95% CI 0.58 to 0.80) and 0.74 (95% CI 0.53 to 0.95) for the eVAS, and 0.73 (95% CI 0.66 to 0.80) and 0.81 (95% CI 0.69 to 0.92) for the eNRS, respectively. Associated MIC thresholds were estimated as 1 (0 to 2) and 2 (–1 to 5), 13 (9 to 17) and 7 (–12 to 26), and 2 (1 to 3) and 1 (0 to 2) points, respectively. Over a 1-week period in participants categorized as “stable” and “about the same” using the transition question, ICCs were 0.87 (95% CI 0.66 to 0.95) and 0.84 (95% CI 0.73 to 0.91) for the eRMDQ with MDC95 of 4 and 5, 0.31 (95% CI –0.25 to 0.71) and 0.61 (95% CI 0.36 to 0.77) for the eVAS with MDC95 of 39 and 34, and 0.52 (95% CI 0.14 to 0.77) to 0.67 (95% CI 0.51 to 0.78) with MDC95 of 4 and 3 for the eNRS. Conclusions: The eRMDQ was reliable with borderline adequate responsiveness. The eNRS was responsive with borderline reliability. While the eVAS had adequate responsiveness, it did not have an attractive reliability profile. Thus, the eNRS might be preferred over the eVAS for measuring pain intensity. The observed electronic outcome measures’ metric properties are within the ranges of values reported in the literature for their paper counterparts and are adequate for measuring changes in a low back pain population. %M 30355556 %R 10.2196/jmir.9828 %U http://www.jmir.org/2018/10/e272/ %U https://doi.org/10.2196/jmir.9828 %U http://www.ncbi.nlm.nih.gov/pubmed/30355556 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 3 %P e10334 %T The Effortless Assessment of Risk States (EARS) Tool: An Interpersonal Approach to Mobile Sensing %A Lind,Monika N %A Byrne,Michelle L %A Wicks,Geordie %A Smidt,Alec M %A Allen,Nicholas B %+ Center for Digital Mental Health, Department of Psychology, University of Oregon, 1227 University Street, Eugene, OR, 97403, United States, 1 541 346 4075, nallen3@uoregon.edu %K passive mobile sensing %K personal sensing %K mobile sensing %K mental health %K risk assessment %K crisis prevention %K individual big data %K telemedicine %K mobile apps %K cell phone %K depression %D 2018 %7 28.08.2018 %9 Viewpoint %J JMIR Ment Health %G English %X Background: To predict and prevent mental health crises, we must develop new approaches that can provide a dramatic advance in the effectiveness, timeliness, and scalability of our interventions. However, current methods of predicting mental health crises (eg, clinical monitoring, screening) usually fail on most, if not all, of these criteria. Luckily for us, 77% of Americans carry with them an unprecedented opportunity to detect risk states and provide precise life-saving interventions. Smartphones present an opportunity to empower individuals to leverage the data they generate through their normal phone use to predict and prevent mental health crises. Objective: To facilitate the collection of high-quality, passive mobile sensing data, we built the Effortless Assessment of Risk States (EARS) tool to enable the generation of predictive machine learning algorithms to solve previously intractable problems and identify risk states before they become crises. Methods: The EARS tool captures multiple indices of a person’s social and affective behavior via their naturalistic use of a smartphone. Although other mobile data collection tools exist, the EARS tool places a unique emphasis on capturing the content as well as the form of social communication on the phone. Signals collected include facial expressions, acoustic vocal quality, natural language use, physical activity, music choice, and geographical location. Critically, the EARS tool collects these data passively, with almost no burden on the user. We programmed the EARS tool in Java for the Android mobile platform. In building the EARS tool, we concentrated on two main considerations: (1) privacy and encryption and (2) phone use impact. Results: In a pilot study (N=24), participants tolerated the EARS tool well, reporting minimal burden. None of the participants who completed the study reported needing to use the provided battery packs. Current testing on a range of phones indicated that the tool consumed approximately 15% of the battery over a 16-hour period. Installation of the EARS tool caused minimal change in the user interface and user experience. Once installation is completed, the only difference the user notices is the custom keyboard. Conclusions: The EARS tool offers an innovative approach to passive mobile sensing by emphasizing the centrality of a person’s social life to their well-being. We built the EARS tool to power cutting-edge research, with the ultimate goal of leveraging individual big data to empower people and enhance mental health. %M 30154072 %R 10.2196/10334 %U http://mental.jmir.org/2018/3/e10334/ %U https://doi.org/10.2196/10334 %U http://www.ncbi.nlm.nih.gov/pubmed/30154072 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 3 %P e61 %T Using Geosocial Networking Apps to Understand the Spatial Distribution of Gay and Bisexual Men: Pilot Study %A Card,Kiffer George %A Gibbs,Jeremy %A Lachowsky,Nathan John %A Hawkins,Blake W %A Compton,Miranda %A Edward,Joshua %A Salway,Travis %A Gislason,Maya K %A Hogg,Robert S %+ School of Public Health and Social Policy, Faculty of Human and Social Development, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada, 1 250 213 1743, kcard@sfu.ca %K service access %K geosocial networking apps %K gay and bisexual men %K spatial distribution %K gay neighborhoods %D 2018 %7 08.08.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: While services tailored for gay, bisexual, and other men who have sex with men (gbMSM) may provide support for this vulnerable population, planning access to these services can be difficult due to the unknown spatial distribution of gbMSM outside of gay-centered neighborhoods. This is particularly true since the emergence of geosocial networking apps, which have become a widely used venue for meeting sexual partners. Objective: The goal of our research was to estimate the spatial density of app users across Metro Vancouver and identify the independent and adjusted neighborhood-level factors that predict app user density. Methods: This pilot study used a popular geosocial networking app to estimate the spatial density of app users across rural and urban Metro Vancouver. Multiple Poisson regression models were then constructed to model the relationship between app user density and areal population-weighted neighbourhood-level factors from the 2016 Canadian Census and National Household Survey. Results: A total of 2021 app user profiles were counted within 1 mile of 263 sampling locations. In a multivariate model controlling for time of day, app user density was associated with several dissemination area–level characteristics, including population density (per 100; incidence rate ratio [IRR] 1.03, 95% CI 1.02-1.04), average household size (IRR 0.26, 95% CI 0.11-0.62), average age of males (IRR 0.93, 95% CI 0.88-0.98), median income of males (IRR 0.96, 95% CI 0.92-0.99), proportion of males who were not married (IRR 1.08, 95% CI 1.02-1.13), proportion of males with a postsecondary education (IRR 1.06, 95% CI 1.03-1.10), proportion of males who are immigrants (IRR 1.04, 95% CI 1.004-1.07), and proportion of males living below the low-income cutoff level (IRR 0.93, 95% CI 0.89-0.98). Conclusions: This pilot study demonstrates how the combination of geosocial networking apps and administrative datasets might help care providers, planners, and community leaders target online and offline interventions for gbMSM who use apps. %M 30089609 %R 10.2196/publichealth.8931 %U http://publichealth.jmir.org/2018/3/e61/ %U https://doi.org/10.2196/publichealth.8931 %U http://www.ncbi.nlm.nih.gov/pubmed/30089609 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 3 %P e11203 %T Bringing Real-Time Geospatial Precision to HIV Surveillance Through Smartphones: Feasibility Study %A Nsabimana,Alain Placide %A Uzabakiriho,Bernard %A Kagabo,Daniel M %A Nduwayo,Jerome %A Fu,Qinyouen %A Eng,Allison %A Hughes,Joshua %A Sia,Samuel K %+ Junco Labs, 423 W 127th Street, Ground Floor, New York, NY,, United States, 1 518 880 9667, samuelsia@juncolabs.com %K HIV surveillance %K smartphones %K mobile phones %K geospatial data %D 2018 %7 07.08.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Precise measurements of HIV incidences at community level can help mount a more effective public health response, but the most reliable methods currently require labor-intensive population surveys. Novel mobile phone technologies are being tested for adherence to medical appointments and antiretroviral therapy, but using them to track HIV test results with automatically generated geospatial coordinates has not been widely tested. Objective: We customized a portable reader for interpreting the results of HIV lateral flow tests and developed a mobile phone app to track HIV test results in urban and rural locations in Rwanda. The objective was to assess the feasibility of this technology to collect front line HIV test results in real time and with geospatial context to help measure HIV incidences and improve epidemiological surveillance. Methods: Twenty health care workers used the technology to track the test results of 2190 patients across 3 hospital sites (2 urban sites in Kigali and a rural site in the Western Province of Rwanda). Mobile phones for less than US $70 each were used. The mobile phone app to record HIV test results could take place without internet connectivity with uploading of results to the cloud taking place later with internet. Results: A total of 91.51% (2004/2190) of HIV test results could be tracked in real time on an online dashboard with geographical resolution down to street level. Out of the 20 health care workers, 14 (70%) would recommend the lateral flow reader, and 100% would recommend the mobile phone app. Conclusions: Smartphones have the potential to simplify the input of HIV test results with geospatial context and in real time to improve public health surveillance of HIV. %M 30087088 %R 10.2196/11203 %U http://publichealth.jmir.org/2018/3/e11203/ %U https://doi.org/10.2196/11203 %U http://www.ncbi.nlm.nih.gov/pubmed/30087088 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 7 %P e10405 %T Accuracy of Internet-Based Patient Self-Report of Postdischarge Health Care Utilization and Complications Following Orthopedic Procedures: Observational Cohort Study %A Rosner,Benjamin I %A Gottlieb,Marc %A Anderson,William N %+ HealthLoop Inc, 605 Ellis St #100, Mountain View, CA,, United States, 1 408 418 0998, ben@healthloop.com %K patient-generated health data %K patient reported outcome measures %K patient self-report %K complications %K utilization %K patient readmission %K emergency room %K hospital economics %D 2018 %7 20.07.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The accuracy of patient self-report of health care utilization and complications has yet to be determined. If patients are accurate and engaged self-reporters, collecting this information in a manner that is temporally proximate to the health care utilization events themselves may prove valuable to health care organizations undertaking quality improvement initiatives for which such data are often unavailable. Objective: The objective of this study was to measure the accuracy of patient self-report of health care utilization and complications in the 90 days following orthopedic procedures using an automated digital patient engagement platform. Methods: We conducted a multicenter real-world observational cohort study across 10 orthopedic practices in California and Nevada. A total of 371 Anthem members with claims data meeting inclusion criteria who had undergone orthopedic procedures between March 1, 2015, and July 1, 2016, at participating practices already routinely using an automated digital patient engagement platform for asynchronous remote guidance and telemonitoring were sent surveys through the platform (in addition to the other materials being provided to them through the platform) regarding 90-day postencounter health care utilization and complications. Their self-reports to structured survey questions of health care utilization and complications were compared to claims data as a reference. Results: The mean age of the 371 survey recipients was 56.5 (SD 15.7) years, 48.8% (181/371) of whom were female; 285 individuals who responded to 1 or more survey questions had a mean age of 56.9 (SD 15.4) years and a 49.5% (141/285) female distribution. There were no significant differences in demographics or event prevalence rates between responders and nonresponders. With an overall survey completion rate of 76.8% (285/371), patients were found to have accuracy of self-report characterized by a kappa of 0.80 and agreement of 0.99 and a kappa of 1.00 and agreement of 1.00 for 90-day hospital admissions and pulmonary embolism, respectively. Accuracy of self-report of 90-day emergency room/urgent care visits and of surgical site infection were characterized by a kappa of 0.45 and agreement of 0.96 and a kappa of 0.53 and agreement of 0.97, respectively. Accuracy for other complications such as deep vein thrombosis, hemorrhage, severe constipation, and fracture/dislocation was lower, influenced by low event prevalence rates within our sample. Conclusions: In this multicenter observational cohort study using an automated internet-based digital patient engagement platform, we found that patients were most accurate self-reporters of 90-day hospital admissions and pulmonary embolism, followed by 90-day surgical site infection and emergency room/urgent care visits. They were less accurate for deep vein thrombosis and least accurate for hemorrhage, severe constipation, and fracture/dislocation. A total of 76.8% (285/371) of patients completed surveys without the need for clinical staff to collect responses, suggesting the acceptability to patients of internet-based survey dissemination from and collection by clinical teams. While our methods enabled detection of events outside of index institutions, assessment of accuracy of self-report for presence and absence of events and nonresponse bias analysis, low event prevalence rates, particularly for several of the complications, limit the conclusions that may be drawn for some of the findings. Nevertheless, this investigation suggests the potential that engaging patients in self-report through such survey modalities may offer for the timely and accurate measurement of matters germane to health care organizations engaged in quality improvement efforts post discharge. %M 30030212 %R 10.2196/10405 %U http://www.jmir.org/2018/7/e10405/ %U https://doi.org/10.2196/10405 %U http://www.ncbi.nlm.nih.gov/pubmed/30030212 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 7 %P e227 %T Relative Validity and Reproducibility of a New 44-Item Diet and Food Frequency Questionnaire Among Adults: Online Assessment %A Affret,Aurélie %A El Fatouhi,Douae %A Dow,Courtney %A Correia,Emmanuelle %A Boutron-Ruault,Marie-Christine %A Fagherazzi,Guy %+ Inserm U1018, Center for Research in Epidemiology and Population Health, 114 Rue Edouard Vaillant, Villejuif, 94805, France, 33 33 142116466, marie-christine.boutron@gustaveroussy.fr %K Short Food Frequency e-Questionnaire %K Web-based %K validity %K reproducibility %K online dietary assessment tool %D 2018 %7 05.07.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Dietary questionnaires currently available which can assess the habitual diet are timely, costly, or not adapted well to the modern diet; thus, there is a need for a shorter food frequency e-Questionnaire (FFeQ) adapted to Western diets, in order to properly estimate energy and macronutrient intakes or rank individuals according to food and nutrient intakes. Objective: The aim of this study was to evaluate the relative validity and reproducibility of a 30-minute and 44-item FFeQ in a sample of adults obtained from the general population. Methods: A sample of French adults was recruited through social media and an advertising campaign. A total of 223 volunteers completed the FFeQ twice at one-year intervals and were included in the reproducibility study. During that interval, 92 participants completed three-to-six 24-hour recalls and were included in the validity study. Nutrient and dietary intakes were computed for all validity and reproducibility participants. The level of agreement between the two methods was evaluated for nutrient and food group intakes using classification into quintiles of daily intake, correlation coefficients and Bland-Altman plots. Results: For relative validity, correlation coefficients ranged from 0.09 to 0.88 (unadjusted correlation coefficients, median: 0.48) and 0.02 to 0.68 (deattenuated and energy adjusted correlation coefficients, median: 0.50) for food group and nutrient intakes, respectively. The median proportion of subjects classified into the same or adjacent quintile was 73% and 66% for food and nutrient intakes, respectively. Bland-Altman plots showed good agreement across the range of intakes. Regarding reproducibility, intraclass correlation coefficients ranged from 0.33 to 0.72 (median: 0.60) and 0.55 to 0.73 (median: 0.64), for food and nutrient intakes, respectively. Conclusions: The FFeQ showed acceptable validity and reproducibility in a sample of adults based on their food and nutrient intakes. The FFeQ is a promising and low-cost tool that can be used in large-scale online epidemiological studies or clinical routines and could be integrated into evidence-based smartphone apps for assessing diet components. %M 29980502 %R 10.2196/jmir.9113 %U http://www.jmir.org/2018/7/e227/ %U https://doi.org/10.2196/jmir.9113 %U http://www.ncbi.nlm.nih.gov/pubmed/29980502 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e148 %T Learnability of a Configurator Empowering End Users to Create Mobile Data Collection Instruments: Usability Study %A Schobel,Johannes %A Pryss,Rüdiger %A Probst,Thomas %A Schlee,Winfried %A Schickler,Marc %A Reichert,Manfred %+ Institute of Databases and Information Systems, Ulm University, James-Franck-Ring, Ulm, 89081, Germany, 49 731 50 24229, johannes.schobel@uni-ulm.de %K mHealth %K data collection %K mobile apps %D 2018 %7 29.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many research domains still heavily rely on paper-based data collection procedures, despite numerous associated drawbacks. The QuestionSys framework is intended to empower researchers as well as clinicians without programming skills to develop their own smart mobile apps in order to collect data for their specific scenarios. Objective: In order to validate the feasibility of this model-driven, end-user programming approach, we conducted a study with 80 participants. Methods: Across 2 sessions (7 days between Session 1 and Session 2), participants had to model 10 data collection instruments (5 at each session) with the developed configurator component of the framework. In this context, performance measures like the time and operations needed as well as the resulting errors were evaluated. Participants were separated into two groups (ie, novices vs experts) based on prior knowledge in process modeling, which is one fundamental pillar of the QuestionSys framework. Results: Statistical analysis (t tests) revealed that novices showed significant learning effects for errors (P=.04), operations (P<.001), and time (P<.001) from the first to the last use of the configurator. Experts showed significant learning effects for operations (P=.001) and time (P<.001), but not for errors as the experts’ errors were already very low at the first modeling of the data collection instrument. Moreover, regarding the time and operations needed, novices got significantly better at the third modeling task than experts were at the first one (t tests; P<.001 for time and P=.002 for operations). Regarding errors, novices did not get significantly better at working with any of the 10 data collection instruments than experts were at the first modeling task, but novices’ error rates for all 5 data collection instruments at Session 2 were not significantly different anymore from those of experts at the first modeling task. After 7 days of not using the configurator (from Session 1 to Session 2), the experts’ learning effect at the end of Session 1 remained stable at the beginning of Session 2, but the novices’ learning effect at the end of Session 1 showed a significant decay at the beginning of Session 2 regarding time and operations (t tests; P<.001 for time and P=.03 for operations). Conclusions: In conclusion, novices were able to use the configurator properly and showed fast (but unstable) learning effects, resulting in their performances becoming as good as those of experts (which were already good) after having little experience with the configurator. Following this, researchers and clinicians can use the QuestionSys configurator to develop data collection apps for smart mobile devices on their own. %M 29959107 %R 10.2196/mhealth.9826 %U http://mhealth.jmir.org/2018/6/e148/ %U https://doi.org/10.2196/mhealth.9826 %U http://www.ncbi.nlm.nih.gov/pubmed/29959107 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e142 %T Tobacco-Smoking, Alcohol-Drinking, and Betel-Quid-Chewing Behaviors: Development and Use of a Web-Based Survey System %A Hsu,Kuo-Yao %A Tsai,Yun-Fang %A Huang,Chu-Ching %A Yeh,Wen-Ling %A Chang,Kai-Ping %A Lin,Chen-Chun %A Chen,Ching-Yen %A Lee,Hsiu-Lan %+ School of Nursing, College of Medicine, Chang Gung University, 259, Wen-Hwa 1st Road, Tao-Yuan, 333, Taiwan, 886 32118800 ext 3204, yftsai@mail.cgu.edu.tw %K tobacco smoking %K alcohol drinking %K betel-quid chewing %K Web-based survey system %D 2018 %7 11.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smoking tobacco, drinking alcohol, and chewing betel quid are health-risk behaviors for several diseases, such as cancer, cardiovascular disease, and diabetes, with severe impacts on health. However, health care providers often have limited time to assess clients’ behaviors regarding smoking tobacco, drinking alcohol, and chewing betel quid and intervene, if needed. Objective: The objective of this study was to develop a Web-based survey system; determine the rates of tobacco-smoking, alcohol-drinking, and betel-quid-chewing behaviors; and estimate the efficiency of the system (time to complete the survey). Methods: Patients and their family members or friends were recruited from gastrointestinal medical–surgical, otolaryngology, orthopedics, and rehabilitation clinics or wards at a medical center in northern Taiwan. Data for this descriptive, cross-sectional study were extracted from a large series of research studies. A Web-based survey system was developed using a Linux, Apache, MySQL, PHP stack solution. The Web survey was set up to include four questionnaires: the Chinese-version Fagerstrom Tolerance Questionnaire, the Chinese-version Alcohol Use Disorders Identification Test, the Betel Nut Dependency Scale, and a sociodemographic form with several chronic diseases. After the participants completed the survey, the system automatically calculated their score, categorized their risk level for each behavior, and immediately presented and explained their results. The system also recorded the time each participant took to complete the survey. Results: Of 782 patient participants, 29.6% were addicted to nicotine, 13.3% were hazardous, harmful, or dependent alcohol drinkers, and 1.5% were dependent on chewing betel quid. Of 425 family or friend participants, 19.8% were addicted to nicotine, 5.6% were hazardous, harmful, or dependent alcohol drinkers, and 0.9% were dependent on chewing betel quid. Regarding the mean time to complete the survey, patients took 7.9 minutes (SD 3.0; range 3-20) and family members or friends took 7.7 minutes (SD 2.8; range 3-18). Most of the participants completed the survey within 5-10 minutes. Conclusions: The Web-based survey was easy to self-administer. Health care providers can use this Web-based survey system to save time in assessing these risk behaviors in clinical settings. All smokers had mild-to-severe nicotine addiction, and 5.6%-12.3% of patients and their family members or friends were at risk of alcohol dependence. Considering that these three behaviors, particularly in combination, dramatically increase the risk of esophageal cancer, appropriate and convenient interventions are necessary for preserving public health in Taiwan. %M 29891467 %R 10.2196/mhealth.9783 %U http://mhealth.jmir.org/2018/6/e142/ %U https://doi.org/10.2196/mhealth.9783 %U http://www.ncbi.nlm.nih.gov/pubmed/29891467 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e127 %T Designing a Tablet-Based Software App for Mapping Bodily Symptoms: Usability Evaluation and Reproducibility Analysis %A Neubert,Till-Ansgar %A Dusch,Martin %A Karst,Matthias %A Beissner,Florian %+ Somatosensory and Autonomic Therapy Research, Institute for Diagnostic and Interventional Neuroradiology, Hannover Medical School, Carl-Neuberg-Strasse 1, Hannover, 30625, Germany, 49 511 53508413, beissner.florian@mh-hannover.de %K pain drawing %K symptom drawing %K body outline %K usability testing %K reproducibility %K tablet computers %K eHealth %K app %K chronic pain %D 2018 %7 30.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Symptom drawings are widely used as a qualitative and quantitative method of assessing pain symptoms for both clinical and research purposes. As electronic drawings offer many advantages over classical pen-and-paper drawings, the last years have seen a shift toward tablet-based acquisition of symptom drawings. However, software that is used in clinical care requires special attention to usability aspects and design to provide easy access for physically impaired or elderly patients. Objective: The aims of this project were to develop a new tablet-based software app specifically designed to collect patients’ and doctors’ drawings of pain and related bodily symptoms and test it for usability in 2 samples of chronic pain patients (Aim 1) and their treating doctors (Aim 2) as well as for test-retest reliability (Aim 3). Methods: In 2 separate studies, symptom drawings from 103 chronic pain patients and their treating doctors were collected using 2 different versions of the app. Both patients and doctors evaluated usability aspects of the app through questionnaires. Results from study 1 were used to improve certain features of the app, which were then evaluated in study 2. Furthermore, a subgroup of 25 patients in study 2 created 2 consecutive symptom drawings for test-retest reproducibility analysis. Usability of both app versions was compared, and reproducibility was calculated for symptom extent, number of symptom clusters, and the whole symptom pattern. Results: The changes we made to the app and the body outline led to significant improvements in patients’ usability evaluation regarding the identification with the body outline (P=.007) and the evaluation of symptom depth (P=.02), and the overall difficultness of the drawing process (P=.003) improved significantly. Doctors’ usability evaluation of the final app showed good usability with 75.63 (SD 19.51) points on the System Usability Scale, Attrakdiff 2 scores from 0.93 to 1.41, and ISONORM 9241/10 scores from −0.05 to 1.80. Test-retest analysis showed excellent reproducibility for pain extent (intraclass correlation coefficient, ICC=0.92) and good results for the number of symptom clusters (ICC=0.70) and a mean overlap of 0.47 (Jaccard index). Conclusions: We developed a tablet-based symptom drawing app and improved it based on usability assessment in a sample of chronic pain patients and their treating doctors. Increases in usability of the improved app comprised identification with the body outline, symptom depth evaluation, and difficultness of the drawing process. Test-retest reliability of symptom drawings by chronic pain patients showed fair to excellent reproducibility. Patients’ usability evaluation is an important factor that should not be neglected when designing apps for mobile or eHealth apps. %R 10.2196/mhealth.8409 %U http://mhealth.jmir.org/2018/5/e127/ %U https://doi.org/10.2196/mhealth.8409 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e56 %T Accurately Inferring Compliance to Five Major Food Guidelines Through Simplified Surveys: Applying Data Mining to the UK National Diet and Nutrition Survey %A Rosso,Nicholas %A Giabbanelli,Philippe %+ Data Analytics for Complex Human Behaviors Laboratory, Department of Computer Science, Furman University, 3300 Poinsett Hwy, Greenville, SC, 29613, United States, 1 864 294 2097, giabbanelli@gmail.com %K diet, food, and nutrition %K public health informatics %K supervised machine learning %D 2018 %7 30.05.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: National surveys in public health nutrition commonly record the weight of every food consumed by an individual. However, if the goal is to identify whether individuals are in compliance with the 5 main national nutritional guidelines (sodium, saturated fats, sugars, fruit and vegetables, and fats), much less information may be needed. A previous study showed that tracking only 2.89% of all foods (113/3911) was sufficient to accurately identify compliance. Further reducing the data needs could lower participation burden, thus decreasing the costs for monitoring national compliance with key guidelines. Objective: This study aimed to assess whether national public health nutrition surveys can be further simplified by only recording whether a food was consumed, rather than having to weigh it. Methods: Our dataset came from a generalized sample of inhabitants in the United Kingdom, more specifically from the National Diet and Nutrition Survey 2008-2012. After simplifying food consumptions to a binary value (1 if an individual consumed a food and 0 otherwise), we built and optimized decision trees to find whether the foods could accurately predict compliance with the major 5 nutritional guidelines. Results: When using decision trees of a similar size to previous studies (ie, involving as many foods), we were able to correctly infer compliance for the 5 guidelines with an average accuracy of 80.1%. This is an average increase of 2.5 percentage points over a previous study, showing that further simplifying the surveys can actually yield more robust estimates. When we allowed the new decision trees to use slightly more foods than in previous studies, we were able to optimize the performance with an average increase of 3.1 percentage points. Conclusions: Although one may expect a further simplification of surveys to decrease accuracy, our study found that public health dietary surveys can be simplified (from accurately weighing items to simply checking whether they were consumed) while improving accuracy. One possibility is that the simplification reduced noise and made it easier for patterns to emerge. Using simplified surveys will allow to monitor public health nutrition in a more cost-effective manner and possibly decrease the number of errors as participation burden is reduced. %R 10.2196/publichealth.9536 %U http://publichealth.jmir.org/2018/2/e56/ %U https://doi.org/10.2196/publichealth.9536 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e48 %T Studying Cannabis Use Behaviors With Facebook and Web Surveys: Methods and Insights %A Borodovsky,Jacob T %A Marsch,Lisa A %A Budney,Alan J %+ The Center for Technology and Behavioral Health, Dartmouth Geisel School of Medicine, 46 Centerra Parkway, Lebanon, NH, 03766, United States, 1 603 646 7004, jacob.borodovsky@gmail.com %K epidemiology %K cross-sectional studies %K sampling studies %K social media %K data collection %K cannabis %K surveys %D 2018 %7 02.05.2018 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The rapid and wide-reaching expansion of internet access and digital technologies offers epidemiologists numerous opportunities to study health behaviors. One particularly promising new data collection strategy is the use of Facebook’s advertising platform in conjunction with Web-based surveys. Our research team at the Center for Technology and Behavioral Health has used this quick and cost-efficient method to recruit large samples and address unique scientific questions related to cannabis use. In conducting this research, we have gleaned several insights for using this sampling method effectively and have begun to document the characteristics of the resulting data. We believe this information could be useful to other researchers attempting to study cannabis use or, potentially, other health behaviors. The first aim of this paper is to describe case examples of procedures for using Facebook as a survey sampling method for studying cannabis use. We then present several distinctive features of the data produced using this method. Finally, we discuss the utility of this sampling method for addressing specific types of epidemiological research questions. Overall, we believe that sampling with Facebook advertisements and Web surveys is best conceptualized as a targeted, nonprobability-based method for oversampling cannabis users across the United States. %M 29720366 %R 10.2196/publichealth.9408 %U http://publichealth.jmir.org/2018/2/e48/ %U https://doi.org/10.2196/publichealth.9408 %U http://www.ncbi.nlm.nih.gov/pubmed/29720366 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 4 %P e96 %T Addressing Participant Validity in a Small Internet Health Survey (The Restore Study): Protocol and Recommendations for Survey Response Validation %A Dewitt,James %A Capistrant,Benjamin %A Kohli,Nidhi %A Rosser,B R Simon %A Mitteldorf,Darryl %A Merengwa,Enyinnaya %A West,William %+ Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, 1300 S. 2nd St., Room 300, Minneapolis, MN, 55410, United States, 1 6126240358, rosser@umn.edu %K fraudulent data %K data accuracy %K research and design %K research activities %K data analysis %D 2018 %7 24.04.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: While deduplication and cross-validation protocols have been recommended for large Web-based studies, protocols for survey response validation of smaller studies have not been published. Objective: This paper reports the challenges of survey validation inherent in a small Web-based health survey research. Methods: The subject population was North American, gay and bisexual, prostate cancer survivors, who represent an under-researched, hidden, difficult-to-recruit, minority-within-a-minority population. In 2015-2016, advertising on a large Web-based cancer survivor support network, using email and social media, yielded 478 completed surveys. Results: Our manual deduplication and cross-validation protocol identified 289 survey submissions (289/478, 60.4%) as likely spam, most stemming from advertising on social media. The basic components of this deduplication and validation protocol are detailed. An unexpected challenge encountered was invalid survey responses evolving across the study period. This necessitated the static detection protocol be augmented with a dynamic one. Conclusions: Five recommendations for validation of Web-based samples, especially with smaller difficult-to-recruit populations, are detailed. %M 29691203 %R 10.2196/resprot.7655 %U http://www.researchprotocols.org/2018/4/e96/ %U https://doi.org/10.2196/resprot.7655 %U http://www.ncbi.nlm.nih.gov/pubmed/29691203 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e141 %T Improving the Usefulness and Use of Patient Survey Programs: National Health Service Interview Study %A Flott,Kelsey %A Darzi,Ara %A Gancarczyk,Sarah %A Mayer,Erik %+ Centre for Health Policy, Imperial College London, 10th Floor QEQM, St Mary’s Campus, London, W2 1NY, United Kingdom, 44 7909248515, k.flott14@imperial.ac.uk %K patient experience %K surveys %K patient data %D 2018 %7 24.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: A growing body of evidence suggests a concerning lag between collection of patient experience data and its application in service improvement. This study aims to identify what health care staff perceive to be the barriers and facilitators to using patient-reported feedback and showcase successful examples of doing so. Objective: This study aimed to apply a systems perspective to suggest policy improvements that could support efforts to use data on the frontlines. Methods: Qualitative interviews were conducted in eight National Health Service provider locations in the United Kingdom, which were selected based on National Inpatient Survey scores. Eighteen patient-experience leads were interviewed about using patient-reported feedback with relevant staff. Interviews were transcribed and underwent thematic analysis. Staff-identified barriers and facilitators to using patient experience feedback were obtained. Results: The most frequently cited barriers to using patient reported feedback pertained to interpreting results, understanding survey methodology, presentation of data in both national Care Quality Commission and contractor reports, inability to link data to other sources, and organizational structure. In terms of a wish list for improved practice, staff desired more intuitive survey methodologies, the ability to link patient experience data to other sources, and more examples of best practice in patient experience improvement. Three organizations also provided examples of how they successfully used feedback to improve care. Conclusions: Staff feedback provides a roadmap for policy makers to reconsider how data is collected and whether or not the national regulations on surveys and patient experience data are meeting the quality improvement needs of local organizations. %M 29691207 %R 10.2196/jmir.8806 %U http://www.jmir.org/2018/4/e141/ %U https://doi.org/10.2196/jmir.8806 %U http://www.ncbi.nlm.nih.gov/pubmed/29691207 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e151 %T Stigma and Its Association With Glycemic Control and Hypoglycemia in Adolescents and Young Adults With Type 1 Diabetes: Cross-Sectional Study %A Brazeau,Anne-Sophie %A Nakhla,Meranda %A Wright,Michael %A Henderson,Mélanie %A Panagiotopoulos,Constadina %A Pacaud,Daniele %A Kearns,Patricia %A Rahme,Elham %A Da Costa,Deborah %A Dasgupta,Kaberi %+ Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Department of Medicine, McGill University, 5252 boul de Maisonneuve, Office 3E.09, Montreal, QC, H4A 3S5, Canada, 1 514 934 1934 ext 44715, kaberi.dasgupta@mcgill.ca %K type 1 diabetes %K youth %K young adult %K social stigma %K perception %K glycated hemoglobin A1c %D 2018 %7 20.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Qualitative studies in type 1 diabetes indicate that visibility of diabetes supplies, self-care, and hypoglycemia symptoms are associated with stigma and suboptimal management. This may be particularly salient in youth who face concurrent challenges such as establishing autonomy and making vocational choices. Objective: The aim of the study was to estimate stigma prevalence in youth (aged 14-24 years) with type 1 diabetes and its associations with glycemic control. Methods: Participants, recruited largely through social media, were asked to complete a Web-based survey and to send via mail capillary blood samples for glycated hemoglobin (HbA1c) measurement. The primary definition of stigma required endorsement of one or more of 3 stigma-specific items of the Barriers to Diabetes Adherence questionnaire. These addressed avoidance of diabetes management with friends present, difficulty telling others about diabetes diagnosis, and embarrassment in performing diabetes care with others present. Poor glycemic control was defined as HbA1c>9% (ie, >75 mmol/mol; measured value when available, else self-report) and/or ≥1 severe hypoglycemic episode in the previous year (reported requiring assistance from someone else during the episode). Stigma prevalence was computed (95% CI), and associations with glycemic control were evaluated (multivariate logistic regression models). Results: Among the 380 respondents, stigma prevalence was 65.5% (95% CI 60.7-70.3). Stigma was associated with a 2-fold higher odds of poor glycemic control overall (odds ratio [OR] 2.25, 95% CI 1.33-3.80; adjusted for age, sex, and type of treatment). There were specific associations with both HbA1c>9% (75 mmol/mol; OR 3.05, 95% CI 1.36-6.86) and severe hypoglycemia in the previous year (OR 1.86, 95% CI 1.05-3.31). Conclusions: There is a high prevalence of stigma in youth with type 1 diabetes that is associated with both elevated HbA1c levels and severe hypoglycemia. Targeted strategies to address stigma are needed. Trial Registration: ClinicalTrials.gov NCT02796248; http://clinicaltrials.gov/ct2/show/NCT02796248 (Archived by WebCite at http://www.webcitation.org/6yisxeV0B) %M 29678801 %R 10.2196/jmir.9432 %U http://www.jmir.org/2018/4/e151/ %U https://doi.org/10.2196/jmir.9432 %U http://www.ncbi.nlm.nih.gov/pubmed/29678801 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e101 %T Novel Interventions and Assessments Using Patient Portals in Adolescent Research: Confidential Survey Study %A Thompson,Lindsay A %A Mercado,Rebeccah %A Martinko,Thomas %A Acharya,Ratna %+ Department of Pediatrics, University of Florida, 1699 SW 16th Ave, Gainesville, FL,, United States, 1 352 627 9323, lathom@ufl.edu %K adolescent health services %K preventive health services %K health information technology %D 2018 %7 21.03.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: While adolescents can receive confidential health care without parental or guardian notification, they are rarely asked about their experiences and opinions regarding their care because participation in research often requires parental consent. Anonymous research with adolescents via confidential patient portals may ameliorate this research gap. Objective: Because use of a confidential online adolescent patient portal is high at our academic institution, we hypothesized that adolescents would also respond to survey-based research via the portal, especially if asked anonymously and without parental consent. We used a clinical scenario of needing to better understanding adolescent and young adults’ views about their health and health care, including information on a long-acting reversible contraceptive (LARC) to test if and how they will use a portal for research. Methods: Upon receiving Institutional Review Board approval, we sent 2 portal-based surveys about confidential services to 2 groups of females, ages 14 to 25 years, who had attended an adolescent clinic in the past 3 years. This clinic mostly serves Medicaid recipients (80%) and is racially and ethnically diverse with half of patients identifying as African American and roughly 10% Hispanic. The control group was a random sample of female patients who never received a LARC (n=150) and the intervention group included all female adolescents who had received a LARC from the same clinic (n=107). This second sample was manually cross-checked to confirm they had an office visit for this reason. Consenting for themselves, the control group received an email through the patient portal with a link and a request to perform an assessment. The survey for the control group included items assessing health literacy and health communication preferences. The survey for the intervention group included health literacy items as well as items to assess their opinions and perceptions regarding LARCs. We tracked click-through rates and opened messages; each participant received 4 reminders. Results: While only 3 participants fully completed either survey, email read rates (29/107 [27.1%] of LARC recipients and 39/150 [26.0%] of controls) were encouraging. Additionally, of those who opened the messages, almost twice as many of the LARC recipients (10/107 [9.3%]) read through the entire survey, while less than half read the entire survey as compared to those who received the survey asking about health literacy and health care preferences (6/150 [4.0%]). Conclusions: The methodology of using adolescent portals for online surveys provides a new avenue for research even though the study did not yield sufficient participation to understand these adolescents’ preferences. Future studies need to test if a different survey topic would engage adolescents or if other methods like text-based reminders would improve participation. %M 29563077 %R 10.2196/jmir.8340 %U http://www.jmir.org/2018/3/e101/ %U https://doi.org/10.2196/jmir.8340 %U http://www.ncbi.nlm.nih.gov/pubmed/29563077 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e64 %T Mode Equivalence of Health Indicators Between Data Collection Modes and Mixed-Mode Survey Designs in Population-Based Health Interview Surveys for Children and Adolescents: Methodological Study %A Mauz,Elvira %A Hoffmann,Robert %A Houben,Robin %A Krause,Laura %A Kamtsiuris,Panagiotis %A Gößwald,Antje %+ Department of Epidemiology and Health Monitoring, Robert Koch Institute, PO Box 650261, Berlin, 13302, Germany, 49 30 18754 3332, MauzE@rki.de %K public health %K child and adolescent health %K health surveys %K survey methods %K mixed-mode survey %K paper-and-pencil questionnaire %K online questionnaire %K mode effects %D 2018 %7 05.03.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The implementation of an Internet option in an existing public health interview survey using a mixed-mode design is attractive because of lower costs and faster data availability. Additionally, mixed-mode surveys can increase response rates and improve sample composition. However, mixed-mode designs can increase the risk of measurement error (mode effects). Objective: This study aimed to determine whether the prevalence rates or mean values of self- and parent-reported health indicators for children and adolescents aged 0-17 years differ between self-administered paper-based questionnaires (SAQ-paper) and self-administered Web-based questionnaires (SAQ-Web), as well as between a single-mode control group and different mixed-mode groups. Methods: Data were collected for a methodological pilot of the third wave of the "German Health Interview and Examination Survey for Children and Adolescents". Questionnaires were completed by parents or adolescents. A population-based sample of 11,140 children and adolescents aged 0-17 years was randomly allocated to 4 survey designs—a single-mode control group with paper-and-pencil questionnaires only (n=970 parents, n=343 adolescents)—and 3 mixed-mode designs, all of which offered Web-based questionnaire options. In the concurrent mixed-mode design, both questionnaires were offered at the same time (n=946 parents, n=290 adolescents); in the sequential mixed-mode design, the SAQ-Web was sent first, followed by the paper questionnaire along with a reminder (n=854 parents, n=269 adolescents); and in the preselect mixed-mode design, both options were offered and the respondents were asked to request the desired type of questionnaire (n=698 parents, n=292 adolescents). In total, 3468 questionnaires of parents of children aged 0-17 years (SAQ-Web: n=708; SAQ-paper: n=2760) and 1194 questionnaires of adolescents aged 11-17 years (SAQ-Web: n=299; SAQ-paper: n=895) were analyzed. Sociodemographic characteristics and a broad range of health indicators for children and adolescents were compared by survey design and data collection mode by calculating predictive margins from regression models. Results: There were no statistically significant differences in sociodemographic characteristics or health indicators between the single-mode control group and any of the mixed-mode survey designs. Differences in sociodemographic characteristics between SAQ-Web and SAQ-paper were found. Web respondents were more likely to be male, have higher levels of education, and higher household income compared with paper respondents. After adjusting for sociodemographic characteristics, only one of the 38 analyzed health indicators showed different prevalence rates between the data collection modes, with a higher prevalence rate for lifetime alcohol consumption among the online-responding adolescents (P<.001). Conclusions: These results suggest that mode bias is limited in health interview surveys for children and adolescents using a mixed-mode design with Web-based and paper questionnaires. %M 29506967 %R 10.2196/jmir.7802 %U http://www.jmir.org/2018/3/e64/ %U https://doi.org/10.2196/jmir.7802 %U http://www.ncbi.nlm.nih.gov/pubmed/29506967 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e15 %T A Mobile Health Platform for Clinical Monitoring in Early Psychosis: Implementation in Community-Based Outpatient Early Psychosis Care %A Kumar,Divya %A Tully,Laura M %A Iosif,Ana-Maria %A Zakskorn,Lauren N %A Nye,Kathleen E %A Zia,Aqsa %A Niendam,Tara Ann %+ Department of Psychiatry and Behavioral Sciences, University of California, Davis, 4701 X Street, Sacramento, CA, 95817, United States, 1 916 734 7927, lmtully@ucdavis.edu %K mHealth %K schizophrenia %K smartphone %K ecological momentary assessment %K experience sampling %D 2018 %7 27.02.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: A growing body of literature indicates that smartphone technology is a feasible add-on tool in the treatment of individuals with early psychosis (EP) . However, most studies to date have been conducted independent of outpatient care or in a research clinic setting, often with financial incentives to maintain user adherence to the technology. Feasibility of dissemination and implementation of smartphone technology into community mental health centers (CMHCs) has yet to be tested, and whether young adults with EP will use this technology for long periods of time without incentive is unknown. Furthermore, although EP individuals willingly adopt smartphone technology as part of their treatment, it remains unclear whether providers are amenable to integrating smartphone technology into treatment protocols. Objective: This study aimed to establish the feasibility of implementing a smartphone app and affiliated Web-based dashboard in 4 community outpatient EP clinics in Northern California. Methods: EP individuals in 4 clinics downloaded an app on their smartphone and responded to daily surveys regarding mood and symptoms for up to 5 months. Treatment providers at the affiliated clinics viewed survey responses on a secure Web-based dashboard in sessions with their clients and between appointments. EP clients and treatment providers filled out satisfaction surveys at study end regarding usability of the app. Results: Sixty-one EP clients and 20 treatment providers enrolled in the study for up to 5 months. Forty-one EP clients completed the study, and all treatment providers remained in the study for their duration in the clinic. Survey completion for all 61 EP clients was moderate: 40% and 39% for daily and weekly surveys, respectively. Completion rates were slightly higher in the participants who completed the study: 44% and 41% for daily and weekly surveys, respectively. Twenty-seven of 41 (66%) EP clients who completed the study and 11 of 13 (85%) treatment providers who responded to satisfaction surveys reported they would continue to use the app as part of treatment services. Six (15%; 6/41) clients and 3 providers (23%; 3/13) stated that technological glitches impeded their engagement with the platform. Conclusions: EP clients and treatment providers in community-based outpatient clinics are responsive to integrating smartphone technology into treatment services. There were logistical and technical challenges associated with enrolling individuals in CMHCs. To be most effective, implementing smartphone technology in CMHC EP care necessitates adequate technical staff and support for utilization of the platform. %M 29487044 %R 10.2196/mental.8551 %U http://mental.jmir.org/2018/1/e15/ %U https://doi.org/10.2196/mental.8551 %U http://www.ncbi.nlm.nih.gov/pubmed/29487044 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 5 %N 1 %P e1 %T Physiotherapy Questionnaires App to Deliver Main Musculoskeletal Assessment Questionnaires: Development and Validation Study %A Teixeira Neto,Nestor Cavalcante %A Lima,Yuri Lopes %A Almeida,Gabriel Peixoto Leão %A Bezerra,Márcio Almeida %A Lima,Pedro Olavo De Paula %A de Oliveira,Rodrigo Ribeiro %+ Department of Physical Therapy, Faculty of Medicine, Federal University of Ceará, 949 Rua Alexandre Baraúna, Fortaleza, 61760000, Brazil, 55 8533668632, rodrigo@ufc.br %K mobile phone %K Foot and Ankle Outcome Score %K American Orthopaedic Foot and Ankle Society %K musculoskeletal assessment questionnaires %K health survey %D 2018 %7 23.02.2018 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Patient-reported outcomes (PROs) translate subjective outcomes into objective data that can be quantified and analyzed. Nevertheless, the use of PROs in their traditional paper format is not practical for clinical practice due to limitations associated with the analysis and management of the data. To address the need for a viable way to group and utilize the main functioning assessment tools in the field of musculoskeletal disorders, the Physiotherapy Questionnaires app was developed. Objective: This study aims to explain the development of the app, to validate it using two questionnaires, and to analyze whether participants prefer to use the app or the paper version of the questionnaires. Methods: In the first stage, the app for an Android operational system was developed. In the second stage, the aim was to select questionnaires that were most often used in musculoskeletal clinical practice and research. The Foot and Ankle Outcome Score (FAOS) and American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire were selected to validate the app. In total, 50 participants completed the paper and app versions of the AOFAS and 50 completed the FAOS. The study’s outcomes were the correlation of the data between the paper and app versions as well as the preference of the participants between the two versions. Results: The app was approved by experts after the adaptations of the layout for mobile phones and a total of 18 questionnaires were included in the app. Moreover, the app allows the generation of PDF and Excel files with the patients’ data. In regards to validity, the mean of the total scores of the FAOS were 91.54% (SD 8.86%) for the paper version and 91.74% (SD 9.20%) for the app. There was no statistically significant differences in the means of the total scores or the subscales (P=.11-.94). The mean total scores for the AOFAS were 93.94 (SD 8.47) for the paper version and 93.96 (SD 8.48) for the app. No statistically significant differences were found for the total scores for the AOFAS or the subscales (P>.99). The app showed excellent agreement with the paper version of the FAOS, with an ICC value of 0.98 for the total score (95% CI 0.98-0.99), which was also found for the AOFAS with the ICC for the total score of 0.99 (95% CI 0.98-0.99). For compliance, 72% (36/50) of the participants in the FAOS group and 94% (47/50) in the AOFAS group preferred the app version. Conclusions: The Physiotherapy Questionnaires app showed validity and high levels of compliance for the FAOS and AOFAS, which indicates it is not inferior to the paper version of these two questionnaires and confirms its viability and feasibility for use in clinical practice. %M 29475827 %R 10.2196/rehab.9247 %U http://rehab.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/rehab.9247 %U http://www.ncbi.nlm.nih.gov/pubmed/29475827 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e57 %T Web-Based Alcohol, Smoking, and Substance Involvement Screening Test Results for the General Spanish Population: Cross-Sectional Study %A Lopez-Rodriguez,Juan A %A Rubio Valladolid,Gabriel %+ Primary Care Research Unit, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Calle San Martín de Porres 6, Madrid, 28035, Spain, 34 913700696, juanantonio.lopez@salud.madrid.org %K screening %K substance-related disorders %K Web-based systems %K primary health care %K ASSIST %D 2018 %7 16.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Information technology in health sciences could be a screening tool of great potential and has been shown to be effective in identifying single-drug users at risk. Although there are many published tests for single-drug screening, there is a gap for concomitant drug use screening in general population. The ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) website was launched on February 2015 in Madrid, Spain, as a tool to identify those at risk. Objective: The aim of this study was to describe the use of a tool and to analyze profiles of drug users, their consumption patterns, and associated factors. Methods: Government- and press-released launching of a Spanish-validated ASSIST test from the World Health Organization (WHO) was used for voluntary Web-based screening of people with drug-related problems. The tests completed in the first 6 months were analyzed . Results: A total of 1657 visitors of the 15,867 visits (1657/15,867, 10.44%) completed the whole Web-based screening over a 6-month period. The users had an average age of 37.4 years, and 78.87% (1307/1657) screened positive for at least one of the 9 drugs tested. The drugs with higher prevalence were tobacco (840/1657, 50.69%), alcohol (437/1657, 26.37%), cannabis (361/1657, 21.79%), and sedatives or hypnotics (192/1657, 11.59%). Polyconsumption or concomitant drug use was stated by 31.80% (527/1657) of the users. Male respondents had a higher risk of having alcohol problems (odds ratio, OR 1.55, 95% CI 1.18-2.04; P=.002) and double the risk for cannabis problems (OR 2.07, 95% CI 1.46-2.92; P<.001). Growing age increased by 3 times the risk of developing alcohol problems for people aged between 45 and 65 years (OR 3.01, 95% CI 1.89-4.79; P<.001). Conclusions: A Web-based screening test could be useful to detect people at risk. The drug-related problem rates detected by the study are consistent with the current literature. This tool could be useful for users, who use information technology on a daily basis, not seeking medical attention. %M 29453188 %R 10.2196/jmir.7121 %U http://www.jmir.org/2018/2/e57/ %U https://doi.org/10.2196/jmir.7121 %U http://www.ncbi.nlm.nih.gov/pubmed/29453188 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e28 %T Effect of Recruitment Methods on Response Rate in a Web-Based Study for Primary Care Physicians: Factorial Randomized Controlled Trial %A So,Ryuhei %A Shinohara,Kiyomi %A Aoki,Takuya %A Tsujimoto,Yasushi %A Suganuma,Aya M %A Furukawa,Toshi A %+ Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto,, Japan, 81 75 753 9491, nexttext@gmail.com %K Web-based surveys %K electronic mail %K incentives %K surveys and questionnaires %K survey methods %K questionnaire design %K data collection %K physicians %K general practitioners %D 2018 %7 08.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Low participation rates are one of the most serious disadvantages of Web-based studies. It is necessary to develop effective strategies to improve participation rates to obtain sufficient data. Objective: The objective of this trial was to investigate the effect of emphasizing the incentive in the subject line of the invitation email and the day of the week of sending the invitation email on the participation rate in a Web-based trial. Methods: We conducted a 2×2 factorial design randomized controlled trial. We contacted 2000 primary care physicians from members of the Japan Primary Care Association in January 2017 and randomly allocated them to 1 of 4 combinations of 2 subject lines (presence or absence of an emphasis on a lottery for an Amazon gift card worth 3000 yen or approximately US $30) and 2 delivery days (sending the invitation email on Tuesday or Friday). The primary outcome was the response rate defined as the number of participants answering the first page of the questionnaire divided by the number of invitation emails delivered. All outcomes were collected between January 17, 2017, and February 8, 2017. Results: We analyzed data from 1943 out of 2000 participants after excluding those whose email addresses were invalid. The overall response rate was 6.3% (123/1943). There was no significant difference in the response rates between the 2 groups regarding incentive in the subject line: the risk ratio was 1.12 (95% CI 0.80 to 1.58) and the risk difference was 0.7% (95% CI –1.5% to 2.9%). Similarly, there was no significant difference in the response rates between the 2 groups regarding sending the email on Tuesday or Friday: the risk ratio was 0.98 (95% CI 0.70 to 1.38) and the risk difference was –0.1% (95% CI –2.3% to 2.1%). Conclusions: Neither emphasizing the incentive in the subject line of the invitation email nor varying the day of the week the invitation email was sent led to a meaningful increase in response rates in a Web-based trial with primary care physicians. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000025317; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000029121 (Archived by WebCite at http://www.webcitation. org/6wOo1jl9t) %M 29422450 %R 10.2196/jmir.8561 %U https://www.jmir.org/2018/2/e28/ %U https://doi.org/10.2196/jmir.8561 %U http://www.ncbi.nlm.nih.gov/pubmed/29422450 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e24 %T Paper- or Web-Based Questionnaire Invitations as a Method for Data Collection: Cross-Sectional Comparative Study of Differences in Response Rate, Completeness of Data, and Financial Cost %A Ebert,Jonas Fynboe %A Huibers,Linda %A Christensen,Bo %A Christensen,Morten Bondo %+ Department of Public Health, Research Unit for General Practice, Aarhus University, Bartholins Allé 2, Aarhus, 8000, Denmark, 45 25309292, jonasebert@ph.au.dk %K questionnaire study %K response rate %K completeness of data %K financial costs %K missing values %K selection bias %K digital post %K digital survey invitation %K Web-based questionnaire %D 2018 %7 23.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Paper questionnaires have traditionally been the first choice for data collection in research. However, declining response rates over the past decade have increased the risk of selection bias in cross-sectional studies. The growing use of the Internet offers new ways of collecting data, but trials using Web-based questionnaires have so far seen mixed results. A secure, online digital mailbox (e-Boks) linked to a civil registration number became mandatory for all Danish citizens in 2014 (exemption granted only in extraordinary cases). Approximately 89% of the Danish population have a digital mailbox, which is used for correspondence with public authorities. Objective: We aimed to compare response rates, completeness of data, and financial costs for different invitation methods: traditional surface mail and digital mail. Methods: We designed a cross-sectional comparative study. An invitation to participate in a survey on help-seeking behavior in out-of-hours care was sent to two groups of randomly selected citizens from age groups 30-39 and 50-59 years and parents to those aged 0-4 years using either traditional surface mail (paper group) or digital mail sent to a secure online mailbox (digital group). Costs per respondent were measured by adding up all costs for handling, dispatch, printing, and work salary and then dividing the total figure by the number of respondents. Data completeness was assessed by comparing the number of missing values between the two methods. Socioeconomic variables (age, gender, family income, education duration, immigrant status, and job status) were compared both between respondents and nonrespondents and within these groups to evaluate the degree of selection bias. Results: A total 3600 citizens were invited in each group; 1303 (36.29%) responded to the digital invitation and 1653 (45.99%) to the paper invitation (difference 9.66%, 95% CI 7.40-11.92). The costs were €1.51 per respondent for the digital group and €15.67 for paper group respondents. Paper questionnaires generally had more missing values; this was significant in five of 17 variables (P<.05). Substantial differences were found in the socioeconomic variables between respondents and nonrespondents, whereas only minor differences were seen within the groups of respondents and nonrespondents. Conclusions: Although we found lower response rates for Web-based invitations, this solution was more cost-effective (by a factor of 10) and had slightly lower numbers of missing values than questionnaires sent with paper invitations. Analyses of socioeconomic variables showed almost no difference between nonrespondents in both groups, which could imply that the lower response rate in the digital group does not necessarily increase the level of selection bias. Invitations to questionnaire studies via digital mail may be an excellent option for collecting research data in the future. This study may serve as the foundational pillar of digital data collection in health care research in Scandinavia and other countries considering implementing similar systems. %M 29362206 %R 10.2196/jmir.8353 %U http://www.jmir.org/2018/1/e24/ %U https://doi.org/10.2196/jmir.8353 %U http://www.ncbi.nlm.nih.gov/pubmed/29362206 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e3 %T A Computer-Assisted Personal Interview App in Research Electronic Data Capture for Administering Time Trade-off Surveys (REDCap): Development and Pretest %A Oremus,Mark %A Sharafoddini,Anis %A Morgano,Gian Paolo %A Jin,Xuejing %A Xie,Feng %+ School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON,, Canada, 1 519 888 4567 ext 35129, moremus@uwaterloo.ca %K computer-assisted personal interview %K health-related quality-of-life %K REDCap %K time trade-off %D 2018 %7 23.01.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The time trade-off (TTO) task is a method of eliciting health utility scores, which range from 0 (equivalent to death) to 1 (equivalent to perfect health). These scores numerically represent a person’s health-related quality of life. Software apps exist to administer the TTO task; however, most of these apps are poorly documented and unavailable to researchers. Objective: To fill the void, we developed an online app to administer the TTO task for a research study that is examining general public proxy health-related quality of life estimates for persons with Alzheimer’s disease. This manuscript describes the development and pretest of the app. Methods: We used Research Electronic Data Capture (REDCap) to build the TTO app. The app’s modular structure and REDCap’s object-oriented environment facilitated development. After the TTO app was built, we recruited a purposive sample of 11 members of the general public to pretest its functionality and ease of use. Results: Feedback from the pretest group was positive. Minor modifications included clarity enhancements, such as rearranging some paragraph text into bullet points, labeling the app to delineate different question sections, and revising or deleting text. We also added a research question to enable the identification of respondents who know someone with Alzheimer’s disease. Conclusions: We developed an online app to administer the TTO task. Other researchers may access and customize the app for their own research purposes. %M 30684429 %R 10.2196/formative.8202 %U http://formative.jmir.org/2018/1/e3/ %U https://doi.org/10.2196/formative.8202 %U http://www.ncbi.nlm.nih.gov/pubmed/30684429 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 1 %P e12 %T Web-Based Survey Application to Collect Contextually Relevant Geographic Data With Exposure Times: Application Development and Feasibility Testing %A Rudolph,Abby %A Tobin,Karin %A Rudolph,Jonathan %A Latkin,Carl %+ Department of Epidemiology, Boston University School of Public Health, 715 Albany St, T418E, Boston, MA, 02118, United States, 1 617 358 3423, arudolph@bu.edu %K spatial analysis %K geographic mapping %K substance-related disorder %D 2018 %7 19.01.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although studies that characterize the risk environment by linking contextual factors with individual-level data have advanced infectious disease and substance use research, there are opportunities to refine how we define relevant neighborhood exposures; this can in turn reduce the potential for exposure misclassification. For example, for those who do not inject at home, injection risk behaviors may be more influenced by the environment where they inject than where they live. Similarly, among those who spend more time away from home, a measure that accounts for different neighborhood exposures by weighting each unique location proportional to the percentage of time spent there may be more correlated with health behaviors than one’s residential environment. Objective: This study aimed to develop a Web-based application that interacts with Google Maps application program interfaces (APIs) to collect contextually relevant locations and the amount of time spent in each. Our analysis examined the extent of overlap across different location types and compared different approaches for classifying neighborhood exposure. Methods: Between May 2014 and March 2017, 547 participants enrolled in a Baltimore HIV care and prevention study completed an interviewer-administered Web-based survey that collected information about where participants were recruited, worked, lived, socialized, injected drugs, and spent most of their time. For each location, participants gave an address or intersection which they confirmed using Google Map and Street views. Geographic coordinates (and hours spent in each location) were joined to neighborhood indicators by Community Statistical Area (CSA). We computed a weighted exposure based on the proportion of time spent in each unique location. We compared neighborhood exposures based on each of the different location types with one another and the weighted exposure using analysis of variance with Bonferroni corrections to account for multiple comparisons. Results: Participants reported spending the most time at home, followed by the location where they injected drugs. Injection locations overlapped most frequently with locations where people reported socializing and living or sleeping. The least time was spent in the locations where participants reported earning money and being recruited for the study; these locations were also the least likely to overlap with other location types. We observed statistically significant differences in neighborhood exposures according to the approach used. Overall, people reported earning money in higher-income neighborhoods and being recruited for the study and injecting in neighborhoods with more violent crime, abandoned houses, and poverty. Conclusions: This analysis revealed statistically significant differences in neighborhood exposures when defined by different locations or weighted based on exposure time. Future analyses are needed to determine which exposure measures are most strongly associated with health and risk behaviors and to explore whether associations between individual-level behaviors and neighborhood exposures are modified by exposure times. %M 29351899 %R 10.2196/publichealth.8581 %U http://publichealth.jmir.org/2018/1/e12/ %U https://doi.org/10.2196/publichealth.8581 %U http://www.ncbi.nlm.nih.gov/pubmed/29351899 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e188 %T The Swedish Web Version of the Quality of Recovery Scale Adapted for Use in a Mobile App: Prospective Psychometric Evaluation Study %A Nilsson,Ulrica %A Dahlberg,Karuna %A Jaensson,Maria %+ School of Health Sciences, Faculty of Medicine and Health, Örebro University, Fakultetsgatan, Örebro, 70182, Sweden, 46 762132685, ulrica.nilsson@oru.se %K psychometric evaluation %K postoperative recovery %K Web version %K evaluation studies %K mobile application %K Quality of Recovery scale %D 2017 %7 3.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The 40-item Quality of Recovery (QoR-40) questionnaire is well validated for measuring self-assessed postoperative recovery. The Swedish version of the 40-item Quality of Recovery (QoR-40) has been developed into a Web-based questionnaire, the Swedish Web version of the Quality of Recovery (SwQoR) questionnaire, adapted for use in a mobile app, Recovery Assessment by Phone Points, or RAPP. Objective: The aim of this study was to test the validity, reliability, responsiveness, and clinical acceptability and feasibility of SwQoR. Methods: We conducted a prospective psychometric evaluation study including 494 patients aged ≥18 years undergoing day surgery at 4 different day-surgery departments in Sweden. SwQoR was completed daily on postoperative days 1 to 14. Results: All a priori hypotheses were confirmed, supporting convergent validity. There was excellent internal consistency (Cronbach alpha range .91-.93), split-half reliability (coefficient range .87-.93), and stability (ri=.99, 95% CI .96-.99; P<.001). Cohen d effect size was 1.00, with a standardized response mean of 1.2 and a percentage change from baseline of 59.1%. An exploratory factor analysis found 5 components explaining 57.8% of the total variance. We noted a floor effect only on postoperative day 14; we found no ceiling effect. Conclusions: SwQoR is valid, has excellent reliability and high responsiveness, and is clinically feasible for the systematic follow-up of patients’ postoperative recovery. %M 29229590 %R 10.2196/mhealth.9061 %U http://mhealth.jmir.org/2017/12/e188/ %U https://doi.org/10.2196/mhealth.9061 %U http://www.ncbi.nlm.nih.gov/pubmed/29229590 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 4 %P e73 %T Implications of Attrition in a Longitudinal Web-Based Survey: An Examination of College Students Participating in a Tobacco Use Study %A McDonald,Bennett %A Haardoerfer,Regine %A Windle,Michael %A Goodman,Michael %A Berg,Carla %+ Emory University, 1518 Clifton Road, Atlanta, GA,, United States, 1 404 558 5395, cjberg@emory.edu %K young adults %K risk factors %K tobacco use %K methods %K surveys and questionnaires %D 2017 %7 16.10.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Web-based survey research has several benefits, including low cost and burden, as well as high use of the Internet, particularly among young adults. In the context of longitudinal studies, attrition raises concerns regarding the validity of data, given the potential associations with individual and institutional characteristics, or the focal area of study (eg, cigarette use). Objectives: The objective of this study was to compare baseline characteristics of nonresponders versus responders in a sample of young adult college students in a Web-based longitudinal study regarding tobacco use. Methods: We conducted a secondary data analysis of 3189 college students from seven Georgia colleges and universities in a 2-year longitudinal study. We examined baseline tobacco use, as well as individual- and institutional-level factors, as predictors of attrition between wave 1 (October and November 2014) and wave 2 (February and March 2015) using multilevel modeling. Results: A total 13.14% (419/3189) participants were lost to follow-up at wave 2. Predictors of nonresponse were similar in the models examining individual-level factors and institutional-level factors only and included being black versus white (odds ratio [OR] 1.74, CI 1.23-2.46); being male versus female (OR 1.41, CI 1.10-1.79); seeking a bachelor’s degree versus advanced degree (OR 1.41, CI 1.09-1.83); not residing on campus (OR 0.62, CI 0.46-0.84); past 30-day tobacco use (OR 1.41, CI 1.10-1.78); attending a nonprivate college (OR 0.48, CI 0.33-0.71); and attending a college with ≤10,000 students (OR 0.56, CI 0.43-0.73). Conclusions: Future longitudinal studies should assess predictors of attrition to examine how survey topic and other individual and institutional factors might influence the response to allow for correction of selection bias. %M 29038092 %R 10.2196/publichealth.7424 %U http://publichealth.jmir.org/2017/4/e73/ %U https://doi.org/10.2196/publichealth.7424 %U http://www.ncbi.nlm.nih.gov/pubmed/29038092 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 3 %P e37 %T Comparison of Self-Reported Telephone Interviewing and Web-Based Survey Responses: Findings From the Second Australian Young and Well National Survey %A Milton,Alyssa C %A Ellis,Louise A %A Davenport,Tracey A %A Burns,Jane M %A Hickie,Ian B %+ Brain and Mind Centre, University of Sydney, 88 Mallet St, Camperdown, 2050, Australia, 61 2 9114 4011, alyssa.milton@sydney.edu.au %K survey methods %K youth %K mental health %K online behaviors %K information disclosure %D 2017 %7 26.09.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Web-based self-report surveying has increased in popularity, as it can rapidly yield large samples at a low cost. Despite this increase in popularity, in the area of youth mental health, there is a distinct lack of research comparing the results of Web-based self-report surveys with the more traditional and widely accepted computer-assisted telephone interviewing (CATI). Objective: The Second Australian Young and Well National Survey 2014 sought to compare differences in respondent response patterns using matched items on CATI versus a Web-based self-report survey. The aim of this study was to examine whether responses varied as a result of item sensitivity, that is, the item’s susceptibility to exaggeration on underreporting and to assess whether certain subgroups demonstrated this effect to a greater extent. Methods: A subsample of young people aged 16 to 25 years (N=101), recruited through the Second Australian Young and Well National Survey 2014, completed the identical items on two occasions: via CATI and via Web-based self-report survey. Respondents also rated perceived item sensitivity. Results: When comparing CATI with the Web-based self-report survey, a Wilcoxon signed-rank analysis showed that respondents answered 14 of the 42 matched items in a significantly different way. Significant variation in responses (CATI vs Web-based) was more frequent if the item was also rated by the respondents as highly sensitive in nature. Specifically, 63% (5/8) of the high sensitivity items, 43% (3/7) of the neutral sensitivity items, and 0% (0/4) of the low sensitivity items were answered in a significantly different manner by respondents when comparing their matched CATI and Web-based question responses. The items that were perceived as highly sensitive by respondents and demonstrated response variability included the following: sexting activities, body image concerns, experience of diagnosis, and suicidal ideation. For high sensitivity items, a regression analysis showed respondents who were male (beta=−.19, P=.048) or who were not in employment, education, or training (NEET; beta=−.32, P=.001) were significantly more likely to provide different responses on matched items when responding in the CATI as compared with the Web-based self-report survey. The Web-based self-report survey, however, demonstrated some evidence of avidity and attrition bias. Conclusions: Compared with CATI, Web-based self-report surveys are highly cost-effective and had higher rates of self-disclosure on sensitive items, particularly for respondents who identify as male and NEET. A drawback to Web-based surveying methodologies, however, includes the limited control over avidity bias and the greater incidence of attrition bias. These findings have important implications for further development of survey methods in the area of health and well-being, especially when considering research topics (in this case diagnosis, suicidal ideation, sexting, and body image) and groups that are being recruited (young people, males, and NEET). %M 28951382 %R 10.2196/mental.8222 %U http://mental.jmir.org/2017/3/e37/ %U https://doi.org/10.2196/mental.8222 %U http://www.ncbi.nlm.nih.gov/pubmed/28951382 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e293 %T Comparing Inpatient Satisfaction Collected via a Web-Based Questionnaire Self-Completion and Through a Telephone Interview: An Ancillary Study of the SENTIPAT Randomized Controlled Trial %A Feldman,Sarah F %A Lapidus,Nathanael %A Cosnes,Jacques %A Tiret,Emmanuel %A Fonquernie,Laurent %A Cabane,Jean %A Chazouilleres,Olivier %A Surgers,Laure %A Beaussier,Marc %A Valleron,Alain-Jacques %A Carrat,Fabrice %A Hejblum,Gilles %+ Institut Pierre Louis d’Épidémiologie et de Santé Publique, Unité Mixte de Recherche en Santé 1136, Sorbonne Universités, Université Pierre et Marie Curie, Institut National de la Santé et de la Recherche Médicale, 27 rue Chaligny, Paris, 75012, France, 33 149283228, gilles.hejblum@inserm.fr %K hospital information systems %K Internet %K patient satisfaction %K quality of health care %K questionnaires and surveys %K patient reported outcome measures %K telephone %D 2017 %7 23.08.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Assessing the satisfaction of patients about the health care they have received is relatively common nowadays. In France, the satisfaction questionnaire, I-Satis, is deployed in each institution admitting inpatients. Internet self-completion and telephone interview are the two modes of administration for collecting inpatient satisfaction that have never been compared in a multicenter randomized experiment involving a substantial number of patients. Objective: The objective of this study was to compare two modes of survey administration for collecting inpatient satisfaction: Internet self-completion and telephone interview. Methods: In the multicenter SENTIPAT (acronym for the concept of sentinel patients, ie, patients who would voluntarily report their health evolution on a dedicated website) randomized controlled trial, patients who were discharged from the hospital to home and had an Internet connection at home were enrolled between February 2013 and September 2014. They were randomized to either self-complete a set of questionnaires using a dedicated website or to provide answers to the same questionnaires administered during a telephone interview. As recommended by French authorities, the analysis of I-Satis satisfaction questionnaire involved all inpatients with a length of stay (LOS), including at least two nights. Participation rates, questionnaire consistency (measured using Cronbach alpha coefficient), and satisfaction scores were compared in the two groups. Results: A total of 1680 eligible patients were randomized to the Internet group (n=840) or the telephone group (n=840). The analysis of I-Satis concerned 392 and 389 patients fulfilling the minimum LOS required in the Internet and telephone group, respectively. There were 39.3% (154/392) and 88.4% (344/389) responders in the Internet and telephone group, respectively (P<.001), with similar baseline variables. Internal consistency of the global satisfaction score was higher (P=.03) in the Internet group (Cronbach alpha estimate=.89; 95% CI 0.86-0.91) than in the telephone group (Cronbach alpha estimate=.84; 95% CI 0.79-0.87). The mean global satisfaction score was lower (P=.03) in the Internet group (68.9; 95% CI 66.4-71.4) than in the telephone group (72.1; 95% CI 70.4-74.6), with a corresponding effect size of the difference at −0.253. Conclusions: The lower response rate issued from Internet administration should be balanced with a likely improved quality in satisfaction estimates, when compared with telephone administration, for which an interviewer effect cannot be excluded. Trial Registration: Clinicaltrials.gov NCT01769261 ; http://clinicaltrials.gov/ct2/show/NCT01769261 (Archived by WebCite at http://www.webcitation.org/6ZDF5lA41) %M 28835354 %R 10.2196/jmir.7061 %U http://www.jmir.org/2017/8/e293/ %U https://doi.org/10.2196/jmir.7061 %U http://www.ncbi.nlm.nih.gov/pubmed/28835354 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e297 %T Validation Relaxation: A Quality Assurance Strategy for Electronic Data Collection %A Kenny,Avi %A Gordon,Nicholas %A Griffiths,Thomas %A Kraemer,John D %A Siedner,Mark J %+ Last Mile Health, 205 Portland St #200, Boston, MA, 02114, United States, 1 9143163681, akenny@lastmilehealth.org %K data accuracy %K data collection %K surveys %K survey methodology %K research methodology %K questionnaire design %K mHealth %K eHealth %D 2017 %7 18.08.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of mobile devices for data collection in developing world settings is becoming increasingly common and may offer advantages in data collection quality and efficiency relative to paper-based methods. However, mobile data collection systems can hamper many standard quality assurance techniques due to the lack of a hardcopy backup of data. Consequently, mobile health data collection platforms have the potential to generate datasets that appear valid, but are susceptible to unidentified database design flaws, areas of miscomprehension by enumerators, and data recording errors. Objective: We describe the design and evaluation of a strategy for estimating data error rates and assessing enumerator performance during electronic data collection, which we term “validation relaxation.” Validation relaxation involves the intentional omission of data validation features for select questions to allow for data recording errors to be committed, detected, and monitored. Methods: We analyzed data collected during a cluster sample population survey in rural Liberia using an electronic data collection system (Open Data Kit). We first developed a classification scheme for types of detectable errors and validation alterations required to detect them. We then implemented the following validation relaxation techniques to enable data error conduct and detection: intentional redundancy, removal of “required” constraint, and illogical response combinations. This allowed for up to 11 identifiable errors to be made per survey. The error rate was defined as the total number of errors committed divided by the number of potential errors. We summarized crude error rates and estimated changes in error rates over time for both individuals and the entire program using logistic regression. Results: The aggregate error rate was 1.60% (125/7817). Error rates did not differ significantly between enumerators (P=.51), but decreased for the cohort with increasing days of application use, from 2.3% at survey start (95% CI 1.8%-2.8%) to 0.6% at day 45 (95% CI 0.3%-0.9%; OR=0.969; P<.001). The highest error rate (84/618, 13.6%) occurred for an intentional redundancy question for a birthdate field, which was repeated in separate sections of the survey. We found low error rates (0.0% to 3.1%) for all other possible errors. Conclusions: A strategy of removing validation rules on electronic data capture platforms can be used to create a set of detectable data errors, which can subsequently be used to assess group and individual enumerator error rates, their trends over time, and categories of data collection that require further training or additional quality control measures. This strategy may be particularly useful for identifying individual enumerators or systematic data errors that are responsive to enumerator training and is best applied to questions for which errors cannot be prevented through training or software design alone. Validation relaxation should be considered as a component of a holistic data quality assurance strategy. %M 28821474 %R 10.2196/jmir.7813 %U http://www.jmir.org/2017/8/e297/ %U https://doi.org/10.2196/jmir.7813 %U http://www.ncbi.nlm.nih.gov/pubmed/28821474 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e249 %T Adherence to Web-Based Self-Assessments in Long-Term Direct-to-Patient Research: Two-Year Study of Multiple Sclerosis Patients %A Jongen,Peter Joseph %A Kremer,Ingrid E.H %A Hristodorova,Elena %A Evers,Silvia M.A.A %A Kool,Anton %A van Noort,Esther M %A Hiligsmann,Mickaël %+ Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, Groningen, 9713 AV, Netherlands, 31 2432 ext 3146, p.j.h.jongen@rug.nl %K Internet %K patients %K multiple sclerosis %K surveys and questionnaires %K self-assessment %K patient compliance %K quality of life %D 2017 %7 21.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Direct-to-patient research via Web-based questionnaires is increasingly being used. Missed data or delayed reporting of data may negatively affect the quality of study results. It is insufficiently known to what degree patients adhere to agreed self-assessment schedule over the long term and whether questionnaires are filled out in a timely manner. Objective: The objective of this study was to investigate patients’ adherence to a self-assessment schedule with low-frequency long questionnaires versus that with a high-frequency short questionnaire. Methods: In this study, the 36-item MS Impact Profile (MSIP) questionnaire measured (perceived) disabilities and the 54-item MS Quality of Life-54 (MSQoL-54) questionnaire measured health-related quality of life at 6-month intervals. Additionally, the 2-item Medication and Adherence (MA) questionnaire documented medication and adherence to disease-modifying medication every month. An experienced MS nurse assessed the Expanded Disability Status Scale (EDSS) score via phone. For both the self-assessment schedules, we calculated the percentage of patients who had completed all the questionnaires in the first 2 years (completion adherence), the percentage of patients who completed all the questionnaires within set time frames (interval adherence), the relationship between adherence and the EDSS score, and the timing of EDSS assessment. Results: Of the 331 patients who enrolled themselves, 301 patients completed at least one questionnaire. At month six (M6), M12, M18, and M24, the MSIP was completed by 83.4% (251/301), 71.8% (216/301), 68.1% (205/301), and 58.5% (176/301) of the patients, respectively; the MSQoL-54 by 82.1% (247/301), 71.8% (216/301), 66.8% (201/301), and 57.1% (172/301), respectively; and the MA questionnaire by 80.1% (241/301), 70.4% (212/301), 62.1% (187/301), and 53.5% (161/301), respectively. For the MSIP, 56.8% (171/301) of the patients were 2-year completion adherent; 55.5% (167/301) and 53.5% (161/301) of the patients were completion adherent for the MSQoL-54 and MA questionnaires, respectively. Whereas 85.5% (142/166) of the patients were interval adherent for the MSIP and MSQoL-54, 25.5% (41/161) were interval adherent for the MA questionnaire, with 73.9% (119/161) exceeding the maximum MA monthly interassessment interval. Completion adherence for the monthly short MA questionnaire was higher in patients with moderately high disability (EDSS 5.0-5.5) than for those with no or minimal disability (EDSS 0-2.5) (OR 5.47, 95% CI 1.08-27.69; P=.040). Completion adherence was also higher in patients with EDSS assessment within 6 months after baseline than in those with later assessment (OR 1.810, 95% CI 0.999-3.280; P=.050). Conclusions: The 2-year completion adherence to Web-based self-assessments did not differ between the low-frequency long questionnaires and a high-frequency short questionnaire, but the interval adherence was substantially higher for the low-frequency long questionnaires. Personal contact with a member of the research team regarding a clinically relevant professional-reported outcome early in the study might positively affect the long-term completion adherence in direct-to-patient studies. %M 28733272 %R 10.2196/jmir.6729 %U http://www.jmir.org/2017/7/e249/ %U https://doi.org/10.2196/jmir.6729 %U http://www.ncbi.nlm.nih.gov/pubmed/28733272 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 2 %N 2 %P e11 %T Assessing Diabetes-Relevant Data Provided by Undergraduate and Crowdsourced Web-Based Survey Participants for Honesty and Accuracy %A DePalma,Mary Turner %A Rizzotti,Michael C %A Branneman,Matthew %+ Ithaca College, Department of Psychology, 119F Williams Hall, 953 Danby Road, Ithaca, NY, 14850, United States, 1 607 274 1323, depalma@ithaca.edu %K crowdsourcing %K diabetes mellitus %K survey design %K survey methodology %K survey quality %K mechanical turks %K MTurk %K data accuracy %D 2017 %7 12.07.2017 %9 Original Paper %J JMIR Diabetes %G English %X Background: To eliminate health disparities, research will depend on our ability to reach select groups of people (eg, samples of a particular racial or ethnic group with a particular disease); unfortunately, researchers often experience difficulty obtaining high-quality data from samples of sufficient size. Objective: Past studies utilizing MTurk applaud its diversity, so our initial objective was to capitalize on MTurk’s diversity to investigate psychosocial factors related to diabetes self-care. Methods: In Study 1, a “Health Survey” was posted on MTurk to examine diabetes-relevant psychosocial factors. The survey was restricted to individuals who were 18 years of age or older with diabetes. Detection of irregularities in the data, however, prompted an evaluation of the quality of MTurk health-relevant data. This ultimately led to Study 2, which utilized an alert statement to improve conscientious behavior, or the likelihood that participants would be thorough and diligent in their responses. Trap questions were also embedded to assess conscientious behavior. Results: In Study 1, of 4165 responses, 1246 were generated from 533 unique IP addresses completing the survey multiple times within close temporal proximity. Ultimately, only 252 responses were found to be acceptable. Further analyses indicated additional quality concerns with this subsample. In Study 2, as compared with the MTurk sample (N=316), the undergraduate sample (N=300) included more females, and fewer individuals who were married. The samples did not differ with respect to race. Although the presence of an alert resulted in fewer trap failures (mean=0.07) than when no alert was present (mean=0.11), this difference failed to reach significance: F1,604=2.5, P=.11, ƞ²=.004, power=.35. The modal trap failure response was zero, while the mean was 0.092 (SD=0.32). There were a total of 60 trap failures in a context where the potential could have exceeded 16,000. Conclusions: Published studies that utilize MTurk participants are rapidly appearing in the health domain. While MTurk may have the potential to be more diverse than an undergraduate sample, our efforts did not meet the criteria for what would constitute a diverse sample in and of itself. Because some researchers have experienced successful data collection on MTurk, while others report disastrous results, Kees et al recently identified that one essential area of research is of the types and magnitude of cheating behavior occurring on Web-based platforms. The present studies can contribute to this dialogue, and alternately provide evidence of disaster and success. Moving forward, it is recommended that researchers employ best practices in survey design and deliberately embed trap questions to assess participant behavior. We would strongly suggest that standards be in place for publishing the results of Web-based surveys—standards that protect against publication unless there are suitable quality assurance tests built into the survey design, distribution, and analysis. %M 30291072 %R 10.2196/diabetes.7473 %U http://diabetes.jmir.org/2017/2/e11/ %U https://doi.org/10.2196/diabetes.7473 %U http://www.ncbi.nlm.nih.gov/pubmed/30291072 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e207 %T Interactive Voice Response System: Data Considerations and Lessons Learned During a Rectal Microbicide Placebo Adherence Trial for Young Men Who Have Sex With Men %A Bauermeister,Jose %A Giguere,Rebecca %A Leu,Cheng-Shiun %A Febo,Irma %A Cranston,Ross %A Mayer,Kenneth %A Carballo-Diéguez,Alex %+ Department of Family and Community Health, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Suite 402, Philadelphia, PA, 19104, United States, 1 2158989993, bjose@nursing.upenn.edu %K user-computer interface %K speech recognition software %K HIV %K survey methodology %D 2017 %7 09.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Rectal microbicides, if proven effective, may aid in reducing human immunodeficiency virus (HIV) incidence; however, demonstration of efficacy and effectiveness is contingent on accurate measurement of product adherence. Delays in self-report, in particular, may affect the accuracy of behavioral data. Objective: The aim of this study was to capitalize on mobile phone use by young men who have sex with men (YMSM), and examine the use of an interactive voice response system (IVRS) by YMSM aged 18-30 years enrolled in a multisite, 12-week microbicide safety and acceptability trial. Methods: YMSM (N=95) enrolled across 3 sites (Boston, Pittsburgh, and San Juan) were asked to report their use of an applicator applied placebo rectal gel product during receptive anal intercourse (RAI) using the IVRS. IVRS was available in Spanish and English. After the 12-week trial, we examined whether IVRS problems were associated with YMSM’s sociodemographic characteristics (eg, age, race and ethnicity, and education), sexual behavior, or recruitment site. We used a multinomial logistic regression to compare YMSM who experienced no IVRS problems (n=40) with those who reported one IVRS problem (n=25) or two or more IVRS problems (n=30). Results: We recorded 1494 IVRS calls over 12 weeks. Over half of the participants (55/95; 58%) experienced challenges using the IVRS during the 12-week trial. YMSM reporting greater RAI occasions during the trial were more likely to experience one (odds ratio [OR]=1.08, 95% CI (1.02-1.14); P ≤.01) or more (OR=1.10, 95% CI (1.03-1.16); P ≤.001) IVRS challenges. Greater educational attainment was associated with multiple IVRS challenges (OR=7.08, 95% CI (1.6-31.6); P ≤.01). Participants in the Puerto Rico site were most likely to report multiple IVRS problems. Conclusions: Although IVRS was a useful data collection technology in our trial, several challenges experienced by English and Spanish speaking YMSM diminish its overall acceptability. We discuss strategies to optimize future development of IVRS data quality protocols based on lessons learned. %M 28600275 %R 10.2196/jmir.7682 %U http://www.jmir.org/2017/6/e207/ %U https://doi.org/10.2196/jmir.7682 %U http://www.ncbi.nlm.nih.gov/pubmed/28600275 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e140 %T Building the Evidence Base for Remote Data Collection in Low- and Middle-Income Countries: Comparing Reliability and Accuracy Across Survey Modalities %A Greenleaf,Abigail R %A Gibson,Dustin G %A Khattar,Christelle %A Labrique,Alain B %A Pariyo,George W %+ Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, 615 N Wolfe Street, Baltimore, MD, 21205, United States, 1 410 955 3543, agreenleaf@jhu.edu %K mHealth %K developing countries %K Africa South of the Sahara %K cell phones %K health surveys %K reproducibility of results %K surveys and questionnaires %K text messaging %K interviews as topic %K humans %K research design %K data collection methods %D 2017 %7 05.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the growing interest in mobile data collection due to the proliferation of mobile phone ownership and network coverage in low- and middle-income countries (LMICs), we synthesized the evidence comparing estimates of health outcomes from multiple modes of data collection. In particular, we reviewed studies that compared a mode of remote data collection with at least one other mode of data collection to identify mode effects and areas for further research. Objective: The study systematically reviewed and summarized the findings from articles and reports that compare a mode of remote data collection to at least one other mode. The aim of this synthesis was to assess the reliability and accuracy of results. Methods: Seven online databases were systematically searched for primary and grey literature pertaining to remote data collection in LMICs. Remote data collection included interactive voice response (IVR), computer-assisted telephone interviews (CATI), short message service (SMS), self-administered questionnaires (SAQ), and Web surveys. Two authors of this study reviewed the abstracts to identify articles which met the primary inclusion criteria. These criteria required that the survey collected the data from the respondent via mobile phone or landline. Articles that met the primary screening criteria were read in full and were screened using secondary inclusion criteria. The four secondary inclusion criteria were that two or more modes of data collection were compared, at least one mode of data collection in the study was a mobile phone survey, the study had to be conducted in a LMIC, and finally, the study should include a health component. Results: Of the 11,568 articles screened, 10 articles were included in this study. Seven distinct modes of remote data collection were identified: CATI, SMS (singular sitting and modular design), IVR, SAQ, and Web surveys (mobile phone and personal computer). CATI was the most frequent remote mode (n=5 articles). Of the three in-person modes (face-to-face [FTF], in-person SAQ, and in-person IVR), FTF was the most common (n=11) mode. The 10 articles made 25 mode comparisons, of which 12 comparisons were from a single article. Six of the 10 articles included sensitive questions. Conclusions: This literature review summarizes the existing research about remote data collection in LMICs. Due to both heterogeneity of outcomes and the limited number of comparisons, this literature review is best positioned to present the current evidence and knowledge gaps rather than attempt to draw conclusions. In order to advance the field of remote data collection, studies that employ standardized sampling methodologies and study designs are necessary to evaluate the potential for differences by survey modality. %M 28476728 %R 10.2196/jmir.7331 %U http://www.jmir.org/2017/5/e140/ %U https://doi.org/10.2196/jmir.7331 %U http://www.ncbi.nlm.nih.gov/pubmed/28476728 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e137 %T Leveraging Mobile Phones for Monitoring Risks for Noncommunicable Diseases in the Future %A Ellis,Jennifer A %+ Bloomberg Philanthropies, 25 E 78th St., New York, NY,, United States, 1 212 205 0129, Jennifer@bloomberg.org %K mHealth %K low- and middle-income countries %K noncommunicable diseases %K health systems strengthening %D 2017 %7 05.05.2017 %9 Guest Editorial %J J Med Internet Res %G English %X %M 28476721 %R 10.2196/jmir.7622 %U http://www.jmir.org/2017/5/e137/ %U https://doi.org/10.2196/jmir.7622 %U http://www.ncbi.nlm.nih.gov/pubmed/28476721 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e129 %T Using mHealth to Predict Noncommunicable Diseases: A Public Health Opportunity for Low- and Middle-Income Countries %A Rosskam,Ellen %A Hyder,Adnan A %+ ER Global Consult, 34D Route du Prieur, Landecy, La Croix-de-Rozon, 1257, Switzerland, 41 223476846, ellenrosskam@gmail.com %K mHealth %K low- and middle-income countries %K noncommunicable diseases %K research agenda %K population health surveys %D 2017 %7 05.05.2017 %9 Editorial %J J Med Internet Res %G English %X %M 28476727 %R 10.2196/jmir.7593 %U http://www.jmir.org/2017/5/e129/ %U https://doi.org/10.2196/jmir.7593 %U http://www.ncbi.nlm.nih.gov/pubmed/28476727 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e139 %T Mobile Phone Surveys for Collecting Population-Level Estimates in Low- and Middle-Income Countries: A Literature Review %A Gibson,Dustin G %A Pereira,Amanda %A Farrenkopf,Brooke A %A Labrique,Alain B %A Pariyo,George W %A Hyder,Adnan A %+ Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 443 287 8763, dgibso28@jhu.edu %K survey methodology %K cellular phone %K interactive voice response %K short messages service %K computer-assisted telephone interview %K mobile phone surveys %D 2017 %7 05.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: National and subnational level surveys are important for monitoring disease burden, prioritizing resource allocation, and evaluating public health policies. As mobile phone access and ownership become more common globally, mobile phone surveys (MPSs) offer an opportunity to supplement traditional public health household surveys. Objective: The objective of this study was to systematically review the current landscape of MPSs to collect population-level estimates in low- and middle-income countries (LMICs). Methods: Primary and gray literature from 7 online databases were systematically searched for studies that deployed MPSs to collect population-level estimates. Titles and abstracts were screened on primary inclusion and exclusion criteria by two research assistants. Articles that met primary screening requirements were read in full and screened for secondary eligibility criteria. Articles included in review were grouped into the following three categories by their survey modality: (1) interactive voice response (IVR), (2) short message service (SMS), and (3) human operator or computer-assisted telephone interviews (CATI). Data were abstracted by two research assistants. The conduct and reporting of the review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: A total of 6625 articles were identified through the literature review. Overall, 11 articles were identified that contained 19 MPS (CATI, IVR, or SMS) surveys to collect population-level estimates across a range of topics. MPSs were used in Latin America (n=8), the Middle East (n=1), South Asia (n=2), and sub-Saharan Africa (n=8). Nine articles presented results for 10 CATI surveys (10/19, 53%). Two articles discussed the findings of 6 IVR surveys (6/19, 32%). Three SMS surveys were identified from 2 articles (3/19, 16%). Approximately 63% (12/19) of MPS were delivered to mobile phone numbers collected from previously administered household surveys. The majority of MPS (11/19, 58%) were panel surveys where a cohort of participants, who often were provided a mobile phone upon a face-to-face enrollment, were surveyed multiple times. Conclusions: Very few reports of population-level MPS were identified. Of the MPS that were identified, the majority of surveys were conducted using CATI. Due to the limited number of identified IVR and SMS surveys, the relative advantages and disadvantages among the three survey modalities cannot be adequately assessed. The majority of MPS were sent to mobile phone numbers that were collected from a previously administered household survey. There is limited evidence on whether a random digit dialing (RDD) approach or a simple random sample of mobile network provided list of numbers can produce a population representative survey. %M 28476725 %R 10.2196/jmir.7428 %U http://www.jmir.org/2017/5/e139/ %U https://doi.org/10.2196/jmir.7428 %U http://www.ncbi.nlm.nih.gov/pubmed/28476725 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e112 %T The Development of an Interactive Voice Response Survey for Noncommunicable Disease Risk Factor Estimation: Technical Assessment and Cognitive Testing %A Gibson,Dustin G %A Farrenkopf,Brooke A %A Pereira,Amanda %A Labrique,Alain B %A Pariyo,George William %+ Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 N Wolfe St, Baltimore, MD, 21231, United States, 1 4432878763, dgibso28@jhu.edu %K interactive voice response %K noncommunicable disease %K survey methodology %K public health surveillance %K cellular phone %K risk factors %D 2017 %7 05.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The rise in mobile phone ownership in low- and middle-income countries (LMICs) presents an opportunity to transform existing data collection and surveillance methods. Administering surveys via interactive voice response (IVR) technology—a mobile phone survey (MPS) method—has potential to expand the current surveillance coverage and data collection, but formative work to contextualize the survey for LMIC deployment is needed. Objective: The primary objectives of this study were to (1) cognitively test and identify challenging questions in a noncommunicable disease (NCD) risk factor questionnaire administered via an IVR platform and (2) assess the usability of the IVR platform. Methods: We conducted two rounds of pilot testing the IVR survey in Baltimore, MD. Participants were included in the study if they identified as being from an LMIC. The first round included individual interviews to cognitively test the participant’s understanding of the questions. In the second round, participants unique from those in round 1 were placed in focus groups and were asked to comment on the usability of the IVR platform. Results: A total of 12 participants from LMICs were cognitively tested in round 1 to assess their understanding and comprehension of questions in an IVR-administered survey. Overall, the participants found that the majority of the questions were easy to understand and did not have difficulty recording most answers. The most frequent recommendation was to use country-specific examples and units of measurement. In round 2, a separate set of 12 participants assessed the usability of the IVR platform. Overall, participants felt that the length of the survey was appropriate (average: 18 min and 31 s), but the majority reported fatigue in answering questions that had a similar question structure. Almost all participants commented that they thought an IVR survey would lead to more honest, accurate responses than face-to-face questionnaires, especially for sensitive topics. Conclusions: Overall, the participants indicated a clear comprehension of the IVR-administered questionnaire and that the IVR platform was user-friendly. Formative research and cognitive testing of the questionnaire is needed for further adaptation before deploying in an LMIC. %M 28476724 %R 10.2196/jmir.7340 %U http://www.jmir.org/2017/5/e112/ %U https://doi.org/10.2196/jmir.7340 %U http://www.ncbi.nlm.nih.gov/pubmed/28476724 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e121 %T Health Surveys Using Mobile Phones in Developing Countries: Automated Active Strata Monitoring and Other Statistical Considerations for Improving Precision and Reducing Biases %A Labrique,Alain %A Blynn,Emily %A Ahmed,Saifuddin %A Gibson,Dustin %A Pariyo,George %A Hyder,Adnan A %+ Johns Hopkins Bloomberg School of Public Health, Department of International Health, W5501, Johns Hopkins Bloomberg SPH, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 4102361568, alabriqu@jhsph.edu %K surveys and questionnaires %K sampling studies %K mobile health %K mobile phone %K research methodology %D 2017 %7 05.05.2017 %9 Policy Proposal %J J Med Internet Res %G English %X In low- and middle-income countries (LMICs), historically, household surveys have been carried out by face-to-face interviews to collect survey data related to risk factors for noncommunicable diseases. The proliferation of mobile phone ownership and the access it provides in these countries offers a new opportunity to remotely conduct surveys with increased efficiency and reduced cost. However, the near-ubiquitous ownership of phones, high population mobility, and low cost require a re-examination of statistical recommendations for mobile phone surveys (MPS), especially when surveys are automated. As with landline surveys, random digit dialing remains the most appropriate approach to develop an ideal survey-sampling frame. Once the survey is complete, poststratification weights are generally applied to reduce estimate bias and to adjust for selectivity due to mobile ownership. Since weights increase design effects and reduce sampling efficiency, we introduce the concept of automated active strata monitoring to improve representativeness of the sample distribution to that of the source population. Although some statistical challenges remain, MPS represent a promising emerging means for population-level data collection in LMICs. %M 28476726 %R 10.2196/jmir.7329 %U http://www.jmir.org/2017/5/e121/ %U https://doi.org/10.2196/jmir.7329 %U http://www.ncbi.nlm.nih.gov/pubmed/28476726 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 5 %P e81 %T Evaluation of Mechanisms to Improve Performance of Mobile Phone Surveys in Low- and Middle-Income Countries: Research Protocol %A Gibson,Dustin G %A Pariyo,George William %A Wosu,Adaeze C %A Greenleaf,Abigail R %A Ali,Joseph %A Ahmed,Saifuddin %A Labrique,Alain B %A Islam,Khaleda %A Masanja,Honorati %A Rutebemberwa,Elizeus %A Hyder,Adnan A %+ Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 443 287 8763, dgibso28@jhu.edu %K IVR %K CATI %K Bangladesh %K Tanzania %K Uganda %K mHealth %K mobile phone survey %K noncommunicable diseases %K survey methodology %D 2017 %7 05.05.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mobile phone ownership and access have increased rapidly across low- and middle-income countries (LMICs) within the last decade. Concomitantly, LMICs are experiencing demographic and epidemiologic transitions, where non-communicable diseases (NCDs) are increasingly becoming leading causes of morbidity and mortality. Mobile phone surveys could aid data collection for prevention and control of these NCDs but limited evidence of their feasibility exists. Objective: The objective of this paper is to describe a series of sub-studies aimed at optimizing the delivery of interactive voice response (IVR) and computer-assisted telephone interviews (CATI) for NCD risk factor data collection in LMICs. These sub-studies are designed to assess the effect of factors such as airtime incentive timing, amount, and structure, survey introduction characteristics, different sampling frames, and survey modality on key survey metrics, such as survey response, completion, and attrition rates. Methods: In a series of sub-studies, participants will be randomly assigned to receive different airtime incentive amounts (eg, 10 minutes of airtime versus 20 minutes of airtime), different incentive delivery timings (airtime delivered before survey begins versus delivery upon completion of survey), different survey introductions (informational versus motivational), different narrative voices (male versus female), and different sampling frames (random digit dialing versus mobile network operator-provided numbers) to examine which study arms will yield the highest response and completion rates. Furthermore, response and completion rates and the inter-modal reliability of the IVR and CATI delivery methods will be compared. Results: Research activities are expected to be completed in Bangladesh, Tanzania, and Uganda in 2017. Conclusions: This is one of the first studies to examine the feasibility of using IVR and CATI for systematic collection of NCD risk factor information in LMICs. Our findings will inform the future design and implementation of mobile phone surveys in LMICs. %M 28476729 %R 10.2196/resprot.7534 %U http://www.researchprotocols.org/2017/5/e81/ %U https://doi.org/10.2196/resprot.7534 %U http://www.ncbi.nlm.nih.gov/pubmed/28476729 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e110 %T Ethics Considerations in Global Mobile Phone-Based Surveys of Noncommunicable Diseases: A Conceptual Exploration %A Ali,Joseph %A Labrique,Alain B %A Gionfriddo,Kara %A Pariyo,George %A Gibson,Dustin G %A Pratt,Bridget %A Deutsch-Feldman,Molly %A Hyder,Adnan A %+ Berman Institute of Bioethics, Johns Hopkins University, Rm 208, 1809 Ashland Avenue, Baltimore, MD, 21205, United States, 1 410 614 5370, jali@jhu.edu %K ethics %K mobile phone survey %K mHealth %K noncommunicable diseases %K research ethics %K bioethics %D 2017 %7 05.05.2017 %9 Viewpoint %J J Med Internet Res %G English %X Mobile phone coverage has grown, particularly within low- and middle-income countries (LMICs), presenting an opportunity to augment routine health surveillance programs. Several LMICs and global health partners are seeking opportunities to launch basic mobile phone–based surveys of noncommunicable diseases (NCDs). The increasing use of such technology in LMICs brings forth a cluster of ethical challenges; however, much of the existing literature regarding the ethics of mobile or digital health focuses on the use of technologies in high-income countries and does not consider directly the specific ethical issues associated with the conduct of mobile phone surveys (MPS) for NCD risk factor surveillance in LMICs. In this paper, we explore conceptually several of the central ethics issues in this domain, which mainly track the three phases of the MPS process: predata collection, during data collection, and postdata collection. These include identifying the nature of the activity; stakeholder engagement; appropriate design; anticipating and managing potential harms and benefits; consent; reaching intended respondents; data ownership, access and use; and ensuring LMIC sustainability. We call for future work to develop an ethics framework and guidance for the use of mobile phones for disease surveillance globally. %M 28476723 %R 10.2196/jmir.7326 %U http://www.jmir.org/2017/5/e110/ %U https://doi.org/10.2196/jmir.7326 %U http://www.ncbi.nlm.nih.gov/pubmed/28476723 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e115 %T Moving the Agenda on Noncommunicable Diseases: Policy Implications of Mobile Phone Surveys in Low and Middle-Income Countries %A Pariyo,George W %A Wosu,Adaeze C %A Gibson,Dustin G %A Labrique,Alain B %A Ali,Joseph %A Hyder,Adnan A %+ Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 North Wolfe Street E 8648, Baltimore, MD, 21205, United States, 1 410 502 5790, gpariyo1@jhu.edu %K NCDs %K policy %K mHealth %K policy analysis %K surveys %D 2017 %7 05.05.2017 %9 Viewpoint %J J Med Internet Res %G English %X The growing burden of noncommunicable diseases (NCDs), for example, cardiovascular diseases and chronic respiratory diseases, in low- and middle-income countries (LMICs) presents special challenges for policy makers, due to resource constraints and lack of timely data for decision-making. Concurrently, the increasing ubiquity of mobile phones in LMICs presents possibilities for rapid collection of population-based data to inform the policy process. The objective of this paper is to highlight potential benefits of mobile phone surveys (MPS) for developing, implementing, and evaluating NCD prevention and control policies. To achieve this aim, we first provide a brief overview of major global commitments to NCD prevention and control, and subsequently explore how countries can translate these commitments into policy action at the national level. Using the policy cycle as our frame of reference, we highlight potential benefits of MPS which include (1) potential cost-effectiveness of using MPS to inform NCD policy actions compared with using traditional household surveys; (2) timeliness of assessments to feed into policy and planning cycles; (3) tracking progress of interventions, hence assessment of reach, coverage, and distribution; (4) better targeting of interventions, for example, to high-risk groups; (5) timely course correction for suboptimal or non-effective interventions; (6) assessing fairness in financial contribution and financial risk protection for those affected by NCDs in the spirit of universal health coverage (UHC); and (7) monitoring progress in reducing catastrophic medical expenditure due to chronic health conditions in general, and NCDs in particular. We conclude that MPS have potential to become a powerful data collection tool to inform policies that address public health challenges such as NCDs. Additional forthcoming assessments of MPS in LMICs will inform opportunities to maximize this technology. %M 28476720 %R 10.2196/jmir.7302 %U http://www.jmir.org/2017/5/e115/ %U https://doi.org/10.2196/jmir.7302 %U http://www.ncbi.nlm.nih.gov/pubmed/28476720 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e133 %T Noncommunicable Disease Risk Factors and Mobile Phones: A Proposed Research Agenda %A Hyder,Adnan A %A Wosu,Adaeze C %A Gibson,Dustin G %A Labrique,Alain B %A Ali,Joseph %A Pariyo,George W %+ Johns Hopkins Bloomberg School of Public Health, Department of International Health, 615 North Wolfe Street, Suite E8132, Baltimore, MD, 21205, United States, 1 410 502 8947, ahyder1@jhu.edu %K mHealth %K noncommunicable disease %K mobile phone %K research agenda %K survey %D 2017 %7 05.05.2017 %9 Viewpoint %J J Med Internet Res %G English %X Noncommunicable diseases (NCDs) account for two-thirds of all deaths globally, with 75% of these occurring in low- and middle-income countries (LMICs). Many LMICs seek cost-effective methods to obtain timely and quality NCD risk factor data that could inform resource allocation, policy development, and assist evaluation of NCD trends over time. Over the last decade, there has been a proliferation of mobile phone ownership and access in LMICs, which, if properly harnessed, has great potential to support risk factor data collection. As a supplement to traditional face-to-face surveys, the ubiquity of phone ownership has made large proportions of most populations reachable through cellular networks. However, critical gaps remain in understanding the ways by which mobile phone surveys (MPS) could aid in collection of NCD data in LMICs. Specifically, limited information exists on the optimization of these surveys with regard to incentives and structure, comparative effectiveness of different MPS modalities, and key ethical, legal, and societal issues (ELSI) in the development, conduct, and analysis of these surveys in LMIC settings. We propose a research agenda that could address important knowledge gaps in optimizing MPS for the collection of NCD risk factor data in LMICs and provide an example of a multicountry project where elements of that agenda aim to be integrated over the next two years. %M 28476722 %R 10.2196/jmir.7246 %U http://www.jmir.org/2017/5/e133/ %U https://doi.org/10.2196/jmir.7246 %U http://www.ncbi.nlm.nih.gov/pubmed/28476722 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 4 %P e66 %T Establishing Linkages Between Distributed Survey Responses and Consumer Wearable Device Datasets: A Pilot Protocol %A Brinton,Julia E %A Keating,Mike D %A Ortiz,Alexa M %A Evenson,Kelly R %A Furberg,Robert D %+ RTI International, 3040 E Cornwallis Dr, Durham, NC, 27709, United States, 1 919 485 5613, jbrinton@rti.org %K Fitbit %K Mturk %K mHealth %K clinical research protocol %K consumer wearable %K physical activity tracker %D 2017 %7 27.04.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: As technology increasingly becomes an integral part of everyday life, many individuals are choosing to use wearable technology such as activity trackers to monitor their daily physical activity and other health-related goals. Researchers would benefit from learning more about the health of these individuals remotely, without meeting face-to-face with participants and avoiding the high cost of providing consumer wearables to participants for the study duration. Objective: The present study seeks to develop the methods to collect data remotely and establish a linkage between self-reported survey responses and consumer wearable device biometric data, ultimately producing a de-identified and linked dataset. Establishing an effective protocol will allow for future studies of large-scale deployment and participant management. Methods: A total of 30 participants who use a Fitbit will be recruited on Mechanical Turk Prime and asked to complete a short online self-administered questionnaire. They will also be asked to connect their personal Fitbit activity tracker to an online third-party software system, called Fitabase, which will allow access to 1 month’s retrospective data and 1 month’s prospective data, both from the date of consent. Results: The protocol will be used to create and refine methods to establish linkages between remotely sourced and de-identified survey responses on health status and consumer wearable device data. Conclusions: The refinement of the protocol will inform collection and linkage of similar datasets at scale, enabling the integration of consumer wearable device data collection in cross-sectional and prospective cohort studies. %M 28450274 %R 10.2196/resprot.6513 %U http://www.researchprotocols.org/2017/4/e66/ %U https://doi.org/10.2196/resprot.6513 %U http://www.ncbi.nlm.nih.gov/pubmed/28450274 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 4 %P e61 %T Using Mobile Phones to Collect Patient Data: Lessons Learned From the SIMPle Study %A Duane,Sinead %A Tandan,Meera %A Murphy,Andrew W %A Vellinga,Akke %+ Discipline of General Practice, National University of Ireland Galway, 1 Distillery Road, Galway,, Ireland, 353 91493855, sinead.duane@nuigalway.ie %K mobile phone apps %K mobile survey %K antimicrobial resistance %K primary care %K quantitative %K prescribing %K urinary tract infection %D 2017 %7 25.04.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Mobile phones offer new opportunities to efficiently and interactively collect real-time data from patients with acute illnesses, such as urinary tract infections (UTIs). One of the main benefits of using mobile data collection methods is automated data upload, which can reduce the chance of data loss, an issue when using other data collection methods such as paper-based surveys. Objective: The aim was to explore differences in collecting data from patients with UTI using text messaging, a mobile phone app (UTI diary), and an online survey. This paper provides lessons learned from integrating mobile data collection into a randomized controlled trial. Methods: Participants included UTI patients consulting in general practices that were participating in the Supporting the Improvement and Management of UTI (SIMPle) study. SIMPle was designed to improve prescribing antimicrobial therapies for UTI in the community. Patients were invited to reply to questions regarding their UTI either via a prospective text message survey, a mobile phone app (UTI diary), or a retrospective online survey. Data were collected from 329 patients who opted in to the text message survey, 71 UTI patients through the mobile phone UTI symptom diary app, and 91 online survey participants. Results: The age profile of UTI diary app users was younger than that of the text message and online survey users. The largest dropout for both the text message survey respondents and UTI diary app users was after the initial opt-in message; once the participants completed question 1 of the text message survey or day 2 in the UTI diary app, they were more likely to respond to the remaining questions/days. Conclusions: This feasibility study highlights the potential of using mobile data collection methods to capture patient data. As well as improving the efficiency of data collection, these novel approaches highlight the advantage of collecting data in real time across multiple time points. There was little variation in the number of patients responding between text message survey, UTI diary, and online survey, but more patients participated in the text message survey than the UTI diary app. The choice between designing a text message survey or UTI diary app will depend on the age profile of patients and the type of information the researchers’ desire. Trial Registration: ClinicalTrials.gov NCT01913860; https://clinicaltrials.gov/ct2/show/NCT01913860 (Archived by WebCite at http://www.webcitation.org/6pfgCztgT). %M 28442451 %R 10.2196/resprot.6389 %U http://www.researchprotocols.org/2017/4/e61/ %U https://doi.org/10.2196/resprot.6389 %U http://www.ncbi.nlm.nih.gov/pubmed/28442451 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e13 %T Gathering Opinions on Depression Information Needs and Preferences: Samples and Opinions in Clinic Versus Web-Based Surveys %A Bernstein,Matthew T %A Walker,John R %A Sexton,Kathryn A %A Katz,Alan %A Beatie,Brooke E %A , %+ Faculty of Health Sciences, Department of Clinical Health Psychology, University of Manitoba, M4 - St. Boniface Hospital, 409 Tache Ave, Winnipeg, MB, R2H 2A6, Canada, 1 204 955 9487, jwalker@cc.umanitoba.ca %K depression %K psychotherapy %K drug therapy %K Internet %K survey methodology %D 2017 %7 24.04.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: There has been limited research on the information needs and preferences of the public concerning treatment for depression. Very little research is available comparing samples and opinions when recruitment for surveys is done over the Web as opposed to a personal invitation to complete a paper survey. Objective: This study aimed to (1) to explore information needs and preferences among members of the public and (2) compare Clinic and Web samples on sample characteristics and survey findings. Methods: Web survey participants were recruited with a notice on three self-help association websites (N=280). Clinic survey participants were recruited by a research assistant in the waiting rooms of a family medicine clinic and a walk-in medical clinic (N=238) and completed a paper version of the survey. Results: The Clinic and Web samples were similar in age (39.0 years, SD 13.9 vs 40.2 years, SD 12.5, respectively), education, and proportion in full time employment. The Clinic sample was more diverse in demographic characteristics and closer to the demographic characteristics of the region (Winnipeg, Canada) with a higher proportion of males (102/238 [42.9%] vs 45/280 [16.1%]) and nonwhites (Aboriginal, Asian, and black) (69/238 [29.0%] vs 39/280 [13.9%]). The Web sample reported a higher level of emotional distress and had more previous psychological (224/280 [80.0%] vs 83/238 [34.9%]) and pharmacological (202/280 [72.1%] vs 57/238 [23.9%]) treatment. In terms of opinions, most respondents in both settings saw information on a wide range of topics around depression treatment as very important including information about treatment choices, effectiveness of treatment, how long it takes treatment to work, how long treatment continues, what happens when treatment stops, advantages and disadvantages of treatments, and potential side effects. Females, respondents with a white background, and those who had received or felt they would have benefited from therapy in the past saw more information topics as very important. Those who had received or thought they would have benefited in the past from medication treatment saw fewer topics as important. Participants in both groups expressed an interest in receiving information through discussion with a counselor or a physician, through written brochures, or through a recommended website. Conclusions: The recruitment strategies were helpful in obtaining opinions from members of the public with different concerns and perspectives, and the results from the two methods were complementary. Persons coping with emotional distress and individuals not specifically seeking help for depression would be interested in information to answer a wide range of important questions about depression treatment. The Clinic sample yielded more cultural diversity that is a closer match to the population. The Web sample was less costly to recruit and included persons who were most interested in receiving information. %M 28438729 %R 10.2196/mental.7231 %U http://mental.jmir.org/2017/2/e13/ %U https://doi.org/10.2196/mental.7231 %U http://www.ncbi.nlm.nih.gov/pubmed/28438729 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 3 %P e83 %T Rates, Delays, and Completeness of General Practitioners’ Responses to a Postal Versus Web-Based Survey: A Randomized Trial %A Sebo,Paul %A Maisonneuve,Hubert %A Cerutti,Bernard %A Fournier,Jean Pascal %A Senn,Nicolas %A Haller,Dagmar M %+ Primary Care Unit, Faculty of Medicine, University of Geneva, rue Michel-Servet 1, Geneva, 1211, Switzerland, 41 223488888, paulsebo@hotmail.com %K participation rate %K response time %K completeness %K survey methods %K primary care %D 2017 %7 22.03.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based surveys have become a new and popular method for collecting data, but only a few studies have directly compared postal and Web-based surveys among physicians, and none to our knowledge among general practitioners (GPs). Objective: Our aim is to compare two modes of survey delivery (postal and Web-based) in terms of participation rates, response times, and completeness of questionnaires in a study assessing GPs’ preventive practices. Methods: This randomized study was conducted in Western Switzerland (Geneva and Vaud) and in France (Alsace and Pays de la Loire) in 2015. A random selection of community-based GPs (1000 GPs in Switzerland and 2400 GPs in France) were randomly allocated to receive a questionnaire about preventive care activities either by post (n=700 in Switzerland, n=400 in France) or by email (n=300 in Switzerland, n=2000 in France). Reminder messages were sent once in the postal group and twice in the Web-based group. Any GPs practicing only complementary and alternative medicine were excluded from the study. Results: Among the 3400 contacted GPs, 764 (22.47%, 95% CI 21.07%-23.87%) returned the questionnaire. Compared to the postal group, the participation rate in the Web-based group was more than four times lower (246/2300, 10.70% vs 518/1100, 47.09%, P<.001), but median response time was much shorter (1 day vs 1-3 weeks, P<.001) and the number of GPs having fully completed the questionnaire was almost twice as high (157/246, 63.8% vs 179/518, 34.6%, P<.001). Conclusions: Web-based surveys offer many advantages such as reduced response time, higher completeness of data, and large cost savings, but our findings suggest that postal surveys can be still considered for GP research. The use of mixed-mode approaches is probably a good strategy to increase GPs’ participation in surveys while reducing costs. %M 28330830 %R 10.2196/jmir.6308 %U http://www.jmir.org/2017/3/e83/ %U https://doi.org/10.2196/jmir.6308 %U http://www.ncbi.nlm.nih.gov/pubmed/28330830 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 3 %P e73 %T Comparison of Different Recruitment Methods for Sexual and Reproductive Health Research: Social Media–Based Versus Conventional Methods %A Motoki,Yoko %A Miyagi,Etsuko %A Taguri,Masataka %A Asai-Sato,Mikiko %A Enomoto,Takayuki %A Wark,John Dennis %A Garland,Suzanne Marie %+ Department of Obstetrics and Gynecology, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa, 236-0004, Japan, 81 45 787 2690, emiyagi@yokohama-cu.ac.jp %K papillomavirus vaccines %K reproductive health %K sexual health %K sexual behavior %K Japan %K uterine cervical neoplasms %D 2017 %7 10.03.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Prior research about the sexual and reproductive health of young women has relied mostly on self-reported survey studies. Thus, participant recruitment using Web-based methods can improve sexual and reproductive health research about cervical cancer prevention. In our prior study, we reported that Facebook is a promising way to reach young women for sexual and reproductive health research. However, it remains unknown whether Web-based or other conventional recruitment methods (ie, face-to-face or flyer distribution) yield comparable survey responses from similar participants. Objective: We conducted a survey to determine whether there was a difference in the sexual and reproductive health survey responses of young Japanese women based on recruitment methods: social media–based and conventional methods. Methods: From July 2012 to March 2013 (9 months), we invited women of ages 16-35 years in Kanagawa, Japan, to complete a Web-based questionnaire. They were recruited through either a social media–based (social networking site, SNS, group) or by conventional methods (conventional group). All participants enrolled were required to fill out and submit their responses through a Web-based questionnaire about their sexual and reproductive health for cervical cancer prevention. Results: Of the 243 participants, 52.3% (127/243) were recruited by SNS, whereas 47.7% (116/243) were recruited by conventional methods. We found no differences between recruitment methods in responses to behaviors and attitudes to sexual and reproductive health survey, although more participants from the conventional group (15%, 14/95) chose not to answer the age of first intercourse compared with those from the SNS group (5.2%, 6/116; P=.03). Conclusions: No differences were found between recruitment methods in the responses of young Japanese women to a Web–based sexual and reproductive health survey. %M 28283466 %R 10.2196/jmir.7048 %U http://www.jmir.org/2017/3/e73/ %U https://doi.org/10.2196/jmir.7048 %U http://www.ncbi.nlm.nih.gov/pubmed/28283466 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 3 %P e61 %T Online Recruitment: Feasibility, Cost, and Representativeness in a Study of Postpartum Women %A Leach,Liana S %A Butterworth,Peter %A Poyser,Carmel %A Batterham,Philip J %A Farrer,Louise M %+ National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Building 54, Mills Road, Canberra, 2614, Australia, 61 261259725, Liana.Leach@anu.edu.au %K online %K Internet %K recruitment %K feasibility %K representativeness %K postpartum %D 2017 %7 08.03.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Online recruitment is feasible, low-cost, and can provide high-quality epidemiological data. However, little is known about the feasibility of recruiting postpartum women online, or sample representativeness. Objective: The current study investigates the feasibility of recruiting a population of postpartum women online for health research and examines sample representativeness. Methods: Two samples of postpartum women were compared: those recruited online as participants in a brief survey of new mothers (n=1083) and those recruited face-to-face as part of a nationally representative study (n=579). Sociodemographic, general health, and mental health characteristics were compared between the two samples. Results: Obtaining a sample of postpartum women online for health research was highly efficient and low-cost. The online sample over-represented those who were younger (aged 25-29 years), were in a de facto relationship, had higher levels of education, spoke only English at home, and were first-time mothers. Members of the online sample were significantly more likely to have poor self-rated health and poor mental health than the nationally representative sample. Health differences remained after adjusting for sociodemographic differences. Conclusions: Potential exists for feasible and low-cost e-epidemiological research with postpartum populations; however, researchers should consider the potential influence of sample nonrepresentativeness. %M 28274906 %R 10.2196/jmir.5745 %U http://www.jmir.org/2017/3/e61/ %U https://doi.org/10.2196/jmir.5745 %U http://www.ncbi.nlm.nih.gov/pubmed/28274906 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 3 %P e66 %T Mobile Device–Based Electronic Data Capture System Used in a Clinical Randomized Controlled Trial: Advantages and Challenges %A Zhang,Jing %A Sun,Lei %A Liu,Yu %A Wang,Hongyi %A Sun,Ningling %A Zhang,Puhong %+ The George Institute for Global Health at Peking University Health Science Center, Level 18, Tower B, Horizon Tower, No. 6 Zhichun Rd Haidian District | Beijing, 100088 P.R. China, Beijing,, China, 86 1082800577 ext 512, zpuhong@georgeinstitute.org.cn %K mEDC %K electronic data capture %K mobile data capture %K mhealth %K randomized controlled trial %K clinical research %D 2017 %7 08.03.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic data capture (EDC) systems have been widely used in clinical research, but mobile device–based electronic data capture (mEDC) system has not been well evaluated. Objective: The aim of our study was to evaluate the feasibility, advantages, and challenges of mEDC in data collection, project management, and telemonitoring in a randomized controlled trial (RCT). Methods: We developed an mEDC to support an RCT called “Telmisartan and Hydrochlorothiazide Antihypertensive Treatment (THAT)” study, which was a multicenter, double-blinded, RCT, with the purpose of comparing the efficacy of telmisartan and hydrochlorothiazide (HCTZ) monotherapy in high-sodium-intake patients with mild to moderate hypertension during a 60 days follow-up. Semistructured interviews were conducted during and after the trial to evaluate the feasibility, advantage, and challenge of mEDC. Nvivo version 9.0 (QSR International) was used to analyze records of interviews, and a thematic framework method was used to obtain outcomes. Results: The mEDC was successfully used to support the data collection and project management in all the 14 study hospitals. A total of 1333 patients were recruited with support of mEDC, of whom 1037 successfully completed all 4 visits. Across all visits, the average time needed for 141 questions per patient was 53 min, which were acceptable to both doctors and patients. All the interviewees, including 24 doctors, 53 patients, 1 clinical research associate (CRA), 1 project manager (PM), and 1 data manager (DM), expressed their satisfaction to nearly all the functions of the innovative mEDC in randomization, data collection, project management, quality control, and remote monitoring in real time. The average satisfaction score was 9.2 (scale, 0-10). The biggest challenge came from the stability of the mobile or Wi-Fi signal although it was not a problem in THAT study. Conclusions: The innovative mEDC has many merits and is well acceptable in supporting data collection and project management in a timely manner in clinical trial. %M 28274907 %R 10.2196/jmir.6978 %U http://www.jmir.org/2017/3/e66/ %U https://doi.org/10.2196/jmir.6978 %U http://www.ncbi.nlm.nih.gov/pubmed/28274907 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 3 %P e64 %T Use of Videos Improves Informed Consent Comprehension in Web-Based Surveys Among Internet-Using Men Who Have Sex With Men: A Randomized Controlled Trial %A Hall,Eric William %A Sanchez,Travis H %A Stein,Aryeh D %A Stephenson,Rob %A Zlotorzynska,Maria %A Sineath,Robert Craig %A Sullivan,Patrick S %+ Department of Epidemiology, Rollins School of Public Health, Emory University, GCR 432, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 404 727 8965, eric.w.hall@emory.edu %K informed consent %K surveys and questionnaires %K HIV %D 2017 %7 06.03.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based surveys are increasingly used to capture data essential for human immunodeficiency virus (HIV) prevention research. However, there are challenges in ensuring the informed consent of Web-based research participants. Objective: The aim of our study was to develop and assess the efficacy of alternative methods of administering informed consent in Web-based HIV research with men who have sex with men (MSM). Methods: From July to September 2014, paid advertisements on Facebook were used to recruit adult MSM living in the United States for a Web-based survey about risk and preventive behaviors. Participants were randomized to one of the 4 methods of delivering informed consent: a professionally produced video, a study staff-produced video, a frequently asked questions (FAQs) text page, and a standard informed consent text page. Following the behavior survey, participants answered 15 questions about comprehension of consent information. Correct responses to each question were given a score of 1, for a total possible scale score of 15. General linear regression and post-hoc Tukey comparisons were used to assess difference (P<.001) in mean consent comprehension scores. A mediation analysis was used to examine the relationship between time spent on consent page and consent comprehension. Results: Of the 665 MSM participants who completed the comprehension questions, 24.2% (161/665) received the standard consent, 27.1% (180/665) received the FAQ consent, 26.8% (178/665) received the professional consent video, and 22.0% (146/665) received the staff video. The overall average consent comprehension score was 6.28 (SD=2.89). The average consent comprehension score differed significantly across consent type (P<.001), age (P=.04), race or ethnicity (P<.001), and highest level of education (P=.001). Compared with those who received the standard consent, comprehension was significantly higher for participants who received the professional video consent (score increase=1.79; 95% CI 1.02-2.55) and participants who received the staff video consent (score increase=1.79; 95% CI 0.99-2.59). There was no significant difference in comprehension for those who received the FAQ consent. Participants spent more time on the 2 video consents (staff video median time=117 seconds; professional video median time=115 seconds) than the FAQ (median=21 seconds) and standard consents (median=37 seconds). Mediation analysis showed that though time spent on the consent page was partially responsible for some of the differences in comprehension, the direct effects of the professional video (score increase=0.93; 95% CI 0.39-1.48) and the staff-produced video (score increase=0.99; 95% CI 0.42-1.56) were still significant. Conclusions: Video-based consent methods improve consent comprehension of MSM participating in a Web-based HIV behavioral survey. This effect may be partially mediated through increased time spent reviewing the consent material; however, the video consent may still be superior to standard consent in improving participant comprehension of key study facts. Trail Registration: Clinicaltrials.gov NCT02139566; https://clinicaltrials.gov/ct2/show/NCT02139566 (Archived by WebCite at http://www.webcitation.org/6oRnL261N). %M 28264794 %R 10.2196/jmir.6710 %U http://www.jmir.org/2017/3/e64/ %U https://doi.org/10.2196/jmir.6710 %U http://www.ncbi.nlm.nih.gov/pubmed/28264794 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 2 %P e50 %T Experience With Direct-to-Patient Recruitment for Enrollment Into a Clinical Trial in a Rare Disease: A Web-Based Study %A Krischer,Jeffrey %A Cronholm,Peter F %A Burroughs,Cristina %A McAlear,Carol A %A Borchin,Renee %A Easley,Ebony %A Davis,Trocon %A Kullman,Joyce %A Carette,Simon %A Khalidi,Nader %A Koening,Curry %A Langford,Carol A %A Monach,Paul %A Moreland,Larry %A Pagnoux,Christian %A Specks,Ulrich %A Sreih,Antoine G %A Ytterberg,Steven %A Merkel,Peter A %A , %+ Rare Diseases Clinical Research Network Data Coordinating Center, Health Informatics Institute, University of South Florida, 3650 Spectrum Blvd, Suite 100, Tampa, FL, 33612, United States, 1 813 396 9512, Jeffrey.Krischer@epi.usf.edu %K clinical trial %K research subject recruitment %K social media %K direct-to-consumer advertising %K granulomatosis with polyangiitis %D 2017 %7 28.02.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The target sample size for clinical trials often necessitates a multicenter (center of excellence, CoE) approach with associated added complexity, cost, and regulatory requirements. Alternative recruitment strategies need to be tested against this standard model. Objectives: The aim of our study was to test whether a Web-based direct recruitment approach (patient-centric, PC) using social marketing strategies provides a viable option to the CoE recruitment method. Methods: PC recruitment and Web-based informed consent was compared with CoE recruitment for a randomized controlled trial (RCT) of continuing versus stopping low-dose prednisone for maintenance of remission of patients with granulomatosis with polyangiitis (GPA). Results: The PC approach was not as successful as the CoE approach. Enrollment of those confirmed eligible by their physician was 10 of 13 (77%) and 49 of 51 (96%) in the PC and CoE arms, respectively (P=.05). The two approaches were not significantly different in terms of eligibility with 34% of potential participants in the CoE found to be ineligible as compared with 22% in the PC arm (P=.11) nor in provider acceptance, 22% versus 26% (P=.78). There was no difference in the understanding of the trial as reflected in the knowledge surveys of individuals in the PC and CoE arms. Conclusions: PC recruitment was substantially less successful than that achieved by the CoE approach. However, the PC approach was good at confirming eligibility and was as acceptable to providers and as understandable to patients as the CoE approach. The PC approach should be evaluated in other clinical settings to get a better sense of its potential. %M 28246067 %R 10.2196/jmir.6798 %U http://www.jmir.org/2017/2/e50/ %U https://doi.org/10.2196/jmir.6798 %U http://www.ncbi.nlm.nih.gov/pubmed/28246067 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 1 %P e7 %T Applying Computerized Adaptive Testing to the Four-Dimensional Symptom Questionnaire (4DSQ): A Simulation Study %A Magnée,Tessa %A de Beurs,Derek P %A Terluin,Berend %A Verhaak,Peter F %+ Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-114, Utrecht, 3500BN, Netherlands, 31 302729854, t.magnee@nivel.nl %K item response theory %K Four-Dimensional Symptom Questionnaire %K computerized adaptive testing %K mental health %K general practice %D 2017 %7 21.02.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Efficient screening questionnaires are useful in general practice. Computerized adaptive testing (CAT) is a method to improve the efficiency of questionnaires, as only the items that are particularly informative for a certain responder are dynamically selected. Objective: The objective of this study was to test whether CAT could improve the efficiency of the Four-Dimensional Symptom Questionnaire (4DSQ), a frequently used self-report questionnaire designed to assess common psychosocial problems in general practice. Methods: A simulation study was conducted using a sample of Dutch patients visiting a general practitioner (GP) with psychological problems (n=379). Responders completed a paper-and-pencil version of the 50-item 4DSQ and a psychometric evaluation was performed to check if the data agreed with item response theory (IRT) assumptions. Next, a CAT simulation was performed for each of the four 4DSQ scales (distress, depression, anxiety, and somatization), based on the given responses as if they had been collected through CAT. The following two stopping rules were applied for the administration of items: (1) stop if measurement precision is below a predefined level, or (2) stop if more than half of the items of the subscale are administered. Results: In general, the items of each of the four scales agreed with IRT assumptions. Application of the first stopping rule reduced the length of the questionnaire by 38% (from 50 to 31 items on average). When the second stopping rule was also applied, the total number of items could be reduced by 56% (from 50 to 22 items on average). Conclusions: CAT seems useful for improving the efficiency of the 4DSQ by 56% without losing a considerable amount of measurement precision. The CAT version of the 4DSQ may be useful as part of an online assessment to investigate the severity of mental health problems of patients visiting a GP. This simulation study is the first step needed for the development a CAT version of the 4DSQ. A CAT version of the 4DSQ could be of high value for Dutch GPs since increasing numbers of patients with mental health problems are visiting the general practice. In further research, the results of a real-time CAT should be compared with the results of the administration of the full scale. %M 28223264 %R 10.2196/mental.6545 %U http://mental.jmir.org/2017/1/e7/ %U https://doi.org/10.2196/mental.6545 %U http://www.ncbi.nlm.nih.gov/pubmed/28223264 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 12 %P e326 %T Recruiting Pregnant Patients for Survey Research: A Head to Head Comparison of Social Media-Based Versus Clinic-Based Approaches %A Admon,Lindsay %A Haefner,Jessica K %A Kolenic,Giselle E %A Chang,Tammy %A Davis,Matthew M %A Moniz,Michelle H %+ National Clinician Scholars Program, University of Michigan Institute for Healthcare Policy and Innovation and the US Department of Veterans Affairs, North Campus Research Complex, 2800 Plymouth Road, Bldg 14 Room G100-22, Ann Arbor, MI, 48109-2800, United States, 1 734 647 0571, lindskb@med.umich.edu %K pregnant women %K surveys and questionnaires %K methods %K social media %D 2016 %7 21.12.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Recruiting a diverse sample of pregnant women for clinical research is a challenging but crucial task for improving obstetric services and maternal and child health outcomes. Objective: To compare the feasibility and cost of recruiting pregnant women for survey research using social media-based and clinic-based approaches. Methods: Advertisements were used to recruit pregnant women from the social media website Facebook. In-person methods were used to recruit pregnant women from the outpatient clinic of a large, tertiary care center. In both approaches, potential respondents were invited to participate in a 15-minute Web-based survey. Each recruitment method was monitored for 1 month. Using bivariate statistics, we compared the number, demographic characteristics, and health characteristics of women recruited and the cost per completed survey for each recruitment method. Results: The social media-based approach recruited 1178 women and the clinic-based approach recruited 219 women. A higher proportion of subjects recruited through social media identified as African American (29.4%, 207/705 vs 11.2%, 20/179), reported household incomes 0.75, P<.001). Conclusions: An electronic questionnaire is uploaded in a dedicated Web-based tool that could implement a telemonitoring system aimed at improving the follow-up of RA patients. High intrarater reliability between paper and electronic methods of data collection encourage the use of a new digital app with consequent benefit for the overall health care system. %M 27852561 %R 10.2196/resprot.5631 %U http://www.researchprotocols.org/2016/4/e219/ %U https://doi.org/10.2196/resprot.5631 %U http://www.ncbi.nlm.nih.gov/pubmed/27852561 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 11 %P e288 %T Comparing Twitter and Online Panels for Survey Recruitment of E-Cigarette Users and Smokers %A Guillory,Jamie %A Kim,Annice %A Murphy,Joe %A Bradfield,Brian %A Nonnemaker,James %A Hsieh,Yuli %+ RTI International, 3040 E Cornwallis Rd, Research Triangle Park, NC, 27709, United States, 1 919 316 3725, jguillory@rti.org %K social media %K electronic cigarettes %K tobacco %K Twitter %D 2016 %7 15.11.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: E-cigarettes have rapidly increased in popularity in recent years, driven, at least in part, by marketing and word-of-mouth discussion on Twitter. Given the rapid proliferation of e-cigarettes, researchers need timely quantitative data from e-cigarette users and smokers who may see e-cigarettes as a cessation tool. Twitter provides an ideal platform for recruiting e-cigarette users and smokers who use Twitter. Online panels offer a second method of accessing this population, but they have been criticized for recruiting too few young adults, among whom e-cigarette use rates are highest. Objective: This study compares effectiveness of recruiting Twitter users who are e-cigarette users and smokers who have never used e-cigarettes via Twitter to online panelists provided by Qualtrics and explores how users recruited differ by demographics, e-cigarette use, and social media use. Methods: Participants were adults who had ever used e-cigarettes (n=278; male: 57.6%, 160/278; age: mean 34.26, SD 14.16 years) and smokers (n=102; male: 38.2%, 39/102; age: mean 42.80, SD 14.16 years) with public Twitter profiles. Participants were recruited via online panel (n=190) or promoted tweets using keyword targeting for e-cigarette users (n=190). Predictor variables were demographics (age, gender, education, race/ethnicity), e-cigarette use (eg, past 30-day e-cigarette use, e-cigarette puffs per day), social media use behaviors (eg, Twitter use frequency), and days to final survey completion from survey launch for Twitter versus panel. Recruitment method (Twitter, panel) was the dependent variable. Results: Across the total sample, participants were recruited more quickly via Twitter (incidence rate ratio=1.30, P=.02) than panel. Compared with young adult e-cigarette users (age 18-24 years), e-cigarette users aged 25 to 34 years (OR 0.01, 95% CI 0.00-0.60, P=.03) and 35 to 44 years (OR 0.01, 95% CI 0.00-0.51, P=.02) were more likely to be recruited via Twitter than panel. Smokers aged 35 to 44 years were less likely than those aged 18 to 24 years to be recruited via Twitter than panel (35-44: OR 0.03, 95% CI 0.00-0.49, P=.01). E-cigarette users who reported a greater number of e-cigarette puffs per day were more likely to be recruited via Twitter than panel compared to those who reported fewer puffs per day (OR 1.12, 95% CI 1.05-1.20, P=.001). With each one-unit increase in Twitter usage, e-cigarette users were 9.55 times (95% CI 2.28-40.00, P=.002) and smokers were 4.91 times (95% CI 1.90-12.74, P=.001) as likely to be recruited via Twitter than panel. Conclusions: Twitter ads were more time efficient than an online panel in recruiting e-cigarette users and smokers. In addition, Twitter provided access to younger adults, who were heavier users of e-cigarettes and Twitter. Recruiting via social media and online panel in combination offered access to a more diverse population of participants. %M 27847353 %R 10.2196/jmir.6326 %U http://www.jmir.org/2016/11/e288/ %U https://doi.org/10.2196/jmir.6326 %U http://www.ncbi.nlm.nih.gov/pubmed/27847353 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 10 %P e281 %T Participant Recruitment and Engagement in Automated eHealth Trial Registration: Challenges and Opportunities for Recruiting Women Who Experience Violence %A Koziol-McLain,Jane %A McLean,Christine %A Rohan,Maheswaran %A Sisk,Rose %A Dobbs,Terry %A Nada-Raja,Shyamala %A Wilson,Denise %A Vandal,Alain C %+ Centre for Interdisciplinary Trauma Research, Faculty of Health and Environmental Sciences, Auckland University of Technology, A-9, Private Bag 92006, Auckland, 1142, New Zealand, 64 9 921 9670, jane.koziol-mclain@aut.ac.nz %K eHealth %K recruitment %K dropout %K intimate partner violence %K Web-based trials %D 2016 %7 25.10.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Automated eHealth Web-based research trials offer people an accessible, confidential opportunity to engage in research that matters to them. eHealth trials may be particularly useful for sensitive issues when seeking health care may be accompanied by shame and mistrust. Yet little is known about people’s early engagement with eHealth trials, from recruitment to preintervention autoregistration processes. A recent randomized controlled trial that tested the effectiveness of an eHealth safety decision aid for New Zealand women in the general population who experienced intimate partner violence (isafe) provided the opportunity to examine recruitment and preintervention participant engagement with a fully automated Web-based registration process. The trial aimed to recruit 340 women within 24 months. Objective: The objective of our study was to examine participant preintervention engagement and recruitment efficiency for the isafe trial, and to analyze dropout through the registration pathway, from recruitment to eligibility screening and consent, to completion of baseline measures. Methods: In this case study, data collection sources included the trial recruitment log, Google Analytics reports, registration and program metadata, and costs. Analysis included a qualitative narrative of the recruitment experience and descriptive statistics of preintervention participant engagement and dropout rates. A Koyck model investigated the relationship between Web-based online marketing website advertisements (ads) and participant accrual. Results: The isafe trial was launched on September 17, 2012. Placement of ads in an online classified advertising platform increased the average number of recruited participants per month from 2 to 25. Over the 23-month recruitment period, the registration website recorded 4176 unique visitors. Among 1003 women meeting eligibility criteria, 51.55% (517) consented to participate; among the 501 women who enrolled (consented, validated, and randomized), 412 (82.2%) were accrued (completed baseline assessments). The majority (n=52, 58%) of the 89 women who dropped out between enrollment and accrual never logged in to the allocated isafe website. Of every 4 accrued women, 3 (314/412, 76.2%) identified the classified ad as their referral source, followed by friends and family (52/412, 12.6%). Women recruited through a friend or relative were more likely to self-identify as indigenous Māori and live in the highest-deprivation areas. Ads increased the accrual rate by a factor of 74 (95% CI 49–112). Conclusions: Print advertisements, website links, and networking were costly and inefficient methods for recruiting participants to a Web-based eHealth trial. Researchers are advised to limit their recruitment efforts to Web-based online marketplace and classified advertising platforms, as in the isafe case, or to social media. Online classified advertising in “Jobs–Other–volunteers” successfully recruited a diverse sample of women experiencing intimate partner violence. Preintervention recruitment data provide critical information to inform future research and critical analysis of Web-based eHealth trials. ClinicalTrial: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000708853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612000708853 (Archived by WebCite at http://www.webcitation/6lMGuVXdK) %M 27780796 %R 10.2196/jmir.6515 %U https://www.jmir.org/2016/10/e281/ %U https://doi.org/10.2196/jmir.6515 %U http://www.ncbi.nlm.nih.gov/pubmed/27780796 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 9 %P e227 %T Australian Gay Men Describe the Details of Their HIV Infection Through a Cross-Sectional Web-Based Survey %A Down,Ian %A Prestage,Garrett %A Ellard,Jeanne %A Triffitt,Kathy %A Brown,Graham %A Callander,Denton %+ Kirby Institute, University of New South Wales Australia, Wallace Wurth Building, Sydney, 2052, Australia, 61 2 9385 9954, idown@kirby.unsw.edu.au %K HIV %K transmission %K sexual behavior %K surveys and questionnaires %D 2016 %7 23.09.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: With emerging opportunities for preventing human immunodeficiency virus (HIV) transmission, it remains important to identify those at greatest risk of infection and to describe and understand the contexts in which transmissions occur. Some gay and bisexual men with recently diagnosed HIV infection are initially unable to identify high-risk behaviors that would explain their HIV infection. We explored whether Web-based data collection could assist them in identifying the circumstances of their infection. Objective: To assess the capacity of a Web-based survey to collect reliable self-report data on the event to which gay and bisexual men ascribe their HIV infection. Methods: The HIV Seroconversion Study included a Web-based survey of gay and bisexual men with recently diagnosed HIV infection in Australia. Participants were asked if they could identify and describe the event they believe led to their infection. Men were also asked about their sexual and other risk practices during the 6 months before their diagnosis. Results: Most (403/506, 79.6%) gay and bisexual men with newly diagnosed HIV infection were able to identify and describe the circumstances that likely led to their infection. Among those who were initially unable to identify possible exposure events, many could nonetheless provide sensible information that ostensibly explained their seroconversion. Free-text responses allowed men to provide more detailed and contextual information, whereas questions about the totality of their sexual behavior before diagnosis provided opportunities for men to describe their sexual risk behavior in general. Overall, 84.0% indicated having engaged in condomless anal intercourse before their HIV diagnosis, including 71.8% in the receptive position. Conclusions: This study demonstrates the effectiveness of using Internet-based technologies to capture sensitive information about the circumstances in which HIV infection occurs among gay and bisexual men. By providing a range of opportunities for relaying experience, this research reveals some of the complexity in how individuals come to understand and explain their HIV infection. These findings may assist in obtaining detailed sexual history in the clinical setting. %M 27663447 %R 10.2196/jmir.5707 %U http://www.jmir.org/2016/9/e227/ %U https://doi.org/10.2196/jmir.5707 %U http://www.ncbi.nlm.nih.gov/pubmed/27663447 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 9 %P e249 %T Linked Patient-Reported Outcomes Data From Patients With Multiple Sclerosis Recruited on an Open Internet Platform to Health Care Claims Databases Identifies a Representative Population for Real-Life Data Analysis in Multiple Sclerosis %A Risson,Valery %A Ghodge,Bhaskar %A Bonzani,Ian C %A Korn,Jonathan R %A Medin,Jennie %A Saraykar,Tanmay %A Sengupta,Souvik %A Saini,Deepanshu %A Olson,Melvin %+ Novartis Pharma AG, Postfach, Basel, 4002, Switzerland, 41 61 324 6036, valery.risson@novartis.com %K Internet %K multiple sclerosis %K outcomes assessment %K linkage analysis %D 2016 %7 22.09.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: An enormous amount of information relevant to public health is being generated directly by online communities. Objective: To explore the feasibility of creating a dataset that links patient-reported outcomes data, from a Web-based survey of US patients with multiple sclerosis (MS) recruited on open Internet platforms, to health care utilization information from health care claims databases. The dataset was generated by linkage analysis to a broader MS population in the United States using both pharmacy and medical claims data sources. Methods: US Facebook users with an interest in MS were alerted to a patient-reported survey by targeted advertisements. Eligibility criteria were diagnosis of MS by a specialist (primary progressive, relapsing-remitting, or secondary progressive), ≥12-month history of disease, age 18-65 years, and commercial health insurance. Participants completed a questionnaire including data on demographic and disease characteristics, current and earlier therapies, relapses, disability, health-related quality of life, and employment status and productivity. A unique anonymous profile was generated for each survey respondent. Each anonymous profile was linked to a number of medical and pharmacy claims datasets in the United States. Linkage rates were assessed and survey respondents’ representativeness was evaluated based on differences in the distribution of characteristics between the linked survey population and the general MS population in the claims databases. Results: The advertisement was placed on 1,063,973 Facebook users’ pages generating 68,674 clicks, 3719 survey attempts, and 651 successfully completed surveys, of which 440 could be linked to any of the claims databases for 2014 or 2015 (67.6% linkage rate). Overall, no significant differences were found between patients who were linked and not linked for educational status, ethnicity, current or prior disease-modifying therapy (DMT) treatment, or presence of a relapse in the last 12 months. The frequencies of the most common MS symptoms did not differ significantly between linked patients and the general MS population in the databases. Linked patients were slightly younger and less likely to be men than those who were not linkable. Conclusions: Linking patient-reported outcomes data, from a Web-based survey of US patients with MS recruited on open Internet platforms, to health care utilization information from claims databases may enable rapid generation of a large population of representative patients with MS suitable for outcomes analysis. %M 27658498 %R 10.2196/jmir.5805 %U http://www.jmir.org/2016/9/e249/ %U https://doi.org/10.2196/jmir.5805 %U http://www.ncbi.nlm.nih.gov/pubmed/27658498 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 9 %P e244 %T Incentive and Reminder Strategies to Improve Response Rate for Internet-Based Physician Surveys: A Randomized Experiment %A Cook,David A %A Wittich,Christopher M %A Daniels,Wendlyn L %A West,Colin P %A Harris,Ann M %A Beebe,Timothy J %+ Division of General Internal Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, United States, 1 5072842269, cook.david33@mayo.edu %K surveys and questionnaires %K survey methods %K questionnaire design %D 2016 %7 16.09.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Most research on how to enhance response rates in physician surveys has been done using paper surveys. Uncertainties remain regarding how to enhance response rates in Internet-based surveys. Objective: To evaluate the impact of a low-cost nonmonetary incentive and paper mail reminders (formal letter and postcard) on response rates in Internet-based physician surveys. Methods: We executed a factorial-design randomized experiment while conducting a nationally representative Internet-based physician survey. We invited 3966 physicians (randomly selected from a commercial database of all licensed US physicians) via email to complete an Internet-based survey. We used 2 randomly assigned email messages: one message offered a book upon survey completion, whereas the other did not mention the book but was otherwise identical. All nonrespondents received several email reminders. Some physicians were further assigned at random to receive 1 reminder via paper mail (either a postcard or a letter) or no paper reminder. The primary outcome of this study was the survey response rate. Results: Of the 3966 physicians who were invited, 451 (11.4%) responded to at least one survey question and 336 (8.5%) completed the entire survey. Of those who were offered a book, 345/2973 (11.6%) responded compared with 106/993 (10.7%) who were not offered a book (odds ratio 1.10, 95% CI 0.87-1.38, P=.42). Regarding the paper mail reminder, 168/1572 (10.7%) letter recipients, 148/1561 (9.5%) postcard recipients, and 69/767 (9.0%) email-only recipients responded (P=.35). The response rate for those receiving letters or postcards was similar (odds ratio 1.14, 95% CI 0.91-1.44, P=.26). Conclusions: Offering a modest nonmonetary incentive and sending a paper reminder did not improve survey response rate. Further research on how to enhance response rates in Internet-based physician surveys is needed. %M 27637296 %R 10.2196/jmir.6318 %U http://www.jmir.org/2016/9/e244/ %U https://doi.org/10.2196/jmir.6318 %U http://www.ncbi.nlm.nih.gov/pubmed/27637296 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 3 %P e179 %T Twitter Strategies for Web-Based Surveying: Descriptive Analysis From the International Concussion Study %A Hendricks,Sharief %A Düking,Peter %A Mellalieu,Stephen D %+ Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Boundary Road, Newlands., Cape Town,, South Africa, 27 216504567, sharief.hendricks01@gmail.com %K Twitter %K social media %K Web-based surveying %K concussion %K rugby %D 2016 %7 01.09.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Social media provides researchers with an efficient means to reach and engage with a large and diverse audience. Twitter allows for the virtual social interaction among a network of users that enables researchers to recruit and administer surveys using snowball sampling. Although using Twitter to administer surveys for research is not new, strategies to improve response rates are yet to be reported. Objective: To compare the potential and actual reach of 2 Twitter accounts that administered a Web-based concussion survey to rugby players and trainers using 2 distinct Twitter-targeting strategies. Furthermore, the study sought to determine the likelihood of receiving a retweet based on the time of the day and day of the week of posting. Methods: A survey based on previous concussion research was exported to a Web-based survey website Survey Monkey. The survey comprised 2 questionnaires, one for players, and one for those involved in the game (eg, coaches and athletic trainers). The Web-based survey was administered using 2 existing Twitter accounts, with each account executing a distinct targeting strategy. A list of potential Twitter accounts to target was drawn up, together with a list of predesigned tweets. The list of accounts to target was divided into ‘High-Profile’ and ‘Low-Profile’, based on each accounts’ position to attract publicity with a high social interaction potential. The potential reach (number of followers of the targeted account), and actual reach (number of retweets received by each post) between the 2 strategies were compared. The number of retweets received by each account was further analyzed to understand when the most likely time of day, and day of the week, a retweet would be received. Results: The number of retweets received by a Twitter account decreased by 72% when using the ‘high-profile strategy’ compared with the ‘low-profile strategy’ (incidence rate ratio (IRR); 0.28, 95% confidence interval (CI) 0.21-0.37, P<.001). When taking into account strategy and day of the week, the IRR for the number of retweets received during the hours of 12 AM to 5:59 AM (IRR 2.98, 95% CI 1.88-4.71, P>.001) and 6 PM to 11:59 PM (IRR 1.48, 95% CI 1.05-2.09, P>.05) were significantly increased relative to 6 AM to 11:59 AM. However, posting tweets during the hours of 12 PM to 5:59 PM, decreased the IRR for retweets by 40% (IRR 0.60, 95% CI 0.46-0.79, P<.001) compared with 6 AM to 11:59 AM. Posting on a Monday (IRR 3.57, 95% CI 2.50-5.09, P<.001) or Wednesday (IRR 1.50, 95% CI 1.11-1.11, P<.01) significantly increased the IRR compared with posting on a Thursday. Conclusions: Surveys are a useful tool to measure the knowledge, attitudes, and behaviors of a given population. Strategies to improve Twitter engagement include targeting low-profile accounts, posting tweets in the morning (12 AM-11:59 AM) or late evenings (6 PM-11:59 PM), and posting on Mondays and Wednesdays. %M 27589958 %R 10.2196/resprot.4542 %U http://www.researchprotocols.org/2016/3/e179/ %U https://doi.org/10.2196/resprot.4542 %U http://www.ncbi.nlm.nih.gov/pubmed/27589958 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 3 %P e166 %T Cloud Based Surveys to Assess Patient Perceptions of Health Care: 1000 Respondents in 3 days for US $300 %A Bardos,Jonah %A Friedenthal,Jenna %A Spiegelman,Jessica %A Williams,Zev %+ Program for Early and Recurrent Pregnancy Loss (PEARL), Department of Obstetrics and Gynecology and Women’s Health, Albert Einstein College of Medicine, 1301 Morris Park Ave, Room 474, Bronx, NY, 10461, United States, 1 718 405 8590, zev.williams@einstein.yu.edu %K Mechanical Turk %K MTurk %K crowdsourcing %K medical survey %K cloud-based survey %K health care perceptions %D 2016 %7 23.08.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: There are many challenges in conducting surveys of study participants, including cost, time, and ability to obtain quality and reproducible work. Cloudsourcing (an arrangement where a cloud provider is paid to carry out services that could be provided in-house) has the potential to provide vastly larger, less expensive, and more generalizable survey pools. Objective: The objective of this study is to evaluate, using Amazon's Mechanical Turk (MTurk), a cloud-based workforce to assess patients’ perspectives of health care. Methods: A national online survey posted to Amazon's MTurk consisted of 33 multiple choice and open-ended questions. Continuous attributes were compared using t tests. Results: We obtained 1084 responses for a total cost of US $298.10 in less than 3 days with 300 responses in under 6 hours. Of those, 44.74% (485/1084) were male and 54.80% (594/1084) female, representing 49 out of 50 states and aged 18 to 69 years. Conclusions: Amazon’s MTurk is a potentially useful survey method for attaining information regarding public opinions and/or knowledge with the distinct advantage of cost, speed, and a wide and relatively good representation of the general population, in a confidential setting for respondents. %M 27554915 %R 10.2196/resprot.5772 %U http://www.researchprotocols.org/2016/3/e166/ %U https://doi.org/10.2196/resprot.5772 %U http://www.ncbi.nlm.nih.gov/pubmed/27554915 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 2 %P e150 %T Determining Survey Satisficing of Online Longitudinal Survey Data in the Multicenter AIDS Cohort Study: A Group-Based Trajectory Analysis %A Di,Junrui %A Li,Ying %A Friedman,M Reuel %A Reddy,Susheel %A Surkan,Pamela J %A Shoptaw,Steven %A Plankey,Michael %+ Georgetown University Medical Center, Department of Medicine, Division of Infectious Diseases, 2115 Wisconsin Avenue, NW, Suite 130, Washington, DC, 20007, United States, 1 202784260, mwp23@georgetown.edu %K ACASI %K cohort studies %K data collection %K data quality %K group-based trajectory analysis %K reading speed %K survey satisficing %D 2016 %7 08.08.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Survey satisficing occurs when participants respond to survey questions rapidly without carefully reading or comprehending them. Studies have demonstrated the occurrence of survey satisficing, which can degrade survey quality, particularly in longitudinal studies. Objective: The aim of this study is to use a group-based trajectory analysis method to identify satisficers when similar survey questions were asked periodically in a long-standing cohort, and to examine factors associated with satisficing in the surveys having sensitive human immunodeficiency virus (HIV)-related behavioral questions. Methods: Behavioral data were collected semiannually online at all four sites of the Multicenter AIDS Cohort Study (MACS) from October 2008 through March 2013. Based on the start and end times, and the word counts per variable, response speed (word counts per second) for each participant visit was calculated. Two-step group-based trajectory analyses of the response speed across 9 study visits were performed to identify potential survey satisficing. Generalized linear models with repeated measures were used to investigate the factors associated with satisficing on HIV-related behavioral surveys. Results: Among the total 2138 male participants, the median baseline age was 51 years (interquartile range, 45-58); most of the participants were non-Hispanic white (62.72%, 1341/2138) and college graduates (46.59%, 996/2138), and half were HIV seropositive (50.00%, 1069/2138). A total of 543 men (25.40%, 543/2138) were considered potential satisficers with respect to their increased trajectory tendency of response speed. In the multivariate analysis, being 10 years older at the baseline visit increased the odds of satisficing by 44% (OR 1.44, 95% CI 1.27-1.62, P<.001). Compared with the non-Hispanic white participants, non-Hispanic black participants were 122% more likely to satisfice the HIV-related behavioral survey (OR 2.22, 95% CI 1.69-2.91, P<.001), and 99% more likely to do so for the other race/ethnicity group (OR 1.99, 95% CI 1.39-2.83, P<.001). Participants with a high school degree or less were 67% more likely to satisfice the survey (OR 1.67, 95% CI 1.26-2.21, P<.001) compared with those with a college degree. Having more than one sex partner and using more than one recreational drug reduced the odds of satisficing by 24% (OR 0.76, 95% CI 0.61-0.94, P=.013) and 28% (OR 0.72, 95% CI 0.55-0.93, P=.013), respectively. No statistically significant association of HIV serostatus with satisficing was observed. Conclusions: Using a group-based trajectory analysis method, we could identify consistent satisficing on HIV-related behavioral surveys among participants in the MACS, which was associated with being older, being non-white, and having a lower education level; however, there was no significant difference by HIV serostatus. Methods to minimize satisficing using longitudinal survey data are warranted. %M 27503107 %R 10.2196/publichealth.5240 %U http://publichealth.jmir.org/2016/2/e150/ %U https://doi.org/10.2196/publichealth.5240 %U http://www.ncbi.nlm.nih.gov/pubmed/27503107 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 2 %P e37 %T A Comparison of Web and Telephone Responses From a National HIV and AIDS Survey %A Jones,Marcella K %A Calzavara,Liviana %A Allman,Dan %A Worthington,Catherine A %A Tyndall,Mark %A Iveniuk,James %+ Faculty of Medicine, University of Toronto, Medical Sciences Building, Rm 2124, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada, 1 416 946 8720, marcella.jones@mail.utoronto.ca %K survey methods %K cross-sectional survey %K community survey %K HIV %K AIDS %K social desirability %K data collection methods %K data quality %K health attitude %K health knowledge %K attitudes %K practice %D 2016 %7 29.07.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Response differences to survey questions are known to exist for different modes of questionnaire completion. Previous research has shown that response differences by mode are larger for sensitive and complicated questions. However, it is unknown what effect completion mode may have on HIV and AIDS survey research, which addresses particularly sensitive and stigmatized health issues. Objectives: We seek to compare responses between self-selected Web and telephone respondents in terms of social desirability and item nonresponse in a national HIV and AIDS survey. Methods: A survey of 2085 people in Canada aged 18 years and older was conducted to explore public knowledge, attitudes, and behaviors around HIV and AIDS in May 2011. Participants were recruited using random-digit dialing and could select to be interviewed on the telephone or self-complete through the Internet. For this paper, 15 questions considered to be either sensitive, stigma-related, or less-sensitive in nature were assessed to estimate associations between responses and mode of completion. Multivariate regression analyses were conducted for questions with significant (P≤.05) bivariate differences in responses to adjust for sociodemographic factors. As survey mode was not randomly assigned, we created a propensity score variable and included it in our multivariate models to control for mode selection bias. Results: A total of 81% of participants completed the questionnaire through the Internet, and 19% completed by telephone. Telephone respondents were older, reported less education, had lower incomes, and were more likely from the province of Quebec. Overall, 2 of 13 questions assessed for social desirability and 3 of 15 questions assessed for item nonresponse were significantly associated with choice of mode in the multivariate analysis. For social desirability, Web respondents were more likely than telephone respondents to report more than 1 sexual partner in the past year (fully adjusted odds ratio (OR)=3.65, 95% CI 1.80-7.42) and more likely to have donated to charity in the past year (OR=1.63, 95% CI 1.15-2.29). For item nonresponse, Web respondents were more likely than telephone respondents to have a missing or “don’t know” response when asked about: the disease they were most concerned about (OR=3.02, 95% CI 1.67-5.47); if they had ever been tested for HIV (OR=8.04, 95% CI 2.46-26.31); and when rating their level of comfort with shopping at grocery store if the owner was known to have HIV or AIDS (OR=3.11, 95% CI 1.47-6.63). Conclusion: Sociodemographic differences existed between Web and telephone respondents, but for 23 of 28 questions considered in our analysis, there were no significant differences in responses by mode. For surveys with very sensitive health content, such as HIV and AIDS, Web administration may be subject to less social desirability bias but may also have greater item nonresponse for certain questions. %M 27473597 %R 10.2196/publichealth.5184 %U http://publichealth.jmir.org/2016/2/e37/ %U https://doi.org/10.2196/publichealth.5184 %U http://www.ncbi.nlm.nih.gov/pubmed/27473597 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 2 %N 2 %P e9 %T Online Versus Telephone Methods to Recruit and Interview Older Gay and Bisexual Men Treated for Prostate Cancer: Findings from the Restore Study %A Rosser,BR Simon %A Capistrant,Benjamin %+ University of Minnesota, Division of Epidemiology and Community Health, 1300 S. 2nd. St., #300, Minneapolis, MN, 55410, United States, 1 612 624 0358, rosser@umn.edu %K Qualitative research %K Aged %K Gays %D 2016 %7 19.07.2016 %9 Short Paper %J JMIR Cancer %G English %X Background: Recently, researchers have faced the challenge of conflicting recommendations for online versus traditional methods to recruit and interview older, sexual minority men. Older populations represent the cohort least likely to be online, necessitating the use of traditional research methods, such as telephone or in-person interviews. By contrast, gay and bisexual men represent a population of early adopters of new technology, both in general and for medical research. In a study of older gay and bisexual men with prostate cancer, we asked whether respondents preferred online versus offline methods for data collection. Given the paucity of research on how to recruit older gay and bisexual men in general, and older gay and bisexual men with prostate cancer in particular, we conducted an observational study to identify participant preferences when participating in research studies. Objective: To test online versus offline recruitment demographic data collection, and interview preferences of older gay and bisexual men with prostate cancer. Methods: Email blasts were sent from a website providing support services for gay and bisexual men with prostate cancer, supplemented with an email invitation from the web-host. All invitations provided information via the study website address and a toll-free telephone number. Study tasks included respondents being screened, giving informed consent, completing a short survey collecting demographic data, and a 60-75 minute telephone or Internet chat interview. All materials stressed that enrollees could participate in each task using either online methods or by telephone, whichever they preferred. Results: A total of 74 men were screened into the study, and 30 were interviewed. The average age of the participants was 63 years (standard deviation 6.9, range 48-75 years), with most residing in 14 American states, and one temporarily located overseas. For screening, consent, and the collection of demographic data, 97% (29/30) of the participants completed these tasks using online methods. For the interview, 97% (29/30) chose to be interviewed by telephone, rather than Internet chat. Conclusions: Older gay and bisexual men, when given choices, appear to prefer a mixed methods approach to qualitative investigations. For most aspects of the study, the older men chose online methods; the exception was the interview, in which case almost all preferred telephone. We speculate that a combination of the deeply personal nature of the topic (sexual effects of prostate cancer treatment), unfamiliarity with online chat, and possibly the subject burden involved in extensive typing contributed to the preference of telephone versus online chat. Recruitment of older men into this study showed good geographic diversity. We recommend that other qualitative researchers consider a mixed methods approach when recruiting older populations online. %M 28410183 %R 10.2196/cancer.5578 %U http://cancer.jmir.org/2016/2/e9/ %U https://doi.org/10.2196/cancer.5578 %U http://www.ncbi.nlm.nih.gov/pubmed/28410183 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e181 %T Evaluation Methods for Assessing Users’ Psychological Experiences of Web-Based Psychosocial Interventions: A Systematic Review %A Feather,Jacqueline Susan %A Howson,Moira %A Ritchie,Linda %A Carter,Philip D %A Parry,David Tudor %A Koziol-McLain,Jane %+ Centre for Interdisciplinary Trauma Research, Department of Psychology, Auckland University of Technology, A-12, Private Bag 92006, Auckland, 1142, New Zealand, 64 99219999 ext 7693, jackie.feather@aut.ac.nz %K eHealth %K medical informatics applications %K web browser %K Web-based %K usability %K computer systems %K psychology, clinical %K usability testing %K eHealth evaluation %D 2016 %7 30.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of Web-based interventions to deliver mental health and behavior change programs is increasingly popular. They are cost-effective, accessible, and generally effective. Often these interventions concern psychologically sensitive and challenging issues, such as depression or anxiety. The process by which a person receives and experiences therapy is important to understanding therapeutic process and outcomes. While the experience of the patient or client in traditional face-to-face therapy has been evaluated in a number of ways, there appeared to be a gap in the evaluation of patient experiences of therapeutic interventions delivered online. Evaluation of Web-based artifacts has focused either on evaluation of experience from a computer Web-design perspective through usability testing or on evaluation of treatment effectiveness. Neither of these methods focuses on the psychological experience of the person while engaged in the therapeutic process. Objective: This study aimed to investigate what methods, if any, have been used to evaluate the in situ psychological experience of users of Web-based self-help psychosocial interventions. Methods: A systematic literature review was undertaken of interdisciplinary databases with a focus on health and computer sciences. Studies that met a predetermined search protocol were included. Results: Among 21 studies identified that examined psychological experience of the user, only 1 study collected user experience in situ. The most common method of understanding users’ experience was through semistructured interviews conducted posttreatment or questionnaires administrated at the end of an intervention session. The questionnaires were usually based on standardized tools used to assess user experience with traditional face-to-face treatment. Conclusions: There is a lack of methods specified in the literature to evaluate the interface between Web-based mental health or behavior change artifacts and users. Main limitations in the research were the nascency of the topic and cross-disciplinary nature of the field. There is a need to develop and deliver methods of understanding users’ psychological experiences while using an intervention. %M 27363519 %R 10.2196/jmir.5455 %U http://www.jmir.org/2016/6/e181/ %U https://doi.org/10.2196/jmir.5455 %U http://www.ncbi.nlm.nih.gov/pubmed/27363519 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e144 %T Trial Promoter: A Web-Based Tool for Boosting the Promotion of Clinical Research Through Social Media %A Reuter,Katja %A Ukpolo,Francis %A Ward,Edward %A Wilson,Melissa L %A Angyan,Praveen %+ Southern California Clinical and Translational Science Institute, Keck School of Medicine of USC, University of Southern California, CSC 200 Bldg, 2nd floor, 2250 Alcazar Street, Los Angeles, CA, 90033, United States, 1 3234422046, Katja.Reuter@usc.edu %K algorithm %K automation %K clinical trial %K communication %K Facebook %K Internet %K online %K patient %K recruitment %K social network %K social media %K Twitter %D 2016 %7 29.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Scarce information about clinical research, in particular clinical trials, is among the top reasons why potential participants do not take part in clinical studies. Without volunteers, on the other hand, clinical research and the development of novel approaches to preventing, diagnosing, and treating disease are impossible. Promising digital options such as social media have the potential to work alongside traditional methods to boost the promotion of clinical research. However, investigators and research institutions are challenged to leverage these innovations while saving time and resources. Objective: To develop and test the efficiency of a Web-based tool that automates the generation and distribution of user-friendly social media messages about clinical trials. Methods: Trial Promoter is developed in Ruby on Rails, HTML, cascading style sheet (CSS), and JavaScript. In order to test the tool and the correctness of the generated messages, clinical trials (n=46) were randomized into social media messages and distributed via the microblogging social media platform Twitter and the social network Facebook. The percent correct was calculated to determine the probability with which Trial Promoter generates accurate messages. Results: During a 10-week testing phase, Trial Promoter automatically generated and published 525 user-friendly social media messages on Twitter and Facebook. On average, Trial Promoter correctly used the message templates and substituted the message parameters (text, URLs, and disease hashtags) 97.7% of the time (1563/1600). Conclusions: Trial Promoter may serve as a promising tool to render clinical trial promotion more efficient while requiring limited resources. It supports the distribution of any research or other types of content. The Trial Promoter code and installation instructions are freely available online. %M 27357424 %R 10.2196/jmir.4726 %U http://www.jmir.org/2016/6/e144/ %U https://doi.org/10.2196/jmir.4726 %U http://www.ncbi.nlm.nih.gov/pubmed/27357424 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 2 %P e139 %T Feasibility of an Electronic Survey on iPads with In-Person Data Collectors for Data Collection with Health Care Professionals and Health Care Consumers in General Emergency Departments %A Scott,Shannon D %A Albrecht,Lauren %A Given,Lisa M %A Arseneau,Danielle %A Klassen,Terry P %+ University of Alberta, Faculty of Nursing, 3rd floor, Edmonton Clinic Health Adacemy, 11405 87 Ave, Edmonton, AB, T6G 1C9, Canada, 1 7804921037, ss14@ualberta.ca %K survey development %K electronic survey %K survey implementation %K needs assessment %K pediatric emergency medicine %D 2016 %7 29.06.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Translating Emergency Knowledge for Kids was established to bridge the research-practice gap in pediatric emergency care by bringing the best evidence to Canadian general emergency departments (EDs). The first step in this process was to conduct a national needs assessment to determine the information needs and preferences of health professionals and parents in this clinical setting. Objective: To describe the development and implementation of two electronic surveys, and determine the feasibility of collecting electronic survey data on iPads with in-person data collectors in a busy clinical environment. Methods: Two descriptive surveys were conducted in 32 general EDs. Specific factors were addressed in four survey development and implementation stages: survey design, survey delivery, survey completion, and survey return. Feasibility of the data collection approach was determined by evaluating participation rates, completion rates, average survey time to completion, and usability of the platform. Usability was assessed with the in-person data collectors on five key variables: interactivity, portability, innovativeness, security, and proficiency. Results: Health professional participation rates (1561/2575, 60.62%) and completion rates (1471/1561, 94.23%) were strong. Parental participation rates (974/1099, 88.63%) and completion rates (897/974, 92.09%) were excellent. Mean time to survey completion was 28.08 minutes for health professionals and 43.23 minutes for parents. Data collectors rated the platform “positively” to “very positively” on all five usability variables. Conclusions: A number of design and implementation considerations were explored and integrated into this mixed-mode survey data collection approach. Feasibility was demonstrated by the robust survey participation and completion rates, reasonable survey completion times, and very positive usability evaluation results. %M 27358205 %R 10.2196/resprot.5170 %U http://www.researchprotocols.org/2016/2/e139/ %U https://doi.org/10.2196/resprot.5170 %U http://www.ncbi.nlm.nih.gov/pubmed/27358205 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 5 %N 2 %P e17 %T Relationship of Buckling and Knee Injury to Pain Exacerbation in Knee Osteoarthritis: A Web-Based Case-Crossover Study %A Zobel,Isabelle %A Erfani,Tahereh %A Bennell,Kim L %A Makovey,Joanna %A Metcalf,Ben %A Chen,Jian Sheng %A March,Lyn %A Zhang,Yuqing %A Eckstein,Felix %A Hunter,David J %+ Institute of Bone and Joint Research, Kolling Institute, University of Sydney, and Rheumatology Department, Royal North Shore Hospital, Sydney, NSW Australia, 7C Clinical Administration, Department of Rheumatology, Royal North Shore Hospital, St Leonards, 2065, Australia, 61 2 94631788, David.Hunter@sydney.edu.au %K knee osteoarthritis %K injury %K buckling pain exacerbation %K case-crossover study %K web-based %D 2016 %7 24.06.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: Knee osteoarthritis (OA) is one of the most frequent causes of limited mobility and diminished quality of life. Pain is the main symptom that drives individuals with knee OA to seek medical care and a recognized antecedent to disability and eventually joint replacement. Evidence shows that patients with symptomatic OA experience fluctuations in pain severity. Mechanical insults to the knee such as injury and buckling may contribute to pain exacerbation. Objective: Our objective was to examine whether knee injury and buckling (giving way) are triggers for exacerbation of pain in persons with symptomatic knee OA. Methods: We conducted a case-crossover study, a novel methodology in which participants with symptomatic radiographic knee OA who have had knee pain exacerbations were used as their own control (self-matched design), with all data collected via the Internet. Participants were asked to log-on to the study website and complete an online questionnaire at baseline and then at regular 10-day intervals for 3 months (control periods)—a total of 10 questionnaires. They were also instructed to go to the website and complete pain exacerbation questionnaires when they experienced an isolated incident of knee pain exacerbation (case periods). A pain exacerbation “case” period was defined as an increase of ≥2 compared to baseline. At each contact the pain exacerbation was designated a case period, and at all other regular 10-day contacts (control periods) participants were asked about knee injuries during the previous 7 days and knee buckling during the previous 2 days. The relationship of knee injury and buckling to the risk of pain exacerbation was examined using conditional logistic regression models. Results: The analysis included 157 participants (66% women, mean age: 62 years, mean BMI: 29.5 kg/m2). Sustaining a knee injury was associated with experiencing a pain exacerbation (odds ratio [OR] 10.2, 95% CI 5.4, 19.3) compared with no injury. Knee buckling was associated with experiencing a pain exacerbation (OR 4.0, 95% CI 2.6, 6.2) compared with no buckling and the association increased with a greater number of buckling events (for ≥ 6 buckling events, OR 20.1, 95% CI 3.7, 110). Conclusions: Knee injury and buckling are associated with knee pain exacerbation. Reducing the likelihood of these mechanical events through avoidance of particular activities and/or appropriate rehabilitation programs may decrease the risk of pain exacerbation. %M 27342008 %R 10.2196/ijmr.5452 %U http://www.i-jmr.org/2016/2/e17/ %U https://doi.org/10.2196/ijmr.5452 %U http://www.ncbi.nlm.nih.gov/pubmed/27342008 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e105 %T Participation in an Intensive Longitudinal Study with Weekly Web Surveys Over 2.5 Years %A Barber,Jennifer %A Kusunoki,Yasamin %A Gatny,Heather %A Schulz,Paul %+ Institute for Social Research, Survey Research Center, University of Michigan, 426 Thompson St, Ann Arbor, MI, 48106, United States, 1 7346153560, hgatny@umich.edu %K RDSL %K web survey %K longitudinal study %K panel study %K intensive data collection %D 2016 %7 23.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Technological advances have made it easier for researchers to collect more frequent longitudinal data from survey respondents via personal computers, smartphones, and other mobile devices. Although technology has led to an increase in data-intensive longitudinal studies, little is known about attrition from such studies or the differences between respondents who complete frequently administered surveys in a timely manner, and respondents who do not. Objective: We examined respondent characteristics and behaviors associated with continued and on-time participation in a population-based intensive longitudinal study, using weekly web-based survey interviews over an extended period. Methods: We analyzed data from the Relationship Dynamics and Social Life study, an intensive longitudinal study that collected weekly web-based survey interviews for 2.5 years from 1003 18- and 19-year-olds to investigate factors shaping the dynamics of their sexual behavior, contraceptive use, and pregnancies. Results: Ordinary least squares and logistic regression analyses showed background respondent characteristics measured at baseline were associated with the number of days respondents remained enrolled in the study, the number of interviews they completed, and the odds that they were late completing interviews. In addition, we found that changes in pregnancy-related behaviors reported in the weekly interviews were associated with late completion of interviews. Specifically, after controlling for sociodemographic, personality, contact information, and prior experience variables, we found that weekly reports such as starting to have sex (odds ratio [OR] 1.17, 95% CI 1.03-1.32, P=.01), getting a new partner (OR 1.76, 95% CI 1.53-2.03, P<.001), stopping the use of contraception (OR 1.28, 95% CI 1.10-1.49, P=.001), and having a new pregnancy (OR 5.57, 95% CI 4.26-7.29, P<.001) were significantly associated with late survey completion. However, young women who reported changes in pregnancy-related behaviors also had lower levels of study attrition, and completed more interviews overall, than did their counterparts. Conclusions: We found that measures of participation in a longitudinal study with weekly web surveys varied not only by respondent characteristics, but also by behaviors measured across the surveys. Our analyses suggest that respondents who experience the behaviors measured by the study may maintain higher participation levels than respondents who do not experience those behaviors. %M 27338859 %R 10.2196/jmir.5422 %U http://www.jmir.org/2016/6/e105/ %U https://doi.org/10.2196/jmir.5422 %U http://www.ncbi.nlm.nih.gov/pubmed/27338859 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e168 %T The Inclusion of African-American Study Participants in Web-Based Research Studies: Viewpoint %A Watson,Bekeela %A Robinson,Dana H.Z %A Harker,Laura %A Arriola,Kimberly R. Jacob %+ Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, 1518 Clifton Rd., NE, Rm 525, Atlanta, GA, 30322, United States, 1 404 594 1156, dhrobin@emory.edu %K Web-based interventions %K African-Americans %K social media %K Internet %K research techniques %D 2016 %7 22.06.2016 %9 Viewpoint %J J Med Internet Res %G English %X The use of Web-based methods for research recruitment and intervention delivery has greatly increased as Internet usage continues to grow. These Internet-based strategies allow for researchers to quickly reach more people. African-Americans are underrepresented in health research studies. Due to this, African-Americans get less benefit from important research that could address the disproportionate health outcomes they face. Web-based research studies are one promising way to engage more African-Americans and build trust with the African-American community. With African-Americans’ increasing access to the Internet using mobile phones and other mobile phone technologies, we advocate for efforts to increase the representation of African-Americans in research studies by using the Internet as a recruitment tool and conclude with recommendations that support this goal. %M 27334683 %R 10.2196/jmir.5486 %U http://www.jmir.org/2016/6/e168/ %U https://doi.org/10.2196/jmir.5486 %U http://www.ncbi.nlm.nih.gov/pubmed/27334683 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e126 %T Using Visual Analogue Scales in eHealth: Non-Response Effects in a Lifestyle Intervention %A Kuhlmann,Tim %A Reips,Ulf-Dietrich %A Wienert,Julian %A Lippke,Sonia %+ Research Methods, Assessment & iScience, Department of Psychology, University of Konstanz, Universitätsstraße 10, Konstanz, 78454, Germany, 49 7531882895, tim.kuhlmann@uni-konstanz.de %K eHealth %K RCT %K VAS %K dropout %K visual analogue scale %K Internet science %K measurement %D 2016 %7 22.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Visual analogue scales (VASs) have been shown to be valid measurement instruments and a better alternative to Likert-type scales in Internet-based research, both empirically and theoretically [1,2]. Upsides include more differentiated responses, better measurement level, and less error. Their feasibility and properties in the context of eHealth, however, have not been examined so far. Objective: The present study examined VASs in the context of a lifestyle study conducted online, measuring the impact of VASs on distributional properties and non-response. Method: A sample of 446 participants with a mean age of 52.4 years (standard deviation (SD) = 12.1) took part in the study. The study was carried out as a randomized controlled trial, aimed at supporting participants over 8 weeks with an additional follow-up measurement. In addition to the randomized questionnaire, participants were further randomly assigned to either a Likert-type or VAS response scale version of the measures. Results: Results showed that SDs were lower for items answered via VASs, 2P (Y ≥ 47 | n=55, P=.5) < .001. Means did not differ across versions. Participants in the VAS version showed lower dropout rates than participants in the Likert version, odds ratio = 0.75, 90% CI (0.58-0.98), P=.04. Number of missing values did not differ between questionnaire versions. Conclusions: The VAS is shown to be a valid instrument in the eHealth context, offering advantages over Likert-type scales. The results of the study provide further support for the use of VASs in Internet-based research, extending the scope to senior samples in the health context. Trial Registration: Clinicaltrials.gov NCT01909349; https://clinicaltrials.gov/ct2/show/NCT01909349 (Archived by WebCite at http://www.webcitation.org/6h88sLw2Y) %M 27334562 %R 10.2196/jmir.5271 %U http://www.jmir.org/2016/6/e126/ %U https://doi.org/10.2196/jmir.5271 %U http://www.ncbi.nlm.nih.gov/pubmed/27334562 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e151 %T A Systematic Review of Methods and Procedures Used in Ecological Momentary Assessments of Diet and Physical Activity Research in Youth: An Adapted STROBE Checklist for Reporting EMA Studies (CREMAS) %A Liao,Yue %A Skelton,Kara %A Dunton,Genevieve %A Bruening,Meg %+ Arizona State University, School of Nutrition and Health Promotion, 500 N 5th Street, Phoenix, AZ, 85004, United States, 1 6028272266, Meg.Bruening@asu.edu %K ecological momentary assessment %K nutrition %K physical activity %K youth %K systematic review %K reporting checklist %D 2016 %7 21.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Ecological momentary assessment (EMA) is a method of collecting real-time data based on careful timing, repeated measures, and observations that take place in a participant’s typical environment. Due to methodological advantages and rapid advancement in mobile technologies in recent years, more studies have adopted EMA in addressing topics of nutrition and physical activity in youth. Objective: The aim of this systematic review is to describe EMA methodology that has been used in studies addressing nutrition and physical activity in youth and provide a comprehensive checklist for reporting EMA studies. Methods: Thirteen studies were reviewed and analyzed for the following 5 areas of EMA methodology: (1) sampling and measures, (2) schedule, (3) technology and administration, (4) prompting strategy, and (5) response and compliance. Results: Results of this review showed a wide variability in the design and reporting of EMA studies in nutrition and physical activity among youth. The majority of studies (69%) monitored their participants during one period of time, although the monitoring period ranged from 4 to 14 days, and EMA surveys ranged from 2 to 68 times per day. More than half (54%) of the studies employed some type of electronic technology. Most (85%) of the studies used interval-contingent prompting strategy. For studies that utilized electronic devices with interval-contingent prompting strategy, none reported the actual number of EMA prompts received by participants out of the intended number of prompts. About half (46%) of the studies failed to report information about EMA compliance rates. For those who reported, compliance rates ranged from 44-96%, with an average of 71%. Conclusions: Findings from this review suggest that in order to identify best practices for EMA methodology in nutrition and physical activity research among youth, more standardized EMA reporting is needed. Missing the key information about EMA design features and participant compliance might lead to misinterpretation of results. Future nutrition and physical activity EMA studies need to be more rigorous and thorough in descriptions of methodology and results. A reporting checklist was developed with the goal of enhancing reliability, efficacy, and overall interpretation of the findings for future studies that use EMAs. %M 27328833 %R 10.2196/jmir.4954 %U http://www.jmir.org/2016/6/e151/ %U https://doi.org/10.2196/jmir.4954 %U http://www.ncbi.nlm.nih.gov/pubmed/27328833 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e138 %T Web-Based Assessment of Mental Well-Being in Early Adolescence: A Reliability Study %A Hamann,Christoph %A Schultze-Lutter,Frauke %A Tarokh,Leila %+ University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstr. 111, Haus A, Bern, 3000, Switzerland, 41 31 932 8554, leila_tarokh@brown.edu %K early adolescence %K online assessment %K reliability %D 2016 %7 15.06.2016 %9 Short Paper %J J Med Internet Res %G English %X Background: The ever-increasing use of the Internet among adolescents represents an emerging opportunity for researchers to gain access to larger samples, which can be queried over several years longitudinally. Among adolescents, young adolescents (ages 11 to 13 years) are of particular interest to clinicians as this is a transitional stage, during which depressive and anxiety symptoms often emerge. However, it remains unclear whether these youngest adolescents can accurately answer questions about their mental well-being using a Web-based platform. Objective: The aim of the study was to examine the accuracy of responses obtained from Web-based questionnaires by comparing Web-based with paper-and-pencil versions of depression and anxiety questionnaires. Methods: The primary outcome was the score on the depression and anxiety questionnaires under two conditions: (1) paper-and-pencil and (2) Web-based versions. Twenty-eight adolescents (aged 11-13 years, mean age 12.78 years and SD 0.78; 18 females, 64%) were randomly assigned to complete either the paper-and-pencil or the Web-based questionnaire first. Intraclass correlation coefficients (ICCs) were calculated to measure intrarater reliability. Intraclass correlation coefficients were calculated separately for depression (Children’s Depression Inventory, CDI) and anxiety (Spence Children’s Anxiety Scale, SCAS) questionnaires. Results: On average, it took participants 17 minutes (SD 6) to answer 116 questions online. Intraclass correlation coefficient analysis revealed high intrarater reliability when comparing Web-based with paper-and-pencil responses for both CDI (ICC=.88; P<.001) and the SCAS (ICC=.95; P<.001). According to published criteria, both of these values are in the “almost perfect” category indicating the highest degree of reliability. Conclusions: The results of the study show an excellent reliability of Web-based assessment in 11- to 13-year-old children as compared with the standard paper-pencil assessment. Furthermore, we found that Web-based assessments with young adolescents are highly feasible, with all enrolled participants completing the Web-based form. As early adolescence is a time of remarkable social and behavioral changes, these findings open up new avenues for researchers from diverse fields who are interested in studying large samples of young adolescents over time. %M 27306932 %R 10.2196/jmir.5482 %U http://www.jmir.org/2016/6/e138/ %U https://doi.org/10.2196/jmir.5482 %U http://www.ncbi.nlm.nih.gov/pubmed/27306932 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 2 %P e95 %T Mediators of Atherosclerosis in South Asians Living in America: Use of Web-Based Methods for Follow-Up and Collection of Patient-Reported Outcome Measures %A Kandula,Namratha R %A Puri-Taneja,Ankita %A Victorson,David E %A Dave,Swapna S %A Kanaya,Alka M %A Huffman,Mark D %+ Feinberg School of Medicine, Division of General Internal Medicine, Department of Preventive Medicine, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 3125036470, nkandula@nm.org %K cardiovascular diseases %K cohort studies %K Internet %K South Asian %D 2016 %7 08.06.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: A key challenge for longitudinal cohort studies is follow-up and retention of study participants. Participant follow-up in longitudinal cohort studies is costly and time-consuming for research staff and participants. Objective: This study determined the feasibility and costs of using Web-based technologies for follow-up and collection of patient-reported outcomes in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Methods: The MASALA study is a community-based cohort of 906 South Asians in the United States. Since the baseline in-person visits (2010-2013), a yearly telephone follow-up survey was used to assess participants’ health status and incidence of cardiovascular disease. A Web-based version of the follow-up survey was developed using the REDCap (Research Electronic Data Capture) Web app. Participants from the Chicago field center who were due for their annual follow-up and who had a valid email address were sent an email link to a secure online portal where they could complete the survey. Telephone follow-up was used with nonresponders. Results: A link to the Web survey was emailed to 285 participants (February to October 2014) and the overall completion rate was 47.7% (136/285). One-third of participants who were unresponsive (n=36) to annual telephone follow-up completed the Web survey. Web responders were younger, more likely to be married, and to have higher education and income compared (P<.05) to telephone-only responders. Web survey development involved 240 hours of research staff time. Since launching, the Web-based survey has required 3 hours per week of staff time. Conclusions: Although electronic follow-up will not be a panacea for cohort operations, it will serve as an adjunctive strategy to telephonic follow-up for maximizing cohort retention with lower costs. %M 27278905 %R 10.2196/resprot.5448 %U http://www.researchprotocols.org/2016/2/e95/ %U https://doi.org/10.2196/resprot.5448 %U http://www.ncbi.nlm.nih.gov/pubmed/27278905 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e141 %T Medical Registry Data Collection Efficiency: A Crossover Study Comparing Web-Based Electronic Data Capture and a Standard Spreadsheet %A Staziaki,Pedro Vinícius %A Kim,Phillip %A Vadvala,Harshna V %A Ghoshhajra,Brian B %+ Massachusetts General Hospital, Department of Radiology, Harvard Medical School, 165 Cambridge St, Suite 400, Boston, MA, 02114, United States, 1 6177263745, bghoshhajra@mgh.harvard.edu %K electronic data capture %K clinical research %K translational research %K registry %K data management %D 2016 %7 08.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic medical records and electronic data capture (EDC) have changed data collection in clinical and translational research. However, spreadsheet programs, such as Microsoft Excel, are still used as data repository to record and organize patient data for research. Objective: The objective of this study is to assess the efficiency of EDC as against a standard spreadsheet in regards to time to collect data and data accuracy, measured in number of errors after adjudication. Methods: This was a crossover study comparing the time to collect data in minutes between EDC and a spreadsheet. The EDC tool used was Research Electronic Data Capture (REDCap), whereas the spreadsheet was Microsoft Excel. The data collected was part of a registry of patients who underwent coronary computed tomography angiography in the emergency setting. Two data collectors with the same experience went over the same patients and collected relevant data on a case report form identical to the one used in our Emergency Department (ED) registry. Data collection tool was switched after the patient that represented half the cohort. For this, the patient cohort was exactly 30 days of our ED coronary Computed Tomography Angiography registry and the point of crossover was determined beforehand to be 15 days. We measured the number of patients admitted, and time to collect data. Accuracy was defined as absence of blank fields and errors, and was assessed by comparing data between data collectors and counting every time the data differed. Statistical analysis was made using paired t -test. Results: The study included 61 patients (122 observations) and 55 variables. The crossover occurred after the 30th patient. Mean time to collect data using EDC in minutes was 6.2±2.3, whereas using Excel was 8.0±2.0 (P <.001), a difference of 1.8 minutes between both means (22%). The cohort was evenly distributed with 3 admissions in the first half of the crossover and 4 in the second half. We saw 2 (<0.1%) continuous variable typos in the spreadsheet that a single data collector made. There were no blank fields. The data collection tools showed no differences in accuracy of data on comparison. Conclusions: Data collection for our registry with an EDC tool was faster than using a spreadsheet, which in turn allowed more efficient follow-up of cases. %M 27277523 %R 10.2196/jmir.5576 %U http://www.jmir.org/2016/6/e141/ %U https://doi.org/10.2196/jmir.5576 %U http://www.ncbi.nlm.nih.gov/pubmed/27277523 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 6 %P e124 %T Achieving Synergy: Linking an Internet-Based Inflammatory Bowel Disease Cohort to a Community-Based Inception Cohort and Multicentered Cohort in Inflammatory Bowel Disease %A Kochar,Bharati %A Aldridge,Molly %A Cook,Suzanne Follan %A Bright,Renee %A Mallette,Meaghan %A Moniz,Heather %A Shah,Samir A %A LeLeiko,Neal S %A Shapiro,Jason %A Sands,Bruce E %A Chen,Wenli %A Jaeger,Elizabeth %A Galanko,Joseph %A Long,Millie D %A Martin,Christopher F %A Sandler,Robert S %A Kappelman,Michael D %+ University of North Carolina, Center for Gastrointestinal Biology and Disease, Campus Box #7080, Bioinformatics Building, 130 Mason Farm Road, Chapel Hill, NC, 27599, United States, 1 9199662514, bharati.kochar@unchealth.unc.edu %K Crohn’s disease %K ulcerative colitis %K inflammatory bowel disease %K cohort study %D 2016 %7 03.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Traditional cohort studies are important contributors to our understanding of inflammatory bowel diseases, but they are labor intensive and often do not focus on patient-reported outcomes. Internet-based studies provide new opportunities to study patient-reported outcomes and can be efficiently implemented and scaled. If a traditional cohort study was linked to an Internet-based study, both studies could benefit from added synergy. Existing cohort studies provide an opportunity to develop and test processes for cohort linkage. The Crohn’s and Colitis Foundation of America’s (CCFA) Partners study is an Internet-based cohort of more than 14,000 participants. The Ocean State Crohn’s and Colitis Area Registry (OSCCAR) is an inception cohort. The Sinai-Helmsley Alliance for Research Excellence (SHARE) is a multicentered cohort of inflammatory bowel disease patients. Both the later cohorts include medical record abstraction, patient surveys, and biospecimen collection. Objective: Given the complementary nature of these existing cohorts, we sought to corecruit and link data. Methods: Eligible OSCCAR and SHARE participants were invited to join the CCFA Partners study and provide consent for data sharing between the 2 cohorts. After informed consent, participants were directed to the CCFA Partners website to complete enrollment and a baseline Web-based survey. Participants were linked across the 2 cohorts by the matching of an email address. We compared demographic and clinical characteristics between OSCCAR and SHARE participants who did and did not enroll in CCFA Partners and the data linkage. Results: Of 408 participants in the OSCCAR cohort, 320 were eligible for participation in the CCFA Partners cohort. Of these participants, 243 consented to participation; however, only 44 enrolled in CCFA Partners and completed the linkage. OSCCAR participants who enrolled in CCFA Partners were better educated (17% with doctoral degrees) than those who did not (3% with doctoral degrees, P=.01). In the SHARE cohort, 436 participants enrolled and linked to the Partners cohort. More women (60% vs 50%) linked and those who linked were predominantly white (96%; P<.01). Crohn’s disease patients who linked had lower mean scores on the Harvey-Bradshaw Index (3.6 vs 4.4, P<.01). Ulcerative colitis patients who linked had less extensive disease than those who did not link (45% vs 60%, P<.01). Conclusions: Linkage of CCFA Partners with cohorts such as OSCCAR and SHARE may be a cost-effective way to expand the infrastructure for clinical outcomes and translational research. Although linkage is feasible from a technical, legal, and regulatory perspective, participant willingness appears to be a limiting factor. Overcoming this barrier will be needed to generate meaningful sample sizes to conduct studies of biomarkers, natural history, and clinical effectiveness using linked data. %M 27261008 %R 10.2196/jmir.5655 %U http://www.jmir.org/2016/6/e124/ %U https://doi.org/10.2196/jmir.5655 %U http://www.ncbi.nlm.nih.gov/pubmed/27261008 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 1 %P e28 %T Development and Implementation of Culturally Tailored Offline Mobile Health Surveys %A McIntosh,Scott %A Pérez-Ramos,José %A Demment,Margaret M %A Vélez Vega,Carmen %A Avendaño,Esteban %A Ossip,Deborah J %A Dye,Timothy D %+ School of Medicine & Dentistry, Department of Public Health Sciences, University of Rochester, CU420644, 265 Crittenden Blvd, Rochester, NY, 14642, United States, 1 585 802 9944, scott_mcintosh@urmc.rochester.edu %K mobile health %K survey research %K ethical review %D 2016 %7 02.06.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In low and middle income countries (LMICs), and other areas with low resources and unreliable access to the Internet, understanding the emerging best practices for the implementation of new mobile health (mHealth) technologies is needed for efficient and secure data management and for informing public health researchers. Innovations in mHealth technology can improve on previous methods, and dissemination of project development details and lessons learned during implementation are needed to provide lessons learned to stakeholders in both the United States and LMIC settings. Objective: The aims of this paper are to share implementation strategies and lessons learned from the development and implementation stages of two survey research projects using offline mobile technology, and to inform and prepare public health researchers and practitioners to implement new mobile technologies in survey research projects in LMICs. Methods: In 2015, two survey research projects were developed and piloted in Puerto Rico and pre-tested in Costa Rica to collect face-to-face data, get formative evaluation feedback, and to test the feasibility of an offline mobile data collection process. Fieldwork in each setting involved survey development, back translation with cultural tailoring, ethical review and approvals, data collector training, and piloting survey implementation on mobile tablets. Results: Critical processes and workflows for survey research projects in low resource settings were identified and implemented. This included developing a secure mobile data platform tailored to each survey, establishing user accessibility, and training and eliciting feedback from data collectors and on-site LMIC project partners. Conclusions: Formative and process evaluation strategies are necessary and useful for the development and implementation of survey research projects using emerging mHealth technologies in LMICs and other low resource settings. Lessons learned include: (1) plan institutional review board (IRB) approvals in multiple countries carefully to allow for development, implementation, and feedback, (2) in addition to testing the content of survey instruments, allow time and consideration for testing the use of novel mHealth technology (hardware and software), (3) incorporate training for and feedback from project staff, LMIC partner staff, and research participants, and (4) change methods accordingly, including content, as mHealth technology usage influences and is influenced by the content and structure of the survey instrument. Lessons learned from early phases of LMIC research projects using emerging mHealth technologies are critical for informing subsequent research methods and study designs. %M 27256208 %R 10.2196/publichealth.5408 %U http://publichealth.jmir.org/2016/1/e28/ %U https://doi.org/10.2196/publichealth.5408 %U http://www.ncbi.nlm.nih.gov/pubmed/27256208 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 5 %P e110 %T Exploring Concordance of Patient-Reported Information on PatientsLikeMe and Medical Claims Data at the Patient Level %A Eichler,Gabriel S %A Cochin,Elisenda %A Han,Jian %A Hu,Sylvia %A Vaughan,Timothy E %A Wicks,Paul %A Barr,Charles %A Devenport,Jenny %+ PatientsLikeMe, 160 Second Street, Cambridge, MA, 02142, United States, 1 617 314 4352, pwicks@patientslikeme.com %K feasibility of data linking %K patient-powered research network %D 2016 %7 12.05.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: With the emergence of data generated by patient-powered research networks, it is informative to characterize their correspondence with health care system-generated data. Objectives: This study explored the linking of 2 disparate sources of real-world data: patient-reported data from a patient-powered research network (PatientsLikeMe) and insurance claims. Methods: Active patients within the PatientsLikeMe community, residing in the United States, aged 18 years or older, with a self-reported diagnosis of multiple sclerosis or Parkinson’s disease (PD) were invited to participate during a 2-week period in December 2014. Patient-reported data were anonymously matched and compared to IMS Health medical and pharmacy claims data with dates of service between December 2009 and December 2014. Patient-level match (identity), diagnosis, and usage of disease-modifying therapies (DMTs) were compared between data sources. Results: Among 603 consenting patients, 94% had at least 1 record in the IMS Health dataset; of these, there was 93% agreement rate for multiple sclerosis diagnosis. Concordance on the use of any treatment was 59%, and agreement on reports of specific treatment usage (within an imputed 5-year period) ranged from 73.5% to 100%. Conclusions: It is possible to match patient identities between the 2 data sources, and the high concordance at multiple levels suggests that the matching process was accurate. Likewise, the high degree of concordance suggests that these patients were able to accurately self-report their diagnosis and, to a lesser degree, their treatment usage. Further studies of linked data types are warranted to evaluate the use of enriched datasets to generate novel insights. %M 27174602 %R 10.2196/jmir.5130 %U http://www.jmir.org/2016/5/e110/ %U https://doi.org/10.2196/jmir.5130 %U http://www.ncbi.nlm.nih.gov/pubmed/27174602 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 4 %P e68 %T Comparison Between a Self-Administered and Supervised Version of a Web-Based Cognitive Test Battery: Results From the NutriNet-Santé Cohort Study %A Assmann,Karen E %A Bailet,Marion %A Lecoffre,Amandine C %A Galan,Pilar %A Hercberg,Serge %A Amieva,Hélène %A Kesse-Guyot,Emmanuelle %+ Université Paris 13, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d'Epidémiologie et Statistiques Sorbonne Paris Cité, Inserm (U1153), Inra (U1125), Cnam, COMUE Sorbonne Paris Cité, UFR SMBH, 74 rue Marcel Cachin, Bobigny, 93017, France, 33 1 48 38 73 78, k.assmann@eren.smbh.univ-paris13.fr %K cognition %K executive function %K internet %K cohort studies %D 2016 %7 05.04.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Dementia is a major public health problem, and repeated cognitive data from large epidemiological studies could help to develop efficient measures of early prevention. Data collection by self-administered online tools could drastically reduce the logistical and financial burden of such large-scale investigations. In this context, it is important to obtain data concerning the comparability of such new online tools with traditional, supervised modes of cognitive assessment. Objective: Our objective was to compare self-administration of the Web-based NutriNet-Santé cognitive test battery (NutriCog) with administration by a neuropsychologist. Methods: The test battery included four tests, measuring, among others aspects, psychomotor speed, attention, executive function, episodic memory, working memory, and associative memory. Both versions of the cognitive battery were completed by 189 volunteers (either self-administered version first, n=99, or supervised version first, n=90). Subjects also completed a satisfaction questionnaire. Concordance was assessed by Spearman correlation. Results: Agreement between both versions varied according to the investigated cognitive task and outcome variable. Spearman correlations ranged between .42 and .73. Moreover, a majority of participants responded that they “absolutely” or “rather” agreed that the duration of the self-administered battery was acceptable (184/185, 99.5%), that the tasks were amusing (162/185, 87.6%), that the instructions were sufficiently detailed (168/185; 90.8%) and understandable (164/185, 88.7%), and that they had overall enjoyed the test battery (182/185, 98.4%). Conclusions: The self-administered version of the Web-based NutriCog cognitive test battery provided similar information as the supervised version. Thus, integrating repeated cognitive evaluations into large cohorts via the implementation of self-administered online versions of traditional test batteries appears to be feasible. %M 27049114 %R 10.2196/jmir.4862 %U http://www.jmir.org/2016/4/e68/ %U https://doi.org/10.2196/jmir.4862 %U http://www.ncbi.nlm.nih.gov/pubmed/27049114 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 3 %P e70 %T Assessing the Effects of Participant Preference and Demographics in the Usage of Web-based Survey Questionnaires by Women Attending Screening Mammography in British Columbia %A Mlikotic,Rebecca %A Parker,Brent %A Rajapakshe,Rasika %+ British Columbia Cancer Agency, Sindi Ahluwalia Hawkins Centre for the Southern Interior, 399 Royal Avenue, Kelowna, BC, V1Y 5L3, Canada, 1 250 712 3966 ext 686912, rebecca.mlikotic@alumni.ubc.ca %K patient preference %K patient reported outcomes %K patient reported outcome measures %K questionnaires %K Internet %K Web-based system %K survey methods %K breast cancer screening %D 2016 %7 22.03.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Increased usage of Internet applications has allowed for the collection of patient reported outcomes (PROs) and other health data through Web-based communication and questionnaires. While these Web platforms allow for increased speed and scope of communication delivery, there are certain limitations associated with this technology, as survey mode preferences vary across demographic groups. Objective: To investigate the impact of demographic factors and participant preferences on the use of a Web-based questionnaire in comparison with more traditional methods (mail and phone) for women participating in screening mammography in British Columbia, Canada. Methods: A sample of women attending the Screening Mammography Program of British Columbia (SMPBC) participated in a breast cancer risk assessment project. The study questionnaire was administered through one of three modes (ie, telephone, mail, or website platform). Survey mode preferences and actual methods of response were analyzed for participants recruited from Victoria General Hospital. Both univariate and multivariate analyses were used to investigate the association of demographic factors (ie, age, education level, and ethnicity) with certain survey response types. Results: A total of 1192 women successfully completed the study questionnaire at Victoria General Hospital. Mail was stated as the most preferred survey mode (509/1192, 42.70%), followed by website platform (422/1192, 35.40%), and telephone (147/1192, 12.33%). Over 80% (955/1192) of participants completed the questionnaire in the mode previously specified as their most preferred; mail was the most common method of response (688/1192, 57.72%). Mail was also the most preferred type of questionnaire response method when participants responded in a mode other than their original preference. The average age of participants who responded via the Web-based platform (age 52.9, 95% confidence interval [CI] 52.1-53.7) was significantly lower than those who used mail and telephone methods (age 55.9, 95% CI 55.2-56.5; P<.001); each decade of increased age was associated with a 0.97-fold decrease in the odds of using the website platform (P<.001). Web-based participation was more likely for those who completed higher levels of education; each interval increase leading to a 1.83 increase in the odds of website platform usage (P<.001). Ethnicity was not shown to play a role in participant preference for the website platform (P=.96). Conclusions: It is beneficial to consider participant survey mode preference when planning to collect PROs and other patient health data. Younger participants and those of higher education level were more likely to use the website platform questionnaire; Web-based participation failed to vary across ethnic group. Because mail questionnaires were still the most preferred survey mode, it will be important to employ strategies, such as user-friendly design and Web-based support, to ensure that the patient feedback being collected is representative of the population being served. %M 27005707 %R 10.2196/jmir.5068 %U http://www.jmir.org/2016/3/e70/ %U https://doi.org/10.2196/jmir.5068 %U http://www.ncbi.nlm.nih.gov/pubmed/27005707 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 3 %P e51 %T Including Online-Recruited Seeds: A Respondent-Driven Sample of Men Who Have Sex With Men %A Lachowsky,Nathan John %A Lal,Allan %A Forrest,Jamie I %A Card,Kiffer George %A Cui,Zishan %A Sereda,Paul %A Rich,Ashleigh %A Raymond,Henry Fisher %A Roth,Eric A %A Moore,David M %A Hogg,Robert S %+ Faculty of Health Science, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada, 1 778 782 7629, robert_hogg@sfu.ca %K men who have sex with men %K respondent driven sampling %K HIV/AIDS %K online recruitment %K Internet %D 2016 %7 15.03.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Technology has changed the way men who have sex with men (MSM) seek sex and socialize, which may impact the implementation of respondent-driven sampling (RDS) among this population. Initial participants (also known as seeds) are a critical consideration in RDS because they begin the recruitment chains. However, little information is available on how the online-recruited seeds may effect RDS implementation. Objective: The objectives of this study were to compare (1) online-recruited versus offline-recruited seeds and (2) subsequent recruitment chains of online-recruited versus offline-recruited seeds. Methods: Between 2012 and 2014, we recruited MSM using RDS in Vancouver, Canada. RDS weights were used with logistic regression to address each objective. Results: A total of 119 seeds were used, 85 of whom were online-recruited seeds, to recruit an additional 600 MSM. Compared with offline-recruited seeds, online-recruited seeds were less likely to be HIV-positive (OR 0.34, 95% CI 0.13-0.88), to have attended a gay community group (AOR 0.33, 95% CI 0.12-0.90), and to feel gay community involvement was “very important” (AOR 0.16, 95% CI 0.03-0.93). Online-recruited seeds were more likely to ask a sexual partner’s HIV status always versus <50% of the time (AOR 5.21, 95% CI 1.17-23.23), to have watched the Pride parade (AOR 6.30, 95% CI 1.69-23.45), and to have sought sex online (AOR 4.29, 95% CI 1.53-12-12.05). Further, compared with recruitment chains started by offline-recruited seeds, recruits from chains started by online-recruited seeds (283/600, 47.2%) were less likely to be HIV-positive (AOR 0.25, 95% CI 0.16-0.40), to report “versatile” versus “bottom” sexual position preference (AOR 0.56, 95% CI 0.35-0.88), and to be in a relationship lasting >1 year (AOR 1.65, 95% CI 1.06-2.56). Recruits of online seeds were more likely to be out as gay for longer (eg, 11-21 vs 1-4 years, AOR 2.22, 95% CI 1.27-3.88) and have fewer Facebook friends (eg, 201-500 vs >500, AOR 1.69, 95% CI 1.02-2.80). Conclusions: Online-recruited seeds were more prevalent, recruited fewer participants, but were different from those recruited offline. This may therefore help create a more diverse overall sample. Our work has shown the value of geosocial networking apps for aiding RDS recruitment efforts, especially when faced with slow participation uptake by other means. Understanding the degree to which networks interact will be an important next step in confirming the efficacy of online RDS recruitment strategies. %M 26980147 %R 10.2196/jmir.5258 %U http://www.jmir.org/2016/3/e51/ %U https://doi.org/10.2196/jmir.5258 %U http://www.ncbi.nlm.nih.gov/pubmed/26980147 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 2 %P e38 %T Can Google Searches Predict the Popularity and Harm of Psychoactive Agents? %A Jankowski,Wojciech %A Hoffmann,Marcin %+ Faculty of Chemistry, Adam Mickiewicz University in Poznan, Umultowska 89b, Poznan, 61-614, Poland, 48 61 829 1554, wojciech.jankowski89@gmail.com %K drugs %K narcotics %K Internet %K psychoactive agents %K forecasting %K trends %D 2016 %7 25.02.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Predicting the popularity of and harm caused by psychoactive agents is a serious problem that would be difficult to do by a single simple method. However, because of the growing number of drugs it is very important to provide a simple and fast tool for predicting some characteristics of these substances. We were inspired by the Google Flu Trends study on the activity of the influenza virus, which showed that influenza virus activity worldwide can be monitored based on queries entered into the Google search engine. Objective: Our aim was to propose a fast method for ranking the most popular and most harmful drugs based on easily available data gathered from the Internet. Methods: We used the Google search engine to acquire data for the ranking lists. Subsequently, using the resulting list and the frequency of hits for the respective psychoactive drugs combined with the word “harm” or “harmful”, we estimated quickly how much harm is associated with each drug. Results: We ranked the most popular and harmful psychoactive drugs. As we conducted the research over a period of several months, we noted that the relative popularity indexes tended to change depending on when we obtained them. This suggests that the data may be useful in monitoring changes over time in the use of each of these psychoactive agents. Conclusions: Our data correlate well with the results from a multicriteria decision analysis of drug harms in the United Kingdom. We showed that Google search data can be a valuable source of information to assess the popularity of and harm caused by psychoactive agents and may help in monitoring drug use trends. %M 26916984 %R 10.2196/jmir.4033 %U http://www.jmir.org/2016/2/e38/ %U https://doi.org/10.2196/jmir.4033 %U http://www.ncbi.nlm.nih.gov/pubmed/26916984 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 5 %N 1 %P e8 %T Surveying End-of-Life Medical Decisions in France: Evaluation of an Innovative Mixed-Mode Data Collection Strategy %A Legleye,Stephane %A Pennec,Sophie %A Monnier,Alain %A Stephan,Amandine %A Brouard,Nicolas %A Bilsen,Johan %A Cohen,Joachim %+ Institut National d'études Démographiques, Department of Survey and Sampling, 133 Boulevard Davout, Paris, 75020, France, 33 1 56 06 20 98, stephane.legleye@ined.fr %K end-of-life decisions %K France %K methodology %K mixed-mode survey %D 2016 %7 18.02.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: Monitoring medical decisions at the end of life has become an important issue in many societies. Built on previous European experiences, the survey and project Fin de Vie en France (“End of Life in France,” or EOLF) was conducted in 2010 to provide an overview of medical end-of-life decisions in France. Objective: To describe the methodology of EOLF and evaluate the effects of design innovations on data quality. Methods: EOLF used a mixed-mode data collection strategy (paper and Internet) along with follow-up campaigns that employed various contact modes (paper and telephone), all of which were gathered from various institutions (research team, hospital, and medical authorities at the regional level). A telephone nonresponse survey was also used. Through descriptive statistics and multivariate logistic regressions, these innovations were assessed in terms of their effects on the response rate, quality of the sample, and differences between Web-based and paper questionnaires. Results: The participation rate was 40.0% (n=5217). The respondent sample was very close to the sampling frame. The Web-based questionnaires represented only 26.8% of the questionnaires, and the Web-based secured procedure led to limitations in data management. The follow-up campaigns had a strong effect on participation, especially for paper questionnaires. With higher participation rates (63.21% and 63.74%), the telephone follow-up and nonresponse surveys showed that only a very low proportion of physicians refused to participate because of the topic or the absence of financial incentive. A multivariate analysis showed that physicians who answered on the Internet reported less medication to hasten death, and that they more often took no medical decisions in the end-of-life process. Conclusions: Varying contact modes is a useful strategy. Using a mixed-mode design is interesting, but selection and measurement effects must be studied further in this sensitive field. %M 26892632 %R 10.2196/ijmr.3712 %U http://www.i-jmr.org/2016/1/e8/ %U https://doi.org/10.2196/ijmr.3712 %U http://www.ncbi.nlm.nih.gov/pubmed/26892632 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 1 %P e22 %T Estimating Skin Cancer Risk: Evaluating Mobile Computer-Adaptive Testing %A Djaja,Ngadiman %A Janda,Monika %A Olsen,Catherine M %A Whiteman,David C %A Chien,Tsair-Wei %+ Research Department, Chi-Mei Medical Center, No. 901, Chung Hwa Road, Yung Kung Dist., Tainan 710, Taiwan, Tainan, 710, Taiwan, 886 937399106, smile@mail.chimei.org.tw %K computer adaptive testing %K skin cancer risk scale %K non adaptive test %K Rasch analysis %K partial credit model %D 2016 %7 22.01.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Response burden is a major detriment to questionnaire completion rates. Computer adaptive testing may offer advantages over non-adaptive testing, including reduction of numbers of items required for precise measurement. Objective: Our aim was to compare the efficiency of non-adaptive (NAT) and computer adaptive testing (CAT) facilitated by Partial Credit Model (PCM)-derived calibration to estimate skin cancer risk. Methods: We used a random sample from a population-based Australian cohort study of skin cancer risk (N=43,794). All 30 items of the skin cancer risk scale were calibrated with the Rasch PCM. A total of 1000 cases generated following a normal distribution (mean [SD] 0 [1]) were simulated using three Rasch models with three fixed-item (dichotomous, rating scale, and partial credit) scenarios, respectively. We calculated the comparative efficiency and precision of CAT and NAT (shortening of questionnaire length and the count difference number ratio less than 5% using independent t tests). Results: We found that use of CAT led to smaller person standard error of the estimated measure than NAT, with substantially higher efficiency but no loss of precision, reducing response burden by 48%, 66%, and 66% for dichotomous, Rating Scale Model, and PCM models, respectively. Conclusions: CAT-based administrations of the skin cancer risk scale could substantially reduce participant burden without compromising measurement precision. A mobile computer adaptive test was developed to help people efficiently assess their skin cancer risk. %M 26800642 %R 10.2196/jmir.4736 %U http://www.jmir.org/2016/1/e22/ %U https://doi.org/10.2196/jmir.4736 %U http://www.ncbi.nlm.nih.gov/pubmed/26800642 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e4 %T How to Conduct Multimethod Field Studies in the Operating Room: The iPad Combined With a Survey App as a Valid and Reliable Data Collection Tool %A Tscholl,David W %A Weiss,Mona %A Spahn,Donat R %A Noethiger,Christoph B %+ Institute for Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, Zurich, , Switzerland, 41 044 255 2695, christoph.noethiger@usz.ch %K data collection %K empirical research %K observation %K computers %K informatics %K anesthesiology %D 2016 %7 05.01.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Tablet computers such as the Apple iPad are progressively replacing traditional paper-and-pencil-based data collection. We combined the iPad with the ready-to-use survey software, iSurvey (from Harvestyourdata), to create a straightforward tool for data collection during the Anesthesia Pre-Induction Checklist (APIC) study, a hospital-wide multimethod intervention study involving observation of team performance and team member surveys in the operating room (OR). Objective: We aimed to provide an analysis of the factors that led to the use of the iPad- and iSurvey-based tool for data collection, illustrate our experiences with the use of this data collection tool, and report the results of an expert survey about user experience with this tool. Methods: We used an iPad- and iSurvey-based tool to observe anesthesia inductions conducted by 205 teams (N=557 team members) in the OR. In Phase 1, expert raters used the iPad- and iSurvey-based tool to rate team performance during anesthesia inductions, and anesthesia team members were asked to indicate their perceptions after the inductions. In Phase 2, we surveyed the expert raters about their perceptions regarding the use of the iPad- and iSurvey-based tool to observe, rate, and survey teams in the ORs. Results: The results of Phase 1 showed that training data collectors on the iPad- and iSurvey-based data collection tool was effortless and there were no serious problems during data collection, upload, download, and export. Interrater agreement of the combined data collection tool was found to be very high for the team observations (median Fleiss’ kappa=0.88, 95% CI 0.78-1.00). The results of the follow-up expert rater survey (Phase 2) showed that the raters did not prefer a paper-and-pencil-based data collection method they had used during other earlier studies over the iPad- and iSurvey-based tool (median response 1, IQR 1-1; 1=do not agree, 2=somewhat disagree, 3=neutral, 4=somewhat agree, 5=fully agree). They found the iPad (median 5, IQR 4.5-5) and iSurvey (median 4, IQR 4-5) to be working flawlessly and easy to use (median 5, IQR 4-5). Expert ratings also showed that the anesthesia team members (ie, the surveyed doctors and nurses) who used the iPad- and iSurvey-based tool in the OR liked it (median 4, IQR 3-4.5). Conclusions: The combination of the iPad and iSurvey provides an efficient and unobtrusive method to observe teams in their natural environment in the OR and to survey team members immediately after completing their task (ie, anesthesia induction). The expert raters positively evaluated the use of the device and user perceptions. Considering these comprehensive results, we can recommend the use of the iPad- and iSurvey-based tool for studying team performance and team member perceptions in the OR. %M 26732090 %R 10.2196/resprot.4713 %U http://www.researchprotocols.org/2016/1/e4/ %U https://doi.org/10.2196/resprot.4713 %U http://www.ncbi.nlm.nih.gov/pubmed/26732090 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e3 %T Collecting Biospecimens From an Internet-Based Prospective Cohort Study of Inflammatory Bowel Disease (CCFA Partners): A Feasibility Study %A Randell,Rachel L %A Gulati,Ajay S %A Cook,Suzanne F %A Martin,Christopher F %A Chen,Wenli %A Jaeger,Elizabeth L %A Schoenborn,Alexi A %A Basta,Patricia V %A Dejong,Hendrik %A Luo,Jingchun %A Gallant,Marisa %A Sandler,Robert S %A Long,Millie D %A Kappelman,Michael D %+ Department of Pediatrics, Duke University School of Medicine, Duke University, 2301 Erwin Road, Durham, NC, 27710, United States, 1 919 684 8111, rachelrandell88@gmail.com %K inflammatory bowel disease %K biobank %K Internet cohort %K CCFA Partners %D 2016 %7 05.01.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The Internet has successfully been used for patient-oriented survey research. Internet-based translational research may also be possible. Objective: Our aim was to study the feasibility of collecting biospecimens from CCFA Partners, an Internet-based inflammatory bowel disease (IBD) cohort. Methods: From August 20, 2013, to January 4, 2014, we randomly sampled 412 participants, plus 179 from a prior validation study, and invited them to contribute a biospecimen. Participants were randomized to type (blood, saliva), incentive (none, US $20, or US $50), and collection method for blood. The first 82 contributors were also invited to contribute stool. We used descriptive statistics and t tests for comparisons. Results: Of the 591 participants, 239 (40.4%) indicated interest and 171 (28.9%) contributed a biospecimen. Validation study participants were more likely to contribute than randomly selected participants (44% versus 23%, P<.001). The return rate for saliva was higher than blood collected by mobile phlebotomist and at doctors’ offices (38%, 31%, and 17% respectively, P<.001). For saliva, incentives were associated with higher return rates (43-44% versus 26%, P=.04); 61% contributed stool. Fourteen IBD-associated single nucleotide polymorphisms were genotyped, and risk allele frequencies were comparable to other large IBD populations. Bacterial DNA was successfully extracted from stool samples and was of sufficient quality to permit quantitative polymerase chain reaction for total bacteria. Conclusions: Participants are willing to contribute and it is feasible to collect biospecimens from an Internet-based IBD cohort. Home saliva kits yielded the highest return rate, though mobile phlebotomy was also effective. All samples were sufficient for genetic testing. These data support the feasibility of developing a centralized collection of biospecimens from this cohort to facilitate IBD translational studies. %M 26732016 %R 10.2196/resprot.5171 %U http://www.researchprotocols.org/2016/1/e3/ %U https://doi.org/10.2196/resprot.5171 %U http://www.ncbi.nlm.nih.gov/pubmed/26732016 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 12 %P e285 %T Potential and Challenges in Collecting Social and Behavioral Data on Adolescent Alcohol Norms: Comparing Respondent-Driven Sampling and Web-Based Respondent-Driven Sampling %A Hildebrand,Janina %A Burns,Sharyn %A Zhao,Yun %A Lobo,Roanna %A Howat,Peter %A Allsop,Steve %A Maycock,Bruce %+ Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, GPO Box U1987, Bentley, 6845, Australia, 61 9266 7988, b.maycock@curtin.edu.au %K Internet %K respondent-driven sampling (RDS) %K WebRDS %K adolescent %K alcohol %K social media %K participant recruitment %D 2015 %7 24.12.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Respondent-driven sampling (RDS) is a method successfully used to research hard-to-access populations. Few studies have explored the use of the Internet and social media with RDS, known as Web-based RDS (WebRDS). This study explored the use of combining both “traditional” RDS and WebRDS to examine the influences on adolescent alcohol use. Objective: This paper reports on the recruitment processes and the challenges and enablers of both RDS and WebRDS. It details comparative recruitment data and provides a summary of the utility of both methods for recruiting adolescents to participate in an online survey investigating youth alcohol norms. Methods: Process evaluation data collected from research staff throughout the study were used to assess the challenges and solutions of RDS and WebRDS. Pearson chi-square test (Fisher’s exact test if applicable) was used to compare the differences in sociodemographics and drinking behavior between data collected by RDS and WebRDS. Results: Of the total sample (N=1012), 232 adolescents were recruited by RDS and 780 by WebRDS. A significantly larger proportion of Aboriginal or Torres Strait Islander (P<.001) participants who spoke English as their main language at home (P=.03), and of middle and lower socioeconomic status (P<.001) was found in the RDS sample. The RDS sample was also found to have a higher occurrence of past 7-day drinking (P<.001) and past 7-day risky drinking (P=.004). No significant differences in gender, age, past month alcohol use, and lifetime alcohol use were observed between the RDS and WebRDS samples. This study revealed RDS and WebRDS used similar lengths of chains for recruiting participants; however, WebRDS conducted a faster rate of recruitment at a lower average cost per participant compared to RDS. Conclusions: Using WebRDS resulted in significant improvements in the recruitment rate and was a more effective and efficient use of resources than the traditional RDS method. However, WebRDS resulted in partially different sample characteristics to traditional RDS. This potential effect should be considered when selecting the most appropriate data collection method. %M 26704736 %R 10.2196/jmir.4762 %U http://www.jmir.org/2015/12/e285/ %U https://doi.org/10.2196/jmir.4762 %U http://www.ncbi.nlm.nih.gov/pubmed/26704736 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 1 %N 2 %P e22 %T Direct-to-Patient Research: Piloting a New Approach to Understanding Drug Safety During Pregnancy %A Dreyer,Nancy A %A Blackburn,Stella CF %A Mt-Isa,Shahrul %A Richardson,Jonathan L %A Thomas,Simon %A Laursen,Maja %A Zetstra-van der Woude,Priscilla %A Jamry-Dziurla,Anna %A Hliva,Valerie %A Bourke,Alison %A de Jong-van den Berg,Lolkje %+ Quintiles Real-World & Late Phase Research, 201 Broadway, 5th floor, Cambridge, MA, 02139, United States, 1 6177156810, nancy.dreyer@quintiles.com %K pharmacovigilance %K direct-to-patient %K drug safety %K validation %D 2015 %7 22.12.2015 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Little is known about the effects of human fetal exposure when a new drug is authorized unless it was specifically developed for use in pregnancy. Since many factors may contribute to adverse fetal effects, having comprehensive information about in utero exposures will enhance our ability to make correct determinations about causality. Objective: The objective of the study was to assess the extent to which women, recruited without the intervention of health care professionals (HCPs), will provide information, suitable for research purposes, via the Internet or by phone on some potential risk factors in pregnancy. Methods: To pilot direct-to-patient research for pharmacovigilance, we conducted a prospective, noninterventional study of medication use and lifestyle factors as part of the Pharmacoepidemiological Research on Outcomes of Therapeutics by a European ConsorTium (PROTECT) Consortium. Consenting women who self-identified as pregnant and residing in the United Kingdom (UK), Denmark (DK), The Netherlands, or Poland were recruited and could then choose to provide data every 2 or 4 weeks via the Internet or a telephonic interactive voice response system (IVRS). Self-reported drug use was compared with pharmacy register data in DK and with electronic health records in the UK. Results: Recruited women were on average older and more highly educated than the general population. Most respondents chose a frequency of every 4 weeks (56.99%, 1177/2065). Only 29.83% (464/1555) of women with due dates occurring during the study provided information on pregnancy outcome. For those responding by Internet, over 90.00% (1915/2065) reported using >1 pregnancy-related medication, 83.34% (1721/2065) reported using >1 other medicine, and 23.53% (486/2065) reported only over-the-counter medications, not counting herbals and dietary supplements. Some respondents (7.16%, 148/2065) reported that they chose not to take a prescribed medication (mostly medicines for pain or inflammation, and for depression) and 1.30% (27/2065) reported using medicines that had been prescribed to a friend or family member (oxycodone, paracetamol, and medications for acid-related problems). Relatively few respondents reported using fish oil (4.60%, 95/2065), other dietary supplements (1.88%, 39/2065), herbal products (7.07%, 146/2065), or homeopathic products (1.16%, 24/2065). Most medications for chronic conditions that were listed in the Danish prescription registry were also self-reported (83.3%, 145/174 agreement), with larger discrepancies for medications indicated for short-term use (54.0%, 153/283 agreement) and pregnancy-related medications (66.1%, 78/118). Conclusions: Self-reported information on medication use as well as other potential teratogenic factors can be collected via the Internet, although recruitment costs are not insubstantial and maintaining follow-up is challenging. Direct data collection from consumers adds detail, but clinical input may be needed to fully understand patients’ medical histories and capture birth outcomes. %M 27227140 %R 10.2196/publichealth.4939 %U http://publichealth.jmir.org/2015/2/e22/ %U https://doi.org/10.2196/publichealth.4939 %U http://www.ncbi.nlm.nih.gov/pubmed/27227140 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 12 %P e281 %T Assessing Pictograph Recognition: A Comparison of Crowdsourcing and Traditional Survey Approaches %A Kuang,Jinqiu %A Argo,Lauren %A Stoddard,Greg %A Bray,Bruce E %A Zeng-Treitler,Qing %+ Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT, 84108, United States, 1 801 581 4080, Jinqiu.kuang@utah.edu %K crowdsourcing %K patient discharge summaries %K Amazon Mechanical Turk %K pictograph recognition %K cardiovascular %D 2015 %7 17.12.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Compared to traditional methods of participant recruitment, online crowdsourcing platforms provide a fast and low-cost alternative. Amazon Mechanical Turk (MTurk) is a large and well-known crowdsourcing service. It has developed into the leading platform for crowdsourcing recruitment. Objective: To explore the application of online crowdsourcing for health informatics research, specifically the testing of medical pictographs. Methods: A set of pictographs created for cardiovascular hospital discharge instructions was tested for recognition. This set of illustrations (n=486) was first tested through an in-person survey in a hospital setting (n=150) and then using online MTurk participants (n=150). We analyzed these survey results to determine their comparability. Results: Both the demographics and the pictograph recognition rates of online participants were different from those of the in-person participants. In the multivariable linear regression model comparing the 2 groups, the MTurk group scored significantly higher than the hospital sample after adjusting for potential demographic characteristics (adjusted mean difference 0.18, 95% CI 0.08-0.28, P<.001). The adjusted mean ratings were 2.95 (95% CI 2.89-3.02) for the in-person hospital sample and 3.14 (95% CI 3.07-3.20) for the online MTurk sample on a 4-point Likert scale (1=totally incorrect, 4=totally correct). Conclusions: The findings suggest that crowdsourcing is a viable complement to traditional in-person surveys, but it cannot replace them. %M 26678085 %R 10.2196/jmir.4582 %U http://www.jmir.org/2015/12/e281/ %U https://doi.org/10.2196/jmir.4582 %U http://www.ncbi.nlm.nih.gov/pubmed/26678085 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 12 %P e273 %T Evaluation of a Web-Based Food Record for Children Using Direct Unobtrusive Lunch Observations: A Validation Study %A Medin,Anine Christine %A Astrup,Helene %A Kåsin,Britt Marlene %A Andersen,Lene Frost %+ Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Postboks 1046, Blindern, Oslo, 0317, Norway, 47 22851349, a.c.medin@medisin.uio.no %K children %K dietary records %K Internet %K observation %K validity %D 2015 %7 07.12.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: High-quality, Web-based dietary assessment tools for children are needed to reduce cost and improve user-friendliness when studying children’s dietary practices. Objective: To evaluate the first Web-based dietary assessment tool for children in Norway, the Web-based Food Record (WebFR), by comparing children’s true school lunch intake with recordings in the WebFR, using direct unobtrusive observation as the reference method. Methods: A total of 117 children, 8-9 years, from Bærum, Norway, were recruited from September to December 2013. Children completed 4 days of recordings in the WebFR, with parental assistance, and were observed during school lunch in the same period by 3 observers. Interobserver reliability assessments were satisfactory. Match, omission, and intrusion rates were calculated to assess the quality of the recordings in the WebFR for different food categories, and for all foods combined. Logistic regression analyses were used to investigate whether body mass index (BMI), parental educational level, parental ethnicity or family structure were associated with having a “low match rate” (≤70%). Results: Bread and milk were recorded with less bias than spreads, fruits, and vegetables. Mean (SD) for match, omission, and intrusion rates for all foods combined were 73% (27%), 27% (27%), and 19% (26%), respectively. Match rates were statistically significantly associated with parental educational level (low education 52% [32%] versus high 77% [24%], P=.008) and parental ethnicity (non-Norwegian 57% [28%] versus others 75% [26%], P=.04). Only parental ethnicity remained statistically significant in the logistic regression model, showing an adjusted odds ratio of 6.9 and a 95% confidence interval between 1.3 and 36.4. Conclusions: Compared with other similar studies, our results indicate that the WebFR is in line with, or better than most of other similar tools, yet enhancements could further improve the WebFR. %M 26680744 %R 10.2196/jmir.5031 %U http://www.jmir.org/2015/12/e273/ %U https://doi.org/10.2196/jmir.5031 %U http://www.ncbi.nlm.nih.gov/pubmed/26680744 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 1 %N 2 %P e11 %T Effect of Web-Based Versus Paper-Based Questionnaires and Follow-Up Strategies on Participation Rates of Dutch Childhood Cancer Survivors: A Randomized Controlled Trial %A Kilsdonk,Ellen %A van Dulmen-den Broeder,Eline %A van der Pal,Helena J %A Hollema,Nynke %A Kremer,Leontien C %A van den Heuvel-Eibrink,Marry M %A van Leeuwen,Flora E %A Jaspers,Monique W %A van den Berg,Marleen H %+ Centre for Human Factors Engineering of interactive Health Information Technology (HIT-lab), Department of Medical Informatics, Academic Medical Center, PO Box 22660, Amsterdam, 1100 DD, Netherlands, 31 205666204, e.kilsdonk@amc.uva.nl %K childhood cancer survivors %K follow-up strategies %K participation rates %K questionnaires %K questionnaire mode %D 2015 %7 24.11.2015 %9 Original Paper %J JMIR Cancer %G English %X Background: Questionnaires are widely used in survey research, especially in cohort studies. However, participation in questionnaire studies has been declining over the past decades. Because high participation rates are needed to limit the risk of selection bias and produce valid results, it is important to investigate invitation strategies which may improve participation. Objectives: The purpose of this study is to investigate the effect of Web-based versus paper-based questionnaires on participation rates in a questionnaire survey on late effects among childhood cancer survivors (CCSs). Methods: A total of 750 CCSs were randomized across 3 study arms. The initial invitation in study arms 1 and 2 consisted of a Web-based questionnaire only, whereas in study arm 3 this invitation was complemented with a paper-based version of the questionnaire. The first postal reminder, sent to the nonresponding CCSs in all 3 study arms, consisted of either a reminder letter only (study arms 1 and 3) or a reminder letter complemented with a paper-based questionnaire (study arm 2). The second postal reminder was restricted to CCSs in study arms 1 and 2, with only those in study arm 1 also receiving a paper-based questionnaire. CCSs in study arm 3 received a second reminder by telephone instead of by mail. In contrast to CCSs in study arm 3, CCSs in study arms 1 and 2 received a third reminder, this time by telephone. Results: Overall, 58.1% (436/750) of the CCSs participated in the survey. Participation rates were equal in all 3 study arms with 57.4% (143/249) in arm 1, 60.6% (152/251) in arm 2, and 56.4% (141/250) in arm 3 (P=.09). Participation rates of CCSs who received an initial invitation for the Web-based questionnaire only and CCSs who received an invitation to complete either a paper-based or Web-based questionnaire did not differ (P=.55). After the first postal reminder, participation rates of CCSs invited for the Web-based questionnaire only also did not differ compared with CCSs invited for both the Web-based and paper-based questionnaires (P=.48). In general, CCSs preferred the paper-based over the Web-based questionnaire, and those completing the paper-based questionnaire were more often unemployed (P=.004) and lower educated (P<.001). Conclusion: Invitation strategies offering a Web-based questionnaire without a paper-based alternative at first invitation can be used without compromising participation rates of CCS. Offering the choice between paper- and Web-based questionnaires seems to result in the highest accrual participation rate. Future research should look into the quality of the data delivered by both questionnaires filled in by respondents themselves. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 84711754; http://www.controlled-trials.com/ISRCTN84711754 (Archived by WebCite at http://www.webcitation.org/6c9ZB8paX) %M 28410161 %R 10.2196/cancer.3905 %U http://cancer.jmir.org/2015/2/e11/ %U https://doi.org/10.2196/cancer.3905 %U http://www.ncbi.nlm.nih.gov/pubmed/28410161 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 11 %P e266 %T Measuring Use of Health-Related Support on the Internet: Development of the Health Online Support Questionnaire (HOSQ) %A Mattsson,Susanne %A Olsson,Erik Martin Gustaf %A Alfonsson,Sven %A Johansson,Birgitta %A Carlsson,Maria %+ Lifestyle and Rehabilitation in Long Term Illness, Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, Box 564, Uppsala 75122, Sweden, 46 018 471 6622, susanne.mattsson@pubcare.uu.se %K social support %K questionnaires %K oncology %K Internet %D 2015 %7 20.11.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Social support plays an important role for the perceived health in people with health problems and chronic diseases. Provision of different kinds of support during the disease trajectory is crucial for many people. Online support is ubiquitous and represents a promising modality for people with chronic diseases. There are no existing instruments that measure various aspects of online support. Objective: The objective of this study was to create a generic questionnaire regarding health-related support online that can be applied to people with various health problems and illnesses. Additionally, we wanted to test the questionnaire in a cancer population to assess its adequacy in the context of severe disease. Methods: Initial items for the Health Online Support Questionnaire (HOSQ) were inspired by sociologist James House regarding social support. An exploratory factor analysis was conducted in healthy persons or with minor health problems (n=243) on 31 initial items. The scale was reduced to 18 items and the internal consistency and reliability of the scale was examined along with content validity. Further validation was conducted by a confirmatory analysis on the 18-item scale in a cancer population (n=215). In addition, data on demographics, health problems experienced, and Internet use were collected. Results: The exploratory factor analysis on the final 18-item scale resulted in 2 factors. After scrutinizing the content, these factors were labeled “reading” and “interacting” and they demonstrated good internal consistency (Cronbach alphas .88 and .77, respectively). The factors were confirmed in the cancer population. The response pattern revealed expected differences both between the interaction and reading scales and according to age, gender, education, and health problems thereby supporting the validity of the HOSQ. Conclusions: The HOSQ may be a reliable and valid instrument for measuring the use of online support for people with health problems, but the results ought to be replicated in more studies to confirm the results for different diagnoses. If the results of this study are corroborated by future studies, the HOSQ may be used as a basis for the development of different forms of support on the Internet. %M 26589638 %R 10.2196/jmir.4425 %U http://www.jmir.org/2015/11/e266/ %U https://doi.org/10.2196/jmir.4425 %U http://www.ncbi.nlm.nih.gov/pubmed/26589638 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 11 %P e249 %T Do Patients Treated for Colorectal Cancer Benefit from General Practitioner Support? A Video Vignette Study %A Ngune,Irene %A Jiwa,Moyez %A McManus,Alexandra %A Parsons,Richard %A Pagey,Georgina %A Hodder,Rupert %+ Faculty of Health, Engineering and Science, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA, Perth, 6027, Australia, 61 63043474, I.ngune@ecu.edu.au %K colorectal cancer %K general practice %K Internet survey %K side effects %K video vignettes %D 2015 %7 05.11.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients who have been treated for colorectal cancer in Australia can consult their general practitioner (GP) for advice about symptoms or side effects at any time following their treatment. However, there is no evidence that such patients are consistently advised by GPs, and patients experience substantial unmet need for reassurance and advice. Objective: To explore the patient management options selected by GPs to treat a set of patients describing their symptoms following treatment for colorectal cancer. Methods: This was an Internet-based survey. Participants (GPs) viewed 6 video vignettes of actors representing patients who had been treated for colorectal cancer. The actor-patients presented problems that resulted from their treatment. Participants indicated their diagnosis and stated if they would prescribe, refer, or order tests, based on that diagnosis. These responses were then rated against the management decisions for those vignettes as recommended by a team of colorectal cancer experts. Results: In total, 52 GPs consented to take part in the study, and 40 (77%) completed the study. Most GPs made a diagnosis of colorectal cancer treatment side effects/symptoms of recurrence that was consistent with the experts’ opinions. However, correct diagnosis was dependent on the type of case viewed. Compared with radiation proctitis, GPs were more likely to recognize peripheral neuropathy (odds ratio, OR, 4.43, 95% CI 1.41-13.96, P=.011) and erectile dysfunction (OR 9.70, 95% CI 2.48-38.03, P=.001), but less likely to identify chemotherapy-induced fatigue (OR 0.19, 95% CI 0.08-0.44). GPs who had more hours of direct patient care (OR 0.38, 95% CI 0.17-0.84, P=.02), were experienced (OR 9.78, 95% CI 1.18-8.84, P=.02), and consulted more patients per week (OR 2.48, 95% CI 1.16-5.30, P=.02) suggested a management plan that was consistent with the expert opinion. Conclusions: In this pilot study, years of experience and direct patient contact hours had a significant and positive impact on the management of patients. This study also showed promising results indicating that management of the common side effects of colorectal cancer treatment can be delegated to general practice. Such an intervention could support the application of shared models of care. However, a larger study, including the management of side effects in real patients, needs to be conducted before this can be safely recommended. %M 26541077 %R 10.2196/jmir.4942 %U http://www.jmir.org/2015/11/e249/ %U https://doi.org/10.2196/jmir.4942 %U http://www.ncbi.nlm.nih.gov/pubmed/26541077 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 4 %P e117 %T Exercise-Induced Tendon and Bone Injury in Recreational Runners: A Test-Retest Reliability Study %A Domaschenz,Renae %A Vlahovich,Nicole %A Keogh,Justin %A Compton,Stacey %A Hughes,David C %A , %+ Department of Sports Medicine, Australian Institute of Sport, Australian Sports Commission, Leverrier St, Bruce, 2621, Australia, 61 2 6214 7319, nicole.vlahovich@ausport.gov.au %K exercise %K genetics %K injury %K reliability %K survey %D 2015 %7 07.10.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Long-distance runners are prone to injuries including Achilles tendinopathy and medial tibial stress syndrome. We have developed an Internet comprehensive self-report questionnaire examining the medical history, injury history, and running habits of adult recreational runners. Objective: The objective of the study was to evaluate two alternative forms of test-retest reliability of a comprehensive self-report Internet questionnaire retrospectively examining the medical history, injury history, and running habits among a sample of adult recreational runners. This will contribute to the broad aims of a wider study investigating genetics and running injury. Methods: Invitations to complete an Internet questionnaire were sent by email to a convenience pilot population (test group 1). Inclusion criteria required participants to be a recreational runner age 18 or over, who ran over 15 km per week on a consistent basis. The survey questions addressed regular running habits and any injuries (including signs, symptoms, and diagnosis) of the lower limbs that resulted in discontinuation of running for a period of 2 consecutive weeks or more, within the last 2 years. Questions also addressed general health, age, sex, height, weight, and ethnic background. Participants were then asked to repeat the survey using the Internet platform again after 10-14 days. Following analysis of test group 1, we soft-launched the survey to a larger population (test group 2), through a local running club of 900 members via email platform. The same inclusion criteria applied, however, participants were asked to complete a repeat of the survey by telephone interview after 7-10 days. Selected key questions, important to clarify inclusion or exclusion from the wider genetics study, were selected to evaluate test-retest reliability. Reliability was quantified using the kappa coefficient for categorical data. Results: In response to the invitation, 28 participants accessed the survey from test group 1, 23 completed the Internet survey on the first occasion, and 20 completed the Internet retest within 10-21 days. Test-retest reliability scored moderate to almost perfect (kappa=.41 to .99) for 19/19 of the key questions analyzed. Following the invitation, 122 participants accessed the survey from test group 2, 101 completed the Internet survey on the first occasion, and 50 were randomly selected and contacted by email inviting them to repeat the survey by telephone interview. There were 33 participants that consented to the telephone interview and 30 completed the questionnaire within 7-10 days. Test-retest reliability scored moderate to almost perfect for 18/19 (kappa=.41 to .99) and slight for 1/19 of the key questions analyzed. %M 36262008 %R 10.2196/resprot.4585 %U http://www.researchprotocols.org/2002/4/e117/ %U https://doi.org/10.2196/resprot.4585 %U http://www.ncbi.nlm.nih.gov/pubmed/36262008 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 3 %P e115 %T An Internet-Based Means of Monitoring Quality of Life in Post-Prostate Radiation Treatment: A Prospective Cohort Study %A Parker,Brent %A Rajapakshe,Rasika %A Moldovan,Andrew %A Araujo,Cynthia %A Crook,Juanita %+ British Columbia Cancer Agency, Sindi Ahluwalia Hawkins Centre for the Southern Interior, 399 Royal Avenue, Kelowna, BC, , Canada, 1 250 712 3966 ext 686912, brent.parker2@interiorhealth.ca %K prostate cancer %K radiation oncology %K quality of life %K patient-reported outcomes %K Internet survey %K prospective study %D 2015 %7 28.09.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Widespread integration of the Internet has resulted in an increase in the feasibility of using Web-based technologies as a means of communicating with patients. It may be possible to develop secure and standardized systems that facilitate Internet-based patient-reported outcomes which could be used to improve patient care. Objective: This study investigates patient interest in participating in an online post-treatment disease outcomes and quality of life monitoring program developed specifically for patients who have received radiation treatment for prostate cancer at a regional oncology center. Methods: Patients treated for prostate cancer between 2007 and 2011 (N=1113) at the British Columbia Cancer Agency, Centre for the Southern Interior were invited by mail to participate in a standardized questionnaire related to their post-treatment health. Overall participation rates were calculated. In addition, demographics, access to broadband Internet services, and treatment modalities were compared between participants and nonparticipants. Results: Of the 1030 eligible invitees, 358 (358/1030, 34.7%) completed the online questionnaire. Participation rates were higher in individuals younger than age 60 when compared to those age 60 or older (42% vs 31%) and also for those living in urban areas compared with rural (37% vs 29%) and in those who received brachytherapy versus external beam radiotherapy (EBRT) (41% vs 31%). Better participation rates were seen in individuals who had access to Internet connectivity based on the different types of broadband services (DSL 35% for those with DSL connectivity vs 29% for those without DSL connectivity; cable 35% vs 32%; wireless 38% vs 26%). After adjusting for age, the model indicates that lack of access to wireless broadband connectivity, living in a rural area, and receiving EBRT were significant predictors of lower participation. Conclusions: This study demonstrates that participation rates vary in patient populations within the interior region of British Columbia, especially with older patients, those in rural areas, and those with limited access to quality Internet services. %M 26416584 %R 10.2196/resprot.3974 %U http://www.researchprotocols.org/2015/3/e115/ %U https://doi.org/10.2196/resprot.3974 %U http://www.ncbi.nlm.nih.gov/pubmed/26416584 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 8 %P e211 %T Assessment of Web-Based Consumer Reviews as a Resource for Drug Performance %A Adusumalli,Swarnaseetha %A Lee,HueyTyng %A Hoi,Qiangze %A Koo,Si-Lin %A Tan,Iain Beehuat %A Ng,Pauline Crystal %+ Genome Institute of Singapore, 60 Biopolis St., Singapore, , Singapore, 65 6808 8310, ngpc4@gis.a-star.edu.sg %K consumer drug reviews %K online drug ratings %K WebMD %K online health websites %D 2015 %7 28.08.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Some health websites provide a public forum for consumers to post ratings and reviews on drugs. Drug reviews are easily accessible and comprehensible, unlike clinical trials and published literature. Because the public increasingly uses the Internet as a source of medical information, it is important to know whether such information is reliable. Objective: We aim to examine whether Web-based consumer drug ratings and reviews can be used as a resource to compare drug performance. Methods: We analyzed 103,411 consumer-generated reviews on 615 drugs used to treat 249 disease conditions from the health website WebMD. Statistical analysis identified 427 drug pairs from 24 conditions for which two drugs treating the same condition had significantly and substantially different satisfaction ratings (with at least a half-point difference between Web-based ratings and P<.01). PubMed and Google Scholar were searched for publications that were assessed for concordance with findings online. Results: Scientific literature was found for 77 out of the 427 drug pairs and compared to findings online. Nearly two-thirds (48/77, 62%) of the online drug trends with at least a half-point difference in online ratings were supported by published literature (P=.02). For a 1-point online rating difference, the concordance rate increased to 68% (15/22) (P=.07). The discrepancies between scientific literature and findings online were further examined to obtain more insights into the usability of Web-based consumer-generated reviews. We discovered that (1) drugs with FDA black box warnings or used off-label were rated poorly in Web-based reviews, (2) drugs with addictive properties were rated higher than their counterparts in Web-based reviews, and (3) second-line or alternative drugs were rated higher. In addition, Web-based ratings indicated drug delivery problems. If FDA black box warning labels are used to resolve disagreements between publications and online trends, the concordance rate increases to 71% (55/77) (P<.001) for a half-point rating difference and 82% (18/22) for a 1-point rating difference (P=.002). Our results suggest that Web-based reviews can be used to inform patients’ drug choices, with certain caveats. Conclusions: Web-based reviews can be viewed as an orthogonal source of information for consumers, physicians, and drug manufacturers to assess the performance of a drug. However, one should be cautious to rely solely on consumer reviews as ratings can be strongly influenced by the consumer experience. %M 26319108 %R 10.2196/jmir.4396 %U http://www.jmir.org/2015/8/e211/ %U https://doi.org/10.2196/jmir.4396 %U http://www.ncbi.nlm.nih.gov/pubmed/26319108 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 3 %P e96 %T Designing an Internationally Accessible Web-Based Questionnaire to Discover Risk Factors for Amyotrophic Lateral Sclerosis: A Case-Control Study %A Parkin Kullmann,Jane Alana %A Hayes,Susan %A Wang,Min-Xia %A Pamphlett,Roger %+ The University of Sydney, 94 Mallett St, Camperdown NSW, , Australia, 61 2 9351 0972, roger.pamphlett@sydney.edu.au %K amyotrophic lateral sclerosis (ALS) %K motor neuron disease (MND) %K web-based %K online %K questionnaire %K epidemiology %K risk factor %K case-control study %K international %K language translation %D 2015 %7 03.08.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with a typical survival of three to five years. Epidemiological studies using paper-based questionnaires in individual countries or continents have failed to find widely accepted risk factors for the disease. The advantages of online versus paper-based questionnaires have been extensively reviewed, but few online epidemiological studies into human neurodegenerative diseases have so far been undertaken. Objective: To design a Web-based questionnaire to identify environmental risk factors for ALS and enable international comparisons of these risk factors. Methods: A Web-based epidemiological questionnaire for ALS has been developed based on experience gained from administering a previous continent-wide paper-based questionnaire for this disease. New and modified questions have been added from our previous paper-based questionnaire, from literature searches, and from validated ALS questionnaires supplied by other investigators. New criteria to allow the separation of familial and sporadic ALS cases have been included. The questionnaire addresses many risk factors that have already been proposed for ALS, as well as a number that have not yet been rigorously examined. To encourage participation, responses are collected anonymously and no personally identifiable information is requested. The survey is being translated into a number of languages which will allow many people around the world to read and answer it in their own language. Results: After the questionnaire had been online for 4 months, it had 379 respondents compared to only 46 respondents for the same initial period using a paper-based questionnaire. The average age of the first 379 web questionnaire respondents was 54 years compared to the average age of 60 years for the first 379 paper questionnaire respondents. The questionnaire is soon to be promoted in a number of countries through ALS associations and disease registries. Conclusions: Web-based questionnaires are a time- and resource-efficient method for performing large epidemiological studies of neurodegenerative diseases such as ALS. The ability to compare risk factors between different countries using the same analysis tool will be of particular value for finding robust risk factors that underlie ALS. %M 26239255 %R 10.2196/resprot.4840 %U http://www.researchprotocols.org/2015/3/e96/ %U https://doi.org/10.2196/resprot.4840 %U http://www.ncbi.nlm.nih.gov/pubmed/26239255 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 7 %P e189 %T Allowing Physicians to Choose the Value of Compensation for Participation in a Web-Based Survey: Randomized Controlled Trial %A Turnbull,Alison E %A O'Connor,Cristi L %A Lau,Bryan %A Halpern,Scott D %A Needham,Dale M %+ School of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 E Monument St., 5th Floor, Baltimore, MD, 21205, United States, 1 4109552190, turnbull@jhmi.edu %K data collection %K monetary incentives %K cash %K physicians %K electronic questionnaire %K survey design %K response rate %D 2015 %7 29.07.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Survey response rates among physicians are declining, and determining an appropriate level of compensation to motivate participation poses a major challenge. Objective: To estimate the effect of permitting intensive care physicians to select their preferred level of compensation for completing a short Web-based survey on physician (1) response rate, (2) survey completion rate, (3) time to response, and (4) time spent completing the survey. Methods: A total of 1850 US intensivists from an existing database were randomized to receive a survey invitation email with or without an Amazon.com incentive available to the first 100 respondents. The incentive could be instantly redeemed for an amount chosen by the respondent, up to a maximum of US $50. Results: The overall response rate was 35.90% (630/1755). Among the 35.4% (111/314) of eligible participants choosing the incentive, 80.2% (89/111) selected the maximum value. Among intensivists offered an incentive, the response was 6.0% higher (95% CI 1.5-10.5, P=.01), survey completion was marginally greater (807/859, 94.0% vs 892/991, 90.0%; P=.06), and the median number of days to survey response was shorter (0.8, interquartile range [IQR] 0.2-14.4 vs 6.6, IQR 0.3-22.3; P=.001), with no difference in time spent completing the survey. Conclusions: Permitting intensive care physicians to determine compensation level for completing a short Web-based survey modestly increased response rate and substantially decreased response time without decreasing the time spent on survey completion. %M 26223821 %R 10.2196/jmir.3898 %U http://www.jmir.org/2015/7/e189/ %U https://doi.org/10.2196/jmir.3898 %U http://www.ncbi.nlm.nih.gov/pubmed/26223821 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 7 %P e183 %T Online Recruitment Methods for Web-Based and Mobile Health Studies: A Review of the Literature %A Lane,Taylor S %A Armin,Julie %A Gordon,Judith S %+ University of Arizona, Department of Family and Community Medicine, 1450 N Cherry Ave, Tucson, AZ, 85719, United States, 1 520 626 6452, taylorlane@email.arizona.edu %K mHealth %K Internet health %K online recruitment %K apps %K social media %K review %D 2015 %7 22.07.2015 %9 Review %J J Med Internet Res %G English %X Background: Internet and mobile health (mHealth) apps hold promise for expanding the reach of evidence-based health interventions. Research in this area is rapidly expanding. However, these studies may experience problems with recruitment and retention. Web-based and mHealth studies are in need of a wide-reaching and low-cost method of recruitment that will also effectively retain participants for the duration of the study. Online recruitment may be a low-cost and wide-reaching tool in comparison to traditional recruitment methods, although empirical evidence is limited. Objective: This study aims to review the literature on online recruitment for, and retention in, mHealth studies. Methods: We conducted a review of the literature of studies examining online recruitment methods as a viable means of obtaining mHealth research participants. The data sources used were PubMed, CINAHL, EbscoHost, PyscINFO, and MEDLINE. Studies reporting at least one method of online recruitment were included. A narrative approach enabled the authors to discuss the variability in recruitment results, as well as in recruitment duration and study design. Results: From 550 initial publications, 12 studies were included in this review. The studies reported multiple uses and outcomes for online recruitment methods. Web-based recruitment was the only type of recruitment used in 67% (8/12) of the studies. Online recruitment was used for studies with a variety of health domains: smoking cessation (58%; 7/12) and mental health (17%; 2/12) being the most common. Recruitment duration lasted under a year in 67% (8/12) of the studies, with an average of 5 months spent on recruiting. In those studies that spent over a year (33%; 4/12), an average of 17 months was spent on recruiting. A little less than half (42%; 5/12) of the studies found Facebook ads or newsfeed posts to be an effective method of recruitment, a quarter (25%; 3/12) of the studies found Google ads to be the most effective way to reach participants, and one study showed better outcomes with traditional (eg in-person) methods of recruitment. Only one study recorded retention rates in their results, and half (50%; 6/12) of the studies recorded survey completion rates. Conclusions: Although online methods of recruitment may be promising in experimental research, more empirical evidence is needed to make specific recommendations. Several barriers to using online recruitment were identified, including participant retention. These unique challenges of virtual interventions can affect the generalizability and validity of findings from Web-based and mHealth studies. There is a need for additional research to evaluate the effectiveness of online recruitment methods and participant retention in experimental mHealth studies. %M 26202991 %R 10.2196/jmir.4359 %U http://www.jmir.org/2015/7/e183/ %U https://doi.org/10.2196/jmir.4359 %U http://www.ncbi.nlm.nih.gov/pubmed/26202991 %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 %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 6 %P e158 %T Comparing Patients’ Opinions on the Hospital Discharge Process Collected With a Self-Reported Questionnaire Completed Via the Internet or Through a Telephone Survey: An Ancillary Study of the SENTIPAT Randomized Controlled Trial %A Couturier,Berengere %A Carrat,Fabrice %A Hejblum,Gilles %A , %+ Assistance Publique - Hôpitaux de Paris, Unité de Santé Publique, Hôpital Saint Antoine, 184 rue du Faubourg Saint Antoine, Paris, 75571, France, 33 (0)149283228, berengere.couturier@aphp.fr %K hospital information systems %K patient-centered care %K patient discharge %K patient satisfaction %K quality of health care %D 2015 %7 24.06.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Hospital discharge, a critical stage in the hospital-to-home transition of patient care, is a complex process with potential dysfunctions having an impact on patients’ health on their return home. No study has yet reported the feasibility and usefulness of an information system that would directly collect and transmit, via the Internet, volunteer patients’ opinions on their satisfaction concerning the organization of hospital discharge. Objective: Our primary objective was to compare patients’ opinions on the discharge process collected with 2 different methods: self-questionnaire completed on a dedicated website versus a telephone interview. The secondary goal was to estimate patient satisfaction. Methods: We created a questionnaire to examine hospital discharge according to 3 dimensions: discharge logistics organization, preplanned posthospital continuity-of-care organization, and patients’ impressions at the time of discharge. A satisfaction score (between 0 and 1) for each of those dimensions and an associated total score were calculated. Taking advantage of the randomized SENTIPAT trial that questioned patients recruited at hospital discharge about the evolution of their health after returning home and randomly assigned them to complete a self-questionnaire directly online or during a telephone interview, we conducted an ancillary study comparing satisfaction with the organization of hospital discharge for these 2 patient groups. The questionnaire was proposed to 1141 patients included in the trial who were hospitalized for ≥2 days, among whom 867 eligible patients had access to the Internet at home and were randomized to the Internet or telephone group. Results: Of the 1141 patients included, 755 (66.17%) completed the questionnaire. The response rates for the Internet (39.1%, 168/430) and telephone groups (87.2%, 381/437) differed significantly (P<.001), but their total satisfaction scores did not (P=.08) nor did the satisfaction subscores (P=.58 for discharge logistics organization, P=.12 for preplanned posthospital continuity-of-care organization, and P=.35 for patients’ impressions at the time of discharge). The total satisfaction score (median 0.83, IQR 0.72-0.92) indicated the patients’ high satisfaction. Conclusions: The direct transmission of personal health data via the Internet requires patients’ active participation and those planning surveys in the domain explored in this study should anticipate a lower response rate than that issued from a similar survey conducted by telephone interviews. Nevertheless, collecting patients’ opinions on their hospital discharge via the Internet proved operational; study results indicate that conducting such surveys via the Internet yields similar estimates to those obtained via a telephone survey. The results support the establishment of a permanent dedicated website that could also be used to obtain users’ opinions on other aspects of their hospital stay and follow-up. Trial Registration: Clinicaltrials.gov NCT01769261; http://clinicaltrials.gov/ct2/show/NCT01769261 (Archived by WebCite at http://www.webcitation.org/6ZDF5bdQb). %M 26109261 %R 10.2196/jmir.4379 %U http://www.jmir.org/2015/6/e158/ %U https://doi.org/10.2196/jmir.4379 %U http://www.ncbi.nlm.nih.gov/pubmed/26109261 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 6 %P e149 %T Using Web-Based Questionnaires and Obstetric Records to Assess General Health Characteristics Among Pregnant Women: A Validation Study %A van Gelder,Marleen MHJ %A Schouten,Naomi PE %A Merkus,Peter JFM %A Verhaak,Chris M %A Roeleveld,Nel %A Roukema,Jolt %+ Department for Health Evidence, Radboud Institute for Health Sciences, Radboud university medical center, P.O. Box 9101, Nijmegen, 6500 HB, Netherlands, 31 24 3666126, Marleen.vanGelder@radboudumc.nl %K questionnaires %K medical records %K validation studies %K pregnancy %K chronic disease %K allergens %K blood pressure %K Internet %K PRIDE Study %D 2015 %7 16.06.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Self-reported medical history information is included in many studies. However, data on the validity of Web-based questionnaires assessing medical history are scarce. If proven to be valid, Web-based questionnaires may provide researchers with an efficient means to collect data on this parameter in large populations. Objective: The aim of this study was to assess the validity of a Web-based questionnaire on chronic medical conditions, allergies, and blood pressure readings against obstetric records and data from general practitioners. Methods: Self-reported questionnaire data were compared with obstetric records for 519 pregnant women participating in the Dutch PRegnancy and Infant DEvelopment (PRIDE) Study from July 2011 through November 2012. These women completed Web-based questionnaires around their first prenatal care visit and in gestational weeks 17 and 34. We calculated kappa statistics (κ) and the observed proportions of positive and negative agreement between the baseline questionnaire and obstetric records for chronic conditions and allergies. In case of inconsistencies between these 2 data sources, medical records from the woman’s general practitioner were consulted as the reference standard. For systolic and diastolic blood pressure, intraclass correlation coefficients (ICCs) were calculated for multiple data points. Results: Agreement between the baseline questionnaire and the obstetric record was substantial (κ=.61) for any chronic condition and moderate for any allergy (κ=.51). For specific conditions, we found high observed proportions of negative agreement (range 0.88-1.00) and on average moderate observed proportions of positive agreement with a wide range (range 0.19-0.90). Using the reference standard, the sensitivity of the Web-based questionnaire for chronic conditions and allergies was comparable to or even better than the sensitivity of the obstetric records, in particular for migraine (0.90 vs 0.40, P=.02), asthma (0.86 vs 0.61, P=.04), inhalation allergies (0.92 vs 0.74, P=.003), hay fever (0.90 vs 0.64, P=.001), and allergies to animals (0.89 vs 0.53, P=.01). However, some overreporting of allergies was observed in the questionnaire and for some nonsomatic conditions sensitivity of both measurement instruments was low. The ICCs for blood pressure readings ranged between 0.72 and 0.92 with very small mean differences between the 2 methods of data collection. Conclusions: Web-based questionnaires can be used to validly collect data on many chronic disorders, allergies, and blood pressure readings among pregnant women. %M 26081990 %R 10.2196/jmir.3847 %U http://www.jmir.org/2015/6/e149/ %U https://doi.org/10.2196/jmir.3847 %U http://www.ncbi.nlm.nih.gov/pubmed/26081990 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 2 %P e71 %T Internet-Based Birth-Cohort Studies: Is This the Future for Epidemiology? %A Firestone,Ridvan %A Cheng,Soo %A Pearce,Neil %A Douwes,Jeroen %A Merletti,Franco %A Pizzi,Costanza %A Pivetta,Emanuele %A Rusconi,Franca %A Richiardi,Lorenzo %+ Centre for Public Health Research, Massey University, Block 3, Level D, Wallace Street, Wellington, 6021, New Zealand, 64 04 801 4987, r.t.firestone@massey.ac.nz %K Internet %K epidemiology %K birth cohort %D 2015 %7 12.06.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: International collaborative cohorts the NINFEA and the ELF studies are mother-child cohorts that use the internet for recruitment and follow-up of their members. The cohorts investigated the association of early life exposures and a wide range of non-communicable diseases. Objective: The objective is to report the research methodology, with emphasis on the advantages and limitations offered by an Internet-based design. These studies were conducted in Turin, Italy and Wellington, New Zealand. Methods: The cohorts utilized various online/offline methods to recruit participants. Pregnant women who became aware volunteered, completed an online questionnaire, thus obtaining baseline information. Results: The NINFEA study has recruited 7003 pregnant women, while the ELF study has recruited 2197 women. The cohorts targeted the whole country, utilizing a range of support processes to reduce the attrition rate of the participants. For the NINFEA and ELF cohorts, online participants were predominantly older (35% and 28.9%, respectively), highly educated (55.6% and 84.9%, respectively), and were in their final trimester of pregnancy (48.5% and 53.6%, respectively). Conclusions: Internet-based cohort epidemiological studies are feasible, however, it is clear that participants are self-selective samples, as is the case for many birth cohorts. Internet-based cohort studies are potentially cost-effective and novel methodology for conducting long-term epidemiology research. However, from our experience, participants tend to be self-selective. In marked time, if the cohorts are to form part of a larger research program they require further use and exploration to address biases and overcome limitations. %M 26071071 %R 10.2196/resprot.3873 %U http://www.researchprotocols.org/2015/2/e71/ %U https://doi.org/10.2196/resprot.3873 %U http://www.ncbi.nlm.nih.gov/pubmed/26071071 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 2 %P e20 %T Word Recall: Cognitive Performance Within Internet Surveys %A Runge,Shannon K %A Craig,Benjamin M %A Jim,Heather S %+ University of South Florida and Moffitt Cancer Center, MRC-CANCONT, 12902 Magnolia Dr., Tampa, FL, , United States, 1 813 745 1245, shannon.runge@moffitt.org %K cognition %K online surveys %K episodic memory %K Health and Retirement Study %K Women’s Health Valuation Study %D 2015 %7 02.06.2015 %9 Original Paper %J JMIR Mental Health %G English %X Background: The use of online surveys for data collection has increased exponentially, yet it is often unclear whether interview-based cognitive assessments (such as face-to-face or telephonic word recall tasks) can be adapted for use in application-based research settings. Objective: The objective of the current study was to compare and characterize the results of online word recall tasks to those of the Health and Retirement Study (HRS) and determine the feasibility and reliability of incorporating word recall tasks into application-based cognitive assessments. Methods: The results of the online immediate and delayed word recall assessment, included within the Women’s Health and Valuation (WHV) study, were compared to the results of the immediate and delayed recall tasks of Waves 5-11 (2000-2012) of the HRS. Results: Performance on the WHV immediate and delayed tasks demonstrated strong concordance with performance on the HRS tasks (ρc=.79, 95% CI 0.67-0.91), despite significant differences between study populations (P<.001) and study design. Sociodemographic characteristics and self-reported memory demonstrated similar relationships with performance on both the HRS and WHV tasks. Conclusions: The key finding of this study is that the HRS word recall tasks performed similarly when used as an online cognitive assessment in the WHV. Online administration of cognitive tests, which has the potential to significantly reduce participant and administrative burden, should be considered in future research studies and health assessments. %M 26543924 %R 10.2196/mental.3969 %U http://mental.jmir.org/2015/2/e20/ %U https://doi.org/10.2196/mental.3969 %U http://www.ncbi.nlm.nih.gov/pubmed/26543924 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 1 %N 1 %P e5 %T Blog Posting After Lung Cancer Notification: Content Analysis of Blogs Written by Patients or Their Families %A Sato,Akira %A Aramaki,Eiji %A Shimamoto,Yumiko %A Tanaka,Shiro %A Kawakami,Koji %+ Design School, Kyoto University, 5th floor Bldg. #9 Kyoto Research Park 91 Awata-cho, Chudoji, Shimogyo-ku, Kyoto, 600-8813, Japan, 81 9040335481, eiji.aramaki@design.kyoto-u.ac.jp %K blog %K lung cancer %K notification %K content analysis %K communication %K Internet %D 2015 %7 18.05.2015 %9 Original Paper %J JMIR Cancer %G English %X Background: The advent and spread of the Internet has changed the way societies communicate. A portion of information on the Internet may constitute an important source of information concerning the experiences and thoughts of patients and their families. Patients and their families use blogs to obtain updated information, search for alternative treatments, facilitate communication with other patients, and receive emotional support. However, much of this information has yet to be actively utilized by health care professionals. Objective: We analyzed health-related information in blogs from Japan, focusing on the feelings and satisfaction levels of lung cancer patients or their family members after being notified of their disease. Methods: We collected 100 blogs written in Japanese by patients (or their families) who had been diagnosed with lung cancer by a physician. These 100 blogs posts were searchable between June 1 and June 30, 2013. We focused on blog posts that addressed the lung cancer notification event. We analyzed the data using two different approaches (Analysis A and Analysis B). Analysis A was blog content analysis in which we analyzed the content addressing the disease notification event in each blog. Analysis B was patient's dissatisfaction and anxiety analysis. Detailed blog content regarding patient's dissatisfaction and anxiety at the individual sentence level was coded and analyzed. Results: The 100 blog posts were written by 48 men, 46 women, and 6 persons whose sex was undisclosed. The average age of the blog authors was 52.4 years. With regard to cancer staging, there were 5 patients at Stage I, 3 patients at Stage II, 14 patients at Stage III, 21 patients at Stage IV, and 57 patients without a disclosed cancer stage. The results of Analysis A showed that the proportion of patients who were dissatisfied with the level of health care exceeded that of satisfied patients (22% vs 8%). From the 2499 sentences in the 100 blog posts analyzed, we identified expressions of dissatisfaction and anxiety in 495 sentences. Our results showed that there were substantially more posts concerning “Way of living, reasons for living, set of values” and “Relationships with medical staff (own hospital)” than in previous studies (Analysis B). Conclusions: This study provides insight into the feelings of dissatisfaction and anxieties held by lung cancer patients and their families, including those regarding the “Way of living, reasons for living, set of values” and “Relationship with medical staff (own hospital),” which were inaccessible in previous survey analyses. When comparing information obtained from patients’ voluntary records and those from previous surveys conducted by health care institutions, it is likely that the former would be more indicative of patients’ actual opinions and feelings. Therefore, it is important to utilize such records as an information resource. %M 28410169 %R 10.2196/cancer.3883 %U https://cancer.jmir.org/2015/1/e5/ %U https://doi.org/10.2196/cancer.3883 %U http://www.ncbi.nlm.nih.gov/pubmed/28410169 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 5 %P e111 %T Response Rates for Patient-Reported Outcomes Using Web-Based Versus Paper Questionnaires: Comparison of Two Invitational Methods in Older Colorectal Cancer Patients %A Horevoorts,Nicole JE %A Vissers,Pauline AJ %A Mols,Floortje %A Thong,Melissa SY %A van de Poll-Franse,Lonneke V %+ Centre of Research on Psychology in Somatic Diseases (CoRPS), Tilburg University, Warandelaan 2, Tilburg, 5037 AB, Netherlands, 31 882346811, n.horevoorts@iknl.nl %K Internet %K questionnaires %K aged %K aged, 80 and over %K cancer, colon %K cancer, rectum %K characteristics, population %K survey methods %K respondents %K patient-reported outcomes %D 2015 %7 07.05.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Improving questionnaire response rates is an everlasting issue for research. Today, the Internet can easily be used to collect data quickly. However, collecting data on the Internet can lead to biased samples because not everyone is able to access or use the Internet. The older population, for example, is much less likely to use the Internet. The Patient-Reported Outcomes Following Initial Treatment and Long-Term Evaluation of Survivorship (PROFILES) registry offers a platform to collect Web-based and paper questionnaires and to try different measures to improve response rates. Objective: In this study, our aim was to study the influence of two methods of invitation on the response rate. Our second aim was to examine the preference of questionnaire mode of administration (paper or Web-based) for the older patient in particular. Methods: To test these two invitational methods, 3406 colorectal cancer patients between ages 18 and 85 years received an invitation containing an access code for the Web-based questionnaire. They could also request a paper questionnaire with an included reply card (paper-optional group). In contrast, 179 randomly selected colorectal cancer patients received a paper questionnaire with the invitation (paper-included group). They could also choose to fill out the Web-based questionnaire with the included access code. Results: Response rates did not differ between the paper-optional and the paper-included groups (73.14%, 2491/3406 and 74.9%, 134/179, P=.57). In the paper-optional group, online response was significantly higher when compared to the paper-included group (41.23%, 1027/2491 vs 12.7%, 17/134, P<.001). The majority of online respondents responded after the first invitation (95.33%, 979/1027), which was significantly higher than the paper respondents (52.19%, 764/1464, P<.001). Respondents aged 70 years and older chose to fill out a paper questionnaire more often (71.0%, 677/954). In the oldest age group (≥80 years), 18.2% (61/336) of the respondents filled out a Web-based questionnaire. Conclusions: The lack of difference in response rates between invitation modes implies that researchers can leave out a paper questionnaire at invitation without lowering response rates. It may be preferable not to include a paper questionnaire because more respondents then will fill out a Web-based questionnaire, which will lead to faster available data. However, due to respondent preference, it is not likely that paper questionnaires can be left out completely in the near future. %M 25953059 %R 10.2196/jmir.3741 %U http://www.jmir.org/2015/5/e111/ %U https://doi.org/10.2196/jmir.3741 %U http://www.ncbi.nlm.nih.gov/pubmed/25953059 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 2 %P e53 %T Feasibility of Using a Multilingual Web Survey in Studying the Health of Ethnic Minority Youth %A Kinnunen,Jaana Maarit %A Malin,Maili %A Raisamo,Susanna Ulrika %A Lindfors,Pirjo Liisa %A Pere,Lasse Antero %A Rimpelä,Arja Hannele %+ School of Health Sciences, University of Tampere, FI-33014 University of Tampere, Tampere, 33014, Finland, 358 40 190 1667, jaana.m.kinnunen@uta.fi %K feasibility %K Web survey %K ethnic minority %K adolescents %K response rate %K representativeness %K multilingual %D 2015 %7 07.05.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Monolingual Web survey is a common tool for studying adolescent health. However, national languages may cause difficulties for some immigrant-origin youths, which lower their participation rate. In national surveys, the number of ethnic minority groups is often too small to assess their well-being. Objective: We studied the feasibility of a multilingual Web survey targeted at immigrant-origin youths by selection of response language, and compared participation in different language groups with a monolingual survey. Methods: The Adolescent Health and Lifestyle Survey (AHLS), Finland, with national languages (Finnish/Swedish) was modified into a multilingual Web survey targeted at a representative sample of 14- and 16-year olds (N=639) whose registry-based mother tongue was other than the national languages. The survey was conducted in 2010 (16-year olds) and 2011 (14-year olds). The response rate of the multilingual survey in 2011 is compared with the AHLS of 2011. We also describe the translation process and the e-form modification. Results: Of the respondents, 57.6% answered in Finnish, whereas the remaining 42.4% used their mother tongue (P=.002). A majority of youth speaking Somali, Middle Eastern, Albanian, and Southeast Asian languages chose Finnish. The overall response rate was 48.7% with some nonsignificant variation between the language groups. The response rate in the multilingual Web survey was higher (51.6%, 163/316) than the survey with national languages (46.5%, 40/86) in the same age group; however, the difference was not significant (P=.47). The adolescents who had lived in Finland for 5 years or less (58.0%, 102/176) had a higher response rate than those having lived in Finland for more than 5 years (45.1%, 209/463; P=.005). Respondents and nonrespondents did not differ according to place of birth (Finland/other) or residential area (capital city area/other). The difference in the response rates of girls and boys was nearly significant (P=.06). Girls of the Somali and Middle Eastern language groups were underrepresented among the respondents. Conclusions: A multilingual Web survey is a feasible method for gathering data from ethnic youth, although it does not necessarily yield a higher response rate than a monolingual survey. The respondents answered more often in the official language of the host country than their mother tongue. The varying response rates by time of residence, ethnicity, and gender pose challenges for developing tempting surveys for youth. %M 25953412 %R 10.2196/resprot.3655 %U http://www.researchprotocols.org/2015/2/e53/ %U https://doi.org/10.2196/resprot.3655 %U http://www.ncbi.nlm.nih.gov/pubmed/25953412 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 3 %N 2 %P e20 %T Web-Based Textual Analysis of Free-Text Patient Experience Comments From a Survey in Primary Care %A Maramba,Inocencio Daniel %A Davey,Antoinette %A Elliott,Marc N %A Roberts,Martin %A Roland,Martin %A Brown,Finlay %A Burt,Jenni %A Boiko,Olga %A Campbell,John %+ Primary Care, University of Exeter Medical School, University of Exeter, JS01 Smeall Building, St Luke's Campus University of Exeter, Magdalen Road, Exeter, EX1 2LU, United Kingdom, 44 1392 722895, I.D.C.Maramba@exeter.ac.uk %K patient experience %K patient feedback %K free-text comments %K quantitative content analysis %K textual analysis %D 2015 %7 06.05.2015 %9 Original Paper %J JMIR Med Inform %G English %X Background: Open-ended questions eliciting free-text comments have been widely adopted in surveys of patient experience. Analysis of free text comments can provide deeper or new insight, identify areas for action, and initiate further investigation. Also, they may be a promising way to progress from documentation of patient experience to achieving quality improvement. The usual methods of analyzing free-text comments are known to be time and resource intensive. To efficiently deal with a large amount of free-text, new methods of rapidly summarizing and characterizing the text are being explored. Objective: The aim of this study was to investigate the feasibility of using freely available Web-based text processing tools (text clouds, distinctive word extraction, key words in context) for extracting useful information from large amounts of free-text commentary about patient experience, as an alternative to more resource intensive analytic methods. Methods: We collected free-text responses to a broad, open-ended question on patients’ experience of primary care in a cross-sectional postal survey of patients recently consulting doctors in 25 English general practices. We encoded the responses to text files which were then uploaded to three Web-based textual processing tools. The tools we used were two text cloud creators: TagCrowd for unigrams, and Many Eyes for bigrams; and Voyant Tools, a Web-based reading tool that can extract distinctive words and perform Keyword in Context (KWIC) analysis. The association of patients’ experience scores with the occurrence of certain words was tested with logistic regression analysis. KWIC analysis was also performed to gain insight into the use of a significant word. Results: In total, 3426 free-text responses were received from 7721 patients (comment rate: 44.4%). The five most frequent words in the patients’ comments were “doctor”, “appointment”, “surgery”, “practice”, and “time”. The three most frequent two-word combinations were “reception staff”, “excellent service”, and “two weeks”. The regression analysis showed that the occurrence of the word “excellent” in the comments was significantly associated with a better patient experience (OR=1.96, 95%CI=1.63-2.34), while “rude” was significantly associated with a worse experience (OR=0.53, 95%CI=0.46-0.60). The KWIC results revealed that 49 of the 78 (63%) occurrences of the word “rude” in the comments were related to receptionists and 17(22%) were related to doctors. Conclusions: Web-based text processing tools can extract useful information from free-text comments and the output may serve as a springboard for further investigation. Text clouds, distinctive words extraction and KWIC analysis show promise in quick evaluation of unstructured patient feedback. The results are easily understandable, but may require further probing such as KWIC analysis to establish the context. Future research should explore whether more sophisticated methods of textual analysis (eg, sentiment analysis, natural language processing) could add additional levels of understanding. %M 25947632 %R 10.2196/medinform.3783 %U http://medinform.jmir.org/2015/2/e20/ %U https://doi.org/10.2196/medinform.3783 %U http://www.ncbi.nlm.nih.gov/pubmed/25947632 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 5 %P e109 %T Online and Offline Recruitment of Young Women for a Longitudinal Health Survey: Findings From the Australian Longitudinal Study on Women’s Health 1989-95 Cohort %A Loxton,Deborah %A Powers,Jennifer %A Anderson,Amy E %A Townsend,Natalie %A Harris,Melissa L %A Tuckerman,Ryan %A Pease,Stephanie %A Mishra,Gita %A Byles,Julie %+ Priority Research Centre for Gender, Health and Ageing, School of Medicine and Public Health, University of Newcastle, Level 4 West, HMRI, c/- University Drive, Callaghan, 2308, Australia, 61 240420690, deborah.loxton@newcastle.edu.au %K cohort studies %K longitudinal studies %K social media %K women’s health %D 2015 %7 04.05.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: In 2012, we set out to recruit a cohort of at least 10,000 women aged 18-23 from across Australia. With recent research demonstrating the inadequacy of traditional approaches to recruiting women in this age group, we elected to conduct open recruiting. Objective: Our aim was to report on the overall success of open recruiting and to evaluate the relative success of a variety of recruitment methods in terms of numbers and demographics. Methods: We used referrals, Facebook, formal advertising, and incentives in order to recruit the cohort. Results: In all, 17,069 women were recruited for the longitudinal online survey, from 54,685 initiated surveys. Of these women, most (69.94%, n=11,799) who joined the longitudinal cohort were recruited via Facebook, 12.72% (n=2145) via the fashion promotion, 7.02% (n=1184) by referral, 4.9% (n=831) via other Web activities, and 5.4% (n=910) via traditional media. Conclusions: Facebook was by far the most successful strategy, enrolling a cohort of women with a similar profile to the population of Australian women in terms of age, area of residence, and relationship status. Women recruited via fashion promotion were the least representative. All strategies underrepresented less educated women—a finding that is consistent with more traditional means of recruiting. In conclusion, flexibility in recruitment design, embracing new and traditional media, adopting a dynamic responsive approach, and monitoring the results of recruiting in terms of sample composition and number recruited led to the successful establishment of a new cohort. %M 25940876 %R 10.2196/jmir.4261 %U http://www.jmir.org/2015/5/e109/ %U https://doi.org/10.2196/jmir.4261 %U http://www.ncbi.nlm.nih.gov/pubmed/25940876 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 2 %P e9 %T Web-Based and Telephone Surveys to Assess Public Perception Toward the National Health Insurance in Taiwan: A Comparison of Cost and Results %A Yang,Ming-Chin %A Tan,Elise Chia-Hui %+ Institute of Health Policy and Management, College of Public Health, National Taiwan University, Room 637, No. 17. Xu-Zhou Road, Taipei City, , Taiwan, 886 2 33668067, mcyang637@ntu.edu.tw %K Web-based survey %K telephone survey %K public perception %K National Health Insurance %K self-reported health status %D 2015 %7 17.04.2015 %9 Original Paper %J Interact J Med Res %G English %X Background: Numerous studies have examined the impact of global budget payment systems of health insurance on patient access to medical care. In order to monitor the population’s accessibility to health services, a series of survey are often used to understand public perceptions of the health care provider. Taiwan implemented the single-payer National Health Insurance in 1995 and has been conducting a series of surveys to monitor public perception of the NHI after adopting a global budget payment system in 2002. Although telephone surveys are commonly used in obtaining public opinions on various public health issues, limitations such as higher cost and influence of interviewers do raise some concerns. Web-based surveys, one of the alternative methods, may be free from these problems. Objective: Our aim was to examine the difference of sociodemographic characteristics, satisfaction of NHI and NHI-contracted health care providers, attitude toward NHI-related issues, behavior in seeking medical advice and self-reported health status between those who completed Web-based surveys and those reached by telephone. Methods: This study compared the demographic factors of participants who took either a Web-based survey (1313 participants) or random digit dialing telephone survey (2411 participants) that contained identical questions. Results: Compared to telephone survey respondents, Web-based respondents tended to be younger (P<.001), unmarried (P<.001), non-smokers (P<.001), with a higher education (P<.001), and a higher monthly household income (P<.001) and worse self-reported health status (P=.008); however, they were less likely to report suffering from a chronic disease (P<.001). Despite these differences in background characteristics, no significant differences were observed in their answers related to the seeking of medical care or NHI-related issues. Telephone survey respondents reported greater satisfaction with NHI services. Web-based surveys were also shown to provide a lower average cost per sample (US$0.71) compared to telephone surveys (US$3.98). Conclusions: Web-based surveys provide a low-cost alternative method for the polling of public attitudes toward NHI-related issues. Despite general similarities between the two polling methods with regard to responses, respondents to telephone surveys reported a stronger agreement with regard to satisfaction with NHI services and a more positive self-reported health status. %M 25886989 %R 10.2196/ijmr.4090 %U http://www.i-jmr.org/2015/2/e9/ %U https://doi.org/10.2196/ijmr.4090 %U http://www.ncbi.nlm.nih.gov/pubmed/25886989 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 4 %P e96 %T Validity of Internet-Based Longitudinal Study Data: The Elephant in the Virtual Room %A Pugh,Carys A %A Summers,Kim M %A Bronsvoort,B Mark C %A Handel,Ian G %A Clements,Dylan N %+ The Roslin Institute and Royal (Dick) School of Veterinary Studies, University of Edinburgh, Easter Bush, Edinburgh, EH25 9RG, United Kingdom, 44 1316519167, Carys.Pugh@roslin.ed.ac.uk %K epidemiology %K validation studies as topic %K Internet %K questionnaires %K longitudinal studies %K health %K canine %D 2015 %7 16.04.2015 %9 Viewpoint %J J Med Internet Res %G English %X Background: Internet-based data collection relies on well-designed and validated questionnaires. The theory behind designing and validating questionnaires is well described, but few practical examples of how to approach validation are available in the literature. Objective: We aimed to validate data collected in an ongoing Internet-based longitudinal health study through direct visits to participants and recall of their health records. We demonstrate that despite extensive pre-planning, social desirability can still affect data in unexpected ways and that anticipation of poor quality data may be confounded by positive validation. Methods: Dogslife is a large-scale, Web-based longitudinal study of canine health, in which owners of Labrador Retrievers were recruited and questioned at regular intervals about the lifestyle and health of their dogs using an Internet-based questionnaire. The Dogslife questionnaire predominantly consists of closed-answer questions. In our work, two separate validation methodologies were used: (1) direct interviews with 43 participants during visits to their households and (2) comparison of owner-entered health reports with 139 historical health records. Results: Our results indicate that user-derived measures should not be regarded as a single category; instead, each measurement should be considered separately as each presents its own challenge to participants. We recommend trying to ascertain the extent of recall decay within a study and, if necessary, using this to guide data collection timepoints and analyses. Finally, we recommend that multiple methods of communication facilitate validation studies and aid cohort engagement. Conclusions: Our study highlighted how the theory underpinning online questionnaire design and validation translates into practical data issues when applied to Internet-based studies. Validation should be regarded as an extension of questionnaire design, and that validation work should commence as soon as sufficient data are available. We believe that validation is a crucial step and hope our suggested guidelines will help facilitate validation of other Internet-based cohort studies. %M 25887101 %R 10.2196/jmir.3530 %U http://www.jmir.org/2015/4/e96/ %U https://doi.org/10.2196/jmir.3530 %U http://www.ncbi.nlm.nih.gov/pubmed/25887101 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 3 %N 2 %P e18 %T Balancing the Interests of Patient Data Protection and Medication Safety Monitoring in a Public-Private Partnership %A Dreyer,Nancy A %A Blackburn,Stella %A Hliva,Valerie %A Mt-Isa,Shahrul %A Richardson,Jonathan %A Jamry-Dziurla,Anna %A Bourke,Alison %A Johnson,Rebecca %+ Quintiles Real-World & Late-Phase Research, Scientific Affairs, 201 Broadway, 5th floor, Cambridge, MA, 02139, United States, 1 617 715 6810, nancy.dreyer@quintiles.com %K pharmacovgilance %K pregnancy %K Internet %K public-private partnerships %K data protection %K ethics %D 2015 %7 15.04.2015 %9 Viewpoint %J JMIR Med Inform %G English %X Obtaining data without the intervention of a health care provider represents an opportunity to expand understanding of the safety of medications used in difficult-to-study situations, like the first trimester of pregnancy when women may not present for medical care. While it is widely agreed that personal data, and in particular medical data, needs to be protected from unauthorized use, data protection requirements for population-based studies vary substantially by country. For public-private partnerships, the complexities are enhanced. The objective of this viewpoint paper is to illustrate the challenges related to data protection based on our experiences when performing relatively straightforward direct-to-patient noninterventional research via the Internet or telephone in four European countries. Pregnant women were invited to participate via the Internet or using an automated telephone response system in Denmark, the Netherlands, Poland, and the United Kingdom. Information was sought on medications, other factors that may cause birth defects, and pregnancy outcome. Issues relating to legal controllership of data were most problematic; assuring compliance with data protection requirements took about two years. There were also inconsistencies in the willingness to accept nonwritten informed consent. Nonetheless, enrollment and data collection have been completed, and analysis is in progress. Using direct reporting from consumers to study the safety of medicinal products allows researchers to address a myriad of research questions relating to everyday clinical practice, including treatment heterogeneity in population subgroups not traditionally included in clinical trials, like pregnant women, children, and the elderly. Nonetheless, there are a variety of administrative barriers relating to data protection and informed consent, particularly within the structure of a public-private partnership. %M 25881627 %R 10.2196/medinform.3937 %U http://medinform.jmir.org/2015/2/e18/ %U https://doi.org/10.2196/medinform.3937 %U http://www.ncbi.nlm.nih.gov/pubmed/25881627 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 4 %P e94 %T Uncontrolled Web-Based Administration of Surveys on Factual Health-Related Knowledge: A Randomized Study of Untimed Versus Timed Quizzing %A Domnich,Alexander %A Panatto,Donatella %A Signori,Alessio %A Bragazzi,Nicola Luigi %A Cristina,Maria Luisa %A Amicizia,Daniela %A Gasparini,Roberto %+ Department of Health Sciences, University of Genoa, Via Pastore, 1, Genoa, 16132, Italy, 39 010 3538524, alexander.domnich@gmail.com %K knowledge questionnaires %K online survey %K time limit %K uncontrolled survey administration %K cheating %K e-cheating %K cribbed answers %D 2015 %7 13.04.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Health knowledge and literacy are among the main determinants of health. Assessment of these issues via Web-based surveys is growing continuously. Research has suggested that approximately one-fifth of respondents submit cribbed answers, or cheat, on factual knowledge items, which may lead to measurement error. However, little is known about methods of discouraging cheating in Web-based surveys on health knowledge. Objective: This study aimed at exploring the usefulness of imposing a survey time limit to prevent help-seeking and cheating. Methods: On the basis of sample size estimation, 94 undergraduate students were randomly assigned in a 1:1 ratio to complete a Web-based survey on nutrition knowledge, with or without a time limit of 15 minutes (30 seconds per item); the topic of nutrition was chosen because of its particular relevance to public health. The questionnaire consisted of two parts. The first was the validated consumer-oriented nutrition knowledge scale (CoNKS) consisting of 20 true/false items; the second was an ad hoc questionnaire (AHQ) containing 10 questions that would be very difficult for people without health care qualifications to answer correctly. It therefore aimed at measuring cribbing and not nutrition knowledge. AHQ items were somewhat encyclopedic and amenable to Web searching, while CoNKS items had more complex wording, so that simple copying/pasting of a question in a search string would not produce an immediate correct answer. Results: A total of 72 of the 94 subjects started the survey. Dropout rates were similar in both groups (11%, 4/35 and 14%, 5/37 in the untimed and timed groups, respectively). Most participants completed the survey from portable devices, such as mobile phones and tablets. To complete the survey, participants in the untimed group took a median 2.3 minutes longer than those in the timed group; the effect size was small (Cohen’s r=.29). Subjects in the untimed group scored significantly higher on CoNKS (mean difference of 1.2 points, P=.008) and the effect size was medium (Cohen’s d=0.67). By contrast, no significant between-group difference in AHQ scores was documented. Unexpectedly high AHQ scores were recorded in 23% (7/31) and 19% (6/32) untimed and timed respondents, respectively, very probably owing to “e-cheating”. Conclusions: Cribbing answers to health knowledge items in researcher-uncontrolled conditions is likely to lead to overestimation of people’s knowledge; this should be considered during the design and implementation of Web-based surveys. Setting a time limit alone may not completely prevent cheating, as some cheats may be very fast in Web searching. More complex and contextualized wording of items and checking for the “findability” properties of items before implementing a Web-based health knowledge survey may discourage help-seeking, thus reducing measurement error. Studies with larger sample sizes and diverse populations are needed to confirm our results. %M 25872617 %R 10.2196/jmir.3734 %U http://www.jmir.org/2015/4/e94/ %U https://doi.org/10.2196/jmir.3734 %U http://www.ncbi.nlm.nih.gov/pubmed/25872617 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 1 %P e34 %T Focus Groups Move Online: Feasibility of Tumblr Use for eHealth Curriculum Development %A Elliot,Diane %A Rohlman,Diane %A Parish,Megan %+ Oregon Health & Science University, Department of Medicine, CR110, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, United States, 1 503 494 6554, elliotd@ohsu.edu %K Tumblr %K focus group %K crowdsourcing %K curriculum development %K Internet %D 2015 %7 27.03.2015 %9 Short Paper %J JMIR Res Protoc %G English %X Background: Constructing successful online programs requires engaging potential users in development. However, assembling focus groups can be costly and time consuming. Objective: The aim of this study is to assess whether Tumblr can be used to prioritize activities for an online younger worker risk reduction and health promotion program. Methods: Younger summer parks and recreation employees were encouraged to visit Tumblr using weekly announcements and competitions. Each week, new activities were posted on Tumblr with linked survey questions. Responses were downloaded and analyzed. Results: An average of 36 young workers rated each activity on its likeability and perceived educational value. The method was feasible, efficient, and sustainable across the summer weeks. Ratings indicated significant differences in likeability among activities (P<.005). Conclusions: Tumblr is a means to crowdsource formative feedback on potential curricular components when assembling an online intervention. This paper describes its initial use as well as suggestions for future refinements. %M 25831197 %R 10.2196/resprot.3432 %U http://www.researchprotocols.org/2015/1/e34/ %U https://doi.org/10.2196/resprot.3432 %U http://www.ncbi.nlm.nih.gov/pubmed/25831197 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 3 %P e57 %T Do Web-Based and Clinic Samples of Gay Men Living With HIV Differ on Self-Reported Physical and Psychological Symptoms? A Comparative Analysis %A Harding,Richard %A Lampe,Fiona %A Molloy,Tim %A Sherr,Lorraine %+ Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, King\\\'s College London, Bessemer Road, London, SE5 9PJ, United Kingdom, 44 (0)2078485518, richard.harding@kcl.ac.uk %K HIV %K pain %K symptoms %K mental health %K methods %K recruitment %K sampling %K Internet %D 2015 %7 19.03.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Although the Internet is commonly used to recruit samples in studies of human immunodeficiency virus (HIV)-related risk behaviors, it has not been used to measure patient-reported well-being. As the burden of long-term chronic HIV infection rises, the Internet may offer enormous potential for recruitment to research and interventions. Objective: This study aimed to compare two samples of gay men living with HIV, one recruited via the Web and the other recruited in outpatient settings, in terms of self-reported physical and psychological symptom burden. Methods: The Internet sample was recruited from a UK-wide Web-based survey of gay men with diagnosed HIV. Of these, 154 respondents identified themselves as resident in London and were included in this analysis. The HIV clinic sample was recruited from five HIV outpatient clinics. Of these participants, 400 gay men recruited in London clinics were included in this analysis. Results: The Web-based sample was younger than the clinic sample (37.3 years, SD 7.0 vs 40.9 years, SD 8.3), more likely to be in paid employment (72.8%, 99/136 vs 60.1%, 227/378), less likely to be on antiretroviral therapy (ART) (58.4%, 90/154 vs 68.0%, 266/391), and had worse mean psychological symptom burden compared to the clinic sample (mean scores: 1.61, SD 1.09 vs 1.36, SD 0.96) but similar physical symptom burden (mean scores: 0.78, SD 0.65 vs 0.70, SD 0.74). In multivariable logistic regression, for the physical symptom burden model, adjusted for age, ethnicity, employment status, and ART use, the recruitment setting (ie, Web-based vs clinic) was not significantly associated with high physical symptom score. The only variable that remained significantly associated with high physical symptom score was employment status, with those in employment being less likely to report being in the upper (worst) physical symptom tertile versus the other two tertiles (adjusted OR 0.41, 95% CI 0.28-0.62, P<.001). For the psychological symptom burden model, those recruited via the Web were significantly more likely to report being in the upper (worst) tertile (adjusted OR 2.20, 95% CI 1.41-3.44, P=.001). In addition, those in employment were less likely to report being in the upper (worst) psychological symptom tertile compared to those not in employment (adjusted OR 0.32, 95% CI 0.21-0.49, P<.001). Conclusions: Our data have revealed a number of differences. Compared to the clinic sample, the Web-based sample had worse psychological symptom burden, younger average age, higher prevalence of employment, and a lower proportion on ART. For future research, we recommend that Web-based data collection should include the demographic variables that we note differed between samples. In addition, we recognize that each recruitment method may bring inherent sampling bias, with clinic populations differing by geographical location and reflecting those accessing regular medical care, and Web-based sampling recruiting those with greater Internet access and identifying survey materials through specific searches and contact with specific websites. %R 10.2196/jmir.3800 %U http://www.jmir.org/2015/3/e57/ %U https://doi.org/10.2196/jmir.3800 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 3 %P e74 %T Use of a Web-Based Physical Activity Record System to Analyze Behavior in a Large Population: Cross-Sectional Study %A Namba,Hideyuki %A Yamada,Yosuke %A Ishida,Mika %A Takase,Hideto %A Kimura,Misaka %+ Department of Health and Nutrition, Wayo Women’s University, 2-3-1 Konodai, Ichikawa, Chiba, 272-8533, Japan, 81 47 371 2160, h-nanba@wayo.ac.jp %K motor activity %K behavior %K Internet %K computer systems %K metabolic equivalent %K Japan %D 2015 %7 19.03.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of Web-based physical activity systems has been proposed as an easy method for collecting physical activity data. We have developed a system that has exhibited high accuracy as assessed by the doubly labeled water method. Objective: The purpose of this study was to collect behavioral data from a large population using our Web-based physical activity record system and assess the physical activity of the population based on these data. In this paper, we address the difference in physical activity for each urban scale. Methods: In total, 2046 participants (aged 30-59 years; 1105 men and 941 women) participated in the study. They were asked to complete data entry before bedtime using their personal computer on 1 weekday and 1 weekend day. Their residential information was categorized as urban, urban-rural, or rural. Participant responses expressed the intensity of each activity at 15-minute increments and were recorded on a Web server. Residential areas were compared and multiple regression analysis was performed. Results: Most participants had a metabolic equivalent (MET) ranging from 1.4 to 1.8, and the mean MET was 1.60 (SD 0.28). The median value of moderate-to-vigorous physical activity (MVPA, ≥3 MET) was 7.92 MET-hours/day. A 1-way ANCOVA showed that total physical activity differed depending on the type of residential area (F2,2027=5.19, P=.006). The urban areas (n=950) had the lowest MET-hours/day (mean 37.8, SD, 6.0), followed by urban-rural areas (n=432; mean 38.6, SD 6.5; P=.04), and rural areas (n=664; mean 38.8, SD 7.4; P=.002). Two-way ANCOVA showed a significant interaction between sex and area of residence on the urban scale (F2,2036=4.53, P=.01). Men in urban areas had the lowest MET-hours/day (MVPA, ≥3 MET) at mean 7.9 (SD 8.7); men in rural areas had a MET-hours/day (MVPA, ≥3 MET) of mean 10.8 (SD 12.1, P=.002). No significant difference was noted in women among the 3 residential areas. Multiple regression analysis showed that physical activity consisting of standing while working was the highest contributor to MVPA, regardless of sex. Conclusions: We were able to compile a detailed comparison of physical activity because our Web-based physical activity record system allowed for the simultaneous evaluation of physical activity from 2046 Japanese people. We found that rural residents had greater total physical activity than urban residents and that working and transportation behaviors differed depending on region type. Multiple regression analysis showed that the behaviors affected MVPA. People are less physically active while working, and sports and active transportation might be effective ways of increasing physical activity levels. %M 25794109 %R 10.2196/jmir.3923 %U http://www.jmir.org/2015/3/e74/ %U https://doi.org/10.2196/jmir.3923 %U http://www.ncbi.nlm.nih.gov/pubmed/25794109 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 3 %P e73 %T Web-Based Self-Reported Height, Weight, and Body Mass Index Among Swedish Adolescents: A Validation Study %A Ekström,Sandra %A Kull,Inger %A Nilsson,Sara %A Bergström,Anna %+ Institute of Environmental Medicine, Karolinska Institutet, BOX 210, Stockholm, 17177, Sweden, 46 852487010, Sandra.Ekstrom@ki.se %K adolescent %K body height %K body weight %K body mass index %K validity %K Internet %D 2015 %7 18.03.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-collected height and weight are increasingly used in epidemiological studies; however, the validity has rarely been evaluated. Objective: The aim of the study was to validate self-reported height, weight, and corresponding body mass index (BMI) among Swedish adolescents aged approximately 16 years. A secondary aim was to investigate possible prediction factors for validity of self-reported BMI. Methods: The study included 1698 adolescents from the population-based cohort BAMSE. Height and weight were collected through a Web-based questionnaire and subsequently measured using standard procedures. Differences between reported and measured height, weight, and corresponding BMI were compared by t tests and agreement was evaluated by Pearson correlation and Bland-Altman plots. Multivariable linear regression analysis was used to investigate whether lifestyle and demographic factors predicted validity of self-reported BMI. Results: On average, weight was underestimated by 1.1 kg and height was overestimated by 0.5 cm, leading to an underestimation of BMI by 0.5 kg/m2. Correlation coefficients were .98 for height, .97 for weight, and .94 for BMI, and highly significant. Females underestimated weight to a higher extent than males and overweight and obese participants underestimated weight to a higher extent than normal-weight participants, which resulted in higher underestimation of BMI. Underweight participants, on the contrary, overestimated weight and correspondingly BMI. Overall, a high proportion of participants were classified into the correct BMI category; however, among overweight and obese participants, only 60.2% (139/231) and 46% (20/44) were correctly classified, respectively. In the multivariable prediction model, only gender and BMI status significantly predicted discrepancy between reported and measured BMI. Conclusions: Web-collected BMI may be used as a valid, quick, and cost-effective alternative to measured BMI among Swedish adolescents. The accuracy of self-reported BMI declines with increasing BMI and self-reported BMI should not be used to estimate the prevalence of overweight or obesity. %M 25791395 %R 10.2196/jmir.3947 %U http://www.jmir.org/2015/3/e73/ %U https://doi.org/10.2196/jmir.3947 %U http://www.ncbi.nlm.nih.gov/pubmed/25791395 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 1 %P e6 %T Preferred Features of Oral Treatments and Predictors of Non-Adherence: Two Web-Based Choice Experiments in Multiple Sclerosis Patients %A Wicks,Paul %A Brandes,David %A Park,Jinhee %A Liakhovitski,Dimitri %A Koudinova,Tatiana %A Sasane,Rahul %+ PatientsLikeMe, 155 2nd Street, Cambridge, MA, 02141, United States, 1 617 499 4003, pwicks@patientslikeme.com %K multiple sclerosis %K drug therapy %K decision making %K cross-sectional survey %D 2015 %7 05.03.2015 %9 Original Paper %J Interact J Med Res %G English %X Background: Oral disease modifying therapies (DMTs) for multiple sclerosis (MS) differ in efficacy, tolerability, and safety. Objective: We sought to understand how these attributes impact patient preference and predicted DMT non-adherence among oral-naïve MS patients. Methods: Adult MS patients from the “PatientsLikeMe” Web-based health data-sharing platform completed a discrete choice exercise where they were asked to express their preference for one of three hypothetical oral DMTs, each with a certain combination of levels of tested attributes. Another Web-based exercise tested a number of possible drivers of non-adherence, mainly side effects. Data from an MS clinic were used to adjust for sample bias. Respondents’ preferences were analyzed using Hierarchical Bayesian estimation. Results: A total of 319 patients completed all questions. Most respondents were female (77.7%, 248/319) with mean age 48 years (SD 10). Liver toxicity was the attribute that emerged as the most important driver of patient preference (25.8%, relative importance out of 100%), followed by severe side effects (15.3%), delay to disability progression (10.7%), and common side effects (10.4%). The most important drivers of predicted non-adherence were frequency of daily dosing (17.4% out of 100%), hair thinning (14.8%), use during pregnancy (14.1%), severe side effects (13.8%), and diarrhea (13.0%). Conclusions: Understanding the important concerns expressed by patients may help health care providers to understand and educate their patients more completely about these concerns. This knowledge may therefore improve both choices of appropriate therapy and adherence to therapy over time. %M 25749630 %R 10.2196/ijmr.3776 %U http://www.i-jmr.org/2015/1/e6/ %U https://doi.org/10.2196/ijmr.3776 %U http://www.ncbi.nlm.nih.gov/pubmed/25749630 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 3 %P e55 %T Multiple Comorbidities of 21 Psychological Disorders and Relationships With Psychosocial Variables: A Study of the Online Assessment and Diagnostic System Within a Web-Based Population %A AL-Asadi,Ali M %A Klein,Britt %A Meyer,Denny %+ Department of Arts and Education, Grande Prairie Regional College, 10726 - 106 Ave., Grande Prairie, AB, T8V 4C4, Canada, 1 780 539 2061, aalasadi@gprc.ab.ca %K comorbidity %K multiple comorbidities %K co-occurrences %K e-mental health %K online %K fully automated %K generalized anxiety disorder %K obsessive-compulsive disorder %K social anxiety disorder %K posttraumatic stress disorder %K panic disorder, major depressive episode %K insomnia, hypersomnia, dependency %K alcohol %K drug %K suicidal ideation %K social support %K quality of life %K sex %K age %D 2015 %7 26.02.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: While research in the area of e-mental health has received considerable attention over the last decade, there are still many areas that have not been addressed. One such area is the comorbidity of psychological disorders in a Web-based sample using online assessment and diagnostic tools, and the relationships between comorbidities and psychosocial variables. Objective: We aimed to identify comorbidities of psychological disorders of an online sample using an online diagnostic tool. Based on diagnoses made by an automated online assessment and diagnostic system administered to a large group of online participants, multiple comorbidities (co-occurrences) of 21 psychological disorders for males and females were identified. We examined the relationships between dyadic comorbidities of anxiety and depressive disorders and the psychosocial variables sex, age, suicidal ideation, social support, and quality of life. Methods: An online complex algorithm based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision, was used to assign primary and secondary diagnoses of 21 psychological disorders to 12,665 online participants. The frequency of co-occurrences of psychological disorders for males and females were calculated for all disorders. A series of hierarchical loglinear analyses were performed to examine the relationships between the dyadic comorbidities of depression and various anxiety disorders and the variables suicidal ideation, social support, quality of life, sex, and age. Results: A 21-by-21 frequency of co-occurrences of psychological disorders matrix revealed the presence of multiple significant dyadic comorbidities for males and females. Also, for those with some of the dyadic depression and the anxiety disorders, the odds for having suicidal ideation, reporting inadequate social support, and poorer quality of life increased for those with two-disorder comorbidity than for those with only one of the same two disorders. Conclusions: Comorbidities of several psychological disorders using an online assessment tool within a Web-based population were similar to those found in face-to-face clinics using traditional assessment tools. Results provided support for the transdiagnostic approaches and confirmed the positive relationship between comorbidity and suicidal ideation, the negative relationship between comorbidity and social support, and the negative relationship comorbidity and quality of life. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG) %M 25803420 %R 10.2196/jmir.4143 %U http://www.jmir.org/2015/3/e55/ %U https://doi.org/10.2196/jmir.4143 %U http://www.ncbi.nlm.nih.gov/pubmed/25803420 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 2 %P e37 %T Assessment of Unconscious Decision Aids Applied to Complex Patient-Centered Medical Decisions %A Manigault,Andrew Wilhelm %A Handley,Ian Michael %A Whillock,Summer Rain %+ Montana State University, Department of Psychology, 322 Traphagen Hall, Bozeman, MT, 59717, United States, 1 406 994 6508, ihandley@montana.edu %K unconscious %K thought %K intuition %K medical %K decision %K judgment %K cognitive load %K patient-centered %D 2015 %7 05.02.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: To improve patient health, recent research urges for medical decision aids that are designed to enhance the effectiveness of specific medically related decisions. Many such decisions involve complex information, and decision aids that independently use deliberative (analytical and slower) or intuitive (more affective and automatic) cognitive processes for such decisions result in suboptimal decisions. Unconscious thought can arguably use both intuitive and deliberative (slow and analytic) processes, and this combination may further benefit complex patient (or practitioner) decisions as medical decision aids. Indeed, mounting research demonstrates that individuals render better decisions generally if they are distracted from thinking consciously about complex information after it is presented (but can think unconsciously), relative to thinking about that information consciously or not at all. Objective: The current research tested whether the benefits of unconscious thought processes can be replicated using an Internet platform for a patient medical decision involving complex information. This research also explored the possibility that judgments reported after a period of unconscious thought are actually the result of a short period of conscious deliberation occurring during the decision report phase. Methods: A total of 173 participants in a Web-based experiment received information about four medical treatments, the best (worst) associated with mostly positive (negative) side-effects/attributes and the others with equal positive-negative ratios. Next, participants were either distracted for 3 minutes (unconscious thought), instructed to think about the information for 3 minutes (conscious thought), or moved directly to the decision task (immediate decision). Finally, participants reported their choice of, and attitudes toward, the treatments while experiencing high, low, or no cognitive load, which varied their ability to think consciously while reporting judgments. Cognitive load was manipulated by having participants memorize semi-random (high), line structured (low), or no dot patterns and recall these intermittently with their decision reports. Overall then, participants were randomly assigned to the conditions of a 3 (thought condition) by 3 (cognitive-load level) between-subjects design. Results: A logistic regression analysis indicated that the odds of participants choosing the best treatment were 2.25 times higher in the unconscious-thought condition compared to the immediate-decision condition (b=.81, Wald=4.32, P=.04, 95% CI 1.048-4.836), and 2.39 times greater compared to the conscious-thought condition (b=.87, Wald=4.87, P=.027, 95% CI 1.103-5.186). No difference was observed between the conscious-thought condition compared to the immediate-decision condition, and cognitive load manipulations did not affect choices or alter the above finding. Conclusions: This research demonstrates a plausible benefit of unconscious thinking as a decision aid for complex medical decisions, and represents the first use of unconscious thought processes as a patient-centered medical decision aid. Further, the quality of decisions reached unconsciously does not appear to be affected by the amount of cognitive load participants experienced. %M 25677337 %R 10.2196/jmir.3739 %U http://www.jmir.org/2015/2/e37/ %U https://doi.org/10.2196/jmir.3739 %U http://www.ncbi.nlm.nih.gov/pubmed/25677337 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 2 %P e34 %T How Computer Literacy and Socioeconomic Status Affect Attitudes Toward a Web-Based Cohort: Results From the NutriNet-Santé Study %A Pouchieu,Camille %A Méjean,Caroline %A Andreeva,Valentina A %A Kesse-Guyot,Emmanuelle %A Fassier,Philippine %A Galan,Pilar %A Hercberg,Serge %A Touvier,Mathilde %+ Sorbonne Paris Cité, Epidemiology and Biostatistics Research Center, Nutritional Epidemiology Research Team (EREN), Inserm U1153; Inra U1125; Cnam; Paris 13, 7 and 5 Universities, EREN, SMBH Paris 13, 74 rue Marcel Cachin, Bobigny cedex, 93017, France, 33 1 48 38 89 57, c.pouchieu@eren.smbh.univ-paris13.fr %K computer literacy %K Internet %K cohort study %K attitudes %D 2015 %7 02.02.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: In spite of the growing literature in the field of e-epidemiology, clear evidence about computer literacy or attitudes toward respondent burden among e-cohort participants is largely lacking. Objective: We assessed the computer and Internet skills of participants in the NutriNet-Santé Web-based cohort. We then explored attitudes toward the study demands/respondent burden according to levels of computer literacy and sociodemographic status. Methods: Self-reported data from 43,028 e-cohort participants were collected in 2013 via a Web-based questionnaire. We employed unconditional logistic and linear regression analyses. Results: Approximately one-quarter of participants (23.79%, 10,235/43,028) reported being inexperienced in terms of computer use. Regarding attitudes toward participant burden, women tended to be more favorable (eg, “The overall website use is easy”) than were men (OR 0.65, 95% CI 0.59-0.71, P<.001), whereas better educated participants (>12 years of schooling) were less likely to accept the demands associated with participation (eg, “I receive questionnaires too often”) compared to their less educated counterparts (OR 1.62, 95% CI 1.48-1.76, P<.001). Conclusions: A substantial proportion of participants had low computer/Internet skills, suggesting that this does not represent a barrier to participation in Web-based cohorts. Our study also suggests that several subgroups of participants with lower computer skills (eg, women or those with lower educational level) might more readily accept the demands associated with participation in the Web cohort. These findings can help guide future Web-based research strategies. %M 25648178 %R 10.2196/jmir.3813 %U http://www.jmir.org/2015/2/e34/ %U https://doi.org/10.2196/jmir.3813 %U http://www.ncbi.nlm.nih.gov/pubmed/25648178 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 1 %P e21 %T Validity of Electronic Diet Recording Nutrient Estimates Compared to Dietitian Analysis of Diet Records: Randomized Controlled Trial %A Raatz,Susan K %A Scheett,Angela J %A Johnson,LuAnn K %A Jahns,Lisa %+ United States Department of Agriculture, Agricultural Research Service, Grand Forks Human Nutrition Research Center, 2420 2nd Avenue N, Grand Forks, ND, 58201, United States, 1 7017958294, susan.raatz@ars.usda.gov %K diet records %K nutrition assessment %K electronic data %D 2015 %7 20.01.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Dietary intake assessment with diet records (DR) is a standard research and practice tool in nutrition. Manual entry and analysis of DR is time-consuming and expensive. New electronic tools for diet entry by clients and research participants may reduce the cost and effort of nutrient intake estimation. Objective: To determine the validity of electronic diet recording, we compared responses to 3-day DR kept by Tap & Track software for the Apple iPod Touch and records kept on the Nutrihand website to DR coded and analyzed by a research dietitian into a customized US Department of Agriculture (USDA) nutrient analysis program, entitled GRAND (Grand Forks Research Analysis of Nutrient Data). Methods: Adult participants (n=19) enrolled in a crossover-designed clinical trial. During each of two washout periods, participants kept a written 3-day DR. In addition, they were randomly assigned to enter their DR in a Web-based dietary analysis program (Nutrihand) or a handheld electronic device (Tap & Track). They completed an additional 3-day DR and the alternate electronic diet recording methods during the second washout. Entries resulted in 228 daily diet records or 12 for each of 19 participants. Means of nutrient intake were calculated for each method. Concordance of the intake estimates were determined by Bland-Altman plots. Coefficients of determination (R2) were calculated for each comparison to assess the strength of the linear relationship between methods. Results: No significant differences were observed between the mean nutrient values for energy, carbohydrate, protein, fat, saturated fatty acids, total fiber, or sodium between the recorded DR analyzed in GRAND and either Nutrihand or Tap & Track, or for total sugars comparing GRAND and Tap & Track. Reported values for total sugars were significantly reduced (P<.05) comparing Nutrihand to GRAND. Coefficients of determination (R2) for Nutrihand and Tap & Track compared to DR entries into GRAND, respectively, were energy .56, .01; carbohydrate .58, .08; total fiber .65, .37; sugar .78, .41; protein .44, .03; fat .36, .03; saturated fatty acids .23, .03; sodium .20, .00; and for Nutrihand only for cholesterol .88; vitamin A .02; vitamin C .37; calcium .05; and iron .77. Bland-Altman analysis demonstrates high variability in individual responses for both electronic capture programs with higher 95% limits of agreement for dietary intake recorded on Tap & Track. Conclusions: In comparison to dietitian-entered 3-day DR, electronic methods resulted in no significant difference in mean nutrient estimates but exhibited larger variability, particularly the Tap & Track program. However, electronic DR provided mean estimates of energy, macronutrients, and some micronutrients, which approximated those of the dietitian-analyzed DR and may be appropriate for dietary monitoring of groups. Electronic diet assessment methods have the potential to reduce the cost and burden of DR analysis for nutrition research and clinical practice. Trial Registration: Clinicaltrials.gov NCT01183520; http://clinicaltrials.gov/ct2/show/NCT01183520 (Archived by WebCite at http://www.webcitation.org/6VSdYznKX). %M 25604640 %R 10.2196/jmir.3744 %U http://www.jmir.org/2015/1/e21/ %U https://doi.org/10.2196/jmir.3744 %U http://www.ncbi.nlm.nih.gov/pubmed/25604640 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 12 %P e292 %T Consumer Participation in Quality Improvements for Chronic Disease Care: Development and Evaluation of an Interactive Patient-Centered Survey to Identify Preferred Service Initiatives %A Fradgley,Elizabeth A %A Paul,Christine L %A Bryant,Jamie %A Roos,Ian A %A Henskens,Frans A %A Paul,David J %+ Priority Research Centre for Health Behaviour, School of Medicine and Public Health & Hunter Medical Research Institute, University of Newcastle, HMRI Building, Level 4 West, Callaghan, 2305, Australia, 61 02 4042 0642, elizabeth.fradgley@newcastle.edu.au %K ambulatory care %K health care surveys %K patient-centered care %K consumer participation %K medical oncology %K chronic disease %K cardiology %K neurology %D 2014 %7 19.12.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: With increasing attention given to the quality of chronic disease care, a measurement approach that empowers consumers to participate in improving quality of care and enables health services to systematically introduce patient-centered initiatives is needed. A Web-based survey with complex adaptive questioning and interactive survey items would allow consumers to easily identify and prioritize detailed service initiatives. Objective: The aim was to develop and test a Web-based survey capable of identifying and prioritizing patient-centered initiatives in chronic disease outpatient services. Testing included (1) test-retest reliability, (2) patient-perceived acceptability of the survey content and delivery mode, and (3) average completion time, completion rates, and Flesch-Kincaid reading score. Methods: In Phase I, the Web-based Consumer Preferences Survey was developed based on a structured literature review and iterative feedback from expert groups of service providers and consumers. The touchscreen survey contained 23 general initiatives, 110 specific initiatives available through adaptive questioning, and a relative prioritization exercise. In Phase II, a pilot study was conducted within 4 outpatient clinics to evaluate the reliability properties, patient-perceived acceptability, and feasibility of the survey. Eligible participants were approached to complete the survey while waiting for an appointment or receiving intravenous therapy. The age and gender of nonconsenters was estimated to ascertain consent bias. Participants with a subsequent appointment within 14 days were asked to complete the survey for a second time. Results: A total of 741 of 1042 individuals consented to participate (71.11% consent), 529 of 741 completed all survey content (78.9% completion), and 39 of 68 completed the test-retest component. Substantial or moderate reliability (Cohen’s kappa>0.4) was reported for 16 of 20 general initiatives with observed percentage agreement ranging from 82.1%-100.0%. The majority of participants indicated the Web-based survey was easy to complete (97.9%, 531/543) and comprehensive (93.1%, 505/543). Participants also reported the interactive relative prioritization exercise was easy to complete (97.0%, 189/195) and helped them to decide which initiatives were of most importance (84.6%, 165/195). Average completion time was 8.54 minutes (SD 3.91) and the Flesch-Kincaid reading level was 6.8. Overall, 84.6% (447/529) of participants indicated a willingness to complete a similar survey again. Conclusions: The Web-based Consumer Preferences Survey is sufficiently reliable and highly acceptable to patients. Based on completion times and reading level, this tool could be integrated in routine clinical practice and allows consumers to easily participate in quality evaluation. Results provide a comprehensive list of patient-prioritized initiatives for patients with major chronic conditions and delivers practice-ready evidence to guide improvements in patient-centered care. %M 25532217 %R 10.2196/jmir.3545 %U http://www.jmir.org/2014/12/e292/ %U https://doi.org/10.2196/jmir.3545 %U http://www.ncbi.nlm.nih.gov/pubmed/25532217 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 12 %P e279 %T Recruitment via the Internet and Social Networking Sites: The 1989-1995 Cohort of the Australian Longitudinal Study on Women’s Health %A Mishra,Gita Devi %A Hockey,Richard %A Powers,Jennifer %A Loxton,Deborah %A Tooth,Leigh %A Rowlands,Ingrid %A Byles,Julie %A Dobson,Annette %+ Centre for Longitudinal and Life Course Research, School of Public Health, University of Queensland, Herston Road, Herston, 4006, Australia, 61 7 33465224, g.mishra@uq.edu.au %K Web-based survey %K online survey %K social media %K Facebook %K representativeness %K education %K socioeconomic factors %K women’s health %K data collection %K young adults %K Australia %D 2014 %7 15.12.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Faced with the challenge of recruiting young adults for health studies, researchers have increasingly turned to the Internet and social networking sites, such as Facebook, as part of their recruitment strategy. As yet, few large-scale studies are available that report on the characteristics and representativeness of the sample obtained from such recruitment methods. Objective: The intent of the study was to describe the sociodemographic and health characteristics of a national sample of young Australian women recruited mainly through the Internet and social networking sites and to discuss the representativeness of their sociodemographic, health, and lifestyle characteristics relative to the population. Methods: A cohort of 17,069 women (born between 1989 and 1995) was recruited in 2012-13 for the Australian Longitudinal Study on Women’s Health. Sociodemographic characteristics (percentages, means, and 95% confidence intervals) from the online survey data were compared with women aged 18-23 years from the 2011 Australian Census. Sample data were compared by age and education level with data from the 2011-13 Australian Health Survey (AHS). Results: Compared to the Australian Census data, study participants were broadly representative in terms of geographical distribution across Australia, marital status (95.62%, 16,321/17,069) were never married), and age distribution. A higher percentage had attained university (22.52%, 3844/17,069) and trade/certificate/diploma qualifications (25.94%, 4428/17,069) compared with this age group of women in the national population (9.4% and 21.7% respectively). Among study participants, 22.05% (3721/16,877) were not in paid employment with 35.18% (5931/16,857) studying 16 or more hours a week. A higher percentage of study participants rated their health in the online survey as fair or poor (rather than good, very good, or excellent) compared with those participating in face-to-face interviews in the AHS (18.77%, 3203/17,069 vs 10.1%). A higher percentage of study participants were current smokers (21.78%, 3718/17,069 vs 16.4%) and physically active (59.30%, 10,089/17,014 were classified as sufficiently active vs 48.3%) but alcohol consumption was lower (59.58%, 9865/16,558 reported drinking alcohol at least once per month vs 65.9% in the AHS). Using self-reported height and weight to determine body mass index (BMI, kg/m2), 34.80% (5901/16,956) of the cohort were classified as overweight or obese (BMI of 25 or more), compared with 33.6% respectively using measured height and weight in the AHS. Conclusions: Findings indicated that using the Internet and social networking sites for an online survey represent a feasible recruitment strategy for a national cohort of young women and result in a broadly representative sample of the Australian population. %M 25514159 %R 10.2196/jmir.3788 %U http://www.jmir.org/2014/12/e279/ %U https://doi.org/10.2196/jmir.3788 %U http://www.ncbi.nlm.nih.gov/pubmed/25514159 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 12 %P e285 %T Automated Indexing of Internet Stories for Health Behavior Change: Weight Loss Attitude Pilot Study %A Manuvinakurike,Ramesh %A Velicer,Wayne F %A Bickmore,Timothy W %+ College of Computer and Information Science, Northeastern University, WVH202, 360 Hutington Ave, Boston, MA, 02115, United States, 1 617 373 5477, bickmore@ccs.neu.edu %K behavioral medicine %K natural language processing %K animation %K consumer health %K health informatics %K self-efficacy %D 2014 %7 09.12.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Automated health behavior change interventions show promise, but suffer from high attrition and disuse. The Internet abounds with thousands of personal narrative accounts of health behavior change that could not only provide useful information and motivation for others who are also trying to change, but an endless source of novel, entertaining stories that may keep participants more engaged than messages authored by interventionists. Objective: Given a collection of relevant personal health behavior change stories gathered from the Internet, the aim of this study was to develop and evaluate an automated indexing algorithm that could select the best possible story to provide to a user to have the greatest possible impact on their attitudes toward changing a targeted health behavior, in this case weight loss. Methods: An indexing algorithm was developed using features informed by theories from behavioral medicine together with text classification and machine learning techniques. The algorithm was trained using a crowdsourced dataset, then evaluated in a 2×2 between-subjects randomized pilot study. One factor compared the effects of participants reading 2 indexed stories vs 2 randomly selected stories, whereas the second factor compared the medium used to tell the stories: text or animated conversational agent. Outcome measures included changes in self-efficacy and decisional balance for weight loss before and after the stories were read. Results: Participants were recruited from a crowdsourcing website (N=103; 53.4%, 55/103 female; mean age 35, SD 10.8 years; 65.0%, 67/103 precontemplation; 19.4%, 20/103 contemplation for weight loss). Participants who read indexed stories exhibited a significantly greater increase in self-efficacy for weight loss compared to the control group (F1,107=5.5, P=.02). There were no significant effects of indexing on change in decisional balance (F1,97=0.05, P=.83) and no significant effects of medium on change in self-efficacy (F1,107=0.04, P=.84) or decisional balance (F1,97=0.78, P=.38). Conclusions: Personal stories of health behavior change can be harvested from the Internet and used directly and automatically in interventions to affect participant attitudes, such as self-efficacy for changing behavior. Such approaches have the potential to provide highly tailored interventions that maximize engagement and retention with minimal intervention development effort. %M 25491243 %R 10.2196/jmir.3702 %U http://www.jmir.org/2014/12/e285/ %U https://doi.org/10.2196/jmir.3702 %U http://www.ncbi.nlm.nih.gov/pubmed/25491243 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 12 %P e276 %T Nonprobability Web Surveys to Measure Sexual Behaviors and Attitudes in the General Population: A Comparison With a Probability Sample Interview Survey %A Erens,Bob %A Burkill,Sarah %A Couper,Mick P %A Conrad,Frederick %A Clifton,Soazig %A Tanton,Clare %A Phelps,Andrew %A Datta,Jessica %A Mercer,Catherine H %A Sonnenberg,Pam %A Prah,Philip %A Mitchell,Kirstin R %A Wellings,Kaye %A Johnson,Anne M %A Copas,Andrew J %+ London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom, 44 (0)20 7927 2784, bob.erens@lshtm.ac.uk %K Internet survey %K Web survey %K survey methods %K sampling bias %K selection bias %K sexual behavior %D 2014 %7 08.12.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Nonprobability Web surveys using volunteer panels can provide a relatively cheap and quick alternative to traditional health and epidemiological surveys. However, concerns have been raised about their representativeness. Objective: The aim was to compare results from different Web panels with a population-based probability sample survey (n=8969 aged 18-44 years) that used computer-assisted self-interview (CASI) for sensitive behaviors, the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Methods: Natsal-3 questions were included on 4 nonprobability Web panel surveys (n=2000 to 2099), 2 using basic quotas based on age and sex, and 2 using modified quotas based on additional variables related to key estimates. Results for sociodemographic characteristics were compared with external benchmarks and for sexual behaviors and opinions with Natsal-3. Odds ratios (ORs) were used to express differences between the benchmark data and each survey for each variable of interest. A summary measure of survey performance was the average absolute OR across variables. Another summary measure was the number of key estimates for which the survey differed significantly (at the 5% level) from the benchmarks. Results: For sociodemographic variables, the Web surveys were less representative of the general population than Natsal-3. For example, for men, the average absolute OR for Natsal-3 was 1.14, whereas for the Web surveys the average absolute ORs ranged from 1.86 to 2.30. For all Web surveys, approximately two-thirds of the key estimates of sexual behaviors were different from Natsal-3 and the average absolute ORs ranged from 1.32 to 1.98. Differences were appreciable even for questions asked by CASI in Natsal-3. No single Web survey performed consistently better than any other did. Modified quotas slightly improved results for men, but not for women. Conclusions: Consistent with studies from other countries on less sensitive topics, volunteer Web panels provided appreciably biased estimates. The differences seen with Natsal-3 CASI questions, where mode effects may be similar, suggest a selection bias in the Web surveys. The use of more complex quotas may lead to some improvement, but many estimates are still likely to differ. Volunteer Web panels are not recommended if accurate prevalence estimates for the general population are a key objective. %M 25488851 %R 10.2196/jmir.3382 %U http://www.jmir.org/2014/12/e276/ %U https://doi.org/10.2196/jmir.3382 %U http://www.ncbi.nlm.nih.gov/pubmed/25488851 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 12 %P e268 %T Interformat Reliability of Digital Psychiatric Self-Report Questionnaires: A Systematic Review %A Alfonsson,Sven %A Maathz,Pernilla %A Hursti,Timo %+ U-CARE, Department of Public Health and Caring Sciences, Uppsala University, A11, Dag Hammarskjölds väg BMC, Uppsala, 751 22, Sweden, 46 0184716194, sven.alfonsson@pubcare.uu.se %K psychometric %K reliability %K questionnaire %K psychotherapy %K computer %K Internet %D 2014 %7 03.12.2014 %9 Review %J J Med Internet Res %G English %X Background: Research on Internet-based interventions typically use digital versions of pen and paper self-report symptom scales. However, adaptation into the digital format could affect the psychometric properties of established self-report scales. Several studies have investigated differences between digital and pen and paper versions of instruments, but no systematic review of the results has yet been done. Objective: This review aims to assess the interformat reliability of self-report symptom scales used in digital or online psychotherapy research. Methods: Three databases (MEDLINE, Embase, and PsycINFO) were systematically reviewed for studies investigating the reliability between digital and pen and paper versions of psychiatric symptom scales. Results: From a total of 1504 publications, 33 were included in the review, and interformat reliability of 40 different symptom scales was assessed. Significant differences in mean total scores between formats were found in 10 of 62 analyses. These differences were found in just a few studies, which indicates that the results were due to study effects and sample effects rather than unreliable instruments. The interformat reliability ranged from r=.35 to r=.99; however, the majority of instruments showed a strong correlation between format scores. The quality of the included studies varied, and several studies had insufficient power to detect small differences between formats. Conclusions: When digital versions of self-report symptom scales are compared to pen and paper versions, most scales show high interformat reliability. This supports the reliability of results obtained in psychotherapy research on the Internet and the comparability of the results to traditional psychotherapy research. There are, however, some instruments that consistently show low interformat reliability, suggesting that these conclusions cannot be generalized to all questionnaires. Most studies had at least some methodological issues with insufficient statistical power being the most common issue. Future studies should preferably provide information about the transformation of the instrument into digital format and the procedure for data collection in more detail. %M 25472463 %R 10.2196/jmir.3395 %U http://www.jmir.org/2014/12/e268/ %U https://doi.org/10.2196/jmir.3395 %U http://www.ncbi.nlm.nih.gov/pubmed/25472463 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 12 %P e269 %T Web-Based Assessments of Physical Activity in Youth: Considerations for Design and Scale Calibration %A Saint-Maurice,Pedro F %A Welk,Gregory J %+ Iowa State University, Department of Kinesiology, 283 Forker Building, Ames, IA, 50010, United States, 1 515294 8009, pedrosm@iastate.edu %K measurement %K questionnaire %K Youth Activity Profile %D 2014 %7 01.12.2014 %9 Tutorial %J J Med Internet Res %G English %X This paper describes the design and methods involved in calibrating a Web-based self-report instrument to estimate physical activity behavior. The limitations of self-report measures are well known, but calibration methods enable the reported information to be equated to estimates obtained from objective data. This paper summarizes design considerations for effective development and calibration of physical activity self-report measures. Each of the design considerations is put into context and followed by a practical application based on our ongoing calibration research with a promising online self-report tool called the Youth Activity Profile (YAP).We first describe the overall concept of calibration and how this influences the selection of appropriate self-report tools for this population. We point out the advantages and disadvantages of different monitoring devices since the choice of the criterion measure and the strategies used to minimize error in the measure can dramatically improve the quality of the data. We summarize strategies to ensure quality control in data collection and discuss analytical considerations involved in group- vs individual-level inference. For cross-validation procedures, we describe the advantages of equivalence testing procedures that directly test and quantify agreement. Lastly, we introduce the unique challenges encountered when transitioning from paper to a Web-based tool. The Web offers considerable potential for broad adoption but an iterative calibration approach focused on continued refinement is needed to ensure that estimates are generalizable across individuals, regions, seasons and countries. %M 25448192 %R 10.2196/jmir.3626 %U http://www.jmir.org/2014/12/e269/ %U https://doi.org/10.2196/jmir.3626 %U http://www.ncbi.nlm.nih.gov/pubmed/25448192 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 11 %P e259 %T Beyond Open Big Data: Addressing Unreliable Research %A Moseley,Edward T %A Hsu,Douglas J %A Stone,David J %A Celi,Leo Anthony %+ Institute for Medical Engineering & Science, Massachusetts Institute of Technology, 77 Massachusetts Avenue, E25-505, Cambridge, MA, 02139, United States, 1 6172537937, lceli@mit.edu %K open data %K unreliable research %K collaborative learning %K knowledge discovery %K peer review %K research culture %D 2014 %7 11.11.2014 %9 Original Paper %J J Med Internet Res %G English %X The National Institute of Health invests US $30.9 billion annually in medical research. However, the subsequent impact of this research output on society and the economy is amplified dramatically as a result of the actual medical treatments, biomedical innovations, and various commercial enterprises that emanate from and depend on these findings. It is therefore a great concern to discover that much of published research is unreliable. We propose extending the open data concept to the culture of the scientific research community. By dialing down unproductive features of secrecy and competition, while ramping up cooperation and transparency, we make a case that what is published would then be less susceptible to the sometimes corrupting and confounding pressures to be first or journalistically attractive, which can compromise the more fundamental need to be robustly correct. %M 25405277 %R 10.2196/jmir.3871 %U http://www.jmir.org/2014/11/e259/ %U https://doi.org/10.2196/jmir.3871 %U http://www.ncbi.nlm.nih.gov/pubmed/25405277 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 11 %P e246 %T Assessment of a New Web-Based Sexual Concurrency Measurement Tool for Men Who Have Sex With Men %A Rosenberg,Eli S %A Rothenberg,Richard B %A Kleinbaum,David G %A Stephenson,Rob B %A Sullivan,Patrick S %+ Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA, 30322, United States, 1 4047128897, esrose2@emory.edu %K HIV %K sexual networks %K questionnaires %K concurrency %K MSM %K sexual network measurement %K online questionnaire %D 2014 %7 10.11.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Men who have sex with men (MSM) are the most affected risk group in the United States’ human immunodeficiency virus (HIV) epidemic. Sexual concurrency, the overlapping of partnerships in time, accelerates HIV transmission in populations and has been documented at high levels among MSM. However, concurrency is challenging to measure empirically and variations in assessment techniques used (primarily the date overlap and direct question approaches) and the outcomes derived from them have led to heterogeneity and questionable validity of estimates among MSM and other populations. Objective: The aim was to evaluate a novel Web-based and interactive partnership-timing module designed for measuring concurrency among MSM, and to compare outcomes measured by the partnership-timing module to those of typical approaches in an online study of MSM. Methods: In an online study of MSM aged ≥18 years, we assessed concurrency by using the direct question method and by gathering the dates of first and last sex, with enhanced programming logic, for each reported partner in the previous 6 months. From these methods, we computed multiple concurrency cumulative prevalence outcomes: direct question, day resolution / date overlap, and month resolution / date overlap including both 1-month ties and excluding ties. We additionally computed variants of the UNAIDS point prevalence outcome. The partnership-timing module was also administered. It uses an interactive month resolution calendar to improve recall and follow-up questions to resolve temporal ambiguities, combines elements of the direct question and date overlap approaches. The agreement between the partnership-timing module and other concurrency outcomes was assessed with percent agreement, kappa statistic (κ), and matched odds ratios at the individual, dyad, and triad levels of analysis. Results: Among 2737 MSM who completed the partnership section of the partnership-timing module, 41.07% (1124/2737) of individuals had concurrent partners in the previous 6 months. The partnership-timing module had the highest degree of agreement with the direct question. Agreement was lower with date overlap outcomes (agreement range 79%-81%, κ range .55-.59) and lowest with the UNAIDS outcome at 5 months before interview (65% agreement, κ=.14, 95% CI .12-.16). All agreements declined after excluding individuals with 1 sex partner (always classified as not engaging in concurrency), although the highest agreement was still observed with the direct question technique (81% agreement, κ=.59, 95% CI .55-.63). Similar patterns in agreement were observed with dyad- and triad-level outcomes. Conclusions: The partnership-timing module showed strong concurrency detection ability and agreement with previous measures. These levels of agreement were greater than others have reported among previous measures. The partnership-timing module may be well suited to quantifying concurrency among MSM at multiple levels of analysis. %M 25386801 %R 10.2196/jmir.3211 %U http://www.jmir.org/2014/11/e246/ %U https://doi.org/10.2196/jmir.3211 %U http://www.ncbi.nlm.nih.gov/pubmed/25386801 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 10 %P e239 %T Tablet, Web-Based, or Paper Questionnaires for Measuring Anxiety in Patients Suspected of Breast Cancer: Patients' Preferences and Quality of Collected Data %A Barentsz,Maarten W %A Wessels,Hester %A van Diest,Paul J %A Pijnappel,Ruud M %A Haaring,Cees %A van der Pol,Carmen C %A Witkamp,Arjen J %A van den Bosch,Maurice A %A Verkooijen,Helena M %+ University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands, 31 887556689, m.barentsz@umcutrecht.nl %K breast cancer %K electronic questionnaires %K paper questionnaires %K quality of collected data %D 2014 %7 31.10.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic applications are increasingly being used in hospitals for numerous purposes. Objective: Our aim was to assess differences in the characteristics of patients who choose paper versus electronic questionnaires and to evaluate the data quality of both approaches. Methods: Between October 2012 and June 2013, 136 patients participated in a study on diagnosis-induced stress and anxiety. Patients were asked to fill out questionnaires at six different moments during the diagnostic phase. They were given the opportunity to fill out the questionnaires on paper or electronically (a combination of tablet and Web-based questionnaires). Demographic characteristics and completeness of returned data were compared between groups. Results: Nearly two-thirds of patients (88/136, 64.7%) chose to fill out the questionnaires on paper, and just over a third (48/136, 35.3%) preferred the electronic option. Patients choosing electronic questionnaires were significantly younger (mean 47.3 years vs mean 53.5 in the paper group, P=.01) and higher educated (P=.004). There was significantly more missing information (ie, at least one question not answered) in the paper group during the diagnostic day compared to the electronic group (using a tablet) (28/88 vs 1/48, P<.001). However, in the week after the diagnostic day, missing information was significantly higher in the electronic group (Web-based questionnaires) compared to the paper group (41/48 vs 38/88, P<.001). Conclusions: Younger patients and patients with a higher level of education have a preference towards filling out questionnaires electronically. In the hospital, a tablet is an excellent medium for patients to fill out questionnaires with very little missing information. However, for filling out questionnaires at home, paper questionnaires resulted in a better response than Web-based questionnaires. %M 25364951 %R 10.2196/jmir.3578 %U http://www.jmir.org/2014/10/e239/ %U https://doi.org/10.2196/jmir.3578 %U http://www.ncbi.nlm.nih.gov/pubmed/25364951 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 10 %P e243 %T Beyond Traditional Advertisements: Leveraging Facebook’s Social Structures for Research Recruitment %A Valdez,Rupa S %A Guterbock,Thomas M %A Thompson,Morgan J %A Reilly,Jeremiah D %A Menefee,Hannah K %A Bennici,Maria S %A Williams,Ishan C %A Rexrode,Deborah L %+ Department of Public Health Sciences, University of Virginia, PO Box 800717, Charlottesville, VA, 22908, United States, 1 434 982 2510, rupavaldez@virginia.edu %K participant recruitment %K Facebook %K social media %K consumer health IT %K ethnicity %K advertising %D 2014 %7 27.10.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Obtaining access to a demographically and geographically diverse sample for health-related research can be costly and time consuming. Previous studies have reported mixed results regarding the potential of using social media-based advertisements to overcome these challenges. Objective: Our aim was to develop and assess the feasibility, benefits, and challenges of recruiting for research studies related to consumer health information technology (IT) by leveraging the social structures embedded in the social networking platform, Facebook. Methods: Two recruitment strategies that involved direct communication with existing Facebook groups and pages were developed and implemented in two distinct populations. The first recruitment strategy involved posting a survey link directly to consenting groups and pages and was used to recruit Filipino-Americans to a study assessing the perceptions, use of, and preferences for consumer health IT. This study took place between August and December 2013. The second recruitment strategy targeted individuals with type 2 diabetes and involved creating a study-related Facebook group and asking administrators of other groups and pages to publicize our group to their members. Group members were then directly invited to participate in an online pre-study survey. This portion of a larger study to understand existing health management practices as a foundation for consumer health IT design took place between May and June 2014. In executing both recruitment strategies, efforts were made to establish trust and transparency. Recruitment rate, cost, content of interaction, and characteristics of the sample obtained were used to assess the recruitment methods. Results: The two recruitment methods yielded 87 and 79 complete responses, respectively. The first recruitment method yielded a rate of study completion proportionate to that of the rate of posts made, whereas recruitment successes of the second recruitment method seemed to follow directly from the actions of a subset of administrators. Excluding personnel time, the first recruitment method resulted in no direct costs, and the second recruitment method resulted in a total direct cost of US $118.17. Messages, posts, and comments received using both recruitment strategies reflected ten themes, including appreciation, assistance, clarification, concerns, encouragement, health information, interest, promotion, solicitations, and support. Both recruitment methods produced mixed results regarding sample representativeness with respect to characteristics such as gender, race, and ethnicity. Conclusions: The results of the study demonstrate that leveraging the social structures of Facebook for health-related research was feasible for obtaining small samples appropriate for qualitative research but not for obtaining large samples needed for quantitative research. The content of interactions with members of the target population prompted ethical deliberations concerning suitable target communities and appropriate boundaries between researchers and participants. Widespread replication of this method would benefit from a broad discussion among researchers, social media users, social media companies, and experts in research ethics to address appropriate protocols for such interactions. %M 25348050 %R 10.2196/jmir.3786 %U http://www.jmir.org/2014/10/e243/ %U https://doi.org/10.2196/jmir.3786 %U http://www.ncbi.nlm.nih.gov/pubmed/25348050 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e207 %T Applying Computer Adaptive Testing to Optimize Online Assessment of Suicidal Behavior: A Simulation Study %A De Beurs,Derek Paul %A de Vries,Anton LM %A de Groot,Marieke H %A de Keijser,Jos %A Kerkhof,Ad JFM %+ EMGO Institute for Health and Care Research, van der Boechorststraat 1, Amsterdam, , Netherlands, 31 205982589, dp.de.beurs@vu.nl %K suicide %K psychometrics %K computing methodologies %K Internet %K suicidal ideation %K risk assessment %D 2014 %7 11.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet is used increasingly for both suicide research and prevention. To optimize online assessment of suicidal patients, there is a need for short, good-quality tools to assess elevated risk of future suicidal behavior. Computer adaptive testing (CAT) can be used to reduce response burden and improve accuracy, and make the available pencil-and-paper tools more appropriate for online administration. Objective: The aim was to test whether an item response–based computer adaptive simulation can be used to reduce the length of the Beck Scale for Suicide Ideation (BSS). Methods: The data used for our simulation was obtained from a large multicenter trial from The Netherlands: the Professionals in Training to STOP suicide (PITSTOP suicide) study. We applied a principal components analysis (PCA), confirmatory factor analysis (CFA), a graded response model (GRM), and simulated a CAT. Results: The scores of 505 patients were analyzed. Psychometric analyses showed the questionnaire to be unidimensional with good internal consistency. The computer adaptive simulation showed that for the estimation of elevation of risk of future suicidal behavior 4 items (instead of the full 19) were sufficient, on average. Conclusions: This study demonstrated that CAT can be applied successfully to reduce the length of the Dutch version of the BSS. We argue that the use of CAT can improve the accuracy and the response burden when assessing the risk of future suicidal behavior online. Because CAT can be daunting for clinicians and applied scientists, we offer a concrete example of our computer adaptive simulation of the Dutch version of the BSS at the end of the paper. %M 25213259 %R 10.2196/jmir.3511 %U http://www.jmir.org/2014/9/e207/ %U https://doi.org/10.2196/jmir.3511 %U http://www.ncbi.nlm.nih.gov/pubmed/25213259 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e198 %T Estimation of Geographic Variation in Human Papillomavirus Vaccine Uptake in Men and Women: An Online Survey Using Facebook Recruitment %A Nelson,Erik J %A Hughes,John %A Oakes,J Michael %A Pankow,James S %A Kulasingam,Shalini L %+ School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, 1300 South Second Street, Suite 300, Minneapolis, MN, 55454, United States, 1 1 612 624 1818, nels6712@umn.edu %K online recruitment %K social media %K Facebook %K local estimation %K geographic variability %K human papillomavirus %K HPV %D 2014 %7 01.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Federally funded surveys of human papillomavirus (HPV) vaccine uptake are important for pinpointing geographically based health disparities. Although national and state level data are available, local (ie, county and postal code level) data are not due to small sample sizes, confidentiality concerns, and cost. Local level HPV vaccine uptake data may be feasible to obtain by targeting specific geographic areas through social media advertising and recruitment strategies, in combination with online surveys. Objective: Our goal was to use Facebook-based recruitment and online surveys to estimate local variation in HPV vaccine uptake among young men and women in Minnesota. Methods: From November 2012 to January 2013, men and women were recruited via a targeted Facebook advertisement campaign to complete an online survey about HPV vaccination practices. The Facebook advertisements were targeted to recruit men and women by location (25 mile radius of Minneapolis, Minnesota, United States), age (18-30 years), and language (English). Results: Of the 2079 men and women who responded to the Facebook advertisements and visited the study website, 1003 (48.2%) enrolled in the study and completed the survey. The average advertising cost per completed survey was US $1.36. Among those who reported their postal code, 90.6% (881/972) of the participants lived within the previously defined geographic study area. Receipt of 1 dose or more of HPV vaccine was reported by 65.6% women (351/535), and 13.0% (45/347) of men. These results differ from previously reported Minnesota state level estimates (53.8% for young women and 20.8% for young men) and from national estimates (34.5% for women and 2.3% for men). Conclusions: This study shows that recruiting a representative sample of young men and women based on county and postal code location to complete a survey on HPV vaccination uptake via the Internet is a cost-effective and feasible strategy. This study also highlights the need for local estimates to assess the variation in HPV vaccine uptake, as these estimates differ considerably from those obtained using survey data that are aggregated to the state or federal level. %M 25231937 %R 10.2196/jmir.3506 %U http://www.jmir.org/2014/9/e198/ %U https://doi.org/10.2196/jmir.3506 %U http://www.ncbi.nlm.nih.gov/pubmed/25231937 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 8 %P e190 %T Online Dietary Intake Estimation: Reproducibility and Validity of the Food4Me Food Frequency Questionnaire Against a 4-Day Weighed Food Record %A Fallaize,Rosalind %A Forster,Hannah %A Macready,Anna L %A Walsh,Marianne C %A Mathers,John C %A Brennan,Lorraine %A Gibney,Eileen R %A Gibney,Michael J %A Lovegrove,Julie A %+ Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, PO Box 226, Reading, RG6 6AP, United Kingdom, 44 118 378 6418, j.a.lovegrove@reading.ac.uk %K food frequency questionnaire %K weighed food record %K validity %K reproducibility %K dietary assessment %K Food4Me %K Web-based %D 2014 %7 11.08.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Advances in nutritional assessment are continuing to embrace developments in computer technology. The online Food4Me food frequency questionnaire (FFQ) was created as an electronic system for the collection of nutrient intake data. To ensure its accuracy in assessing both nutrient and food group intake, further validation against data obtained using a reliable, but independent, instrument and assessment of its reproducibility are required. Objective: The aim was to assess the reproducibility and validity of the Food4Me FFQ against a 4-day weighed food record (WFR). Methods: Reproducibility of the Food4Me FFQ was assessed using test-retest methodology by asking participants to complete the FFQ on 2 occasions 4 weeks apart. To assess the validity of the Food4Me FFQ against the 4-day WFR, half the participants were also asked to complete a 4-day WFR 1 week after the first administration of the Food4Me FFQ. Level of agreement between nutrient and food group intakes estimated by the repeated Food4Me FFQ and the Food4Me FFQ and 4-day WFR were evaluated using Bland-Altman methodology and classification into quartiles of daily intake. Crude unadjusted correlation coefficients were also calculated for nutrient and food group intakes. Results: In total, 100 people participated in the assessment of reproducibility (mean age 32, SD 12 years), and 49 of these (mean age 27, SD 8 years) also took part in the assessment of validity. Crude unadjusted correlations for repeated Food4Me FFQ ranged from .65 (vitamin D) to .90 (alcohol). The mean cross-classification into “exact agreement plus adjacent” was 92% for both nutrient and food group intakes, and Bland-Altman plots showed good agreement for energy-adjusted macronutrient intakes. Agreement between the Food4Me FFQ and 4-day WFR varied, with crude unadjusted correlations ranging from .23 (vitamin D) to .65 (protein, % total energy) for nutrient intakes and .11 (soups, sauces and miscellaneous foods) to .73 (yogurts) for food group intake. The mean cross-classification into “exact agreement plus adjacent” was 80% and 78% for nutrient and food group intake, respectively. There were no significant differences between energy intakes estimated using the Food4Me FFQ and 4-day WFR, and Bland-Altman plots showed good agreement for both energy and energy-controlled nutrient intakes. Conclusions: The results demonstrate that the online Food4Me FFQ is reproducible for assessing nutrient and food group intake and has moderate agreement with the 4-day WFR for assessing energy and energy-adjusted nutrient intakes. The Food4Me FFQ is a suitable online tool for assessing dietary intake in healthy adults. %M 25113936 %R 10.2196/jmir.3355 %U http://www.jmir.org/2014/8/e190/ %U https://doi.org/10.2196/jmir.3355 %U http://www.ncbi.nlm.nih.gov/pubmed/25113936 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 8 %P e189 %T Motives for Participating in a Web-Based Nutrition Cohort According to Sociodemographic, Lifestyle, and Health Characteristics: The NutriNet-Santé Cohort Study %A Méjean,Caroline %A Szabo de Edelenyi,Fabien %A Touvier,Mathilde %A Kesse-Guyot,Emmanuelle %A Julia,Chantal %A Andreeva,Valentina A %A Hercberg,Serge %+ Université Paris 13, Sorbonne Paris Cité, Equipe de Recherche en Epidémiologie Nutritionnelle (EREN), Centre d’Epidémiologie et Biostatistiques Paris Nord, Inserm (U1153), Inra (U1125), Cnam, Université Paris 5, Université Paris 7, 74 rue marcel cachin, Bobigny, F-93017, France, 33 148388958, c.mejean@uren.smbh.univ-paris13.fr %K Internet %K cohort study %K population characteristics %K motivation %K participation %D 2014 %7 07.08.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: In traditional epidemiological studies, participants are likely motivated by perceived benefits, feelings of accomplishment, and belonging. No study has explored motives for participation in a Web-based cohort and the associated participant characteristics, although such information is useful for enhancing recruitment and improving cohort retention. Objective: We aimed to evaluate the relationships between motives for participation and sociodemographic, health, and lifestyle characteristics of participants in the NutriNet-Santé Web-based cohort, designed to identify nutritional risk or protective factors for chronic diseases. Methods: The motives for participation were assessed using a specifically developed questionnaire administered approximately 2 years after baseline. A total of 6352 completed the motives questionnaire (43.34%, 6352/15,000 randomly invited cohort participants). We studied the associations between motives (dependent variables) and individual characteristics with multivariate multinomial logistic regression models providing odds ratios and 95% confidence intervals. Results: In total, 46.45% (2951/6352) of participants reported that they would not have enrolled if the study had not been conducted on the Internet, whereas 28.75% (1826/6352) were not sure. Men (OR 1.21, 95% CI 1.04-1.42), individuals aged 26-35 years (OR 1.51, 95% CI 1.20-1.91), and obese participants (OR 1.30, 95% CI 1.02-1.65) were more inclined to be motivated by the Internet aspect. Compared with younger adults and managerial staff, individuals >55 years (OR 0.60, 95% CI 0.48-0.45) and employees/manual workers were less likely motivated by the Internet aspect (OR 0.77, 95% CI 0.63-0.92). Regarding reasons for participation, 61.37% (3898/6352) reported participating to help advance public health research on chronic disease prevention; 22.24% (1413/6352) to help advance nutrition-focused research; 6.89% (438/6352) in response to the call from the media, after being encouraged by a close friend/associate, or a medical provider. Individuals >45 years (vs younger participants) were more likely (OR 1.62, 95% CI 1.07-2.47), whereas overweight and obese participants (vs nonobese participants) were less likely to participate in the study for reasons related to helping public health research on chronic disease prevention (OR 0.72, 95% CI 0.58-0.89; OR 0.62, 95% CI 0.46-0.84; respectively). Exclusive public funding of the study was important for 67.02% (4257/6352) of the participants. Men (OR 1.37, 95% CI 1.17-1.61) and persons >55 years (OR 1.97, 95% CI 1.57-2.47) were more likely to consider the exclusive public funding as very important. Conclusions: The use of the Internet, the willingness to help advance public health research, and the study being publicly funded were key motives for participating in the Web-based NutriNet-Santé cohort. These motives differed by sociodemographic profile and obesity, yet were not associated with lifestyle or health status. These findings can help improve the retention strategies in Web-based cohorts, particularly during decisive study periods when principal exposure information is collected. %M 25135800 %R 10.2196/jmir.3161 %U http://www.jmir.org/2014/8/e189/ %U https://doi.org/10.2196/jmir.3161 %U http://www.ncbi.nlm.nih.gov/pubmed/25135800 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 7 %P e173 %T Longitudinal Accuracy of Web-Based Self-Reported Weights: Results From the Hopkins POWER Trial %A Jerome,Gerald J %A Dalcin,Arlene %A Coughlin,Janelle W %A Fitzpatrick,Stephanie %A Wang,Nae-Yuh %A Durkin,Nowella %A Yeh,Hsin-Chieh %A Charleston,Jeanne %A Pozefsky,Thomas %A Daumit,Gail L %A Clark,Jeanne M %A Louis,Thomas A %A Appel,Lawrence J %+ Department of Kinesiology, Towson University, 8000 York Road, Towson, MD, 21252, United States, 1 410 704 5283, gjerome@towson.edu %K self-report %K weight loss %K obesity %K Internet %D 2014 %7 15.07.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Websites and phone apps are increasingly used to track weights during weight loss interventions, yet the longitudinal accuracy of these self-reported weights is uncertain. Objective: Our goal was to compare the longitudinal accuracy of self-reported weights entered online during the course of a randomized weight loss trial to measurements taken in the clinic. We aimed to determine if accuracy of self-reported weight is associated with weight loss and to determine the extent of misclassification in achieving 5% weight loss when using self-reported compared to clinic weights. Methods: This study examined the accuracy of self-reported weights recorded online among intervention participants in the Hopkins Practice-Based Opportunities for Weight Reduction (POWER) trial, a randomized trial examining the effectiveness of two lifestyle-based weight loss interventions compared to a control group among obese adult patients with at least one cardiovascular risk factor. One treatment group was offered telephonic coaching and the other group was offered in-person individual coaching and group sessions. All intervention participants (n=277) received a digital scale and were asked to track their weight weekly on a study website. Research staff used a standard protocol to measure weight in the clinic. Differences (self-reported weight – clinic weight) indicate if self-report under (-) or over (+) estimated clinic weight using the self-reported weight that was closest in time to the clinic weight and was within a window ranging from the day of the clinic visit to 7 days before the 6-month (n=225) and 24-month (n=191) clinic visits. The absolute value of the differences (absolute difference) describes the overall accuracy. Results: Underestimation of self-reported weights increased significantly from 6 months (mean -0.5kg, SD 1.0kg) to 24 months (mean -1.1kg, SD 2.0kg; P=.002). The average absolute difference also increased from 6 months (mean 0.7kg, SD 0.8kg) to 24 months (mean 1.3, SD 1.8kg; P<.001). Participants who achieved the study weight loss goal at 24 months (based on clinic weights) had lower absolute differences (P=.01) compared to those who did not meet this goal. At 24 months, there was 9% misclassification of weight loss goal success when using self-reported weight compared to clinic weight as an outcome. At 24 months, those with self-reported weights (n=191) had three times the weight loss compared to those (n=73) without self-reported weights (P<.001). Conclusions: Underestimation of weight increased over time and was associated with less weight loss. In addition to intervention adherence, weight loss programs should emphasize accuracy in self-reporting. Trial Registration: ClinicalTrials.gov: NCT00783315; http://clinicaltrials.gov/show/NCT00783315 (Archived by WebCite at http://www.webcitation.org/6R4gDAK5K). %M 25042773 %R 10.2196/jmir.3332 %U http://www.jmir.org/2014/7/e173/ %U https://doi.org/10.2196/jmir.3332 %U http://www.ncbi.nlm.nih.gov/pubmed/25042773 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 7 %P e171 %T Social Network Sites as a Mode to Collect Health Data: A Systematic Review %A Alshaikh,Fahdah %A Ramzan,Farzan %A Rawaf,Salman %A Majeed,Azeem %+ School of Public Health, Department of Primary Care and Public Health, Imperial College London, 324 The Reynolds Building, St Dunstan’s Road, London, W6 8RP, United Kingdom, 44 (0)20 7594 7386, fahdah.alshaikh09@imperial.ac.uk %K social network %K social media %K Internet %K systematic review %K young people %K health education %K health behaviors %D 2014 %7 14.07.2014 %9 Review %J J Med Internet Res %G English %X Background: To date, health research literature has focused on social network sites (SNS) either as tools to deliver health care, to study the effect of these networks on behavior, or to analyze Web health content. Less is known about the effectiveness of these sites as a method for collecting data for health research and the means to use such powerful tools in health research. Objective: The objective of this study was to systematically review the available literature and explore the use of SNS as a mode of collecting data for health research. The review aims to answer four questions: Does health research employ SNS as method for collecting data? Is data quality affected by the mode of data collection? What types of participants were reached by SNS? What are the strengths and limitations of SNS? Methods: The literature was reviewed systematically in March 2013 by searching the databases MEDLINE, Embase, and PsycINFO, using the Ovid and PubMed interface from 1996 to the third week of March 2013. The search results were examined by 2 reviewers, and exclusion, inclusion, and quality assessment were carried out based on a pre-set protocol. Results: The inclusion criteria were met by 10 studies and results were analyzed descriptively to answer the review questions. There were four main results. (1) SNS have been used as a data collection tool by health researchers; all but 1 of the included studies were cross-sectional and quantitative. (2) Data quality indicators that were reported include response rate, cost, timeliness, missing data/completion rate, and validity. However, comparison was carried out only for response rate and cost as it was unclear how other reported indicators were measured. (3) The most targeted population were females and younger people. (4) All studies stated that SNS is an effective recruitment method but that it may introduce a sampling bias. Conclusions: SNS has a role in health research, but we need to ascertain how to use it effectively without affecting the quality of research. The field of SNS is growing rapidly, and it is necessary to take advantage of the strengths of this tool and to avoid its limitations by effective research design. This review provides an important insight for scholars who plan to conduct research using SNS. %M 25048247 %R 10.2196/jmir.3050 %U http://www.jmir.org/2014/7/e171/ %U https://doi.org/10.2196/jmir.3050 %U http://www.ncbi.nlm.nih.gov/pubmed/25048247 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 7 %P e164 %T Does Self-Selection Affect Samples’ Representativeness in Online Surveys? An Investigation in Online Video Game Research %A Khazaal,Yasser %A van Singer,Mathias %A Chatton,Anne %A Achab,Sophia %A Zullino,Daniele %A Rothen,Stephane %A Khan,Riaz %A Billieux,Joel %A Thorens,Gabriel %+ Geneva University Hospitals, Grand pré, 70 C, Geneva, 1206, Switzerland, 41 795535682, yasser.khazaal@hcuge.ch %K Internet %K bias %K online survey %K self-selection %K random sample %K World of Warcraft %K massively multiplayer online role-playing %D 2014 %7 07.07.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of medical studies performed through online surveys has increased dramatically in recent years. Despite their numerous advantages (eg, sample size, facilitated access to individuals presenting stigmatizing issues), selection bias may exist in online surveys. However, evidence on the representativeness of self-selected samples in online studies is patchy. Objective: Our objective was to explore the representativeness of a self-selected sample of online gamers using online players’ virtual characters (avatars). Methods: All avatars belonged to individuals playing World of Warcraft (WoW), currently the most widely used online game. Avatars’ characteristics were defined using various games’ scores, reported on the WoW’s official website, and two self-selected samples from previous studies were compared with a randomly selected sample of avatars. Results: We used scores linked to 1240 avatars (762 from the self-selected samples and 478 from the random sample). The two self-selected samples of avatars had higher scores on most of the assessed variables (except for guild membership and exploration). Furthermore, some guilds were overrepresented in the self-selected samples. Conclusions: Our results suggest that more proficient players or players more involved in the game may be more likely to participate in online surveys. Caution is needed in the interpretation of studies based on online surveys that used a self-selection recruitment procedure. Epidemiological evidence on the reduced representativeness of sample of online surveys is warranted. %M 25001007 %R 10.2196/jmir.2759 %U http://www.jmir.org/2014/7/e164/ %U https://doi.org/10.2196/jmir.2759 %U http://www.ncbi.nlm.nih.gov/pubmed/25001007 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 7 %P e161 %T Employing Computers for the Recruitment into Clinical Trials: A Comprehensive Systematic Review %A Köpcke,Felix %A Prokosch,Hans-Ulrich %+ Department for Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Lehrstuhl für Medizinische Informatik, Wetterkreuz 13, Erlangen, 91058, Germany, 49 91318526720, Hans-Ulrich.Prokosch@uk-erlangen.de %K automation %K clinical trials as topic %K decision support systems, clinical %K patient selection %K research subject recruitment %D 2014 %7 01.07.2014 %9 Review %J J Med Internet Res %G English %X Background: Medical progress depends on the evaluation of new diagnostic and therapeutic interventions within clinical trials. Clinical trial recruitment support systems (CTRSS) aim to improve the recruitment process in terms of effectiveness and efficiency. Objective: The goals were to (1) create an overview of all CTRSS reported until the end of 2013, (2) find and describe similarities in design, (3) theorize on the reasons for different approaches, and (4) examine whether projects were able to illustrate the impact of CTRSS. Methods: We searched PubMed titles, abstracts, and keywords for terms related to CTRSS research. Query results were classified according to clinical context, workflow integration, knowledge and data sources, reasoning algorithm, and outcome. Results: A total of 101 papers on 79 different systems were found. Most lacked details in one or more categories. There were 3 different CTRSS that dominated: (1) systems for the retrospective identification of trial participants based on existing clinical data, typically through Structured Query Language (SQL) queries on relational databases, (2) systems that monitored the appearance of a key event of an existing health information technology component in which the occurrence of the event caused a comprehensive eligibility test for a patient or was directly communicated to the researcher, and (3) independent systems that required a user to enter patient data into an interface to trigger an eligibility assessment. Although the treating physician was required to act for the patient in older systems, it is now becoming increasingly popular to offer this possibility directly to the patient. Conclusions: Many CTRSS are designed to fit the existing infrastructure of a clinical care provider or the particularities of a trial. We conclude that the success of a CTRSS depends more on its successful workflow integration than on sophisticated reasoning and data processing algorithms. Furthermore, some of the most recent literature suggest that an increase in recruited patients and improvements in recruitment efficiency can be expected, although the former will depend on the error rate of the recruitment process being replaced. Finally, to increase the quality of future CTRSS reports, we propose a checklist of items that should be included. %M 24985568 %R 10.2196/jmir.3446 %U http://www.jmir.org/2014/7/e161/ %U https://doi.org/10.2196/jmir.3446 %U http://www.ncbi.nlm.nih.gov/pubmed/24985568 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 6 %P e152 %T Pretreatment Attrition and Formal Withdrawal During Treatment and Their Predictors: An Exploratory Study of the Anxiety Online Data %A AL-Asadi,Ali M %A Klein,Britt %A Meyer,Denny %+ Department of Arts and Education, Grande Prairie Regional College, 10726 - 106 Ave, Grande Prairie, AB, T8V 4C4, Canada, 1 780 539 2061, aalasadi@gprc.ab.ca %K pretreatment attrition %K treatment withdrawal dropouts %K predictors, anxiety disorders %K eTherapy %K e-mental health %K Internet interventions %D 2014 %7 17.06.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Although in its infancy, the field of e-mental health interventions has been gaining popularity and afforded considerable research attention. However, there are many gaps in the research. One such gap is in the area of attrition predictors at various stages of assessment and treatment delivery. Objective: This exploratory study applied univariate and multivariate analysis to a large dataset provided by the Anxiety Online (now called Mental Health Online) system to identify predictors of attrition in treatment commencers and in those who formally withdrew during treatment based on 24 pretreatment demographic and personal variables and one clinical measure. Methods: Participants were assessed using a complex online algorithm that resulted in primary and secondary diagnoses in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Those who received a primary or secondary diagnosis of 1 of 5 anxiety disorders (generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and panic disorder) were offered an online 12-week disorder-specific treatment program. Results: Of 9394 potential participants, a total of 3880 clients enrolled and 5514 did not enroll in one of the treatment programs following the completion of pretreatment assessment measures (pretreatment attrition rate: 58.70%). A total of 3199 individuals did not formally withdraw from the 12-week treatment cycle, whereas 142 individuals formally dropped out (formal withdrawal during treatment dropout rate of 4.25%). The treatment commencers differed significantly (P<.001-.03) from the noncommencers on several variables (reason for registering, mental health concerns, postsecondary education, where first heard about Anxiety Online, Kessler-6 score, stage of change, quality of life, relationship status, preferred method of learning, and smoking status). Those who formally withdrew during treatment differed significantly (P=.002-.03) from those who did not formally withdraw in that they were less likely to express concerns about anxiety, stress, and depression; to rate their quality of life as very poor, poor, or good; to report adequate level of social support; and to report readiness to make or were in the process of making changes. Conclusions: This exploratory study identified predictors of pretreatment attrition and formal withdrawal during treatment dropouts for the Anxiety Online program. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG). %M 24938311 %R 10.2196/jmir.2989 %U http://www.jmir.org/2014/6/e152/ %U https://doi.org/10.2196/jmir.2989 %U http://www.ncbi.nlm.nih.gov/pubmed/24938311 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 5 %P e117 %T Using Online Social Media for Recruitment of Human Immunodeficiency Virus-Positive Participants: A Cross-Sectional Survey %A Yuan,Patrick %A Bare,Michael G %A Johnson,Mallory O %A Saberi,Parya %+ Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, Box 0886, San Francisco, CA, 94122, United States, 1 415 597 8177, parya.saberi@ucsf.edu %K HIV %K AIDS %K online social media %K Facebook %K Twitter %K recruitment %K Internet research %K survey retention %K online data collection software %K non-financial incentives %D 2014 %7 01.05.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: There are many challenges in recruiting and engaging participants when conducting research, especially with HIV-positive individuals. Some of these challenges include geographical barriers, insufficient time and financial resources, and perceived HIV-related stigma. Objective: This paper describes the methodology of a recruitment approach that capitalized on existing online social media venues and other Internet resources in an attempt to overcome some of these barriers to research recruitment and retention. Methods: From May through August 2013, a campaign approach using a combination of online social media, non-financial incentives, and Web-based survey software was implemented to advertise, recruit, and retain participants, and collect data for a survey study with a limited budget. Results: Approximately US $5,000 was spent with a research staff designated at 20% of full-time effort, yielding 2034 survey clicks, 1404 of which met the inclusion criteria and initiated the survey, for an average cost of US $3.56 per survey initiation. A total of 1221 individuals completed the survey, yielding 86.97% retention. Conclusions: These data indicate that online recruitment is a feasible and efficient tool that can be further enhanced by sophisticated online data collection software and the addition of non-financial incentives. %M 24784982 %R 10.2196/jmir.3229 %U http://www.jmir.org/2014/5/e117/ %U https://doi.org/10.2196/jmir.3229 %U http://www.ncbi.nlm.nih.gov/pubmed/24784982 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 4 %P e115 %T Electronic Versus Paper-Based Assessment of Health-Related Quality of Life Specific to HIV Disease: Reliability Study of the PROQOL-HIV Questionnaire %A Duracinsky,Martin %A Lalanne,Christophe %A Goujard,Cécile %A Herrmann,Susan %A Cheung-Lung,Christian %A Brosseau,Jean-Paul %A Schwartz,Yannick %A Chassany,Olivier %+ Université Paris-Diderot, Sorbonne Paris-Cité, Unité de Méthodologie des critères d’évaluation (Patient-Reported Outcomes), EA Recherche Clinique Coordonnée Ville-Hôpital, Méthodologies et Société (ED 393), Carré historique de l'Hôpital Saint-Louis, porte 23, 1 avenue Claude Vellefaux, Paris cedex 10, 75475, France, 33 1 40 27 57 48, duracinsky.m@gmail.com %K HIV %K quality of life %K patient-reported outcomes %K electronic records %K reliability %D 2014 %7 25.04.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic patient-reported outcomes (PRO) provide quick and usually reliable assessments of patients’ health-related quality of life (HRQL). Objective: An electronic version of the Patient-Reported Outcomes Quality of Life-human immunodeficiency virus (PROQOL-HIV) questionnaire was developed, and its face validity and reliability were assessed using standard psychometric methods. Methods: A sample of 80 French outpatients (66% male, 52/79; mean age 46.7 years, SD 10.9) were recruited. Paper-based and electronic questionnaires were completed in a randomized crossover design (2-7 day interval). Biomedical data were collected. Questionnaire version and order effects were tested on full-scale scores in a 2-way ANOVA with patients as random effects. Test-retest reliability was evaluated using Pearson and intraclass correlation coefficients (ICC, with 95% confidence interval) for each dimension. Usability testing was carried out from patients’ survey reports, specifically, general satisfaction, ease of completion, quality and clarity of user interface, and motivation to participate in follow-up PROQOL-HIV electronic assessments. Results: Questionnaire version and administration order effects (N=59 complete cases) were not significant at the 5% level, and no interaction was found between these 2 factors (P=.94). Reliability indexes were acceptable, with Pearson correlations greater than .7 and ICCs ranging from .708 to .939; scores were not statistically different between the two versions. A total of 63 (79%) complete patients’ survey reports were available, and 55% of patients (30/55) reported being satisfied and interested in electronic assessment of their HRQL in clinical follow-up. Individual ratings of PROQOL-HIV user interface (85%-100% of positive responses) confirmed user interface clarity and usability. Conclusions: The electronic PROQOL-HIV introduces minor modifications to the original paper-based version, following International Society for Pharmacoeconomics and Outcomes Research (ISPOR) ePRO Task Force guidelines, and shows good reliability and face validity. Patients can complete the computerized PROQOL-HIV questionnaire and the scores from the paper or electronic versions share comparable accuracy and interpretation. %M 24769643 %R 10.2196/jmir.3330 %U http://www.jmir.org/2014/4/e115/ %U https://doi.org/10.2196/jmir.3330 %U http://www.ncbi.nlm.nih.gov/pubmed/24769643 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 3 %N 2 %P e24 %T Use of a Google Map Tool Embedded in an Internet Survey Instrument: Is it a Valid and Reliable Alternative to Geocoded Address Data? %A Dasgupta,Sharoda %A Vaughan,Adam S %A Kramer,Michael R %A Sanchez,Travis H %A Sullivan,Patrick S %+ Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Mailstop: 1518-002-4AA, Atlanta, GA, 30322, United States, 1 404 727 2773, sdasgu4@emory.edu %K HIV %K geographic mapping %K survey %K validity %K reliability %D 2014 %7 10.04.2014 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Men who have sex with men (MSM) in the United States are at high risk for human immunodeficiency virus (HIV) and poor HIV related outcomes. Maps can be used to identify, quantify, and address gaps in access to HIV care among HIV-positive MSM, and tailor intervention programs based on the needs of patients being served. Objective: The objective of our study was to assess the usability of a Google map question embedded in a Web-based survey among Atlanta-based, HIV-positive MSM, and determine whether it is a valid and reliable alternative to collection of address-based data on residence and last HIV care provider. Methods: Atlanta-based HIV-positive MSM were recruited through Facebook and from two ongoing studies recruiting primarily through venue-based sampling or peer referral (VBPR). Participants were asked to identify the locations of their residence and last attended HIV care provider using two methods: (1) by entering the street address (gold standard), and (2) “clicking” on the locations using an embedded Google map. Home and provider addresses were geocoded, mapped, and compared with home and provider locations from clicked map points to assess validity. Provider location error values were plotted against home location error values, and a kappa statistic was computed to assess agreement in degree of error in identifying residential location versus provider location. Results: The median home location error across all participants was 0.65 miles (interquartile range, IQR, 0.10, 2.5 miles), and was lower among Facebook participants (P<.001), whites (P<.001), and those reporting higher annual household income (P=.04). Median home location error was lower, although not statistically significantly, among older men (P=.08) and those with higher educational attainment (P=.05). The median provider location error was 0.32 miles (IQR, 0.12, 1.2 miles), and did not vary significantly by age, recruitment method, race, income, or level of educational attainment. Overall, the kappa was 0.20, indicating poor agreement between the two error measures. However, those recruited through Facebook had a greater level of agreement (κ=0.30) than those recruited through VBPR methods (κ=0.16), demonstrating a greater level of consistency in using the map question to identify home and provider locations for Facebook-recruited individuals. Conclusions: Most participants were able to click within 1 mile of their home address and their provider’s office, and were not always able to identify the locations on a map consistently, although some differences were observed across recruitment methods. This map tool may serve as the basis of a valid and reliable tool to identify residence and HIV provider location in the absence of geocoded address data. Further work is needed to improve and compare map tool usability with the results from this study. %M 24726954 %R 10.2196/resprot.2946 %U http://www.researchprotocols.org/2014/2/e24/ %U https://doi.org/10.2196/resprot.2946 %U http://www.ncbi.nlm.nih.gov/pubmed/24726954 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 3 %P e81 %T Considerations for Conducting Web-Based Survey Research With People Living With Human Immunodeficiency Virus Using a Community-Based Participatory Approach %A O'Brien,Kelly K %A Solomon,Patricia %A Worthington,Catherine %A Ibáñez-Carrasco,Francisco %A Baxter,Larry %A Nixon,Stephanie A %A Baltzer-Turje,Rosalind %A Robinson,Greg %A Zack,Elisse %A , %+ Department of Physical Therapy, Faculty of Medicine, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada, 1 416 978 0565, kelly.obrien@utoronto.ca %K HIV infections %K Internet %K self-report %K health surveys %K questionnaires %K community-based participatory research %D 2014 %7 13.03.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Web or Internet-based surveys are increasingly popular in health survey research. However, the strengths and challenges of Web-based surveys with people living with human immunodeficiency virus (HIV) are unclear. Objective: The aim of this article is to describe our experience piloting a cross-sectional, Web-based, self-administered survey with adults living with HIV using a community-based participatory research approach. Methods: We piloted a Web-based survey that investigated disability and rehabilitation services use with a sample of adults living with HIV in Canada. Community organizations in five provinces emailed invitations to clients, followed by a thank you/reminder one week later. We obtained survey feedback in a structured phone interview with respondents. Participant responses were transcribed verbatim and analyzed using directed content analysis. Results: Of 30 people living with HIV who accessed the survey link, 24/30 (80%) initiated and 16/30 (53%) completed the survey instrument. A total of 17 respondents participated in post-survey interviews. Participants described the survey instrument as comprehensive, suggesting content validity. The majority (13/17, 76%) felt instruction and item wording were clear and easy to understand, and found the software easy to navigate. Participants felt having a pop-up reminder directing them to missed items would be useful. Conclusions: Strengths of implementing the Web-based survey included: our community-based participatory approach, ease of software use, ability for respondents to complete the questionnaire on one’s own time at one’s own pace, opportunity to obtain geographic variation, and potential for respondent anonymity. Considerations for future survey implementation included: respondent burden and fatigue, the potentially sensitive nature of HIV Web-based research, data management and storage, challenges verifying informed consent, varying computer skills among respondents, and the burden on community organizations. Overall, results provide considerations for researchers conducting community-based participatory Web-based survey research with people living with HIV. %M 24642066 %R 10.2196/jmir.3064 %U http://www.jmir.org/2014/3/e81/ %U https://doi.org/10.2196/jmir.3064 %U http://www.ncbi.nlm.nih.gov/pubmed/24642066 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 1 %P e10 %T The Schisto Track: A System for Gathering and Monitoring Epidemiological Surveys by Connecting Geographical Information Systems in Real Time %A Leal Neto,Onicio B %A Albuquerque,Cesar M %A Albuquerque,Jones O %A Barbosa,Constança S %+ Aggeu Magalhaes Research Center, Schistosomiasis Reference Service, Oswaldo Cruz Foundation, Professor Moraes Rego Avenue, Cidade Universitaria., Recife, 50670420, Brazil, 55 21012572, onicio@gmail.com %K epidemiological survey %K schistosomiasis %K public health %D 2014 %7 10.03.2014 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Using the Android platform as a notification instrument for diseases and disorders forms a new alternative for computerization of epidemiological studies. Objective: The objective of our study was to construct a tool for gathering epidemiological data on schistosomiasis using the Android platform. Methods: The developed application (app), named the Schisto Track, is a tool for data capture and analysis that was designed to meet the needs of a traditional epidemiological survey. An initial version of the app was finished and tested in both real situations and simulations for epidemiological surveys. Results: The app proved to be a tool capable of automation of activities, with data organization and standardization, easy data recovery (to enable interfacing with other systems), and totally modular architecture. Conclusions: The proposed Schisto Track is in line with worldwide trends toward use of smartphones with the Android platform for modeling epidemiological scenarios. %M 25099881 %R 10.2196/mhealth.2859 %U http://mhealth.jmir.org/2014/1/e10/ %U https://doi.org/10.2196/mhealth.2859 %U http://www.ncbi.nlm.nih.gov/pubmed/25099881 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 3 %P e78 %T Determinants of Follow-Up Participation in the Internet-Based European Influenza Surveillance Platform Influenzanet %A Bajardi,Paolo %A Vespignani,Alessandro %A Funk,Sebastian %A Eames,Ken TD %A Edmunds,W John %A Turbelin,Clément %A Debin,Marion %A Colizza,Vittoria %A Smallenburg,Ronald %A Koppeschaar,Carl E %A Franco,Ana O %A Faustino,Vitor %A Carnahan,Annasara %A Rehn,Moa %A Paolotti,Daniela %+ Institute for Scientific Interchange Foundation, via Alassio 11/c, Torino, , Italy, 39 011 6603090, daniela.paolotti@isi.it %K participatory surveillance %K Internet %K influenza %D 2014 %7 10.03.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: “Influenzanet” is a network of Internet-based platforms aimed at collecting real-time data for influenza surveillance in several European countries. More than 30,000 European volunteers participate every year in the study, representing one of the largest existing Internet-based multicenter cohorts. Each week during the influenza season, participants are asked to report their symptoms (if any) along with a set of additional questions. Objective: Focusing on the first influenza season of 2011-12, when the Influenzanet system was completely harmonized within a common framework in Sweden, the United Kingdom, the Netherlands, Belgium, France, Italy, and Portugal, we investigated the propensity of users to regularly come back to the platform to provide information about their health status. Our purpose was to investigate demographic and behavioral factors associated with participation in follow-up. Methods: By means of a multilevel analysis, we evaluated the association between regular participation during the season and sociodemographic and behavioral characteristics as measured by a background questionnaire completed by participants on registration. Results: We found that lower participation in follow-up was associated with lower educational status (odds ratio [OR] 0.80, 95% CI 0.75-0.85), smoking (OR 0.64, 95% CI 0.59-0.70), younger age (OR ranging from 0.30, 95% CI 0.26-0.33 to 0.70, 95% CI 0.64-0.77), not being vaccinated against seasonal influenza (OR 0.77, 95% CI 0.72-0.84), and living in a household with children (OR 0.69, 95% CI 0.65-0.74). Most of these results hold when single countries are analyzed separately. Conclusions: Given the opportunistic enrollment of self-selected volunteers in the Influenzanet study, we have investigated how sociodemographic and behavioral characteristics may be associated with follow-up participation in the Influenzanet cohort. The study described in this paper shows that, overall, the most important determinants of participation are related to education and lifestyle: smoking, lower education level, younger age, people living with children, and people who have not been vaccinated against seasonal influenza tend to have a lower participation in follow-up. Despite the cross-country variation, the main findings are similar in the different national cohorts, and indeed the results are found to be valid also when performing a single-country analysis. Differences between countries do not seem to play a crucial role in determining the factors associated with participation in follow-up. %M 24613818 %R 10.2196/jmir.3010 %U http://www.jmir.org/2014/3/e78/ %U https://doi.org/10.2196/jmir.3010 %U http://www.ncbi.nlm.nih.gov/pubmed/24613818 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 1 %P e7 %T Customized-Language Voice Survey on Mobile Devices for Text and Image Data Collection Among Ethnic Groups in Thailand: A Proof-of-Concept Study %A Jandee,Kasemsak %A Lawpoolsri,Saranath %A Taechaboonsermsak,Pimsurang %A Khamsiriwatchara,Amnat %A Wansatid,Peerawat %A Kaewkungwal,Jaranit %+ Center of Excellence for Biomedical and Public Health Informatics (BIOPHICS), Mahidol University, Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand, 66 23549181 ext 412, jaranit.kae@mahidol.ac.th %K expanded program on immunization %K EPI %K ethnicity %K mobile technology %K smartphone questionnaire survey %K voiced question %D 2014 %7 06.03.2014 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Public health surveys are often conducted using paper-based questionnaires. However, many problems are associated with this method, especially when collecting data among ethnic groups who speak a different language from the survey interviewer. The process can be time-consuming and there is the risk of missing important data due to incomplete surveys. Objective: This study was conducted as a proof-of-concept to develop a new electronic tool for data collection, and compare it with standard paper-based questionnaire surveys using the research setting of assessing Knowledge Attitude and Practice (KAP) toward the Expanded Program on Immunization (EPI) among 6 ethnic groups in Chiang Rai Province, Thailand. The two data collection methods were compared on data quality in terms of data completeness and time consumed in collecting the information. In addition, the initiative assessed the participants’ satisfaction toward the use of a smartphone customized-language voice-based questionnaire in terms of perceived ease of use and perceived usefulness. Methods: Following a cross-over design, all study participants were interviewed using two data collection methods after a one-week washout period. Questions in the paper-based questionnaires in Thai language were translated to each ethnic language by the interviewer/translator when interviewing the study participant. The customized-language voice-based questionnaires were programmed to a smartphone tablet in six, selectable dialect languages and used by the trained interviewer when approaching participants. Results: The study revealed positive data quality outcomes when using the smartphone, voice-based questionnaire survey compared with the paper-based questionnaire survey, both in terms of data completeness and time consumed in data collection process. Since the smartphone questionnaire survey was programmed to ask questions in sequence, no data was missing and there were no entry errors. Participants had positive attitudes toward answering the smartphone questionnaire; 69% (48/70) reported they understood the questions easily, 71% (50/70) found it convenient, and 66% (46/70) reported a reduced time in data collection. The smartphone data collection method was acceptable by both the interviewers and by the study participants of different ethnicities. Conclusions: To our knowledge, this is the first study showing that the application of specific features of mobile devices like smartphone tablets (including dropdown choices, capturing pictures, and voiced questions) can be successfully used for data collection. The mobile device can be effectively used for capturing photos of secondary data and collecting primary data with customized-language and voiced questionnaire survey. Using smartphone questionnaires can minimize or eliminate missing data and reduce the time consumed during the data collection process. Smartphone customized-language, voice-based questionnaires for data collection can be an alternative and better approach than standard translated paper-based questionnaires for public health surveys, especially when collecting data among ethnic and hard-to-reach groups residing in multilanguage-speaking settings. %M 25098776 %R 10.2196/mhealth.3058 %U http://mhealth.jmir.org/2014/1/e7/ %U https://doi.org/10.2196/mhealth.3058 %U http://www.ncbi.nlm.nih.gov/pubmed/25098776 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 2 %P e50 %T Applying Computerized Adaptive Testing to the Negative Acts Questionnaire-Revised: Rasch Analysis of Workplace Bullying %A Ma,Shu-Ching %A Chien,Tsair-Wei %A Wang,Hsiu-Hung %A Li,Yu-Chi %A Yui,Mei-Shu %+ College of Nursing, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Road, Kaohsiung, 80708, Taiwan, 886 7 3121101 ext 2624, hhwang@kmu.edu.tw %K computerized adaptive testing %K computer on wheels %K classic test theory %K item response theory %K nonadaptive testing %K the Negative Acts Questionnaire-Revised %D 2014 %7 17.02.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Workplace bullying is a prevalent problem in contemporary work places that has adverse effects on both the victims of bullying and organizations. With the rapid development of computer technology in recent years, there is an urgent need to prove whether item response theory–based computerized adaptive testing (CAT) can be applied to measure exposure to workplace bullying. Objective: The purpose of this study was to evaluate the relative efficiency and measurement precision of a CAT-based test for hospital nurses compared to traditional nonadaptive testing (NAT). Under the preliminary conditions of a single domain derived from the scale, a CAT module bullying scale model with polytomously scored items is provided as an example for evaluation purposes. Methods: A total of 300 nurses were recruited and responded to the 22-item Negative Acts Questionnaire-Revised (NAQ-R). All NAT (or CAT-selected) items were calibrated with the Rasch rating scale model and all respondents were randomly selected for a comparison of the advantages of CAT and NAT in efficiency and precision by paired t tests and the area under the receiver operating characteristic curve (AUROC). Results: The NAQ-R is a unidimensional construct that can be applied to measure exposure to workplace bullying through CAT-based administration. Nursing measures derived from both tests (CAT and NAT) were highly correlated (r=.97) and their measurement precisions were not statistically different (P=.49) as expected. CAT required fewer items than NAT (an efficiency gain of 32%), suggesting a reduced burden for respondents. There were significant differences in work tenure between the 2 groups (bullied and nonbullied) at a cutoff point of 6 years at 1 worksite. An AUROC of 0.75 (95% CI 0.68-0.79) with logits greater than –4.2 (or >30 in summation) was defined as being highly likely bullied in a workplace. Conclusions: With CAT-based administration of the NAQ-R for nurses, their burden was substantially reduced without compromising measurement precision. %M 24534113 %R 10.2196/jmir.2819 %U http://www.jmir.org/2014/2/e50/ %U https://doi.org/10.2196/jmir.2819 %U http://www.ncbi.nlm.nih.gov/pubmed/24534113 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 2 %P e38 %T Validation and Reliability of a Smartphone Application for the International Prostate Symptom Score Questionnaire: A Randomized Repeated Measures Crossover Study %A Kim,Jae Heon %A Kwon,Soon-Sun %A Shim,Sung Ryul %A Sun,Hwa Yeon %A Ko,Young Myoung %A Chun,Dong-Il %A Yang,Won Jae %A Song,Yun Seob %+ Department of Urology, Soonchunhyang University, College of Medicine, Soonchunhyang University Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul, 140-743, Korea, Republic Of, 82 2 709 9377, yssong@schmc.ac.kr %K smartphone %K International Prostate Symptom Score %K lower urinary tract symptoms %K health survey %K questionnaires %D 2014 %7 10.02.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphone-based assessment may be a useful diagnostic and monitoring tool for patients. There have been many attempts to create a smartphone diagnostic tool for clinical use in various medical fields but few have demonstrated scientific validity. Objective: The purpose of this study was to develop a smartphone application of the International Prostate Symptom Score (IPSS) and to demonstrate its validity and reliability. Methods: From June 2012 to May 2013, a total of 1581 male participants (≥40 years old), with or without lower urinary tract symptoms (LUTS), visited our urology clinic via the health improvement center at Soonchunhyang University Hospital (Republic of Korea) and were enrolled in this study. A randomized repeated measures crossover design was employed using a smartphone application of the IPSS and the conventional paper form of the IPSS. Paired t test under a hypothesis of non-inferior trial was conducted. For the reliability test, the intraclass correlation coefficient (ICC) was measured. Results: The total score of the IPSS (P=.289) and each item of the IPSS (P=.157-1.000) showed no differences between the paper version and the smartphone version of the IPSS. The mild, moderate, and severe LUTS groups showed no differences between the two versions of the IPSS. A significant correlation was noted in the total group (ICC=.935, P<.001). The mild, moderate, and severe LUTS groups also showed significant correlations (ICC=.616, .549, and .548 respectively, all P<.001).There was selection bias in this study, as only participants who had smartphones could participate. Conclusions: The validity and reliability of the smartphone application version were comparable to the conventional paper version of the IPSS. The smartphone application of the IPSS could be an effective method for measuring lower urinary tract symptoms. %M 24513507 %R 10.2196/jmir.3042 %U http://www.jmir.org/2014/2/e38/ %U https://doi.org/10.2196/jmir.3042 %U http://www.ncbi.nlm.nih.gov/pubmed/24513507 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e24 %T The Influence of Two Different Invitation Letters on Chlamydia Testing Participation: Randomized Controlled Trial %A ten Hoor,Gill %A Hoebe,Christian JPA %A van Bergen,Jan EAM %A Brouwers,Elfi EHG %A Ruiter,Robert AC %A Kok,Gerjo %+ Maastricht University, Department of Work & Social Psychology, PO Box 616, Maastricht, 6200MD, Netherlands, 31 433881617, gill.tenhoor@maastrichtuniversity.nl %K invitation letter %K chlamydia %K screening %K testing %K behavior change theories %D 2014 %7 30.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: In the Netherlands, screening for chlamydia (the most prevalent sexually transmitted infection worldwide) is a relatively simple and free procedure. Via an invitation letter sent by the public health services (PHS), people are asked to visit a website to request a test kit. They can then do a chlamydia test at home, send it anonymously to a laboratory, and, within two weeks, they can review their test results online and be treated by their general practitioner or the PHS. Unfortunately, the participation rates are low and the process is believed to be not (cost-) effective. Objective: The objective of this study was to assess whether the low participation rate of screening for chlamydia at home, via an invitation letter asking to visit a website and request a test kit, could be improved by optimizing the invitation letter through systematically applied behavior change theories and evidence. Methods: The original letter and a revised letter were randomly sent out to 13,551 citizens, 16 to 29 years old, in a Dutch municipality. Using behavior change theories, the revised letter sought to increase motivation to conduct chlamydia screening tests. The revised letter was tailored to beliefs that were found in earlier studies: risk perception, advantages and disadvantages (attitude), moral norm, social influence, and response- and self-efficacy. Revisions to the new letter also sought to avoid possible unwanted resistance caused when people feel pressured, and included prompts to trigger the desired behavior. Results: No significant differences in test package requests were found between the two letters. There were also no differences between the original and revised letters in the rates of returned tests (11.80%, 581/4922 vs 11.07%, 549/4961) or positive test results (4.8%, 23/484 vs 4.1%, 19/460). It is evident that the new letter did not improve participation compared to the original letter. Conclusions: It is clear that the approach of inviting the target population through a letter does not lead to higher participation rates for chlamydia screening. Other approaches have to be developed and pilot tested. %M 24480721 %R 10.2196/jmir.2907 %U http://www.jmir.org/2014/1/e24/ %U https://doi.org/10.2196/jmir.2907 %U http://www.ncbi.nlm.nih.gov/pubmed/24480721 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e6 %T Keywords to Recruit Spanish- and English-Speaking Participants: Evidence From an Online Postpartum Depression Randomized Controlled Trial %A Barrera,Alinne Z %A Kelman,Alex R %A Muñoz,Ricardo F %+ Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, United States, 1 650 433 3854, abarrera@paloaltou.edu %K Internet intervention %K prevention %K depression, postpartum %K research subject recruitment %K women %K Spanish speaking %D 2014 %7 09.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: One of the advantages of Internet-based research is the ability to efficiently recruit large, diverse samples of international participants. Currently, there is a dearth of information on the behind-the-scenes process to setting up successful online recruitment tools. Objective: The objective of the study was to examine the comparative impact of Spanish- and English-language keywords for a Google AdWords campaign to recruit pregnant women to an Internet intervention and to describe the characteristics of those who enrolled in the trial. Methods: Spanish- and English-language Google AdWords campaigns were created to advertise and recruit pregnant women to a Web-based randomized controlled trial for the prevention of postpartum depression, the Mothers and Babies/Mamás y Bebés Internet Project. Search engine users who clicked on the ads in response to keyword queries (eg, pregnancy, depression and pregnancy) were directed to the fully automated study website. Data on the performance of keywords associated with each Google ad reflect Web user queries from February 2009 to June 2012. Demographic information, self-reported depression symptom scores, major depressive episode status, and Internet use data were collected from enrolled participants before randomization in the intervention study. Results: The Google ads received high exposure (12,983,196 impressions) and interest (176,295 clicks) from a global sample of Web users; 6745 pregnant women consented to participate and 2575 completed enrollment in the intervention study. Keywords that were descriptive of pregnancy and distress or pregnancy and health resulted in higher consent and enrollment rates (ie, high-performing ads). In both languages, broad keywords (eg, pregnancy) had the highest exposure, more consented participants, and greatest cost per consent (up to US $25.77 per consent). The online ads recruited a predominantly Spanish-speaking sample from Latin America of Mestizo racial identity. The English-speaking sample was also diverse with most participants residing in regions of Asia and Africa. Spanish-speaking participants were significantly more likely to be of Latino ethnic background, not married, completed fewer years of formal education, and were more likely to have accessed the Internet for depression information (P<.001). Conclusions: The Internet is an effective method for reaching an international sample of pregnant women interested in online interventions to manage changes in their mood during the perinatal period. To increase efficiency, Internet advertisements need to be monitored and tailored to reflect the target population’s conceptualization of health issues being studied. Trial Registration: ClinicalTrials.gov NCT00816725; http://clinicaltrials.gov/show/NCT00816725 (Archived by WebCite at http://www.webcitation.org/6LumonjZP). %M 24407163 %R 10.2196/jmir.2999 %U http://www.jmir.org/2014/1/e6/ %U https://doi.org/10.2196/jmir.2999 %U http://www.ncbi.nlm.nih.gov/pubmed/24407163 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e4 %T How Accurate is Web-Based Self-Reported Height, Weight, and Body Mass Index in Young Adults? %A Pursey,Kirrilly %A Burrows,Tracy L %A Stanwell,Peter %A Collins,Clare E %+ Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 0249215514, Tracy.Burrows@newcastle.edu.au %K Internet %K height %K weight %K body mass index %K self-report %D 2014 %7 07.01.2014 %9 Short Paper %J J Med Internet Res %G English %X Background: Web-based approaches are an effective and convenient medium to deliver eHealth interventions. However, few studies have attempted to evaluate the accuracy of online self-reported weight, and only one has assessed the accuracy of online self-reported height and body mass index (BMI). Objective: This study aimed to validate online self-reported height, weight, and calculated BMI against objectively measured data in young Australian adults. Methods: Participants aged 18-35 years were recruited via advertisements on social media sites and reported their current height and weight as part of an online survey. They then subsequently had the same measures objectively assessed by a trained researcher. Results: Self-reported height was significantly overestimated by a mean of 1.36 cm (SD 1.93; P<.001), while self-reported weight was significantly underestimated by –0.55 kg (SD 2.03; P<.001). Calculated BMI was also underestimated by –0.56 kg/m2 (SD 0.08; P<.001). The discrepancy in reporting resulted in the misclassification of the BMI category of three participants. Measured and self-reported data were strongly positively correlated (height: r=.98, weight: r=.99, BMI: r=.99; P<.001). When accuracy was evaluated by BMI category and gender, weight remained significantly underreported by females (P=.002) and overweight/obese participants (P=.02). Conclusions: There was moderate to high agreement between self-reported and measured anthropometric data. Findings suggest that online self-reported height and weight can be a valid method of collecting anthropometric data. %M 24398335 %R 10.2196/jmir.2909 %U http://www.jmir.org/2014/1/e4/ %U https://doi.org/10.2196/jmir.2909 %U http://www.ncbi.nlm.nih.gov/pubmed/24398335 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 3 %N 1 %P e1 %T Feasibility of a Web-Based Survey of Hallucinations and Assessment of Visual Function in Patients With Parkinson’s Disease %A Jackson,Mary Lou %A Bex,Peter J %A Ellison,James M %A Wicks,Paul %A Wallis,Jennifer %+ Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, 243 Charles Street, Boston, MA, 02114, United States, 1 617 573 4177 ext 4177, marylou_jackson@meei.harvard.edu %K Parkinson’s disease %K hallucinations %K contrast sensitivity %K Charles Bonnet Syndrome %D 2014 %7 06.01.2014 %9 Original Paper %J Interact J Med Res %G English %X Background: Patients with Parkinson’s disease (PD) experience visual hallucinations, which may be related to decreased contrast sensitivity (ie, the ability to discern shades of grey). Objective: The objective of this study was to investigate if an online research platform can be used to survey patients with Parkinson’s disease regarding visual hallucinations, and also be used to assess visual contrast perception. Methods: From the online patient community, PatientsLikeMe, 964 members were invited via email to participate in this study. Participants completed a modified version of the University of Miami Parkinson’s disease hallucinations questionnaire and an online vision test. Results: The study was completed by 27.9% (269/964) of those who were invited: 56.9% of this group had PD (153/269) and 43.1% (116/269) were non-Parkinson’s controls. Hallucinations were reported by 18.3% (28/153) of the Parkinson’s group. Although 10 subjects (9%) in the control group reported experiencing hallucinations, only 2 of them actually described formed hallucinations. Participants with Parkinson’s disease with a mean of 1.75 (SD 0.35) and the control group with a mean of 1.85 (SD 0.36) showed relatively good contrast perception as measured with the online letter test (P=.07). People who reported hallucinations showed contrast sensitivity levels that did not differ from levels shown by people without hallucinations (P=.96), although there was a trend towards lower contrast sensitivity in hallucinators. Conclusions: Although more Parkinson's responders reported visual hallucinations, a significant number of non-Parkinson's control group responders also reported visual hallucinations. The online survey method may have failed to distinguish between formed hallucinations, which are typical in Parkinson's disease, and non-formed hallucinations that have less diagnostic specificity. Multiple questions outlining the nature of the hallucinations are required. In a clinical interview, the specific nature of the hallucination would be further refined to rule out a vague description that does not indicate a true, formed visual hallucination. Contrary to previous literature, both groups showed relatively good contrast sensitivity, perhaps representing a ceiling effect or limitations of online testing conditions that are difficult to standardize. Steps can be taken in future trials to further standardize online visual function testing, to refine control group parameters and to take steps to rule out confounding variables such as comorbid disease that could be associated with hallucinations. Contacting subjects via an online health social network is a novel, cost-effective method of conducting vision research that allows large numbers of individuals to be contacted quickly, and refinement of questionnaires and visual function testing may allow more robust findings in future research. %M 24394559 %R 10.2196/ijmr.2744 %U http://www.i-jmr.org/2014/1/e1/ %U https://doi.org/10.2196/ijmr.2744 %U http://www.ncbi.nlm.nih.gov/pubmed/24394559 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e1 %T Evaluating a Web-Based Health Risk Assessment With Tailored Feedback: What Does an Expert Focus Group Yield Compared to a Web-Based End-User Survey? %A Vosbergen,Sandra %A Mahieu,Guy R %A Laan,Eva K %A Kraaijenhagen,Roderik A %A Jaspers,Monique WM %A Peek,Niels %+ Academic Medical Center, Department of Medical Informatics, Room J1b-110.1, PO Box 226600, Amsterdam, 1100DD, Netherlands, 31 20 5667872, n.b.peek@amc.uva.nl %K health risk assessment %K health information systems %K qualitative research %K evaluation %K end users %K professional review %K designers %K optimization %D 2014 %7 02.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Increasingly, Web-based health applications are developed for the prevention and management of chronic diseases. However, their reach and utilization is often disappointing. Qualitative evaluations post-implementation can be used to inform the optimization process and ultimately enhance their adoption. In current practice, such evaluations are mainly performed with end-user surveys. However, a review approach by experts in a focus group may be easier to administer and might provide similar results. Objective: The aim of this study was to assess whether industrial design engineers in a focus group would address the same issues as end users in a Web-based survey when evaluating a commercial Web-based health risk assessment (HRA) with tailored feedback. Methods: Seven Dutch companies used the HRA as part of their corporate health management strategy. Employees using the HRA (N=2289) and 10 independent industrial designers were invited to participate in the study. The HRA consisted of four components: (1) an electronic health questionnaire, (2) biometric measurements, (3) laboratory evaluation, and (4) individually tailored feedback generated by decision support software. After participating in the HRA as end users, both end users and designers evaluated the program. End users completed an evaluation questionnaire that included a free-text field. Designers participated in a focus group discussion. Constructs from user satisfaction and technology acceptance theories were used to categorize and compare the remarks from both evaluations. Results: We assessed and qualitatively analyzed 294 remarks of 189 end users and 337 remarks of 6 industrial designers, pertaining to 295 issues in total. Of those, 137 issues were addressed in the end-user survey and 148 issues in the designer focus group. Only 7.3% (10/137) of the issues addressed in the survey were also addressed in the focus group. End users made more remarks about the usefulness of the HRA and prior expectations that were not met. Designers made more remarks about how the information was presented to end users, quality of the feedback provided by the HRA, recommendations on the marketing and on how to create more unity in the design of the HRA, and on how to improve the HRA based on these issues. Conclusions: End-user surveys should not be substituted for expert focus groups. Issues identified by end users in the survey and designers in the focus group differed considerably, and the focus group produced a lot of new issues. The issues addressed in the focus group often focused on different aspects of user satisfaction and technology acceptance than those addressed by the survey participants; when they did focus on the same aspects, then the nature of issues differed considerably in content. %M 24384408 %R 10.2196/jmir.2517 %U http://www.jmir.org/2014/1/e1/ %U https://doi.org/10.2196/jmir.2517 %U http://www.ncbi.nlm.nih.gov/pubmed/24384408 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 12 %P e278 %T The Sexunzipped Trial: Optimizing the Design of Online Randomized Controlled Trials %A Bailey,Julia V %A Pavlou,Menelaos %A Copas,Andrew %A McCarthy,Ona %A Carswell,Ken %A Rait,Greta %A Hart,Graham %A Nazareth,Irwin %A Free,Caroline %A French,Rebecca %A Murray,Elizabeth %+ e-Health Unit, Research Department of Primary Care and Population Health, University College London, Upper 3rd Floor, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, United Kingdom, 44 7766617783, julia.bailey@ucl.ac.uk %K Internet %K randomized controlled trials as topic %K outcome assessment (health care) %K sexual health %K sexually transmitted diseases %K behavioral research %D 2013 %7 11.12.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexual health problems such as unwanted pregnancy and sexually transmitted infection are important public health concerns and there is huge potential for health promotion using digital interventions. Evaluations of digital interventions are increasingly conducted online. Trial administration and data collection online offers many advantages, but concerns remain over fraudulent registration to obtain compensation, the quality of self-reported data, and high attrition. Objective: This study addresses the feasibility of several dimensions of online trial design—recruitment, online consent, participant identity verification, randomization and concealment of allocation, online data collection, data quality, and retention at 3-month follow-up. Methods: Young people aged 16 to 20 years and resident in the United Kingdom were recruited to the “Sexunzipped” online trial between November 2010 and March 2011 (n=2036). Participants filled in baseline demographic and sexual health questionnaires online and were randomized to the Sexunzipped interactive intervention website or to an information-only control website. Participants were also randomly allocated to a postal request (or no request) for a urine sample for genital chlamydia testing and receipt of a lower (£10/US$16) or higher (£20/US$32) value shopping voucher compensation for 3-month outcome data. Results: The majority of the 2006 valid participants (90.98%, 1825/2006) were aged between 18 and 20 years at enrolment, from all four countries in the United Kingdom. Most were white (89.98%, 1805/2006), most were in school or training (77.48%, 1545/1994), and 62.81% (1260/2006) of the sample were female. In total, 3.88% (79/2036) of registrations appeared to be invalid and another 4.00% (81/2006) of participants gave inconsistent responses within the questionnaire. The higher value compensation (£20/US$32) increased response rates by 6-10%, boosting retention at 3 months to 77.2% (166/215) for submission of online self-reported sexual health outcomes and 47.4% (118/249) for return of chlamydia urine samples by post. Conclusions: It was quick and efficient to recruit young people to this online trial. Our procedures for obtaining online consent, verifying participant identity, automated randomization, and concealment of allocation worked well. The optimal response rate for the online sexual health outcome measurement was comparable to face-to-face trials. Multiple methods of participant contact, requesting online data only, and higher value compensation increased trial retention at 3-month follow-up. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 55651027; http://www.controlled-trials.com/ISRCTN55651027 (Archived by WebCite at http://www.webcitation.org/6LbkxdPKf). %M 24334216 %R 10.2196/jmir.2668 %U http://www.jmir.org/2013/12/e278/ %U https://doi.org/10.2196/jmir.2668 %U http://www.ncbi.nlm.nih.gov/pubmed/24334216 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 11 %P e260 %T Comparison of US Panel Vendors for Online Surveys %A Craig,Benjamin M %A Hays,Ron D %A Pickard,A Simon %A Cella,David %A Revicki,Dennis A %A Reeve,Bryce B %+ Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612-9416, United States, 1 813 745 6710, Benjamin.Craig@moffitt.org %K survey methods %K community surveys %K sampling bias %K selection bias %K Internet %K data sources %D 2013 %7 29.11.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the increasing use of panel surveys, little is known about the differences in data quality across panels. Objective: The aim of this study was to characterize panel survey companies and their respondents based on (1) the timeliness of response by panelists, (2) the reliability of the demographic information they self-report, and (3) the generalizability of the characteristics of panelists to the US general population. A secondary objective was to highlight several issues to consider when selecting a panel vendor. Methods: We recruited a sample of US adults from 7 panel vendors using identical quotas and online surveys. All vendors met prespecified inclusion criteria. Panels were compared on the basis of how long the respondents took to complete the survey from time of initial invitation. To validate respondent identity, this study examined the proportion of consented respondents who failed to meet the technical criteria, failed to complete the screener questions, and provided discordant responses. Finally, characteristics of the respondents were compared to US census data and to the characteristics of other panels. Results: Across the 7 panel vendors, 2% to 9% of panelists responded within 2 days of invitation; however, approximately 20% of the respondents failed the screener, largely because of the discordance between self-reported birth date and the birth date in panel entry data. Although geographic characteristics largely agreed with US Census estimates, each sample underrepresented adults who did not graduate from high school and/or had annual incomes less than US $15,000. Except for 1 vendor, panel vendor samples overlapped one another by approximately 20% (ie, 1 in 5 respondents participated through 2 or more panel vendors). Conclusions: The results of this head-to-head comparison provide potential benchmarks in panel quality. The issues to consider when selecting panel vendors include responsiveness, failure to maintain sociodemographic diversity and validated data, and potential overlap between panels. %M 24292159 %R 10.2196/jmir.2903 %U http://www.jmir.org/2013/11/e260/ %U https://doi.org/10.2196/jmir.2903 %U http://www.ncbi.nlm.nih.gov/pubmed/24292159 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 11 %P e250 %T The Good, Bad, and Ugly of Online Recruitment of Parents for Health-Related Focus Groups: Lessons Learned %A Quach,Susan %A Pereira,Jennifer A %A Russell,Margaret L %A Wormsbecker,Anne E %A Ramsay,Hilary %A Crowe,Lois %A Quan,Sherman D %A Kwong,Jeff %+ Institute for Clinical Evaluative Sciences, G1 06, 2075 Bayview Avenue, Toronto, ON, , Canada, 1 4164804055 ext 7665, jeff.kwong@utoronto.ca %K parents %K data collection %K communication %K social media %K Internet %D 2013 %7 11.11.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: We describe our experiences with identifying and recruiting Ontario parents through the Internet, primarily, as well as other modes, for participation in focus groups about adding the influenza vaccine to school-based immunization programs. Objective: Our objectives were to assess participation rates with and without incentives and software restrictions. We also plan to examine study response patterns of unique and multiple submissions and assess efficiency of each online advertising mode. Methods: We used social media, deal forum websites, online classified ads, conventional mass media, and email lists to invite parents of school-aged children from Ontario, Canada to complete an online questionnaire to determine eligibility for focus groups. We compared responses and paradata when an incentive was provided and there were no software restrictions to the questionnaire (Period 1) to a period when only a single submission per Internet protocol (IP) address (ie, software restrictions invoked) was permitted and no incentive was provided (Period 2). We also compared the median time to complete a questionnaire, response patterns, and percentage of missing data between questionnaires classified as multiple submissions from the same Internet protocol (IP) address or email versus unique submissions. Efficiency was calculated as the total number of hours study personnel devoted to an advertising mode divided by the resultant number of unique eligible completed questionnaires . Results: Of 1346 submitted questionnaires, 223 (16.6%) were incomplete and 34 (2.52%) did not meet the initial eligibility criteria. Of the remaining 1089 questionnaires, 246 (22.6%) were not from Ontario based on IP address and postal code, and 469 (43.1%) were submitted from the same IP address or email address (multiple submissions). In Period 2 vs Period 1, a larger proportion of questionnaires were submitted from Ontario (92.8%, 141/152 vs 75.1%, 702/937, P<.001), and a smaller proportion of same IP addresses (7.9%, 12/152 vs 47.1%, 441/937, P<.001) were received. Compared to those who made unique submissions, those who made multiple submissions spent less time per questionnaire (166 vs 215 seconds, P<.001), and had a higher percentage of missing data among their responses (15.0% vs 7.6%, P=.004). Advertisements posted on RedFlagDeals were the most efficient for recruitment (0.03 hours of staff time per questionnaire), whereas those placed on Twitter were the least efficient (3.64 hours of staff time per questionnaire). Conclusions: Using multiple online advertising strategies was effective for recruiting a large sample of participants in a relatively short period time with minimal resources. However, risks such as multiple submissions and potentially fraudulent information need to be considered. In our study, these problems were associated with providing an incentive for responding, and could have been partially avoided by activating restrictive software features for online questionnaires. %M 24231040 %R 10.2196/jmir.2829 %U http://www.jmir.org/2013/11/e250/ %U https://doi.org/10.2196/jmir.2829 %U http://www.ncbi.nlm.nih.gov/pubmed/24231040 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 10 %P e229 %T Telephone Versus Internet Administration of Self-Report Measures of Social Anxiety, Depressive Symptoms, and Insomnia: Psychometric Evaluation of a Method to Reduce the Impact of Missing Data %A Hedman,Erik %A Ljótsson,Brjánn %A Blom,Kerstin %A El Alaoui,Samir %A Kraepelien,Martin %A Rück,Christian %A Andersson,Gerhard %A Svanborg,Cecilia %A Lindefors,Nils %A Kaldo,Viktor %+ Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Retzius väg 8, Stockholm, 171 77, Sweden, 46 08 524 800 00, kire.hedman@ki.se %K Internet %K telephone %K self-report measures %K missing data %K method validation %D 2013 %7 18.10.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-administered self-report measures of social anxiety, depressive symptoms, and sleep difficulties are widely used in clinical trials and in clinical routine care, but data loss is a common problem that could render skewed estimates of symptom levels and treatment effects. One way of reducing the negative impact of missing data could be to use telephone administration of self-report measures as a means to complete the data missing from the online data collection. Objective: The aim of the study was to compare the convergence of telephone and Internet administration of self-report measures of social anxiety, depressive symptoms, and sleep difficulties. Methods: The Liebowitz Social Anxiety Scale-Self-Report (LSAS-SR), Montgomery-Åsberg Depression Rating Scale-Self-Rated (MADRS-S), and the Insomnia Severity Index (ISI) were administered over the telephone and via the Internet to a clinical sample (N=82) of psychiatric patients at a clinic specializing in Internet-delivered treatment. Shortened versions of the LSAS-SR and the ISI were used when administered via telephone. Results: As predicted, the results showed that the estimates produced by the two administration formats were highly correlated (r=.82-.91; P<.001) and internal consistencies were high in both administration formats (telephone: Cronbach alpha=.76-.86 and Internet: Cronbach alpha=.79-.93). The correlation coefficients were similar across questionnaires and the shorter versions of the questionnaires used in the telephone administration of the LSAS-SR and ISI performed in general equally well compared to when the full scale was used, as was the case with the MADRS-S. Conclusions: Telephone administration of self-report questionnaires is a valid method that can be used to reduce data loss in routine psychiatric practice as well as in clinical trials, thereby contributing to more accurate symptom estimates. %M 24140566 %R 10.2196/jmir.2818 %U http://www.jmir.org/2013/10/e229/ %U https://doi.org/10.2196/jmir.2818 %U http://www.ncbi.nlm.nih.gov/pubmed/24140566 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 9 %P e205 %T Participant Profiles According to Recruitment Source in a Large Web-Based Prospective Study: Experience From the Nutrinet-Santé Study %A Kesse-Guyot,Emmanuelle %A Andreeva,Valentina %A Castetbon,Katia %A Vernay,Michel %A Touvier,Mathilde %A Méjean,Caroline %A Julia,Chantal %A Galan,Pilar %A Hercberg,Serge %+ Université Paris 13, Sorbonne Paris Cité, UREN, Inserm (U557); Inra (U1125), Cnam, UREN, SMBH Paris 13, SMBH, 74 rue Marcel Cachin, Bobigny, 93017, France, 33 1 48 38 89 79, e.kesse@uren.smbh.univ-paris13.fr %K cohort study %K Internet %K selection bias %K population characteristics %D 2013 %7 13.09.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Interest in Internet-based epidemiologic research is growing given the logistic and cost advantages. Cohort recruitment to maximally diversify the sociodemographic profiles of participants, however, remains a contentious issue. Objective: The aim of the study was to characterize the sociodemographic profiles according to the recruitment mode of adult volunteers enrolled in a Web-based cohort. Methods: The French NutriNet-Santé Web-based cohort was launched in 2009. Recruitment is ongoing and largely relies on recurrent multimedia campaigns. One month after enrollment, participants are asked how they learned about the study (eg, general newscast or a health program on television, radio newscast, newspaper articles, Internet, personal advice, leaflet/flyers) The sociodemographic profiles of participants recruited through operative communication channels (radio, print media, Internet, advice) were compared with the profiles of those informed through television by using polytomous logistic regression. Results: Among the 88,238 participants enrolled through the end of 2011, 30,401 (34.45%), 16,751 (18.98%), and 14,309 (16.22%) learned about the study from television, Internet, and radio newscasts, respectively. Sociodemographic profiles were various, with 14,541 (16.5%) aged ≥60 years, 20,166 (22.9%) aged <30 years, 27,766 (32.1%) without postsecondary education, 15,397 (19.7%) with household income <€1200/month, and 8258 (10.6%) with household income €3700/month. Compared to employed individuals, unemployed and retired participants were less likely to be informed about the study through other sources than through television (adjusted ORs 0.56-0.83, P<.001). Participants reporting up to secondary education were also less likely to have learned about the study through radio newscasts, newspaper articles, Internet, and advice than through television (adjusted ORs 0.60-0.77, P<.001). Conclusions: Television broadcasts appear to permit the recruitment of e-cohort participants with diverse sociodemographic backgrounds, including socioeconomically disadvantaged individuals who are usually difficult to reach and retain in long-term epidemiologic studies. These findings could inform future Web-based studies regarding the development of promising targeted or general population recruitment strategies. %M 24036068 %R 10.2196/jmir.2488 %U http://www.jmir.org/2013/9/e205/ %U https://doi.org/10.2196/jmir.2488 %U http://www.ncbi.nlm.nih.gov/pubmed/24036068 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 8 %P e173 %T Web-Based Versus Traditional Paper Questionnaires: A Mixed-Mode Survey With a Nordic Perspective %A Hohwü,Lena %A Lyshol,Heidi %A Gissler,Mika %A Jonsson,Stefan Hrafn %A Petzold,Max %A Obel,Carsten %+ Department of Public Health, Section for General Practice, Aarhus University, Bartholins Allé 2, Aarhus C, 8000, Denmark, 45 87167942, lena.hohwu@alm.au.dk %K mixed-mode survey %K patient participation rate %K Web-based %K paper %K questionnaires %K nonmonetary incentive %D 2013 %7 26.08.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Survey response rates have been declining over the past decade. The more widespread use of the Internet and Web-based technologies among potential health survey participants suggests that Web-based questionnaires may be an alternative to paper questionnaires in future epidemiological studies. Objective: To compare response rates in a population of parents by using 4 different modes of data collection for a questionnaire survey of which 1 involved a nonmonetary incentive. Methods: A random sample of 3148 parents of Danish children aged 2-17 years were invited to participate in the Danish part of the NordChild 2011 survey on their children’s health and welfare. NordChild was conducted in 1984 and 1996 in collaboration with Finland, Iceland, Norway, and Sweden using mailed paper questionnaires only. In 2011, all countries used conventional paper versions only except Denmark where the parents were randomized into 4 groups: (1) 789 received a paper questionnaire only (paper), (2) 786 received the paper questionnaire and a log-in code to the Web-based questionnaire (paper/Web), (3) 787 received a log-in code to the Web-based questionnaire (Web), and (4) 786 received log-in details to the Web-based questionnaire and were given an incentive consisting of a chance to win a tablet computer (Web/tablet). In connection with the first reminder, the nonresponders in the paper, paper/Web, and Web groups were also present with the opportunity to win a tablet computer as a means of motivation. Descriptive analysis was performed using chi-square tests. Odds ratios were used to estimate differences in response rates between the 4 modes. Results: In 2011, 1704 of 3148 (54.13%) respondents answered the Danish questionnaire. The highest response rate was with the paper mode (n=443, 56.2%). The other groups had similar response rates: paper/Web (n=422, 53.7%), Web (n=420, 53.4%), and Web/tablet (n=419, 53.3%) modes. Compared to the paper mode, the odds for response rate in the paper/Web decreased by 9% (OR 0.91, 95% CI 0.74-1.10) and by 11% (OR 0.89, 95% CI 0.73-1.09) in the Web and Web/tablet modes. The total number of responders for NordChild declined from 10,291 of 15,339 (67.09%) in 1984 and 10,667 of 15,254 (69.93%) in 1996 to 7805 of 15,945 (48.95%) in 2011 with similar declines in all 5 Nordic countries. Conclusions: Web-based questionnaires could replace traditional paper questionnaires with minor effects on response rates and lower costs. The increasing effect on the response rate on participants replying for a nonmonetary incentive could only be estimated within the 2 Web-based questionnaire modes before the first reminder. Alternative platforms to reach higher participation rates in population surveys should reflect the development of electronic devices and the ways in which the population primarily accesses the Internet. %M 23978658 %R 10.2196/jmir.2595 %U http://www.jmir.org/2013/8/e173/ %U https://doi.org/10.2196/jmir.2595 %U http://www.ncbi.nlm.nih.gov/pubmed/23978658 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 6 %P e116 %T Collecting Maternal Health Information From HIV-Positive Pregnant Women Using Mobile Phone-Assisted Face-to-Face Interviews in Southern Africa %A van Heerden,Alastair %A Norris,Shane %A Tollman,Stephen %A Richter,Linda %A Rotheram-Borus,Mary Jane %+ Human Sciences Research Council, PO Box 90, Msunduzi, Pietermaritzburg, 3201, South Africa, 27 333245015, avanheerden@hsrc.ac.za %K mobile phones %K human immunodeficiency virus %K mobile health %D 2013 %7 10.06.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Most of the world’s women living with human immunodeficiency virus (HIV) reside in sub-Saharan Africa. Although efforts to reduce mother-to-child transmission are underway, obtaining complete and accurate data from rural clinical sites to track progress presents a major challenge. Objective: To describe the acceptability and feasibility of mobile phones as a tool for clinic-based face-to-face data collection with pregnant women living with HIV in South Africa. Methods: As part of a larger clinic-based trial, 16 interviewers were trained to conduct mobile phone–assisted personal interviews (MPAPI). These interviewers (participant group 1) completed the same short questionnaire based on items from the Technology Acceptance Model at 3 different time points. Questions were asked before training, after training, and 3 months after deployment to clinic facilities. In addition, before the start of the primary intervention trial in which this substudy was undertaken, 12 mothers living with HIV (MLH) took part in a focus group discussion exploring the acceptability of MPAPI (participant group 2). Finally, a sample of MLH (n=512) enrolled in the primary trial were asked to assess their experience of being interviewed by MPAPI (participant group 3). Results: Acceptability of the method was found to be high among the 16 interviewers in group 1. Perceived usefulness was reported to be slightly higher than perceived ease of use across the 3 time points. After 3 months of field use, interviewer perceptions of both perceived ease of use and perceived usefulness were found to be higher than before training. The feasibility of conducting MPAPI interviews in this setting was found to be high. Network coverage was available in all clinics and hardware, software, cost, and secure transmission to the data center presented no significant challenges over the 21-month period. For the 12 MHL participants in group 2, anxiety about the multimedia capabilities of the phone was evident. Their concern centered on the possibility that their privacy may be invaded by interviewers using the mobile phone camera to photograph them. For participants in group 3, having the interviewer sit beside vs across from the interviewee during the MPAPI interview was received positively by 94.7% of MHL. Privacy (6.3%) and confidentiality (5.3%) concerns were low for group 3 MHL. Conclusions: Mobile phones were found both to be acceptable and feasible in the collection of maternal and child health data from women living with HIV in South Africa. Trial Registration: Clinicaltrials.gov NCT00972699; http://clinicaltrials.gov/ct2/show/NCT00972699 (Archived by WebCite at http://clinicaltrials.gov/ct2/show/NCT00972699) %M 23748182 %R 10.2196/jmir.2207 %U http://www.jmir.org/2013/6/e116/ %U https://doi.org/10.2196/jmir.2207 %U http://www.ncbi.nlm.nih.gov/pubmed/23748182 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 4 %P e52 %T How Valid are Web-Based Self-Reports of Weight? %A Bonn,Stephanie Erika %A Trolle Lagerros,Ylva %A Bälter,Katarina %+ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12a, Stockholm, SE-17177, Sweden, 46 852482298, stephanie.bonn@ki.se %K body weight %K Internet %K validity %D 2013 %7 09.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Many studies rely on self-reported anthropometric data. While paper-based self-reports have been the standard collection mode, the number of studies collecting self-reported data via the Web is increasing rapidly. Although numerous studies have shown good agreement between self-reported and measured weight using paper-based questionnaires, the validity of using the Web to inquire about weight is unknown. Objective: The objective of this study was to validate Web-based self-reports of bodyweight compared to weight measured at the study center. Methods: The validity of weight self-reported via the Web was assessed by comparing self-reports against measurements of weight in a convenience sample of 149 individuals (77.2% women, 115/149), aged 20-65 years. Study participants self-reported their weight via a Web-based questionnaire and thereafter had their weight measured in the research center. Results: The Spearman correlation coefficient between self-reported and measured weight was 0.98 (P<.001). The mean difference between self-reported and measured weight was -1.2 (SD 2.6) kg. There was a statistically significant difference between self-reported and measured weight with the self-reported being lower (P<.001). Subjects with a body mass index (BMI) ≥25 kg/m2, and subjects ≥30 years of age, under-reported their weight statistically significantly more than subjects with a BMI <25 kg/m2, and subjects <30 years of age, respectively. Conclusions: Our results show that self-reported weight via the Web can be a valid method of data collection. %M 23570956 %R 10.2196/jmir.2393 %U http://www.jmir.org/2013/4/e52/ %U https://doi.org/10.2196/jmir.2393 %U http://www.ncbi.nlm.nih.gov/pubmed/23570956 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e49 %T An Assessment of Incentive Versus Survey Length Trade-offs in a Web Survey of Radiologists %A Ziegenfuss,Jeanette Y %A Niederhauser,Blake D %A Kallmes,David %A Beebe,Timothy J %+ HealthPartners, 8170 33rd Ave S, Bloomington, MN, 55425, United States, 1 952 967 5020, Jeanette.Y.Ziegenfuss@HealthPartners.com %K survey methods %K Internet methods %K physician surveys %D 2013 %7 20.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: It is generally understood that shorter Web surveys and use of incentives result in higher response rates in Web surveys directed to health care providers. Less is known about potential respondent preference for reduced burden as compared to increased reward. Objective: To help elicit preference for minimized burden compared to reward for completion of a survey, we observed physician preferences for shorter Web surveys compared to incentives as well as incentive preference (small guaranteed incentive compared to larger lottery incentive) accompanying an electronic request to complete a survey. Methods: This was an observational study that accompanied a large Web survey study of radiology staff, fellows, and residents at select academic medical centers in the United States. With the request to complete the survey, potential respondents were offered three options: (1) a 10-minute Web survey with the chance to win an iPad, (2) a 10-minute Web survey with a guaranteed nominal incentive ($5 amazon.com gift card), or (3) a shorter (5-7 minute) Web survey with no incentive. A total of 254 individuals responded to the Web survey request. Results: Overwhelmingly, individuals chose a longer survey accompanied by an incentive compared to a shorter survey with no incentive (85% compared to 15%, P<.001). Of those opting for an incentive, a small, but not significant majority chose the chance to win an iPad over a guaranteed $5 gift card (56% compared to 44%). Conclusions: When given the choice, radiologists preferred a reward (either guaranteed or based on a lottery) to a less burdensome survey, indicating that researchers should focus more attention at increasing perceived benefits of completing a Web survey compared to decreasing perceived burden. %M 23514869 %R 10.2196/jmir.2322 %U http://www.jmir.org/2013/3/e49/ %U https://doi.org/10.2196/jmir.2322 %U http://www.ncbi.nlm.nih.gov/pubmed/23514869 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 2 %P e31 %T Internet-Based Recruitment to a Depression Prevention Intervention: Lessons From the Mood Memos Study %A Morgan,Amy Joanna %A Jorm,Anthony Francis %A Mackinnon,Andrew James %+ Population Mental Health Group, Melbourne School of Population and Global Health, The University of Melbourne, Level 3, 207 Bouverie Street, Parkville, 3010, Australia, 61 390357711, ajmorgan@unimelb.edu.au %K Internet %K research subject recruitment %K depressive disorder %K preventive psychiatry %K randomized controlled trial %D 2013 %7 12.02.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Recruiting participants to randomized controlled trials of health interventions can be very difficult. Internet-based recruitment is becoming an increasingly important mode of recruitment, yet there are few detailed accounts of experiences recruiting participants to mental health interventions. Objective: To report on our experience with Internet-based recruitment to an online depression prevention intervention and pass on lessons we learned. Methods: Participants were recruited to the Mood Memos study, an online preventive depression intervention, purely through Internet-based sources. The study was targeted to adults with subthreshold depression symptoms from several English-speaking countries. A variety of online recruitment sources were trialed, including search engine advertising (Google, Yahoo!, Bing), Facebook advertising, posts in forums and online noticeboards, and promotion through relevant websites and email newsletters of mental health organizations. Results: The study website received visits from 94,808 individuals over the 14-month recruitment period. The recruitment target was reached with 1699 individuals signing up to the randomized controlled trial and 1326 fully enrolling. Most visitors arrived via Google advertising, which promoted a depression-screening questionnaire. Google advertising accounted for nearly half of the total participants who signed up to the study, at an average cost of AUD $12 per participant. Promoting the study through trustworthy organizations and websites known to participants was also effective. Recruitment techniques that were less effective were contacting forums, email groups, and community noticeboards. Conclusions: Several techniques, including Google advertising, were successful in recruiting participants to a trial evaluating an online depression intervention. Results suggest that Internet-based recruitment to mental health interventions is feasible and can be relatively affordable. Trial Registration: ACTRN12609000925246 %M 23403043 %R 10.2196/jmir.2262 %U http://www.jmir.org/2013/2/e31/ %U https://doi.org/10.2196/jmir.2262 %U http://www.ncbi.nlm.nih.gov/pubmed/23403043 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 1 %P e10 %T Challenges for Researchers Investigating Contraceptive Use and Pregnancy Intentions of Young Women Living in Urban and Rural Areas of Australia: Face-to-Face Discussions to Increase Participation in a Web-Based Survey %A Herbert,Danielle L %A Loxton,Deborah %A Bateson,Deborah %A Weisberg,Edith %A Lucke,Jayne C %+ UQ Centre for Clinical Research, University of Queensland, Building 71/918, Level 7, Royal Brisbane & Women's Hospital Site, Herston Road,, Brisbane, 4029, Australia, 61 733466031, j.lucke@uq.edu.au %K Rural %K urban %K Australia %K contraception %K pregnancy %K participant recruitment %K women’s health %K Facebook %K social media %K web-based survey %D 2013 %7 21.01.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: It is imperative to understand how to engage young women in research about issues that are important to them. There is limited reliable data on how young women access contraception in Australia especially in rural areas where services may be less available. Objective: This paper identifies the challenges involved in engaging young Australian women aged 18-23 years to participate in a web-based survey on contraception and pregnancy and ensure their ongoing commitment to follow-up web-based surveys. Methods: A group of young women, aged 18-23 years and living in urban and rural New South Wales, Australia, were recruited to participate in face-to-face discussions using several methods of recruitment: direct contact (face-to-face, telephone or email) and snowball sampling by potential participants inviting their friends. All discussions were transcribed verbatim and analyzed using thematic analysis. Results: Twenty young women participated (urban, n=10: mean age 21.6 years; rural, n=10: 20.0 years) and all used computers or smart phones to access the internet on a daily basis. All participants were concerned about the cost of internet access and utilized free access to social media on their mobile phones. Their willingness to participate in a web-based survey was dependent on incentives with a preference for small financial rewards. Most participants were concerned about their personal details and survey responses remaining confidential and secure. The most appropriate survey would take up to 15 minutes to complete, be a mix of short and long questions and eye-catching with bright colours. Questions on the sensitive topics of sexual activity, contraception and pregnancy were acceptable if they could respond with “I prefer not to answer”. Conclusions: There are demographic, participation and survey design challenges in engaging young women in a web-based survey. Based on our findings, future research efforts are needed to understand the full extent of the role social media and incentives play in the decision of young women to participate in web-based research. %M 23337208 %R 10.2196/jmir.2266 %U http://www.jmir.org/2013/1/e10/ %U https://doi.org/10.2196/jmir.2266 %U http://www.ncbi.nlm.nih.gov/pubmed/23337208 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 5 %P e137 %T Conducting Research on the Internet: Medical Record Data Integration with Patient-Reported Outcomes %A Cascade,Elisa %A Marr,Paige %A Winslow,Matthew %A Burgess,Andrew %A Nixon,Mark %+ Digital Patient Unit, Quintiles, 4820 Emperor Blvd, 7th Floor #773C, Durham, NC, 27707, United States, 1 703 597 6642, elisa.cascade@quintiles.com %K Direct-to-patient study %K patient-reported outcomes %K observational research %K medical record review %K Internet recruitment %K online patient communities %D 2012 %7 11.10.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: The growth in the number of patients seeking health information online has given rise to new direct-to-patient research methods, including direct patient recruitment and study conduct without use of physician sites. While such patient-centric designs offer time and cost efficiencies, the absence of physician-reported data is a key concern, with potential impact on both scientific rigor and operational feasibility. Objective: To (1) gain insight into the viability of collecting patient-reported outcomes and medical record information in a sample of gout patients through a direct-to-patient approach (ie, without the involvement of physician sites), and (2) evaluate the validity of patient-reported diagnoses collected during a patient-reported outcomes plus medical record (PRO+MR) direct-to-patient study. Methods: We invited a random sample of MediGuard.org members aged 18 to 80 years to participate via email based on a gout treatment or diagnosis in their online profiles. Interested members clicked on an email link to access study information, consent to participate electronically, and be screened for eligibility. The first 50 consenting participants completed an online survey and provided electronic and wet signatures on medical record release forms for us to obtain medical charts from their managing physicians. Results: A total of 108 of 1250 MediGuard.org members (8.64%) accessed study information before we closed the study at 50 completed surveys. Of these 108 members who took the screener, 50 (46.3%) completed the study, 19 (17.6%) did not pass the screening, 5 (4.6%) explicitly declined to participate due to the medical record requirement, and 34 (31.5%) closed the browser without completing the survey screener. Ultimately, we obtained 38 of 50 charts (76%): 28 collected using electronic signature and 10 collected based on wet signature on a paper form. Of the 38 charts, 37 cited a gout diagnosis (35 charts) or use of a gout medication (2 charts). Only 1 chart lacked any mention of gout. Conclusions: Patients can be recruited directly for observational study designs that include patient-reported outcomes and medical record data with over 75% data completeness. Although the validity of self-reported diagnosis is often a concern in Internet-based studies, in this PRO+MR study pilot, nearly all (37 of 38) charts confirmed patient-reported data. %M 23060427 %R 10.2196/jmir.2202 %U http://www.jmir.org/2012/5/e137/ %U https://doi.org/10.2196/jmir.2202 %U http://www.ncbi.nlm.nih.gov/pubmed/23060427 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 4 %P e116 %T Online Advertising to Reach and Recruit Latino Smokers to an Internet Cessation Program: Impact and Costs %A Graham,Amanda L %A Fang,Ye %A Moreno,Jose L %A Streiff,Shawn L %A Villegas,Jorge %A Muñoz,Ricardo F %A Tercyak,Kenneth P %A Mandelblatt,Jeanne S %A Vallone,Donna M %+ Schroeder Institute for Tobacco Research & Policy Studies, American Legacy Foundation, 1724 Massachusetts Ave NW, Washington, DC, 20036, United States, 1 202 454 5938, agraham@legacyforhealth.org %K Internet %K smoking cessation %K recruitment %K Hispanic/Latino %K advertising %D 2012 %7 27.08.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Tobacco cessation among Latinos is a public health priority in the United States, particularly given the relatively high growth of this population segment. Although a substantial percentage of American Latinos use the Internet, they have not engaged in Web-based cessation programs as readily as other racial/ethnic subgroups. A lack of culturally specific advertising efforts may partly explain this disparity. Objective: Phase I of this study focused on the development of four Spanish-language online banner advertisements to promote a free Spanish-language smoking cessation website (es.BecomeAnEX.org). Phase II examined the relative effectiveness of the four banner ads in reaching and recruiting Latino smokers to the cessation website. Methods: In Phase I, 200 Spanish-speaking Latino smokers completed an online survey to indicate their preference for Spanish-language banner ads that incorporated either the cultural value of family (familismo) or fatalism (fatalismo). Ads included variations on message framing (gain vs loss) and depth of cultural targeting (surface vs deep). In Phase II, a Latin square design evaluated the effectiveness of the four preferred ads from Phase I. Ads were systematically rotated across four popular Latino websites (MySpace Latino, MSN Latino, MiGente, and Yahoo! en Español) over four months from August to November 2009. Tracking software recorded ad clicks and registrants on the cessation website. Negative binomial regression and general linear modeling examined the main and interacting effects of message framing and depth of cultural targeting for four outcomes: number of clicks, click-through rate, number of registrants, and cost per registrant. Results: In Phase I, smokers preferred the four ads featuring familismo. In Phase II, 24,829,007 impressions were placed, yielding 24,822 clicks, an overall click-through rate of 0.10%, and 500 registrants (2.77% conversion rate). Advertising costs totaled US $104,669.49, resulting in an overall cost per click of US $4.22 and cost per registrant of US $209.34. Website placement predicted all four outcomes (all P values < .01). Yahoo! en Español yielded the highest click-through rate (0.167%) and number of registrants (n = 267). The message framing and cultural targeting interaction was not significant. Contrary to hypotheses, loss-framed ads yielded a higher click-through rate than gain-framed ads (point estimate = 1.08, 95% CI 1.03 1.14, P = 0.004), and surface-targeted ads outperformed deep-targeted ads for clicks (point estimate = 1.20, 95% CI 1.13 1.28, P < .001), click-through rate (point estimate = 1.22, 95% CI 1.16 1.29, P < .001), and number of registrants (point estimate = 2.73, 95% CI 2.14 3.48, P < .001). Conclusions: Online advertising can be an effective and cost-efficient strategy to reach and engage Spanish-speaking Latino smokers in an evidence-based Internet cessation program. Cultural targeting and smoking-relevant images may be important factors for banner ad design. Online advertising holds potential for Web-based cessation program implementation and research. %M 22954502 %R 10.2196/jmir.2162 %U http://www.jmir.org/2012/4/e116/ %U https://doi.org/10.2196/jmir.2162 %U http://www.ncbi.nlm.nih.gov/pubmed/22954502 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 3 %P e84 %T Accuracy of Geographically Targeted Internet Advertisements on Google Adwords for Recruitment in a Randomized Trial %A Jones,Ray B %A Goldsmith,Lesley %A Williams,Christopher J %A Kamel Boulos,Maged N %+ Faculty of Health, Education, and Society, University of Plymouth, 3 Portland Villas, Plymouth, PL4 8AA, United Kingdom, 44 1752586532, ray.jones@plymouth.ac.uk %K Cluster randomized trial %K contamination in RCTs %K online advertising %K depression %K MoodGym %K Living Life to the Full %K Google Analytics %K Google Adwords %D 2012 %7 20.06.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Google AdWords are increasingly used to recruit people into research studies and clinical services. They offer the potential to recruit from targeted control areas in cluster randomized controlled trials (RCTs), but little is known about the feasibility of accurately targeting ads by location and comparing with control areas. Objective: To examine the accuracy and contamination of control areas by a location-targeted online intervention using Google AdWords in a pilot cluster RCT. Methods: Based on previous use of online cognitive behavioral therapy for depression and population size, we purposively selected 16 of the 121 British postcode areas and randomized them to three intervention and one (do-nothing) control arms. Two intervention arms included use of location-targeted AdWords, and we compared these with the do-nothing control arm. We did not raise the visibility of our research website to normal Web searches. Users who clicked on the ad were directed to our project website, which collected the computer Internet protocol (IP) address, date, and time. Visitors were asked for their postcode area and to complete the Patient Health Questionnaire (depression). They were then offered links to several online depression resources. Google Analytics largely uses IP methods to estimate location, but AdWords uses additional information. We compared locations assessed by (1) Analytics, and (2) as self-identified by users. Results: Ads were shown 300,523 times with 4207 click-throughs. There were few site visits except through AdWord click-throughs. Both methods of location assessment agreed there was little contamination of control areas. According to Analytics, 69.75% (2617/3752) of participants were in intervention areas, only 0% (8/3752) in control areas, but 30.04% (1127/3752) in other areas. However, according to user-stated postcodes, only 20.7% (463/2237) were in intervention areas, 1% (22/2236) in control areas, but 78.31% (1751/2236) in other areas. Both location assessments suggested most leakage from the intervention arms was to nearby postcode areas. Analytics data differed from postcodes reported by participants. Analysis of a subset of 200/2236 records over 10 days comparing IP-estimated location with stated postcode suggested that Google AdWords targeted correctly in just half the cases. Analytics agreed with our assessment that, overall, one-third were wrongly targeted by AdWords. There appeared little evidence that people who bothered to give their postcode did not answer truthfully. Conclusions: Although there is likely to be substantial leakage from the targeted areas, if intervention and control areas are a sufficient distance apart, it is feasible to conduct a cluster RCT using online ads to target British postcode areas without significant contamination. Trial Registration: Clinicaltrials.gov NCT01469689; http://clinicaltrials.gov/ct2/show/NCT01469689 (Archived by WebCite at http://www.webcitation.org/681iro5OU) %M 22718043 %R 10.2196/jmir.1991 %U http://www.jmir.org/2012/3/e84/ %U https://doi.org/10.2196/jmir.1991 %U http://www.ncbi.nlm.nih.gov/pubmed/22718043 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 3 %P e79 %T Using Crowdsourcing Technology for Testing Multilingual Public Health Promotion Materials %A Turner,Anne M %A Kirchhoff,Katrin %A Capurro,Daniel %+ Department of Health Services, University of Washington, 1107 NE 45th Street, Suite 400, Seattle, WA, 98105, United States, 1 2066851130, amturner@uw.edu %K Crowdsourcing %K health promotion %K public health informatics %K limited English proficiency populations %D 2012 %7 04.06.2012 %9 Tutorial %J J Med Internet Res %G English %X Background: Effective communication of public health messages is a key strategy for health promotion by public health agencies. Creating effective health promotion materials requires careful message design and feedback from representatives of target populations. This is particularly true when the target audiences are hard to reach as limited English proficiency groups. Traditional methods of soliciting feedback—such as focus groups and convenience sample interviews—are expensive and time consuming. As a result, adequate feedback from target populations is often insufficient due to the time and resource constraints characteristic to public health. Objective: To describe a pilot study investigating the use of crowdsourcing technology as a method to gather rapid and relevant feedback on the design of health promotion messages for oral health. Our goal was to better describe the demographics of participants responding to a crowdsourcing survey and to test whether crowdsourcing could be used to gather feedback from English-speaking and Spanish-speaking participants in a short period of time and at relatively low costs. Methods: We developed health promotion materials on pediatric dental health issues in four different formats and in two languages (English and Spanish). We then designed an online survey to elicit feedback on format preferences and made it available in both languages via the Amazon Mechanical Turk crowdsourcing platform. Results: We surveyed 236 native English-speaking and 163 native Spanish-speaking participants in less than 12 days, at a cost of US $374. Overall, Spanish-speaking participants originated from a wider distribution of countries than the overall Latino population in the United States. Most participants were in the 18- to 29-year age range and had some college or graduate education. Participants provided valuable input for the health promotion material design. Conclusions: Our results indicate that crowdsourcing can be an effective method for recruiting and gaining feedback from English-speaking and Spanish-speaking people. Compared with traditional methods, crowdsourcing has the potential to reach more diverse populations than convenience sampling, while substantially reducing the time and cost of gathering participant feedback. More widespread adoption of this method could streamline the development of effective health promotion materials in multiple languages. %M 22664384 %R 10.2196/jmir.2063 %U http://www.jmir.org/2012/3/e79/ %U https://doi.org/10.2196/jmir.2063 %U http://www.ncbi.nlm.nih.gov/pubmed/22664384 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 3 %P e76 %T Clinicians’ Perspectives on a Web-Based System for Routine Outcome Monitoring in Old-Age Psychiatry in the Netherlands %A Veerbeek,Marjolein A %A Oude Voshaar,Richard C %A Pot,Anne Margriet %+ Netherlands Insitute of Mental Health and Addiction, PO Box 725, Utrecht, 3500 AS, Netherlands, 31 30 2959313, mveerbeek@trimbos.nl %K Quality of care %K health care %K routine outcome monitoring %K Web-based monitoring %K clinicians %K feedback %D 2012 %7 30.05.2012 %9 Short Paper %J J Med Internet Res %G English %X Background: In health care, the use of physical parameters to monitor physical disease progress is common. In mental health care, the periodic measurement of a client’s functioning during treatment, or routine outcome monitoring, has recently become important. Online delivery of questionnaires has the potential to reduce clinicians’ resistance to the implementation of routine outcome monitoring. Online delivery enables clinicians to receive results on a questionnaire in a graphic directly after data entry. This gives them insight into the progress of a client at a single glance. Objective: To explore clinicians’ perspectives on a routine outcome monitoring procedure where questionnaires and feedback on scores were delivered online. Questionnaires could also be filled out on paper and then entered into the online system by a research assistant. Methods: In 2009 we sent an online survey, consisting of five yes-or-no questions and six open-ended questions, to all clinicians in the 14 mental health care organizations working with the routine outcome monitoring system in the Netherlands. Of the 172 clinicians contacted, 80 (47%) opened the link and 70 of these 80 (88%) clinicians completed the survey. Results: Clinicians seldom used the graphical feedback from the Web-based system, which indicates that direct feedback on scores did not enhance the implementation of routine outcome monitoring. Integration into the electronic patient record and more training on interpretation and implementation of feedback in daily practice were seen as the primary points for further improvement. It was mainly the availability of a research assistant that made the routine outcome monitoring procedure feasible. Conclusions: Without a research assistant and training in the interpretation of outcomes, software programs alone cannot ensure effective implementation of monitoring activities in everyday practice. %M 22647771 %R 10.2196/jmir.1937 %U http://www.jmir.org/2012/3/e76/ %U https://doi.org/10.2196/jmir.1937 %U http://www.ncbi.nlm.nih.gov/pubmed/22647771 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e42 %T Validation of an Informant-Reported Web-Based Data Collection to Assess Dementia Symptoms %A Rockwood,Kenneth %A Zeng,An %A Leibman,Chris %A Mucha,Lisa %A Mitnitski,Arnold %+ DGI Clinical Inc, 1344 Summer Street, Suite 208, Halifax, NS, B3H 0A8, Canada, 1 902 421 5710 ext 5, KRockwood@dgiclinical.com %K Dementia %K online survey %K symptoms %K Dependence Scale %K staging %K cognitive impairment not dementia %K mild cognitive impairment %K validation %K World Wide Web %D 2012 %7 12.03.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: The Web offers unprecedented access to the experience of people with dementia and their care partners, but data gathered online need to be validated to be useful. Objective: To test the construct validity of an informant Web-based data collection to assess dementia symptoms in relation to the 15-point Dependence Scale (DS). Methods: In an online survey posted on the DementiaGuide website, care partners of people with dementia built individualized profiles from the 60-item SymptomGuide and completed a questionnaire, which included the DS and a staging tool. Results: In the 250 profilees (155, 62% women, mean age 77 years), increasing dependence was associated with a greater chance of institutionalization. For example, no one at the lowest levels of dependence (DS score < 5, n = 33) was in long-term care, compared with half (13/25) of the profilees at the highest levels of dependence (DS score > 12) being in institutions (χ24 = 27.9, P < .001). The Web-based DS was correlated with the number of symptoms: higher DS scores were associated with a higher stage of dementia (F > 50, P < .001). Conclusion: In an online survey, the Web-based DS showed good construct validity, potentially demonstrating how the Web can be used to learn more about dementia progression and how it relates to symptoms experienced by patients across the course of dementing illnesses. Even so, caution is needed to assure the validity of data collected online. %M 22411293 %R 10.2196/jmir.1941 %U http://www.jmir.org/2012/2/e42/ %U https://doi.org/10.2196/jmir.1941 %U http://www.ncbi.nlm.nih.gov/pubmed/22411293 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 1 %P e28 %T Broad Reach and Targeted Recruitment Using Facebook for an Online Survey of Young Adult Substance Use %A Ramo,Danielle E %A Prochaska,Judith J %+ Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, Box TRC-0984, San Francisco, CA, 94143, United States, 1 415 476 7071, danielle.ramo@ucsf.edu %K social media, Facebook, participant recruitment, young adult, tobacco %D 2012 %7 23.02.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Studies of tobacco use and other health behaviors have reported great challenges in recruiting young adults. Social media is widely used by young adults in the United States and represents a potentially fast, affordable method of recruiting study participants for survey research. Objective: The present study examined Facebook as a mechanism to reach and survey young adults about tobacco and other substance use. Methods: Participants were cigarette users, age 18-25 years old, living throughout the United States and recruited through Facebook to complete a survey about tobacco and other substance use. Paid advertising using Facebook’s Ad program over 13 months from 2010 Feb 28 to 2011 Apr 4 targeted by age (18-25), location (United States or California), language (English), and tobacco- and/or marijuana-related keywords. Facebook approved all ads. Results: The campaign used 20 ads, which generated 28,683,151 impressions, yielding 14,808 clicks (0.7% of targeted Facebook members), at an overall cost of $6,628.24. The average cost per click on an ad was $0.45. The success of individual ads varied widely. There was a rise in both clicks and impressions as the campaign grew. However, the peak for clicks was 3 months before the peak for ad impressions. Of the 69,937,080 accounts for those age 18-25 in the United States, Facebook estimated that 2.8% (n = 1,980,240) were reached through tobacco and marijuana keywords. Our campaign yielded 5237 signed consents (35.4% of clicks), of which 3093 (59%) met criteria, and 1548 (50% of those who met criteria) completed the survey. The final cost per valid completed survey was $4.28. The majority of completed surveys came from whites (69%) and males (72%). The sample averaged 8.9 cigarettes per day (SD 7.5), 3.8 years of smoking (SD 2.9), with a median of 1 lifetime quit attempts; 48% did not intend to quit smoking in the next 6 months. Conclusions: Despite wide variety in the success of individual ads and potential concerns about sample representativeness, Facebook was a useful, cost-effective recruitment source for young-adult smokers to complete a survey about the use of tobacco and other substances. The current findings support Facebook as a viable recruitment option for assessment of health behavior in young adults. %M 22360969 %R 10.2196/jmir.1878 %U http://www.jmir.org/2012/1/e28/ %U https://doi.org/10.2196/jmir.1878 %U http://www.ncbi.nlm.nih.gov/pubmed/22360969 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 1 %P e20 %T Web-Based Recruiting for Health Research Using a Social Networking Site: An Exploratory Study %A Fenner,Yeshe %A Garland,Suzanne M %A Moore,Elya E %A Jayasinghe,Yasmin %A Fletcher,Ashley %A Tabrizi,Sepehr N %A Gunasekaran,Bharathy %A Wark,John D %+ Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Parkville, 3050, Australia, 61 393427109, jdwark@unimelb.edu.au %K Advertising %K research subject recruitment %K women’s health %K Facebook %D 2012 %7 01.02.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Recruitment of young people for health research by traditional methods has become more expensive and challenging over recent decades. The Internet presents an opportunity for innovative recruitment modalities. Objective: To assess the feasibility of recruiting young females using targeted advertising on the social networking site Facebook. Methods: We placed an advertisement on Facebook from May to September 2010, inviting 16- to 25-year-old females from Victoria, Australia, to participate in a health study. Those who clicked on the advertisement were redirected to the study website and were able to express interest by submitting their contact details online. They were contacted by a researcher who assessed eligibility and invited them to complete a health-related survey, which they could do confidentially and securely either at the study site or remotely online. Results: A total of 551 females responded to the advertisement, of whom 426 agreed to participate, with 278 completing the survey (139 at the study site and 139 remotely). Respondents’ age distribution was representative of the target population, while 18- to 25-year-olds were more likely to be enrolled in the study and complete the survey than 16- to 17-year-olds (prevalence ratio = 1.37, 95% confidence interval 1.05–1.78, P = .02). The broad geographic distribution (major city, inner regional, and outer regional/remote) and socioeconomic profile of participants matched the target population. Predictors of participation were older age, higher education level, and higher body mass index. Average cost in advertising fees per compliant participant was US $20, making this highly cost effective. Conclusions: Results demonstrate the potential of using modern information and communication technologies to engage young women in health research and penetrate into nonurban communities. The success of this method has implications for future medical and population research in this and other demographics. %M 22297093 %R 10.2196/jmir.1978 %U http://www.jmir.org/2012/1/e20/ %U https://doi.org/10.2196/jmir.1978 %U http://www.ncbi.nlm.nih.gov/pubmed/22297093 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 4 %P e109 %T Methodological Issues in Internet-Mediated Research: A Randomized Comparison of Internet Versus Mailed Questionnaires %A Whitehead,Lisa %+ Centre for Postgraduate Nursing Studies, University of Otago, 72 Oxford Terrace, Christchurch, 4345, New Zealand, 64 0064 364 3858, lisa.whitehead@otago.ac.nz %K Paper-and-pencil questionnaire %K equivalence %K questionnaire %D 2011 %7 12.12.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: The majority of Internet-mediated studies use measures developed as paper-and-pencil measures or face-to-face-delivered material. Previous research suggests that the equivalence between online and offline measures must be demonstrated rather than assumed. Objective: The objective of this study was to explore the equivalence 4 measures completed in an online or offline setting. Methods: A sample of students (n = 1969) was randomly assigned to complete 4 popular scales (the SF-12v2, the Hospital Anxiety and Depression Scale (HADS), the Fatigue Symptom Inventory, and a single-item fatigue measure) either online or by mail survey (pencil and paper). The response rate was 52.51% (n = 1034) and comparable between the online and offline groups. Results: Significant differences were noted in fatigue levels between the online and offline group (P = .01) as measured by the Fatigue Symptom Inventory, with the online sample demonstrating higher levels of fatigue. Equivalency was noted for the SF-12v2, the Hospital Anxiety and Depression Scale, and the single-item fatigue measure. Internal consistency was high except for the SF-12v2. The SF-12v2 may not be an ideal measure to use for remote administration. Conclusions: Equivalency of the Hospital Anxiety and Depression Scale (HADS) and the Physical Component Score and Mental Component Score of the SF-12v2 for online and offline data were demonstrated. Equivalency was not demonstrated for the Fatigue Symptom Inventory. Explanations for the difference in fatigue score between the online and offline samples are unclear. Research that seeks to match samples and control for extraneous online and offline variables is called for, along with exploration of factors that may mediate the completion of questionnaires or alter the respondents’ relationship with the same, to enhance progress in this area. %M 22155721 %R 10.2196/jmir.1593 %U http://www.jmir.org/2011/4/e109/ %U https://doi.org/10.2196/jmir.1593 %U http://www.ncbi.nlm.nih.gov/pubmed/22155721 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 4 %P e96 %T Impact of Length or Relevance of Questionnaires on Attrition in Online Trials: Randomized Controlled Trial %A McCambridge,Jim %A Kalaitzaki,Eleftheria %A White,Ian R %A Khadjesari,Zarnie %A Murray,Elizabeth %A Linke,Stuart %A Thompson,Simon G %A Godfrey,Christine %A Wallace,Paul %+ Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, 15 - 17 Tavistock Place, London, WC1H 9SH, United Kingdom, 44 (0)20 7927 2945, Jim.McCambridge@lshtm.ac.uk %K Attrition %K retention %K missing data %K response rates %K alcohol %K online %D 2011 %7 18.11.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: There has been limited study of factors influencing response rates and attrition in online research. Online experiments were nested within the pilot (study 1, n = 3780) and main trial (study 2, n = 2667) phases of an evaluation of a Web-based intervention for hazardous drinkers: the Down Your Drink randomized controlled trial (DYD-RCT). Objectives: The objective was to determine whether differences in the length and relevance of questionnaires can impact upon loss to follow-up in online trials. Methods: A randomized controlled trial design was used. All participants who consented to enter DYD-RCT and completed the primary outcome questionnaires were randomized to complete one of four secondary outcome questionnaires at baseline and at follow-up. These questionnaires varied in length (additional 23 or 34 versus 10 items) and relevance (alcohol problems versus mental health). The outcome measure was the proportion of participants who completed follow-up at each of two follow-up intervals: study 1 after 1 and 3 months and study 2 after 3 and 12 months. Results: At all four follow-up intervals there were no significant effects of additional questionnaire length on follow-up. Randomization to the less relevant questionnaire resulted in significantly lower rates of follow-up in two of the four assessments made (absolute difference of 4%, 95% confidence interval [CI] 0%-8%, in both study 1 after 1 month and in study 2 after 12 months). A post hoc pooled analysis across all four follow-up intervals found this effect of marginal statistical significance (unadjusted difference, 3%, range 1%-5%, P = .01; difference adjusted for prespecified covariates, 3%, range 0%-5%, P = .05). Conclusions: Apparently minor differences in study design decisions may have a measurable impact on attrition in trials. Further investigation is warranted of the impact of the relevance of outcome measures on follow-up rates and, more broadly, of the consequences of what we ask participants to do when we invite them to take part in research studies. Trial registration: ISRCTN Register 31070347; http://www.controlled-trials.com/ISRCTN31070347/31070347 Archived by WebCite at (http://www.webcitation.org/62cpeyYaY) %M 22100793 %R 10.2196/jmir.1733 %U http://www.jmir.org/2011/4/e96/ %U https://doi.org/10.2196/jmir.1733 %U http://www.ncbi.nlm.nih.gov/pubmed/22100793 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 3 %P e76 %T Using Web-Based and Paper-Based Questionnaires for Collecting Data on Fertility Issues Among Female Childhood Cancer Survivors: Differences in Response Characteristics %A van den Berg,Marleen H %A Overbeek,Annelies %A van der Pal,Helena J %A Versluys,A. Birgitta %A Bresters,Dorine %A van Leeuwen,Flora E %A Lambalk,Cornelis B %A Kaspers,Gertjan J.L %A van Dulmen-den Broeder,Eline %+ VU University Medical Center Amsterdam, Department of Pediatrics, division of Oncology-Hematology, P.O. box 7057, Amsterdam, 1007 MB, Netherlands, 31 20 4446021, mh.vandenberg@vumc.nl %K Paper %K Internet %K questionnaire %K response %K fertility %K cancer survivors %D 2011 %7 29.09.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based questionnaires have become increasingly popular in health research. However, reported response rates vary and response bias may be introduced. Objective: The aim of this study was to evaluate whether sending a mixed invitation (paper-based together with Web-based questionnaire) rather than a Web-only invitation (Web-based questionnaire only) results in higher response and participation rates for female childhood cancer survivors filling out a questionnaire on fertility issues. In addition, differences in type of response and characteristics of the responders and nonresponders were investigated. Moreover, factors influencing preferences for either the Web- or paper-based version of the questionnaire were examined. Methods: This study is part of a nationwide study on reproductive function, ovarian reserve, and risk of premature menopause in female childhood cancer survivors. The Web-based version of the questionnaire was available for participants through the Internet by means of a personalized user name and password. Participants were randomly selected to receive either a mixed invitation (paper-based questionnaire together with log-in details for Web-based questionnaire, n = 137) or a Web-only invitation (log-in details only, n = 140). Furthermore, the latter group could request a paper-based version of the questionnaire by filling out a form. Results: Overall response rates were comparable in both randomization groups (83% mixed invitation group vs 89% in Web-only invitation group, P = .20). In addition, participation rates appeared not to differ (66% or 90/137, mixed invitation group vs 59% or 83/140, Web-only invitation group, P =.27). However, in the mixed invitation group, significantly more respondents filled out the paper-based questionnaire compared with the Web-only invitation group (83% or 75/90 and 65% or 54/83, respectively, P = .01). The 44 women who filled out the Web-based version of the questionnaire had a higher educational level than the 129 women who filled out the paper-based version (P = .01). Furthermore, the probability of filling out the Web-based questionnaire appeared to be greater for women who were allocated to the Web-only invitation group (OR = 2.85, 95% CI 1.31 - 6.21), were older (OR = 1.08, 95% CI 1.02 - 1.15), had a higher educational level (OR high vs low = 0.06, 95% CI 0.01 - 0.52), or were students (OR employed vs student = 3.25, 95% CI 1.00 - 10.56). Conclusions: Although overall response as well as participation rates to both types of invitations were similar, adding a paper version of a questionnaire to a Web-only invitation resulted in more respondents filling out the paper-based version. In addition, women who were older, had a higher level of education, or were students, were more likely to have filled out the Web-based version of the questionnaire. Given the many advantages of Web-based over paper-based questionnaires, researchers should strongly consider using Web-based questionnaires, although possible response bias when using these types of questionnaires should be taken into account. Trial Registration: Nederlands Trial Register NTR2922; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2922 (Archived by WebCite at http://www.webcitation.org/5zRRdMrDv) %M 21955527 %R 10.2196/jmir.1707 %U http://www.jmir.org/2011/3/e76/ %U https://doi.org/10.2196/jmir.1707 %U http://www.ncbi.nlm.nih.gov/pubmed/21955527 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 3 %P e68 %T A Comparison of a Postal Survey and Mixed-Mode Survey Using a Questionnaire on Patients’ Experiences With Breast Care %A Zuidgeest,Marloes %A Hendriks,Michelle %A Koopman,Laura %A Spreeuwenberg,Peter %A Rademakers,Jany %+ Tranzo, Academic Research Centre for Health and Social Care, Tilburg University, PO Box 90153, Tilburg, 5000 LE, Netherlands, 31 134663627, m.zuidgeest@uvt.nl %K Data collection %K health care quality %K consumer satisfaction %K breast cancer %K patient preferences %K health care quality indicator %D 2011 %7 27.09.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet is increasingly considered to be an efficient medium for assessing the quality of health care seen from the patients’ perspective. Potential benefits of Internet surveys such as time efficiency, reduced effort, and lower costs should be balanced against potential weaknesses such as low response rates and accessibility for only a subset of potential participants. Combining an Internet questionnaire with a traditional paper follow-up questionnaire (mixed-mode survey) can possibly compensate for these weaknesses and provide an alternative to a postal survey. Objective: To examine whether there are differences between a mixed-mode survey and a postal survey in terms of respondent characteristics, response rate and time, quality of data, costs, and global ratings of health care or health care providers (general practitioner, hospital care in the diagnostic phase, surgeon, nurses, radiotherapy, chemotherapy, and hospital care in general). Methods: Differences between the two surveys were examined in a sample of breast care patients using the Consumer Quality Index Breast Care questionnaire. We selected 800 breast care patients from the reimbursement files of Dutch health insurance companies. We asked 400 patients to fill out the questionnaire online followed by a paper reminder (mixed-mode survey) and 400 patients, matched by age and gender, received the questionnaire by mail only (postal survey). Both groups received three reminders. Results: The respondents to the two surveys did not differ in age, gender, level of education, or self-reported physical and psychological health (all Ps > .05). In the postal survey, the questionnaires were returned 20 days earlier than in the mixed-mode survey (median 12 and 32 days, respectively; P < .001), whereas the response rate did not differ significantly (256/400, 64.0% versus 242/400, 60.5%, respectively; P = .30). The costs were lower for the mixed-mode survey (€2 per questionnaire). Moreover, there were fewer missing items (3.4% versus 4.4%, P = .002) and fewer invalid answers (3.2% versus 6.2%, P < .001) in the mixed-mode survey than in the postal survey. The answers of the two respondent groups on the global ratings did not differ. Within the mixed-mode survey, 52.9% (128/242) of the respondents filled out the questionnaire online. Respondents who filled out the questionnaire online were significantly younger (P < .001), were more often highly educated (P = .002), and reported better psychological health (P = .02) than respondents who filled out the paper questionnaire. Respondents to the paper questionnaire rated the nurses significantly more positively than respondents to the online questionnaire (score 9.2 versus 8.4, respectively; χ21 = 5.6). Conclusions: Mixed-mode surveys are an alternative method to postal surveys that yield comparable response rates and groups of respondents, at lower costs. Moreover, quality of health care was not rated differently by respondents to the mixed-mode or postal survey. Researchers should consider using mixed-mode surveys instead of postal surveys, especially when investigating younger or more highly educated populations. %M 21946048 %R 10.2196/jmir.1241 %U http://www.jmir.org/2011/3/e68/ %U https://doi.org/10.2196/jmir.1241 %U http://www.ncbi.nlm.nih.gov/pubmed/21946048 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 3 %P e66 %T Development of a Web-Based Survey for Monitoring Daily Health and its Application in an Epidemiological Survey %A Sugiura,Hiroaki %A Ohkusa,Yasushi %A Akahane,Manabu %A Sano,Tomomi %A Okabe,Nobuhiko %A Imamura,Tomoaki %+ Department of Public Health, Health Management and Policy, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, 634-8521, Japan, 81 744 22 3051, tomomarie@smn.enjoy.ne.jp %K Web-based survey %K syndromic surveillance %K long-term operation %D 2011 %7 23.09.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: Early detection of symptoms arising from exposure to pathogens, harmful substances, or environmental changes is required for timely intervention. The administration of Web-based questionnaires is a potential method for collecting information from a sample population. Objective: The objective of our study was to develop a Web-based daily questionnaire for health (WDQH) for symptomatic surveillance. Methods: We adopted two different survey methods to develop the WDQH: an Internet panel survey, which included participants already registered with an Internet survey company, and the Tokyo Consumers’ Co-operative Union (TCCU) Internet survey, in cooperation with the Japanese Consumers’ Co-operative Union, which recruited participants by website advertising. The Internet panel survey participants were given a fee every day for providing answers, and the survey was repeated twice with modified surveys and collection methods: Internet Panel Survey I was conducted every day, and Internet Panel Survey II was conducted every 3 days to reduce costs. We examined whether the survey remained valid by reporting health conditions on day 1 over a 3-day period, and whether the response rate would vary among groups with different incentives. In the TCCU survey, participants were given a fee only for initially registering, and health information was provided in return for survey completion. The WDQH included the demographic details of participants and prompted them to answer questions about the presence of various symptoms by email. Health information collected by the WDQH was then used for the syndromic surveillance of infection. Results: Response rates averaged 47.3% for Internet Panel Survey I, 42.7% for Internet Panel Survey II, and 40.1% for the TCCU survey. During a seasonal influenza epidemic, the WDQH detected a rapid increase in the number of participants with fever through the early aberration reporting system. Conclusions: We developed a health observation method based on self-reporting by participants via the Internet. We validated the usefulness of the WDQH by its practical use in syndromic surveillance. %M 21946004 %R 10.2196/jmir.1872 %U http://www.jmir.org/2011/3/e66/ %U https://doi.org/10.2196/jmir.1872 %U http://www.ncbi.nlm.nih.gov/pubmed/21946004 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 3 %P e61 %T A Web-Based Computerized Adaptive Testing (CAT) to Assess Patient Perception in Hospitalization %A Chien,Tsair-Wei %A Wang,Wen-Chung %A Huang,Sheng-Yun %A Lai,Wen-Pin %A Chow,Julie Chi %+ Department of Paediatrics, Chi Mei Medical Center, No. 901 Junghua Rd., Yungkang, 710, Taiwan, 886 62812811 ext 52903, jchow@mail.chimei.org.tw %K Computerized adaptive testing %K computer on wheels %K classic test theory %K IRT %K item response theory %K nonadaptive testing %D 2011 %7 15.08.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: Many hospitals have adopted mobile nursing carts that can be easily rolled up to a patient’s bedside to access charts and help nurses perform their rounds. However, few papers have reported data regarding the use of wireless computers on wheels (COW) at patients’ bedsides to collect questionnaire-based information of their perception of hospitalization on discharge from the hospital. Objective: The purpose of this study was to evaluate the relative efficiency of computerized adaptive testing (CAT) and the precision of CAT-based measures of perceptions of hospitalized patients, as compared with those of nonadaptive testing (NAT). An Excel module of our CAT multicategory assessment is provided as an example. Method: A total of 200 patients who were discharged from the hospital responded to the CAT-based 18-item inpatient perception questionnaire on COW. The numbers of question administrated were recorded and the responses were calibrated using the Rasch model. They were compared with those from NAT to show the advantage of CAT over NAT. Results: Patient measures derived from CAT and NAT were highly correlated (r = 0.98) and their measurement precisions were not statistically different (P = .14). CAT required fewer questions than NAT (an efficiency gain of 42%), suggesting a reduced burden for patients. There were no significant differences between groups in terms of gender and other demographic characteristics. Conclusions: CAT-based administration of surveys of patient perception substantially reduced patient burden without compromising the precision of measuring patients’ perceptions of hospitalization. The Excel module of animation-CAT on the wireless COW that we developed is recommended for use in hospitals. %M 21844001 %R 10.2196/jmir.1785 %U http://www.jmir.org/2011/3/e61/ %U https://doi.org/10.2196/jmir.1785 %U http://www.ncbi.nlm.nih.gov/pubmed/21844001 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 3 %P e47 %T Predictors of Retention in an Online Follow-up Study of Men Who Have Sex With Men %A Khosropour,Christine M %A Sullivan,Patrick S %+ Rollins School of Public Health, Department of Epidemiology, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 404 727 2038, patrick.sullivan@emory.edu %K HIV infections/prevention and control %K Internet %K homosexuality male %K research methodology %K behavioral research %D 2011 %7 11.07.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: In the past 10 years, the Internet has emerged as a venue for men who have sex with men (MSM) to meet sex partners. Because online sex seeking has increased among MSM, Internet-based human immunodeficiency virus (HIV) prevention interventions are of interest. However, few online studies to date have demonstrated an ability to retain study participants, specifically MSM of color, in longitudinal online studies. Objective: The current analysis examines data from a 3-month online prospective study of MSM to determine the association of race and incentive level with two retention outcomes: (1) agreeing to participate in a follow-up survey and providing an email address and (2) linking into the follow-up survey at the follow-up time point. Methods: Internet-using MSM were recruited through banner advertisements on MySpace.com. White, black, and Hispanic participants from 18 to 35 years of age were randomized to an offer of enrollment in an online follow-up survey at four levels of incentive (US $0, US $5, US $10, and US $20). Multivariable logistic regression models were used to estimate the odds of the two outcome measures of interest controlling for additional independent factors of interest. Results: Of eligible participants, 92% (2405/2607) agreed to participate in the follow-up survey and provided an email address. Hispanic men had decreased odds (adjusted odds ratio [OR] = 0.66, 95% confidence interval [CI] 0.47-0.92) of agreeing to participate in the follow-up survey compared with white men. Men reporting unprotected anal intercourse with a male sex partner in the past 12 months had increased odds of agreeing to participate in the follow-up survey (adjusted OR = 1.42, 95% CI 1.05-1.93). Of the participants who provided an email address, 22% (539/2405) linked into the follow-up survey at the 3-month follow-up time point. The odds of linking into the follow-up survey for black men were approximately half the odds for white men (adjusted OR = 0.47, 95% CI 0.35-0.63). Participants who were offered an incentive had increased odds of linking into the follow-up survey (adjusted OR = 1.29, 95% CI 1.02-1.62). Email addresses provided by participants that were used for online financial management and email accounts that were checked daily were associated with increased odds of linking into the follow-up survey (adjusted OR = 1.97, 95% CI 1.54-2.52; adjusted OR = 1.51, 95% CI 1.22-1.87, respectively). Conclusions: This analysis identified factors that predicted retention in an online, prospective study of MSM. Hispanic and black study participants were less likely to be retained in the study compared with white study participants. Because these men bear the greatest burden of HIV incidence among MSM in the United States, it is critical that new research methods be developed to increase retention of these groups in online research studies. %M 21745792 %R 10.2196/jmir.1717 %U http://www.jmir.org/2011/3/e47/ %U https://doi.org/10.2196/jmir.1717 %U http://www.ncbi.nlm.nih.gov/pubmed/21745792 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 2 %P e38 %T Bias in Online Recruitment and Retention of Racial and Ethnic Minority Men Who Have Sex With Men %A Sullivan,Patrick S %A Khosropour,Christine M %A Luisi,Nicole %A Amsden,Matthew %A Coggia,Tom %A Wingood,Gina M %A DiClemente,Ralph J %+ Rollins School of Public Health, Department of Epidemiology, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 404 727 2038, patrick.sullivan@emory.edu %K HIV infections/prevention and control %K Internet %K homosexuality male %K research methodology %K behavioral research %D 2011 %7 13.05.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet has become an increasingly popular venue for men who have sex with men (MSM) to meet potential sex partners. Given this rapid increase in online sex-seeking among MSM, Internet-based interventions represent an important HIV (human immunodeficiency virus) prevention strategy. Unfortunately, black and Hispanic MSM, who are disproportionately impacted by the HIV epidemic in the United States, have been underrepresented in online research studies. Objective: Our objective was to examine and quantify factors associated with underrecruitment and underretention of MSM of color in an online HIV behavioral risk research study of MSM recruited from an online social networking site. Methods: Internet-using MSM were recruited through banner advertisements on MySpace.com targeted at men who reported in their MySpace profile their age as at least 18 and their sexual orientation as gay, bisexual, or unsure. Multivariable logistic regression models were used to estimate the odds stratified by race and ethnicity of the MySpace user clicking through the banner advertisement. To characterize survey retention, Kaplan-Meier survival curves and multivariable Cox proportional hazards models identified factors associated with survey dropout. Results: Over 30,000 MySpace users clicked on the study banner advertisements (click-through rate of 0.37%, or 30,599 clicks from 8,257,271 impressions). Black (0.36% or 6474 clicks from 1,785,088 impressions) and Hispanic (0.35% or 8873 clicks from 2,510,434 impressions) MySpace users had a lower click-through rate compared with white (0.48% or 6995 clicks from 1,464,262 impressions) MySpace users. However, black men had increased odds of click-through for advertisements displaying a black model versus a white model (adjusted odds ratio [OR] = 1.83, 95% confidence interval [CI] 1.72 - 1.95), and Hispanic participants had increased odds of click-through when shown an advertisement displaying an Asian model versus a white model (adjusted OR = 1.70, 95% CI 1.62 - 1.79). Of the 9005 men who consented to participate, 6258 (69%) completed the entire survey. Among participants reporting only male sex partners, black non-Hispanic and Hispanic participants were significantly more likely to drop out of the survey relative to white non-Hispanic participants (hazard ratio [HR] = 1.6, 95% CI 1.4 - 1.8 and HR = 1.3, 95% CI 1.1 - 1.4, respectively). Men with a college-level of education were more likely to complete the survey than those with a high-school level of education (HR = 0.8, 95% CI 0.7 - 0.9), while men who self-identified as heterosexual were more likely to drop out of the survey compared with men who self-identified as gay (HR = 2.1, 95% CI 1.1 - 3.7). Conclusions: This analysis identified several factors associated with recruitment and retention of MSM in an online survey. Differential click-through rates and increased survey dropout by MSM of color indicate that methods to recruit and retain black and Hispanic MSM in Internet-based research studies are paramount. Although targeting banner advertisements to MSM of color by changing the racial/ethnic composition of the advertisements may increase click-through, decreasing attrition of these study participants once they are engaged in the survey remains a challenge. %M 21571632 %R 10.2196/jmir.1797 %U http://www.jmir.org/2011/2/e38/ %U https://doi.org/10.2196/jmir.1797 %U http://www.ncbi.nlm.nih.gov/pubmed/21571632