%0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e66859 %T Effect of Smartphone-Based Messaging on Interns and Nurses at an Academic Medical Center: Observational Study %A Madabhushi,Sankirth %A Nguyen,Andrew M %A Hsia,Katie %A Kher,Sucharita %A Harvey,William %A Murzycki,Jennifer %A Chandler,Daniel %A Davis,Michael %K secure messaging %K alert fatigue %K burnout %K clinical communication %K TigerConnect %K healthcare communication %K text %K texting %K messaging %K app %K application %K smartphone %K digital health %K digital technology %K digital intervention %K medical informatics %K messaging patterns %D 2025 %7 17.4.2025 %9 %J JMIR Med Inform %G English %X Background: Digital communication between nurses and medicine interns plays a crucial role in patient care. However, excessive messaging may contribute to alert fatigue, potentially affecting workflow efficiency and clinical decision-making. Although prior research has examined general messaging behaviors among clinicians, few studies have specifically analyzed messaging patterns between nurses and interns, who serve as primary points of contact in inpatient care. Objectives: This study aims to quantitatively characterize messaging patterns between the primary nurse and primary provider (ie, medicine intern) of hospitalized patients at an academic medical center in order to identify communication burdens and potential inefficiencies. By identifying trends in message volume, timing, and response rates, we seek to inform strategies to optimize communication workflows and mitigate alert fatigue. Methods: At a large academic hospital (Tufts Medical Center, Boston, MA), we analyzed secure messaging transactions between internal medicine interns and nurses across three medical-surgical units over 6 months. Transaction metadata, time stamps, and unique message tokens were extracted. Data processing was performed using Python, Microsoft Excel, and R. Message volume, interaction frequencies, and response times were analyzed using measures of central tendency and statistical tests of significance. Results: A total of 61,057 unique messages were exchanged between interns and nurses, with interns exchanging 2.5 times more messages per day with nurses than vice versa (P<.001). Messaging volume exhibited diurnal variation, indicating periods of increased communication burden. Interns read messages from nurses within a median of 35 (range: 0‐3589) seconds, whereas nurses read messages from interns within a median of 26 (range: 0‐3584) seconds (P<.001). The longest message response delays occurred at 4 AM, whereas the shortest occurred at 8 AM. Conclusions: Interns experience a significantly higher messaging burden than nurses, with distinct peaks in message volume during morning rounds and overnight shifts. These findings suggest a need for interventions such as optimized digital communication protocols to reduce nonessential messaging and alert fatigue. Future research should explore the effectiveness of these interventions in enhancing workflow efficiency and the development of both in-person and digital interventions to optimize communication workflows and mitigate alert fatigue. %R 10.2196/66859 %U https://medinform.jmir.org/2025/1/e66859 %U https://doi.org/10.2196/66859 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65268 %T Effect of a WeChat-Based Hybrid Intervention on the Adaptation Outcomes of People Living With HIV/AIDS: Pilot Randomized Controlled Trial %A Wang,Honghong %A Qin,Ziqi %A Li,Yixuan %A Duan,Yuqiong %A Lu,Qiaoyue %A Xiao,Xueling %+ Xiangya School of Nursing, Central South University, No. 172 Tongzipo Road, Changsha, 410083, China, 86 15286826132, xuelingxiao93@hotmail.com %K HIV/AIDS %K quality of life %K acceptance of illness %K mental health %K randomized controlled trial %K mobile phone %D 2025 %7 3.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: People living with HIV/AIDS face multiple challenges that collectively impede their adaptation outcomes. These outcomes include quality of life (QoL), acceptance of illness, mental health (including symptoms of anxiety and depression), and antiretroviral therapy (ART) adherence. While existing evidence addresses specific challenges, it often overlooks the interactions among the various problems people living with HIV/AIDS encounter. The comprehensive-task disease management framework and positive self-management framework provide a theoretical basis for understanding the adaptation process. A culturally tailored, theory-based intervention may be necessary and effective in facilitating better adaptation outcomes for people living with HIV/AIDS. Objective: This study aimed to evaluate the effect of a hybrid intervention called AiCare (Adaptation intervention with Comprehensive-task disease management framework to achieve renormal life) on improving QoL, acceptance of illness, mental health (anxiety and depression), and ART adherence among people living with HIV/AIDS in China. Methods: We conducted a 2-arm randomized controlled trial, recruiting 92 people living with HIV/AIDS from an HIV clinic in Hunan, China. Participants were randomly assigned in a 1:1 ratio to either the control group (receiving standard care) or the intervention group (receiving AiCare in addition to standard care). All analyses were performed from an intention-to-treat perspective. Sociodemographic and HIV-specific clinical characteristics, along with key adaptation outcomes—including QoL, acceptance of illness, mental health (anxiety and depression), and ART adherence—were assessed at baseline (T0), post intervention (T1), and 3 months post intervention (T2). We used generalized estimating equation models and difference-in-difference analysis to evaluate the interventions’ effects. Results: The difference-in-difference model showed that at T1, the intervention group experienced significant improvements compared to the control group. QoL increased by 6.35 (95% CI 2.62-10.93, P=.001), acceptance of illness improved by 4.49 (95% CI 2.29-6.68, P<.001), and anxiety decreased by 2.15 (95% CI 1.19-3.11; P=.01). At T2, the intervention group’s improvement in QoL was not statistically significant (β 3.62, 95% CI –1.53 to 8.77; P=.17). However, acceptance of illness remained significantly improved by 3.65 (95% CI 1.22-6.08; P=.003), and anxiety decreased by 1.58 (95% CI 0.42-2.74; P=.007). No significant changes were observed in depression or ART adherence between the intervention and control groups. Feedback regarding the AiCare program indicated its acceptability and feasibility. Conclusions: The AiCare program demonstrated promising effects in improving disease adaptation outcomes among people living with HIV/AIDS, notably in enhancing QoL, fostering acceptance of illness, and mitigating anxiety symptoms. These findings underscore the hybrid program’s potential clinical utility to facilitate the adaptation of people living with HIV/AIDS. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400087255; https://www.chictr.org.cn/showproj.html?proj=220729 %M 39988931 %R 10.2196/65268 %U https://www.jmir.org/2025/1/e65268 %U https://doi.org/10.2196/65268 %U http://www.ncbi.nlm.nih.gov/pubmed/39988931 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57679 %T The Dynamics of Doctor-Patient Communication During Remote Consultations: Qualitative Study Among Norwegian Contract General Practitioners %A Norberg,Børge Lønnebakke %A Austad,Bjarne %A Kristiansen,Eli %A Zanaboni,Paolo %A Getz,Linn Okkenhaug %+ General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, PO Box 8905, Trondheim, 7491, Norway, 47 73598859, borge.norberg@ntnu.no %K remote consultations %K digital consultations %K telemedicine %K eHealth %K communication %K safety %K general practice %K family medicine %K focus groups %K telehealth %K digital health %K relationship %K patient-physician %K general practitioner %K thematic analysis %K qualitative analysis %D 2025 %7 27.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient consultations in general practice are undergoing a digital transformation, embracing diverse modalities such as video, text-based, and telephone consultations. The quality of communication in medical consultations is pivotal for successful outcomes, necessitating a comprehensive assessment of the impact of this transformation on doctor-patient communication and interaction. Objective: This study aims to explore general practitioners’ (GPs’) perspectives on how the communication between Norwegian contract GPs and patients has been affected by the large-scale implementation of remote consultations following the onset of the COVID-19 pandemic. Methods: Five focus groups, comprising 18 purposefully recruited GPs from diverse settings and geographical regions in Norway, were carried out in 2022. We applied thematic analysis guided by the framework proposed by Braun and Clarke. Results: Six themes resulted from the analysis. First, suitability regarding remote communication is context-dependent: knowing the characteristics of the patient as a person and the clinical relationship is more important than the reason for contact or type of health problem—even more so than during ordinary physical consultations. Second, remote consultations favor a demarcated communication style, “keeping things simple—the one-problem approach,” which can increase work effectiveness. Third, a downside of such effective minimalism is that the uncritical use of remote consultations may undermine the quality of care. Communication becomes too transactional, limiting the chances of addressing more implicit and complex issues, with the risk of missing vital information. Fourth, remote modalities can help engage hesitant and vulnerable patients. Fifth, GPs make communicative trade-offs in the name of continuity to be able to maintain relationships with patients they see as vulnerable or fugitive. Finally, there are advantages and dilemmas stemming from text-based consultations. Although they offer benefits such as multimedia-enabled patient expression and sharing of digital information, some concerns include the risk of information loss through triage errors, managing informal language, and ending chat-like interactions between patients and doctors. Conclusions: The implementation of remote consultations has many effects on clinical interaction and communication. Although these modalities can enhance efficiency, there is a discernible risk of compromised retrieval of essential information and unvoiced problems, potentially resulting in unintended consequences. The preservation of continuity of care emerges as a pivotal strategy to mitigate some of these challenges. %M 40146204 %R 10.2196/57679 %U https://www.jmir.org/2025/1/e57679 %U https://doi.org/10.2196/57679 %U http://www.ncbi.nlm.nih.gov/pubmed/40146204 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65241 %T The Role of the Installed Base in Information Exchange Among General Practitioners in Germany: Mixed Methods Study %A Holetzek,Tim %A Häusler,Andreas %A Gödde,Kathrin %A Rapp,Michael %A Spallek,Jacob %A Holmberg,Christine %+ Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Hochstrasse 15, Brandenburg/Havel, 14770, Germany, 49 03381411282, tim.holetzek@mhb-fontane.de %K digitalization %K general practitioners %K Germany %K information and communication technologies %K information exchange %K primary health care %K digital transformation %K mixed methods study %K digital health %K health application %K qualitative interview %D 2025 %7 24.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Digitalization is steadily advancing on a global scale, exerting a profound influence on health care systems. To facilitate acceptance of the digital transformation, guiding principles emphasize the need for digital health structures to be person-centered and promote high-quality care. This paper examines the implementation challenges within the German health care system, with a particular focus on how change initiatives engage with existing infrastructures and organizational modes of health care delivery. This approach provides a framework for analyzing how established infrastructure determines new developments while also highlighting the procedural dynamics of change and the integration of innovations within existing information infrastructures. These established infrastructures are referred to as the installed base. Objective: The aim of the study is to examine the installed base encountered by the digital transformation within the German health care system by investigating information exchange practices among general practitioners (GPs) and their communication with other health care actors. Methods: A mixed methods study including a quantitative survey and semistructured qualitative interviews was conducted. The study sample consisted of all publicly accessible GP practices (N=1348) situated in the state of Brandenburg, Germany. The survey captured demographic data, communication practices, and perceived barriers to digitalization. The interviews explored experiences with digital applications. Quantitative data were analyzed using R (R Foundation for Statistical Computing), and qualitative data were managed and analyzed in MAXQDA (VERBI Software GmbH) through content analysis. Results: A total of 250 questionnaires (response rate 18.5%) and 10 interviews with GPs were included in the analysis. GPs primarily use the telephone (n=138, 55.2%, SD 24.64), fax (n=109, 43.9%, SD 25.40), or post (n=50, 20.2%, SD 9.46) to exchange information. Newer digital communication channels such as messenger applications (n=2, 0.8%, SD 0.72) and Communication in the Medical Sector (n=1, 0.5%, SD 0.97) play a minor role. We identified three intertwined clusters displaying diverse barriers to the digitalization of GPs’ communication practices: (1) incompatibility issues and technical immaturity, (2) lack of knowledge and technical requirements, and (3) additional technical, financial, and time-related burdens. These barriers were perceived as significant deterrents to the adoption of digital tools, with older GPs more reliant on analog systems and more likely to view digitalization as a source of frustration. Conclusions: Newly established communication channels in the German health care system compete with the existing information infrastructure, which is deeply integrated into GPs’ practice routines and care processes. However, this installed base has been largely overlooked in digital transformation initiatives. While newer channels hold potential, they often malfunction and are incompatible with long-established, individualized GP workflows. Addressing these issues rather than imposing coercive measures is crucial for increasing adoption. Incorporating health care providers’ perspectives and aligning new channels with established routines can prevent frustration and facilitate a smoother digital transformation. %M 40127672 %R 10.2196/65241 %U https://www.jmir.org/2025/1/e65241 %U https://doi.org/10.2196/65241 %U http://www.ncbi.nlm.nih.gov/pubmed/40127672 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e54516 %T Mechanism Assessment of Physician Discourse Strategies and Patient Consultation Behaviors on Online Health Platforms: Mixed Methods Study %A Kong,Menglei %A Wang,Yu %A Li,Meixuan %A Yao,Zhong %+ School of Economics and Management, Beihang University, No. 37 Xueyuan Road, Haidian District, Beijing, 100083, China, 86 13811013409, 05723@buaa.edu.cn %K online health consultation %K physician discourse strategies %K online physician-patient trust %K shared decision-making %K patient consultation behavior %D 2025 %7 19.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Online health platforms are currently experiencing significant growth. Patients can conveniently seek medical consulting services on such platforms. Against the backdrop of the thriving development of digital health care, the patterns of physician-patient communication are undergoing profound changes. It is imperative to focus on physician discourse strategies during online physician-patient interactions, which will improve the efficiency of physician-patient communication and achieve better management of the physician-patient relationship. Objective: This study aims to explore the influencing mechanism between physician discourse strategies and patient consultation behavior on online health platforms. Additionally, we explore the crucial mediating role of online physician-patient trust and the moderating role of shared decision-making in the online physician-patient communication process. Methods: We used a mixed research approach to explore the influencing mechanism. Data on physician basic attributes and physician-patient communication text records were collected from the Chunyu Doctor website using a web spider. The study obtained a total of 8628 interaction texts from January 2022 to July 2023. Physician discourse strategies (capacity-oriented strategy, quality-oriented strategy, and goodwill-oriented strategy), online physician-patient trust, and shared decision-making were captured through text mining and a random forest model. First, we employed text mining to extract the speech acts, modal resources, and special linguistic resources of each record. Then, using a well-trained random forest model, we captured the specific discourse strategy of each interaction text based on the learned features and patterns. The study generated 863 groups of physician samples with 17 data fields. The hypotheses were tested using an “ordinary least squares” model, and a stability test was conducted by replacing the dependent variable. Results: The capacity-oriented strategy, goodwill-oriented strategy, and quality-oriented strategy had significant effects on patient consultation behavior (β=.151, P=.007; β=.154, P<.001; and β=.17, P<.001, respectively). It should be noted that the anticipated strong effect of the capacity-oriented strategy on patient consultation behavior was not observed. Instead, the effects of the quality-oriented strategy and goodwill-oriented strategy were more prominent. Physician notification adequacy from shared decision-making moderated the effect between the goodwill-oriented strategy and patient consultation behavior (β=.172; P<.001). Additionally, patient expression adequacy from shared decision-making moderated the effect between the capacity-oriented strategy and patient consultation behavior (β=.124; P<.001), and between the goodwill-oriented strategy and patient consultation behavior (β=.104; P=.003). Online physician-patient trust played a significant mediating role between physician discourse strategies and patient consultation behavior. Conclusions: The study findings suggest significant implications for stimulating patient consultation behavior on online health platforms by providing guidance on effective discourse strategies for physicians, thus constructing a trustworthy physician image, improving the physician-patient relationship, and increasing platform traffic. %M 40106798 %R 10.2196/54516 %U https://www.jmir.org/2025/1/e54516 %U https://doi.org/10.2196/54516 %U http://www.ncbi.nlm.nih.gov/pubmed/40106798 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e60506 %T A Comparison of Patient and Provider Perspectives on an Electronic Health Record–Based Discharge Communication Tool: Survey Study %A Wang,Dorothy Yingxuan %A Wong,Eliza Lai-Yi %A Cheung,Annie Wai-Ling %A Tang,Kam-Shing %A Yeoh,Eng-Kiong %K older adult %K gerontology %K geriatric %K old %K older %K elderly %K aging %K aged %K post-acute care %K communication %K satisfaction %K medication information %K patient-provider comparison %K technology-based intervention %K technology acceptance model %K discharge %K EHR %K record %K portal %K cross-sectional %K survey %K questionnaire %K experience %K attitude %K opinion %K perception %K perspective %K acceptance %K adoption %K design %K user experience %D 2025 %7 29.1.2025 %9 %J JMIR Aging %G English %X Background: Hospital discharge for older adult patients carries risks. Effective patient-provider communication is crucial for postacute care. Technology-based communication tools are promising in improving patient experience and outcomes. However, there is limited evidence comparing patient and provider user experiences on a large-scale basis, hindering the exploration of true patient-provider shared understanding. Objective: This study aimed to evaluate an electronic health record–based discharge communication tool by examining and comparing patient and provider perspectives. Methods: This study comprised a cross-sectional self-administered staff survey and a pre-post cross-sectional patient survey. Physicians, nurses, and older adult patients aged 65 years and older discharged from 4 public hospitals were included. Patient-provider comparison items focused on 3 aspects of the design quality of the tool (information clarity, adequacy, and usefulness) and overall satisfaction with the tool. In addition, patients’ experience of discharge information and their medication-taking behaviors before and after the program implementation were compared based on a validated local patient experience survey instrument. Providers’ perceived usefulness of this tool to their work and implementation intentions were measured based on the technology acceptance model to enhance understanding of their experiences by conducting structural equation modeling analysis. Results: A total of 1375 and 2353 valid responses were received from providers and patients, respectively. Patients’ overall satisfaction with this communication tool is significantly higher than providers’, and patients rated the information clarity and usefulness presented by this tool higher as well (P<.001). However, patients rated information adequacy significantly lower than providers (P<.001). Meanwhile, patients reported a significant improvement in their experience of discharge medication information, and fewer patients reported side effects encounters after the program implementation (126/1083, 11.6% vs 111/1235, 9%; P=.04). However, providers showed inconsistent implementation fidelity. Providers’ perceived quality of the tool design (β coefficient=0.24, 95% CI 0.08-0.40) and perceived usefulness to their work (β coefficient=0.57, 95% CI 0.43-0.71) significantly impacted their satisfaction. Satisfaction can significantly impact implementation intentions (β coefficient=0.40, 95% CI 0.17-0.64), which further impacts implementation behaviors (β coefficient=0.16, 95% CI 0.10-0.23). Conclusions: A notable disparity exists between patients and health care providers. This may hinder the achievement of the tool’s benefits. Future research should aim for a comprehensive overview of implementation barriers and corresponding strategies to enhance staff performance and facilitate patient-provider shared understanding. %R 10.2196/60506 %U https://aging.jmir.org/2025/1/e60506 %U https://doi.org/10.2196/60506 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e60585 %T Oncology Clinicians' Perspectives of a Remote Patient Monitoring Program: Multi-Modal Case Study Approach %A Mazzella-Ebstein,Ann Marie %A Daly,Robert %A Huang,Jennie %A Bernal,Camila %A Wilhelm,Clare %A Panageas,Katherine S %A Holland,Jessie %A Salvaggio,Rori %A Ackerman,Jill %A Cracchiolo,Jennifer %A Kuperman,Gilad %A Mao,Jun %A Begue,Aaron %A Barton-Burke,Margaret %K cancer %K oncology %K clinician end users %K remote patient monitoring %K digital health %K implementation science %K patient monitoring %K patient access %K care %K communication %K usability %K functionality %K survey %K interview %K efficiency %K workflow %K user %K clinician support %D 2025 %7 24.1.2025 %9 %J JMIR Hum Factors %G English %X Background: Remote patient monitoring (RPM) aims to improve patient access to care and communication with clinical providers. Overall, understanding the usability of RPM applications and their influence on clinical care workflows is limited from the perspectives of clinician end users at a cancer center in the Northeastern United States. Objective: This study aims to explore the usability and functionality of RPM and elicit the perceptions and experiences of oncology clinicians using RPM for oncology patients after hospital discharge. Methods: The sample included 30 of 98 clinicians (31% response rate) managing at least 5 patients in the RPM program and responding to the mHealth usability between March 2021 and October 2021. Overall, clinicians responded positively to the survey. Item responses with the highest proportion of disagreement were explored further. A nested sample of 5 clinicians who responded to the study survey (30% response rate) participated in interview sessions conducted from November 2021 to February 2022, averaging 60 minutes each. Results: Survey responses highlighted that RPM was easy to use and learn and verified symptom alerts during follow-up phone calls. Areas to improve identified practice changes from reporting RPM alerts through digital portals and its influence on clinicians’ workload burden. Interview sessions revealed 3 main themes: clinician understanding and usability constraints, patient constraints, and suggestions for improving the program. Subthemes for each theme were explored, characterizing technical and functional limitations that could be addressed to enhance efficiency, workflow, and user experience. Conclusions: Clinicians support the value of RPM for improving symptom management and engaging with providers. Improvements to address RPM challenges include functional changes to enhance the program’s utility, such as input from patients about temporal changes in their symptoms and technical resources for home monitoring devices. %R 10.2196/60585 %U https://humanfactors.jmir.org/2025/1/e60585 %U https://doi.org/10.2196/60585 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55158 %T Patients’ Use of e-Consultations as an Alternative to Other General Practitioner Services: Cross-Sectional Survey Study %A Kristiansen,Eli %A Atherton,Helen %A Austad,Bjarne %A Bergmo,Trine Strand %A Norberg,Børge Lønnebakke %A Salisbury,Chris %A Zanaboni,Paolo %+ Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Hansine Hansens veg 18, Tromsø, 9019, Norway, 47 97162311, eli.kristiansen@ehealthresearch.no %K e-consultation %K remote consultation %K telehealth %K primary care %K general practitioner %K patient experience %K cross-sectional %K digital health %K survey %D 2025 %7 8.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: e-Consultations, defined as asynchronous text-based messaging, have transformed how patients interact with their general practitioner (GP). While e-consultations can improve patient access to GP care, concerns about increased workload for GPs are raised. Objective: This study aimed to address three research questions: (1) For what purpose and with what expectations do patients initiate e-consultations? (2) If e-consultations had not been available, what alternative actions would the patient have taken? and (3) How are the alternative actions associated with patient and e-consultation characteristics? Methods: A cross-sectional study was conducted through a web-based survey on Helsenorge. Helsenorge is the national citizen portal for digital health services in Norway, including e-consultations with the GP. All users who sent e-consultations through Helsenorge were invited to participate between January and February 2023. The survey addressed questions on users’ expectations and experience with e-consultations. The association between patient and e-consultation characteristics and alternative actions to e-consultations were analyzed using multinomial logistic regression. Results: Overall, 13,011 users answered the survey. The most common reason for initiating an e-consultation was requesting a sick certificate (4940/13,011, 38%). Overall, 68.7% (8802/13,011) of respondents expected an answer within 24 hours, and 17.7% (2310/13,011) anticipated that the GP would ask them to attend a physical examination. If e-consultations had not been available, 45.5% (5917/13,011) of respondents would have booked a GP appointment, and 44.9% (5846/13,011) would have called the front desk. Users who expected a quicker response (odds ratio [OR] 1.64, 95% CI 1.46-1.85) and were less concerned about their health issues (OR 1.29, 95% CI 1.18-1.40) were more likely to call the front desk. Only 2.5% (323/13,011) of respondents would have contacted out-of-hours services. Users with longer travel time to the GP office (OR 6.08, 95% CI 3.46-10.66) and with a new health problem (OR 2.71, 95% CI 2.09-3.51) were more likely to choose this option. In addition, 4.7% (609/13,011) of the users would not have sought help if e-consultations had not been available. Younger patients (OR 2.16, 95% CI 1.38-3.37) and those with a longer travel time to the GP office (OR 2.19, 95% CI 1.27-3.80) or a new health issue (OR 1.74, 95% CI 1.43-2.12) had higher odds for not seeking help. Conclusions: e-Consultations were often the patients’ first choice of access route, and users expected a fast response. e-Consultations were mostly perceived as an alternative to GP appointments or calling the front desk. Patients with lower availability to the GP office had higher odds of using e-consultations as an alternative to out-of-hours service or waiting and not seeking GP care. Guidance for patient use should be developed to ensure appropriate and safe use. Further research should assess the effect of e-consultations on health outcomes and efficiency. %M 39778196 %R 10.2196/55158 %U https://www.jmir.org/2025/1/e55158 %U https://doi.org/10.2196/55158 %U http://www.ncbi.nlm.nih.gov/pubmed/39778196 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58306 %T The Effectiveness of Video Animations as a Tool to Improve Health Information Recall for Patients: Systematic Review %A Hansen,Steffen %A Jensen,Tue Secher %A Schmidt,Anne Mette %A Strøm,Janni %A Vistisen,Peter %A Høybye,Mette Terp %+ University Clinic for Interdisciplinary Orthopedic Pathways (UCOP), Elective Surgery Center, Silkeborg Regional Hospital, Falkevej 1-3, Silkeborg, 8600, Denmark, 45 61106066, hoybye@clin.au.dk %K public health %K health information %K patient information %K animation video %K digital health %K visualization %K memory %K recall %K education %K synthesis %K review methods %K review methodology %K systematic %K PRISMA %D 2024 %7 30.12.2024 %9 Review %J J Med Internet Res %G English %X Background: Access to clear and comprehensible health information is crucial for patient empowerment, leading to improved self-care, adherence to treatment plans, and overall health outcomes. Traditional methods of information delivery, such as written documents and oral communication, often result in poor memorization and comprehension. Recent innovations, such as animation videos, have shown promise in enhancing patient understanding, but comprehensive investigations into their effectiveness across various health care settings are lacking. Objective: This systematic review aims to investigate the effectiveness of animation videos on health information recall in adult patients across diverse health care sectors, comparing their impact to usual information delivery methods on short-term and long-term recall of health information. Methods: We conducted systematic searches in PubMed, CINAHL, and Embase databases, supplemented by manual searches of reference lists. Included studies were randomized controlled trials involving adult participants (≥18 years) that focused on the use of animation videos to provide health information measured against usual information delivery practice. There were no language restrictions. Out of 2 independent reviewers screened studies, extracted data, and assessed the risk of bias using the Revised Cochrane risk-of-bias tool for randomized trials (RoB2), Covidence was used to handle screening and risk of bias process. A narrative synthesis approach was applied to present results. Results: A total of 15 randomized controlled trials—3 in the United States, 2 in France, 2 in Australia, 2 in Canada, and 1 in the United Kingdom, Japan, Singapore, Brazil, Austria, and Türkiye, respectively—met the inclusion criteria, encompassing 2,454 patients across various health care settings. The majority of studies (11/15, 73%) reported statistically significant improvements in health information recall when animation videos were used, compared with usual care. Animation videos ranged from 1 to 15 minutes in duration with the most common length ranging from 1 to 8 minutes (10/15) and used various styles including 2D cartoons, 3D computers, and whiteboard animations. Most studies (12/15) assessed information recall immediately after intervention, with only 3 studies including longer follow-up periods. Most studies exhibited some concerns related to the risk of bias, particularly in domains related to deviations from intended interventions and selection of reported results. Conclusions: Animation videos appear to significantly improve short-term recall of health information among adult patients across various health care settings compared with usual care. This suggests that animation videos could be a valuable tool for informing patients in different health care settings. However, further research is needed to explore the long-term efficacy of these interventions, their impact on diverse populations, and how different animation styles might affect information recall. Future studies should also address methodological limitations identified in current research, including the use of validated outcome measures and longer follow-up periods. Trial Registration: PROSPERO CRD42022380016; http://crd.york.ac.uk/prospero/display_record.php?RecordID=380016 %M 39753224 %R 10.2196/58306 %U https://www.jmir.org/2024/1/e58306 %U https://doi.org/10.2196/58306 %U http://www.ncbi.nlm.nih.gov/pubmed/39753224 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55753 %T Platform-Based Patient-Clinician Digital Health Interventions for Care Transitions: Scoping Review %A Backman,Chantal %A Papp,Rosie %A Tonjock Kolle,Aurelie %A Papp,Steve %A Visintini,Sarah %A Schaefer Ferreira de Mello,Ana Lúcia %A de Melo Lanzoni,Gabriela Marcellino %A Harley,Anne %+ University of Ottawa, 200 Lees Ave, Ottawa, ON, K1N 6N5, Canada, 1 6133240838, chantal.backman@uottawa.ca %K platform based %K patient-clinician %K digital health intervention %K care transition %K mobile phone %D 2024 %7 30.12.2024 %9 Review %J J Med Internet Res %G English %X Background: Care transitions are complex and can make patients vulnerable to adverse events. Poor communication among clinicians, patients, and their caregivers is a critical gap during these periods of transition. Technology solutions such as platform-based patient-clinician digital health interventions (DHIs) can provide support and education to patients. Objective: The aims of this scoping review were to explore the literature on platform-based patient-clinician DHIs specific to hospital-to-home care transitions and identify the barriers to and enablers of the uptake and implementation of these DHIs. Methods: A scoping review was conducted. A total of 4 databases (MEDLINE, CINAHL, Embase, and the Cochrane Central Register of Controlled Trials) were searched on July 13, 2022. Studies involving patients aged >18 years who used platform-based DHIs during their hospital-to-home transition were included. In total, 2 reviewers independently screened the articles for eligibility using a 2-stage process of title and abstract and full-text screening. Eligible studies underwent data extraction, and the results were analyzed using descriptive and narrative methods. Results: We screened 8322 articles, of which 97 (1.17%) met our inclusion criteria. DHIs were implemented using a mobile app (59/97, 61%), a web-based platform (28/97, 29%), or a combination of both (10/97, 10%). The 2 most common health conditions related to the DHIs were cardiac disease (22/97, 23%) and stroke (11/97, 11%). Outcomes varied greatly but were grouped by health care use, complications, and wellness outcomes. The top 2 barriers were lack of interest (13/97, 13%) and time constraints to use the DHIs (10/97, 10%), and the top 2 enablers were the ability to use the DHIs (17/97, 18%) and their ease of use (11/97, 11%). The main conflicting theme was access (enabler; 28/97, 29%) or limited access (barrier; 15/97, 15%) to technology or the internet. Conclusions: Platform-based DHIs could help improve communication, coordination, and information sharing between clinicians and patients during transition periods. Further research is needed to assess the effectiveness of these platform-based DHIs on patient outcomes. %M 39753212 %R 10.2196/55753 %U https://www.jmir.org/2024/1/e55753 %U https://doi.org/10.2196/55753 %U http://www.ncbi.nlm.nih.gov/pubmed/39753212 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58510 %T Emerging Use of Social Media in Clinical Urology Practice in the 21st Century: Survey Study %A Alfozan,Mohammed %A Alshahrani,Saad %A Alasmi,Raed %K delivery of health care %K social media %K urologists %K urology %K Saudi Arabia %K professional communication %K physician behavior %D 2024 %7 16.12.2024 %9 %J JMIR Form Res %G English %X Background: Social media (So-Me) platforms are valuable resources for health care professionals and academics to discover, discuss, and distribute current advances in research and clinical practices, including technology trends. Objective: This study aims to assess the role of So-Me in urological practice in Saudi Arabia. It explores the influence of digital platforms on patient interaction, professional communication, decision-making, and education. Methods: The survey was conducted among 145 urologists from July 2021 to July 2022 following institutional review board approval. A questionnaire designed using the SurveyMonkey platform examined urologists’ knowledge of So-Me. The survey was conducted using the CHERRIES (Checklist for Reporting Results of Internet E-Surveys) guidelines and was open for 17 weeks. Data analysis was performed using SPSS 21.0. Results: Of the 145 participants, 70% (n=102) were Saudi Arabians. The most common age groups were 30‐40 (n=68, 46.8%) and 41‐50 (n=61, 42.2%) years, with a gender distribution of 44.8% (n=65) women and 55.2% (n=80) men. A total of 61.5% (n=89) of urologists reported using So-Me accounts for professional purposes, with 54.9% (n=80) sharing health-related information. Social media enhanced patient connections beyond clinic visits for 55.8% (n=81) of respondents, while 57.2% (n=83) used it to provide educational resources. Additionally, 56.5% (n=82) believed So-Me facilitated patient feedback and improved their practice. In terms of professional communication, 60.6% (n=88) of urologists agreed that So-Me facilitated collaboration with colleagues, while 63.3% (n=92) used it to stay updated on the latest advances in urology. Furthermore, 62% (n=90) followed professional societies or journals on So-Me, and 63.3% (n=92) used it for continuing medical education. A majority (n=94, 64.7%) reported that So-Me influenced treatment decisions based on new research findings, and 85.3% (n=124) learned about novel technologies and treatment options through these platforms. Regression analysis showed a significant positive correlation between gender and social media usage patterns (R=0.653, R2=0.426), indicating that approximately 42.6% of the differences in usage patterns can be attributed to gender. However, the Pearson χ2 analysis showed that gender did not significantly affect most aspects of social media use, except information sharing and participating in online discussions (both P<.05). Conclusions: This study highlights the widespread use of So-Me among urologists in Saudi Arabia, underscoring its role in enhancing patient interaction, professional development, and clinical decision-making. Strategically designed health care programs using social media could improve and modernize professional and patient-centered care in Saudi Arabia through legislative assistance and guidelines. %R 10.2196/58510 %U https://formative.jmir.org/2024/1/e58510 %U https://doi.org/10.2196/58510 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e60352 %T Electronic Communication Between Children’s Caregivers and Health Care Teams: Scoping Review on Parental Caregiver’s Perceptions and Experience %A Gamper,Mary Jo %A Singer Cohen,Rebecca %A Esperanza Razaz,Maryam %A Parrillo,Elaina %A Thornton,Clifton P %A Wec,Aleksandra %A McDonald,Kathryn %A Gleason,Kelly T %K electronic communication %K patient portal %K provider-patient relations %K parental caregiver %K relational coordination theory %K patient-clinician relationship %K mobile phone %D 2024 %7 13.12.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Asynchronous communication via electronic modes (e-communication), including patient portals, secure messaging services, SMS text messaging, and email, is increasingly used to supplement synchronous face-to-face medical visits; however, little is known about its quality in pediatric settings. Objective: This review aimed to summarize contemporary literature on pediatric caregivers’ experiences with and perspectives of e-communication with their child’s health care team to identify how e-communication has been optimized to improve patient care. Methods: A scoping review following the Arksey and O’Malley methodological framework searched PubMed, CINAHL, Embase, and Web of Science using terms such as “Electronic Health Records” and “Communication” from 2013 to 2023 that discussed caregiver experiences and perspectives of e-communication with their child’s health care provider. Studies were excluded if they were abstracts, non-English papers, nonscientific papers, systematic reviews, or quality improvement initiatives, or pertained to synchronous telemedicine. We conducted a two-step screening process by scanning the title and abstract and reviewing the full text by two independent screeners to confirm eligibility. From an initial 903 articles identified via the database search, 23 articles fulfilled all the inclusion criteria and are included in this review. Results: Of the 23 articles meeting the inclusion criteria, 11 used quantitative methods, 7 used qualitative methods, and 5 used mixed methods. The caregiver sample sizes ranged from 51 to 3339 in the quantitative studies and 8 to 36 in the qualitative and mixed methods studies. A majority (n=17) used the patient portal that was self-categorized by the study. Secure messaging through a portal or other mobile health app was used in 26% (n=6) of the studies, while nonsecure messaging outside of the portal was used 17% (n=4) of the time and email was used 33.3% (n=8) of the time. In 19 of the studies, parents reported positive experiences with and a desire for e-communication methods. Conclusions: The literature overwhelmingly supported caregiver satisfaction with and desire for e-communication in health care, but no literature intentionally studied how to improve the quality of e-communication, which is a critical gap to address. %R 10.2196/60352 %U https://pediatrics.jmir.org/2024/1/e60352 %U https://doi.org/10.2196/60352 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 8 %N %P e63006 %T Ethical Dilemmas Among Oncology Nurses in China: Cross-Sectional Study %A Ko,Eunjeong %A Shamsalizadeh,Neda %A Lee,Jaehoon %A Ni,Ping %K prognosis-related communication %K ethical dilemmas %K oncology %K ethics %K China %K beliefs %K nursing %K cultural values %K prognosis %D 2024 %7 13.12.2024 %9 %J Asian Pac Isl Nurs J %G English %X Background: Effective communication about cancer prognosis is imperative for enhancing the quality of end-of-life care and improving patient well-being. This practice is sensitive and is heavily influenced by cultural values, beliefs, and norms, which can lead to ethical dilemmas. Despite their significance, ethical challenges in nursing related to prognosis communication are understudied in China. Objective: This study aimed to examine the ethical dilemmas relating to cancer prognosis communication and their associated factors. Methods: A cross-sectional design was employed to survey 373 oncology nurses in mainland China. Data were collected on ethical dilemmas, attitudes, barriers, experiences with prognosis communication, sociodemographics, and practice-related information. Ordinary least squares regressions were used to identify factors contributing to ethical dilemmas. Results: Participants reported a moderate level of ethical dilemmas in prognostic communication (mean 13.5, SD 3.42; range 5‐20). Significant predictors of these dilemmas included perceived barriers (P<.001), experiences with prognosis communication (P<.001), and years of work experience (P=.002). Nurses who perceived greater communication barriers, had more negative experiences with prognosis communication, and had less work experience were more likely to encounter ethical dilemmas in prognosis-related communication. Conclusions: Chinese oncology nurses frequently encounter ethical dilemmas, as well as barriers, in communicating cancer prognoses. This study’s findings emphasize the importance of culturally tailored communication training. Collaborative interprofessional training, particularly through physician-nurse partnerships, can perhaps enhance the proficiency of cancer prognosis-related communication. %R 10.2196/63006 %U https://apinj.jmir.org/2024/1/e63006 %U https://doi.org/10.2196/63006 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e63311 %T Discussions of Cannabis Over Patient Portal Secure Messaging: Content Analysis %A Shetty,Vishal A %A Gregor,Christina M %A Tusing,Lorraine D %A Pradhan,Apoorva M %A Romagnoli,Katrina M %A Piper,Brian J %A Wright,Eric A %+ Department of Health Promotion and Policy, University of Massachusetts, 715 North Pleasant St., Amherst, MA, 01003, United States, 1 413 230 4015, vashetty@geisinger.edu %K patient portal %K secure message %K marijuana %K patient-provider communication %K message content %K content analysis %K United States %K pain %K anxiety %K depression %K insomnia %K electronic messaging %K electronic health record %K EHR %K cannabis %D 2024 %7 12.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient portal secure messaging allows patients to describe health-related behaviors in ways that may not be sufficiently captured in standard electronic health record (EHR) documentation, but little is known about how cannabis is discussed on this platform. Objective: This study aimed to identify patient and provider secure messages that discussed cannabis and contextualize these discussions over periods before and after its legalization for medical purposes in Pennsylvania. Methods: We examined 382,982 secure messages sent by 15,340 patients and 6101 providers from an integrated health delivery system in Pennsylvania, United States, from January 2012 to June 2022. We used an unsupervised natural language processing approach to construct a lexicon that identified messages explicitly discussing cannabis. We then conducted a qualitative content analysis on a random sample of identified messages to understand the medical reasons behind patients’ use, the primary purposes of the cannabis-related discussions, and changes in these purposes over time. Results: We identified 1782 messages sent by 1098 patients (7.2% of total patients in the study) and 800 messages sent by 430 providers (7% of total providers in the study) as explicitly discussing cannabis. The most common medical reasons for use stated by patients in 190 sampled messages included pain or a pain-related condition (50.5% of messages), anxiety (13.7% of messages), and sleep (11.1% of messages). We coded 56 different purposes behind the mentions of cannabis in patient messages and 33 purposes in 100 sampled provider messages. In years before the legalization (2012-2016), patient and provider messages (n=20 for both) were primarily driven by discussions about cannabis screening results (38.9% and 76.5% of messages, respectively). In the years following legalization (2017-2022), patient messages (n=170) primarily involved seeking assistance to facilitate medical use (35.2% of messages) and reporting current use (25.3% of messages). Provider messages (n=80) were driven by giving assistance with medical marijuana access (27.5% of messages) and stating that they were unable to refer, prescribe or recommend medical marijuana (26.3% of messages). Conclusions: Patients showed a willingness to discuss cannabis use over patient portal secure messages and expressed interest in use after the legalization of medical marijuana. Some providers responded to patient inquiries with assistance in obtaining access to medical marijuana, while others cautioned patients on the risks of use. Insight into cannabis-related discussions through secure messages can help health systems determine opportunities to improve care processes around patients’ cannabis use, and providers should be supported to communicate accurate and consistent information. %M 39666375 %R 10.2196/63311 %U https://www.jmir.org/2024/1/e63311 %U https://doi.org/10.2196/63311 %U http://www.ncbi.nlm.nih.gov/pubmed/39666375 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48882 %T Individual Characteristics in the Comprehension of Pandemic Video Communication: Randomized Controlled Between-Subjects Design %A Lungu,Daniel Adrian %A Røislien,Jo %A Smeets,Ionica %A Wiig,Siri %A Brønnick,Kolbjørn Kallesten %+ SHARE – Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, PO Box 8600, Stavanger, 4021, Norway, 47 91532327, daniel.a.lungu@uis.no %K video communication %K COVID-19 pandemic %K comprehension %K health literacy %K video %K videos %K health communication %K psychology %K perception %K comprehend %K understanding %K coronavirus disease 2019 %D 2024 %7 4.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Video played an important role in health communication throughout the COVID-19 pandemic. It was used to communicate pandemic information to the public, with a variety of formats, presenters, and topics. Evidence regarding the effectiveness of video features is available, while how individual characteristics of recipients influence communication comprehension is still limited. Objective: This study aimed to test 6 individual characteristics and assess their effect on the comprehension of pandemic video communication. Methods: Short health communication videos were presented to a large sample of subjects, receiving questionnaire responses from 1194 participants. Individual characteristics consisted of age, sex, living area, education level, income level, and belief in science. Communication comprehension consisted of both perceived and objective comprehension. The data were analyzed by multiple linear regression. Results: Age had a negative effect on both perceived and objective comprehension—age was negatively associated with comprehension. There were sex differences, with higher perceived comprehension and lower objective comprehension among female than male individuals. Living in an urban or a rural area had no significant effect (all P>.05). The level of education and income had a positive effect on both subjective and objective comprehension. Finally, the belief in science had a positive effect on perceived comprehension (P<.001) but did not have a statistically significant effect on objective comprehension (P=.87). Conclusions: The main differences between those who think they understand pandemic communication and those who comprehend it better are sex (female individuals have a higher perception of having comprehended, while male individuals have higher levels of objective comprehension) and belief in science (higher belief in science leads to higher perceived comprehension, while it does not have any impact on objectively understanding the message conveyed). %M 39631064 %R 10.2196/48882 %U https://www.jmir.org/2024/1/e48882 %U https://doi.org/10.2196/48882 %U http://www.ncbi.nlm.nih.gov/pubmed/39631064 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47311 %T Cybersecurity Interventions in Health Care Organizations in Low- and Middle-Income Countries: Scoping Review %A Hasegawa,Kaede %A O'Brien,Niki %A Prendergast,Mabel %A Ajah,Chris Agape %A Neves,Ana Luisa %A Ghafur,Saira %+ Institute of Global Health Innovation, Imperial College London, 10th Floor, St Mary's Hospital, Praed Street, London, W2 1NY, United Kingdom, 44 020 7594 1419, n.obrien@imperial.ac.uk %K computer security %K internet security %K network security %K digital health %K digital health technology %K cybersecurity %K health data %K global health %K security %K data science %K LMIC %K low income %K low resource %K scoping review %K review methodology %K implementation %K barrier %K facilitator %D 2024 %7 20.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Health care organizations globally have seen a significant increase in the frequency of cyberattacks in recent years. Cyberattacks cause massive disruptions to health service delivery and directly impact patient safety through disruption and treatment delays. Given the increasing number of cyberattacks in low- and middle-income countries (LMICs), there is a need to explore the interventions put in place to plan for cyberattacks and develop cyber resilience. Objective: This study aimed to describe cybersecurity interventions, defined as any intervention to improve cybersecurity in a health care organization, including but not limited to organizational strategy(ies); policy(ies); protocol(s), incident plan(s), or assessment process(es); framework(s) or guidelines; and emergency planning, implemented in LMICs to date and to evaluate their impact on the likelihood and impact of attacks. The secondary objective was to describe the main barriers and facilitators for the implementation of such interventions, where reported. Methods: A systematic search of the literature published between January 2017 and July 2024 was performed on Ovid Medline, Embase, Global Health, and Scopus using a combination of controlled terms and free text. A search of the gray literature within the same time parameters was undertaken on the websites of relevant stakeholder organizations to identify possible additional studies that met the inclusion criteria. Findings from included papers were mapped against the dimensions of the Essentials of Cybersecurity in Health Care Organizations (ECHO) framework and presented as a narrative synthesis. Results: We included 20 studies in this review. The sample size of the majority of studies (13/20, 65%) was 1 facility to 5 facilities, and the studies were conducted in 14 countries. Studies were categorized into the thematic dimensions of the ECHO framework, including context; governance; organizational strategy; risk management; awareness, education, and training; and technical capabilities. Few studies (6/20, 30%) discussed cybersecurity intervention(s) as the primary focus of the paper; therefore, information on intervention(s) implemented had to be deduced. There was no attempt to report on the impact and outcomes in all papers except one. Facilitators and barriers identified were grouped and presented across national or regional, organizational, and individual staff levels. Conclusions: This scoping review’s findings highlight the limited body of research published on cybersecurity interventions implemented in health care organizations in LMICs and large heterogeneity across existing studies in interventions, research objectives, methods, and outcome measures used. Although complex and challenging, future research should specifically focus on the evaluation of cybersecurity interventions and their impact in order to build a robust evidence base to inform evidence-based policy and practice. %M 39566062 %R 10.2196/47311 %U https://www.jmir.org/2024/1/e47311 %U https://doi.org/10.2196/47311 %U http://www.ncbi.nlm.nih.gov/pubmed/39566062 %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 %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57040 %T How Do Scholars Conceptualize and Conduct Health and Digital Health Literacy Research? Survey of Federally Funded Scholars %A Sakhuja,Mayank %A Yelton,Brooks %A Kavarana,Simone %A Schaurer,Lauren %A Rumthao,Jancham Rachel %A Noblet,Samuel %A Arent,Michelle A %A Macauda,Mark M %A Donelle,Lorie %A Friedman,Daniela B %+ UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 323A Rosenau Hall, Chapel Hill, NC, 27599-7295, United States, 1 8034468063, msakhuja@unc.edu %K health literacy %K digital health literacy %K eHealth literacy %K social determinants of health %K SDoH %K research scholarship %K health care %K public health research %K digital health tools %K community health %D 2024 %7 31.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The concept of health literacy (HL) is constantly evolving, and social determinants of health (SDoH) have been receiving considerable attention in public health scholarship. Since a 1-size-fits-all approach for HL fails to account for multiple contextual factors and as a result poses challenges in improving literacy levels, there is a need to develop a deeper understanding of the current state of HL and digital health literacy (DHL) research. Objective: This study examined scholars’ conceptualization and scope of work focused on HL and DHL. Methods: Using a search string, investigators (N=2042) focusing on HL, DHL, or both were identified from the grantee websites of the National Institutes of Health RePORTER (RePORT Expenditures and Results) and the Canadian Institutes of Health Research. The investigators were emailed a survey via Qualtrics. Survey questions examined the focus of work; whether the investigators studied HL/DHL in combination with other SDoH; the frameworks, definitions, and approaches used; and research settings. We analyzed survey data using SPSS Statistics version 28 and descriptive analysis, including frequencies and percentages, was conducted. Chi-square tests were performed to explore the association between the focus of work, settings, and age groups included in the investigators’ research. Results: A total of 193 (9.5%) of 2042 investigators responded to the online survey. Most investigators (76/153, 49.7%) were from public health, 83/193 (43%) reported their research focused on HL alone, 46/193 (23.8%) mentioned DHL, and 64/193 (33.2%) mentioned both. The majority (133/153, 86.9%) studied HL/DHL in combination with other SDoH, 106/135 (78.5%) conducted HL/DHL work in a community setting, and 100/156 (64.1%) reported not using any specific definition to guide their work. Digital tools (89/135, 65.9%), plain-language materials (82/135, 60.7%), and visual guides (56/135, 41.5%) were the top 3 approaches used. Most worked with adults (131/139, 94.2%) and all races and ethnicities (47/121, 38.8%). Conclusions: HL and DHL research largely considered SDoH. Multiple HL tools and approaches were used that support the examination and improvement of literacy and communication surrounding health care issues. %M 39481097 %R 10.2196/57040 %U https://www.jmir.org/2024/1/e57040 %U https://doi.org/10.2196/57040 %U http://www.ncbi.nlm.nih.gov/pubmed/39481097 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e62691 %T Transitioning Perspectives in Digital Health Through Phenomenology Integration %A Fiordelli,Maddalena %+ Institute of Public Health, Faculty of Biomedical Sciences, Università della Svizzera italiana, Via Buffi 13, Lugano, 6900, Switzerland, 41 586664139, maddalena.fiordelli@usi.ch %K eHealth %K digital health %K phenomenology %K phenomenological %K participatory %K health communication %K health information %K active listening %K lived experience %D 2024 %7 23.10.2024 %9 Viewpoint %J J Med Internet Res %G English %X The evolution of digital health, from its early days as eHealth to its current expansive scope, reflects a significant transformation in health care delivery and management. This transition underscores the integration of digital technologies across the health continuum from prevention and diagnosis to treatment and rehabilitation. The emergence of digital health has introduced innovative solutions but also posed challenges, particularly in aligning technological advancements with health needs, human experiences, and ethical considerations. This position paper aims to explore the integration of phenomenology in digital health, advocating for a paradigm that emphasizes the centrality of human experience in the design and implementation of digital health solutions. It specifically seeks to address challenges related to relevance for individuals who “speak” different languages, ensuring long-term use, addressing digital and health literacy, coordinating various sources, and navigating ethical issues in the rapidly evolving digital health landscape. Drawing upon years of research and practical experience in communication technologies and health, this paper uses a reflective approach to examine the intersection of digital health and phenomenology. It reviews the historical development of digital health, identifies the challenges faced during its evolution, and discusses the potential of phenomenological methods to enhance user-centered design and ethical practices in digital health. The integration of phenomenology into digital health facilitates a deeper understanding of user experiences, enabling the development of more responsive and ethical digital health solutions. Participatory design models, informed by phenomenological perspectives, offer a pathway to bridge the gap between technological innovation and human-centric health care. The paper highlights successful practices in digital health development, including mobile apps for vaccination decision-making and platforms for managing chronic conditions, illustrating the benefits of a phenomenological approach. Transitioning perspectives in digital health through phenomenology integration represents a critical step toward realizing the full potential of digital technologies in health care. %M 39442170 %R 10.2196/62691 %U https://www.jmir.org/2024/1/e62691 %U https://doi.org/10.2196/62691 %U http://www.ncbi.nlm.nih.gov/pubmed/39442170 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53705 %T Exploring Physicians’ Perceptions of Digital Health’s Impact on the Patient-Physician Relationship in the Primary Health Care Setting: Qualitative Descriptive Study %A Sze,Kai Ping %A Fong,Qi Wei %A De Roza,Jacqueline Giovanna %A Lee,Eng Sing %A Tan,Shu Yun %+ National Healthcare Group Polyclinics, 3 Fusionopolis Link, #03-08, Singapore, 138543, Singapore, 65 63553000, kai_ping_sze@nhgp.com.sg %K patient-physician relationship %K patient communication %K trust %K primary care medicine %K digital health %K primary care %K longitudinal care %K policy %K implementation %D 2024 %7 15.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health has become essential for effective clinical practice. However, the successful adoption of digital health is dependent on the strength of the patient-physician relationship. The patient-physician relationship shapes the quality of care and impacts health care outcomes, especially in primary care. However, the impact of the increasing use of digital health on the patient-physician relationship is uncertain. Objective: This study aims to explore the types of digital health primary care physicians use and understand their impact on the patient-physician relationship from their perspective. Methods: This exploratory qualitative descriptive study used individual in-depth interviews guided by a semistructured topic guide. We purposively sampled physicians from 6 general primary care clinics in Singapore and used thematic analysis to identify emergent themes. Results: We conducted 12 interviews. We found that primary care physicians in Singapore had minimal exposure to digital health beyond the scope of institutional implementation. The three key themes that emerged were as follows: (1) evolving roles of both physicians and patients; (2) impact on trust, knowledge acquisition, and longitudinal care; and (3) adoption and use factors of digital health impacting patient-physician relationships. The adoption and use factors comprised “social and personal,” “technical and material,” and “organization and policy” factors. Conclusions: The study identified that, while primary care physicians held mostly positive views on adopting digital health in improving the patient-physician relationship, they were concerned that digital health might erode trust, hinder proper knowledge acquisition, and reduce humanistic interaction. These concerns called for a nuanced approach to ensure that digital health would not compromise the patient-physician relationship. This could be achieved by ensuring that physicians possess the necessary skills, knowledge, and positive attitude, while health care organizations would provide robust IT capabilities and support. We recommend that education be refined and government policies on digital health adoption and use be revised to align with the goal of strengthening the patient-physician relationship. %M 39405515 %R 10.2196/53705 %U https://www.jmir.org/2024/1/e53705 %U https://doi.org/10.2196/53705 %U http://www.ncbi.nlm.nih.gov/pubmed/39405515 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e64092 %T Retention in HIV Primary Care Using a Web-Based Patient Engagement Platform: Multistate Case-Control Study %A Sukhija-Cohen,Adam Carl %A Patani,Henna %A Blasingame,Michael Foxworth %A Vu,Kathy Linh %A Bastani,Ramin %+ Sutter Health, Palo Alto Medical Foundation Research Institute, 795 El Camino Real, Ames Building, Palo Alto, CA, 94301, United States, 1 (650) 330 5963, adam.sukhija-cohen@sutterhealth.org %K HIV %K primary health care %K retention in care %K digital technology %K appointments and schedules %D 2024 %7 2.10.2024 %9 Short Paper %J J Med Internet Res %G English %X Background: Digital interventions to improve retention in HIV care are critical to ensure viral suppression and prevent further transmission. AIDS Healthcare Foundation Healthcare Centers are centers across the United States that provide primary HIV care. Traditionally, the Healthcare Centers conduct phone calls with patients to schedule and confirm appointments, as well as share laboratory results. In 2017, Healthvana piloted a digital platform at AIDS Healthcare Foundation Healthcare Centers to send patients SMS text message appointment reminders and allow patients to review their upcoming appointment and view their laboratory results in the web-based patient portal. Objective: A national implementation in 15 US states and Washington, DC, of this digital intervention pilot by Healthvana aims to determine whether SMS appointment reminders and web-based patient portal logins improved retention in care compared to traditional methods. Methods: A retrospective analysis of 40,028 patients living with HIV was conducted at the 61 AIDS Healthcare Foundation Healthcare Centers between January 2, 2017, and May 22, 2018. Patients were invited to enroll in Healthvana’s digital intervention pilot, allowing for a natural, organization-wide case-control study. Separate binary logistic regression models evaluated the relationship between receiving SMS appointment reminders and completing scheduled appointments, as well as the relationship between logging into the web-based patient portal and completing scheduled appointments. Four scheduled consecutive appointments for each patient were included in the analysis to account for 1 full year of data per patient. Results: Patients who received the SMS appointment reminder were 1.7 times more likely to complete appointment 1 compared to patients who did not receive the SMS appointment reminder (P<.001). In addition, patients who received the SMS appointment reminder were 1.6 times more likely to complete appointment 2 (P<.001), 1.7 times more likely to complete appointment 3 (P<.001), and 1.8 times more likely to complete appointment 4 (P<.001) compared to patients who did not receive the SMS appointment reminder. Patients who logged in to the web-based patient portal prior to their scheduled appointment were 7.4 times more likely to complete appointment 1 compared to patients who did not log in (P<.001). In addition, patients who logged in to the web-based patient portal prior to their scheduled appointment were 3.6 times more likely to complete appointment 2 (P<.001), 3.2 times more likely to complete appointment 3 (P<.001), and 2.8 times more likely to complete appointment 4 (P<.001) compared to patients who did not log in. Conclusions: HIV primary care appointment completion was higher when patients engaged with Healthvana’s digital platform. Digital technology interventions to ensure patients complete their scheduled HIV care appointments are imperative to curb the HIV epidemic. %M 39357049 %R 10.2196/64092 %U https://www.jmir.org/2024/1/e64092 %U https://doi.org/10.2196/64092 %U http://www.ncbi.nlm.nih.gov/pubmed/39357049 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46556 %T Designing A Blockchain-Empowered Telehealth Artifact for Decentralized Identity Management and Trustworthy Communication: Interdisciplinary Approach %A Liang,Xueping %A Alam,Nabid %A Sultana,Tahmina %A Bandara,Eranga %A Shetty,Sachin %+ Florida International University, 11200 S.W. 8th Street, Miami, FL, 33199, United States, 1 305 348 2830, xuliang@fiu.edu %K telehealth %K blockchain %K security %K software %K proof of concept %K implementation %K privacy %D 2024 %7 25.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Telehealth played a critical role during the COVID-19 pandemic and continues to function as an essential component of health care. Existing platforms cannot ensure privacy and prevent cyberattacks. Objective: The main objectives of this study are to understand existing cybersecurity issues in identity management and trustworthy communication processes in telehealth platforms and to design a software architecture integrated with blockchain to improve security and trustworthiness with acceptable performance. Methods: We improved personal information security in existing telehealth platforms by adopting an innovative interdisciplinary approach combining design science, social science, and computer science in the health care domain, with prototype implementation. We used the design science research methodology to implement our overall design. We innovated over existing telehealth platforms with blockchain integration that improves health care delivery services in terms of security, privacy, and efficiency. We adopted a user-centric design approach and started with user requirement collection, followed by system functionality development. Overall system implementation facilitates user requirements, thus promoting user behavior for the adoption of the telehealth platform with decentralized identity management and an access control mechanism. Results: Our investigation identified key challenges to identity management and trustworthy communication processes in telehealth platforms used in the current health care domain. By adopting distributed ledger technology, we proposed a decentralized telehealth platform to support identity management and a trustworthy communication process. Our design and prototype implementation using a smart contract–driven telehealth platform to provide decentralized identity management and trustworthy communication with token-based access control addressed several security challenges. This was substantiated by testing with 10,000 simulated transactions across 5 peers in the Rahasak blockchain network. The proposed design provides resistance to common attacks while maintaining a linear time overhead, demonstrating improved security and efficiency in telehealth services. We evaluated the performance in terms of transaction throughput, smart contract execution time, and block generation time. To create a block with 10,000 transactions, it takes 8 seconds on average, which is an acceptable overhead for blockchain-based applications. Conclusions: We identified technical limitations in current telehealth platforms. We presented several design innovations using blockchain to prototype a system. We also presented the implementation details of a unique distributed architecture for a trustworthy communication system. We illustrated how this design can overcome privacy, security, and scalability limitations. Moreover, we illustrated how improving these factors sets the stage for improving and standardizing the application and for the wide adoption of blockchain-enabled telehealth platforms. %M 39320943 %R 10.2196/46556 %U https://www.jmir.org/2024/1/e46556 %U https://doi.org/10.2196/46556 %U http://www.ncbi.nlm.nih.gov/pubmed/39320943 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51690 %T Preferences for Text Messaging Supports During Youth Transition to Adult Mental Health Services: Theory-Informed Modified e-Delphi Study %A Vakili,Negar %A Curran,Janet A %A Walls,Roisin %A Phillips,Debbie %A Miller,Alanna %A Cassidy,Christine %A Wozney,Lori %+ Mental Health and Addictions, IWK Health, 5850/5980 University Avenue, Halifax, NS, PO Box 9700, Canada, 1 902 719 9285, lori.wozney@iwk.nshealth.ca %K patient satisfaction %K satisfaction %K cross-sectional %K survey %K surveys %K engagement %K usage %K technology use %K transitional %K transition %K coordinated care %K service %K services %K feature %K features %K need %K needs %K transitional care %K information science %K human-computer interaction %K health behavior %K text-messaging %K messaging %K text messages %K text message %K SMS %K mental health %K persuasive system design %K youth %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %D 2024 %7 27.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: For many young people, the transition from child to adult mental health services is a vulnerable time associated with treatment disengagement and illness progression. Providing service information and options to youth, appealing to them, and tailoring to their needs during this period could help overcome systematic barriers to a successful transition. We know little about how SMS text message–based interventions might be leveraged to support the motivational, informational, and behavioral needs of youth during this time. Ascertaining youth preferences for the content and functionality of an SMS text message service could inform prototype development. Objective: This study investigated consensus preferences among youth on important content, technology features, and engagement supports to inform a transition-focused SMS text message service. Methods: A modified e-Delphi survey design was used to collect demographics, current levels of technology use, importance ratings on message content, preferred technical features, and barriers and enablers to engagement for youth in Canada aged 16-26 years who have accessed mental health services within the past 5 years. Survey items on content were categorized according to the information-motivation-behavioral skills (IMB) model. Survey items on technical features were categorized according to the persuasive system design (PSD) model. A predefined consensus rating matrix and descriptive statistics were used to characterize the sample. The high consensus threshold was 70%. Results: A total of 100 participants, predominantly non-White (n=47, 47%), aged 20-26 years (n=59, 59%), and who had first accessed mental health services between the ages of 13 and 19 years (n=60, 60%), were selected. The majority (n=90, 90%) identified as daily SMS text message users. A high level of consensus on importance ratings was reported in 45% (9/20) of content items based on the IMB model. There were higher levels of consensus on importance ratings related to behavior domain items (3/3, 100%) than information domain items (4/9, 44%) or motivation domain items (2/8, 25%). A high level of consensus on importance ratings was reported in only 19% (4/21) of feature and functionality items based on the PSD model. Among PSD model categories, there was a high level of consensus on importance ratings in 8% (1/12) of the primary task support domain items and 100% (3/3) of the system credibility support domain items. None of the dialogue-support and social-support domain items met the high level of consensus thresholds. In total, 27% (27/100) of youth indicated that the most significant enabler for engaging with a transition-focused SMS text message intervention was the personalization of text messages. Conclusions: Scientists developing next-generation SMS text messaging interventions for this population need to consider how levels of consensus on different features may impact feasibility and personalization efforts. Youth can (and should) play an integral role in the development of these interventions. %M 39190437 %R 10.2196/51690 %U https://formative.jmir.org/2024/1/e51690 %U https://doi.org/10.2196/51690 %U http://www.ncbi.nlm.nih.gov/pubmed/39190437 %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 e51672 %T Examining the Role of Physician Characteristics in Web-Based Verified Primary Care Physician Reviews: Observational Study %A Sehgal,Neil K R %A Rader,Benjamin %A Brownstein,John S %+ Department of Computer and Information Science, University of Pennsylvania, 3330 Walnut St, Philadelphia, PA, 19104, United States, 1 215 898 9672, neilsehgal99@gmail.com %K patient review websites %K patient online review %K telemedicine %K internet %K online review %K online reviews %K rating %K physician review %K physician reviews %K doctor review %K doctor reviews %D 2024 %7 29.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Doctor review websites have become increasingly popular as a source of information for patients looking to select a primary care provider. Zocdoc is one such platform that allows patients to not only rate and review their experiences with doctors but also directly schedule appointments. This study examines how several physician characteristics including gender, age, race, languages spoken in a physician’s office, education, and facial attractiveness impact the average numerical rating of primary care doctors on Zocdoc. Objective: The aim of this study was to investigate the association between physician characteristics and patient satisfaction ratings on Zocdoc. Methods: A data set of 1455 primary care doctor profiles across 30 cities was scraped from Zocdoc. The profiles contained information on the physician’s gender, education, and languages spoken in their office. Age, facial attractiveness, and race were imputed from profile pictures using commercial facial analysis software. Each doctor profile listed an average overall satisfaction rating, bedside manner rating, and wait time rating from verified patients. Descriptive statistics, the Wilcoxon rank sum test, and multivariate logistic regression were used to analyze the data. Results: The average overall rating on Zocdoc was highly positive, with older age, lower facial attractiveness, foreign degrees, allopathic degrees, and speaking more languages negatively associated with the average rating. However, the effect sizes of these factors were relatively small. For example, graduates of Latin American medical schools had a mean overall rating of 4.63 compared to a 4.77 rating for US graduates (P<.001), a difference roughly equivalent to a 2.8% decrease in appointments. On multivariate analysis, being Asian and having a doctor of osteopathic medicine degree were positively associated with higher overall ratings, while attending a South Asian medical school and speaking more European and Middle Eastern languages in the office were negatively associated with higher overall ratings. Conclusions: Overall, the findings suggest that age, facial attractiveness, education, and multilingualism do have some impact on web-based doctor reviews, but the numerical effect is small. Notably, bias may play out in many forms. For example, a physician's appearance or accent may impact a patient's trust, confidence, or satisfaction with their physician, which could in turn influence their take-up of preventative services and lead to either better or worse health outcomes. The study highlights the need for further research in how physician characteristics influence patient ratings of care. %M 39074363 %R 10.2196/51672 %U https://www.jmir.org/2024/1/e51672 %U https://doi.org/10.2196/51672 %U http://www.ncbi.nlm.nih.gov/pubmed/39074363 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e52985 %T Using a Mobile Messenger Service as a Digital Diary to Capture Patients’ Experiences Along Their Interorganizational Treatment Path in Gynecologic Oncology: Lessons Learned %A Baum,Eleonore %A Thiel,Christian %A Kobleder,Andrea %A Bernhardsgrütter,Daniela %A Engst,Ramona %A Maurer,Carola %A Koller,Antje %+ Institute of Applied Nursing Science, School of Health, Eastern Switzerland University of Applied Sciences, Neumarkt 3, Vadianstrasse 29, St.Gallen, 9000, Switzerland, 41 58 257 12 13, antje.koller@ost.ch %K mobile apps %K computer security %K confidentiality %K data collection %K oncology %K breast neoplasms %K mobile phone %D 2024 %7 29.7.2024 %9 Viewpoint %J JMIR Cancer %G English %X A digital diary in the form of a mobile messenger service offers a novel method for data collection in cancer research. Little is known about the things to consider when using this data collection method in clinical research for patients with cancer. In this Viewpoint paper, we discuss the lessons we learned from using a qualitative digital diary method via a mobile messenger service for data collection in oncology care. The lessons learned focus on three main topics: (1) data quality, (2) practical aspects, and (3) data protection. We hope to provide useful information to other researchers who consider this method for their research with patients. First, in this paper, we argue that the interactive nature of a digital diary via a messenger service is very well suited for the phenomenological approach and produces high-quality data. Second, we discuss practical issues of data collection with a mobile messenger service, including participant and researcher interaction. Third, we highlight corresponding aspects around technicalities, particularly those regarding data security. Our views on data privacy and information security are summarized in a comprehensive checklist to inform fellow researchers on the selection of a suitable messenger service for different scenarios. In our opinion, a digital diary via a mobile messenger service can provide high-quality data almost in real time and from participants’ daily lives. However, some considerations must be made to ensure that patient data are sufficiently protected. The lessons we learned can guide future qualitative research using this relatively novel method for data collection in cancer research. %M 39073852 %R 10.2196/52985 %U https://cancer.jmir.org/2024/1/e52985 %U https://doi.org/10.2196/52985 %U http://www.ncbi.nlm.nih.gov/pubmed/39073852 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e43894 %T Investigating How the Use of Technology Can Reduce Missed Appointments: Quantitative Case Study at a General Practitioner Surgery %A Sides,Teresa %A Kbaier,Dhouha %+ The Open University, Walton Hall, Kents Hill, Milton Keynes, MK7 6AA, United Kingdom, 44 0300 303 5303, Teresa.Sides@open.ac.uk %K National Health Service %K primary care %K SMS text messaging %K SMS reminders %K missed appointments %K quantitative research %K Kruskal-Wallis test %K Mann-Whitney test %D 2024 %7 29.7.2024 %9 Short Paper %J J Med Internet Res %G English %X Background: SMS texting systems have been considered a potential solution to reduce missed appointments in primary care. Existing research in this area focuses on qualitative studies investigating the attitudes of SMS text users and receivers. Objective: This study aimed to examine appointment data from an independent general practitioner (GP) surgery in Wrexham, United Kingdom, with approximately 15,000 patients, to determine the impact of text messaging systems on reducing missed appointments. The objective of this study was to investigate whether the use of text messages can effectively reduce missed appointments. Methods: To collect data for the study, SQL reports were run on EMIS Web, the United Kingdom’s most widely used clinical system. The data spanned 10 years, from September 1, 2010, to March 31, 2020. Data accuracy was verified by cross-referencing with appointment diary records. Mann-Whitney and Kruskal-Wallis tests, chosen for their suitability in comparing groups in nonparametric settings, were conducted in Microsoft Excel due to its accessibility. Results: Statistical analyses were conducted to compare data before and after implementation of the text messaging system. The results revealed a significant 42.8% reduction in missed appointments (before: 5848; after: 3343; P<.001). Further analysis of demographic characteristics revealed interesting trends, with no significant difference in missed appointments between genders, and variations observed across different age groups. The median number of missed appointments was not significantly different between genders (women: 1.55, IQR 1.11-2.16; men: 1.61, IQR 1.08-2.12; P=.73). Despite the prevalence of mobile phone use among young adults aged 20-25 years, the highest rates of missed appointments (848/7256, 11.7%) were noted in this group, whereas the lowest rates were noted in the 75-80 years age group (377/7256; 5.2%; P<.001). Analysis by age and gender indicated inconsistencies: women aged 20-25 years (571/4216) and men aged 35-40 years (306/3040) had the highest rates of missed appointments, whereas women aged 70-75 years (177/4216) and men aged 75-80 years (129/3040) had the lowest rates (P<.001 for both). Conclusions: This study demonstrates that SMS text messaging in primary care can significantly reduce missed appointments. Implementing technology such as SMS text messaging systems enables patients to cancel appointments on time, leading to improved efficiency in primary care settings. %M 39073855 %R 10.2196/43894 %U https://www.jmir.org/2024/1/e43894 %U https://doi.org/10.2196/43894 %U http://www.ncbi.nlm.nih.gov/pubmed/39073855 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51272 %T The Use of Online Consultation Systems and Patient Experience of Primary Care: Cross-Sectional Analysis Using the General Practice Patient Survey %A Ge,Xiaochen %A Chappell,Paul %A Ledger,Jean %A Bakhai,Minal %A Clarke,Geraldine M %+ Improvement Analytics Unit, The Health Foundation, 8 Salisbury Square, London, EC4Y 8AP, United Kingdom, 44 207257 ext 8000, geraldine.clarke@health.org.uk %K general practice %K online consultation %K patient experience %K modern general practice %K sociodemographic health inequalities %K General Practice Patient Survey %K cross-sectional study %D 2024 %7 26.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: NHS England encourages the use of online consultation (OC) systems alongside traditional access methods for patients to contact their general practice online and for practices to manage workflow. Access is a key driver of patients’ primary care experience. The use of online technology and patient experience vary by sociodemographic characteristics. Objective: This study aims to assess the association between OC system use and patient experience of primary care in English general practice and how that varies by OC system model and practice sociodemographic characteristics (rurality, deprivation, age, and ethnicity). Methods: We categorized practices as “low-use” or “high-use” according to the volume of patient-initiated contacts made via the OC system. We considered practices using one of 2 OC systems with distinct designs and implementation models—shorter “free text” input with an embedded single workflow OC system (FT practices) and longer “mixed text” input with variation in implemented workflow OC system (MT practices). We used 2022 General Practice Patient Survey data to capture 4 dimensions of patient experience—overall experience, experience of making an appointment, continuity of care, and use of self-care before making an appointment. We used logistic regression at the practice level to explore the association between OC system use and patient experience, including interaction terms to assess sociodemographic variation. Results: We included 287,194 responses from 2423 MT and 170 FT practices. The proportions of patients reporting positive experiences at MT and FT practices were similar or better than practices nationally, except at high-use MT practices. At high-use MT practices, patients were 19.8% (odds ratio [OR] 0.802, 95% CI 0.782-0.823) less likely to report a good overall experience; 24.5% (OR 0.755, 95% CI 0.738-0.773) less likely to report a good experience of making an appointment; and 18.9% (OR 0.811, 95% CI 0.792-0.83) less likely to see their preferred general practitioner; but 27.8% (OR 1.278, 95% CI 1.249-1.308) more likely to use self-care, compared with low-use MT practices. Opposite trends were seen at FT practices. Sociodemographic inequalities in patient experience were generally lower at high-use than low-use practices; for example, gaps in overall experience between practices with the most and fewest White patients decreased by 2.7 percentage points at MT practices and 6.4 percentage points at FT practices. Trends suggested greater improvements in experience for traditionally underserved groups—patients from urban and deprived areas, younger patients, and non-White patients. Conclusions: An OC system with shorter free text input and an integrated single workflow can enhance patient experience and reduce sociodemographic inequalities. Variation in patient experience between practices with different sociodemographic characteristics and OC systems underscores the importance of tailored design and implementation. Generalizing results across different OC systems is difficult due to variations in how they are integrated into practice workflows and communicated to patients. %M 39058543 %R 10.2196/51272 %U https://www.jmir.org/2024/1/e51272 %U https://doi.org/10.2196/51272 %U http://www.ncbi.nlm.nih.gov/pubmed/39058543 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48092 %T Implementation of a Web-Based Outpatient Asynchronous Consultation Service: Mixed Methods Study %A Rzewuska Díaz,Magdalena %A Locock,Louise %A Keen,Andrew %A Melvin,Mike %A Myhill,Anthony %A Ramsay,Craig %+ Health Services Research Unit, University of Aberdeen, 2nd floor, Health Sciences Building, Aberdeen, AB252ZD, United Kingdom, 44 1224438148, magdalena.rzewuska@abdn.ac.uk %K outpatient care %K teleconsultation %K asynchronous communication %K implementation %K mixed methods research %K qualitative research %K hospital data %D 2024 %7 4.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Asynchronous outpatient patient-to-provider communication is expanding in UK health care, requiring evaluation. During the pandemic, Aberdeen Royal Infirmary in Scotland expanded its outpatient asynchronous consultation service from dermatology (deployed in May 2020) to gastroenterology and pain management clinics. Objective: We conducted a mixed methods study using staff, patient, and public perspectives and National Health Service (NHS) numerical data to obtain a rounded picture of innovation as it happened. Methods: Focus groups (3 web-based and 1 face-to-face; n=22) assessed public readiness for this service, and 14 interviews with staff focused on service design and delivery. The service’s effects were examined using NHS Grampian service use data, a patient satisfaction survey (n=66), and 6 follow-up patient interviews. Survey responses were descriptively analyzed. Demographics, acceptability, nonattendance rates, and appointment outcomes of users were compared across levels of area deprivation in which they live and medical specialties. Interviews and focus groups underwent theory-informed thematic analysis. Results: Staff anticipated a simple technical system transfer from dermatology to other receptive medical specialties, but despite a favorable setting and organizational assistance, it was complicated. Key implementation difficulties included pandemic-induced technical integration delays, misalignment with existing administrative processes, and discontinuity in project management. The pain management clinic began asynchronous consultations (digital appointments) in December 2021, followed by the gastroenterology clinic in February 2022. Staff quickly learned how to explain and use this service. It was thought to function better for pain management as it fitted preexisting practices. From May to September 2022, the dermatology (adult and pediatric), gastroenterology, and pain management clinics offered 1709 appointments to a range of patients (n=1417). Digital appointments reduced travel by an estimated 44,712 miles (~71,956.81 km) compared to the face-to-face mode. The deprivation profile of people who chose to use this service closely mirrored that of NHS Grampian’s population overall. There was no evidence that deprivation impacted whether digital appointment users subsequently received treatment. Only 18% (12/66) of survey respondents were unhappy or very unhappy with being offered a digital appointment. The benefits mentioned included better access, convenience, decreased travel and waiting time, information sharing, and clinical flexibility. Overall, patients, the public, and staff recognized its potential as an NHS service but highlighted informed choice and flexibility. Better communication—including the use of the term assessment instead of appointment—may increase patient acceptance. Conclusions: Asynchronous pain management and gastroenterology consultations are viable and acceptable. Implementing this service is easiest when existing administrative processes face minimal disruption, although continuous support is needed. This study can inform practical strategies for supporting staff in adopting asynchronous consultations (eg, preparing for nonlinearity and addressing task issues). Patients need clear explanations and access to technical support, along with varied consultation options, to ensure digital inclusion. %M 38833695 %R 10.2196/48092 %U https://www.jmir.org/2024/1/e48092 %U https://doi.org/10.2196/48092 %U http://www.ncbi.nlm.nih.gov/pubmed/38833695 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e42049 %T Rapport Building in Written Crisis Services: Qualitative Content Analysis %A Schwab-Reese,Laura %A Short,Caitlyn %A Jacobs,Larel %A Fingerman,Michelle %+ Department of Public Health, Purdue University, MTHW 214F, West Lafayette, IN, 47907, United States, 1 765 496 6723, lschwabr@purdue.edu %K empathy %K crisis hotline %K child maltreatment %K text hotline %K chat hotline %K telehealth %K digital empathy %K counseling %K child abuse %K family violence %K crisis %K hotline %K chat %K tele %K emotional dynamics %K therapeutic relationships %K therapy %K content analysis %K text %K inductive %K deductive %K emotion %K affect %K emotional dynamic %K counseling psychology %D 2024 %7 15.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Building therapeutic relationships and social presence are challenging in digital services and maybe even more difficult in written services. Despite these difficulties, in-person care may not be feasible or accessible in all situations. Objective: This study aims to categorize crisis counselors’ efforts to build rapport in written conversations by using deidentified conversation transcripts from the text and chat arms of the National Child Abuse Hotline. Using these categories, we identify the common characteristics of successful conversations. We defined success as conversations where help-seekers reported the hotline was a good way to seek help and that they were a lot more hopeful, a lot more informed, a lot more prepared to address the situation, and experiencing less stress, as reported by help-seekers. Methods: The sample consisted of transcripts from 314 purposely selected conversations from of the 1153 text and chat conversations during July 2020. Hotline users answered a preconversation survey (ie, demographics) and a postconversation survey (ie, their perceptions of the conversation). We used qualitative content analysis to process the conversations. Results: Active listening skills, including asking questions, paraphrasing, reflecting feelings, and interpreting situations, were commonly used by counselors. Validation, unconditional positive regard, and evaluation-based language, such as praise and apologies, were also often used. Compared with less successful conversations, successful conversations tended to include fewer statements that attend to the emotional dynamics. There were qualitative differences in how the counselors applied these approaches. Generally, crisis counselors in positive conversations tended to be more specific and tailor their comments to the situation. Conclusions: Building therapeutic relationships and social presence are essential to digital interventions involving mental health professionals. Prior research demonstrates that they can be challenging to develop in written conversations. Our work demonstrates characteristics associated with successful conversations that could be adopted in other written help-seeking interventions. %M 38748472 %R 10.2196/42049 %U https://www.jmir.org/2024/1/e42049 %U https://doi.org/10.2196/42049 %U http://www.ncbi.nlm.nih.gov/pubmed/38748472 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50747 %T Assessing the Feasibility and Preliminary Effects of a Web-Based Self-Management Program for Chronic Noncancer Pain: Mixed Methods Study %A Marier-Deschenes,Pascale %A Pinard,Anne Marie %A Jalbert,Laura %A LeBlanc,Annie %+ CIRRIS, Centre interdisciplinaire de recherche en réadaptation et intégration sociale, 525, boul. Wilfrid-Hamel Québec, Québec, QC, G1M 2S8, Canada, 1 418 649 3735, pascale.marier-deschenes.1@ulaval.ca %K persistent pain %K eHealth %K self-paced intervention %K web-based program %K evidence based %K web based %K self-management %K pain %K chronic pain %K mixed methods study %K pain treatment %K pain education %D 2024 %7 3.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In Canada, adults with chronic noncancer pain face a persistent insufficiency of publicly funded resources, with the gold standard multidisciplinary pain treatment facilities unable to meet the high clinical demand. Web-based self-management programs cost-effectively increase access to pain management and can improve several aspects of physical and emotional functioning. Aiming to meet the demand for accessible, fully automated resources for individuals with chronic noncancer pain, we developed a French web- and evidence-based self-management program, Agir pour moi (APM). This program includes pain education and strategies to reduce stress, practice mindfulness, apply pacing, engage in physical activity, identify and manage thinking traps, sleep better, adapt diet, and sustain behavior change. Objective: This study aims to assess the APM self-management program’s feasibility, acceptability, and preliminary effects in adults awaiting specialized services from a center of expertise in chronic pain management. Methods: We conducted a mixed methods study with an explanatory sequential design, including a web-based 1-arm trial and qualitative semistructured interviews. We present the results from both phases through integrative tables called joint displays. Results: Response rates were 70% (44/63) at postintervention and 56% (35/63) at 3-month follow-up among the 63 consenting participants who provided self-assessed information at baseline. In total, 46% (29/63) of the participants completed the program. We interviewed 24% (15/63) of the participants. The interview’s first theme revolved around the overall acceptance, user-friendliness, and engaging nature of the program. The second theme emphasized the differentiation between microlevel and macrolevel engagements. The third theme delved into the diverse effects observed, potentially influenced by the macrolevel engagements. Participants highlighted the features that impacted their self-efficacy and the adoption of self-management strategies. We observed indications of improvement in self-efficacy, pain intensity, pain interference, depression, and catastrophizing. Interviewees described these and various other effects as potentially influenced by macrolevel engagement through behavioral change. Conclusions: These findings provided preliminary evidence that the APM self-management program and research methods are feasible. However, some participants expressed the need for at least phone reminders and minimal support from a professional available to answer questions over the first few weeks of the program to engage. Recruitment strategies of a future randomized controlled trial should focus on attracting a broader representation of individuals with chronic pain in terms of gender and ethnicity. Trial Registration: ClinicalTrials.gov NCT05319652; https://clinicaltrials.gov/study/NCT05319652 %M 38701440 %R 10.2196/50747 %U https://humanfactors.jmir.org/2024/1/e50747 %U https://doi.org/10.2196/50747 %U http://www.ncbi.nlm.nih.gov/pubmed/38701440 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51694 %T Group Cohesion and Necessary Adaptations in Online Hearing Voices Peer Support Groups: Qualitative Study With Group Facilitators %A Branitsky,Alison %A Longden,Eleanor %A Bucci,Sandra %A Morrison,Anthony P %A Varese,Filippo %+ Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 07936813441, alison.branitsky@postgrad.manchester.ac.uk %K peer support %K group cohesion %K web-based delivery %K hearing voices %K Hearing Voices Movement %K self-help groups %D 2024 %7 3.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Face-to-face hearing voices peer support groups (HVGs), a survivor-led initiative that enables individuals who hear voices to engage with the support of peers, have a long-standing history in community settings. HVGs are premised on the notion that forming authentic, mutual relationships enables the exploration of one’s voice hearing experiences and, in turn, reduces subjective distress. As such, group cohesion is assumed to be a central mechanism of change in HVGs. The rise of digital mental health support, coupled with the COVID-19 pandemic, has resulted in many HVGs adapting to online delivery. However, to date no studies have examined the implementation of these online groups and the adaptations necessary to foster cohesion. Objective: This study aims to understand the experience of group cohesion among HVG facilitators in online groups compared with face-to-face groups. Specifically, we examined the ways in which the medium through which groups run (online or face-to-face) impacts group cohesion and how facilitators adapted HVGs to foster group cohesion online. Methods: Semistructured qualitative interviews were conducted with 11 facilitators with varied experience of facilitating online and face-to-face HVGs. Data were analyzed using reflexive thematic analysis. Results: The findings are organized into 3 themes and associated subthemes: nonverbal challenges to cohesion (lack of differentiation, transitional space, inability to see the whole picture, and expressions of empathy); discursive challenges to cohesion (topic-based conversation and depth of disclosure); and necessary adaptations for online groups (fostering shared experience and using the unique context to demonstrate investment in others). Despite challenges in both the setting and content of online groups, facilitators felt that group cohesion was still possible to achieve online but that it had to be facilitated intentionally. Conclusions: This study is the first to specifically investigate group cohesion in online HVGs. Participants noted numerous challenges to group cohesion when adapting groups to run online, including the unnaturally linear narrative flow of dialogue in online settings; lack of transitional spaces, and associated small talk before and after the session; ease of disengagement online; inhibited sharing; and absence of shared physical presence online. Although these challenges were significant, facilitators nevertheless emphasized that the benefits provided by the accessibility of online groups outweighed these challenges. Necessary adaptations for cultivating group cohesion online are outlined and include capitalizing on moments of humor and spontaneity, using group activities, encouraging information sharing between participants using the chat and screen-sharing features, and using objects from participants’ environments to gain deeper insight into their subjective worlds. %M 38701439 %R 10.2196/51694 %U https://formative.jmir.org/2024/1/e51694 %U https://doi.org/10.2196/51694 %U http://www.ncbi.nlm.nih.gov/pubmed/38701439 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e49696 %T Patient Perspectives on Communication Pathways After Orthopedic Surgery and Discharge and Evaluation of Team-Based Digital Communication: Qualitative Exploratory Study %A Jensen,Lili Worre Høpfner %A Rahbek,Ole %A Lauritsen,Rikke Emilie Kildahl %A Kold,Søren %A Dinesen,Birthe %+ Interdisciplinary Orthopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Hobrovej 18-22, Aalborg, 9000, Denmark, 45 60229406, lili.jensen@rn.dk %K digital communication %K patient-provider communication %K continuity of care %K interdisciplinary communication %K hospital discharge %K orthopedic surgery %K postoperative care %K text messaging %K mobile phone %D 2024 %7 29.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The transition from hospital to home after orthopedic surgery requires smooth communication and coordination between patients and their team of care to avoid fragmented care pathways. Digital communication is increasingly being used to facilitate easy and accessible asynchronous communication between patients and health care professionals across settings. A team-based approach to digital communication may provide optimized quality of care in the postoperative period following orthopedic surgery and hospital discharge. Objective: This study was divided into two phases that aimed to (1) explore the perspectives of patients undergoing orthopedic surgery on current communication pathways at a tertiary hospital in Denmark and (2) test and explore patients’ experiences and use of team-based digital communication following hospital discharge (eDialogue). Methods: A triangulation of qualitative data collection techniques was applied: document analysis, participant observations (n=16 hours), semistructured interviews with patients before (n=31) and after (n=24) their access to eDialogue, and exploration of use data. Results: Findings show that patients experience difficult communication pathways after hospital discharge and a lack of information due to inadequate coordination of care. eDialogue was used by 84% (26/31) of the patients, and they suggested that it provided a sense of security, coherence, and proximity in the aftercare rearranging communication pathways for the better. Specific drivers and barriers to use were identified, and these call for further exploration of eDialogue. Conclusions: In conclusion, patients evaluated eDialogue positively and suggested that it could support them after returning home following orthopedic surgery. %M 38551641 %R 10.2196/49696 %U https://humanfactors.jmir.org/2024/1/e49696 %U https://doi.org/10.2196/49696 %U http://www.ncbi.nlm.nih.gov/pubmed/38551641 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52071 %T An Electronic Health Record–Based Automated Self-Rescheduling Tool to Improve Patient Access: Retrospective Cohort Study %A Ganeshan,Smitha %A Liu,Andrew W %A Kroeger,Anne %A Anand,Prerna %A Seefeldt,Richard %A Regner,Alexis %A Vaughn,Diana %A Odisho,Anobel Y %A Mourad,Michelle %+ Department of Medicine, University of California San Francisco, 505 Parnassus Avenue, #M1493, San Francisco, CA, 94117‭, United States, 1 415 514 1000, smitha.ganeshan@ucsf.edu %K appointment %K consultation %K cost %K digital health %K digital tools %K electronic health record %K EHR %K informatics %K patient access %K retrospective review %K revenue %K self-rescheduling tool %K self-scheduling %K waiting time %D 2024 %7 19.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In many large health centers, patients face long appointment wait times and difficulties accessing care. Last-minute cancellations and patient no-shows leave unfilled slots in a clinician’s schedule, exacerbating delays in care from poor access. The mismatch between the supply of outpatient appointments and patient demand has led health systems to adopt many tools and strategies to minimize appointment no-show rates and fill open slots left by patient cancellations. Objective: We evaluated an electronic health record (EHR)–based self-scheduling tool, Fast Pass, at a large academic medical center to understand the impacts of the tool on the ability to fill cancelled appointment slots, patient access to earlier appointments, and clinical revenue from visits that may otherwise have gone unscheduled. Methods: In this retrospective cohort study, we extracted Fast Pass appointment offers and scheduling data, including patient demographics, from the EHR between June 18, 2022, and March 9, 2023. We analyzed the outcomes of Fast Pass offers (accepted, declined, expired, and unavailable) and the outcomes of scheduled appointments resulting from accepted Fast Pass offers (completed, canceled, and no-show). We stratified outcomes based on appointment specialty. For each specialty, the patient service revenue from appointments filled by Fast Pass was calculated using the visit slots filled, the payer mix of the appointments, and the contribution margin by payer. Results: From June 18 to March 9, 2023, there were a total of 60,660 Fast Pass offers sent to patients for 21,978 available appointments. Of these offers, 6603 (11%) were accepted across all departments, and 5399 (8.9%) visits were completed. Patients were seen a median (IQR) of 14 (4-33) days sooner for their appointments. In a multivariate logistic regression model with primary outcome Fast Pass offer acceptance, patients who were aged 65 years or older (vs 20-40 years; P=.005 odds ratio [OR] 0.86, 95% CI 0.78-0.96), other ethnicity (vs White; P<.001, OR 0.84, 95% CI 0.77-0.91), primarily Chinese speakers (P<.001; OR 0.62, 95% CI 0.49-0.79), and other language speakers (vs English speakers; P=.001; OR 0.71, 95% CI 0.57-0.87) were less likely to accept an offer. Fast Pass added 2576 patient service hours to the clinical schedule, with a median (IQR) of 251 (216-322) hours per month. The estimated value of physician fees from these visits scheduled through 9 months of Fast Pass scheduling in professional fees at our institution was US $3 million. Conclusions: Self-scheduling tools that provide patients with an opportunity to schedule into cancelled or unfilled appointment slots have the potential to improve patient access and efficiently capture additional revenue from filling unfilled slots. The demographics of the patients accepting these offers suggest that such digital tools may exacerbate inequities in access. %M 38502159 %R 10.2196/52071 %U https://www.jmir.org/2024/1/e52071 %U https://doi.org/10.2196/52071 %U http://www.ncbi.nlm.nih.gov/pubmed/38502159 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53391 %T Health Care Professionals’ Perspectives Before and After Use of eDialogue for Team-Based Digital Communication Across Settings: Qualitative Study %A Jensen,Lili Worre Høpfner %A Rahbek,Ole %A Lauritsen,Rikke Emilie Kildahl %A Kold,Søren %A Dinesen,Birthe %+ Interdisciplinary Othopaedics, Orthopaedic Surgery Department, Aalborg University Hospital, Hobrovej 18-22, Aalborg, 9000, Denmark, 45 60229406, lili.jensen@rn.dk %K CFIR %K Consolidated Framework for Implementation Research %K digital communication %K hospital discharge %K implementation science %K interdisciplinary communication %K orthopedic surgery %K patient-provider communication %K postoperative care %K qualitative research %K text messaging %D 2024 %7 8.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Orthopedic surgical treatment is a transversal task that requires the active involvement of patients, relatives, and health care professionals (HCPs) across various settings. However, after hospital discharge, communication is challenged and undertaken primarily by phone. New digital communication solutions have the potential to create a space for seamless and patient-centered dialogue across discipline and sector boundaries. When evaluating new communication solutions, knowledge about HCPs’ needs and perspectives of use must be explored, as it is they who are responsible for implementing changes in practice. Objective: This study aimed to (1) investigate HCPs’ perceptions of current communication pathways (phase 1) and (2) explore their experiences of using a simple messenger-like solution (eDialogue) for team-based digital communication across settings (phase 2). Methods: We used a triangulation of qualitative data collection techniques, including document analysis, observations, focus groups, and individual interviews of HCPs before (n=28) and after (n=12) their use of eDialogue. Data collection and analysis were inspired by the Consolidated Framework for Implementation Research (CFIR) to specifically understand facilitators and barriers to implementation as perceived by HCPs. Results: HCPs perceive current communication pathways as insufficient for both patients and themselves. Phone calls are disruptive, and there is a lack of direct communication modalities when communication crosses sector boundaries. HCPs experienced the use of eDialogue as a quick and easy way for timely interdisciplinary interaction with patients and other HCPs across settings; however, concerns were raised about time consumption. Conclusions: eDialogue can provide needed support for interdisciplinary and cross-sectoral patient-centered communication. However, future studies of this solution should address its impact and the use of resources. %M 38457798 %R 10.2196/53391 %U https://humanfactors.jmir.org/2024/1/e53391 %U https://doi.org/10.2196/53391 %U http://www.ncbi.nlm.nih.gov/pubmed/38457798 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 9 %N %P e49491 %T Care Partner Engagement in Secure Messaging Between Patients With Diabetes and Their Clinicians: Cohort Study %A Semere,Wagahta %A Karter,Andrew J %A Lyles,Courtney R %A Reed,Mary E %A Karliner,Leah %A Kaplan,Celia %A Liu,Jennifer Y %A Livaudais-Toman,Jennifer %A Schillinger,Dean %+ Department of Medicine, University of California San Francisco, Pride Hall, 2540 23rd Street, 4th Floor, Box 1364, San Francisco, CA, 94110, United States, 1 6282068494, wagahta.semere@ucsf.edu %K caregivers %K diabetes %K telehealth %K secure messaging %K patient portal %K messaging %K diabetes outcomes %K family care %K clinical care %D 2024 %7 9.2.2024 %9 Original Paper %J JMIR Diabetes %G English %X Background: Patient engagement with secure messaging (SM) via digital patient portals has been associated with improved diabetes outcomes, including increased patient satisfaction and better glycemic control. Yet, disparities in SM uptake exist among older patients and racial and ethnic underserved groups. Care partners (family members or friends) may provide a means for mitigating these disparities; however, it remains unclear whether and to what extent care partners might enhance SM use. Objective: We aim to examine whether SM use differs among older patients with diabetes based on the involvement of care partner proxies. Methods: This is a substudy of the ECLIPPSE (Employing Computational Linguistics to Improve Patient-Provider Secure Emails) project, a cohort study taking place in a large, fully integrated health care delivery system with an established digital patient portal serving over 4 million patients. Participants included patients with type 2 diabetes aged ≥50 years, newly registered on the patient portal, who sent ≥1 English-language message to their clinician between July 1, 2006, and December 31, 2015. Proxy SM was identified by having a registered proxy. To identify nonregistered proxies, a computational linguistics algorithm was applied to detect words and phrases more likely to appear in proxy messages compared to patient-authored messages. The primary outcome was the annual volume of secure messages (sent or received); secondary outcomes were the length of time to the first SM sent by patient or proxy and the number of annual SM exchanges (unique message topics generating ≥1 reply). Results: The mean age of the cohort (N=7659) at this study’s start was 61 (SD 7.16) years; 75% (n=5573) were married, 15% (n=1089) identified as Black, 10% (n=747) Chinese, 12% (n=905) Filipino, 13% (n=999) Latino, and 30% (n=2225) White. Further, 49% (n=3782) of patients used a proxy to some extent. Compared to nonproxy users, proxy users were older (P<.001), had lower educational attainment (P<.001), and had more comorbidities (P<.001). Adjusting for patient sociodemographic and clinical characteristics, proxy users had greater annual SM volume (20.7, 95% CI 20.2-21.2 vs 10.9, 95% CI 10.7-11.2; P<.001), shorter time to SM initiation (hazard ratio vs nonusers: 1.30, 95% CI 1.24-1.37; P<.001), and more annual SM exchanges (6.0, 95% CI 5.8-6.1 vs 2.9, 95% CI 2.9-3.0, P<.001). Differences in SM engagement by proxy status were similar across patient levels of education, and racial and ethnic groups. Conclusions: Among a cohort of older patients with diabetes, proxy SM involvement was independently associated with earlier initiation and increased intensity of messaging, although it did not appear to mitigate existing disparities in SM. These findings suggest care partners can enhance patient-clinician telecommunication in diabetes care. Future studies should examine the effect of care partners’ SM involvement on diabetes-related quality of care and clinical outcomes. %M 38335020 %R 10.2196/49491 %U https://diabetes.jmir.org/2024/1/e49491 %U https://doi.org/10.2196/49491 %U http://www.ncbi.nlm.nih.gov/pubmed/38335020 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e42850 %T The Association Between Linguistic Characteristics of Physicians’ Communication and Their Economic Returns: Mixed Method Study %A Geng,Shuang %A He,Yuqin %A Duan,Liezhen %A Yang,Chen %A Wu,Xusheng %A Liang,Gemin %A Niu,Ben %+ College of Management, Shenzhen University, Xueyuan Road 1066, Shenzhen, 518055, China, 86 18565859968, yangc@szu.edu.cn %K web-based health care %K instrumental communication %K affective communication %K linguistic features %K economic returns %K linguistic inquiry and word count %D 2024 %7 11.1.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based health care has the potential to improve health care access and convenience for patients with limited mobility, but its success depends on active physician participation. The economic returns of internet-based health care initiatives are an important factor that can motivate physicians to continue their participation. Although several studies have examined the communication patterns and influences of web-based health consultations, the correlation between physicians’ communication characteristics and their economic returns remains unexplored. Objective: This study aims to investigate how the linguistic features of 2 modes of physician-patient communication, instrumental and affective, determine the physician’s economic returns, measured by the honorarium their patients agree to pay per consultation. We also examined the moderating effects of communication media (web-based text messages and voice messages) and the compounding effects of different communication features on economic returns. Methods: We collected 40,563 web-based consultations from 528 physicians across 4 disease specialties on a large, web-based health care platform in China. Communication features were extracted using linguistic inquiry and word count, and we used multivariable linear regression and K-means clustering to analyze the data. Results: We found that the use of cognitive processing language (ie, words related to insight, causation, tentativeness, and certainty) in instrumental communication and positive emotion–related words in affective communication were positively associated with the economic returns of physicians. However, the extensive use of discrepancy-related words could generate adverse effects. We also found that the use of voice messages for service delivery magnified the effects of cognitive processing language but did not moderate the effects of affective processing language. The highest economic returns were associated with consultations in which the physicians used few expressions related to negative emotion; used more terms associated with positive emotions; and later, used instrumental communication language. Conclusions: Our study provides empirical evidence about the relationship between physicians’ communication characteristics and their economic returns. It contributes to a better understanding of patient-physician interactions from a professional-client perspective and has practical implications for physicians and web-based health care platform executives. %M 38206657 %R 10.2196/42850 %U https://www.jmir.org/2024/1/e42850 %U https://doi.org/10.2196/42850 %U http://www.ncbi.nlm.nih.gov/pubmed/38206657 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 7 %N %P e51316 %T Automated Messaging Program to Facilitate Systematic Home Blood Pressure Monitoring: Qualitative Analysis of Provider Interviews %A Einhorn,Julian %A Murphy,Andrew R %A Rogal,Shari S %A Suffoletto,Brian %A Irizarry,Taya %A Rollman,Bruce L %A Forman,Daniel E %A Muldoon,Matthew F %+ Division of Cardiology, Department of Medicine, University of Pittsburgh School of Medicine, 4015 OHara Street, Old Engineering Hall, Room 506, University of Pittsburgh, Pittsburgh, PA, 15213, United States, 1 4126248798, mfm10@pitt.edu %K mHealth %K digital intervention %K qualitative research %K provider stakeholders %K hypertension %K home blood pressure monitoring %K implementation research %K short-messaging system %K remote monitoring %K qualitative analysis %K messaging program %K blood pressure %K monitoring %K cardiovascular %K disease %K text messaging %K text mining %K self-management %K mobile phone %D 2023 %7 4.12.2023 %9 Original Paper %J JMIR Cardio %G English %X Background: Hypertension is a leading cause of cardiovascular and kidney disease in the United States, yet blood pressure (BP) control at a population level is poor and worsening. Systematic home BP monitoring (HBPM) programs can lower BP, but programs supporting HBPM are not routinely used. The MyBP program deploys automated bidirectional text messaging for HBPM and disease self-management support. Objective: We aim to produce a qualitative analysis of input from providers and staff regarding implementation of an innovative HBPM program in primary care practices. Methods: Semistructured interviews (average length 31 minutes) were conducted with physicians (n=11), nurses, and medical assistants (n=6) from primary care settings. The interview assessed multiple constructs in the Consolidated Framework for Implementation Research domains of intervention characteristics, outer setting, inner setting, and characteristics of individuals. Interviews were transcribed verbatim and analyzed using inductive coding to organize meaningful excerpts and identify salient themes, followed by mapping to the updated Consolidated Framework for Implementation Research constructs. Results: Health care providers reported that MyBP has good ease of use and was likely to engage patients in managing their high BP. They also felt that it would directly support systematic BP monitoring and habit formation in the convenience of the patient’s home. This could increase health literacy and generate concrete feedback to raise the day-to-day salience of BP control. Providers expressed concern that the cost of BP devices remains an encumbrance. Some patients were felt to have overriding social or emotional barriers, or lack the needed technical skills to interact with the program, use good measurement technique, and input readings accurately. With respect to effects on their medical practice, providers felt MyBP would improve the accuracy and frequency of HBPM data, and thereby improve diagnosis and treatment management. The program may positively affect the patient-provider relationship by increasing rapport and bidirectional accountability. Providers appreciated receiving aggregated HBPM data to increase their own efficiency but also expressed concern about timely routing of incoming HBPM reports, lack of true integration with the electronic health record, and the need for a dedicated and trained staff member. Conclusions: In this qualitative analysis, health care providers perceived strong relative advantages of using MyBP to support patients. The identified barriers suggest the need for corrective implementation strategies to support providers in adopting the program into routine primary care practice, such as integration into the workflow and provider education. Trial Registration: ClinicalTrials.gov NCT03650166; https://tinyurl.com/bduwn6r4 %M 38048147 %R 10.2196/51316 %U https://cardio.jmir.org/2023/1/e51316 %U https://doi.org/10.2196/51316 %U http://www.ncbi.nlm.nih.gov/pubmed/38048147 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e44849 %T The Usefulness of Web-Based Communication Data for Social Network Health Interventions: Agent-Based Modeling Study %A Blok,David J %A Simoski,Bojan %A van Woudenberg,Thabo J %A Buijzen,Moniek %+ Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, 3062 PA, Netherlands, 31 107546208, d.j.blok@essb.eur.nl %K agent-based modeling %K peer nomination network data %K physical activity %K social network analysis %K social network interventions %K web-based communication network data %D 2023 %7 22.11.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Social network interventions are an effective approach to promote physical activity. These interventions are traditionally designed using self-reported peer nomination network data to represent social connections. However, there is unexplored potential in communication data exchanged through web-based messaging apps or social platforms, given the availability of these data, the developments in artificial intelligence to analyze these data, and the shift of personal communication to the web sphere. The implications of using web-based versus offline social networks on the effectiveness of social network interventions remain largely unexplored. Objective: This study aims to investigate the differences in the impact of social network interventions on physical activity levels (PALs) between networks derived from web-based communication and peer nomination data. Methods: We used the data on sociometric questionnaires, messages from a web-based communication app, and PAL (number of steps per day) of 408 participants in 21 school classes. We applied social network analysis to identify influential peers and agent-based modeling to simulate the diffusion of PAL and explore the impact of social network interventions on PAL among adolescents in school classes. Influential peers (n=63) were selected based on centrality measures (ie, in-degree, closeness, and betweenness) to spread the intervention. They received health education, which increased their PAL by 17%. In sensitivity analyses, we tested the impact of a 5%, 10%, and 20% increase in PAL among influential peers. Results: There was a 24%-27% overlap in selected influential peers between the 2 network representations. In general, the simulations showed that interventions could increase PAL by 5.0%-5.8% within 2 months. However, the predicted median impact on PAL was slightly higher in networks based on web-based communication data than peer nomination data for in-degree (5.7%, IQR 5.5%-6.1% vs 5.5%, IQR 5.2%-5.8%; P=.002), betweenness (5.6%, IQR 5.4%-5.9% vs 5.0%, IQR 4.7%-5.3%; P<.001), and closeness centrality (5.8%, IQR 5.6%-6.1% vs 5.3%, IQR 5.0%-5.6%; P<.001). A large variation in impact was observed between school classes (range 1.5%-17.5%). Lowering the effectiveness of health education from 17% to 5% would reduce the overall impact of the social network intervention by 3-fold in both networks. Conclusions: Our findings showed that network interventions based on web-based communication data could increase PAL. Web-based communication data may therefore be a valuable addition to peer nomination data for future social network intervention design. Artificial intelligence methods, including agent-based modeling, can help to design these network interventions and provide insights into the role of network characteristics in their effectiveness. %M 37991813 %R 10.2196/44849 %U https://pediatrics.jmir.org/2023/1/e44849 %U https://doi.org/10.2196/44849 %U http://www.ncbi.nlm.nih.gov/pubmed/37991813 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e41393 %T An After-Hours Virtual Care Service for Children With Medical Complexity and New Medical Technology: Mixed Methods Feasibility Study %A Babayan,Katherine %A Keilty,Krista %A Esufali,Jessica %A Grajales III,Francisco J %A , %+ Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M6, Canada, 1 (416) 978 4326, katherine.babayan@gmail.com %K children with medical complexity %K technology dependence %K medical devices %K family caregivers %K virtual care %K home and community care %K emergency department visits %K enteral feeding tubes %K hospital-to-home transition %K feasibility %K mixed methods %D 2023 %7 8.11.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Family caregivers (FCs) of children with medical complexity require specialized support to promote the safe management of new medical technologies (eg, gastrostomy tubes) during hospital-to-home transitions. With limited after-hours services available to families in home and community care, medical device complications that arise often lead to increased FC stress and unplanned emergency department (ED) visits. To improve FC experiences, enable safer patient discharge, and reduce after-hours ED visits, this study explores the feasibility of piloting a 24/7 virtual care service (Connected Care Live) with families to provide real-time support by clinicians expert in the use of pediatric home care technologies. Objective: This study aims to establish the economic, operational, and technical feasibility of piloting the expansion of an existing nurse-led after-hours virtual care service offered to home and community care providers to FCs of children with newly inserted medical devices after hospital discharge at Toronto’s Hospital for Sick Children (SickKids). Methods: This exploratory study, conducted from October 2020 to August 2021, used mixed data sources to inform service expansion feasibility. Semistructured interviews were conducted with FCs, nurses, and hospital leadership to assess the risks, benefits, and technical and operational requirements for sustainable and cost-effective future service operations. Time and travel savings were estimated using ED visit data in SickKids’ electronic medical records (Epic) with a chief complaint of “medical device problems,” after-hours medical device inquiries from clinician emails and voicemails, and existing service operational data. Results: A total of 30 stakeholders were interviewed and voiced the need for the proposed service. Safer and more timely management of medical device complications, improved caregiver and provider experiences, and strengthened partnerships were identified as expected benefits, while service demand, nursing practice, and privacy and security were identified as potential risks. A total of 47 inquiries were recorded over 2 weeks from March 26, 2021, to April 8, 2021, with 51% (24/47) assessed as manageable via service expansion. This study forecasted annual time and travel savings of 558 hours for SickKids and 904 hours and 22,740 km for families. Minimal technical and operational requirements were needed to support service expansion by leveraging an existing platform and clinical staff. Of the 212 ED visits related to “medical device problems” over 6 months from September 1, 2020, to February 28, 2021, enteral feeding tubes accounted for nearly two-thirds (n=137, 64.6%), with 41.6% (57/137) assessed as virtually manageable. Conclusions: Our findings indicate that it is feasible to pilot the expansion of Connected Care Live to FCs of children with newly inserted enteral feeding tubes. This nurse-led virtual caregiver service is a promising tool to promote safe hospital-to-home transitions, improve FC experiences, and reduce after-hours ED visits. %M 37938869 %R 10.2196/41393 %U https://pediatrics.jmir.org/2023/1/e41393 %U https://doi.org/10.2196/41393 %U http://www.ncbi.nlm.nih.gov/pubmed/37938869 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 6 %N %P e44139 %T Efficacy of Electronic Reminders in Increasing the Enhanced Recovery After Surgery Protocol Use During Major Breast Surgery: Prospective Cohort Study %A Gopwani,Sumeet %A Bahrun,Ehab %A Singh,Tanvee %A Popovsky,Daniel %A Cramer,Joseph %A Geng,Xue %+ Department of Anesthesiology, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC, 20007, United States, 1 7344764041, sumeet.gopwani@medstar.net %K ERAS protocol %K electronic notification system %K clinical decision support system %K postoperative outcomes %K breast surgery %K surgery %K surgical %K postoperative %K decision support %K notification %K recovery %K anesthesia %K cohort study %K patient outcome %K enhanced recovery %K patient education %K surgical stress %D 2023 %7 3.11.2023 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Enhanced recovery after surgery (ERAS) protocols are patient-centered, evidence-based guidelines for peri-, intra-, and postoperative management of surgical candidates that aim to decrease operative complications and facilitate recovery after surgery. Anesthesia providers can use these protocols to guide decision-making and standardize aspects of their anesthetic plan in the operating room. Objective: Research across multiple disciplines has demonstrated that clinical decision support systems have the potential to improve protocol adherence by reminding providers about departmental policies and protocols via notifications. There remains a gap in the literature about whether clinical decision support systems can improve patient outcomes by improving anesthesia providers’ adherence to protocols. Our hypothesis is that the implementation of an electronic notification system to anesthesia providers the day prior to scheduled breast surgeries will increase the use of the already existing but underused ERAS protocols. Methods: This was a single-center prospective cohort study conducted between October 2017 and August 2018 at an urban academic medical center. After obtaining approval from the institutional review board, anesthesia providers assigned to major breast surgery cases were identified. Patient data were collected pre- and postimplementation of an electronic notification system that sent the anesthesia providers an email reminder of the ERAS breast protocol the night before scheduled surgeries. Each patient’s record was then reviewed to assess the frequency of adherence to the various ERAS protocol elements. Results: Implementation of an electronic notification significantly improved overall protocol adherence and several preoperative markers of ERAS protocol adherence. Protocol adherence increased from 16% (n=14) to 44% (n=44; P<.001), preoperative administration of oral gabapentin (600 mg) increased from 13% (n=11) to 43% (n=43; P<.001), and oral celebrex (400 mg) use increased from 16% (n=14) to 35% (n=35; P=.006). There were no statistically significant differences in the use of scopolamine transdermal patch (P=.05), ketamine (P=.35), and oral acetaminophen (P=.31) between the groups. Secondary outcomes such as intraoperative and postoperative morphine equivalent administered, postanesthesia care unit length of stay, postoperative pain scores, and incidence of postoperative nausea and vomiting did not show statistical significance. Conclusions: This study examines whether sending automated notifications to anesthesia providers increases the use of ERAS protocols in a single academic medical center. Our analysis exhibited statistically significant increases in overall protocol adherence but failed to show significant differences in secondary outcome measures. Despite the lack of a statistically significant difference in secondary postoperative outcomes, our analysis contributes to the limited literature on the relationship between using push notifications and clinical decision support in guiding perioperative decision-making. A variety of techniques can be implemented, including technological solutions such as automated notifications to providers, to improve awareness and adherence to ERAS protocols. %M 37921854 %R 10.2196/44139 %U https://periop.jmir.org/2023/1/e44139 %U https://doi.org/10.2196/44139 %U http://www.ncbi.nlm.nih.gov/pubmed/37921854 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48583 %T Characterizing the Patterns of Electronic Health Record–Integrated Secure Messaging Use: Cross-Sectional Study %A Baratta,Laura R %A Harford,Derek %A Sinsky,Christine A %A Kannampallil,Thomas %A Lou,Sunny S %+ Department of Anesthesiology, Washington University School of Medicine, 660 South Euclid, Campus Box 8054, Saint Louis, MO, 63110, United States, 1 314 362 1196, slou@wustl.edu %K clinical care %K clinician burden %K communication %K electronic health record %K EHR %K interprofessional communication %K medical assistant %K messaging %K nurses %K observational study %K physicians %K secure messaging %K users %D 2023 %7 6.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Communication among health care professionals is essential for the delivery of safe clinical care. Secure messaging has rapidly emerged as a new mode of asynchronous communication. Despite its popularity, relatively little is known about how secure messaging is used and how such use contributes to communication burden. Objective: This study aims to characterize the use of an electronic health record–integrated secure messaging platform across 14 hospitals and 263 outpatient clinics within a large health care system. Methods: We collected metadata on the use of the Epic Systems Secure Chat platform for 6 months (July 2022 to January 2023). Information was retrieved on message volume, response times, message characteristics, messages sent and received by users, user roles, and work settings (inpatient vs outpatient). Results: A total of 32,881 users sent 9,639,149 messages during the study. Median daily message volume was 53,951 during the first 2 weeks of the study and 69,526 during the last 2 weeks, resulting in an overall increase of 29% (P=.03). Nurses were the most frequent users of secure messaging (3,884,270/9,639,149, 40% messages), followed by physicians (2,387,634/9,639,149, 25% messages), and medical assistants (1,135,577/9,639,149, 12% messages). Daily message frequency varied across users; inpatient advanced practice providers and social workers interacted with the highest number of messages per day (median 19). Conversations were predominantly between 2 users (1,258,036/1,547,879, 81% conversations), with a median of 2 conversational turns and a median response time of 2.4 minutes. The largest proportion of inpatient messages was from nurses to physicians (972,243/4,749,186, 20% messages) and physicians to nurses (606,576/4,749,186, 13% messages), while the largest proportion of outpatient messages was from physicians to nurses (344,048/2,192,488, 16% messages) and medical assistants to other medical assistants (236,694/2,192,488, 11% messages). Conclusions: Secure messaging was widely used by a diverse range of health care professionals, with ongoing growth throughout the study and many users interacting with more than 20 messages per day. The short message response times and high messaging volume observed highlight the interruptive nature of secure messaging, raising questions about its potentially harmful effects on clinician workflow, cognition, and errors. %M 37801359 %R 10.2196/48583 %U https://www.jmir.org/2023/1/e48583 %U https://doi.org/10.2196/48583 %U http://www.ncbi.nlm.nih.gov/pubmed/37801359 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46701 %T Flexible and Innovative Connectivity Solution to Support National Decentralized Infectious Diseases Point-of-Care Testing Programs in Primary Health Services: Descriptive Evaluation Study %A Saha,Amit %A Andrewartha,Kelly %A Badman,Steven G %A Tangey,Annie %A Smith,Kirsty S %A Sandler,Sergio %A Ramsay,Stuart %A Braund,Wilton %A Manoj-Margison,Stuart %A Matthews,Susan %A Shephard,Mark D S %A Guy,Rebecca %A Causer,Louise %+ Kirby Institute, University of New South Wales, Level 6, Wallace Wurth Building, Sydney, NSW, 2052, Australia, 61 2 9385 9254, asaha@kirby.unsw.edu.au %K infectious disease %K diagnostics %K POC testing %K point-of-care %K connectivity %K digital health %K disease surveillance %K GeneXpert %D 2023 %7 1.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Molecular point-of-care (POC) testing for Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and Trichomonas vaginalis (TV) has been available in regional and remote primary health services in Australia as part of a decentralized POC testing program since 2016 and for SARS-CoV-2 from 2020. As there was no suitable existing connectivity infrastructure to capture and deliver POC test results to a range of end users, a new system needed to be established. Objective: The aim of the study is to design, implement, and optimize a connectivity system to meet clinical management, analytical quality management, and public health surveillance needs. Methods: We used commercially available e-messaging technology coupled with adapted proprietary software to integrate a decentralized molecular POC testing platform (GeneXpert) in primary health services and interface with end-user databases. This connectivity infrastructure was designed to overcome key barriers to the implementation, integration, and monitoring of these large multijurisdictional infectious disease POC testing networks. Test result messages were tailored to meet end-user needs. Using centrally captured deidentified data, we evaluated the time to receipt of test results and completeness of accompanying demographic data. Results: From January 2016 to April 2020, we operationalized the system at 31 health services across 4 jurisdictions and integrated with 5 different patient management systems to support the real-time delivery of 29,356 CT/NG and TV test results to designated recipients (patient management system and local clinical and central program databases). In 2019, 12,105 CT/NG and TV results were delivered, and the median time to receipt of results was 3.2 (IQR 2.2-4.6) hours, inclusive of test runtime. From May 2020 to August 2022, we optimized the system to support rapid scale-up of SARS-CoV-2 testing (105 services; 6 jurisdictions; 71,823 tests) and additional sexually transmissible infection testing (16,232 tests), including the electronic disease-specific notifications to jurisdictional health departments and alerts for connectivity disruption and positive results. In 2022, 19,355 results were delivered with an overall median transmission time of 2.3 (IQR 1.4-3.1) hours, 2.2 (IQR 1.2-2.3) hours for SARS-CoV-2 (n=16,066), 3.0 (IQR 2.0-4.0) hours for CT/NG (n=1843), and 2.6 (IQR 1.5-3.8) hours for TV (n=1446). Demographic data (age, sex, and ethnicity) were completed for 99.5% of test results in 2022. Conclusions: This innovative connectivity system designed to meet end-user needs has proven to be sustainable, flexible, and scalable. It represents the first such system in Australia established independent of traditional pathology providers to support POC testing in geographically dispersed remote primary health services. The system has been optimized to deliver real-time test results and has proven critical for clinical, public health, and quality management. The system has significantly supported equitable access to rapid diagnostics for infectious diseases across Australia, and its design is suitable for onboarding other POC tests and testing platforms in the future. %M 37656506 %R 10.2196/46701 %U https://www.jmir.org/2023/1/e46701 %U https://doi.org/10.2196/46701 %U http://www.ncbi.nlm.nih.gov/pubmed/37656506 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45198 %T Intentions of Patients With Cancer and Their Relatives to Use a Live Chat on Familial Cancer Risk: Results From a Cross-Sectional Web-Based Survey %A Memenga,Paula %A Baumann,Eva %A Luetke Lanfer,Hanna %A Reifegerste,Doreen %A Geulen,Julia %A Weber,Winja %A Hahne,Andrea %A Müller,Anne %A Weg-Remers,Susanne %+ Hanover Center for Health Communication, Department of Journalism and Communication Research, Hanover University of Music, Drama and Media, Expo Plaza 12, Hannover, 30539, Germany, 49 5113100488, paula.memenga@ijk.hmtm-hannover.de %K live chat %K technology acceptance %K familial cancer risk %K Extended Unified Theory of Acceptance and Use of Technology %K cancer information seeking %K patients and relatives with cancer %K patients with cancer %K cancer risk %K genetic testing %K diagnosis %K severity %K cross-sectional survey %D 2023 %7 28.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: An important prerequisite for actively engaging in cancer prevention and early detection measures, which is particularly recommended in cases of familial cancer risk, is the acquisition of information. Although a lot of cancer information is available, not all social groups are equally well reached because information needs and communicative accessibility differ. Previous research has shown that a live chat service provided by health professionals could be an appropriate, low-threshold format to meet individual information needs on sensitive health topics such as familial cancer risk. An established German Cancer Information Service is currently developing such a live chat service. As it is only worthwhile if accepted by the target groups, formative evaluation is essential in the course of the chat service’s development and implementation. Objective: This study aimed to explore the acceptance of a live chat on familial cancer risk by patients with cancer and their relatives (research question [RQ] 1) and examine the explanatory power of factors associated with their intentions to use such a service (RQ2). Guided by the Extended Unified Theory of Acceptance and Use of Technology (UTAUT2), we examined the explanatory power of the following UTAUT2 factors: performance expectancy, effort expectancy, social influence, facilitating conditions, and habit, supplemented by perceived information insufficiency, perceived susceptibility, perceived severity, and cancer diagnosis as additional factors related to information seeking about familial cancer. Methods: We conducted a cross-sectional survey via a German web-based access panel in March 2022 that was stratified by age, gender, and education (N=1084). The participants are or have been diagnosed with cancer themselves (n=144) or have relatives who are or have been affected (n=990). All constructs were measured with established scales. To answer RQ1, descriptive data (mean values and distribution) were used. For RQ2, a blockwise multiple linear regression analysis was conducted. Results: Overall, 32.7% of participants were (rather) willing, 28.9% were undecided, and 38.4% were (rather) not willing to use a live chat on familial cancer risk in the future. A multiple linear regression analysis explained 47% of the variance. It revealed that performance expectancy, social influence, habit, perceived susceptibility, and perceived severity were positively associated with the intention to use a live chat on familial cancer risk. Effort expectancy, facilitating conditions, information insufficiency, and cancer diagnosis were not related to usage intentions. Conclusions: A live chat seems promising for providing information on familial cancer risk. When promoting the service, the personal benefits should be addressed in particular. UTAUT2 is an effective theoretical framework for explaining live chat usage intentions and does not need to be extended in the context of familial cancer risk. %M 37639311 %R 10.2196/45198 %U https://www.jmir.org/2023/1/e45198 %U https://doi.org/10.2196/45198 %U http://www.ncbi.nlm.nih.gov/pubmed/37639311 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39089 %T Online Physician-Patient Interaction and Patient Satisfaction: Empirical Study of the Internet Hospital Service %A Wu,Doris Chenguang %A Zhao,Xianduo %A Wu,Ji %+ School of Business, Sun Yat-Sen University, No. 135, Xingang Xi Road, Guangzhou, 510275, China, 86 02084112443, wuji3@mail.sysu.edu.cn %K internet hospital %K online health service %K online physician-patient interaction %K patient satisfaction %K COVID-19 %D 2023 %7 24.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In China, a form of online health service called the internet hospital became a prominent means of patient care when face-to-face visits were not possible during the COVID-19 pandemic to minimize transmission of the SARS-CoV-2 virus. Patients’ internet hospital experiences largely depend on online physician-patient interaction. Yet, little is known about how physicians can improve patient satisfaction by using specific communication strategies online. Objective: This study aimed to identify specific communication strategies to help physicians deliver better quality internet hospital services. We also outline recommendations for hospitals to operate internet hospital platforms more effectively. Methods: A longitudinal data set was collected from an internet hospital platform operated by a top hospital in China. By extracting communication patterns from approximately 20,000 records of online health care services and by controlling the features of service requests, we tested the impacts of response load, more detailed style, and emotional comfort on patient satisfaction. We further explored the effects of these communication patterns in different service contexts. Results: Physicians with a low response load, a more detailed style, and expressions of emotional comfort received more positive patient feedback. Response load did not affect patient satisfaction with free online health service, whereas a more detailed style and emotional comfort enhanced satisfaction with free service. Response load significantly reduced patient satisfaction with paid online health service, while a more detailed style had no effect. Compared with free service, emotional comfort more strongly promoted patient satisfaction with paid service. Conclusions: The communication strategies identified can help physicians provide patients with a better internet hospital experience. These strategies require hospitals to schedule each physician’s online service period more appropriately. In addition, tailoring the strategies to service situations can facilitate more targeted and effective internet hospital service for patients. %M 37616031 %R 10.2196/39089 %U https://www.jmir.org/2023/1/e39089 %U https://doi.org/10.2196/39089 %U http://www.ncbi.nlm.nih.gov/pubmed/37616031 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e41552 %T Alerts and Collections for Automating Patients’ Sensemaking and Organizing of Their Electronic Health Record Data for Reflection, Planning, and Clinical Visits: Qualitative Research-Through-Design Study %A Nakikj,Drashko %A Kreda,David %A Gehlenborg,Nils %+ Department of Biomedical Informatics, Harvard Medical School, Harvard University, 10 Shattuck Street, Suite 514, Boston, MA, 02115, United States, 1 857 272 5075, nils@hms.harvard.edu %K patients %K electronic health records %K sensemaking %K pattern detection %K data organization %K alerts %K reports %K collections %D 2023 %7 21.8.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Electronic health record (EHR) data from multiple providers often exhibit important but convoluted and complex patterns that patients find hard and time-consuming to identify and interpret. However, existing patient-facing applications lack the capability to incorporate automatic pattern detection robustly and toward supporting making sense of the patient’s EHR data. In addition, there is no means to organize EHR data in an efficient way that suits the patient’s needs and makes them more actionable in real-life settings. These shortcomings often result in a skewed and incomplete picture of the patient’s health status, which may lead to suboptimal decision-making and actions that put the patient at risk. Objective: Our main goal was to investigate patients’ attitudes, needs, and use scenarios with respect to automatic support for surfacing important patterns in their EHR data and providing means for organizing them that best suit patients’ needs. Methods: We conducted an inquisitive research-through-design study with 14 participants. Presented in the context of a cutting-edge application with strong emphasis on independent EHR data sensemaking, called Discovery, we used high-level mock-ups for the new features that were supposed to support automatic identification of important data patterns and offer recommendations—Alerts—and means for organizing the medical records based on patients’ needs, much like photos in albums—Collections. The combined audio recording transcripts and in-study notes were analyzed using the reflexive thematic analysis approach. Results: The Alerts and Collections can be used for raising awareness, reflection, planning, and especially evidence-based patient-provider communication. Moreover, patients desired carefully designed automatic pattern detection with safe and actionable recommendations, which produced a well-tailored and scoped landscape of alerts for both potential threats and positive progress. Furthermore, patients wanted to contribute their own data (eg, progress notes) and log feelings, daily observations, and measurements to enrich the meaning and enable easier sensemaking of the alerts and collections. On the basis of the findings, we renamed Alerts to Reports for a more neutral tone and offered design implications for contextualizing the reports more deeply for increased actionability; automatically generating the collections for more expedited and exhaustive organization of the EHR data; enabling patient-generated data input in various formats to support coarser organization, richer pattern detection, and learning from experience; and using the reports and collections for efficient, reliable, and common-ground patient-provider communication. Conclusions: Patients need to have a flexible and rich way to organize and annotate their EHR data; be introduced to insights from these data—both positive and negative; and share these artifacts with their physicians in clinical visits or via messaging for establishing shared mental models for clear goals, agreed-upon priorities, and feasible actions. %M 37603400 %R 10.2196/41552 %U https://humanfactors.jmir.org/2023/1/e41552 %U https://doi.org/10.2196/41552 %U http://www.ncbi.nlm.nih.gov/pubmed/37603400 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50231 %T Examining the Use of Text Messages Among Multidisciplinary Care Teams to Reduce Avoidable Hospitalization of Nursing Home Residents with Dementia: Protocol for a Secondary Analysis %A Powell,Kimberly R %A Popescu,Mihail %A Lee,Suhwon %A Mehr,David R %A Alexander,Gregory L %+ Sinclair School of Nursing, University of Missouri, 915 Hitt Street, Columbia, MO, 65211, United States, 1 5026407556, powellk@missouri.edu %K age-friendly health systems %K Alzheimer disease %K communication %K dementia %K nursing homes %K older adults %D 2023 %7 9.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Reducing avoidable nursing home (NH)–to-hospital transfers of residents with Alzheimer disease or a related dementia (ADRD) has become a national priority due to the physical and emotional toll it places on residents and the high costs to Medicare and Medicaid. Technologies supporting the use of clinical text messages (TMs) could improve communication among health care team members and have considerable impact on reducing avoidable NH-to-hospital transfers. Although text messaging is a widely accepted mechanism of communication, clinical models of care using TMs are sparsely reported in the literature, especially in NHs. Protocols for assessing technologies that integrate TMs into care delivery models would be beneficial for end users of these systems. Without evidence to support clinical models of care using TMs, users are left to design their own methods and protocols for their use, which can create wide variability and potentially increase disparities in resident outcomes. Objective: Our aim is to describe the protocol of a study designed to understand how members of the multidisciplinary team communicate using TMs and how salient and timely communication can be used to avert poor outcomes for NH residents with ADRD, including hospitalization. Methods: This project is a secondary analysis of data collected from a Centers for Medicare & Medicaid Services (CMS)–funded demonstration project designed to reduce avoidable hospitalizations for long-stay NH residents. We will use two data sources: (1) TMs exchanged among the multidisciplinary team across the 7-year CMS study period (August 2013-September 2020) and (2) an adapted acute care transfer tool completed by advanced practice registered nurses to document retrospective details about NH-to-hospital transfers. The study is guided by an age-friendly model of care called the 4Ms (What Matters, Medications, Mentation, and Mobility) framework. We will use natural language processing, statistical methods, and social network analysis to generate a new ontology and to compare communication patterns found in TMs occurring around the time NH-to-hospital transfer decisions were made about residents with and without ADRD. Results: After accounting for inclusion and exclusion criteria, we will analyze over 30,000 TMs pertaining to over 3600 NH-to-hospital transfers. Development of the 4M ontology is in progress, and the 3-year project is expected to run until mid-2025. Conclusions: To our knowledge, this project will be the first to explore the content of TMs exchanged among a multidisciplinary team of care providers as they make decisions about NH-to-hospital resident transfers. Understanding how the presence of evidence-based elements of high-quality care relate to avoidable hospitalizations among NH residents with ADRD will generate knowledge regarding the future scalability of behavioral interventions. Without this knowledge, NHs will continue to rely on ineffective and outdated communication methods that fail to account for evidence-based elements of age-friendly care. International Registered Report Identifier (IRRID): DERR1-10.2196/50231 %M 37556199 %R 10.2196/50231 %U https://www.researchprotocols.org/2023/1/e50231 %U https://doi.org/10.2196/50231 %U http://www.ncbi.nlm.nih.gov/pubmed/37556199 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e44701 %T Comparing the Effectiveness of a Web-Based Application With a Digital Live Seminar to Improve Safe Communication for Pregnant Women: 3-Group Partially Randomized Controlled Trial %A Kötting,Lukas %A Derksen,Christina %A Keller,Franziska Maria %A Lippke,Sonia %+ Psychology & Methods, Constructor University, Campus Ring 1, Bremen, 28759, Germany, 49 421 200 4721, l.koetting@jacobs-university.de %K Health Action Process Approach %K HAPA %K intention %K safe communication behavior %K patient safety %K obstetric patients %K digital intervention %K web-based app %D 2023 %7 24.7.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Medical internet interventions such as asynchronous apps and synchronous digital live seminars can be effective behavior change interventions. The research question of this study was whether digital interventions based on the Health Action Process Approach can improve pregnant women’s safe communication and patient safety in obstetric care. Objective: This study aims to compare a digital live seminar with a web-based application intervention and a passive control group and to identify which social cognitive variables determine safe communication behavior and patient safety. Methods: In total, 657 pregnant women were recruited, and hereof, 367 expectant mothers from 2 German university hospitals participated in the pre-post study (live seminar: n=142; web-based app: n=81; passive control group: n=144). All interventions targeted intention, planning, self-efficacy, and communication of personal preferences. The 2.5-hour midwife-assisted live seminar included exercises on empathy and clear communication. The fully automated web-based application consisted of 9 consecutive training lessons with the same content as that of the live seminar. Results: Controlled for sociodemographic characteristics, repeated measures analyses of covariance revealed that pregnant women significantly improved their self-reported communication behavior in all groups. The improvement was more pronounced after the digital live seminar than after the web-based application (P<.001; ηp2=0.043). Perceived patient safety improved more for pregnant women participating in the live seminar than for those participating in the web-based application group (P=.03 ηp2=0.015). A regression analysis revealed that social cognitive variables predicted safe communication behavior. Conclusions: Overall, the web-based application intervention appeared to be less effective than the digital live training in terms of communication behavior. Application interventions addressing communication behaviors might require more face-to-face elements. Improving intention, coping planning, and coping self-efficacy appeared to be key drivers in developing safe communication behavior in pregnant women. Future research should include social learning aspects and focus on the practical application of medical internet interventions when aiming to improve pregnant women’s communication and patient safety in obstetrics. Trial Registration: ClinicalTrials.gov NCT03855735; https://clinicaltrials.gov/ct2/show/NCT03855735 %M 37486755 %R 10.2196/44701 %U https://pediatrics.jmir.org/2023/1/e44701 %U https://doi.org/10.2196/44701 %U http://www.ncbi.nlm.nih.gov/pubmed/37486755 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41884 %T Provider Interaction With an Electronic Health Record Notification to Identify Eligible Patients for a Cluster Randomized Trial of Advance Care Planning in Primary Care: Secondary Analysis %A Ma,Jessica E %A Lowe,Jared %A Berkowitz,Callie %A Kim,Azalea %A Togo,Ira %A Musser,R Clayton %A Fischer,Jonathan %A Shah,Kevin %A Ibrahim,Salam %A Bosworth,Hayden B %A Totten,Annette M %A Dolor,Rowena %+ Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, 508 Fulton Street, Durham, NC, 27705, United States, 1 9192860411, jessica.ma@duke.edu %K advance care planning %K electronic health record %K notification %K EHR %K provider interaction %K primary care %K clinical study %K referral %K notifications %K alerts %D 2023 %7 12.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Advance care planning (ACP) improves patient-provider communication and aligns care to patient values, preferences, and goals. Within a multisite Meta-network Learning and Research Center ACP study, one health system deployed an electronic health record (EHR) notification and algorithm to alert providers about patients potentially appropriate for ACP and the clinical study. Objective: The aim of the study is to describe the implementation and usage of an EHR notification for referring patients to an ACP study, evaluate the association of notifications with study referrals and engagement in ACP, and assess provider interactions with and perspectives on the notifications. Methods: A secondary analysis assessed provider usage and their response to the notification (eg, acknowledge, dismiss, or engage patient in ACP conversation and refer patient to the clinical study). We evaluated all patients identified by the EHR algorithm during the Meta-network Learning and Research Center ACP study. Descriptive statistics compared patients referred to the study to those who were not referred to the study. Health care utilization, hospice referrals, and mortality as well as documentation and billing for ACP and related legal documents are reported. We evaluated associations between notifications with provider actions (ie, referral to study, ACP not documentation, and ACP billing). Provider free-text comments in the notifications were summarized qualitatively. Providers were surveyed on their satisfaction with the notification. Results: Among the 2877 patients identified by the EHR algorithm over 20 months, 17,047 unique notifications were presented to 45 providers in 6 clinics, who then referred 290 (10%) patients. Providers had a median of 269 (IQR 65-552) total notifications, and patients had a median of 4 (IQR 2-8). Patients with more (over 5) notifications were less likely to be referred to the study than those with fewer notifications (57/1092, 5.2% vs 233/1785, 13.1%; P<.001). The most common free-text comment on the notification was lack of time. Providers who referred patients to the study were more likely to document ACP and submit ACP billing codes (P<.001). In the survey, 11 providers would recommend the notification (n=7, 64%); however, the notification impacted clinical workflow (n=9, 82%) and was difficult to navigate (n=6, 55%). Conclusions: An EHR notification can be implemented to remind providers to both perform ACP conversations and refer patients to a clinical study. There were diminishing returns after the fifth EHR notification where additional notifications did not lead to more trial referrals, ACP documentation, or ACP billing. Creation and optimization of EHR notifications for study referrals and ACP should consider the provider user, their workflow, and alert fatigue to improve implementation and adoption. Trial Registration: ClinicalTrials.gov NCT03577002; https://clinicaltrials.gov/ct2/show/NCT03577002 %M 37171856 %R 10.2196/41884 %U https://www.jmir.org/2023/1/e41884 %U https://doi.org/10.2196/41884 %U http://www.ncbi.nlm.nih.gov/pubmed/37171856 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40634 %T User Testing of the Veteran Delegation Tool: Qualitative Inquiry %A Haun,Jolie N %A Melillo,Christine %A Schneider,Tali %A Merzier,Marie M %A Klanchar,S Angelina %A Fowler,Christopher A %A Benzinger,Rachel C %+ James A Haley Veterans Hospital, 8900 Grand Oak Circle, Tampa, FL, 33637, United States, 1 813 558 3938, christine.melillo@va.gov %K electronic health portal %K human-centered design %K delegate %K electronic resources %K delegation %K care partner %K veteran %K Veteran Delegation Tool %K Veterans Health Administration %D 2023 %7 23.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Informal caregivers, or care partners, provide critical support to care recipients when managing health care. Veterans Health Administration (VHA) priorities identify care partners as vital in supporting veterans’ care management. The Veteran Delegation Tool (VDT) is VHA’s Health Insurance Portability and Accountability Act–compliant solution for care partners to comanage veterans’ care through VHA’s electronic health portal. Human-centered design approaches in VDT development are needed to inform enhancements aimed at promoting uptake and sustained use. Objective: The objective of this prospective descriptive quality improvement project was to use a human-centered design approach to examine VDT use perceptions and practical experiences. Methods: This project was conducted using a 4-phase approach: frame, discover, design, and deliver. The frame phase designed the protocol and prepared the VDT system for testing. This paper reports on the discover phase, which used semistructured and follow-up interviews and user testing to examine VDT’s benefits, facilitators, and barriers. The discover phase data informed the design and deliver phases, which are underway. Results: Veterans (24/54, 44%), care partners (21/54, 39%), and individuals who represented dual roles (9/54, 17%)—namely veteran care partner (4/54, 7%), veteran clinical provider (2/54, 4%), and care partner provider (3/54, 6%)—participated in semistructured interviews in the discover phase. A subsample of these participants (3/54, 6%) participated in the follow-up interviews and user testing. Analysis of the semistructured interviews indicated convergence on the respondents’ perceptions of VDT’s benefits, facilitators, and barriers and recommendations for improving VDT. The perceived benefits were authorized access, comanagement of care needs on the web, communication with the clinical team, access to resources, and ease of burden. Perceived barriers were nonrecognition of the benefits of VDT, technical literacy access issues, increased stress in or burden on care partners, and personal health information security. Participant experiences across 4 VDT activity domains were upgrade to My HealtheVet Premium account, registration, sign-in, and use. User testing demonstrated users’ challenges to register, navigate, and use VDT. Findings informed VDT development enhancements and recommendations. Conclusions: Care partners need Health Insurance Portability and Accountability Act–compliant access to electronic health portals to assist with care management. VDT is VHA’s solution, allowing communication among delegates, veterans, and clinical care teams. Users value VDT’s potential use and benefits, while access and navigation improvements to ensure uptake and sustained use are needed. Future efforts need to iteratively evaluate the human-centered phases, design and deliver, of VDT to target audiences. Continued efforts to understand and respond to care partners’ needs are warranted. %M 36821364 %R 10.2196/40634 %U https://www.jmir.org/2023/1/e40634 %U https://doi.org/10.2196/40634 %U http://www.ncbi.nlm.nih.gov/pubmed/36821364 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42881 %T Evaluation of a Secure Messaging System in the Care of Children With Medical Complexity: Mixed Methods Study %A Parpia,Camilla %A Moore,Clara %A Beatty,Madison %A Miranda,Susan %A Adams,Sherri %A Stinson,Jennifer %A Desai,Arti %A Bartlett,Leah %A Culbert,Erin %A Cohen,Eyal %A Orkin,Julia %+ Temerty Faculty of Medicine, University of Toronto, 27 King's College Cir, Toronto, ON, Toronto, ON, M5S 3H7, Canada, 1 6472292363, camilla.parpia@mail.utoronto.ca %K secure messaging %K children with medical complexity %K patient-physician relationship %K care coordination %K partnership %K email communication %K online information %K children %K pediatrics %K caregiver %K information sharing %K electronic medical record %D 2023 %7 23.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The Connecting2gether (C2) platform is a web and mobile–based information-sharing tool that aims to improve care for children with medical complexity and their families. A key feature of C2 is secure messaging, which enables parental caregivers (PCs) to communicate with their child’s care team members (CTMs) in a timely manner. Objective: The objectives of this study were to (1) evaluate the use of a secure messaging system, (2) examine and compare the content of messages to email and phone calls, and (3) explore PCs’ and CTMs’ perceptions and experiences using secure messaging as a method of communication. Methods: This is a substudy of a larger feasibility evaluation of the C2 platform. PCs of children with medical complexity were recruited from a tertiary-level complex care program to use the C2 platform for 6 months. PCs could invite CTMs involved in their child’s care to register on the platform. Messages were extracted from C2, and phone and email data were extracted from electronic medical records. Quantitative data from the use of C2 were analyzed using descriptive statistics. Messaging content codes were iteratively developed through a review of the C2 messages and phone and email communication. Semistructured interviews were completed with PCs and CTMs. Communication and interview data were analyzed using thematic analysis. Results: A total of 36 PCs and 66 CTMs registered on the C2 platform. A total of 1861 messages were sent on C2, with PCs and nurse practitioners sending a median of 30 and 74 messages, respectively. Of all the C2 messages, 85.45% (1257/1471) were responded to within 24 hours. Email and phone calls focused primarily on clinical concerns and medications, whereas C2 messaging focused more on parent education, proactive check-ins, and nonmedical aspects of the child’s life. Four themes emerged from the platform user interviews related to C2 messaging: (1) connection to the care team, (2) efficient communication, (3) clinical uses of secure messaging, and (4) barriers to use. Conclusions: Overall, our study provides valuable insight into the benefits of secure messaging in the care of children with medical complexity. Secure messaging provided the opportunity for continued family teaching, proactive check-ins from health care providers, and casual conversations about family and child life, which contributed to PCs feeling an improved sense of connection with their child’s health care team. Secure messaging can be a beneficial additional communication method to improve communication between PCs and their care team, reducing the associated burden of care coordination and ultimately enhancing the experience of care delivery. Future directions include the evaluation of secure messaging when integrated into electronic medical records, as this has the potential to work well with CTM workflow, reduce redundancy, and allow for new features of secure messaging. %M 36821356 %R 10.2196/42881 %U https://formative.jmir.org/2023/1/e42881 %U https://doi.org/10.2196/42881 %U http://www.ncbi.nlm.nih.gov/pubmed/36821356 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43496 %T Patient Online Record Access in English Primary Care: Qualitative Survey Study of General Practitioners’ Views %A Blease,Charlotte %A Torous,John %A Dong,Zhiyong %A Davidge,Gail %A DesRoches,Catherine %A Kharko,Anna %A Turner,Andrew %A Jones,Ray %A Hägglund,Maria %A McMillan,Brian %+ Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, General Medicine and Primary Care, Beth Israel Deaconess Medical Center Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, United States, 1 7921587211, charlotteblease@gmail.com %K electronic health records %K attitudes %K general practice %K patients %K online record access %K open notes %K opinions %K primary care %K qualitative research %D 2023 %7 22.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In 2022, NHS England announced plans to ensure that all adult primary care patients in England would have full online access to new data added to their general practitioner (GP) record. However, this plan has not yet been fully implemented. Since April 2020, the GP contract in England has already committed to offering patients full online record access on a prospective basis and on request. However, there has been limited research into UK GPs’ experiences and opinions about this practice innovation. Objective: This study aimed to explore the experiences and opinions of GPs in England about patients’ access to their full web-based health record, including clinicians’ free-text summaries of the consultation (so-called “open notes”). Methods: In March 2022, using a convenience sample, we administered a web-based mixed methods survey of 400 GPs in the United Kingdom to explore their experiences and opinions about the impact on patients and GPs’ practices to offer patients full online access to their health records. Participants were recruited using the clinician marketing service Doctors.net.uk from registered GPs currently working in England. We conducted a qualitative descriptive analysis of written responses (“comments”) to 4 open-ended questions embedded in a web-based questionnaire. Results: Of 400 GPs, 224 (56%) left comments that were classified into 4 major themes: increased strain on GP practices, the potential to harm patients, changes to documentation, and legal concerns. GPs believed that patient access would lead to extra work for them, reduced efficiency, and increased burnout. The participants also believed that access would increase patient anxiety and incur risks to patient safety. Experienced and perceived documentation changes included reduced candor and changes to record functionality. Anticipated legal concerns encompassed fears about increased litigation risks and lack of legal guidance to GPs about how to manage documentation that would be read by patients and potential third parties. Conclusions: This study provides timely information on the views of GPs in England regarding patient access to their web-based health records. Overwhelmingly, GPs were skeptical about the benefits of access both for patients and to their practices. These views are similar to those expressed by clinicians in other countries, including Nordic countries and the United States before patient access. The survey was limited by the convenience sample, and it is not possible to infer that our sample was representative of the opinions of GPs in England. More extensive, qualitative research is required to understand the perspectives of patients in England after experiencing access to their web-based records. Finally, further research is needed to explore objective measures of the impact of patient access to their records on health outcomes, clinician workload, and changes to documentation. %M 36811939 %R 10.2196/43496 %U https://www.jmir.org/2023/1/e43496 %U https://doi.org/10.2196/43496 %U http://www.ncbi.nlm.nih.gov/pubmed/36811939 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e39051 %T The Perceived Ease of Use and Perceived Usefulness of a Web-Based Interprofessional Communication and Collaboration Platform in the Hospital Setting: Interview Study With Health Care Providers %A Nie,Jason Xin %A Heidebrecht,Christine %A Zettler,Andrea %A Pearce,Jacklyn %A Cunha,Rafael %A Quan,Sherman %A Mansfield,Elizabeth %A Tang,Terence %+ Institute for Better Health, Trillium Health Partners, 2200 Eglinton Avenue West, Mississauga, ON, L5M 2N1, Canada, 1 9058132200, terence.tang@thp.ca %K health information technology %K communication and collaboration %K teamwork %K design %K technology acceptance model %K qualitative method %K communication %K collaboration %K hospital %K care %K team %K professional %K support %K health information %K technology %K clinician %K members %K complex %K lesson %K education %D 2023 %7 23.1.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Hospitalized patients with complex care needs require an interprofessional team of health professionals working together to support their care in hospitals and during discharge planning. However, interprofessional communication and collaboration in inpatient settings are often fragmented and inefficient, leading to poor patient outcomes and provider frustration. Health information technology can potentially help improve team communication and collaboration; however, to date, evidence of its effectiveness is lacking. There are also concerns that current implementations might further fragment communication and increase the clinician burden without proven benefits. Objective: In this study, we aimed to generate transferrable lessons for future designers of health information technology tools that facilitate team communication and collaboration. Methods: A secondary analysis of the qualitative component of the mixed methods evaluation was performed. The electronic communication and collaboration platform was implemented in 2 general internal medicine wards in a large community teaching hospital in Mississauga, Ontario, Canada. Fifteen inpatient clinicians in those wards, including nurses, physicians, and allied health care providers, were recruited to participate in semistructured interviews about their experience with a co-designed electronic communication and collaboration tool. Data were analyzed using the Technology Acceptance Model, and themes related to the constructs of perceived ease of use (PEOU) and perceived usefulness (PU) were identified. Results: A secondary analysis guided by the Technology Acceptance Model highlighted important points. Intuitive design precluded training as a barrier to use, but lack of training may hinder participants’ PEOU if features designed for efficiency are not discovered by users. Organized information was found to be useful for creating a comprehensive clinical picture of each patient and facilitating improved handovers. However, information needs to be both comprehensive and succinct, and information overload may negatively impact PEOU. The mixed paper and electronic practice environment also negatively impacted PEOU owing to unavoidable double documentation and the need for printing. Participants perceived the tool to be useful as it improved efficiency in information retrieval and documentation, improved the handover process, afforded another mode of communication when face-to-face communication was impractical, and improved shared awareness. The PU of this tool depends on its optimal use by all team members. Conclusions: Electronic tools can support communication and collaboration among interprofessional teams caring for patients with complex needs. There are transferable lessons learned that can improve the PU and PEOU of future systems. %M 36689261 %R 10.2196/39051 %U https://humanfactors.jmir.org/2023/1/e39051 %U https://doi.org/10.2196/39051 %U http://www.ncbi.nlm.nih.gov/pubmed/36689261 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40725 %T Web-Based Asynchronous Tool to Facilitate Communication Between Primary Care Providers and Cancer Specialists: Pragmatic Randomized Controlled Trial %A Petrovic,Bojana %A Julian,Jim A %A Liddy,Clare %A Afkham,Amir %A McGee,Sharon F %A Morgan,Scott C %A Segal,Roanne %A Sussman,Jonathan %A Pond,Gregory R %A O'Brien,Mary Ann %A Bender,Jacqueline L %A Grunfeld,Eva %+ Department of Family and Community Medicine, University of Toronto, 500 University Ave, 5th floor, Toronto, ON, M5G 1V7, Canada, 1 416 978 7518, bojana.petrovic@utoronto.ca %K electronic communication %K coordination of care %K cancer %K primary care %D 2023 %7 18.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Cancer poses a significant global health burden. With advances in screening and treatment, there are now a growing number of cancer survivors with complex needs, requiring the involvement of multiple health care providers. Previous studies have identified problems related to communication and care coordination between primary care providers (PCPs) and cancer specialists. Objective: This study aimed to examine whether a web- and text-based asynchronous system (eOncoNote) could facilitate communication between PCPs and cancer specialists (oncologists and oncology nurses) to improve patient-reported continuity of care among patients receiving treatment or posttreatment survivorship care. Methods: In this pragmatic randomized controlled trial, a total of 173 patients were randomly assigned to either the intervention group (eOncoNote plus usual methods of communication between PCPs and cancer specialists) or a control group (usual communication only), including 104 (60.1%) patients in the survivorship phase (breast and colorectal cancer) and 69 (39.9%) patients in the treatment phase (breast and prostate cancer). The primary outcome was patient-reported team and cross-boundary continuity (Nijmegen Continuity Questionnaire). Secondary outcome measures included the Generalized Anxiety Disorder Screener (GAD-7), Patient Health Questionnaire on Major Depression, and Picker Patient Experience Questionnaire. Patients completed the questionnaires at baseline and at 2 points following randomization. Patients in the treatment phase completed follow-up questionnaires at 1 month and at either 4 months (patients with prostate cancer) or 6 months following randomization (patients with breast cancer). Patients in the survivorship phase completed follow-up questionnaires at 6 months and at 12 months following randomization. Results: The results did not show an intervention effect on the primary outcome of team and cross-boundary continuity of care or on the secondary outcomes of depression and patient experience with their health care. However, there was an intervention effect on anxiety. In the treatment phase, there was a statistically significant difference in the change score from baseline to the 1-month follow-up for GAD-7 (mean difference −2.3; P=.03). In the survivorship phase, there was a statistically significant difference in the change score for GAD-7 between baseline and the 6-month follow-up (mean difference −1.7; P=.03) and between baseline and the 12-month follow-up (mean difference −2.4; P=.004). Conclusions: PCPs’ and cancer specialists’ access to eOncoNote is not significantly associated with patient-reported continuity of care. However, PCPs’ and cancer specialists’ access to the eOncoNote intervention may be a factor in reducing patient anxiety. Trial Registration: ClinicalTrials.gov NCT03333785; https://clinicaltrials.gov/ct2/show/NCT03333785 %M 36652284 %R 10.2196/40725 %U https://www.jmir.org/2023/1/e40725 %U https://doi.org/10.2196/40725 %U http://www.ncbi.nlm.nih.gov/pubmed/36652284 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e37467 %T Web-Based Short Video Intervention and Short Message Comparison of Repeat Blood Donation Behavior Based on an Extended Theory of Planned Behavior: Prospective Randomized Controlled Trial Study %A Hu,Qiuyue %A Hu,Wei %A Han,Wenjuan %A Pan,Lingling %+ Blood Center of Zhejiang Province, 789 Jianye Road, Binjiang District, Hangzhou, 310052, China, 86 13588809060, panbbs@163.com %K extended theory of planned behavior %K repeated blood donation intervention %K randomized controlled trial %K mobile phone %D 2022 %7 23.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Although blood is an indispensable and important resource for clinical treatment, an imbalance between supply and demand may occur as the population ages and diversifies. Studies indicate that repeat blood donors are safe blood sources because of their voluntary blood donation education and frequent blood screening. However, the high rate of reduction in the number of first-time voluntary blood donors and low rate of repeated blood donation are common problems worldwide. Objective: This study aimed to evaluate the effect of an intervention in nonregular blood donors using web-based videos and SMS text messages, in which the former was guided by the extended theory of planned behavior, to discover effective intervention methods to improve repeat blood donation rates among nonregular blood donors. Methods: A total of 692 nonregular blood donors in Zhejiang province were randomly divided into intervention and control groups. The control group received regular, short reminder messages for a 6-month period, whereas the intervention group received web-based videos on the WeChat platform. The intervention group was guided by an extended theory of planned behavior, which included 9 factors: the respondents’ attitude, subjective behavioral norms, perceived behavioral control, the willingness to donate blood, outcome expectations, self-identity, blood donation–related anxiety, cognition of the blood donation environment, and previous blood donation experience. The intervention group was divided into 2 stages: those with an intervention at 3 months and those with a follow-up 3 months later. After 6 months, the redonation rate was evaluated for the 2 groups, and the scale in the intervention group was determined both before and after the intervention. A t test, chi-square test, logistic stepwise regression, and ANOVA were performed. Results: The intervention group’s redonation rate was 16.14%, which was significantly higher than the control group’s redonation rate of 5.16%; P<.001. Men who were aged 31 to 45 years and had donated blood twice had a higher redonation rate after the web-based video intervention than after the SMS text messages; P<.05. The repeat donors’ improved blood donation anxiety (P=.01), outcome expectations (P=.008), and cognition of the blood donation environment (P=.005) after the intervention were significantly higher than those of the nonrepeat donors. Conclusions: The web-based short video intervention based on the extended theory of planned behavior can effectively improve redonation rates. Outcome expectations, blood donation anxiety, and cognition of the blood donation environment can directly influence irregular blood donors to redonate blood. %M 36379691 %R 10.2196/37467 %U https://www.jmir.org/2022/12/e37467 %U https://doi.org/10.2196/37467 %U http://www.ncbi.nlm.nih.gov/pubmed/36379691 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e42941 %T Patient Trust in Physicians Matters—Understanding the Role of a Mobile Patient Education System and Patient-Physician Communication in Improving Patient Adherence Behavior: Field Study %A Wu,Dezhi %A Lowry,Paul Benjamin %A Zhang,Dongsong %A Tao,Youyou %+ Department of Integrated Information Technology, University of South Carolina, 550 Assembly Street, Columbia, SC, 29298, United States, 1 8037774691, dezhiwu@cec.sc.edu %K mobile health %K mHealth %K trust %K patient adherence %K mobile patient education system %K MPES %K patient-physician communication %K theory of planned behavior %K TPB %K patient-centered care %K mobile phone %D 2022 %7 20.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The ultimate goal of any prescribed medical therapy is to achieve desired outcomes of patient care. However, patient nonadherence has long been a major problem detrimental to patient health, and thus is a concern for all health care providers. Moreover, nonadherence is extremely costly for global medical systems because of unnecessary complications and expenses. Traditional patient education programs often serve as an intervention tool to increase patients’ self-care awareness, disease knowledge, and motivation to change patient behaviors for better adherence. Patient trust in physicians, patient-physician relationships, and quality of communication have also been identified as critical factors influencing patient adherence. However, little is known about how mobile patient education technologies help foster patient adherence. Objective: This study aimed to empirically investigate whether and how a mobile patient education system (MPES) juxtaposed with patient trust can increase patient adherence to prescribed medical therapies. Methods: This study was conducted based on a field survey of 125 patients in multiple states in the United States who have used an innovative mobile health care system for their health care education and information seeking. Partial least squares techniques were used to analyze the collected data. Results: The results revealed that patient-physician communication and the use of an MPES significantly increase patients’ trust in their physicians. Furthermore, patient trust has a prominent effect on patient attitude toward treatment adherence, which in turn influences patients’ behavioral intention and actual adherence behavior. Based on the theory of planned behavior, the results also indicated that behavioral intention, response efficacy, and self-efficacy positively influenced patients’ actual treatment adherence behavior, whereas descriptive norms and subjective norms do not play a role in this process. Conclusions: Our study is one of the first that examines the relationship between patients who actively use an MPES and their trust in their physicians. This study contributes to this context by enriching the trust literature, addressing the call to identify key patient-centered technology determinants of trust, advancing the understanding of patient adherence mechanisms, adding a new explanation of the influence of education mechanisms delivered via mobile devices on patient adherence, and confirming that the theory of planned behavior holds in this patient adherence context. %M 36538351 %R 10.2196/42941 %U https://www.jmir.org/2022/12/e42941 %U https://doi.org/10.2196/42941 %U http://www.ncbi.nlm.nih.gov/pubmed/36538351 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e36652 %T The Perceived Effectiveness of Secure Messaging for Medication Reconciliation During Transitions of Care: Semistructured Interviews With Patients %A Brady,Julianne E %A Linsky,Amy M %A Simon,Steven R %A Yeksigian,Kate %A Rubin,Amy %A Zillich,Alan J %A Russ-Jara,Alissa L %+ Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, 02130, United States, 1 857 364 5110, julianne.brady@va.gov %K medication reconciliation %K patient portals %K telemedicine %K pharmacist-patient relationship %K medication errors %D 2022 %7 3.8.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Medication discrepancies can lead to adverse drug events and patient harm. Medication reconciliation is a process intended to reduce medication discrepancies. We developed a Secure Messaging for Medication Reconciliation Tool (SMMRT), integrated into a web-based patient portal, to identify and reconcile medication discrepancies during transitions from hospital to home. Objective: We aimed to characterize patients’ perceptions of the ease of use and effectiveness of SMMRT. Methods: We recruited 20 participants for semistructured interviews from a sample of patients who had participated in a randomized controlled trial of SMMRT. Interview transcripts were transcribed and then qualitatively analyzed to identify emergent themes. Results: Although most patients found SMMRT easy to view at home, many patients struggled to return SMMRT through secure messaging to clinicians due to technology-related barriers. Patients who did use SMMRT indicated that it was time-saving and liked that they could review it at their own pace and in the comfort of their own home. Patients reported SMMRT was effective at clarifying issues related to medication directions or dosages and that SMMRT helped remove medications erroneously listed as active in the patient’s electronic health record. Conclusions: Patients viewed SMMRT utilization as a positive experience and endorsed future use of the tool. Veterans reported SMMRT is an effective tool to aid patients with medication reconciliation. Adoption of SMMRT into regular clinical practice could reduce medication discrepancies while increasing accessibility for patients to help manage their medications. Trial Registration: ClinicalTrials.gov NCT02482025; https://clinicaltrials.gov/ct2/show/NCT02482025 %M 35921139 %R 10.2196/36652 %U https://humanfactors.jmir.org/2022/3/e36652 %U https://doi.org/10.2196/36652 %U http://www.ncbi.nlm.nih.gov/pubmed/35921139 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e34949 %T Communications Through Contemporary Tools of Information and Communication Technology: Cross-sectional Study Evaluating Health Among Separated Family Members %A Nishikitani,Mariko %A Ariyoshi,Mie %A Nohara,Yasunobu %A Umihara,Junko %+ Medical Information Center, Kyushu University Hospital, 3-1-1 Collabo 2-705, Maidashi Higashi-ku, Fukuoka, 812-8582, Japan, 81 92 642 6475, nishikitani.mariko.585@m.kyushu-u.ac.jp %K family relations %K interpersonal communication %K internet use %K smartphone %K home environment %K psychosocial functioning %D 2022 %7 3.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The number of single-living workers separated from their spouses and families has been increasing due to the need to create a balance between life and work. Workers are assigned everywhere in globalized workplaces while also caring for their family members in the context of Japan’s aging society. At the same time, the mental and health status of persons living separately from their families is a matter of concern. The development of interpersonal communication means using information and communications technology (ICT) tools and the internet is remarkable, enabling simultaneous 2-way communication across distances and national borders. The easy accessibility to simultaneous communication is expected to improve the psychosocial status of isolated family members. Objective: This study aims to clarify the health benefits of ICT by using a psychosocial health assessment, the characteristics of ICT tools, and the frequency of communication among the workers and their families who live separately. Methods: This was a cross-sectional study planned and conducted in Japan. Study participants, including adults who live separately from other family members or have separately living family members due to work, were recruited to answer a web response survey about ICT usage status, health status, and life and society evaluation. This study recruited 73 participants divided into 2 groups by their communication tools and frequencies, and their separated life, health, and psychosocial status were statistically compared. Results: Among the 73 study participants, 15 were categorized in the high communication–skilled (HCS) group that used both types of ICT tools to communicate frequently: “live,” such as video chat and voice call, and “nonlive,” such as SMS text message service and email. A simple comparison between the HCS and reference groups showed significant differences in the cohesion with the neighborhood (P=.03), perceived social position (P=.01), and happiness (P<.001); however, there were no significant differences in the health (psychological distress, P=.08; self-rated health, P=.07), lifestyle (drinking, P>.99; current smoking, P=.37), and dyadic trust in family members living separately (P=.80). Further, in a multivariate regression analysis adjusted for confounding factors, such as educational history, age, gender, and job status, poor subjective health showed a prevalence odds ratio of less than 1 (OR 0.17, 95% CI 0.03-1.02). The HCS group showed significant positive relationships in the cohesion score with the neighborhood (P=.01; β=2.40, 95% CI 0.56-4.24), perceived social position (P=.03; β=1.17, 95% CI 0.11-2.23), and happiness score (P=.002; β=1.46, 95% CI 0.58-2.34) in the same multivariate regression models. Conclusions: This study suggested that people who frequently communicate with separated family members by taking advantage of various ICT tools can maintain a better mental state and better social relations among those who live alone and are separated from their families. %M 35921127 %R 10.2196/34949 %U https://formative.jmir.org/2022/8/e34949 %U https://doi.org/10.2196/34949 %U http://www.ncbi.nlm.nih.gov/pubmed/35921127 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e37403 %T Language Use in Conversational Agent–Based Health Communication: Systematic Review %A Shan,Yi %A Ji,Meng %A Xie,Wenxiu %A Qian,Xiaobo %A Li,Rongying %A Zhang,Xiaomin %A Hao,Tianyong %+ School of Foreign Studies, Nantong University, No. 9, Seyuan Rd., Nantong, 226019, China, 86 15558121896, victorsyhz@hotmail.com %K systematic review %K health communication %K language use %K conversational agent %D 2022 %7 8.7.2022 %9 Review %J J Med Internet Res %G English %X Background: Given the growing significance of conversational agents (CAs), researchers have conducted a plethora of relevant studies on various technology- and usability-oriented issues. However, few investigations focus on language use in CA-based health communication to examine its influence on the user perception of CAs and their role in delivering health care services. Objective: This review aims to present the language use of CAs in health care to identify the achievements made and breakthroughs to be realized to inform researchers and more specifically CA designers. Methods: This review was conducted by following the protocols of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement. We first designed the search strategy according to the research aim and then performed the keyword searches in PubMed and ProQuest databases for retrieving relevant publications (n=179). Subsequently, 3 researchers screened and reviewed the publications independently to select studies meeting the predefined selection criteria. Finally, we synthesized and analyzed the eligible articles (N=11) through thematic synthesis. Results: Among the 11 included publications, 6 deal exclusively with the language use of the CAs studied, and the remaining 5 are only partly related to this topic. The language use of the CAs in these studies can be roughly classified into six themes: (1) personal pronouns, (2) responses to health and lifestyle prompts, (3) strategic wording and rich linguistic resources, (4) a 3-staged conversation framework, (5) human-like well-manipulated conversations, and (6) symbols and images coupled with phrases. These derived themes effectively engaged users in health communication. Meanwhile, we identified substantial room for improvement based on the inconsistent responses of some CAs and their inability to present large volumes of information on safety-critical health and lifestyle prompts. Conclusions: This is the first systematic review of language use in CA-based health communication. The results and limitations identified in the 11 included papers can give fresh insights into the design and development, popularization, and research of CA applications. This review can provide practical implications for incorporating positive language use into the design of health CAs and improving their effective language output in health communication. In this way, upgraded CAs will be more capable of handling various health problems particularly in the context of nationwide and even worldwide public health crises. %M 35802407 %R 10.2196/37403 %U https://www.jmir.org/2022/7/e37403 %U https://doi.org/10.2196/37403 %U http://www.ncbi.nlm.nih.gov/pubmed/35802407 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e36878 %T Electronic Discharge Communication Tools Used in Pediatric Emergency Departments: Systematic Review %A Wozney,Lori %A Curran,Janet %A Archambault,Patrick %A Cassidy,Christine %A Jabbour,Mona %A Mackay,Rebecca %A Newton,Amanda %A Plint,Amy C %A Somerville,Mari %+ Mental Health and Addictions, Nova Scotia Health, 300 Pleasant St., Dartmouth, NS, B2Y 3Z9, Canada, 1 902 449 0603, loriwozney@gmail.com %K emergency department %K medical informatics %K pediatric %K systematic review %K patient discharge summaries %K patient-centered care %K technology %K hospital %D 2022 %7 24.6.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Electronic discharge communication tools (EDCTs) are increasingly common in pediatric emergency departments (EDs). These tools have been shown to improve patient-centered communication, support postdischarge care at home, and reduce unnecessary return visits to the ED. Objective: This study aimed to map and assess the evidence base for EDCTs used in pediatric EDs according to their functionalities, intended purpose, implementation context features, and outcomes. Methods: A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) procedures for identification, screening, and eligibility. A total of 7 databases (EBSCO, MEDLINE, CINAHL, PsycINFO, EMBASE Scopus, and Web of Science) were searched for studies published between 1989 and 2021. Studies evaluating discharge communication–related outcomes using electronic tools (eg, text messages, videos, and kiosks) in pediatric EDs were included. In all, 2 researchers independently assessed the eligibility. Extracted data related to study identification, methodology, settings and demographics, intervention features, outcome implementation features, and practice, policy, and research implications. The Mixed Method Appraisal Tool was used to assess methodological quality. The synthesis of results involved structured tabulation, vote counting, recoding into common metrics, inductive thematic analysis, descriptive statistics, and heat mapping. Results: In total, 231 full-text articles and abstracts were screened for review inclusion with 49 reports (representing 55 unique tools) included. In all, 70% (26/37) of the studies met at least three of five Mixed Method Appraisal Tool criteria. The most common EDCTs were videos, text messages, kiosks, and phone calls. The time required to use the tools ranged from 120 seconds to 80 minutes. The EDCTs were evaluated for numerous presenting conditions (eg, asthma, fracture, head injury, fever, and otitis media) that required a range of at-home care needs after the ED visit. The most frequently measured outcomes were knowledge acquisition, caregiver and patient beliefs and attitudes, and health service use. Unvalidated self-report measures were typically used for measurement. Health care provider satisfaction or system-level impacts were infrequently measured in studies. The directionality of primary outcomes pointed to positive effects for the primary measure (44/55, 80%) or no significant difference (10/55, 18%). Only one study reported negative findings, with an increase in return visits to the ED after receiving the intervention compared with the control group. Conclusions: This review is the first to map the broad literature of EDCTs used in pediatric EDs. The findings suggest a promising evidence base, demonstrating that EDCTs have been successfully integrated across clinical contexts and deployed via diverse technological modalities. Although caregiver and patient satisfaction with EDCTs is high, future research should use robust trials using consistent measures of communication quality, clinician experience, cost-effectiveness, and health service use to accumulate evidence regarding these outcomes. Trial Registration: PROSPERO CRD42020157500; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=157500 %M 35608929 %R 10.2196/36878 %U https://pediatrics.jmir.org/2022/2/e36878 %U https://doi.org/10.2196/36878 %U http://www.ncbi.nlm.nih.gov/pubmed/35608929 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e36208 %T Automated Intraoperative Short Messaging Service Updates: Quality Improvement Initiative to Relieve Caregivers’ Worries %A Mignault,Alexandre %A Tchouaket Nguemeleu,Éric %A Robins,Stephanie %A Maillet,Éric %A Matetsa,Edwige %A Dupuis,Stéphane %+ Département des sciences infirmières, Université du Québec en Outaouais, 5 Rue St Joseph, St-Jérome, QC, J7Z 0B7, Canada, 1 450 530 7616 ext 4039, Eric.Tchouaket@uqo.ca %K COVID-19 %K surgery %K intraoperative %K OR nurse %K communication %K technology %K short messaging service %K SMS %K text message %K caregiver %K anxiety %K perioperative %K surgical %K surgical procedure %K mHealth %K mental health %K digital health %K digital health care %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Undergoing a surgical procedure is anxiety provoking for patients and their caregivers. During the intraoperative period, caregivers seek out informational updates from health care professionals, a situation complicated by COVID-19 health measures that require caregivers to wait outside the hospital. Short messaging service (SMS)-based communication that allows caregivers to follow their loved ones through surgery has shown promise in relieving anxiety and improving satisfaction with overall care. This form of communication is also well accepted by health care professionals and may be effective at relieving staff burden. Objective: Here, we describe a quality improvement initiative of a standardized and integrated intraoperative SMS-based system to improve communication between surgical teams and caregivers. The main goal was to improve satisfaction with care, while the secondary goal was to reduce caregiver anxiety. Methods: The initiative followed the framework of the Model for Improvement. A large tertiary care hospital offered the SMS to caregivers who were waiting for loved ones undergoing surgery. SMS messages were integrated into the clinical information system software and sent at key points during the surgical journey to phone numbers provided by caregivers. A satisfaction survey was sent to caregivers 1 business day after surgery. Data were collected between February 16 and July 14, 2021. Results: Of the 8129 surgeries scheduled, caregivers waiting for 6149 (75.6%) surgeries agreed to receive SMS messages. A total of 34,129 messages were sent. The satisfaction survey was completed by 2088 (34%) of the 6149 caregivers. Satisfaction with messages was high, with the majority of respondents reporting that the messages received were adequate (1476/2085, 70.8%), clear (1545/2077, 74.4%), informative (1488/2078, 71.6%), and met their needs (1234/2077, 59.4%). The overall satisfaction score was high (4.5 out of 5), and caregivers reported that receiving text messages resulted in a reduction in anxiety (score=8.2 out of 10). Technical errors were reported by 69 (3.3%) caregivers. Suggestions for improvements included having messages sent more often; providing greater patient details, including the patient’s health status; and the service being offered in other languages. Conclusions: This digital health initiative provided SMS messages that were systematically sent to caregivers waiting for their loved ones undergoing surgery, just as COVID-19 restrictions began preventing waiting onsite. The messages were used across 15 surgical specialties and have since been implemented hospital-wide. Digital health care innovations have the capacity to improve family-centered communication; what patients and their families find useful and appreciate will ultimately determine their success. %M 35436760 %R 10.2196/36208 %U https://periop.jmir.org/2022/1/e36208 %U https://doi.org/10.2196/36208 %U http://www.ncbi.nlm.nih.gov/pubmed/35436760 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35187 %T Patient Portal Messaging for Asynchronous Virtual Care During the COVID-19 Pandemic: Retrospective Analysis %A Huang,Ming %A Khurana,Aditya %A Mastorakos,George %A Wen,Andrew %A He,Huan %A Wang,Liwei %A Liu,Sijia %A Wang,Yanshan %A Zong,Nansu %A Prigge,Julie %A Costello,Brian %A Shah,Nilay %A Ting,Henry %A Fan,Jungwei %A Patten,Christi %A Liu,Hongfang %+ Department of Artificial Intelligence and Informatics, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, United States, 1 507 293 0057, Liu.Hongfang@mayo.edu %K patient portal %K patient portal message %K asynchronous communication %K COVID-19 %K utilization %K digital health %K healthcare %K health care %K remote healthcare %K virtual care %K pandemic %D 2022 %7 5.5.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: During the COVID-19 pandemic, patient portals and their message platforms allowed remote access to health care. Utilization patterns in patient messaging during the COVID-19 crisis have not been studied thoroughly. In this work, we propose characterizing patients and their use of asynchronous virtual care for COVID-19 via a retrospective analysis of patient portal messages. Objective: This study aimed to perform a retrospective analysis of portal messages to probe asynchronous patient responses to the COVID-19 crisis. Methods: We collected over 2 million patient-generated messages (PGMs) at Mayo Clinic during February 1 to August 31, 2020. We analyzed descriptive statistics on PGMs related to COVID-19 and incorporated patients’ sociodemographic factors into the analysis. We analyzed the PGMs on COVID-19 in terms of COVID-19–related care (eg, COVID-19 symptom self-assessment and COVID-19 tests and results) and other health issues (eg, appointment cancellation, anxiety, and depression). Results: The majority of PGMs on COVID-19 pertained to COVID-19 symptom self-assessment (42.50%) and COVID-19 tests and results (30.84%). The PGMs related to COVID-19 symptom self-assessment and COVID-19 test results had dynamic patterns and peaks similar to the newly confirmed cases in the United States and in Minnesota. The trend of PGMs related to COVID-19 care plans paralleled trends in newly hospitalized cases and deaths. After an initial peak in March, the PGMs on issues such as appointment cancellations and anxiety regarding COVID-19 displayed a declining trend. The majority of message senders were 30-64 years old, married, female, White, or urban residents. This majority was an even higher proportion among patients who sent portal messages on COVID-19. Conclusions: During the COVID-19 pandemic, patients increased portal messaging utilization to address health care issues about COVID-19 (in particular, symptom self-assessment and tests and results). Trends in message usage closely followed national trends in new cases and hospitalizations. There is a wide disparity for minority and rural populations in the use of PGMs for addressing the COVID-19 crisis. %M 35171108 %R 10.2196/35187 %U https://humanfactors.jmir.org/2022/2/e35187 %U https://doi.org/10.2196/35187 %U http://www.ncbi.nlm.nih.gov/pubmed/35171108 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e33080 %T Comparing the Ratio of Therapist Support to Internet Sessions in a Blended Therapy Delivered to Trauma-Exposed Veterans: Quasi-experimental Comparison Study %A Cloitre,Marylene %A Amspoker,Amber Bush %A Fletcher,Terri L %A Hogan,Julianna B %A Jackson,Christie %A Jacobs,Adam %A Shammet,Rayan %A Speicher,Sarah %A Wassef,Miryam %A Lindsay,Jan %+ National Center for PTSD Dissemination and Training Division, Veterans Administration Palo Alto Health Care System, 795 Willow Road, Palo Alto, CA, 94025, United States, 1 415 603 8093, marylene.cloitre@gmail.com %K PTSD %K depression %K veterans %K blended therapy %K iCBT %K web-based %K webSTAIR %K noninferiority %K mental health %K digital health %D 2022 %7 27.4.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Blended models of therapy, which incorporate elements of both internet and face-to-face methods, have been shown to be effective, but therapists and patients have expressed concerns that fewer face-to-face therapy sessions than self-guided internet sessions may be associated with lower therapeutic alliance, lower program completion rates, and poorer outcomes. Objective: A multisite quasi-experimental comparison study with a noninferiority design implemented in routine clinical care was used to assess webSTAIR, a 10-module blended therapy derived from STAIR (skills training in affective and interpersonal regulation) for trauma-exposed individuals delivered with 10 weekly therapist sessions (termed Coach10) compared to 5 biweekly sessions (Coach5). It was hypothesized that Coach5 would be as good as Coach10 in a range of outcomes. Methods: A total of 202 veterans were enrolled in the study with 101 assigned to Coach5 and 101 to Coach10. Posttraumatic stress disorder (PTSD) symptoms, depression, emotion regulation, interpersonal problems, and social functioning measures were collected pre-, mid-, and posttreatment, and at a 3-month follow-up. Noninferiority analyses were conducted on symptom outcome measures. Comparisons were made of continuous and categorical measures regarding participant and therapist activities. Results: Participants reported moderate to severe levels of baseline PTSD, depression, or both. Significant reductions were obtained in all symptom measures posttreatment and at the 3-month follow up. Coach5 was not inferior to Coach10 in any outcome. Therapeutic alliance was at an equivalently high level across the 2 treatment conditions; completion rates and web usage were similar. Total session time was substantially less for the Coach5 therapists than the Coach10 therapists. Both programs were associated with a low, but equal number of therapist activities related to scheduling and crisis or motivational sessions. Conclusions: A blended model delivered with 5 sessions of therapist support was noninferior to 10 sessions in individuals with moderate to severe symptoms. Future studies identifying patient characteristics as moderators of outcomes with high versus low doses of therapist support will help create flexible, technology-based intervention programming. %M 35475777 %R 10.2196/33080 %U https://mental.jmir.org/2022/4/e33080 %U https://doi.org/10.2196/33080 %U http://www.ncbi.nlm.nih.gov/pubmed/35475777 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e32630 %T The Effects of Health Care Chatbot Personas With Different Social Roles on the Client-Chatbot Bond and Usage Intentions: Development of a Design Codebook and Web-Based Study %A Nißen,Marcia %A Rüegger,Dominik %A Stieger,Mirjam %A Flückiger,Christoph %A Allemand,Mathias %A v Wangenheim,Florian %A Kowatsch,Tobias %+ Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Weinbergstrasse 56/58, Zurich, 8092, Switzerland, 41 44 632 65 66, mnissen@ethz.ch %K chatbot %K conversational agent %K social roles %K interpersonal closeness %K social role theory %K working alliance %K design %K persona %K digital health intervention %K web-based experiment %D 2022 %7 27.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The working alliance refers to an important relationship quality between health professionals and clients that robustly links to treatment success. Recent research shows that clients can develop an affective bond with chatbots. However, few research studies have investigated whether this perceived relationship is affected by the social roles of differing closeness a chatbot can impersonate and by allowing users to choose the social role of a chatbot. Objective: This study aimed at understanding how the social role of a chatbot can be expressed using a set of interpersonal closeness cues and examining how these social roles affect clients’ experiences and the development of an affective bond with the chatbot, depending on clients’ characteristics (ie, age and gender) and whether they can freely choose a chatbot’s social role. Methods: Informed by the social role theory and the social response theory, we developed a design codebook for chatbots with different social roles along an interpersonal closeness continuum. Based on this codebook, we manipulated a fictitious health care chatbot to impersonate one of four distinct social roles common in health care settings—institution, expert, peer, and dialogical self—and examined effects on perceived affective bond and usage intentions in a web-based lab study. The study included a total of 251 participants, whose mean age was 41.15 (SD 13.87) years; 57.0% (143/251) of the participants were female. Participants were either randomly assigned to one of the chatbot conditions (no choice: n=202, 80.5%) or could freely choose to interact with one of these chatbot personas (free choice: n=49, 19.5%). Separate multivariate analyses of variance were performed to analyze differences (1) between the chatbot personas within the no-choice group and (2) between the no-choice and the free-choice groups. Results: While the main effect of the chatbot persona on affective bond and usage intentions was insignificant (P=.87), we found differences based on participants’ demographic profiles: main effects for gender (P=.04, ηp2=0.115) and age (P<.001, ηp2=0.192) and a significant interaction effect of persona and age (P=.01, ηp2=0.102). Participants younger than 40 years reported higher scores for affective bond and usage intentions for the interpersonally more distant expert and institution chatbots; participants 40 years or older reported higher outcomes for the closer peer and dialogical-self chatbots. The option to freely choose a persona significantly benefited perceptions of the peer chatbot further (eg, free-choice group affective bond: mean 5.28, SD 0.89; no-choice group affective bond: mean 4.54, SD 1.10; P=.003, ηp2=0.117). Conclusions: Manipulating a chatbot’s social role is a possible avenue for health care chatbot designers to tailor clients’ chatbot experiences using user-specific demographic factors and to improve clients’ perceptions and behavioral intentions toward the chatbot. Our results also emphasize the benefits of letting clients freely choose between chatbots. %M 35475761 %R 10.2196/32630 %U https://www.jmir.org/2022/4/e32630 %U https://doi.org/10.2196/32630 %U http://www.ncbi.nlm.nih.gov/pubmed/35475761 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e34832 %T Effectiveness of an Online Peer Gatekeeper Training Program for Postsecondary Students on Suicide Prevention in Japan: Protocol for a Randomized Controlled Trial %A Nozawa,Kyosuke %A Ishii,Ayaka %A Asaoka,Hiroki %A Iwanaga,Mai %A Kumakura,Yousuke %A Oyabu,Yuri %A Shinozaki,Tomohiro %A Imamura,Kotaro %A Kawakami,Norito %A Miyamoto,Yuki %+ Department of Psychiatric Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan, 81 358413611, yyuki@m.u-tokyo.ac.jp %K gatekeeper %K suicide prevention %K mental health %K youth %K school %K student %K peer support %K depression %K self-efficacy %K suicide %K prevention %K online training %K online program %K protocol %K RCT %K control trial %D 2022 %7 26.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Postsecondary student suicide is one of Japan’s most severe public health problems. Gatekeeper training (GKT) programs are a generally recommended suicide prevention intervention in Japan. For suicide countermeasures, an online program tailored to students may enhance self-efficacy as a gatekeeper. Objective: This study aims to describe a research protocol to investigate the effect of a newly developed internet-delivered online peer GKT program to improve postsecondary student self-efficacy as gatekeepers for suicide countermeasures in Japan. Methods: This study is a 2-arm, parallel, randomized controlled trial with a 1:1 (intervention: waiting list) allocation. Participants (n=320) will be recruited, and those who meet the inclusion criteria will be randomly allocated to the intervention or waiting list control group. An approximately 85-minute, 6-section, internet-based gatekeeper program for postsecondary students has been developed that includes videos to help participants acquire skills as gatekeepers. The intervention group will complete the program within 10 days. The primary outcome, self-efficacy as a gatekeeper, is measured using the Gatekeeper Self-Efficacy Scale at baseline, immediately after taking the program, and 2 months after the survey after completing the program follow-up. To compare the primary outcomes, a t test, where the significance level is 5% (2-sided), will be used to test the intervention effect on an intention-to-treat basis. Results: The study was at the stage of data collection at the time of submission. We recruited participants for this study during August and September 2021, and data collection will continue until December 2021. The data analysis related to the primary outcome will start in December 2021, and we hope to publish the results in 2022 or 2023. Conclusions: This is the first study to investigate the effectiveness of an online GKT program for postsecondary students to improve self-efficacy as a gatekeeper using a randomized controlled trial design. The study will explore the potential of an online peer gatekeeper program for postsecondary students that can be disseminated online to a large number of students with minimal cost. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000045325; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000051685 International Registered Report Identifier (IRRID): DERR1-10.2196/34832 %M 35471412 %R 10.2196/34832 %U https://www.researchprotocols.org/2022/4/e34832 %U https://doi.org/10.2196/34832 %U http://www.ncbi.nlm.nih.gov/pubmed/35471412 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e33586 %T Uncovering Important Drivers of the Increase in the Use of Virtual Care Technologies in Nursing Care: Quantitative Analysis From the 2020 National Survey of Canadian Nurses %A Beauséjour,Waldo %A Hagens,Simon %+ Canada Health Infoway, 150 King St W, Toronto, ON, M5H 1J9, Canada, 1 416 595 3449 ext 3421, wbeausejour@infoway-inforoute.ca %K adoption of virtual care %K secure messaging %K nurses %K nursing %K telehealth %K telehomecare %K telemonitoring %K remote patient monitoring %K virtual videoconferencing %K uptake of virtual care %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: Canadian nurses are at the forefront of patient care delivery. Although the use of digital health technologies for care delivery is gaining momentum in Canada, nurses are encouraged to integrate virtual care into their practice. In early 2020, more Canadian nurses delivered care virtually compared with 3 years ago. Objective: This study seeks to uncover the professional characteristics of Canadian nurses accessing virtual care in 2020, understand how these characteristics differ across types of technologies, investigate whether the nurses accessing virtual care possess the skills and knowledge needed to use these technologies, and determine the important drivers of the uptake of virtual care observed in 2020. Methods: We used data from the 2017 and 2020 National Survey of Canadian Nurses. This survey collected data on the use of digital health technologies in nursing practice. It concerned regulated nursing professionals working in different health care settings and from different domains of nursing practice. We combined the chi-square independence test and logistic regression analysis to uncover the most relevant drivers of virtual care uptake by nurses in 2020. Results: In early 2020, before the declaration of the COVID-19 pandemic, nurses who delivered care virtually were predominantly nurse practitioners (135/159, 84.9%) and more likely to work in a primary or community care setting (202/367, 55%) and in an urban setting (194/313, 61.9%). Factors such as nursing designation (P<.001), perceived quality of care at the health facility where the nurses practiced (P<.001), and the type of patient record–keeping system they had access to (P=.04) had a statistically significant effect on the probability of nurses to deliver care virtually in early 2020. Furthermore, nurses’ perception of the quality of care they delivered through virtual technologies was statistically associated with their perception of the skills (χ24=308.7; P<.001) and knowledge (χ24=283.4; P<.001) to use these technologies. Conclusions: This study emphasizes the critical importance of nursing designation, geographic location, and type of patient record–keeping system in predicting virtual care integration in nursing practice. The findings related to geographic location can be used by decision-makers for better allocation of digital health resources among care settings in rural and urban areas. Similarly, the disparities observed across nursing designations have some implications for the digital training of nurses at all levels of practice. Finally, the association between electronic medical record use and uptake of virtual care could accelerate the implementation of more modernized record-keeping systems in care settings. Hence, this could advance interoperability and improve health care delivery. %M 35357326 %R 10.2196/33586 %U https://nursing.jmir.org/2022/1/e33586 %U https://doi.org/10.2196/33586 %U http://www.ncbi.nlm.nih.gov/pubmed/35357326 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e34452 %T Understanding Patients’ Intention to Use Digital Health Apps That Support Postdischarge Symptom Monitoring by Providers Among Patients With Acute Coronary Syndrome: Survey Study %A Chen,Jinying %A Wijesundara,Jessica G %A Enyim,Gabrielle E %A Lombardini,Lisa M %A Gerber,Ben S %A Houston,Thomas K %A Sadasivam,Rajani S %+ Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 368 Plantation Street, Worcester, MA, 01605, United States, 1 508 856 6063, jinying.chen@umassmed.edu %K coronary %K monitor %K elder %K health app %K symptom %K eHealth %K mobile health %K intention %K barrier %K facilitator %D 2022 %7 7.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: After hospital discharge, patients with acute coronary syndrome (ACS) often experience symptoms that prompt them to seek acute medical attention. Early evaluation of postdischarge symptoms by health care providers may reduce unnecessary acute care utilization. However, hospital-initiated follow-up encounters are insufficient for timely detection and assessment of symptoms. While digital health tools can help address this issue, little is known about the intention to use such tools in ACS patients. Objective: This study aimed to assess ACS patients’ intention to use digital health apps that support postdischarge symptom monitoring by health care providers and identify patient-perceived facilitators and barriers to app use. Methods: Using email invitations or phone calls, we recruited ACS patients discharged from a central Massachusetts health care system between December 2020 and April 2021, to participate in the study. Surveys were delivered online or via phone to individual participants. Demographics and access to technology were assessed. The intention to use a symptom monitoring app was assessed using 5-point Likert-type (from strongly agree to strongly disagree) items, such as “If this app were available to me, I would use it.” Responses were compared across demographic subgroups and survey delivery methods. Two open-ended questions assessed perceived facilitators and barriers to app use, with responses analyzed using qualitative content analysis. Results: Among 100 respondents (response rate 8.1%), 45 (45%) completed the survey by phone. The respondents were on average 68 years old (SD 13 years), with 90% (90/100) White, 39% (39/100) women, and 88% (88/100) having access to the internet or a mobile phone. Most participants (65/100, 65%) agreed or strongly agreed that they would use the app, among which 53 (82%) would use the app as often as possible. The percentage of participants with the intention to use the app was 75% among those aged 65-74 years and dropped to 44% among those older than 75 years. The intention to use was higher in online survey respondents (vs phone survey respondents; odds ratio 3.07, 95% CI 1.20-7.88) after adjusting for age and access to technology. The analysis of open-ended questions identified the following 4 main facilitators (motivations): (1) easily reaching providers, (2) accessing or providing information, (3) quickly reaching providers, and (4) consulting providers for symptoms, and the following 4 main barriers: (1) privacy/security concerns, (2) uncomfortable using technology, (3) user-unfriendly app interface, and (4) preference for in-person/phone care. Conclusions: There was a strong intention to use a symptom monitoring app postdischarge among ACS patients. However, this intent decreased in patients older than 75 years. The survey identified barriers related to technology use, privacy/security, and the care delivery mode. Further research is warranted to determine if such intent translates into app use, and better symptom management and health care quality. %M 35254269 %R 10.2196/34452 %U https://humanfactors.jmir.org/2022/1/e34452 %U https://doi.org/10.2196/34452 %U http://www.ncbi.nlm.nih.gov/pubmed/35254269 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e29506 %T How Can Research on Artificial Empathy Be Enhanced by Applying Deepfakes? %A Yang,Hsuan-Chia %A Rahmanti,Annisa Ristya %A Huang,Chih-Wei %A Li,Yu-Chuan Jack %+ Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, No 172-1, Sec 2 Keelung Rd, Taipei, 106, Taiwan, 886 966 546 813, jack@tmu.edu.tw %K artificial empathy %K deepfakes %K doctor-patient relationship %K face emotion recognition %K artificial intelligence %K facial recognition %K facial emotion recognition %K medical images %K patient %K physician %K therapy %D 2022 %7 4.3.2022 %9 Viewpoint %J J Med Internet Res %G English %X We propose the idea of using an open data set of doctor-patient interactions to develop artificial empathy based on facial emotion recognition. Facial emotion recognition allows a doctor to analyze patients' emotions, so that they can reach out to their patients through empathic care. However, face recognition data sets are often difficult to acquire; many researchers struggle with small samples of face recognition data sets. Further, sharing medical images or videos has not been possible, as this approach may violate patient privacy. The use of deepfake technology is a promising approach to deidentifying video recordings of patients’ clinical encounters. Such technology can revolutionize the implementation of facial emotion recognition by replacing a patient's face in an image or video with an unrecognizable face—one with a facial expression that is similar to that of the original. This technology will further enhance the potential use of artificial empathy in helping doctors provide empathic care to achieve good doctor-patient therapeutic relationships, and this may result in better patient satisfaction and adherence to treatment. %M 35254278 %R 10.2196/29506 %U https://www.jmir.org/2022/3/e29506 %U https://doi.org/10.2196/29506 %U http://www.ncbi.nlm.nih.gov/pubmed/35254278 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e33034 %T Trends in Remote Health Care Consumption in Sweden: Comparison Before and During the First Wave of the COVID-19 Pandemic %A Milos Nymberg,Veronica %A Ellegård,Lina Maria %A Kjellsson,Gustav %A Wolff,Moa %A Borgström Bolmsjö,Beata %A Wallman,Thorne %A Calling,Susanna %+ Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Building 28, Floor 11, Jan Waldenströms Street 35, Malmö, 20502, Sweden, 46 767700240, veronica.milos_nymberg@med.lu.se %K remote health care %K telemedicine %K primary health care %K respiratory tract infections %K COVID-19 %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Remote assessment of respiratory tract infections (RTIs) has been a controversial topic during the fast development of private telemedicine providers in Swedish primary health care. The possibility to unburden the traditional care has been put against a questionable quality of care as well as risks of increased utilization and costs. The COVID-19 pandemic has contributed to a changed management of patient care to decrease viral spread, with an expected shift in contact types from in-person to remote ones. Objective: The main aim of this study was to compare health care consumption and type of contacts (in-person or remote) for RTIs before and during the COVID-19 pandemic. The second aim was to study whether the number of follow-up contacts after an index contact for RTIs changed during the study period, and whether the number of follow-up contacts differed if the index contact was in-person or remote. A third aim was to study whether the pattern of follow-up contacts differed depending on whether the index contact was with a traditional or a private telemedicine provider. Methods: The study design was an observational retrospective analysis with a description of all index contacts and follow-up contacts with physicians in primary care and emergency rooms in a Swedish region (Skåne) for RTIs including patients of all ages and comparison for the same periods in 2018, 2019, and 2020. Results: Compared with 2018 and 2019, there were fewer index contacts for RTIs per 1000 inhabitants in 2020. By contrast, the number of follow-up contacts, both per 1000 inhabitants and per index contact, was higher in 2020. The composition of both index and follow-up contacts changed as the share of remote contacts, in particular for traditional care providers, increased. Conclusions: During the COVID-19 pandemic in 2020, fewer index contacts for RTIs but more follow-up contacts were conducted, compared with 2018-2019. The share of both index and follow-up contacts that were conducted remotely increased. Further studies are needed to study the reasons behind the increase in remote contacts, and if it will last after the pandemic, and more clinical guidelines for remote assessments of RTI are warranted. %M 34846304 %R 10.2196/33034 %U https://humanfactors.jmir.org/2022/1/e33034 %U https://doi.org/10.2196/33034 %U http://www.ncbi.nlm.nih.gov/pubmed/34846304 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e29647 %T Accessing Patient Electronic Health Record Portals Safely Using Social Credentials: Demonstration Pilot Study %A SooHoo,Spencer %A Keller,Michelle S %A Moyse,Harold %A Robbins,Benjamin %A McLaughlin,Matthew %A Arora,Ajay %A Burger,Abigail %A Huang,Lilith %A Huang,Shao-Chi %A Goud,Anil %A Truong,Lyna %A Rodriguez,Donaldo %A Roberts,Pamela %+ Enterprise Information Systems, Cedars-Sinai Medical Center, 6500 Wilshire Bl, Suite 200, Los Angeles, CA, 90048, United States, 1 310 678 3640, spencer.soohoo@csmc.edu %K patient portal access %K single sign-on %K federated identity %K social credentials %K social identity %K patient portal %K electronic health records %K EHR %K credentials %K patient communication %K communication %K clinical support %K feasibility %K acceptability %D 2022 %7 27.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient portals allow communication with clinicians, access to test results, appointments, etc, and generally requires another set of log-ins and passwords, which can become cumbersome, as patients often have records at multiple institutions. Social credentials (eg, Google and Facebook) are increasingly used as a federated identity to allow access and reduce the password burden. Single Federated Identity Log-in for Electronic health records (Single-FILE) is a real-world test of the feasibility and acceptability of federated social credentials for patients to access their electronic health records (EHRs) at multiple organizations with a single sign-on (SSO). Objective: This study aims to deploy a federated identity system for health care in a real-world environment so patients can safely use a social identity to access their EHR data at multiple organizations. This will help identify barriers and inform guidance for the deployment of such systems. Methods: Single-FILE allowed patients to pick a social identity (such as Google or Facebook) as a federated identity for multisite EHR patient portal access with an SSO. Binding the identity to the patient’s EHR records was performed by confirming that the patient had a valid portal log-in and sending a one-time passcode to a telephone (SMS text message or voice) number retrieved from the EHR. This reduced the risk of stolen EHR portal credentials. For a real-world test, we recruited 8 patients and (or) their caregivers who had EHR data at 2 independent health care facilities, enrolled them into Single-FILE, and allowed them to use their social identity credentials to access their patient records. We used a short qualitative interview to assess their interest and use of a federated identity for SSO. Single-FILE was implemented as a web-based patient portal, although the concept can be readily implemented on a variety of mobile platforms. Results: We interviewed the patients and their caregivers to assess their comfort levels with using a social identity for access. Patients noted that they appreciated only having to remember 1 log-in as part of Single-FILE and being able to sign up through Facebook. Conclusions: Our results indicate that from a technical perspective, a social identity can be used as a federated identity that is bound to a patient’s EHR data. The one-time passcode sent to the patient’s EHR phone number provided assurance that the binding is valid. The patients indicated that they were comfortable with using their social credentials instead of having to remember the log-in credentials for their EHR portal. Our experience will help inform the implementation of federated identity systems in health care in the United States. %M 34762594 %R 10.2196/29647 %U https://formative.jmir.org/2022/1/e29647 %U https://doi.org/10.2196/29647 %U http://www.ncbi.nlm.nih.gov/pubmed/34762594 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e33188 %T Predictors of Smartphone and Tablet Use Among Patients With Hypertension: Secondary Analysis of Health Information National Trends Survey Data %A Eze,Chinwe E %A West,Brady T %A Dorsch,Michael P %A Coe,Antoinette B %A Lester,Corey A %A Buis,Lorraine R %A Farris,Karen %+ College of Pharmacy, University of Michigan, 428 Church Street, Ann Arbor, MI, 48109-1065, United States, 1 7346806587, ceeze@umich.edu %K hypertension %K mHealth %K remote monitoring %K telemonitoring %K smartphones %K tablets %K text messaging %K Health Information National Trends Survey %K mobile health %K digital health %K mobile phone %D 2022 %7 24.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Uncontrolled hypertension leads to significant morbidity and mortality. The use of mobile health technology, such as smartphones, for remote blood pressure (BP) monitoring has improved BP control. An increase in BP control is more significant when patients can remotely communicate with their health care providers through technologies and receive feedback. Little is known about the predictors of remote BP monitoring among hypertensive populations. Objective: The objective of this study is to quantify the predictors of smartphone and tablet use in achieving health goals and communicating with health care providers via SMS text messaging among hypertensive patients in the United States. Methods: This study was a cross-sectional, secondary analysis of the 2017 and 2018 Health Information National Trends Survey 5, cycles 1 and 2 data. A total of 3045 respondents answered “Yes” to the question “Has a doctor or other healthcare provider ever told you that you had high blood pressure or hypertension?”, which defined the subpopulation used in this study. We applied the Health Information National Trends Survey full sample weight to calculate the population estimates and 50 replicate weights to calculate the SEs of the estimates. We used design-adjusted descriptive statistics to describe the characteristics of respondents who are hypertensive based on relevant survey items. Design-adjusted multivariable logistic regression models were fitted to estimate predictors of achieving health goals with the help of smartphone or tablet and sending or receiving an SMS text message to or from a health care provider in the last 12 months. Results: An estimated 36.9%, SE 0.9% (183,285,150/497,278,883) of the weighted adult population in the United States had hypertension. The mean age of the hypertensive population was 58.3 (SE 0.48) years. Electronic communication with the doctor or doctor’s office through email or internet (odds ratio 2.93, 95% CI 1.85-4.63; P<.001) and having a wellness app (odds ratio 1.82, 95% CI 1.16-2.86; P=.02) were significant predictors of using SMS text message communication with a health care professional, adjusting for other demographic and technology-related variables. The odds of achieving health-related goals with the help of a tablet or smartphone declined significantly with older age (P<.001) and ownership of basic cellphones (P=.04). However, they increased significantly with being a woman (P=.045) or with being married (P=.03), having a wellness app (P<.001), using devices other than smartphones or tablets to monitor health (P=.008), making health treatment decisions (P=.048), and discussing with a provider (P=.02) with the help of a tablet or smartphone. Conclusions: Intervention measures accounting for age, gender, marital status, and the patient’s technology-related health behaviors are required to increase smartphone and tablet use in self-care and SMS text message communication with health care providers. %M 35072647 %R 10.2196/33188 %U https://www.jmir.org/2022/1/e33188 %U https://doi.org/10.2196/33188 %U http://www.ncbi.nlm.nih.gov/pubmed/35072647 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e17273 %T Characterizing Patient-Clinician Communication in Secure Medical Messages: Retrospective Study %A Huang,Ming %A Fan,Jungwei %A Prigge,Julie %A Shah,Nilay D %A Costello,Brian A %A Yao,Lixia %+ Department of Artificial Intelligence and Informatics, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, 1 507 293 7953, lixia.cn.yao@gmail.com %K patient portal %K secure message %K patient-clinician communication %K workload %K response time %K message round %D 2022 %7 11.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient-clinician secure messaging is an important function in patient portals and enables patients and clinicians to communicate on a wide spectrum of issues in a timely manner. With its growing adoption and patient engagement, it is time to comprehensively study the secure messages and user behaviors in order to improve patient-centered care. Objective: The aim of this paper was to analyze the secure messages sent by patients and clinicians in a large multispecialty health system at Mayo Clinic, Rochester. Methods: We performed message-based, sender-based, and thread-based analyses of more than 5 million secure messages between 2010 and 2017. We summarized the message volumes, patient and clinician population sizes, message counts per patient or clinician, as well as the trends of message volumes and user counts over the years. In addition, we calculated the time distribution of clinician-sent messages to understand their workloads at different times of a day. We also analyzed the time delay in clinician responses to patient messages to assess their communication efficiency and the back-and-forth rounds to estimate the communication complexity. Results: During 2010-2017, the patient portal at Mayo Clinic, Rochester experienced a significant growth in terms of the count of patient users and the total number of secure messages sent by patients and clinicians. Three clinician categories, namely “physician—primary care,” “registered nurse—specialty,” and “physician—specialty,” bore the majority of message volume increase. The patient portal also demonstrated growing trends in message counts per patient and clinician. The “nurse practitioner or physician assistant—primary care” and “physician—primary care” categories had the heaviest per-clinician workload each year. Most messages by the clinicians were sent from 7 AM to 5 PM during a day. Yet, between 5 PM and 7 PM, the physicians sent 7.0% (95,785/1,377,006) of their daily messages, and the nurse practitioner or physician assistant sent 5.4% (22,121/408,526) of their daily messages. The clinicians replied to 72.2% (1,272,069/1,761,739) patient messages within 1 day and 90.6% (1,595,702/1,761,739) within 3 days. In 95.1% (1,499,316/1,576,205) of the message threads, the patients communicated with their clinicians back and forth for no more than 4 rounds. Conclusions: Our study found steady increases in patient adoption of the secure messaging system and the average workload per clinician over 8 years. However, most clinicians responded timely to meet the patients’ needs. Our study also revealed differential patient-clinician communication patterns across different practice roles and care settings. These findings suggest opportunities for care teams to optimize messaging tasks and to balance the workload for optimal efficiency. %M 35014964 %R 10.2196/17273 %U https://www.jmir.org/2022/1/e17273 %U https://doi.org/10.2196/17273 %U http://www.ncbi.nlm.nih.gov/pubmed/35014964 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e33873 %T Implementation and Evaluation of a Digitally Enabled Precision Public Health Intervention to Reduce Inappropriate Gabapentinoid Prescription: Cluster Randomized Controlled Trial %A Andrade,Andre Q %A Calabretto,Jean-Pierre %A Pratt,Nicole L %A Kalisch-Ellett,Lisa M %A Kassie,Gizat M %A LeBlanc,Vanessa T %A Ramsay,Emmae %A Roughead,Elizabeth E %+ Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Medical Sciences, University of South Australia, GPO Box 2471, Adelaide, 5001, Australia, 61 8 8302 2314, andre.andrade@unisa.edu.au %K audit and feedback %K digital health %K precision public health %K digital intervention %K primary care %K physician %K health professional %K health education %D 2022 %7 10.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital technologies can enable rapid targeted delivery of audit and feedback interventions at scale. Few studies have evaluated how mode of delivery affects clinical professional behavior change and none have assessed the feasibility of such an initiative at a national scale. Objective: The aim of this study was to develop and evaluate the effect of audit and feedback by digital versus postal (letter) mode of delivery on primary care physician behavior. Methods: This study was developed as part of the Veterans’ Medicines Advice and Therapeutics Education Services (MATES) program, an intervention funded by the Australian Government Department of Veterans’ Affairs that provides targeted education and patient-specific audit with feedback to Australian general practitioners, as well as educational material to veterans and other health professionals. We performed a cluster randomized controlled trial of a multifaceted intervention to reduce inappropriate gabapentinoid prescription, comparing digital and postal mode of delivery. All veteran patients targeted also received an educational intervention (postal delivery). Efficacy was measured using a linear mixed-effects model as the average number of gabapentinoid prescriptions standardized by defined daily dose (individual level), and number of veterans visiting a psychologist in the 6 and 12 months following the intervention. Results: The trial involved 2552 general practitioners in Australia and took place in March 2020. Both intervention groups had a significant reduction in total gabapentinoid prescription by the end of the study period (digital: mean reduction of 11.2%, P=.004; postal: mean reduction of 11.2%, P=.001). We found no difference between digital and postal mode of delivery in reduction of gabapentinoid prescriptions at 12 months (digital: –0.058, postal: –0.058, P=.98). Digital delivery increased initiations to psychologists at 12 months (digital: 3.8%, postal: 2.0%, P=.02). Conclusions: Our digitally delivered professional behavior change intervention was feasible, had comparable effectiveness to the postal intervention with regard to changes in medicine use, and had increased effectiveness with regard to referrals to a psychologist. Given the logistical benefits of digital delivery in nationwide programs, the results encourage exploration of this mode in future interventions. %M 35006086 %R 10.2196/33873 %U https://www.jmir.org/2022/1/e33873 %U https://doi.org/10.2196/33873 %U http://www.ncbi.nlm.nih.gov/pubmed/35006086 %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 %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e32785 %T An mHealth App-Based Self-management Intervention for Family Members of Pediatric Transplant Recipients (myFAMI): Framework Design and Development Study %A Adib,Riddhiman %A Das,Dipranjan %A Ahamed,Sheikh Iqbal %A Lerret,Stacee Marie %+ Department of Pediatrics, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI, 53226, United States, 1 4142663944, slerret@mcw.edu %K pediatric patients %K transplant %K mobile health %K mHealth %K family self-management %K smartphone %D 2022 %7 4.1.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: Solid-organ transplantation is the treatment of choice for children with end-stage organ failure. Ongoing recovery and medical management at home after transplant are important for recovery and transition to daily life. Smartphones are widely used and hold the potential for aiding in the establishment of mobile health (mHealth) protocols. Health care providers, nurses, and computer scientists collaboratively designed and developed mHealth family self-management intervention (myFAMI), a smartphone-based intervention app to promote a family self-management intervention for pediatric transplant patients’ families. Objective: This paper presents outcomes of the design stages and development actions of the myFAMI app framework, along with key challenges, limitations, and strengths. Methods: The myFAMI app framework is built upon a theory-based intervention for pediatric transplant patients, with aid from the action research (AR) methodology. Based on initially defined design motivation, the team of researchers collaboratively explored 4 research stages (research discussions, feedback and motivations, alpha testing, and deployment and release improvements) and developed features required for successful inauguration of the app in the real-world setting. Results: Deriving from app users and their functionalities, the myFAMI app framework is built with 2 primary components: the web app (for nurses’ and superadmin usage) and the smartphone app (for participant/family member usage). The web app stores survey responses and triggers alerts to nurses, when required, based on the family members’ response. The smartphone app presents the notifications sent from the server to the participants and captures survey responses. Both the web app and the smartphone app were built upon industry-standard software development frameworks and demonstrate great performance when deployed and used by study participants. Conclusions: The paper summarizes a successful and efficient mHealth app-building process using a theory-based intervention in nursing and the AR methodology in computer science. Focusing on factors to improve efficiency enabled easy navigation of the app and collection of data. This work lays the foundation for researchers to carefully integrate necessary information (from the literature or experienced clinicians) to provide a robust and efficient solution and evaluate the acceptability, utility, and usability for similar studies in the future. International Registered Report Identifier (IRRID): RR2-10.1002/nur.22010 %M 34780344 %R 10.2196/32785 %U https://nursing.jmir.org/2022/1/e32785 %U https://doi.org/10.2196/32785 %U http://www.ncbi.nlm.nih.gov/pubmed/34780344 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e27392 %T Comparison of User-Oriented Information Services on the Websites of Large Hospitals in China and the United States: Cross-sectional Study %A Zhong,Yang %A Tao,Wenjuan %A Yang,Yanlin %A Wu,Hao %A Li,Weimin %A Wen,Jin %+ Institute of Hospital Management, West China Hospital, Sichuan University, No 37 Guoxue Xiang, Chengdu, 610041, China, 86 2885422671, huaxiwenjin@163.com %K hospital websites %K internet %K information services %K marketing mix %K 7Ps %K health care information services %K hospital management %K hospitals %K patient services %K eHealth %D 2021 %7 29.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Many people use the internet to access health care information to support health care decisions, and hospital websites can be the first point of contact to provide health care information services for consumers. However, little is known about the current information services provided by the websites of large Chinese hospitals. Objective: The aim of this study is to evaluate and compare the information services of the websites of large hospitals in China and the United States. We hope that our findings will benefit hospital managers worldwide in providing service information on the web. Methods: This study adopted a cross-sectional analytical approach to evaluate the websites of large hospitals in China and the United States in 2020. A total of 300 large hospitals were randomly selected, of which half were in China and half were in the United States. Based on the 7Ps marketing mix, we identified 39 items that represent typical hospital website information services, covering the following seven dimensions: product, price, place, propagation, people, process, and physical evidence. Results: Most of the items (34/39, 87%) related to information services offered by hospital websites were less covered in China than in the United States; however, 5 items (appointments by a third-party platform, mobile payment, hospital value, hospital environment display, and physicians’ profiles) had higher coverage in China. The average scores for hospital websites in China and the United States were 13.25 (SD 2.99) points and 23.16 (SD 2.76) points, respectively. Generally, high scores were given to the south areas of China and north areas of the United States. Conclusions: Hospital websites in China lagged behind those in the United States with regard to information services offered. We recommend that hospital managers in China place more emphasis on the people, product, and propagation dimensions of the 7Ps marketing mix in the construction of information services on hospital websites. Through the comparison of the websites of large hospitals in China and the United States, our study findings can provide suggestions for forming standard hospital website construction guidelines worldwide. %M 34964717 %R 10.2196/27392 %U https://www.jmir.org/2021/12/e27392 %U https://doi.org/10.2196/27392 %U http://www.ncbi.nlm.nih.gov/pubmed/34964717 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e25498 %T The Impact of Patient Characteristics on Their Attitudes Toward an Online Patient Portal for Communicating Laboratory Test Results: Real-World Study %A Tossaint-Schoenmakers,Rosian %A Kasteleyn,Marise %A Goedhart,Annelijn %A Versluis,Anke %A Talboom-Kamp,Esther %+ Saltro Diagnostic Centre, Mississippidreef 83, Utrecht, 3565 CE, Netherlands, 31 302361136, rtossaint@saltro.nl %K patient portal %K eHealth impact questionnaire %K laboratory test results %K self-efficacy %K usability %K age %K gender %K chronic disease %K education %K patient characteristics %D 2021 %7 17.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient portals are promising tools to increase patient involvement and allow them to manage their health. To optimally facilitate patients, laboratory test results should be explained in easy language. Patient characteristics affect the usage of portals and the user satisfaction. However, limited research is available, specified for online communicating laboratory test results, on whether portal use and acceptance differ between groups. Objective: The aim of this study was to assess the effect of patient characteristics (gender, age, education, and chronic disease) on the self-efficacy and perceived usability of an online patient portal that communicates diagnostic test results. Methods: We used the online-administered eHealth impact questionnaire (eHIQ) to explore patients’ attitudes toward the portal. Patients visiting the portal were asked to complete the questionnaire and to answer questions regarding gender, age, education, and chronic disease. The subscale “information and presentation” of the eHIQ assessed the usability of the patient portal and the subscale “motivation and confidence to act” assessed self-efficacy to determine whether patients were motivated to act on the presented information. Age, gender, education, and chronic disease were the determinants to analyze the effect on usability and self-efficacy. Descriptive analyses were performed to explore patient characteristics, usability, and self-efficacy. Univariable and multivariable regression analyses were performed with age, gender, education, and chronic disease as determinants, and usability and self-efficacy as outcomes. Results: The questionnaire was completed by 748 respondents, of which 428 (57.2%) were female, 423 (56.6%) were highly educated, and 509 (68%) had no chronic disease. The mean age was 58.5 years (SD 16.4). Higher age, high education, and asthma or chronic obstructive pulmonary disease were significant determinants for decreased usability; respectively, b=-.094, 95% CI -1147 to 0.042 (P<.001); b=-2.512, 95% CI -4.791 to -0.232 (P=.03); and b=-3.630, 95% CI -6.545 to -0.715 (P=.02). High education was also a significant determinant for a lower self-efficacy (b=-3.521, 95% CI -6.469 to -0.572; P=.02). Other determinants were not significant. Conclusions: This study showed that the higher-educated users of a patient portal scored lower on usability and self-efficacy. Usability was also lower for older people and for patients with asthma or chronic obstructive pulmonary disease. The results portal is not tailored for different groups. Further research should investigate which factors from a patient’s perspective are essential to tailor the portal for different groups and how a result portal can be optimally integrated within the daily practice of a doctor. %M 34927593 %R 10.2196/25498 %U https://formative.jmir.org/2021/12/e25498 %U https://doi.org/10.2196/25498 %U http://www.ncbi.nlm.nih.gov/pubmed/34927593 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e28128 %T A Wearable Activity Tracker Intervention With and Without Weekly Behavioral Support Emails to Promote Physical Activity Among Women Who Are Overweight or Obese: Randomized Controlled Trial %A Black,Melissa %A Brunet,Jennifer %+ School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, 125 University Private, Ottawa, ON, K1N6N5, Canada, 1 6135625800 ext 3068, jennifer.brunet@uottawa.ca %K behavior change %K motivation %K obesity %K physical activity %K women %K mobile phone %D 2021 %7 16.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity (PA) plays a fundamental role in combating the current obesity epidemic; however, most women who are overweight or obese are generally physically inactive. Wearable activity tracker interventions can help increase the PA levels in this population. Supplementing such interventions with behavioral support emails may further improve their effectiveness, but this remains to be confirmed. Objective: This study aims to determine if adding behavioral support emails to a wearable activity tracker intervention can further increase PA levels among women who are overweight or obese in comparison to a wearable activity tracker–only intervention and a control condition. Methods: Women with a BMI ≥25 kg/m2 who were not meeting the Canadian PA guidelines for aerobic and strength training were randomized into 1 of 3 groups. Group 1 received 6 weekly behavioral support emails, a wearable activity tracker, and a copy of the Canadian PA guidelines. Group 2 received a wearable activity tracker and a copy of the Canadian PA guidelines, and group 3 (control condition) received a copy of the Canadian PA guidelines. Self-reported data for walking and moderate to vigorous intensity PA were collected preintervention (week 0; prerandomization), postintervention (7 weeks postrandomization), and at follow-up (21 weeks postrandomization) and analyzed as metabolic equivalent of task minutes per week. In addition, potential mechanisms of behavior change (ie, basic psychological needs satisfaction and motivational regulations) were assessed for within- and between-group differences at all 3 time points. Data were analyzed using nonparametric statistical tests. Results: A total of 49 women were recruited; data from 47 women (mean age 37.57 years, SD 11.78 years; mean BMI 31.69 kg/m2, SD 5.97 kg/m2) were available for analysis. Group 1 reported a significant increase in walking from preintervention to postintervention (χ22=7.5; P=.02) but not in moderate to vigorous intensity PA (P=.24). Group 1 also reported significant increases in perceptions of competence from preintervention to follow-up (χ22=7.6; P=.02) and relatedness from preintervention to follow-up (χ22=8.7; P=.005). Increases in perceived autonomy were observed for group 2 (χ22=7.0) and group 3 (χ22=10.6). There were no significant changes in the motivational regulations within the groups. The difference between the groups was not significant for any outcome variable. Conclusions: The results suggest that adding behavioral support emails to a wearable activity tracker intervention may help to increase time spent walking and perceptions of competence and relatedness for PA among women who are overweight or obese. Trial Registration: ClinicalTrials.gov NCT03601663; http://clinicaltrials.gov/ct2/show/NCT03601663 %M 34927590 %R 10.2196/28128 %U https://mhealth.jmir.org/2021/12/e28128 %U https://doi.org/10.2196/28128 %U http://www.ncbi.nlm.nih.gov/pubmed/34927590 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31121 %T An Integrated, Scalable, Electronic Video Consent Process to Power Precision Health Research: Large, Population-Based, Cohort Implementation and Scalability Study %A Lajonchere,Clara %A Naeim,Arash %A Dry,Sarah %A Wenger,Neil %A Elashoff,David %A Vangala,Sitaram %A Petruse,Antonia %A Ariannejad,Maryam %A Magyar,Clara %A Johansen,Liliana %A Werre,Gabriela %A Kroloff,Maxwell %A Geschwind,Daniel %+ Center for SMART Health, Institute for Precision Health, David Geffen School of Medicine at UCLA, 10911 Weyburn Ave, Suite 300e, Los Angeles, CA, 90095, United States, 1 3103670148, anaeim@mednet.ucla.edu %K biobanking %K precision medicine %K electronic consent %K privacy %K consent %K patient privacy %K clinical data %K eHealth %K recruitment %K population health %K data collection %K research methods %K video %K research %K validation %K scalability %D 2021 %7 8.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Obtaining explicit consent from patients to use their remnant biological samples and deidentified clinical data for research is essential for advancing precision medicine. Objective: We aimed to describe the operational implementation and scalability of an electronic universal consent process that was used to power an institutional precision health biobank across a large academic health system. Methods: The University of California, Los Angeles, implemented the use of innovative electronic consent videos as the primary recruitment tool for precision health research. The consent videos targeted patients aged ≥18 years across ambulatory clinical laboratories, perioperative settings, and hospital settings. Each of these major areas had slightly different workflows and patient populations. Sociodemographic information, comorbidity data, health utilization data (ambulatory visits, emergency room visits, and hospital admissions), and consent decision data were collected. Results: The consenting approach proved scalable across 22 clinical sites (hospital and ambulatory settings). Over 40,000 participants completed the consent process at a rate of 800 to 1000 patients per week over a 2-year time period. Participants were representative of the adult University of California, Los Angeles, Health population. The opt-in rates in the perioperative (16,500/22,519, 73.3%) and ambulatory clinics (2308/3390, 68.1%) were higher than those in clinical laboratories (7506/14,235, 52.7%; P<.001). Patients with higher medical acuity were more likely to opt in. The multivariate analyses showed that African American (odds ratio [OR] 0.53, 95% CI 0.49-0.58; P<.001), Asian (OR 0.72, 95% CI 0.68-0.77; P<.001), and multiple-race populations (OR 0.73, 95% CI 0.69-0.77; P<.001) were less likely to participate than White individuals. Conclusions: This is one of the few large-scale, electronic video–based consent implementation programs that reports a 65.5% (26,314/40,144) average overall opt-in rate across a large academic health system. This rate is higher than those previously reported for email (3.6%) and electronic biobank (50%) informed consent rates. This study demonstrates a scalable recruitment approach for population health research. %M 34889741 %R 10.2196/31121 %U https://www.jmir.org/2021/12/e31121 %U https://doi.org/10.2196/31121 %U http://www.ncbi.nlm.nih.gov/pubmed/34889741 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e27497 %T Information Patients With Melanoma Spontaneously Report About Health-Related Quality of Life on Web-Based Forums: Case Study %A Kalf,Rachel R J %A Delnoij,Diana M J %A Ryll,Bettina %A Bouvy,Marcel L %A Goettsch,Wim G %+ Department of Pharmacoepidemiology and Clinical Pharmacology, University Utrecht, Universiteitsweg 99, Utrecht, 3584 CG, Netherlands, 31 302537324, m.l.bouvy@uu.nl %K reimbursement decision-making %K QoL %K health care %K quality of life %D 2021 %7 7.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a general agreement on the importance of health-related quality of life (HRQoL). This type of information is becoming increasingly important for the value assessment of health technology assessment agencies in evaluating the benefits of new health technologies, including medicines. However, HRQoL data are often limited, and additional sources that provide this type of information may be helpful. Objective: We aim to identify the HRQoL topics important to patients with melanoma based on web-based discussions on public social media forums. Methods: We identified 3 public web-based forums from the United States and the United Kingdom, namely the Melanoma Patient Information Page, the Melanoma International Forum, and MacMillan. Their posts were randomly selected and coded using qualitative methods until saturation was reached. Results: Of the posts assessed, 36.7% (150/409) of posts on Melanoma International Forum, 45.1% (198/439) on MacMillan, and 35.4% (128/362) on Melanoma Patient Information Page focused on HRQoL. The 2 themes most frequently mentioned were mental health and (un)certainty. The themes were constructed based on underlying and more detailed codes. Codes related to fear, worry and anxiety, uncertainty, and unfavorable effects were the most-often discussed ones. Conclusions: Web-based forums are a valuable source for identifying relevant HRQoL aspects in patients with a given disease. These aspects could be cross-referenced with existing tools and they might improve the content validity of patient-reported outcome measures, including HRQoL questionnaires. In addition, web-based forums may provide health technology assessment agencies with a more holistic understanding of the external aspects affecting patient HRQoL. These aspects might support the value assessment of new health technologies and could therefore help inform topic prioritization as well as the scoping phase before any value assessment. %M 34878994 %R 10.2196/27497 %U https://www.jmir.org/2021/12/e27497 %U https://doi.org/10.2196/27497 %U http://www.ncbi.nlm.nih.gov/pubmed/34878994 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 6 %N 4 %P e32320 %T Differences in Secure Messaging, Self-management, and Glycemic Control Between Rural and Urban Patients: Secondary Data Analysis %A Robinson,Stephanie A %A Netherton,Dane %A Zocchi,Mark %A Purington,Carolyn %A Ash,Arlene S %A Shimada,Stephanie L %+ Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bldg 70, 200 Springs Rd, Bedford, MA, 01730, United States, 1 5712767178, stephanie.robinson5@va.gov %K diabetes %K secure messaging %K rural %K self-management %K patient portal %K urban %K data %K access %K risk %K portal %K eHealth %K digital health %K messaging %K support %K accessible %K cross-sectional %K veteran %D 2021 %7 19.11.2021 %9 Original Paper %J JMIR Diabetes %G English %X Background: Rural patients with diabetes have difficulty accessing care and are at higher risk for poor diabetes management. Sustained use of patient portal features such as secure messaging (SM) can provide accessible support for diabetes self-management. Objective: This study explored whether rural patients’ self-management and glycemic control was associated with the use of SM. Methods: This secondary, cross-sectional, mixed methods analysis of 448 veterans with diabetes used stratified random sampling to recruit a diverse sample from the United States (rural vs urban and good vs poor glycemic control). Administrative, clinical, survey, and interview data were used to determine patients’ rurality, use of SM, diabetes self-management behaviors, and glycemic control. Moderated mediation analyses assessed these relationships. Results: The sample was 51% (n=229) rural and 49% (n=219) urban. Mean participant age was 66.4 years (SD 7.7 years). More frequent SM use was associated with better diabetes self-management (P=.007), which was associated with better glycemic control (P<.001). Among rural patients, SM use was indirectly associated with better glycemic control through improved diabetes self-management (95% CI 0.004-0.927). These effects were not observed among urban veterans with diabetes (95% CI –1.039 to 0.056). Rural patients were significantly more likely than urban patients to have diabetes-related content in their secure messages (P=.01). Conclusions: More frequent SM use is associated with engaging in diabetes self-management, which, in turn, is associated with better diabetes control. Among rural patients with diabetes, SM use is indirectly associated with better diabetes control. Frequent patient-team communication through SM about diabetes-related content may help rural patients with diabetes self-management, resulting in better glycemic control. %M 34807834 %R 10.2196/32320 %U https://diabetes.jmir.org/2021/4/e32320 %U https://doi.org/10.2196/32320 %U http://www.ncbi.nlm.nih.gov/pubmed/34807834 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e30125 %T Mapping Information Needs of Patients With Sexually Transmitted Infections Using Web-Based Data Sources: Grounded Theory Investigation %A Mulgund,Pavankumar %A Sharman,Raj %A Purao,Sandeep %A Thimmanayakanapalya,Sagarika Suresh %A Winkelstein,Peter %+ Department of Management Science and Systems, State University of New York at Buffalo, 325 Jacobs Management Center, Buffalo, NY, 14260, United States, 1 7166453271, pmulgund@buffalo.edu %K information needs %K sexually transmitted diseases %K patient journey maps %K health information seeking %K stigmatizing disorders %K online forum %K sexually transmitted infection %K American Sexual Health Association %K grounded theory %K stigma %D 2021 %7 10.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: According to the World health organization (WHO), more than 1 million sexually transmitted infections (STIs) are acquired each day across the world. The incidence rates of STIs in the United States are at a record high for the fourth consecutive year. Owing to the stigma associated with the incidence of STI, there is a general reluctance to seek information in person. Instead, web-based information sources remain the primary avenues of information-seeking. However, these sources are designed without a comprehensive understanding of the information needs of individuals who have contracted STIs. Objective: This study aimed to investigate the information needs of individuals who have or suspect they have contracted an STI. A better understanding of their information needs can drive the design of more effective digital interventions. Methods: This is a qualitative and analytical study of 549 transcripts (consisting of queries posted over the last 10 years) from web-based forums of the American Sexual Health Association (ASHA), which allows patients, volunteers, and health care providers connect anonymously. The analysis follows a grounded theory (GT) approach with multiple coding stages to uncover categories and themes. Results: Three categories of information needs emerged. The first two, clinical and logistical, are similar to other contexts. However, our analysis shows that there is a significant need for the last category—psychosocial information. Approximately 59% of instances are linked to concerns such as confusion, discretion, remorse, and others. These needs vary across the stages of a patient’s journey from symptom manifestation to treatment maintenance. Conclusions: Responding to the needs of individuals who have or suspect they have contracted an STI requires compassionate and personalized responses (beyond factual clinical and logistical information). Web-based forums provide anonymity but do not adequately incorporate mechanisms, practices, or incentives to respond to diverse psychosocial concerns. Innovative approaches to add such support can make the digital interventions more effective for this group of individuals. %M 34757326 %R 10.2196/30125 %U https://www.jmir.org/2021/11/e30125 %U https://doi.org/10.2196/30125 %U http://www.ncbi.nlm.nih.gov/pubmed/34757326 %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 %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29868 %T A Human, Organization, and Technology Perspective on Patients’ Experiences of a Chat-Based and Automated Medical History–Taking Service in Primary Health Care: Interview Study Among Primary Care Patients %A Nilsson,Evalill %A Sverker,Annette %A Bendtsen,Preben %A Eldh,Ann Catrine %+ eHealth Institute, Department of Medicine and Optometry, Linnaeus University, Hus Vita, Universitetskajen, Kalmar, 391 82, Sweden, 46 730377913, evalill.nilsson@lnu.se %K digital encounter %K digital healthcare %K e-consultation %K e-health %K interview %K patient perspective %K primary healthcare %K qualitative study %K telemedicine %K telehealth %D 2021 %7 18.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of e-visits in health care is progressing rapidly worldwide. To date, studies on the advantages and disadvantages of e-consultations in the form of chat services for all inquiries in primary care have focused on the perspective of health care professionals (HCPs) rather than those of end users (patients). Objective: This study aims to explore patients’ experiences using a chat-based and automated medical history–taking service in regular, tax-based, not-for-profit primary care in Sweden. Methods: Overall, 25 individual interviews were conducted with patients in the catchment areas of 5 primary care centers (PCCs) in Sweden that tested a chat-based and automated medical history–taking service for all types of patient inquiries. The semistructured interviews were transcribed verbatim before content analysis using inductive and deductive strategies, the latter including an unconstrained matrix of human, organization, and technology perspectives. Results: The service provided an easily managed way for patients to make written contact with HCPs, which was considered beneficial for some patients and issues but less suitable for others (acute or more complex cases). The automated medical history–taking service was perceived as having potential but still derived from what HCPs need to know and how they address and communicate health and health care issues. Technical skills were not considered as necessary for a mobile phone chat as for handling a computer; however, patients still expressed concern for people with less digital literacy. The opportunity to take one’s time and reflect on one’s situation before answering questions from the HCPs was found to reduce stress and prevent errors, and patients speculated that it might be the same for the HCPs on the other end of the system. Patients appreciated the ability to have a conversation from almost anywhere, even from places not suitable for telephone calls. The asynchronicity of the chat service allowed the patients to take more control of the conversation and initiate a chat at any time at their own convenience; however, it could also lead to lengthy conversations where a single issue in the worst cases could take days to close. The opportunity to upload photographs made some visits to the PCC redundant, which would otherwise have been necessary if the ordinary telephone service had been used, saving patients both time and money. Conclusions: Patients generally had a positive attitude toward e-visits in primary care and were generally pleased with the prospects of the digital tool tested, somewhat more with the actual chat than with the automated history-taking system preceding the chat. Although patients expect their PCC to offer a range of different means of communication, the human, organization, and technology analysis revealed a need for more extensive (end) user experience design in the further development of the chat service. %M 34661544 %R 10.2196/29868 %U https://www.jmir.org/2021/10/e29868 %U https://doi.org/10.2196/29868 %U http://www.ncbi.nlm.nih.gov/pubmed/34661544 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e29495 %T Text Messaging Versus Email Messaging to Support Patients With Major Depressive Disorder: Protocol for a Randomized Hybrid Type II Effectiveness-Implementation Trial %A Adu,Medard Kofi %A Shalaby,Reham %A Eboreime,Ejemai %A Sapara,Adegboyega %A Nkire,Nnamdi %A Chawla,Rajan %A Chima,Chidi %A Achor,Michael %A Osiogo,Felix %A Chue,Pierre %A Greenshaw,Andrew J %A Agyapong,Vincent Israel %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor Abbie J. Lane Memorial Building QEII Health Sciences Centre, Halifax, NS, T6G 2B7, Canada, 1 7807144315, vincent.agyapong@nshealth.ca %K email messaging %K text messaging %K supportive %K major depressive disorder %K randomized trial %K mental health %K digital health %K mobile health %K mHealth %K patient care %K health policy %K decision-making %K health care resources %D 2021 %7 13.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Major depressive disorder (MDD) accounts for 40.5% of disability-adjusted life years caused by mental and substance use disorders. Barriers such as stigma and financial and physical access to care have been reported, highlighting the need for innovative, accessible, and cost-effective psychological interventions. The effectiveness of supportive SMS text messaging in alleviating depression symptoms has been proven in clinical trials, but this approach can only help those with mobile phones. Objective: This paper presents the protocol for a study that will aim to evaluate the feasibility, comparative effectiveness, and user satisfaction of daily supportive email messaging as an effective strategy compared to daily supportive text messaging as part of the treatment of patients with MDD. Methods: This trial will be carried out using a hybrid type II implementation-effectiveness design. This design evaluates the effectiveness of an implementation strategy or intervention, while also evaluating the implementation context associated with the intervention. Patients with MDD receiving usual care will be randomized to receive either daily supportive email messaging or daily supportive text messaging of the same content for 6 months. The Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the 5-item World Health Organization Well-Being Index will be used to evaluate the effectiveness of both strategies. The implementation evaluation will be guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, as well as the Consolidated Framework for Implementation Research. All outcome measures will be analyzed using descriptive and inferential statistics. Qualitative data will be analyzed using thematic analysis. Results: Data collection for this trial began in April 2021. We expect the study results to be available within 18 months of study commencement. The results will shed light on the feasibility, acceptability, and effectiveness of using automated emails as a strategy for delivering supportive messages to patients with MDD in comparison to text messaging. Conclusions: The outcome of this trial will have translational impact on routine patient care and access to mental health, as well as potentially support mental health policy decision-making for health care resource allocation. Trial Registration: ClinicalTrials.gov NCT04638231; https://clinicaltrials.gov/ct2/show/NCT04638231 International Registered Report Identifier (IRRID): DERR1-10.2196/29495 %M 34643541 %R 10.2196/29495 %U https://www.researchprotocols.org/2021/10/e29495 %U https://doi.org/10.2196/29495 %U http://www.ncbi.nlm.nih.gov/pubmed/34643541 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29406 %T Questioning the Yelp Effect: Mixed Methods Analysis of Web-Based Reviews of Urgent Cares %A Hu,Dian %A Liu,Cindy Meng-Hsin %A Hamdy,Rana %A Cziner,Michael %A Fung,Melody %A Dobbs,Samuel %A Rogers,Laura %A Turner,Monique Mitchell %A Broniatowski,David André %+ Department of Engineering Management and Systems Engineering, School of Engineering and Applied Science, George Washington University, B1800, Science and Engineering Hall 2700, 800 22nd St NW, Washington, DC, 20052, United States, 1 2027251564, hudian@gwmail.gwu.edu %K urgent care %K doctor-patient communication %K doctor web-based review %K review websites %D 2021 %7 8.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Providers of on-demand care, such as those in urgent care centers, may prescribe antibiotics unnecessarily because they fear receiving negative reviews on web-based platforms from unsatisfied patients—the so-called Yelp effect. This effect is hypothesized to be a significant driver of inappropriate antibiotic prescribing, which exacerbates antibiotic resistance. Objective: In this study, we aimed to determine the frequency with which patients left negative reviews on web-based platforms after they expected to receive antibiotics in an urgent care setting but did not. Methods: We obtained a list of 8662 urgent care facilities from the Yelp application programming interface. By using this list, we automatically collected 481,825 web-based reviews from Google Maps between January 21 and February 10, 2019. We used machine learning algorithms to summarize the contents of these reviews. Additionally, 200 randomly sampled reviews were analyzed by 4 annotators to verify the types of messages present and whether they were consistent with the Yelp effect. Results: We collected 481,825 reviews, of which 1696 (95% CI 1240-2152) exhibited the Yelp effect. Negative reviews primarily identified operations issues regarding wait times, rude staff, billing, and communication. Conclusions: Urgent care patients rarely express expectations for antibiotics in negative web-based reviews. Thus, our findings do not support an association between a lack of antibiotic prescriptions and negative web-based reviews. Rather, patients’ dissatisfaction with urgent care was most strongly linked to operations issues that were not related to the clinical management plan. %M 34623316 %R 10.2196/29406 %U https://www.jmir.org/2021/10/e29406 %U https://doi.org/10.2196/29406 %U http://www.ncbi.nlm.nih.gov/pubmed/34623316 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e23312 %T Engaging Institutional Stakeholders to Develop and Implement Guidelines for Recruiting Participants in Research Studies Using Social Media: Mixed Methods, Multi-Phase Process %A Flood-Grady,Elizabeth %A Solberg,Lauren B %A Baralt,Claire %A Meyer,Meghan %A Stevens,Jeff %A Krieger,Janice L %+ STEM Translational Communication Center, College of Journalism and Communications, University of Florida, PO Box 118400, Gainesville, FL, 32611, United States, 1 352 273 0240, efloodgrady@ufl.edu %K social media %K research recruitment %K stakeholder engagement %K health communication %D 2021 %7 8.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Limited regulatory guidance surrounding the use of social media channels for participant recruitment is an interdisciplinary challenge. Establishing stakeholder-informed procedures is essential for ethical and effective use of social media for participant recruitment. Objective: This study aims to provide replicable procedures for developing and implementing guidelines for using social media to recruit participants in research studies. Methods: Social media use cases at the university were used to identify institutional stakeholders for the initiative. After establishing workflow procedures, a scoping review of web-based materials about recruitment and research on the internet and social media from 19 peer institutions and 2 federal agencies was conducted to inform the structure of the policies and procedures. End users (investigators and study coordinators; N=14) also provided feedback on the policies and procedures and implementation. Results: Representatives (n=7) from 5 institutional offices and 15 subject-matter experts from 5 areas were identified as stakeholders in the development of policies and procedures. Peers with web-based materials (n=16) identified in the scoping review revealed 4 themes that served as a basis for developing our policies and procedures. End user feedback further informed the policies and procedures and implementation. A centrally managed social media account for communicating with participants and hosting advertising campaigns on social media was also established and, when combined with the policies and procedures, resulted in 39 advertising campaigns, and 2846 participants were enrolled in health and clinical research studies. Conclusions: Our policies and procedures allow research teams to harness the potential of social media to increase study recruitment and participation; the transparent, stakeholder-informed process can be replicated by institutional administrators to establish policies and procedures that meet the interests and needs of their research community. %M 34623319 %R 10.2196/23312 %U https://www.jmir.org/2021/10/e23312 %U https://doi.org/10.2196/23312 %U http://www.ncbi.nlm.nih.gov/pubmed/34623319 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26224 %T Understanding Preferences for Lifestyle-Focused Visual Text Messages in Patients With Cardiovascular and Chronic Respiratory Disease: Discrete Choice Experiment %A Choi,Michael %A Raeside,Rebecca %A Hyun,Karice %A Partridge,Stephanie R %A Thiagalingam,Aravinda %A Redfern,Julie %+ Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Level 6, Block K, Westmead Hospital, Westmead, Sydney, 2154, Australia, 61 88909214, julie.redfern@sydney.edu.au %K mHealth %K cardiovascular disease %K respiratory disease %K visual communication %K lifestyle change %K consumer preferences %K secondary prevention %K rehabilitation %K persuasive health technology %D 2021 %7 20.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Supporting healthy lifestyle changes is a key aim of cardiovascular and pulmonary rehabilitation programs. SMS text messaging programs have demonstrated effectiveness in cardiovascular disease risk reduction, weight loss, increasing physical activity, and smoking cessation. The optimization of SMS text messaging programs may deliver greater population benefits as mobile phone use becomes ubiquitous. Visual messaging (ie, image-based messages) has the potential to communicate health messages via digital technology and result in enhanced engagement. Objective: This study aims to determine and understand patient preferences for lifestyle-focused visual text messages that support cardiovascular and pulmonary rehabilitation. Methods: A discrete choice experiment was conducted in a 4-stage iterative process to elicit patient preferences for visual message features. Attribute and level development yielded 3 attributes (purpose, image type, and web address), and 16 choice sets were subsequently constructed according to a full factorial design. Patients participating in cardiovascular and pulmonary rehabilitation were surveyed (on the web) for their preferences regarding the visual message choice sets. Respondents were asked to choose among 16 pairs of visual messages regarding key lifestyle behaviors, namely, physical activity and nutrition. The data were analyzed using a conditional logit model. Results: There was a total of 1728 observations from 54 unique respondents. Two factors that were associated with patient preference were gain-framed purpose compared with no purpose (odds ratio [OR] 1.93, 95% CI 1.40-2.65) and real images compared with cartoon images (OR 1.26, 95% CI 1.04-1.54). A loss-framed purpose was less preferred than no purpose (OR 0.55, 95% CI 0.42-0.74). Overall, patients preferred positive images that were colorful and engaged with text that supported the image and had a preference for images of real people rather than cartoons. Conclusions: A discrete choice experiment is a scientific method for eliciting patient preferences for a visual messaging intervention that is designed to support changes in lifestyle behaviors. SMS text messaging programs that use visual aids may result in greater patient satisfaction by using a gain frame, using real images, and avoiding a loss frame. Further research is needed to explore the feasibility of implementation and the health and behavioral outcomes associated with such visual messaging programs. %M 34542413 %R 10.2196/26224 %U https://www.jmir.org/2021/9/e26224 %U https://doi.org/10.2196/26224 %U http://www.ncbi.nlm.nih.gov/pubmed/34542413 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e14908 %T Association Between eHealth Literacy in Online Health Communities and Patient Adherence: Cross-sectional Questionnaire Study %A Lu,Xinyi %A Zhang,Runtong %+ School of Management and E-business, Zhejiang Gongshang University, 18 Xuezheng Street, Qiantang District, Hangzhou, 310018, China, 86 18801329327, xinyilu@bjtu.edu.cn %K online health communities %K OHCs %K eHealth literacy %K patient adherence %K health information %K physician-patient communication %D 2021 %7 13.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth literacy is significantly associated with patients’ online information behavior, physician-patient relationship, patient adherence, and health outcomes. As an important product of the internet, online health communities (OHCs) can help redistribute idle medical resources, increase medical resource utilization, and improve patient adherence. However, studies on eHealth literacy in OHCs are limited. Therefore, this study examined patients’ eHealth literacy regarding health information–seeking behavior and physician-patient communication in OHCs. Objective: This study aimed to investigate the association between eHealth literacy in OHCs and patient adherence by employing social cognitive theory. Methods: This was an empirical study, in which a research model consisting of 1 independent variable (patients’ eHealth literacy), 3 mediators (physician-patient communication in OHCs, patient health information–seeking behavior in OHCs, and patients’ perceived quality of health information in OHCs), 1 dependent variable (patient adherence), and 4 control variables (age, gender, living area, and education level) was established to examine the associations. Multi-item scales were used to measure variables. An anonymous online survey involving 560 participants was conducted through Chinese OHCs in July 2018 to collect data. Partial least squares and structural equation modeling were adopted to analyze data and test hypotheses. Results: The survey response rate was 79.6% (446/560). The reliability, convergent validity, and discriminant validity were acceptable. Age, gender, living area, and education level were positively associated with patient adherence, and gender was positively associated with physician-patient communication and patients’ perceived quality of internet health information in OHCs. Patients’ eHealth literacy was positively associated with patient adherence through the mediations of physician-patient communication, internet health information–seeking behavior, and perceived quality of internet health information in OHCs. Conclusions: Results indicate that physician-patient communication, internet health information–seeking behavior, and the perceived quality of internet health information are significantly associated with improving patient adherence via a guiding of eHealth literacy in OHCs. These findings suggest that physicians can understand and guide their patients’ eHealth literacy to improve treatment efficiency; OHCs’ operators should this strengthen the management of information quality, develop user-friendly features, and minimize the gap between the actual and perceived information quality. %M 34515638 %R 10.2196/14908 %U https://www.jmir.org/2021/9/e14908 %U https://doi.org/10.2196/14908 %U http://www.ncbi.nlm.nih.gov/pubmed/34515638 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e29061 %T Digital Technology Tools to Examine Patient Adherence to a Prescription-Only Omega-3 Polyunsaturated Fatty Acid Therapy To Mitigate Cardiovascular Risk: Protocol for a Prospective Observational Study and Preliminary Demographic Analysis %A Arutyunov,Gregory P %A Arutyunov,Alexander G %A Ageev,Fail T %A Fofanova,Tatiana V %+ Pirogov Russian National Research Medical University, Department of Internal Medicine, Ostrovityanova Street, Moscow, 117997, Russian Federation, 7 9103281989, arut@ossn.ru %K omega-3-acid ethyl esters %K myocardial infarction %K hypertriglyceridemia %K adherence %K compliance %K persistence %K mHealth %K eHealth %K patient-reported outcomes %D 2021 %7 30.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sustained adherence and persistence with prescription medications is considered essential to achieve maximal treatment benefit for patients with major chronic, noncommunicable diseases such as hyperlipidemia and lipid-associated cardiovascular disease. It is widely documented, however, that many patients with these conditions have poor long-term adherence to their treatments. The population of Russia is affected by poor adherence in the same ways as populations elsewhere and continues to have high rates of cardiovascular disease. Objective: The purpose of this study was to examine patient adherence to a prescription-only preparation of highly purified omega-3 polyunsaturated fatty acids (1.2 to 1 eicosapentaenoic acid to docosahexaenoic ratio, 90% purity) in a large sample of patients at risk for cardiovascular diseases using digital technology to monitor patient behavior and as an outreach facility for patient education and engagement. Methods: We conducted a 6-month prospective observational study (DIAPAsOn) at >100 centers in the Russian Federation. A bespoke electronic data capture and patient engagement system were developed with a well-established Russian technology supplier that enables information obtained during clinic visits to be supplemented by remote patient self-reporting. Other aspects of the program included raising patients' awareness about their condition via educational materials available in personal patient accounts in the electronic system. Results: From an initial cohort of 3000 patients, a safety population of 2572 patients (age: mean 60 years) with an equal proportion of men and women has been characterized. There was widespread concomitant cardiovascular pathology and commensurate use of multiple classes of cardiovascular medication, notably lipid-modifying and antihypertensive drugs. The program was completed by 1975 patients, of whom 780 were prescribed highly purified omega-3 polyunsaturated fatty acid supplements for secondary prevention after myocardial infarction and 1195 were prescribed highly purified omega-3 polyunsaturated fatty acid supplements for hypertriglyceridemia. Data collection and analysis have been completed. Conclusions: DIAPAsOn will provide insights into patient adherence with prescription-grade omega-3 polyunsaturated fatty acid therapy and perspectives on the role of mobile technology in monitoring and encouraging adherence to therapy. %M 34459746 %R 10.2196/29061 %U https://www.researchprotocols.org/2021/8/e29061 %U https://doi.org/10.2196/29061 %U http://www.ncbi.nlm.nih.gov/pubmed/34459746 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e26650 %T Patient and Clinician Characteristics Associated With Secure Message Content: Retrospective Cohort Study %A Heisey-Grove,Dawn %A Rathert,Cheryl %A McClelland,Laura E %A Jackson,Kevin %A DeShazo,Jonathan P %+ The MITRE Corporation, 7525 Colshire Dr, McLean, VA, 22102, United States, 1 7035477389, heiseygroved@mitre.org %K patient-provider communication %K electronic messaging %K hypertension %K diabetes %D 2021 %7 19.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Good communication has been shown to affect patient outcomes; however, the effect varies according to patient and clinician characteristics. To date, no research has explored the differences in the content of secure messages based on these characteristics. Objective: This study aims to explore characteristics of patients and clinic staff associated with the content exchanged in secure messages. Methods: We coded 18,309 messages that were part of threads initiated by 1031 patients with hypertension, diabetes, or both conditions, in communication with 711 staff members. We conducted four sets of analyses to identify associations between patient characteristics and the types of messages they sent, staff characteristics and the types of messages they sent, staff characteristics and the types of messages patients sent to them, and patient characteristics and the types of messages they received from staff. Logistic regression was used to estimate the strength of the associations. Results: We found that younger patients had reduced odds of sharing clinical updates (odds ratio [OR] 0.77, 95% CI 0.65-0.91) and requesting prescription refills (OR 0.77, 95% CI 0.65-0.90). Women had reduced odds of self-reporting biometrics (OR 0.78, 95% CI 0.62-0.98) but greater odds of responding to a clinician (OR 1.20, 95% CI 1.02-1.42) and seeking medical guidance (OR 1.19, 95% CI 1.01-1.40). Compared with White patients, Black patients had greater odds of requesting preventive care (OR 2.68, 95% CI 1.30-5.51) but reduced odds of requesting a new or changed prescription (OR 0.72, 95% CI 0.53-0.98) or laboratory or other diagnostic procedures (OR 0.66, 95% CI 0.46-0.95). Staff had lower odds of sharing medical guidance with younger patients (OR 0.83, 95% CI 0.69-1.00) and uninsured patients (OR 0.21, 95% CI 0.06-0.73) but had greater odds of sharing medical guidance with patients with public payers (OR 2.03, 95% CI 1.26-3.25) compared with patients with private payers. Staff had reduced odds of confirming to women that their requests were fulfilled (OR 0.82, 95% CI 0.69-0.98). Compared with physicians, nurse practitioners had greater odds of sharing medical guidance with patients (OR 2.74, 95% CI 1.12-6.68) and receiving prescription refill requests (OR 3.39, 95% CI 1.49-7.71). Registered nurses had greater odds of deferred information sharing (OR 1.61, 95% CI 1.04-2.49) and receiving responses to messages (OR 3.93, 95% CI 2.18-7.11) than physicians. Conclusions: The differences we found in content use based on patient characteristics could lead to the exacerbation of health disparities when content is associated with health outcomes. Disparities in the content of secure messages could exacerbate disparities in patient outcomes, such as satisfaction, trust in the system, self-care, and health outcomes. Staff and administrators should evaluate how secure messaging is used to ensure that disparities in care are not perpetuated via this communication modality. %M 34420923 %R 10.2196/26650 %U https://www.jmir.org/2021/8/e26650 %U https://doi.org/10.2196/26650 %U http://www.ncbi.nlm.nih.gov/pubmed/34420923 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 3 %P e23790 %T Email Patient-Provider Communication and Cancer Screenings Among US Adults: Cross-sectional Study %A Kindratt,Tiffany B %A Allicock,Marlyn %A Atem,Folefac %A Dallo,Florence J %A Balasubramanian,Bijal A %+ Public Health Program, Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, 500 W. Nedderman Drive, Arlington, TX, 75919, United States, 1 1 817 938 9223, tiffany.kindratt@uta.edu %K email %K patient-provider communication %K online, patient portals %K mammogram %K Pap test %K colon cancer screening %K cancer screenings %K National Health Interview Survey %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: The growth of electronic medical records and use of patient portals have allowed for patients and health care providers to communicate via email and direct messaging between health care visits. Email patient-provider communication (PPC) may enhance traditional face-to-face PPC by allowing patients to ask questions, receive clear explanations, engage in shared decision-making, and confirm their understanding between in-person visits. Despite increasing trends in the use of email PPC since the early 2000s, few studies have evaluated associations between email PPC and the uptake of preventive services. Objective: The objective of this study was to determine associations between the use of email PPC and the likelihood of undergoing breast, cervical, and colon cancer screenings among adults who have received health care in the past 12 months. Methods: Secondary, cross-sectional data from the 2011-2015 National Health Interview Survey were combined and analyzed. For each cancer screening, inclusion criteria were based on the age of screening recommendations and prior history of cancer diagnosis (n=35,912 for breast, n=48,512 for cervical, and n=45,884 for colon). The independent variable was whether adults used email PPC in the past 12 months (yes or no). The dependent variables were whether (1) women (aged ≥40 years) received a mammogram in the past 12 months; (2) women (aged 21-65 years) received a Pap test in the past 12 months; and (3) individuals (aged ≥50 years) received a colon cancer screening in the past 12 months. Bivariate and multivariable logistic regression analyses were conducted. Results: Adults who reported receiving all three cancer screenings in the past 12 months were more likely to be non-Hispanic White; be married or living with a partner; have a bachelor’s degree or higher education level; have health insurance coverage; and perceive their health as excellent, very good, or good (all P<.001). Men were more likely to receive colon cancer screenings than women (P<.001). Multivariable logistic regression models showed women who used email to communicate with their health care providers had greater odds of receiving breast (odds ratio [OR] 1.32, 95% CI 1.20-1.44) and cervical (OR 1.11, 95% CI 1.02-1.20) cancer screenings than women who did not use email PPC. Adults who used email to communicate with their health care providers had 1.55 times greater odds (95% CI 1.42-1.69) of receiving a colon cancer screening than those who did not use email PPC. Conclusions: Our results demonstrate that email PPC is a marker of increased likelihood of adults completing age-appropriate cancer screenings, particularly breast, cervical, and colon cancer screenings. More research is needed to examine other factors related to the reasons for and quality of email PPC between patients and health care providers and determine avenues for health education and intervention to further explore this association. %M 34328421 %R 10.2196/23790 %U https://cancer.jmir.org/2021/3/e23790 %U https://doi.org/10.2196/23790 %U http://www.ncbi.nlm.nih.gov/pubmed/34328421 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 3 %P e19191 %T The Role of Computer Skills in Personal Health Record Adoption Among Patients With Heart Disease: Multidimensional Evaluation of Users Versus Nonusers %A Clarke,Martina A %A Fruhling,Ann L %A Lyden,Elizabeth L %A Tarrell,Alvin E %A Bernard,Tamara L %A Windle,John R %+ School of Interdisciplinary Informatics, College of Information Science and Technology, University of Nebraska Omaha, 6001 Dodge Street, Omaha, NE, 68182-0116, United States, 1 402 554 2801, martinaclarke@unomaha.edu %K patient portal %K communication %K patients %K precision medicine %K health literacy %D 2021 %7 26.7.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In the era of precision medicine, it is critical for health communication efforts to prioritize personal health record (PHR) adoption. Objective: The objective of this study was to describe the characteristics of patients with heart disease that choose to adopt a PHR. Methods: A total of 79 patients with chronic cardiovascular disease participated in this study: 48 PHR users and 31 nonusers. They completed 5 surveys related to their choice to use or not use the PHR: demographics, patient activation, medication adherence, health literacy, and computer self-efficacy (CSE). Results: There was a significant difference between users and nonusers in the sociodemographic measure education (P=.04). There was no significant difference between users and nonusers in other sociodemographic measures: age (P=.20), sex (P=.35), ethnicity (P=.43), race (P=.42), and employment (P=.63). There was a significant difference between PHR users and PHR nonusers in CSE (P=.006). Conclusions: In this study, we demonstrate that sociodemographic characteristics were not an important factor in patients’ use of their PHR, except for education. This study had a small sample size and may not have been large enough to detect differences between groups. Our results did demonstrate that there is a difference between PHR users and nonusers related to their CSE. This work suggests that incorporating CSE into the design of PHRs is critical. The design of patient-facing tools must take into account patients’ preferences and abilities when developing effective user-friendly health information technologies. %M 34309574 %R 10.2196/19191 %U https://humanfactors.jmir.org/2021/3/e19191 %U https://doi.org/10.2196/19191 %U http://www.ncbi.nlm.nih.gov/pubmed/34309574 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e20969 %T Designing Asynchronous Remote Support for Behavioral Activation in Teenagers With Depression: Formative Study %A Bhattacharya,Arpita %A Nagar,Ria %A Jenness,Jessica %A Munson,Sean A %A Kientz,Julie A %+ Department of Informatics, University of California, Irvine, 6210 Donald Bren Hall, Irvine, CA, 92697, United States, 1 (949) 824 2901, arpitab@uci.edu %K teens %K mental health %K behavioral activation %K asynchronous remote communities %D 2021 %7 13.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Many teenagers in the United States experience challenges with symptoms of depression, and they lack adequate resources for accessing in-person mental health care. Involving teens and clinicians in designing technologies that use evidence-based practices that reduce barriers to accessing mental health care is crucial. Interventions based on behavioral activation (BA) help teens understand the relationship between mood and activity, help them practice goal-directed behaviors to improve mood, and may be particularly well-suited to delivery via internet-based platforms. Objective: This study aims to understand the needs and challenges that teens and mental health clinicians face in depression management and involve them in the design process of a remote intervention that uses asynchronous remote communities. Our goal is to understand the benefits and challenges of adapting BA to an internet-based platform that supports the asynchronous remote community approach as a delivery tool for teen depression management. Methods: We enrolled mental health clinicians (n=10) and teens (n=8) in separate, private, internet-based groups on Slack (Slack Technologies Inc). They participated in 20-minute design activities for 10 weeks and were then invited to interviews about their experiences in the study. Results: Both teen and clinician participants wanted internet-based support for BA as a supplement to in-person therapy. Although participants perceived the asynchronous format as conducive to supporting accessible care, teens and clinicians raised concerns about safety, privacy, and the moderating of the internet-based group. Design decisions that address these concerns need to be balanced with the potential benefits of learning coping skills, increasing access to mental health care, and promoting asynchronous human connection to support teens. Conclusions: We discuss considerations for balancing tensions in privacy and safety while designing and selecting internet-based platforms to support remote care and integrating evidence-based support when designing digital technologies for the treatment of teens with depression. %M 34255665 %R 10.2196/20969 %U https://formative.jmir.org/2021/7/e20969 %U https://doi.org/10.2196/20969 %U http://www.ncbi.nlm.nih.gov/pubmed/34255665 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e27531 %T Impact of Asynchronous Electronic Communication–Based Visits on Clinical Outcomes and Health Care Delivery: Systematic Review %A Nguyen,Oliver T %A Alishahi Tabriz,Amir %A Huo,Jinhai %A Hanna,Karim %A Shea,Christopher M %A Turner,Kea %+ Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612, United States, 1 (813) 745 5213, kea.turner@moffitt.org %K telemedicine %K telehealth %K e-visits %K electronic visits %K digital care %K outcome %K delivery %K review %K access %K utilization %K cost %K patient portal %K eHealth %D 2021 %7 5.5.2021 %9 Review %J J Med Internet Res %G English %X Background: Electronic visits (e-visits) involve asynchronous communication between clinicians and patients through a secure web-based platform, such as a patient portal, to elicit symptoms and determine a diagnosis and treatment plan. E-visits are now reimbursable through Medicare due to the COVID-19 pandemic. The state of evidence regarding e-visits, such as the impact on clinical outcomes and health care delivery, is unclear. Objective: To address this gap, we examine how e-visits have impacted clinical outcomes and health care quality, access, utilization, and costs. Methods: We conducted a systematic review; MEDLINE, Embase, and Web of Science were searched from January 2000 through October 2020 for peer-reviewed studies that assessed e-visits’ impacts on clinical and health care delivery outcomes. Results: Out of 1859 papers, 19 met the inclusion criteria. E-visit usage was associated with improved or comparable clinical outcomes, especially for chronic disease management (eg, diabetes care, blood pressure management). The impact on quality of care varied across conditions. Quality of care was equivalent or better for chronic conditions, but variable quality was observed in infection management (eg, appropriate antibiotic prescribing). Similarly, the impact on health care utilization varied across conditions (eg, lower utilization for dermatology but mixed impact in primary care). Health care costs were lower for e-visits than those for in-person visits for a wide range of conditions (eg, dermatology and acute visits). No studies examined the impact of e-visits on health care access. It is difficult to draw firm conclusions about effectiveness or impact on care delivery from the studies that were included because many used observational designs. Conclusions: Overall, the evidence suggests e-visits may provide clinical outcomes that are comparable to those provided by in-person care and reduce health care costs for certain health care conditions. At the same time, there is mixed evidence on health care quality, especially regarding infection management (eg, sinusitis, urinary tract infections, conjunctivitis). Further studies are needed to test implementation strategies that might improve delivery (eg, clinical decision support for antibiotic prescribing) and to assess which conditions can be managed via e-visits. %M 33843592 %R 10.2196/27531 %U https://www.jmir.org/2021/5/e27531 %U https://doi.org/10.2196/27531 %U http://www.ncbi.nlm.nih.gov/pubmed/33843592 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e21127 %T Brief Interventions via Electronic Health Record Messaging for Population-Based Suicide Prevention: Mixed Methods Pilot Study %A Whiteside,Ursula %A Richards,Julie %A Simon,Gregory E %+ NowMattersNow.org, 1645 140th Ave NE, Suite A41053, Bellevue, WA, 98005, United States, 1 206 679 6349, ursulawhiteside@gmail.com %K suicide %K suicide prevention %K dialectical behavior therapy %K caring message %K web-based %K NowMattersNow.org %K prevention %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: New opportunities to create and evaluate population-based selective prevention programs for suicidal behavior are emerging in health care settings. Standard depression severity measures recorded in electronic medical records (EMRs) can be used to identify patients at risk for suicide and suicide attempt, and promising interventions for reducing the risk of suicide attempt in at-risk populations can be adapted for web-based delivery in health care. Objective: This study aims to evaluate a pilot of a psychoeducational program, focused on developing emotion regulation techniques via a web-based dialectical behavior therapy (DBT) skills site, including four DBT skills, and supported by secure message coaching, including elements of caring messages. Methods: Patients were eligible based on the EMR-documented responses to the Patient Health Questionnaire indicating suicidal thoughts. We measured feasibility via the proportion of invitees who opened program invitations, visited the web-based consent form page, and consented; acceptability via qualitative feedback from participants about the DBT program; and engagement via the proportion of invitees who began DBT skills as well as the number of website visits for DBT skills and the degree of site engagement. Results: A total of 60 patients were invited to participate. Overall, 93% (56/60) of the patients opened the invitation and 43% (26/60) consented to participate. DBT skills website users visited the home page on an average of 5.3 times (SD 6.0). Procedures resulted in no complaints and some participant feedback emphasizing the usefulness of DBT skills. Conclusions: This study supports the potential of using responses to patient health questionnaires in EMRs to identify a high-risk population and offer key elements of caring messages and DBT adapted for a low-intensity intervention. A randomized trial evaluating the effectiveness of this program is now underway (ClinicalTrials.gov: NCT02326883). %M 33843599 %R 10.2196/21127 %U https://formative.jmir.org/2021/4/e21127 %U https://doi.org/10.2196/21127 %U http://www.ncbi.nlm.nih.gov/pubmed/33843599 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e22399 %T A Digital Patient-Provider Communication Intervention (InvolveMe): Qualitative Study on the Implementation Preparation Based on Identified Facilitators and Barriers %A Seljelid,Berit %A Varsi,Cecilie %A Solberg Nes,Lise %A Øystese,Kristin Astrid %A Børøsund,Elin %+ Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Box 4950 Nydalen, Oslo, N-0424, Norway, 47 22894357, elin.borosund@rr-research.no %K eHealth %K digital communication %K secure messages %K digital symptom assessment %K implementation %K tailoring %K Consolidated Framework for Implementation Research %K CFIR %K facilitators %K barriers %K stakeholders %D 2021 %7 8.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic health conditions are affecting an increasing number of individuals, who experience various symptoms that decrease their quality of life. Digital communication interventions that enable patients to report their symptoms have been shown to positively impact chronic disease management by improving access to care, patient-provider communication, clinical outcomes, and health-related quality of life. These interventions have the potential to prepare patients and health care providers (HCPs) before visits and improve patient-provider communication. Despite the recent rapid development and increasing number of digital communication interventions that have shown positive research results, barriers to realizing the benefits offered through these types of interventions still exist. Objective: The aim of this study is to prepare for the implementation of a digital patient-provider communication intervention in the daily workflow at 2 outpatient clinics by identifying potential determinants of implementation using the Consolidated Framework for Implementation Research (CFIR) to tailor the use of digital communication intervention to the intended context and identify key aspects for an implementation plan. Methods: A combination of focus groups, workshops, and project steering committee meetings was conducted with HCPs (n=14) and patients (n=2) from 2 outpatient clinics at a university hospital. The CFIR was used to guide data collection and analysis. Transcripts, written minutes, and notes were analyzed and coded into 5 CFIR domains using thematic analysis. Results: Data were examined and analyzed into 18 CFIR constructs relevant to the study purpose. On the basis of the identified determinants, important intervention tailoring includes adjustments to the digital features and adjustments to fit the clinical workflow and a decision to conduct a future pilot study. Furthermore, it was decided to provide the intervention to patients as early as possible in their disease trajectory, with tailored information about its use. Key aspects for the implementation plan encompassed maintaining the identified engagement and positive attitude, involving key stakeholders in the implementation process, and providing the needed support and training. Conclusions: This study offers insight into the involvement of stakeholders in the tailoring and implementation planning of a digital communication intervention in clinical practice. Stakeholder involvement in the identification of implementation facilitators and barriers can contribute to the tailoring of digital communication interventions and how they are used and can also inform systematic and targeted implementation planning. %M 33830063 %R 10.2196/22399 %U https://www.jmir.org/2021/4/e22399 %U https://doi.org/10.2196/22399 %U http://www.ncbi.nlm.nih.gov/pubmed/33830063 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e13992 %T The Epidemiology of Patients' Email Addresses in a French University Hospital: Case-Control Study %A Looten,Vincent %A Neuraz,Antoine %A Garcelon,Nicolas %A Burgun,Anita %A Chatellier,Gilles %A Rance,Bastien %+ Medical Informatics Department, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, 20 rue Leblanc, Paris, France, 33 156095985, bastien.rance@aphp.fr %K email %K data privacy %K health communication %D 2021 %7 24.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Health care professionals are caught between the wish of patients to speed up health-related communication via emails and the need for protecting health information. Objective: We aimed to analyze the demographic characteristics of patients providing an email, and study the distribution of emails’ domain names. Methods: We used the information system of the European Hospital Georges Pompidou (HEGP) to identify patients who provided an email address. We used a 1:1 matching strategy to study the demographic characteristics of the patients associated with the presence of an email, and described the characteristics of the emails used (in terms of types of emails—free, business, and personal). Results: Overall, 4.22% (41,004/971,822) of the total population of patients provided an email address. The year of last contact with the patient is the strongest driver of the presence of an email address (odds ratio [OR] 20.8, 95% CI 18.9-22.9). Patients more likely to provide an email address were treated for chronic conditions and were more likely born between 1950 and 1969 (taking patients born before 1950 as reference [OR 1.60, 95% CI 1.54-1.67], and compared to those born after 1990 [OR 0.56, 95% CI 0.53-0.59]). Of the 41,004 email addresses collected, 37,779 were associated with known email providers, 31,005 email addresses were associated with Google, Microsoft, Orange, and Yahoo!, 2878 with business emails addresses, and 347 email addresses with personalized domain names. Conclusions: Emails have been collected only recently in our institution. The importance of the year of last contact probably reflects this recent change in contact information collection policy. The demographic characteristics and especially the age distribution are likely the result of a population bias in the hospital: patients providing email are more likely to be treated for chronic diseases. A risk analysis of the use of email revealed several situations that could constitute a breach of privacy that is both likely and with major consequences. Patients treated for chronic diseases are more likely to provide an email address, and are also more at risk in case of privacy breach. Several common situations could expose their private information. We recommend a very restrictive use of the emails for health communication. %M 33625375 %R 10.2196/13992 %U https://www.jmir.org/2021/2/e13992 %U https://doi.org/10.2196/13992 %U http://www.ncbi.nlm.nih.gov/pubmed/33625375 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e25062 %T An Asynchronous, Mobile Text-Based Platform (XatJove Anoia) for Providing Health Services to Teenagers: Protocol for a Quasiexperimental Study %A Sauch Valmaña,Glòria %A Vidal-Alaball,Josep %A Garcia Furió,Victoria %A Testoni,Giorgia %A Espelt,Albert %A Exposito,Katarin %A Saigí-Rubió,Francesc %A Carré,Núria %A Sanz,Ikuska %A Vicens,Victor %+ 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 6930040, jvidal.cc.ics@gencat.cat %K mHealth %K telehealth %K teenager %K health promotion and sexual health %K health promotion %K sexual health %D 2021 %7 3.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Due to the COVID-19 pandemic, it is more essential than ever to implement protective measures in primary care centers to ensure patients’ safety. This protocol describes a quasiexperimental study on the use of a mobile chat platform as a clinical consultation tool for adolescents and primary health care physicians. Objective: The purpose of the quasiexperimental study is to demonstrate that the use of mobile phones and messaging apps increases the number of health consultations. The study will be performed as part of the Health and School program in the Anoia region. Methods: The quasiexperimental study will compare the number of face-to-face consultations to the number of consultations conducted on XatJove Anoia, as part of the Health in Schools program in the Anoia region. The study will involve the use of a new communication platform (ie, XatJove Anoia) for health care professionals and adolescents, and data on the number of face-to-face consultations will be collected as part of the same program in another region. Data will be collected from secondary schools during the academic year 2020-2021. Statistical analyses will be performed on the data that users will enter in the registration form. These data will be collected by means of a questionnaire, which will be submitted once the questionnaire is closed. The questionnaire will consist of multiple-choice questions, which will allow numerical values to be assigned to various responses in order to carry out statistical analyses. Results: The study is projected to start at the beginning of November 2020 and finish in June 2021, which is when data analysis is expected to start. Conclusions: The results of the quasiexperimental study may assist in the development and planning of school health programs. Trial Registration: ClinicalTrials.gov NCT04562350; https://clinicaltrials.gov/ct2/show/NCT04562350. International Registered Report Identifier (IRRID): PRR1-10.2196/25062 %M 33533729 %R 10.2196/25062 %U https://www.researchprotocols.org/2021/2/e25062 %U https://doi.org/10.2196/25062 %U http://www.ncbi.nlm.nih.gov/pubmed/33533729 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e21623 %T Health Care Professionals’ Experiences of Patient-Professional Communication Over Patient Portals: Systematic Review of Qualitative Studies %A Laukka,Elina %A Huhtakangas,Moona %A Heponiemi,Tarja %A Kujala,Sari %A Kaihlanen,Anu-Marja %A Gluschkoff,Kia %A Kanste,Outi %+ Finnish Institute for Health and Welfare, Social and Health System Research Unit, Mannerheimintie 166, Helsinki, 00271, Finland, 358 29 524 7368, elina.laukka@thl.fi %K telemedicine %K communication %K patient portals %K nurses %K physicians %K systematic literature review %K thematic analysis %D 2020 %7 8.12.2020 %9 Review %J J Med Internet Res %G English %X Background: The popularity of web-based patient-professional communication over patient portals is constantly increasing. Good patient-professional communication is a prerequisite for high-quality care and patient centeredness. Understanding health care professionals’ experiences of web-based patient-professional communication is important as they play a key role in engaging patients to use portals. More information is needed on how patient-professional communication could be supported by patient portals in health care. Objective: This systematic review of qualitative studies aims to identify how health care professionals experience web-based patient-professional communication over the patient portals. Methods: Abstract and full-text reviews were conducted by 2 reviewers independently. A total of 4 databases were used for the study: CINAHL (EBSCO), ProQuest (ABI/INFORM), Scopus, and PubMed. The inclusion criteria for the reviewed studies were as follows: the examination of health care professionals’ experiences, reciprocal communication between patients and health care professionals, peer-reviewed scientific articles, and studies published between 2010 and 2019. The Joanna Briggs Institute’s quality assessment criteria were used in the review process. A total of 13 included studies were analyzed using a thematic synthesis, which was conducted by 3 reviewers. Results: A total of 6 analytical themes concerning health care professionals’ experiences of web-based patient-professional communication were identified. The themes were related to health care professionals’ work, change in communication over patient portals, patients’ use of patient portals, the suitability of patient portals for communication, the convenience of patient portals for communication, and change in roles. Conclusions: Health care professionals’ experiences contain both positive and negative insights into web-based patient-professional communication over patient portals. Most commonly, the positive experiences seem to be related to the patients and patient outcomes, such as having better patient engagement. Health care professionals also have negative experiences, for example, web-based patient-professional communication sometimes has deficiencies and has a negative impact on their workload. These negative experiences may be explained by the poor functionality of the patient portals and insufficient training and resources. To reduce health care professionals’ negative experiences of web-based patient-professional communication, their experiences should be taken into account by policy makers, health care organizations, and information technology enterprises when developing patient portals. In addition, more training regarding web-based patient-professional communication and patient portals should be provided to health care professionals. %M 33289674 %R 10.2196/21623 %U http://www.jmir.org/2020/12/e21623/ %U https://doi.org/10.2196/21623 %U http://www.ncbi.nlm.nih.gov/pubmed/33289674 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22307 %T Impact of Patient-Clinical Team Secure Messaging on Communication Patterns and Patient Experience: Randomized Encouragement Design Trial %A Shimada,Stephanie L %A Zocchi,Mark S %A Hogan,Timothy P %A Kertesz,Stefan G %A Rotondi,Armando J %A Butler,Jorie M %A Knight,Sara J %A DeLaughter,Kathryn %A Kleinberg,Felicia %A Nicklas,Jeff %A Nazi,Kim M %A Houston,Thomas K %+ Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Department of Veterans Affairs, 200 Springs Road, Bedford, MA, 01730, United States, 1 7816872208, stephanie.shimada@va.gov %K patient portal adoption %K secure messaging %K communication %K provider autonomy support %K patient experience %K patient portal %K continuous care %K patient %K design %K effectiveness %K engagement %D 2020 %7 18.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Although secure messaging (SM) between patients and clinical team members is a recommended component of continuous care, uptake by patients remains relatively low. We designed a multicomponent Supported Adoption Program (SAP) to increase SM adoption among patients using the Veterans Health Administration (VHA) for primary care. Objective: Our goals were to (1) conduct a multisite, randomized, encouragement design trial to test the effectiveness of an SAP designed to increase patient engagement with SM through VHA’s online patient portal (My HealtheVet [MHV]) and (2) evaluate the impact of the SAP and patient-level SM adoption on perceived provider autonomy support and communication. Patient-reported barriers to SM adoption were also assessed. Methods: We randomized 1195 patients at 3 VHA facilities who had MHV portal accounts but had never used SM. Half were randomized to receive the SAP, and half served as controls receiving usual care. The SAP consisted of encouragement to adopt SM via mailed educational materials, proactive SM sent to patients, and telephone-based motivational interviews. We examined differences in SM adoption rates between SAP recipients and controls at 9 months and 21 months. Follow-up telephone surveys were conducted to assess perceived provider autonomy support and self-report of telephone communication with clinical teams. Results: Patients randomized to the SAP had significantly higher rates of SM adoption than the control group (101/595, 17.0% vs 40/600, 6.7%; P<.001). Most adopters in the SAP sent their first message without a motivational interview (71/101, 70.3%). The 10-percentage point difference in adoption persisted a full year after the encouragement ended (23.7%, 142/600 in the SAP group vs 13.5%, 80/595 in the control group, P<.001). We obtained follow-up survey data from 49.54% (592/1195) of the participants. SAP participants reported higher perceived provider autonomy support (5.7 vs 5.4, P=.007) and less telephone use to communicate with their provider (68.8% vs 76.0%, P=.05), compared to patients in the control group. Patient-reported barriers to SM adoption included self-efficacy (eg, not comfortable using a computer, 24%), no perceived need for SM (22%), and difficulties with portal password or login (17%). Conclusions: The multicomponent SAP was successful in increasing use of SM 10 percentage points above standard care; new SM adopters reported improved perceptions of provider autonomy support and less use of the telephone to communicate with their providers. Still, despite the encouragement and technical assistance provided through the SAP, adoption rates were lower than anticipated, reaching only 24% at 21 months (10% above controls). Common barriers to adoption such as limited perceived need for SM may be more challenging to address and require different interventions than barriers related to patient self-efficacy or technical difficulties. Trial Registration: ClinicalTrials.gov NCT02665468; https://clinicaltrials.gov/ct2/show/NCT02665468 %M 33206052 %R 10.2196/22307 %U https://www.jmir.org/2020/11/e22307 %U https://doi.org/10.2196/22307 %U http://www.ncbi.nlm.nih.gov/pubmed/33206052 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e18218 %T Email Consultations Between Patients and Doctors in Primary Care: Content Analysis %A Atherton,Helen %A Boylan,Anne-Marie %A Eccles,Abi %A Fleming,Joanna %A Goyder,Clare R %A Morris,Rebecca L %+ Warwick Medical School, University of Warwick, Coventry, CV4 7AL, United Kingdom, 1 +442476151405, h.atherton@warwick.ac.uk %K remote consultation %K communication %K primary care %D 2020 %7 9.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Increasingly, consultations in health care settings are conducted remotely using a range of communication technologies. Email allows for 2-way text-based communication, occurring asynchronously. Studies have explored the content and nature of email consultations to understand the use, structure, and function of email consultations. Most previous content analyses of email consultations in primary care settings have been conducted in North America, and these have shown that concerns and assumptions about how email consultations work have not been realized. There has not been a UK-based content analysis of email consultations. Objective: This study aims to explore and delineate the content of consultations conducted via email in English general practice by conducting a content analysis of email consultations between general practitioners (GPs) and patients. Methods: We conducted a content analysis of anonymized email consultations between GPs and patients in 2 general practices in the United Kingdom. We examined the descriptive elements of the correspondence to ascertain when the emails were sent, the number of emails in an email consultation, and the nature of the content. We used a normative approach to analyze the content of the email consultations to explore the use and function of email consultation. Results: We obtained 100 email consultations from 85 patients, which totaled 262 individual emails. Most email users were older than 40 years, and over half of the users were male. The email consultations were mostly short and completed in a few days. Emails were mostly sent and received during the day. The emails were mostly clinical in content rather than administrative and covered a wide range of clinical presentations. There were 3 key themes to the use and function of the email consultations: the role of the GP and email consultation, the transactional nature of an email consultation, and the operationalization of an email consultation. Conclusions: Most cases where emails are used to have a consultation with a patient in general practice have a shorter consultation, are clinical in nature, and are resolved quickly. GPs approach email consultations using key elements similar to that of the face-to-face consultation; however, using email consultations has the potential to alter the role of the GP, leading them to engage in more administrative tasks than usual. Email consultations were not a replacement for face-to-face consultations. %M 33164902 %R 10.2196/18218 %U https://www.jmir.org/2020/11/e18218 %U https://doi.org/10.2196/18218 %U http://www.ncbi.nlm.nih.gov/pubmed/33164902 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e19477 %T Associations Between Patient Health Outcomes and Secure Message Content Exchanged Between Patients and Clinicians: Retrospective Cohort Study %A Heisey-Grove,Dawn M %A McClelland,Laura E %A Rathert,Cheryl %A Tartaglia,Alexander %A Jackson,Kevin %A DeShazo,Jonathan P %+ MITRE Corporation, 7525 Colshire Drive, McLean, VA, 22102, United States, 1 7035477389, heiseygroved@mitre.org %K health information technology %K electronic messaging %K patient physician communication %K diabetes %K hypertension %D 2020 %7 29.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of electronic messages securely exchanged between clinic staff and patients has risen dramatically over the last decade. A variety of studies explored whether the volume of messages sent by patients was associated with outcomes. None of these studies, however, examined whether message content itself was associated with outcomes. Because secure messaging is a significant form of communication between patients and clinic staff, it is critical to evaluate the context of the communication to best understand its impact on patient health outcomes. Objective: To examine associations between patients’ and clinicians’ message content and changes in patients’ health outcomes. Methods: We applied a taxonomy developed specifically for secure messages to 14,394 patient- and clinic staff–generated messages derived from patient-initiated message threads. Our study population included 1602 patients, 50.94% (n=816) of whom initiated message threads. We conducted linear regression analyses to determine whether message codes were associated with changes in glycemic (A1C) levels in patients with diabetes and changes in systolic (SBP) and diastolic (DBP) blood pressure in patients with hypertension. Results: Patients who initiated threads had larger declines in A1Cs (P=.01) compared to patients who did not initiate threads. Clinic nonresponse was associated with decreased SBP (β=–.30; 95% CI –0.56 to –0.04), as were staffs’ action responses (β=–30; 95% CI –0.58 to –0.02). Increased DBP, SBP, and A1C levels were associated with patient-generated appreciation and praise messages and staff encouragement with effect sizes ranging from 0.51 (A1C) to 5.80 (SBP). We found improvements in SBP associated with patients’ complaints (β=–4.03; 95% CI –7.94 to –0.12). Deferred information sharing by clinic staff was associated with increased SBP (β=1.29; 95% CI 0.4 to 2.19). Conclusions: This is the first research to find associations between message content and patients’ health outcomes. Our findings indicate mixed associations between patient message content and patient outcomes. Further research is needed to understand the implications of this work; in the meantime, health care providers should be aware that their message content may influence patient health outcomes. %M 33118938 %R 10.2196/19477 %U http://www.jmir.org/2020/10/e19477/ %U https://doi.org/10.2196/19477 %U http://www.ncbi.nlm.nih.gov/pubmed/33118938 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e17154 %T eHealth Communication With Clients at Community-Based HIV/AIDS Service Organizations in the Southern United States: Cross-Sectional Survey %A Wigfall,Lisa Tisdale %+ Division of Health Education, Department of Health and Kinesiology, Texas A&M University, 2929 Research Parkway, College Station, TX, 77843-4243, United States, 1 979 845 4779, lwigfall@tamu.edu %K eHealth %K communication %K HIV %K disparities %K inequalities %D 2020 %7 9.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Providing HIV/STD testing and prevention education, medical and nonmedical case management, housing assistance, transportation services, and patient navigation are just a few examples of how community-based HIV/AIDS service organizations will help the United States realize the goals of the updated National HIV/AIDS Strategy. Objective: In this study, the aim was to assess electronic data security confidence level, electronic communication behaviors, and interest in using eHealth communication tools with clients of staff at community-based HIV/AIDS service organizations. Methods: Staff were recruited from 7 community-based HIV/AIDS service organizations in the southern United States (3 in South Carolina and 4 in Texas). The principal investigator used state department of health websites to identify community-based HIV/AIDS service organizations. Staff were included if they provided HIV/STD prevention education to clients. A recruitment letter was sent to community-based HIV/AIDS service organization leaders who then used snowball sampling to recruit eligible staff. Chi-square tests were used. Results: Among staff (n=59) who participated in the study, 66% (39/59) were very or completely confident that safeguards are in place to keep electronically shared information from being seen by other people; 68% (40/59) used email, 58% (34/59) used text messages, 25% (15/59) used social media, 15% (9/59) used a mobile app, 8% (5/59) used web-enabled videoconferencing, and 3% (2/59) used other tools (eg, electronic medical record, healthnavigator.com website) to communicate electronically with their clients. More than half were very interested in using eHealth communication tools in the future for sharing appointment reminders (67%, 38/59) and general health tips (61%, 34/59) with their clients. Half were very interested in using eHealth communication tools in the future to share HIV medication reminders with their clients (50%, 29/59). Forty percent (23/59) were very interested in using eHealth communication tools to share vaccination reminders with their clients. Conclusions: Community-based HIV/AIDS service organization staff had some level of confidence that safeguards were in place to keep electronically shared information from being seen by other people. This is critically important given the sensitivity of the information shared between community-based HIV/AIDS service organization staff and their clients, and because many staff were very interested in using eHealth communication tools with their clients in the future. It is very likely that eHealth communication tools can be used in community settings to improve health outcomes across the HIV care continuum; in the interim, more research is needed to better understand factors that may facilitate or impede community-based HIV/AIDS service organization staff use and client acceptability. %M 32902395 %R 10.2196/17154 %U http://formative.jmir.org/2020/9/e17154/ %U https://doi.org/10.2196/17154 %U http://www.ncbi.nlm.nih.gov/pubmed/32902395 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17186 %T Communication Behavior Changes Between Patients With Diabetes and Healthcare Providers Over 9 Years: Retrospective Cohort Study %A Benis,Arriel %A Barak Barkan,Refael %A Sela,Tomer %A Harel,Nissim %+ Faculty of Technology Management, Holon Institute of Technology, Golomb St 52, POB 305, Holon, Israel, 972 3 5026892, arrielb@hit.ac.il %K population characteristics %K eHealth %K mHealth %K consumer health informatics %K delivery of health care %K machine learning %K clustering %K quality of health care %K point-of-care systems %K physician-patient relations %D 2020 %7 11.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Health organizations and patients interact over different communication channels and are harnessing digital communications for this purpose. Assisting health organizations to improve, adapt, and introduce new patient–health care practitioner communication channels (such as patient portals, mobile apps, and text messaging) enhances health care services access. Objective: This retrospective data study aims to assist health care administrators and policy makers to improve and personalize communication between patients and health care professionals by expanding the capabilities of current communication channels and introducing new ones. Our main hypothesis is that patient follow-up and clinical outcomes are influenced by their preferred communication channels with the health care organization. Methods: This study analyzes data stored in electronic medical records and logs documenting access to various communication channels between patients and a health organization (Clalit Health Services, Israel). Data were collected between 2008 and 2016 from records of 311,168 patients diagnosed with diabetes, aged 21 years and over, members of Clalit at least since 2007, and still alive in 2016. The analysis consisted of characterizing the use profiles of communication channels over time and used clustering for discretization purposes and patient profile building and then a hierarchical clustering and heatmaps to visualize the different communication profiles. Results: A total of 13 profiles of patients were identified and characterized. We have shown how the communication channels provided by the health organization influence the communication behavior of patients. We observed how different patients respond differently to technological means of communication and change or don’t change their communication patterns with the health care organization based on the communication channels available to them. Conclusions: Identifying the channels of communication within the health organization and which are preferred by each patient creates an opportunity to convey messages adapted to the patient in the most appropriate way. The greater the likelihood that the therapeutic message is received by the patient, the greater the patient's response and proactiveness to the treatment will be. International Registered Report Identifier (IRRID): RR2-10.2196/10734 %M 32648555 %R 10.2196/17186 %U http://www.jmir.org/2020/8/e17186/ %U https://doi.org/10.2196/17186 %U http://www.ncbi.nlm.nih.gov/pubmed/32648555 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e19126 %T Information Overload in Emergency Medicine Physicians: A Multisite Case Study Exploring the Causes, Impact, and Solutions in Four North England National Health Service Trusts %A Sbaffi,Laura %A Walton,James %A Blenkinsopp,John %A Walton,Graham %+ Information School, University of Sheffield, 211 Portobello Street, Regent Court, Sheffield, S1 4DP, United Kingdom, 44 114 2222686, L.Sbaffi@sheffield.ac.uk %K emergency medicine %K information overload %K physicians %K national health care system %D 2020 %7 27.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Information overload is affecting modern society now more than ever because of the wide and increasing distribution of digital technologies. Social media, emails, and online communications among others infuse a sense of urgency as information must be read, produced, and exchanged almost instantaneously. Emergency medicine is a medical specialty that is particularly affected by information overload with consequences on patient care that are difficult to quantify and address. Understanding the current causes of medical information overload, their impact on patient care, and strategies to handle the inflow of constant information is crucial to alleviating stress and anxiety that is already crippling the profession. Objective: This study aims to identify and evaluate the main causes and sources of medical information overload, as experienced by emergency medicine physicians in selected National Health Service (NHS) trusts in the United Kingdom. Methods: This study used a quantitative, survey-based data collection approach including close- and open-ended questions. A web-based survey was distributed to emergency physicians to assess the impact of medical information overload on their jobs. In total, 101 valid responses were collected from 4 NHS trusts in north England. Descriptive statistics, principal component analysis, independent sample two-tailed t tests, and one-way between-group analysis of variance with post hoc tests were performed on the data. Open-ended questions were analyzed using thematic analysis to identify key topics. Results: The vast majority of respondents agreed that information overload is a serious issue in emergency medicine, and it increases with time. The always available culture (mean 5.40, SD 1.56), email handling (mean 4.86, SD 1.80), and multidisciplinary communications (mean 4.51, SD 1.61) are the 3 main reasons leading to information overload. Due to this, emergency physicians experience guideline fatigue, stress and tension, longer working hours, and impaired decision making, among other issues. Aspects of information overload are also reported to have different impacts on physicians depending on demographic factors such as age, years spent in emergency medicine, and level of employment. Conclusions: There is a serious concern regarding information overload in emergency medicine. Participants identified a considerable number of daily causes affecting their job, particularly the traditional culture of emergency departments being always available on the ward, exacerbated by email and other forms of communication necessary to maintain optimal, evidence-based practice standards. However, not all information is unwelcome, as physicians also need to stay updated with the latest guidelines on conditions and treatment, and communicate with larger medical teams to provide quality care. %M 32716313 %R 10.2196/19126 %U http://www.jmir.org/2020/7/e19126/ %U https://doi.org/10.2196/19126 %U http://www.ncbi.nlm.nih.gov/pubmed/32716313 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 7 %P e16521 %T A Retrospective Analysis of Provider-to-Patient Secure Messages: How Much Are They Increasing, Who Is Doing the Work, and Is the Work Happening After Hours? %A North,Frederick %A Luhman,Kristine E %A Mallmann,Eric A %A Mallmann,Toby J %A Tulledge-Scheitel,Sidna M %A North,Emily J %A Pecina,Jennifer L %+ Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, 1 5072842511, north.frederick@mayo.edu %K patient messages %K secure messages %K patient portal %K provider messages %K electronic health records %K electronic mail %K communication %K patients %K physicians %K physician assistants %K nurse practitioners %K nurses %D 2020 %7 8.7.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Patient portal registration and the use of secure messaging are increasing. However, little is known about how the work of responding to and initiating patient messages is distributed among care team members and how these messages may affect work after hours. Objective: This study aimed to examine the growth of secure messages and determine how the work of provider responses to patient-initiated secure messages and provider-initiated secure messages is distributed across care teams and across work and after-work hours. Methods: We collected secure messages sent from providers from January 1, 2013, to March 15, 2018, at Mayo Clinic, Rochester, Minnesota, both in response to patient secure messages and provider-initiated secure messages. We examined counts of messages over time, how the work of responding to messages and initiating messages was distributed among health care workers, messages sent per provider, messages per unique patient, and when the work was completed (proportion of messages sent after standard work hours). Results: Portal registration for patients having clinic visits increased from 33% to 62%, and increasingly more patients and providers were engaged in messaging. Provider message responses to individual patients increased significantly in both primary care and specialty practices. Message responses per specialty physician provider increased from 15 responses per provider per year to 53 responses per provider per year from 2013 to 2018, resulting in a 253% increase. Primary care physician message responses increased from 153 per provider per year to 322 from 2013 to 2018, resulting in a 110% increase. Physicians, nurse practitioners, physician assistants, and registered nurses, all contributed to the substantial increases in the number of messages sent. Conclusions: Provider-sent secure messages at a large health care institution have increased substantially since implementation of secure messaging between patients and providers. The effort of responding to and initiating messages to patients was distributed across multiple provider categories. The percentage of message responses occurring after hours showed little substantial change over time compared with the overall increase in message volume. %M 32673238 %R 10.2196/16521 %U https://medinform.jmir.org/2020/7/e16521 %U https://doi.org/10.2196/16521 %U http://www.ncbi.nlm.nih.gov/pubmed/32673238 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e16451 %T Patient-Centric Scheduling With the Implementation of Health Information Technology to Improve the Patient Experience and Access to Care: Retrospective Case-Control Analysis %A Chung,Sukyung %A Martinez,Meghan C %A Frosch,Dominick L %A Jones,Veena G %A Chan,Albert S %+ Quantitative Sciences Unit, School of Medicine, Stanford University, 1701 Page Mill Rd, Palo Alto, CA, 94304, United States, 1 4088363738, schung1@stanford.edu %K access to care %K health information technology %K appointment scheduling %K patient-centered care %D 2020 %7 10.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Cancellations and rescheduling of doctor’s appointments are common. An automated rescheduling system has the potential to facilitate the rescheduling process so that newly opened slots are promptly filled by patients who need and can take the slot. Building on an existing online patient portal, a large health care system adopted an automated rescheduling system, Fast Pass, that sends out an earlier appointment offer to patients via email or SMS text messaging and allows patients to reschedule their appointment through the online portal. Objective: We examined the uptake of Fast Pass at its early stage of implementation. We assessed program features and patient and visit characteristics associated with higher levels of Fast Pass utilization and the association between Fast Pass use and no-show and cancellation rates. Methods: This study was a retrospective analysis of Fast Pass offers sent between July and December 2018. Multivariable logistic regression was used to assess the independent contribution of program, patient, and visit characteristics on the likelihood of accepting an offer. We then assessed the appointment outcome (completion, cancellation, or no-show) of Fast Pass offered appointments compared to appointments with the same patient and visit characteristics, but without an offer. Results: Of 177,311 Fast Pass offers sent, 14,717 (8.3%) were accepted. Overall, there was a 1.3 percentage point (38%) reduction in no-show rates among Fast Pass accepted appointments compared to other appointments with matching characteristics (P<.001). The offers were more likely to be accepted if they were sent in the evening (versus early morning), the first (versus repeated) offer for the same appointment, for a slot 1-31 days ahead (versus same-day), for later in a day (versus before 10am), for a primary care (versus specialty) visit, sent via SMS text messaging (versus email only), for an appointment made through the online patient portal (versus via phone call or in-person), or for younger adults aged 18-49 years (versus those aged 65 years or older; all at P<.001). Factors negatively associated with offer acceptance were a higher number of comorbidities (P=.02) and visits scheduled for chronic conditions (versus acute conditions only; P=.002). Conclusions: An automated rescheduling system can improve patients’ access by reducing wait times for an appointment, with an added benefit of reducing no-shows by serving as a reminder of an upcoming appointment. Future modifications, such as increasing the adoption of SMS text messaging offers and targeting older adults or patients with complex conditions, may make the system more patient-centered and help promote wider utilization. %M 32519970 %R 10.2196/16451 %U https://www.jmir.org/2020/6/e16451 %U https://doi.org/10.2196/16451 %U http://www.ncbi.nlm.nih.gov/pubmed/32519970 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 6 %N 1 %P e19300 %T Email Use Reconsidered in Health Professions Education: Viewpoint %A De Gagne,Jennie C %A Yang,Yesol %A Rushton,Sharron %A Koppel,Paula D %A Hall,Katherine %+ Duke University School of Nursing, 307 Trent Drive, DUMC 3322, Durham, NC, 27710, United States, 1 713 927 1698, yesol.yang@duke.edu %K communication %K electronic mail %K professionalism %K faculty %K health occupations %K health occupations students %D 2020 %7 1.6.2020 %9 Viewpoint %J JMIR Med Educ %G English %X Email has become a popular means of communication in the past 40 years, with more than 200 billion emails sent each day worldwide. When used appropriately, email can be an effective and useful form of correspondence, although improper practices, such as email incivility, can present challenges. Email is ubiquitous in education and health care, where it is used for student-to-teacher, provider-to-provider, and patient-to-provider communications, but not all students, faculty members, and health professionals are skilled in its use. This paper examines the challenges and opportunities posed by email communication in health professions education and reveals important deficiencies in training, as well as steps that can be taken by health professions educators to address them. Recommendations are offered to help health professions educators develop approaches for teaching email professionalism. %M 32478659 %R 10.2196/19300 %U http://mededu.jmir.org/2020/1/e19300/ %U https://doi.org/10.2196/19300 %U http://www.ncbi.nlm.nih.gov/pubmed/32478659 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16965 %T Revisiting Effective Communication Between Patients and Physicians: Cross-Sectional Questionnaire Study Comparing Text-Based Electronic Versus Face-to-Face Communication %A Mirzaei,Tala %A Kashian,Nicole %+ Department of Information Systems and Business Analytics, Florida International University, 11200 SW 8th Street, Miami, FL, 33199-0001, United States, 1 3053482830, tmirzaei@fiu.edu %K telemedicine %K telemedicine %K eHealth %K text telecommunication %K health communication %D 2020 %7 13.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Research has shown that text-based communication via telemedicine will continue to be a mode of communication that patients and physicians use in the future. However, very few studies have examined patients’ perspectives regarding the increased use of text-based communication versus face-to-face (FtF) communication. Objective: This study aimed to understand and compare the potential differences in patients’ perceptions of communication effectiveness with their physicians through different modes of communication. Methods: We conducted a web-based survey of 345 patients to explore the impact of different channels on effective communication and perceived health behavior and outcomes. We tested the impact of patients’ perceived communication and media effectiveness on their self-efficacy, communication satisfaction, and perceived health outcomes, separately for text-based information technology (IT)–mediated communication and FtF communication. Furthermore, we conducted a group comparison to identify significant differences across these 2 groups. Results: We found no significant differences between patients’ perceptions of effective communication using either IT-mediated communication or FtF communication with their physicians. However, we found significant differences in patients’ perception of media effectiveness: patients perceived FtF communication to be a more favorable medium (P=.02). Interestingly, we found no significant difference in terms of benefits (P=.09) and success (P=.08) of IT-mediated communication versus FtF communication. Conclusions: The results of this study imply that patients can achieve the same level of communication effectiveness with their physicians using IT-mediated communication as they would in comparable FtF interactions, but patients view FtF communication to be a more favorable medium than IT-mediated communication. %M 32401213 %R 10.2196/16965 %U https://www.jmir.org/2020/5/e16965 %U https://doi.org/10.2196/16965 %U http://www.ncbi.nlm.nih.gov/pubmed/32401213 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e13289 %T Secure Asynchronous Communication Between Smokers and Tobacco Treatment Specialists: Secondary Analysis of a Web-Assisted Tobacco Intervention in the QUIT-PRIMO and National Dental PBRN Networks %A Sadasivam,Rajani Shankar %A Kamberi,Ariana %A DeLaughter,Kathryn %A Phillips,Barrett %A Williams,Jessica H %A Cutrona,Sarah L %A Ray,Midge N %A Gilbert,Gregg H %A Houston,Thomas K %A , %A , %+ University of Massachusetts Medical School, 365 Plantation Street, Worcester, MA, 01605, United States, 1 508 856 8923, rajani.sadasivam@umassmed.edu %K distance counseling %K tobacco cessation %K internet-based intervention %K smoking cessation %D 2020 %7 6.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Within a web-assisted tobacco intervention, we provided a function for smokers to asynchronously communicate with a trained tobacco treatment specialist (TTS). Previous studies have not attempted to isolate the effect of asynchronous counseling on smoking cessation. Objective: This study aimed to conduct a semiquantitative analysis of TTS-smoker communication and evaluate its association with smoking cessation. Methods: We conducted a secondary analysis of data on secure asynchronous communication between trained TTSs and a cohort of smokers during a 6-month period. Smokers were able to select their preferred TTS and message them using a secure web-based form. To evaluate whether the TTS used evidence-based practices, we coded messages using the Motivational Interviewing Self-Evaluation Checklist and Smoking Cessation Counseling (SCC) Scale. We assessed the content of messages initiated by the smokers by creating topical content codes. At 6 months, we assessed the association between smoking cessation and the amount of TTS use and created a multivariable model adjusting for demographic characteristics and smoking characteristics at baseline. Results: Of the 725 smokers offered asynchronous counseling support, 33.8% (245/725) messaged the TTS at least once. A total of 1082 messages (TTSs: 565; smokers 517) were exchanged between the smokers and TTSs. The majority of motivational interviewing codes were those that supported client strengths (280/517, 54.1%) and promoted engagement (280/517, 54.1%). SCC code analysis showed that the TTS provided assistance to smokers if they were willing to quit (247/517, 47.8%) and helped smokers prepare to quit (206/517, 39.8%) and anticipate barriers (197/517, 38.1%). The majority of smokers’ messages discussed motivations to quit (234/565, 41.4%) and current and past treatments (talking about their previous use of nicotine replacement therapy and medications; 201/565, 35.6%). The majority of TTS messages used behavioral strategies (233/517, 45.1%), offered advice on treatments (189/517, 36.5%), and highlighted motivations to quit (171/517, 33.1%). There was no association between the amount of TTS use and cessation. In the multivariable model, after adjusting for gender, age, race, education, readiness at baseline, number of cigarettes smoked per day at baseline, and the selected TTS, smokers messaging the TTS one or two times had a smoking cessation odds ratio (OR) of 0.8 (95% CI 0.4-1.4), and those that messaged the TTS more than two times had a smoking cessation OR of 1.0 (95% CI 0.4-2.3). Conclusions: Our study demonstrated the feasibility of using asynchronous counseling to deliver evidence-based counseling. Low participant engagement or a lack of power could be potential explanations for the nonassociation with smoking cessation. Future trials should explore approaches to increase participant engagement and test asynchronous counseling in combination with other approaches for improving the rates of smoking cessation. %M 32374266 %R 10.2196/13289 %U https://www.jmir.org/2020/5/e13289 %U https://doi.org/10.2196/13289 %U http://www.ncbi.nlm.nih.gov/pubmed/32374266 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e12611 %T Disparities in Secure Messaging Uptake Between Patients and Physicians: Longitudinal Analysis of Two National Cross-Sectional Surveys %A Heisey-Grove,Dawn M %A Carretta,Henry J %+ Department of Clinical Quality and Informatics, Health Technical Center, MITRE Corporation, 7515 Colshire Dr, McLean, VA, 22102, United States, 1 7035477389, heiseygrovedm@vcu.edu %K electronic mail %K health communication %K electronic health records %D 2020 %7 1.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Emails securely exchanged between patients and clinicians offer the promise of improved access to care and indirectly improved health outcomes. Yet research to date is mixed on who—among both patients and clinicians—is using secure messaging. Objective: Using data from two large nationally representative cross-sectional surveys, this study aimed to compare the prevalence of secure messaging use among patients and their access to the functionality through their physicians, and to explore the clinical practice and physician characteristics and patient sociodemographic characteristics associated with the use of secure messaging. Methods: We conducted regression analyses to identity statistical associations between self-reported secure messaging use and access, and the patient, practice, and physician characteristics from the National Health Interview Survey (NHIS) and the National Ambulatory Medical Care Survey (NAMCS). The NHIS data collected between 2013 and 2018, with approximately 150,000 adult individuals, were used to evaluate patient characteristics associated with email communication with clinicians. The NAMCS data included 7340 physicians who reported on secure messaging use between 2013 and 2016 and provided context on physician specialty, use of certified health information technology (IT), and practice size and ownership associated with secure messaging access and use. Results: By 2016, two-thirds of ambulatory care visits were conducted by a physician who reported using secure messaging, up from 40.70% in 2013. The percentage of US residents who reported sending an email to their clinician, however, only increased from 7.22% to 16.67% between 2013 and 2018. We observed a strong positive association between certified health IT use and secure messaging use (odds ratio [OR] 11.46, 95% CI 7.55-17.39). Individuals who were black, had lower levels of education, had Medicaid or other public payer insurance, or those who were uninsured had reduced odds for using email to communicate with clinicians. No differences were observed in secure messaging use based on physician specialty, but significant differences were observed by practice size (OR 0.46, 95% CI 0.35-0.60 in solo practices vs nonsolo practices) and practice ownership (P<.001 for the different categories). Conclusions: This study is the first to use two large nationally representative surveys to produce longitudinal estimates on the access and use of patient-clinician email communication in the United States. The survey findings complement each other: one provides the patient perspective of their use and the other indicates potential patient access to secure messaging based on the use of the functionality by the physicians providing treatment. This study provides nationally representative data on the characteristics of patients and physicians who have access to and are using secure messaging. This information can be used to target interventions to promote adoption and use of secure messaging. %M 32356775 %R 10.2196/12611 %U https://www.jmir.org/2020/5/e12611 %U https://doi.org/10.2196/12611 %U http://www.ncbi.nlm.nih.gov/pubmed/32356775 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e14646 %T Surgeons’ Interactions With and Attitudes Toward E-Patients: Questionnaire Study in Germany and Oman %A Masters,Ken %A Loda,Teresa %A Johannink,Jonas %A Al-Abri,Rashid %A Herrmann-Werner,Anne %+ Medical Education and Informatics Department, College of Medicine and Health Sciences, Sultan Qaboos University, Box 50, Al-Khoud, 123, Oman, 968 2414 3499, itmeded@gmail.com %K internet %K e-patient %K internet-informed patient %K doctor-patient relationship %K attitude %K digital health %K technology %K e-physician %K empowerment %K physician %K communication %D 2020 %7 9.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Doctors’ interactions with and attitudes toward e-patients have an overall impact on health care delivery. Objective: This study aimed to gauge surgeons’ interactions with e-patients, their attitudes toward those e-patient activities, the possible impact on the delivery of health care, and the reasons behind those activities and attitudes. Methods: We created a paper-based and electronic survey form based on pertinent variables identified in the literature, and from March 2018 to July 2018 we surveyed 49 surgeons in Germany and 59 surgeons in Oman, asking them about their interactions with and attitudes toward e-patients. Data were stored in Microsoft Excel and SPSS, and descriptive statistics, Pearson correlations, and chi-square tests were performed on the data. Results: Of our sample, 71% (35/49) of the German surgeons and 56% (33/59) of the Omani surgeons communicated electronically with their patients. Although the German surgeons spent a greater percentage of Internet usage time on work-related activities (χ218=32.5; P=.02) than the Omani surgeons, there were many similarities in their activities. An outstanding difference was that the German surgeons used email with their patients more than the Omani surgeons (χ21=9.0; P=.003), and the Omani surgeons used social media, specifically WhatsApp, more than the German surgeons (χ21=18.6; P<.001). Overall, the surgeons were equally positive about the most common e-patient activities such as bringing material from the internet to the consultation (mean 4.11, SD 1.6), although the German surgeons (mean 3.43, SD 1.9) were more concerned (P=.001) than the Omani surgeons (mean 2.32, SD 1.3) about the potential loss of control and time consumption (German: mean 5.10, SD 1.4 and Omani: mean 3.92, SD 1.6; P<.001). Conclusions: The interactions show a high degree of engagement with e-patients. The differences between the German and the Omani surgeons in the preferred methods of communication are possibly closely linked to cultural differences and recent historical events. These differences may, moreover, indicate e-patients’ desired method of electronic communication to include social media. The low impact of surgeons’ attitudes on the activities may also result from a normalization of many e-patient activities, irrespective of the doctors’ attitudes and influences. %M 32149714 %R 10.2196/14646 %U http://www.jmir.org/2020/3/e14646/ %U https://doi.org/10.2196/14646 %U http://www.ncbi.nlm.nih.gov/pubmed/32149714 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 2 %P e16765 %T Analysis of Massive Online Medical Consultation Service Data to Understand Physicians’ Economic Return: Observational Data Mining Study %A Jiang,Jinglu %A Cameron,Ann-Frances %A Yang,Ming %+ Binghamton University, 4400 Vestal Pkwy E, Binghamton, NY, 13902, United States, 1 6077773016, jingluj@binghamton.edu %K Web-based health services %K remote consultation %K machine learning %K data mining %K decision tree %K patient involvement %D 2020 %7 18.2.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Online health care consultation has become increasingly popular and is considered a potential solution to health care resource shortages and inefficient resource distribution. However, many online medical consultation platforms are struggling to attract and retain patients who are willing to pay, and health care providers on the platform have the additional challenge of standing out in a crowd of physicians who can provide comparable services. Objective: This study used machine learning (ML) approaches to mine massive service data to (1) identify the important features that are associated with patient payment, as opposed to free trial–only appointments; (2) explore the relative importance of these features; and (3) understand how these features interact, linearly or nonlinearly, in relation to payment. Methods: The dataset is from the largest China-based online medical consultation platform, which covers 1,582,564 consultation records between patient-physician pairs from 2009 to 2018. ML techniques (ie, hyperparameter tuning, model training, and validation) were applied with four classifiers—logistic regression, decision tree (DT), random forest, and gradient boost—to identify the most important features and their relative importance for predicting paid vs free-only appointments. Results: After applying the ML feature selection procedures, we identified 11 key features on the platform, which are potentially useful to predict payment. For the binary ML classification task (paid vs free services), the 11 features as a whole system achieved very good prediction performance across all four classifiers. DT analysis further identified five distinct subgroups of patients delineated by five top-ranked features: previous offline connection, total dialog, physician response rate, patient privacy concern, and social return. These subgroups interact with the physician differently, resulting in different payment outcomes. Conclusions: The results show that, compared with features related to physician reputation, service-related features, such as service delivery quality (eg, consultation dialog intensity and physician response rate), patient source (eg, online vs offline returning patients), and patient involvement (eg, provide social returns and reveal previous treatment), appear to contribute more to the patient’s payment decision. Promoting multiple timely responses in patient-provider interactions is essential to encourage payment. %M 32069213 %R 10.2196/16765 %U http://medinform.jmir.org/2020/2/e16765/ %U https://doi.org/10.2196/16765 %U http://www.ncbi.nlm.nih.gov/pubmed/32069213 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e16775 %T Why Employees (Still) Click on Phishing Links: Investigation in Hospitals %A Jalali,Mohammad S %A Bruckes,Maike %A Westmattelmann,Daniel %A Schewe,Gerhard %+ Center for Management, University of Muenster, Universitaetsstraße 14-16, Muenster, Germany, 49 2518323539, maike.bruckes@wiwi.uni-muenster.de %K information security management %K phishing emails %K compliance %K trust %K theory of planned behavior %D 2020 %7 23.1.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Hospitals have been one of the major targets for phishing attacks. Despite efforts to improve information security compliance, hospitals still significantly suffer from such attacks, impacting the quality of care and the safety of patients. Objective: This study aimed to investigate why hospital employees decide to click on phishing emails by analyzing actual clicking data. Methods: We first gauged the factors that influence clicking behavior using the theory of planned behavior (TPB) and integrating trust theories. We then conducted a survey in hospitals and used structural equation modeling to investigate the components of compliance intention. We matched employees’ survey results with their actual clicking data from phishing campaigns. Results: Our analysis (N=397) reveals that TPB factors (attitude, subjective norms, and perceived behavioral control), as well as collective felt trust and trust in information security technology, are positively related to compliance intention. However, compliance intention is not significantly related to compliance behavior. Only the level of employees’ workload is positively associated with the likelihood of employees clicking on a phishing link. Conclusions: This is one of the few studies in information security and decision making that observed compliance behavior by analyzing clicking data rather than using self-reported data. We show that, in the context of phishing emails, intention and compliance might not be as strongly linked as previously assumed; hence, hospitals must remain vigilant with vulnerabilities that cannot be easily managed. Importantly, given the significant association between workload and noncompliance behavior (ie, clicking on phishing links), hospitals should better manage employees’ workload to increase information security. Our findings can help health care organizations augment employees’ compliance with their cybersecurity policies and reduce the likelihood of clicking on phishing links. %M 32012071 %R 10.2196/16775 %U http://www.jmir.org/2020/1/e16775/ %U https://doi.org/10.2196/16775 %U http://www.ncbi.nlm.nih.gov/pubmed/32012071 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e14976 %T Growing Disparities in Patient-Provider Messaging: Trend Analysis Before and After Supportive Policy %A Senft,Nicole %A Butler,Evan %A Everson,Jordan %+ Department of Health Policy, Vanderbilt University School of Medicine, 2525 West End Avenue, Suite 1275, Nashville, TN, 37203, United States, 1 16158756207, jordan.everson@vanderbilt.edu %K eHealth %K policy %K communication %K secure messaging %K disparities %K socioeconomic factors %K inequality %D 2019 %7 7.10.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Public policy introduced since 2011 has supported provider adoption of electronic medical records (EMRs) and patient-provider messaging, primarily through financial incentives. It is unclear how disparities in patients’ use of incentivized electronic health (eHealth) tools, like patient-provider messaging, have changed over time relative to disparities in use of eHealth tools that were not directly incentivized. Objective: This study examines trends in eHealth disparities before and after the introduction of US federal financial incentives. We compare rates of patient-provider messaging, which was directly incentivized, with rates of looking for health information on the Web, which was not directly incentivized. Methods: We used nationally representative Health Information National Trends Survey data from 2003 to 2018 (N=37,300) to describe disparities in patient-provider messaging and looking for health information on the Web. We first reported the percentage of individuals across education and racial and ethnic groups who reported using these tools in each survey year and compared changes in unadjusted disparities during preincentive (2003-2011) and postincentive (2011-2018) periods. Using multivariable linear probability models, we then examined adjusted effects of education and race and ethnicity in 3 periods—preincentive (2003-2005), early incentive (2011-2013), and postincentive (2017-2018)—controlling for sociodemographic and health factors. In the postincentive period, an additional model tested whether internet adoption, provider access, or providers’ use of EMRs explained disparities. Results: From 2003 to 2018, overall rates of provider messaging increased from 4% to 36%. The gap in provider messaging between the highest and lowest education groups increased by 10 percentage points preincentive (P<.001) and 22 additional points postincentive (P<.001). The gap between Hispanics and non-Hispanic whites increased by 3.2 points preincentive (P=.42) and 11 additional points postincentive (P=.01). Trends for blacks resembled those for Hispanics, whereas trends for Asians resembled those for non-Hispanic whites. In contrast, education-based disparities in looking for health information on the Web (which was not directly incentivized) did not significantly change in preincentive or postincentive periods, whereas racial disparities narrowed by 15 percentage points preincentive (P=.008) and did not significantly change postincentive. After adjusting for other sociodemographic and health factors, observed associations were similar to unadjusted associations, though smaller in magnitude. Including internet adoption, provider access, and providers’ use of EMRs in the postincentive model attenuated, but did not eliminate, education-based disparities in provider messaging and looking for health information on the Web. Racial and ethnic disparities were no longer statistically significant in adjusted models. Conclusions: Disparities in provider messaging widened over time, particularly following federal financial incentives. Meanwhile, disparities in looking for health information on the Web remained stable or narrowed. Incentives may have disproportionately benefited socioeconomically advantaged groups. Future policy could address disparities by incentivizing providers treating these populations to adopt messaging capabilities and encouraging patients’ use of messaging. %M 31593539 %R 10.2196/14976 %U https://www.jmir.org/2019/10/e14976 %U https://doi.org/10.2196/14976 %U http://www.ncbi.nlm.nih.gov/pubmed/31593539 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 9 %P e13940 %T The Antecedents and Consequences of Health Care Professional–Patient Online Interactions: Systematic Review %A Shang,Lili %A Zuo,Meiyun %A Ma,Dan %A Yu,Qinjun %+ Research Institute of Smart Senior Care, School of Information, Renmin University of China, 59 Zhongguancun Street, Haidian District, Beijing, 100872, China, 86 10 62511569, zuomy@ruc.edu.cn %K health care professional–patient interaction %K online health care service %K online communication %K eHealth %K review %D 2019 %7 25.9.2019 %9 Review %J J Med Internet Res %G English %X Background: Online health care services effectively supplement traditional medical treatment. The development of online health care services depends on sustained interactions between health care professionals (HCPs) and patients. Therefore, it is necessary to understand the demands and gains of health care stakeholders in HCP-patient online interactions and determine an agenda for future work. Objective: This study aims to present a systematic review of the antecedents and consequences of HCP-patient online interactions. It seeks to reach a better understanding of why HCPs and patients are willing to interact with each other online and what the consequences of HCP-patient online interactions are for health care stakeholders. Based on this, we intend to identify the gaps in existing studies and make recommendations for future research. Methods: In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic retrieval was carried out from the Web of Science, PubMed, and Scopus electronic databases. The search results were confined to those papers published in English between January 1, 2000 and June 30, 2018. Selected studies were then evaluated for quality; studies that did not meet quality criteria were excluded from further analysis. Findings of the reviewed studies related to our research questions were extracted and synthesized through inductive thematic analysis. Results: A total of 8440 records were found after the initial search, 28 papers of which were selected for analysis. Accessibility to HCPs, self-management, and unmet needs were the main triggers for patients to participate in online interaction. For HCPs, patient education, career needs, and self-promotion were the major reasons why they took the online approach. There were several aspects of the consequences of HCP-patient online interactions on health care stakeholders. Consequences for patients included patient empowerment, health promotion, and acquisition of uncertain answers. Consequences for HCPs included social and economic returns, lack of control over their role, and gaining more appointments. HCP-patient online interactions also improved communication efficiency in offline settings and helped managers of online health care settings get a better understanding of patients’ needs. Health care stakeholders have also encountered ethical and legal issues during online interaction. Conclusions: Through a systematic review, we sought out the antecedents and consequences of HCP-patient online interactions to understand the triggers for HCPs and patients to participate and the consequences of participating. Potential future research topics are the influences on the chain of online interaction, specifications and principles of privacy design within online health care settings, and roles that sociodemographic and psychological characteristics play. Longitudinal studies and the adoption of text-mining method are worth encouraging. This paper is expected to contribute to the sustained progress of online health care settings. %M 31573908 %R 10.2196/13940 %U http://www.jmir.org/2019/9/e13940/ %U https://doi.org/10.2196/13940 %U http://www.ncbi.nlm.nih.gov/pubmed/31573908 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e12891 %T Impact of Physician-Patient Communication in Online Health Communities on Patient Compliance: Cross-Sectional Questionnaire Study %A Lu,Xinyi %A Zhang,Runtong %+ School of Economics and Management, Beijing Jiaotong University, Shangyuancun No 3, Haidian District, Beijing, 100044, China, 86 10 51683854, rtzhang@bjtu.edu.cn %K patient portals %K communication %K patient compliance %K consumer health information %K decision making %K physician-patient relations %K personal autonomy %D 2019 %7 13.05.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: In China, the utilization of medical resources is tense, and most hospitals are highly congested because of the large population and uneven distribution of medical resources. Online health communities (OHCs) play an important role in alleviating hospital congestions, thereby improving the utilization of medical resources and relieving medical resource shortages. OHCs have positive effects on physician-patient relationships and health outcomes. Moreover, as one of the main ways for patients to seek health-related information in OHCs, physician-patient communication may affect patient compliance in various ways. In consideration of the inevitable development of OHCs, although they have several shortcomings, identifying how physician-patient communication can impact patient compliance is important to improve patients’ health outcomes through OHCs. Objective: This study aimed to investigate the impact of physician-patient communication on patient compliance in OHCs through the mediation of the perceived quality of internet health information, decision-making preference, and physician-patient concordance, using an empirical study based on the self-determination theory. Methods: A research model was established, including 1 independent variable (physician-patient communication), 3 mediators (perceived quality of internet health information, decision-making preference, and physician-patient concordance), 1 dependent variable (patient compliance), and 4 control variables (age, gender, living area, and education level). Furthermore, a Web-based survey involving 423 valid responses was conducted in China to collect data, and structural equation modeling and partial least squares were adopted to analyze data and test the hypotheses. Results: The questionnaire response rate was 79.2% (487/615) and the validity rate was 86.9% (423/487); reliability and validity are acceptable. The communication between physicians and patients in OHCs positively affects patient compliance through the mediation of the perceived quality of internet health information, decision-making preference, and physician-patient concordance. Moreover, physician-patient communication exhibits similar impacts on the perceived quality of internet health information, decision-making preference, and physician-patient concordance. Patients’ decision-making preference shows the weakest impact on patient compliance compared with the other 2 mediators. Ultimately, all 3 mediators play a partially mediating role between physician-patient communication and patient compliance. Conclusions: We conclude that physician-patient communication in OHCs exhibits a positive impact on patient compliance; thus, patient compliance can be improved by guiding physician-patient communication in OHCs. Furthermore, our findings suggest that physicians can share high-quality health information with patients, discuss benefits, risks, and costs of treatment options with patients, encourage patients to express their attitudes and participate in health-related decision making, and strengthen the emotional connection with patients in OHCs, thereby decreasing patients’ misunderstanding of information and increasing concordance between physicians and patients. OHCs are required to not only strengthen the management of their published health information quality but also understand users’ actual attitudes toward information quality and then try to reduce the gap between the perceived and actual quality of information. %M 31094342 %R 10.2196/12891 %U http://www.jmir.org/2019/5/e12891/ %U https://doi.org/10.2196/12891 %U http://www.ncbi.nlm.nih.gov/pubmed/31094342 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e10165 %T Pediatric Web-Based Chat Services for Caregivers of Children: Descriptive Study %A Kaskinen,Anu %A Ayeboa-Sallah,Benjamin %A Teivaanmäki,Tiina %A Wärnhjelm,Elina %A Korhonen,Liisa %A Helve,Otto %+ Pediatric Research Center, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbäckinkatu 9, PB 347, Helsinki, 00029 HUS, Finland, 358 94711, anu.kaskinen@helsinki.fi %K chat service %K health information %K internet %K Web-based resources %K pediatrics %K social media %D 2018 %7 14.12.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Pediatric physician-led Web-based chat services offer a novel, low-threshold communication channel between caregivers and physicians. Objective: Our aim was to describe chat conversations between caregivers and physicians in a Web-based chat service to determine the factors that should be considered when planning a similar chat service. We also aimed to evaluate whether caregivers considered the consultations helpful, whether physicians considered they could answer caregivers’ questions, and whether further face-to-face medical contact was needed. Methods: In September 2015, a private medical center for children in the greater Helsinki area initiated a Web-based chat service, accessible via any device with an internet connection, open from 9 am to 9 pm local time. Four residents in pediatrics, who had performed at least 60% of their 6-year residency program, served as the physicians responsible for chat consultations with caregivers of children. Between October 2015 and March 2016, 343 consecutive consultations were immediately evaluated by a chat physician. On average, caregivers were followed up by email questionnaire 7-14 days later, which 98 caregivers answered a median of 11 (interquartile range, IQR, 7-20) days later. Results: The age of the children whose caregivers contacted the chat service was a median of 2.1 (IQR 0.83-4.69) years, and 29.8% (102/342) of the children were less than 1 year old. The majority (119/343, 34.7%) of the chat conversations took place from 9 am to noon, and infections were the most common concern in over half of cases (189/343, 55.1%). Chat physicians recommended a face-to-face appointment with a physician for that same day in 13.7% (47/343) of the cases. A face-to-face exam was recommended for that same day more often if the chat concerned infection (36/189, 19.0% cases) compared with other reasons (11/154, 7.1%, cases; P=.001). Physicians felt capable of answering caregivers’ questions in 72.6% (249/343) of the cases, whereas 93% (91/98) of caregivers considered physicians’ answers helpful. Whether caregivers had to take their children to see a physician that same day or whether caregivers’ main concern was infection was not found to be associated with whether caregivers considered physicians’ answers helpful or not. However, physicians felt more capable of answering caregivers’ questions when the main concern was infection. Conclusions: Parental consultations via Web-based chat service often take place before noon and focus on infection-related issues as well as on the health and illness of very young children. These factors should be considered when planning or setting up such a service. Based on the high satisfaction with the chat service by both physicians and caregivers, Web-based chat services may be a useful way to help caregivers with concerns about their child’s health or illness. %M 30552087 %R 10.2196/10165 %U https://www.jmir.org/2018/12/e10165/ %U https://doi.org/10.2196/10165 %U http://www.ncbi.nlm.nih.gov/pubmed/30552087 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 4 %P e48 %T Benefits and Costs of Digital Consulting in Clinics Serving Young People With Long-Term Conditions: Mixed-Methods Approach %A Kim,Sung Wook %A Madan,Jason %A Dritsaki,Melina %A Bryce,Carol %A Forjaz,Vera %A Fraser,Joe %A Griffiths,Frances %A Hamilton,Kathryn %A Huxley,Caroline %A Sturt,Jackie %+ Division of Health Sciences, Warwick Medical School, The University of Warwick, Medical School Building, Gibett Hill Road, Coventry, CV4 7AL, United Kingdom, 44 02476 151254, s.w.kim@warwick.ac.uk %K digital consulting %K long-term conditions %K costing analysis %K young people %K mental health %K diabetes %D 2018 %7 30.10.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: Since the introduction of digital health technologies in National Health Service (NHS), health professionals are starting to use email, text, and other digital methods to consult with their patients in a timely manner. There is lack of evidence regarding the economic impact of digital consulting in the United Kingdom (UK) NHS. Objective: This study aimed to estimate the direct costs associated with digital consulting as an adjunct to routine care at 18 clinics serving young people aged 16-24 years with long-term conditions. Methods: This study uses both quantitative and qualitative approaches. Semistructured interviews were conducted with 173 clinical team members on the impacts of digital consulting. A structured questionnaire was developed and used for 115 health professionals across 12 health conditions at 18 sites in the United Kingdom to collect data on time and other resources used for digital consulting. A follow-up semistructured interview was conducted with a single senior clinician at each site to clarify the mechanisms through which digital consulting use might lead to outcomes relevant to economic evaluation. We used the two-part model to see the association between the time spent on digital consulting and the job role of staff, type of clinic, and the average length of the working hours using digital consulting. Results: When estimated using the two-part model, consultants spent less time on digital consulting compared with nurses (95.48 minutes; P<.001), physiotherapists (55.3 minutes; P<.001), and psychologists (31.67 minutes; P<.001). Part-time staff spent less time using digital consulting than full-time staff despite insignificant result (P=.15). Time spent on digital consulting differed across sites, and no clear pattern in using digital consulting was found. Health professionals qualitatively identified the following 4 potential economic impacts for the NHS: decreasing adverse events, improving patient well-being, decreasing wait lists, and staff workload. We did not find evidence to suggest that the clinical condition was associated with digital consulting use. Conclusions: Nurses and physiotherapists were the greatest users of digital consulting. Teams appear to use an efficient triage system with the most expensive members digitally consulting less than lower-paid team members. Staff report showed concerns regarding time spent digitally consulting, which implies that direct costs increase. There remain considerable gaps in evidence related to cost-effectiveness of digital consulting, but this study has highlighted important cost-related outcomes for assessment in future cost-effectiveness trials of digital consulting. %M 30377145 %R 10.2196/medinform.9577 %U http://medinform.jmir.org/2018/4/e48/ %U https://doi.org/10.2196/medinform.9577 %U http://www.ncbi.nlm.nih.gov/pubmed/30377145 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e285 %T Responding to Unsolicited Medical Requests from Health Care Professionals on Pharmaceutical Industry-Owned Social Media Sites: Three Pilot Studies %A TenBarge,Andrea M %A Riggins,Jennifer L %+ Medical Digital Strategy and Capabilities, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, IN,, United States, 1 317 276 4320, tenbarge_andrea_marie@lilly.com %K social media %K health care professionals %K medical information %D 2018 %7 29.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of social media has risen tremendously over the past decade with usage rates spanning from 5% American adults in 2005 up to 69% in 2016. A 2011 survey of 4033 clinicians found that 65% physicians use social media for professional purposes. To meet the changing needs and preferences of their customers, medical information departments within the pharmaceutical industry must continue to assess new digital channels such as social media and evolve their medical information services. Objective: The objective of the study was to pilot the use of social media as an additional channel to respond to unsolicited medical requests from health care professionals (HCP RUR) directed toward the pharmaceutical industry. Methods: From November 2016 to June 2017, 3 pilots were conducted during 3 professional congresses: the 2016 American College of Rheumatology Annual Meeting, the 2017 American Society of Clinical Oncology Annual Meeting, and the 2017 American Headache Society Annual Scientific Meeting. For each social media account, an identified community manager monitored the incoming account feed for proper triaging of posts. When an unsolicited medical request appeared, the community manager routed the question to the Tier One medical information contact center agents to respond. The following metrics were collected: total number of unsolicited requests directed to medical information contact center agents, total number of unsolicited requests that required escalation to Tier Two medical information associates, total number of unsolicited requests that were confirmed US HCPs, total number of unsolicited requests received after hours, and total number of unsolicited requests that were redirected to a different channel. Results: During the 3 pilots, 9 unsolicited medical requests were received with request numbers ranging from 2 to 4 requests per pilot. Of these, 1 was from a confirmed US HCP that required escalation to the Tier Two medical information associates. A majority of requests (7 out of 9) came in after the scheduled monitoring hours. There were 4 requests redirected to the medical information contact center phone number. The marketing accounts received more unsolicited medical requests than the corporate accounts (7 vs 2, respectively), and the 3 Twitter accounts saw more overall engagement (ie, medical requests and other general engagement) than the LinkedIn account. Conclusions: A limited number of medical questions were asked by confirmed HCPs using social media during the 3 pilots. New innovative medical information contact center channels often take time to build awareness. Continued channel awareness is needed to fully understand the channel’s desired use. Because consumers currently make up a majority of social media engagement, companies should look into creating a combined consumer and HCP RUR strategy to provide a better experience for all customers. %M 30373730 %R 10.2196/jmir.9643 %U http://www.jmir.org/2018/10/e285/ %U https://doi.org/10.2196/jmir.9643 %U http://www.ncbi.nlm.nih.gov/pubmed/30373730 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 9 %P e10135 %T A Cloud-Based Virtual Outpatient Clinic for Patient-Centered Care: Proof-of-Concept Study %A de Jong,Jelske Marije %A Ogink,Paula AM %A van Bunningen,Carin GM %A Driessen,Rieke JB %A Engelen,Lucien JLPG %A Heeren,Barend %A Bredie,Sebastian JH %A van de Belt,Tom H %+ Radboud REshape Innovation Center, Radboud University Medical Center, Reinier Postlaan 4, Nijmegen, 6525GC, Netherlands, 31 247440080
, tom.vandebelt@radboudumc.nl %K cloud service %K digital health %K eHealth %K mHealth %K mobile phone %K outpatient clinic %K patient-centeredness %D 2018 %7 24.9.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Most electronic health (eHealth) interventions offered to patients serve a single purpose and lack integration with other tools or systems. This is problematic because the majority of patients experience comorbidity and chronic disease, see multiple specialists, and therefore have different needs regarding access to patient data, communication with peers or providers, and self-monitoring of vital signs. A multicomponent digital health cloud service that integrates data sharing, collection, and communication could facilitate patient-centered care in combination with a hospital patient portal and care professionals. Objective: This study aimed to assess the feasibility and functionality of a new cloud-based and multicomponent outpatient clinic, the “Virtual Outpatient Clinic” (VOC). Methods: The VOC consists of 6 digital tools that facilitate self-monitoring (blood pressure, weight, and pain) and communication with peers and providers (chat and videoconferencing) connected to a cloud-based platform and the hospital patient portal to facilitate access to (self-collected) medical data. In this proof-of-concept study, 10 patients from both Departments of Internal Medicine and Dermatology (N=20) used all options of the VOC for 6 weeks. An eNurse offered support to participants during the study. We assessed the feasibility, usage statistics, content, adherence, and identified technical issues. Moreover, we conducted qualitative interviews with all participants by following a standard interview guide to identify user experiences, including barriers, facilitators, and potential effects. Results: Most participants successfully used all options of the VOC and were positive about different tools and apps and the integral availability of their information. The adherence was 37% (7/19) for weight scale, 58% (11/19) for blood pressure monitor, and 70% (14/20) and 85% (17/20) for pain score and daily questions, respectively. The adherence for personal health record was 65% (13/20) and 60% (12/20) for the patient portal system. Qualitative data showed that performance and effort expectancy scored high among participants, indicating that using the VOC is convenient, easy, and time-saving. Conclusions: The VOC is a promising integrated Web-based technology that combines self-management, data sharing, and communication between patients and professionals. The system can be personalized by connecting various numbers of components, which could make it a relevant tool for other patient groups. Before a system, such as the VOC, can be implemented in daily practice, prospective studies focused on evaluating outcomes, costs, and patient-centeredness are needed. %M 30249584 %R 10.2196/10135 %U http://www.jmir.org/2018/9/e10135/ %U https://doi.org/10.2196/10135 %U http://www.ncbi.nlm.nih.gov/pubmed/30249584 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 7 %P e218 %T Examining the Complexity of Patient-Outpatient Care Team Secure Message Communication: Qualitative Analysis %A Lanham,Holly Jordan %A Leykum,Luci K %A Pugh,Jacqueline A %+ Division of General and Hospital Medicine, Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, United States, 1 210 567 7000, lanham@uthscsa.edu %K secure messaging %K patient-physician communication %K complexity science %K outpatient care %K outpatients %K confidentiality %D 2018 %7 11.07.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The value of secure messaging in streamlining routine patient care activities is generally agreed upon. However, the differences in how patients use secure messaging, including for communicating both routine and nonroutine issues, and the implications of these differences in use are less well understood. Objective: The purpose of this study was to examine secure messaging use to extend current knowledge of how this tool is being used in outpatient care settings and generate new research questions to improve our understanding of the role of secure messaging in the patient-provider communication toolbox. Methods: We conducted an in-depth qualitative analysis of secure message threads in 12 US Department of Veterans Affairs outpatient clinics in south Texas. We analyzed 70 secure message threads with a total of 179 unique communications between patients and their outpatient teams for patterns in communication and secure message content. We used theories from information systems and complexity science in organizations to explain our observations. Results: Analysis identified content relating to 3 main themes: (1) information management, (2) uncertainty management, and (3) patient safety and engagement risks and opportunities. Within these themes, we identified 2 subcategories of information management (information exchange and problem solving), 2 subcategories of uncertainty management (relationship building and sensemaking), and 3 subcategories of patient safety and engagement risks and opportunities (unresolved issues, tone mismatch, and urgent medical issues). Secure messages were most often used to communicate routine issues (eg, information exchange and problem solving). However, the presence of subcategories pertaining to nonroutine issues (eg, relationship building, sensemaking, tone mismatch, urgent issues, and unresolved issues) requires attention, particularly for improving opportunities in outpatient care settings using secure messaging. Conclusions: Patients use secure messaging for both routine and nonroutine purposes. Our analysis sheds light on potentially new patient safety concerns, particularly when using secure messaging to address some of the more complex issues patients are communicating with providers. Secure messaging is an asynchronous communication information system operated by patients and providers who are often characterized as having significant differences in knowledge, experience and expectations. As such, justification for its use beyond routine purposes is limited—yet this occurs, presenting a multifaceted dilemma for health care organizations. Secure messaging use in outpatient care settings may be more nuanced, and thus more challenging to understand and manage than previously recognized. New information system designs that acknowledge the use of secure messaging for nonroutine and complex health topics are needed. %M 29997107 %R 10.2196/jmir.9269 %U http://www.jmir.org/2018/7/e218/ %U https://doi.org/10.2196/jmir.9269 %U http://www.ncbi.nlm.nih.gov/pubmed/29997107 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 2 %P e18 %T Patient-Physician Communication in the Era of Mobile Phones and Social Media Apps: Cross-Sectional Observational Study on Lebanese Physicians’ Perceptions and Attitudes %A Daniel,Fady %A Jabak,Suha %A Sasso,Roula %A Chamoun,Yara %A Tamim,Hani %+ Department of Internal Medicine, American University of Beirut Medical Center, American University of Beirut, Hamra, Cairo Street, Beirut,, Lebanon, 961 3614660, fd21@aub.edu.lb %K social media %K communication %K patient-physician communication %K technology use %D 2018 %7 06.04.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: The increased prevalence of virtual communication technology, particularly social media, has shifted the physician-patient relationship away from the well-established face-to-face interaction. The views and habits of physicians in Lebanon toward the use of online apps and social media as forms of patient communication have not been previously described. Objective: The aim of this study is to describe the views of Lebanese physicians toward the use of social media and other online apps as means of patient communication. Methods: This was a cross-sectional observational study using an online survey that addressed physicians’ perceptions on the use of virtual communication in their clinical practice. The study took place between April and June 2016, and was directed toward physicians at the American University of Beirut Medical Center. Results: A total of 834 doctors received the online survey, with 238 physicians completing the survey. Most of the participants were from medical specialties. Most responders were attending physicians. Less than half of the respondents believed that Web-based apps and social media could be a useful tool for communicating with patients. Email was the most common form of professional online app, followed by WhatsApp (an instant messaging service). The majority of participants felt that this mode of communication can result in medicolegal issues and that it was a breach of privacy. Participants strictly against the use of virtual forms of communication made up 47.5% (113/238) of the study sample. Conclusions: The majority of physicians at the American University of Beirut Medical Center are reluctant to use virtual communication technology as a form of patient communication. Appropriate policy making and strategies can allow both physicians and patients to communicate virtually in a more secure setting without fear of breaching privacy and confidentiality. %M 29625955 %R 10.2196/medinform.8895 %U http://medinform.jmir.org/2018/2/e18/ %U https://doi.org/10.2196/medinform.8895 %U http://www.ncbi.nlm.nih.gov/pubmed/29625955 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e109 %T Growth Dynamics of Patient-Provider Internet Communication: Trend Analysis Using the Health Information National Trends Survey (2003 to 2013) %A Tarver,Will L %A Menser,Terri %A Hesse,Bradford W %A Johnson,Tyler J %A Beckjord,Ellen %A Ford,Eric W %A Huerta,Timothy R %+ Department of Family Medicine, The Ohio State University, 2231 N High Street, Columbus, OH, 43201, United States, 1 614 293 8973, tim.huerta@osumc.edu %K internet %K health communication %D 2018 %7 29.03.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Communication is key in chronic disease management, and the internet has altered the manner in which patients and providers can exchange information. Adoption of secure messaging differs among patients due to the digital divide that keeps some populations from having effective access to online resources. Objective: This study aimed to examine the current state of online patient-provider communication, exploring trends over time in the use of online patient-provider communication tools. Methods: A 3-part analytic process was used to study the following: (1) reanalysis, (2) close replication across years, and (3) trend analysis extension. During the reanalysis stage, the publicly available Health Information National Trends Survey (HINTS) 1 and 2 data were used with the goal of identifying the precise analytic methodology used in a prior study, published in 2007. The original analysis was extended to add 3 additional data years (ie, 2008, 2011, and 2013) using the original analytical approach with the purpose of identifying trends over time. Multivariate logistic regression was used to analyze pooled data across all years, with year as an added predictor, in addition to a model for each individual data year. Results: The odds of internet users to communicate online with health care providers was significantly and increasingly higher year-over-year, starting in 2003 (2005: odds ratio [OR] 1.31, 95% CI 1.03-1.68; 2008: OR 2.14, 95% CI 1.76-2.59; 2011: OR 2.92, 95% CI 2.33-3.66; and 2013: OR 5.77; 95% CI 4.62-7.20). Statistically significant socio-economic factors found to be associated with internet users communicating online with providers included age, having health insurance, having a history of cancer, and living in an urban area of residence. Conclusions: The proportion of internet users communicating online with their health care providers has significantly increased since 2003. Although these trends are encouraging, access challenges still exist for some groups, potentially giving rise to a new set of health disparities related to communication. %M 29599107 %R 10.2196/jmir.7851 %U http://www.jmir.org/2018/3/e109/ %U https://doi.org/10.2196/jmir.7851 %U http://www.ncbi.nlm.nih.gov/pubmed/29599107 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e82 %T Patient Centeredness in Electronic Communication: Evaluation of Patient-to-Health Care Team Secure Messaging %A Hogan,Timothy P %A Luger,Tana M %A Volkman,Julie E %A Rocheleau,Mary %A Mueller,Nora %A Barker,Anna M %A Nazi,Kim M %A Houston,Thomas K %A Bokhour,Barbara G %+ Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Building 70 (152), 200 Springs Road, Bedford, MA, 01730, United States, 1 781 687 3181, timothy.hogan@va.gov %K health communication %K electronic mail %K patient portals %K patient-centered care %K veterans %D 2018 %7 08.03.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: As information and communication technology is becoming more widely implemented across health care organizations, patient-provider email or asynchronous electronic secure messaging has the potential to support patient-centered communication. Within the medical home model of the Veterans Health Administration (VA), secure messaging is envisioned as a means to enhance access and strengthen the relationships between veterans and their health care team members. However, despite previous studies that have examined the content of electronic messages exchanged between patients and health care providers, less research has focused on the socioemotional aspects of the communication enacted through those messages. Objective: Recognizing the potential of secure messaging to facilitate the goals of patient-centered care, the objectives of this analysis were to not only understand why patients and health care team members exchange secure messages but also to examine the socioemotional tone engendered in these messages. Methods: We conducted a cross-sectional coding evaluation of a corpus of secure messages exchanged between patients and health care team members over 6 months at 8 VA facilities. We identified patients whose medical records showed secure messaging threads containing at least 2 messages and compiled a random sample of these threads. Drawing on previous literature regarding the analysis of asynchronous, patient-provider electronic communication, we developed a coding scheme comprising a series of a priori patient and health care team member codes. Three team members tested the scheme on a subset of the messages and then independently coded the sample of messaging threads. Results: Of the 711 messages coded from the 384 messaging threads, 52.5% (373/711) were sent by patients and 47.5% (338/711) by health care team members. Patient and health care team member messages included logistical content (82.6%, 308/373 vs 89.1%, 301/338), were neutral in tone (70.2%, 262/373 vs 82.0%, 277/338), and respectful in nature (25.7%, 96/373 vs 33.4%, 113/338). Secure messages from health care team members sometimes appeared hurried (25.4%, 86/338) but also displayed friendliness or warmth (18.9%, 64/338) and reassurance or encouragement (18.6%, 63/338). Most patient messages involved either providing or seeking information; however, the majority of health care team member messages involved information provision in response to patient questions. Conclusions: This evaluation is an important step toward understanding the content and socioemotional tone that is part of the secure messaging exchanges between patients and health care team members. Our findings were encouraging; however, there are opportunities for improvement. As health care organizations seek to supplement traditional encounters with virtual care, they must reexamine their use of secure messaging, including the patient centeredness of the communication, and the potential for more proactive use by health care team members. %M 29519774 %R 10.2196/jmir.8801 %U http://www.jmir.org/2018/3/e82/ %U https://doi.org/10.2196/jmir.8801 %U http://www.ncbi.nlm.nih.gov/pubmed/29519774 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e18 %T Targeted Secure Messages to Facilitate Access to Tobacco Treatment Counseling for Veterans: Feasibility Study %A Shahani,Shaun %A Korenblit,Pearl %A Thomas,Pauline %A Passannante,Marian R %A Carr,Richard %A Davis,Lynn %+ Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07103, United States, 1 732 445 4636, shaun.shahani@tu.edu %K secure messaging %K tobacco use %K smoking cessation %D 2018 %7 05.03.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Studies show that combining nicotine replacement therapy (NRT) with tobacco treatment counseling is most effective for smoking cessation. However, tobacco treatment counseling has been underutilized across the nation. A secure email message sent to patients already taking NRT was hypothesized to increase the utilization of tobacco treatment counseling among Veterans in New Jersey. Secure messaging for communication between patients and providers was implemented through a web-based password-protected, secure messaging account, where Veterans get notified through their personal email when they have a message awaiting them. Objective: The main objective of this project was to determine if there was a significant increase in adoption of tobacco treatment counseling among Veterans who received a secure message describing the options for tobacco treatment counseling available to them. Secondary objectives were to demographically characterize Veterans who were and were not enrolled in secure messaging, as well as those who opened or did not open a message. Finally, because the language and content of the messages were changed across project phases, this project also sought to determine (by analysis of response rates) the type of language that was most effective at eliciting a response. Methods: Over two phases, messages were sent to two samples of Veterans prescribed NRT within the prior 90 days of each phase. In phase 1, one message was sent in December 2015 (message 1). In phase 2, one message was sent in July 2016 (message 2) and the same message (message 3) was resent in August 2016 to persons who did not open message 2. Messages 2 and 3 were more directive than message 1. Response rates to message 1 versus message 2 were compared. A logistic regression analysis determined effect of age and gender on enrollment in secure messaging across both phases. The effectiveness of each phase at increasing tobacco treatment counseling was analyzed using a McNemar test. Results: Message 2, sent to 423 Veterans, had a significantly higher response rate than message 1, sent to 348 Veterans (18%, 17/93 vs 8%, 6/78, P=.04). Phase 2 (ie, messages 2 and 3) significantly increased utilization of tobacco treatment counseling (net increase of six tobacco treatment counseling adopters, P=.04), whereas phase 1 (ie, message 1) did not (net increase of two tobacco treatment counseling adopters, P=.48). Women (odds ratio [OR] 1.6, 95% CI 1.1-2.3) and those aged 30 to 49 years (compared to other age groups) were more likely to be enrolled in secure messaging. Gender and age were not significant predictors of opening or replying to either message. Conclusions: Although the effect was small, secure messaging was a useful modality to increase tobacco treatment counseling. Directive content with a follow-up message appeared useful. Female Veterans and/or Veterans aged between 30 and 49 years are more likely to use secure messaging. %M 29506969 %R 10.2196/mental.7957 %U http://mental.jmir.org/2018/1/e18/ %U https://doi.org/10.2196/mental.7957 %U http://www.ncbi.nlm.nih.gov/pubmed/29506969 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 1 %P e13 %T Experiences of Indian Health Workers Using WhatsApp for Improving Aseptic Practices With Newborns: Exploratory Qualitative Study %A Pahwa,Parika %A Lunsford,Sarah %A Livesley,Nigel %+ EnCompass LLC, 5404 Wisconsin Ave, Chevy Chase, MD, 20815, United States, 1 6177849008, ssmith@urc-chs.com %K quality improvement %K mobile apps %K communication %K patient care team %D 2018 %7 01.03.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: Quality improvement (QI) involves the following 4 steps: (1) forming a team to work on a specific aim, (2) analyzing the reasons for current underperformance, (3) developing changes that could improve care and testing these changes using plan-do-study-act cycles (PDSA), and (4) implementing successful interventions to sustain improvements. Teamwork and group discussion are key for effective QI, but convening in-person meetings with all staff can be challenging due to workload and shift changes. Mobile technologies can support communication within a team when face-to-face meetings are not possible. WhatsApp, a mobile messaging platform, was implemented as a communication tool by a neonatal intensive care unit (NICU) team in an Indian tertiary hospital seeking to reduce nosocomial infections in newborns. Objective: This exploratory qualitative study aimed to examine experiences with WhatsApp as a communication tool among improvement team members and an external coach to improve adherence to aseptic protocols. Methods: Ten QI team members and the external coach were interviewed on communication processes and approaches and thematically analyzed. The WhatsApp transcript for the implementation period was also included in the analysis. Results: WhatsApp was effective for disseminating information, including guidance on QI and clinical practice, and data on performance indicators. It was not effective as a platform for group discussion to generate change ideas or analyze the performance indicator data. The decision of who to include in the WhatsApp group and how members engaged in the group may have reinforced existing hierarchies. Using WhatsApp created a work environment in which members were accessible all the time, breaking down barriers between personal and professional time. The continual influx of messages was distracting to some respondents, and how respondents managed these messages (eg, using the silent function) may have influenced their perceptions of WhatsApp. The coach used WhatsApp to share information, schedule site visits, and prompt action on behalf of the team. Conclusions: WhatsApp is a productive communication tool that can be used by teams and coaches to disseminate information and prompt action to improve the quality of care, but cannot replace in-person meetings. %M 29496651 %R 10.2196/medinform.8154 %U http://medinform.jmir.org/2018/1/e13/ %U https://doi.org/10.2196/medinform.8154 %U http://www.ncbi.nlm.nih.gov/pubmed/29496651 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e73 %T The Effect of Doctor-Consumer Interaction on Social Media on Consumers’ Health Behaviors: Cross-Sectional Study %A Wu,Tailai %A Deng,Zhaohua %A Feng,Zhanchun %A Gaskin,Darrell J %A Zhang,Donglan %A Wang,Ruoxi %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13# Hangkong Road, Wuhan City, Hubei Province, Wuhan, 430074, China, 86 27 83692731, zcfeng@hust.edu.cn %K physician patient relationships %K health behavior %K social media %K social theory %K psychological theory %K medical informatics %D 2018 %7 28.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Both doctors and consumers have engaged in using social media for health purposes. Social media has changed traditional one-to-one communication between doctors and patients to many-to-many communication between doctors and consumers. However, little is known about the effect of doctor-consumer interaction on consumers’ health behaviors. Objective: The aim of this study was to investigate how doctor-consumer interaction in social media affects consumers’ health behaviors. Methods: On the basis of professional-client interaction theory and social cognitive theory, we propose that doctor-consumer interaction can be divided into instrumental interaction and affective interaction. These two types of interactions influence consumers’ health behaviors through declarative knowledge (DK), self-efficacy (SE), and outcome expectancy (OE). To validate our proposed research model, we employed the survey method and developed corresponding measurement instruments for constructs in our research model. A total of 352 valid answers were collected, and partial least square was performed to analyze the data. Results: Instrumental doctor-consumer interaction was found to influence consumers’ DK (t294=5.763, P<.001), SE (t294=4.891, P<.001), and OE (t294=7.554, P<.001) significantly, whereas affective doctor-consumer interaction also impacted consumers’ DK (t294=4.025, P<.001), SE (t294=4.775, P<.001), and OE (t294=4.855, P<.001). Meanwhile, consumers’ DK (t294=3.838, P<.001), SE (t294=3.824, P<.001), and OE (t294=2.985, P<.01) all significantly affected consumers’ health behaviors. Our mediation analysis showed that consumers’ DK, SE, and OE partially mediated the effect of instrumental interaction on health behaviors, whereas the three mediators fully mediated the effect of affective interaction on health behaviors. Conclusions: Compared with many intentional intervention programs, doctor-consumer interaction can be treated as a natural cost-effective intervention to promote consumers’ health behaviors. Meanwhile, both instrumental and affective interaction should be highlighted for the best interaction results. DK, SE, and OE are working mechanisms of doctor-consumer interaction. %M 29490892 %R 10.2196/jmir.9003 %U http://www.jmir.org/2018/2/e73/ %U https://doi.org/10.2196/jmir.9003 %U http://www.ncbi.nlm.nih.gov/pubmed/29490892 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 1 %P e2 %T The Perceived Ease of Use and Usefulness of Loop: Evaluation and Content Analysis of a Web-Based Clinical Collaboration System %A Kurahashi,Allison M %A Stinson,Jennifer N %A van Wyk,Margaret %A Luca,Stephanie %A Jamieson,Trevor %A Weinstein,Peter %A Cafazzo,Joseph A %A Lokuge,Bhadra %A Cohen,Eyal %A Rapoport,Adam %A Husain,Amna %+ The Temmy Latner Centre for Palliative Care, Sinai Health System, 60 Murray Street, 4th Floor, Box 13, Toronto, ON, M5T 3L9, Canada, 1 416 586 4800 ext 7886, amna.husain@sinaihealthsystem.ca %K patient-centered care %K patient participation %K chronic disease %K communication %K internet communication tools %K usability testing %K interdisciplinary communication %K health communication %K continuity of patient care %K patient care team %K inventions %D 2018 %7 09.01.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Patients with complex health care needs require the expertise of many health care providers. Communication, collaboration, and patient-centered care positively impact care quality and patient outcomes. Few technologies exist that facilitate collaboration between providers across settings of care and also engage the patient. We developed a Web-based clinical collaboration system, Loop, to address this gap. The likelihood of a technological system’s uptake is associated with its perceived ease of use and perceived usefulness. We engaged stakeholders in the conceptualization and development of Loop in an effort to maximize its intuitiveness and utility. Objective: This study aimed to report end users’ perceptions about the ease of use and usefulness of Loop captured during usability tests of Loop. Methods: Participants represented three user types (patients, caregivers, and health care providers) recruited from three populations (adults with cancer, adolescents and young adults with cancer, and children with medical complexity). We conducted usability testing over three iterative cycles of testing and development in both laboratory-based and off-site environments. We performed a content analysis of usability testing transcripts to summarize and describe participant perceptions about the ease of use and usefulness of Loop. Results: Participants enjoyed testing Loop and were able to use the core functions—composing, posting, and reading messages—with little difficulty. They had difficulty interpreting certain visual cues and design elements or the purpose of some features. This difficulty negatively impacted perceived ease of use but was primarily limited to auxiliary features. Participants predicted that Loop could improve the efficiency and effectiveness of communication between care team members; however, this perceived usefulness could be compromised by disruptions to personal workflow such as additional time or task requirements. Conclusions: Loop was perceived to have value as a collaboration system; however, usability testing findings indicate that some design and functional elements need to be addressed to improve ease of use. Additionally, participant concerns highlight the need to consider how a system can be implemented so as to minimize impact on workflow and optimize usefulness. %M 29317386 %R 10.2196/humanfactors.7882 %U http://humanfactors.jmir.org/2018/1/e2/ %U https://doi.org/10.2196/humanfactors.7882 %U http://www.ncbi.nlm.nih.gov/pubmed/29317386 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e5 %T Digital Clinical Communication for Families and Caregivers of Children or Young People With Short- or Long-Term Conditions: Rapid Review %A Armoiry,Xavier %A Sturt,Jackie %A Phelps,Emma Elizabeth %A Walker,Clare-Louise %A Court,Rachel %A Taggart,Frances %A Sutcliffe,Paul %A Griffiths,Frances %A Atherton,Helen %+ Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom, 44 02476522534, f.e.griffiths@warwick.ac.uk %K digital clinical communication %K professional-family relations %K family %K caregivers %K young adult %K children %K child health %D 2018 %7 05.01.2018 %9 Review %J J Med Internet Res %G English %X Background: The communication relationship between parents of children or young people with health conditions and health professionals is an important part of treatment, but it is unclear how far the use of digital clinical communication tools may affect this relationship. Objective: The objective of our study was to describe, assess the feasibility of, and explore the impact of digital clinical communication between families or caregivers and health professionals. Methods: We searched the literature using 5 electronic databases. We considered all types of study design published in the English language from January 2009 to August 2015. The population of interest included families and caregivers of children and young people aged less than 26 years with any type of health condition. The intervention was any technology permitting 2-way communication. Results: We included 31 articles. The main designs were randomized controlled trials (RCTs; n=10), cross-sectional studies (n=9), pre- and postintervention uncontrolled (pre/post) studies (n=7), and qualitative interview studies (n=2); 6 had mixed-methods designs. In the majority of cases, we considered the quality rating to be fair. Many different types of health condition were represented. A breadth of digital communication tools were included: videoconferencing or videoconsultation (n=14), and Web messaging or emails (n=12). Health care professionals were mainly therapists or cognitive behavioral therapists (n=10), physicians (n=8), and nurses (n=6). Studies were very heterogeneous in terms of outcomes. Interventions were mainly evaluated using satisfaction or acceptance, or outcomes relating to feasibility. Clinical outcomes were rarely used. The RCTs showed that digital clinical communication had no impact in comparison with standard care. Uncontrolled pre/post studies showed good rates of satisfaction or acceptance. Some economic studies suggested that digital clinical communication may save costs. Conclusions: This rapid review showed an emerging body of literature on the use of digital clinical communication to improve families’ and caregivers’ involvement in the health management of children or young people. Further research with appropriate study designs and longer-term outcome measures should be encouraged. Trial Registration: PROSPERO CRD42016035467; http://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD 42016 035467(Archived by WebCite at http://www.webcitation.org/6vpgZU1FU) %M 29305339 %R 10.2196/jmir.7999 %U http://www.jmir.org/2018/1/e5/ %U https://doi.org/10.2196/jmir.7999 %U http://www.ncbi.nlm.nih.gov/pubmed/29305339 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e366 %T Web-Based Tools for Text-Based Patient-Provider Communication in Chronic Conditions: Scoping Review %A Voruganti,Teja %A Grunfeld,Eva %A Makuwaza,Tutsirai %A Bender,Jacqueline L %+ Institute for Health Policy, Management and Evaluation, University of Toronto, 500 University Avenue, Toronto, ON, M5G1V7, Canada, 1 416 978 3140, teja.voruganti@mail.utoronto.ca %K Internet %K telemedicine and telecommunication %K chronic diseases %K physician-patient relations %K communication %K electronic mail %K text messaging %K patient portal %K patient care team %K interdisciplinary communication %D 2017 %7 27.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients with chronic conditions require ongoing care which not only necessitates support from health care providers outside appointments but also self-management. Web-based tools for text-based patient-provider communication, such as secure messaging, allow for sharing of contextual information and personal narrative in a simple accessible medium, empowering patients and enabling their providers to address emerging care needs. Objective: The objectives of this study were to (1) conduct a systematic search of the published literature and the Internet for Web-based tools for text-based communication between patients and providers; (2) map tool characteristics, their intended use, contexts in which they were used, and by whom; (3) describe the nature of their evaluation; and (4) understand the terminology used to describe the tools. Methods: We conducted a scoping review using the MEDLINE (Medical Literature Analysis and Retrieval System Online) and EMBASE (Excerpta Medica Database) databases. We summarized information on the characteristics of the tools (structure, functions, and communication paradigm), intended use, context and users, evaluation (study design and outcomes), and terminology. We performed a parallel search of the Internet to compare with tools identified in the published literature. Results: We identified 54 papers describing 47 unique tools from 13 countries studied in the context of 68 chronic health conditions. The majority of tools (77%, 36/47) had functions in addition to communication (eg, viewable care plan, symptom diary, or tracker). Eight tools (17%, 8/47) were described as allowing patients to communicate with the team or multiple health care providers. Most of the tools were intended to support communication regarding symptom reporting (49%, 23/47), and lifestyle or behavior modification (36%, 17/47). The type of health care providers who used tools to communicate with patients were predominantly allied health professionals of various disciplines (30%, 14/47), nurses (23%, 11/47), and physicians (19%, 9/47), among others. Over half (52%, 25/48) of the tools were evaluated in randomized controlled trials, and 23 tools (48%, 23/48) were evaluated in nonrandomized studies. Terminology of tools varied by intervention type and functionality and did not consistently reflect a theme of communication. The majority of tools found in the Internet search were patient portals from 6 developers; none were found among published articles. Conclusions: Web-based tools for text-based patient-provider communication were identified from a wide variety of clinical contexts and with varied functionality. Tools were most prevalent in contexts where intended use was self-management. Few tools for team-based communication were found, but this may become increasingly important as chronic disease care becomes more interdisciplinary. %M 29079552 %R 10.2196/jmir.7987 %U http://www.jmir.org/2017/10/e366/ %U https://doi.org/10.2196/jmir.7987 %U http://www.ncbi.nlm.nih.gov/pubmed/29079552 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 5 %N 3 %P e13 %T The Rules of Engagement: Perspectives on Secure Messaging From Experienced Ambulatory Patient Portal Users %A Sieck,Cynthia J %A Hefner,Jennifer L %A Schnierle,Jeanette %A Florian,Hannah %A Agarwal,Aradhna %A Rundell,Kristen %A McAlearney,Ann Scheck %+ The Ohio State University College of Medicine, 2231 North High St, 277 Northwood-High Bldg, Columbus, OH, 43201, United States, 1 614 366 0218, cynthia.sieck@osumc.edu %K patient portals %K secure messaging %K patient-provider communication %K qualitative study %D 2017 %7 04.07.2017 %9 Original Paper %J JMIR Med Inform %G English %X Background: Patient portals have shown promise in engaging individuals in self-management of chronic conditions by allowing patients to input and track health information and exchange secure electronic messages with their providers. Past studies have identified patient barriers to portal use including usability issues, low health literacy, and concerns about loss of personal contact as well as provider concerns such as increased time spent responding to messages. However, to date, studies of both patient and provider perspectives on portal use have focused on the pre-implementation or initial implementation phases and do not consider how these issues may change as patients and providers gain greater experience with portals. Objective: Our study examined the following research question: Within primary care offices with high rates of patient-portal use, what do experienced physician and patient users of the ambulatory portal perceive as the benefits and challenges of portal use in general and secure messaging in particular? Methods: This qualitative study involved 42 interviews with experienced physician and patient users of an ambulatory patient portal, Epic’s MyChart. Participants were recruited from the Department of Family Medicine at a large Academic Medical Center (AMC) and included providers and their patients, who had been diagnosed with at least one chronic condition. A total of 29 patients and 13 primary care physicians participated in the interviews. All interviews were conducted by telephone and followed a semistructured interview guide. Interviews were transcribed verbatim to permit rigorous qualitative analysis. Both inductive and deductive methods were used to code and analyze the data iteratively, paying particular attention to themes involving secure messaging. Results: Experienced portal users discussed several emergent themes related to a need for greater clarity on when and how to use the secure messaging feature. Patient concerns included worry about imposing on their physician’s time, the lack of provider compensation for responding to secure messages, and uncertainty about when to use secure messaging to communicate with their providers. Similarly, providers articulated a lack of clarity as to the appropriate way to communicate via MyChart and suggested that additional training for both patients and providers might be important. Patient training could include orienting patients to the “rules of engagement” at portal sign-up, either in the office or through an online tutorial. Conclusions: As secure messaging through patient portals is increasingly being used as a method of physician-patient communication, both patients and providers are looking for guidance on how to appropriately engage with each other using this tool. Patients worry about whether their use is appropriate, and providers are concerned about the content of messages, which allow them to effectively manage patient questions. Our findings suggest that additional training may help address the concerns of both patients and providers, by providing “rules of engagement” for communication via patient portals. %M 28676467 %R 10.2196/medinform.7516 %U http://medinform.jmir.org/2017/3/e13/ %U https://doi.org/10.2196/medinform.7516 %U http://www.ncbi.nlm.nih.gov/pubmed/28676467 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e227 %T Tailored Communication Within Mobile Apps for Diabetes Self-Management: A Systematic Review %A Holmen,Heidi %A Wahl,Astrid Klopstad %A Cvancarova Småstuen,Milada %A Ribu,Lis %+ Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, PB. 4, St. Olavs plass, Oslo,, Norway, 47 67 23 62 41, heidi.holmen@hioa.no %K diabetes mellitus (MeSH) %K communication (MeSH) %K mobile apps %K self-management %K systematic review %K mHealth %D 2017 %7 23.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The prevalence of diabetes is increasing and with the requirements for self-management and risk of late complications, it remains a challenge for the individual and society. Patients can benefit from support from health care personnel in their self-management, and the traditional communication between patients and health care personnel is changing. Smartphones and apps offer a unique platform for communication, but apps with integrated health care personnel communication based on patient data are yet to be investigated to provide evidence of possible effects. Objective: Our goal was to systematically review studies that aimed to evaluate integrated communication within mobile apps for tailored feedback between patients with diabetes and health care personnel in terms of (1) study characteristics, (2) functions, (3) study outcomes, (4) effects, and (5) methodological quality. Methods: A systematic literature search was conducted following our International Prospective Register of Systematic Reviews (PROSPERO) protocol, searching for apps with integrated communication for persons with diabetes tested in a controlled trial in the period 2008 to 2016. We searched the databases PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central, Excerpta Medica database (EMBASE), ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform. The search was closed in September 2016. Reference lists of primary articles and review papers were assessed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and we applied the Cochrane risk of bias tool to assess methodological quality. Results: We identified 2822 citations and after duplicate removal, we assessed 1128 citations. A total of 6 papers were included in this systematic review, reporting on data from 431 persons participating in small trials of short duration. The integrated communication features were mostly individualized as written non–real-time feedback. The number of functions varied from 2 to 9, and blood glucose tracking was the most common. HbA1c was the most common primary outcome, but the remaining reported outcomes were not standardized and comparable. Because of both the heterogeneity of the included trials and the poor methodological quality of the studies, a meta-analysis was not possible. A statistically significant improvement in the primary measure of outcome was found in 3 of the 6 included studies, of which 2 were HbA1c and 1 was mean daytime ambulatory blood pressure. Participants in the included trials reported positive usability or feasibility postintervention in 5 out of 6 trials. The overall methodological quality of the trials was, however, scored as an uncertain risk of bias. Conclusions: This systematic review highlights the need for more trials of higher methodological quality. Few studies offer an integrated function for communication and feedback from health care personnel, and the research field represents an area of heterogeneity with few studies of highly rigorous methodological quality. This, in combination with a low number of participants and a short follow-up, is making it difficult to provide reliable evidence of effects for stakeholders. %M 28645890 %R 10.2196/jmir.7045 %U http://www.jmir.org/2017/6/e227/ %U https://doi.org/10.2196/jmir.7045 %U http://www.ncbi.nlm.nih.gov/pubmed/28645890 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e221 %T The Effectiveness of Information Technology-Supported Shared Care for Patients With Chronic Disease: A Systematic Review %A Kooij,Laura %A Groen,Wim G %A van Harten,Wim H %+ The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Plesmanlaan 121, Amsterdam, 1066CX, Netherlands, 31 88 005 75, w.v.harten@nki.nl %K review %K integrated healthcare systems %K health information systems %K chronic disease %D 2017 %7 22.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: In patients with chronic disease, many health care professionals are involved during treatment and follow-up. This leads to fragmentation that in turn may lead to suboptimal care. Shared care is a means to improve the integration of care delivered by various providers, specifically primary care physicians (PCPs) and specialty care professionals, for patients with chronic disease. The use of information technology (IT) in this field seems promising. Objective: Our aim was to systematically review the literature regarding the effectiveness of IT-supported shared care interventions in chronic disease in terms of provider or professional, process, health or clinical and financial outcomes. Additionally, our aim was to provide an inventory of the IT applications' characteristics that support such interventions. Methods: PubMed, Scopus, and EMBASE were searched from 2006 to 2015 to identify relevant studies using search terms related to shared care, chronic disease, and IT. Eligible studies were in the English language, and the randomized controlled trials (RCTs), controlled trials, or single group pre-post studies used reported on the effects of IT-supported shared care in patients with chronic disease and cancer. The interventions had to involve providers from both primary and specialty health care. Intervention and IT characteristics and effectiveness—in terms of provider or professional (proximal), process (intermediate), health or clinical and financial (distal) outcomes—were extracted. Risk of bias of (cluster) RCTs was assessed using the Cochrane tool. Results: The initial search yielded 4167 results. Thirteen publications were used, including 11 (cluster) RCTs, a controlled trial, and a pre-post feasibility study. Four main categories of IT applications were identified: (1) electronic decision support tools, (2) electronic platform with a call-center, (3) electronic health records, and (4) electronic communication applications. Positive effects were found for decision support-based interventions on financial and health outcomes, such as physical activity. Electronic health record use improved PCP visits and reduced rehospitalization. Electronic platform use resulted in fewer readmissions and better clinical outcomes—for example, in terms of body mass index (BMI) and dyspnea. The use of electronic communication applications using text-based information transfer between professionals had a positive effect on the number of PCPs contacting hospitals, PCPs’ satisfaction, and confidence. Conclusions: IT-supported shared care can improve proximal outcomes, such as confidence and satisfaction of PCPs, especially in using electronic communication applications. Positive effects on intermediate and distal outcomes were also reported but were mixed. Surprisingly, few studies were found that substantiated these anticipated benefits. Studies showed a large heterogeneity in the included populations, outcome measures, and IT applications used. Therefore, a firm conclusion cannot be drawn. As IT applications are developed and implemented rapidly, evidence is needed to test the specific added value of IT in shared care interventions. This is expected to require innovative research methods. %M 28642218 %R 10.2196/jmir.7405 %U http://www.jmir.org/2017/6/e221/ %U https://doi.org/10.2196/jmir.7405 %U http://www.ncbi.nlm.nih.gov/pubmed/28642218 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e102 %T Timely Digital Patient-Clinician Communication in Specialist Clinical Services for Young People: A Mixed-Methods Study (The LYNC Study) %A Griffiths,Frances %A Bryce,Carol %A Cave,Jonathan %A Dritsaki,Melina %A Fraser,Joseph %A Hamilton,Kathryn %A Huxley,Caroline %A Ignatowicz,Agnieszka %A Kim,Sung Wook %A Kimani,Peter K %A Madan,Jason %A Slowther,Anne-Marie %A Sujan,Mark %A Sturt,Jackie %+ Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom, 44 24765 ext 22534, f.e.griffiths@warwick.ac.uk %K digital communication %K long-term conditions %K young people %K digital health care %K patient communication %K NHS %K National Health Service %D 2017 %7 10.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Young people (aged 16-24 years) with long-term health conditions can disengage from health services, resulting in poor health outcomes, but clinicians in the UK National Health Service (NHS) are using digital communication to try to improve engagement. Evidence of effectiveness of this digital communication is equivocal. There are gaps in evidence as to how it might work, its cost, and ethical and safety issues. Objective: Our objective was to understand how the use of digital communication between young people with long-term conditions and their NHS specialist clinicians changes engagement of the young people with their health care; and to identify costs and necessary safeguards. Methods: We conducted mixed-methods case studies of 20 NHS specialist clinical teams from across England and Wales and their practice providing care for 13 different long-term physical or mental health conditions. We observed 79 clinical team members and interviewed 165 young people aged 16-24 years with a long-term health condition recruited via case study clinical teams, 173 clinical team members, and 16 information governance specialists from study NHS Trusts. We conducted a thematic analysis of how digital communication works, and analyzed ethics, safety and governance, and annual direct costs. Results: Young people and their clinical teams variously used mobile phone calls, text messages, email, and voice over Internet protocol. Length of clinician use of digital communication varied from 1 to 13 years in 17 case studies, and was being considered in 3. Digital communication enables timely access for young people to the right clinician at the time when it can make a difference to how they manage their health condition. This is valued as an addition to traditional clinic appointments and can engage those otherwise disengaged, particularly at times of change for young people. It can enhance patient autonomy, empowerment and activation. It challenges the nature and boundaries of therapeutic relationships but can improve trust. The clinical teams studied had not themselves formally evaluated the impact of their intervention. Staff time is the main cost driver, but offsetting savings are likely elsewhere in the health service. Risks include increased dependence on clinicians, inadvertent disclosure of confidential information, and communication failures, which are mostly mitigated by young people and clinicians using common-sense approaches. Conclusions: As NHS policy prompts more widespread use of digital communication to improve the health care experience, our findings suggest that benefit is most likely, and harms are mitigated, when digital communication is used with patients who already have a relationship of trust with the clinical team, and where there is identifiable need for patients to have flexible access, such as when transitioning between services, treatments, or lived context. Clinical teams need a proactive approach to ethics, governance, and patient safety. %M 28396301 %R 10.2196/jmir.7154 %U http://www.jmir.org/2017/4/e102/ %U https://doi.org/10.2196/jmir.7154 %U http://www.ncbi.nlm.nih.gov/pubmed/28396301 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e103 %T Is Provider Secure Messaging Associated With Patient Messaging Behavior? Evidence From the US Army %A Wolcott,Vickee %A Agarwal,Ritu %A Nelson,D. Alan %+ Army-Baylor University Graduate Program in Health and Business Administration, 3599 Winfield Scott Rd, Suite 1224, JBSA Ft Sam Houston, TX, 78234, United States, 1 210 701 0415, vickee_wolcott@baylor.edu %K patient portal %K physician-patient relations %K health communication %D 2017 %7 06.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Secure messaging with health care providers offers the promise of improved patient-provider relationships, potentially facilitating outcome improvements. But, will patients use messaging technology in the manner envisioned by policy-makers if their providers do not actively use it? Objective: We hypothesized that the level and type of secure messaging usage by providers might be associated with messaging initiation by their patients. Methods: The study employed a dataset of health care and secure messaging records of more than 81,000 US Army soldiers and nearly 3000 clinicians with access to a patient portal system. We used a negative binomial regression model on over 25 million observations to determine the adjusted association between provider-initiated and provider-response messaging and subsequent messaging by their patients in this population over a 4-year period. Results: Prior provider-initiated and response messaging levels were associated with new patient messaging when controlling for the patient’s health care utilization and diagnoses, with the strongest association for high provider-response messaging level. Patients whose providers were highly responsive to the messages of other patients initiated 334% more secure messages (P<.001) than patients with providers who did not personally respond to other patients’ messages. Conclusions: Our results indicate that provider messaging usage levels and types thereof predict their patients’ subsequent communication behavior. The findings suggest the need for more study into the factors associated with provider messaging to fully understand the mechanisms of this relationship. %M 28385681 %R 10.2196/jmir.6804 %U http://www.jmir.org/2017/4/e103/ %U https://doi.org/10.2196/jmir.6804 %U http://www.ncbi.nlm.nih.gov/pubmed/28385681 %0 Journal Article %I %V %N %P %T %D %7 .. %9 %J %G English %X %U %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 4 %N 4 %P e42 %T Email Between Patient and Provider: Assessing the Attitudes and Perspectives of 624 Primary Health Care Patients %A Seth,Puneet %A Abu-Abed,Mohamed Ismail %A Kapoor,Vikram %A Nicholson,Kathryn %A Agarwal,Gina %+ Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada, 1 519 661 2111, puneetsethmd@gmail.com %K electronic mail %K email %K communication %K primary health care %K surveys %K patient engagement %D 2016 %7 22.12.2016 %9 Original Paper %J JMIR Med Inform %G English %X Background: Email between patients and their health care providers can serve as a continuous and collaborative forum to improve access to care, enhance convenience of communication, reduce administrative costs and missed appointments, and improve satisfaction with the patient-provider relationship. Objective: The main objective of this study was to investigate the attitudes of patients aged 16 years and older toward receiving email communication for health-related purposes from an academic inner-city family health team in Southern Ontario. In addition to exploring the proportion of patients with a functioning email address and interest in email communication with their health care provider, we also examined patient-level predictors of interest in email communication. Methods: A cross-sectional study was conducted using a self-administered, 1-page survey of attitudes toward electronic communication for health purposes. Participants were recruited from attending patients at the McMaster Family Practice in Hamilton, Ontario, Canada. These patients were aged 16 years and older and were approached consecutively to complete the self-administered survey (N=624). Descriptive analyses were conducted using the Pearson chi-square test to examine correlations between variables. A logistic regression analysis was conducted to determine statistically significant predictors of interest in email communication (yes or no). Results: The majority of respondents (73.2%, 457/624) reported that they would be willing to have their health care provider (from the McMaster Family Practice) contact them via email to communicate health-related information. Those respondents who checked their personal email more frequently were less likely to want to engage in this electronic communication. Among respondents who check their email less frequently (fewer than every 3 days), 46% (37/81) preferred to communicate with the McMaster Family Practice via email. Conclusions: Online applications, including email, are emerging as a viable avenue for patient communication. With increasing utility of mobile devices in the general population, the proportion of patients interested in email communication with their health care providers may continue to increase. When following best practices and appropriate guidelines, health care providers can use this resource to enhance patient-provider communication in their clinical work, ultimately leading to improved health outcomes and satisfaction with care among their patients. %M 28007688 %R 10.2196/medinform.5853 %U http://medinform.jmir.org/2016/4/e42/ %U https://doi.org/10.2196/medinform.5853 %U http://www.ncbi.nlm.nih.gov/pubmed/28007688 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 11 %P e304 %T How Professionals Share an E-Care Plan for the Elderly in Primary Care: Evaluating the Use of an E-Communication Tool by Different Combinations of Professionals %A de Jong,Catharina C %A Ros,Wynand JG %A van Leeuwen,Mia %A Schrijvers,Guus %+ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Postbus 85500, Huispostnr STR 6.131, Utrecht, 3508 GA, Netherlands, 31 623908387, cjong8@umcutrecht.nl %K eHealth %K primary care %K elderly %K email %K nurses %K general practitioners %K medical informatics %K Internet %D 2016 %7 24.11.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Home-dwelling elderly patients with multimorbidity are at risk of fragmentation of care because of the many different professionals involved and a potentially unclear level of communication. Multidisciplinary communication seems to occur incidentally. Mutual feedback is needed for a professional team to provide consistent care and adequate support to the patient system. eHealth technology can improve outcomes. Objective: The aim of this study was to evaluate the use of a tool, Congredi, for electronic communication by professionals for the care of home-dwelling elderly patients. Methods: The research group was recruited through general practices and home care organizations. Congredi, a tool designed for multidisciplinary communication, was made available for professionals in primary care. It consists of a care plan and a communication channel (secure emailing). Professionals opened Congredi records for elderly patients who had 2 or more professionals involved. The records were the unit of analysis. Data were gathered from the Congredi system over a period of 42 weeks. Results: An inclusion rate of 21.4% (203/950) was achieved; nearly half of the participants were nurses. During the study, professionals were active in 448 patient records; female professionals were prevalent. In the patient records, 3 types of actions (care activities, emailing, and process activities) were registered. Most activities occurred in the multidisciplinary records (mean 12.2), which had twice the number of activities of monodisciplinary records (6.35), and solo records had a mean of 3.43 activities. Most activities were care activities (mean 9.14), emailing had a mean of 0.89 activities, and process activities had a mean of 0.29. Conclusions: An e-communication tool (Congredi) was usable for improving multidisciplinary communication among professionals. It even seemed to yield results for 40% of the professionals who used the e-care plan on their own. The content of the tool provided an active communication practice, with significant increases observed in the actions that must be shared for the effective coordination of care. %M 27884811 %R 10.2196/jmir.6332 %U http://www.jmir.org/2016/11/e304/ %U https://doi.org/10.2196/jmir.6332 %U http://www.ncbi.nlm.nih.gov/pubmed/27884811 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 3 %P e35 %T Barriers to Office-Based Mental Health Care and Interest in E-Communication With Providers: A Survey Study %A Rai,Minnie %A Vigod,Simone N %A Hensel,Jennifer M %+ Department of Psychiatry, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S1B2, Canada, 1 416 323 6400, jennifer.hensel@wchospital.ca %K e-communication %K mental health %K technology %K barriers %K social media %D 2016 %7 01.08.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: With rising availability and use of Internet and mobile technology in society, the demand and need for its integration into health care is growing. Despite great potential within mental health care and growing uptake, there is still little evidence to guide how these tools should be integrated into traditional care, and for whom. Objective: To examine factors that might inform how e-communication should be implemented in our local outpatient mental health program, including barriers to traditional office-based care, patient preferences, and patient concerns. Methods: We conducted a survey in the waiting room of our outpatient mental health program located in an urban, academic ambulatory hospital. The survey assessed (1) age, mobile phone ownership, and general e-communication usage, (2) barriers to attending office-based appointments, (3) preferences for, and interest in, e-communication for mental health care, and (4) concerns about e-communication use for mental health care. We analyzed the data descriptively and examined associations between the presence of barriers, identifying as a social media user, and interest level in e-communication. Results: Respondents (N=68) were predominantly in the age range of 25-54 years. The rate of mobile phone ownership was 91% (62/68), and 59% (40/68) of respondents identified as social media users. There was very low existing use of e-communication between providers and patients, with high levels of interest endorsed by survey respondents. Respondents expressed an interest in using e-communication with their provider to share updates and get feedback, coordinate care, and get general information. In regression analysis, both a barrier to care and identifying as a social media user were significantly associated with e-communication interest (P=.03 and P=.003, respectively). E-communication interest was highest among people who both had a barrier to office-based care and were a social media user. Despite high interest, there were also many concerns including privacy and loss of in-person contact. Conclusions: A high burden of barriers to attending office-based care paired with a high interest in e-communication supports the integration of e-communication within our outpatient services. There may be early adopters to target: those with identified barriers to office-based care and who are active on social media. There is also a need for caution and preservation of existing services for those who choose not to, or cannot, access e-services. %M 27480108 %R 10.2196/mental.6068 %U http://mental.jmir.org/2016/3/e35/ %U https://doi.org/10.2196/mental.6068 %U http://www.ncbi.nlm.nih.gov/pubmed/27480108 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 3 %N 1 %P e12 %T In the Loop: The Organization of Team-Based Communication in a Patient-Centered Clinical Collaboration System %A Kurahashi,Allison M %A Weinstein,Peter B %A Jamieson,Trevor %A Stinson,Jennifer N %A Cafazzo,Joseph A %A Lokuge,Bhadra %A Morita,Plinio P %A Cohen,Eyal %A Rapoport,Adam %A Bezjak,Andrea %A Husain,Amna %+ Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, 4th Floor, Box 13, 60 Murray Street, Toronto, ON, , Canada, 1 416 586 4800 ext 7884, amna.husain@utoronto.ca %K collaborative care %K patient-centered care %K patient engagement %K chronic disease %K communication %K Internet communication tools %K Internet communication technologies %D 2016 %7 24.03.2016 %9 Original Paper %J JMIR Human Factors %G English %X Background: We describe the development and evaluation of a secure Web-based system for the purpose of collaborative care called Loop. Loop assembles the team of care with the patient as an integral member of the team in a secure space. Objective: The objectives of this paper are to present the iterative design of the separate views for health care providers (HCPs) within each patient’s secure space and examine patients’, caregivers’, and HCPs’ perspectives on this separate view for HCP-only communication. Methods: The overall research program includes cycles of ethnography, prototyping, usability testing, and pilot testing. This paper describes the usability testing phase that directly informed development. A descriptive qualitative approach was used to analyze participant perspectives that emerged during usability testing. Results: During usability testing, we sampled 89 participants from three user groups: 23 patients, 19 caregivers, and 47 HCPs. Almost all perspectives from the three user groups supported the need for an HCP-only communication view. In an earlier prototype, the visual presentation caused confusion among HCPs when reading and composing messages about whether a message was visible to the patient. Usability testing guided us to design a more deliberate distinction between posting in the Patient and Team view and the Health Care Provider Only view at the time of composing a message, which once posted is distinguished by an icon. Conclusions: The team made a decision to incorporate an HCP-only communication view based on findings during earlier phases of work. During usability testing we tested the separate communication views, and all groups supported this partition. We spent considerable effort designing the partition; however, preliminary findings from the next phase of evaluation, pilot testing, show that the Patient and Team communication is predominantly being used. This demonstrates the importance of a subsequent phase of the clinical trial of Loop to validate the concept and design. %M 27025912 %R 10.2196/humanfactors.4996 %U http://humanfactors.jmir.org/2016/1/e12/ %U https://doi.org/10.2196/humanfactors.4996 %U http://www.ncbi.nlm.nih.gov/pubmed/27025912 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 2 %P e43 %T Patients Know Best: Qualitative Study on How Families Use Patient-Controlled Personal Health Records %A Schneider,Hanna %A Hill,Susan %A Blandford,Ann %+ UCLIC & Institute of Digital Health, UCL, Gower Street, London, WC1E 6BT, United Kingdom, 44 203 108 7049, a.blandford@ucl.ac.uk %K electronic health record %K patient empowerment %K self-determination theory %D 2016 %7 24.02.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Self-management technologies, such as patient-controlled electronic health records (PCEHRs), have the potential to help people manage and cope with disease. Objective: This study set out to investigate patient families’ lived experiences of working with a PCEHR. Methods: We conducted a semistructured qualitative field study with patient families and clinicians at a children’s hospital in the UK that uses a PCEHR (Patients Know Best). All families were managing the health of a child with a serious chronic condition, who was typically under the care of multiple clinicians. As data gathering and analysis progressed, it became clear that while much of the literature assumes that patients are willing and waiting to take more responsibility for and control over their health management (eg, with PCEHRs), only a minority of participants in our study responded in this way. Their experiences with the PCEHR were diverse and strongly shaped by their coping styles. Theory on coping identifies a continuum of coping styles, from approach to avoidance oriented, and proposes that patients’ information needs depend on their style. Results: We identified 3 groups of patient families and an outlier, distinguished by their coping style and their PCEHR use. We refer to the outlier as controlling (approach oriented, highly motivated to use PCEHR), and the 3 groups as collaborating (approach oriented, motivated to use PCEHR), cooperating (avoidance oriented, less motivated to use PCEHR), and avoiding (very avoidance oriented, not motivated to use PCEHR). Conclusions: The PCEHR met the needs of controller and collaborators better than the needs of cooperators and avoiders. We draw on the Self-Determination Theory to propose ways in which a PCEHR design might better meet the needs of avoidance-oriented users. Further, we highlight the need for families to also relinquish control at times, and propose ways in which PCEHR design might support a better distribution of control, based on effective training, ease of use, comprehensibility of data security mechanisms, timely information provision (recognizing people’s different needs), personalization of use, and easy engagement with clinicians through the PCEHR. %M 26912201 %R 10.2196/jmir.4652 %U http://www.jmir.org/2016/2/e43/ %U https://doi.org/10.2196/jmir.4652 %U http://www.ncbi.nlm.nih.gov/pubmed/26912201 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 12 %P e282 %T Large-Scale Survey Findings Inform Patients’ Experiences in Using Secure Messaging to Engage in Patient-Provider Communication and Self-Care Management: A Quantitative Assessment %A Haun,Jolie N %A Patel,Nitin R %A Lind,Jason D %A Antinori,Nicole %+ Veterans Health Administration, HSR&D Center of Innovation on Disability and Rehabilitation Research, 8900 Grand Oak Circle (118M), Tampa, FL, 33637, United States, 1 904 377 6796, joliehaun@gmail.com %K cross-sectional survey %K email %K Internet communication tools %K veterans %D 2015 %7 21.12.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Secure email messaging is part of a national transformation initiative in the United States to promote new models of care that support enhanced patient-provider communication. To date, only a limited number of large-scale studies have evaluated users’ experiences in using secure email messaging. Objective: To quantitatively assess veteran patients’ experiences in using secure email messaging in a large patient sample. Methods: A cross-sectional mail-delivered paper-and-pencil survey study was conducted with a sample of respondents identified as registered for the Veteran Health Administrations’ Web-based patient portal (My HealtheVet) and opted to use secure messaging. The survey collected demographic data, assessed computer and health literacy, and secure messaging use. Analyses conducted on survey data include frequencies and proportions, chi-square tests, and one-way analysis of variance. Results: The majority of respondents (N=819) reported using secure messaging 6 months or longer (n=499, 60.9%). They reported secure messaging to be helpful for completing medication refills (n=546, 66.7%), managing appointments (n=343, 41.9%), looking up test results (n=350, 42.7%), and asking health-related questions (n=340, 41.5%). Notably, some respondents reported using secure messaging to address sensitive health topics (n=67, 8.2%). Survey responses indicated that younger age (P=.039) and higher levels of education (P=.025) and income (P=.003) were associated with more frequent use of secure messaging. Females were more likely to report using secure messaging more often, compared with their male counterparts (P=.098). Minorities were more likely to report using secure messaging more often, at least once a month, compared with nonminorities (P=.086). Individuals with higher levels of health literacy reported more frequent use of secure messaging (P=.007), greater satisfaction (P=.002), and indicated that secure messaging is a useful (P=.002) and easy-to-use (P≤.001) communication tool, compared with individuals with lower reported health literacy. Many respondents (n=328, 40.0%) reported that they would like to receive education and/or felt other veterans would benefit from education on how to access and use the electronic patient portal and secure messaging (n=652, 79.6%). Conclusions: Survey findings validated qualitative findings found in previous research, such that veterans perceive secure email messaging as a useful tool for communicating with health care teams. To maximize sustained utilization of secure email messaging, marketing, education, skill building, and system modifications are needed. These findings can inform ongoing efforts to promote the sustained use of this electronic tool to support for patient-provider communication. %M 26690761 %R 10.2196/jmir.5152 %U http://www.jmir.org/2015/12/e282/ %U https://doi.org/10.2196/jmir.5152 %U http://www.ncbi.nlm.nih.gov/pubmed/26690761 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 4 %N 4 %P e21 %T Internet Services for Communicating With the General Practice: Barely Noticed and Used by Patients %A Huygens,Martine WJ %A Vermeulen,Joan %A Friele,Roland D %A van Schayck,Onno CP %A de Jong,Judith D %A de Witte,Luc P %+ School for Public Health and Primary Care (CAPHRI), Department of Health Services Research, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, Netherlands, 31 43 38 81 700, m.huygens@maastrichtuniversity.nl %K eHealth %K online communication %K primary care %K general practice %D 2015 %7 24.11.2015 %9 Original Paper %J Interact J Med Res %G English %X Background: The Netherlands is one of the frontrunners of eHealth in Europe. Many general practices offer Internet services, which can be used by patients to communicate with their general practice. In promoting and implementing such services, it is important to gain insight into patients’ actual use and intention toward using. Objective: The objective of the study is to investigate the actual use and intention toward using Internet services to communicate with the general practice by the general practice population. The secondary objective is to study the factors and characteristics that influence their intention to use such services. Methods: There were 1500 members of the Dutch Health Care Consumer Panel, age over 18 years, that were invited to participate in this cross-sectional study. People who had contacted their general practitioner at least once in the past year were included. Participants were asked to fill out a questionnaire about the following services: Internet appointment planning, asking questions on the Internet, email reminders about appointments, Internet prescription refill requests, Internet access to medical data, and Internet video consultation. Participants indicated whether they had used these services in the past year, they would like to use them, and whether they thought their general practice had these services. For the first two services, participants rated items based on the unified theory of acceptance and use of technology complemented with additional constructs. These items were divided into six subscales: effort expectancy, performance expectancy, trust, attitude, facilitating conditions, and social influence. Results: There were 546 participants that were included in the analyses out of 593 who met the inclusion criteria. The participants had a mean age of 53 years (SD 15.4), 43.6% (n=238) were male, and 66.8% (n=365) had at least one chronic illness. Actual use of the services varied between 0% (n=0, video consultation) and 10.4% (n=57, requesting prescription refill by Internet). The proportion of participants with a positive intention to use the service varied between 14.7% (n=80, video consultation) and 48.7% (n=266, Internet access to medical data). For each service, approximately half indicated that they did not know whether the service was available. Univariate logistic regression analyses revealed that all the constructs as well as age, level of education, and Internet usage had a significant association with intention toward using Internet appointment planning and asking questions by Internet. Conclusions: Internet communication services to contact the general practice are not yet frequently used by this population. Although a substantial number of persons have a positive intention toward using such services, not all people who receive primary care seem willing to use them. The lack of awareness of the availability and functionality of such services might play an important role. %M 26601596 %R 10.2196/ijmr.4245 %U http://www.i-jmr.org/2015/4/e21/ %U https://doi.org/10.2196/ijmr.4245 %U http://www.ncbi.nlm.nih.gov/pubmed/26601596 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 11 %P e262 %T Using the Consolidated Framework for Implementation Research to Identify Barriers and Facilitators for the Implementation of an Internet-Based Patient-Provider Communication Service in Five Settings: A Qualitative Study %A Varsi,Cecilie %A Ekstedt,Mirjam %A Gammon,Deede %A Ruland,Cornelia M %+ Center for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, P.b. 4950 Nydalen N-0424 Oslo, Oslo, 0424, Norway, 47 91583400, cornelia.ruland@rr-research.no %K implementation %K Internet %K electronic mail %K secure Web communication %K eHealth %K qualitative research %K Consolidated Framework for Implementation Research %K CFIR %D 2015 %7 18.11.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Although there is growing evidence of the positive effects of Internet-based patient-provider communication (IPPC) services for both patients and health care providers, their implementation into clinical practice continues to be a challenge. Objective: The 3 aims of this study were to (1) identify and compare barriers and facilitators influencing the implementation of an IPPC service in 5 hospital units using the Consolidated Framework for Implementation Research (CFIR), (2) assess the ability of the different constructs of CFIR to distinguish between high and low implementation success, and (3) compare our findings with those from other studies that used the CFIR to discriminate between high and low implementation success. Methods: This study was based on individual interviews with 10 nurses, 6 physicians, and 1 nutritionist who had used the IPPC to answer messages from patients. Results: Of the 36 CFIR constructs, 28 were addressed in the interviews, of which 12 distinguished between high and low implementation units. Most of the distinguishing constructs were related to the inner setting domain of CFIR, indicating that institutional factors were particularly important for successful implementation. Health care providers’ beliefs in the intervention as useful for themselves and their patients as well as the implementation process itself were also important. A comparison of constructs across ours and 2 other studies that also used the CFIR to discriminate between high and low implementation success showed that 24 CFIR constructs distinguished between high and low implementation units in at least 1 study; 11 constructs distinguished in 2 studies. However, only 2 constructs (patient need and resources and available resources) distinguished consistently between high and low implementation units in all 3 studies. Conclusions: The CFIR is a helpful framework for illuminating barriers and facilitators influencing IPPC implementation. However, CFIR’s strength of being broad and comprehensive also limits its usefulness as an implementation framework because it does not discriminate between the relative importance of its many constructs for implementation success. This is the first study to identify which CFIR constructs are the most promising to distinguish between high and low implementation success across settings and interventions. Findings from this study can contribute to the refinement of CFIR toward a more succinct and parsimonious framework for planning and evaluation of the implementation of clinical interventions. ClinicalTrial: Clinicaltrials.gov NCT00971139; http://clinicaltrial.gov/ct2/show/NCT00971139 (Archived by WebCite at http://www.webcitation.org/6cWeqN1uY) %M 26582138 %R 10.2196/jmir.5091 %U http://www.jmir.org/2015/11/e262/ %U https://doi.org/10.2196/jmir.5091 %U http://www.ncbi.nlm.nih.gov/pubmed/26582138 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 11 %P e250 %T A Patient Portal With Electronic Messaging: Controlled Before-and-After Study %A Riippa,Iiris %A Linna,Miika %A Rönkkö,Ilona %+ Department of Industrial Engineering and Management, Aalto University, Otaniementie 17, Espoo, 02150, Finland, 358 503430063, iiris.riippa@aalto.fi %K chronic illness %K patient activation %K self-management %K cost-effectiveness %K patient portal %D 2015 %7 09.11.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients’ access to their medical records, along with electronic messaging, offers an efficient means of information transition between patients and their caregivers. Easier access to information and interaction with health care professionals may reduce use of other services while increasing patients’ activation in the management of their own health. Patient portals may therefore have a favorable impact on the cost-effectiveness of care. Objective: The aim was to assess the benefits and risks of providing electronic messaging services to patients with chronic conditions. Using cost-effectiveness analysis, the outcomes and costs of providing access to an electronic patient portal were evaluated in a real-life treatment process in primary care. Methods: A total of 876 chronically ill patients from public primary care were allocated to either an intervention group receiving immediate access to a patient portal that included their medical records, care plan, and secure messaging with a care team, or to a control group receiving standard care. Incremental direct heath care costs, health status based on the Short-Form Health Survey, version 2 (SF-36v2), and patient activation based on the short form of the Patient Activation Measure (PAM13) were compared to standard care in a 6-month follow-up. Incremental cost-effectiveness ratios were calculated using a sample of 80 patients in the intervention group and 57 patients in the control group; thus, a total of 137 patients were included in the final analysis. Propensity-score matching was used to assess the sensitivity of the results to the possible attrition bias. Results: Patient activation improved more in the intervention group but the effect was not statistically significant. The effect on cost of care was ambiguous; costs decreased by an average of €91 in the unadjusted model, but increased by €48 in the adjusted model. Due to the controversial results on cost, the unadjusted analysis showed an 89% probability of cost-effectiveness with no willingness to pay for increased patient activation, whereas in the adjusted sample, the probability of the portal being more cost-effective than care as usual exceeded 50% probability at a willingness to pay €700 per clinically significant increase in patient activation score. There was no marked short-term impact on health status based on the SF-36v2 measure. Conclusions: Offering the possibility to substitute health care visits with less costly contacts using self-management tools did not seem to compromise the health status or treatment of chronic care patients. Patient activation increased, and this could be achieved with moderate costs in a short-term experiment. In the long term, increased activation is proposed to lead to better health outcomes and eventually cut down resource use. Future studies should assess the long-term effects of patient portals on patients’ health status and cost of care. %M 26553595 %R 10.2196/jmir.4487 %U http://www.jmir.org/2015/11/e250/ %U https://doi.org/10.2196/jmir.4487 %U http://www.ncbi.nlm.nih.gov/pubmed/26553595 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 1 %N 2 %P e10 %T The Impact of Advice Seekers’ Need Salience and Doctors’ Communication Style on Attitude and Decision Making: A Web-Based Mammography Consultation Role Play %A Fissler,Tim %A Bientzle,Martina %A Cress,Ulrike %A Kimmerle,Joachim %+ Leibniz-Institut fuer Wissensmedien, Knowledge Media Research Center, Knowledge Construction Lab, Schleichstrasse 6, Tuebingen, , Germany, 49 7071 979 363, j.kimmerle@iwm-tuebingen.de %K communication style %K needs %K need salience %K attitude %K decision-making %K mammography screening %K online consultation %D 2015 %7 08.09.2015 %9 Original Paper %J JMIR Cancer %G English %X Background: Patients and advice seekers come to a medical consultation with typical needs, and physicians require adequate communication skills in order to address those needs effectively. It is largely unclear, however, to what extent advice seekers’ attitudes toward a medical procedure or their resulting decisions are influenced by a physician’s communication that ignores or explicitly takes these needs into account. Objective: This experimental study tested how advice seekers’ salient needs and doctor’s communication styles influenced advice seekers’ attitudes toward mammography screening and their decision whether or not to participate in this procedure. Methods: One hundred women (age range 20-47 years, mean 25.22, SD 4.71) participated in an interactive role play of an online consultation. During the consultation, a fictitious, program-controlled physician provided information about advantages and disadvantages of mammography screening. The physician either merely communicated factual medical information or made additional comments using a communication style oriented toward advice seekers’ typical needs for clarity and well-being. Orthogonal to this experimental treatment, participants’ personal needs for clarity and for well-being were either made salient before or after the consultation with a needs questionnaire. We also measured all participants’ attitudes toward mammography screening and their hypothetical decisions whether or not to participate before and after the experiment. Results: As assumed, the participants expressed strong needs for clarity (mean 4.57, SD 0.42) and for well-being (mean 4.21, SD 0.54) on 5-point Likert scales. Making these needs salient or not revealed significant interaction effects with the physician’s communication style regarding participants’ attitude change (F1,92=7.23, P=.009, η2=.073) and decision making (F1,92=4.43, P=.038, η2=.046). Those participants whose needs were made salient before the consultation responded to the physician’s communication style, while participants without salient needs did not. When the physician used a need-oriented communication style, those participants with salient needs had a more positive attitude toward mammography after the consultation than before (mean 0.13, SD 0.54), while they changed their attitude in a negative direction when confronted with a purely fact-oriented communication style (mean −0.35, SD 0.80). The same applied to decision modification (need-oriented: mean 0.10, SD 0.99; fact-oriented: mean −0.30, SD 0.88). Conclusions: The findings underline the importance of communicating in a need-oriented style with patients and advice seekers who are aware of their personal needs. Ignoring the needs of those people appears to be particularly problematic. So physicians’ sensitivity for advice seekers’ currently relevant needs is essential. %M 28410160 %R 10.2196/cancer.4279 %U http://cancer.jmir.org/2015/2/e10/ %U https://doi.org/10.2196/cancer.4279 %U http://www.ncbi.nlm.nih.gov/pubmed/28410160 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 9 %P e213 %T Swab2know: An HIV-Testing Strategy Using Oral Fluid Samples and Online Communication of Test Results for Men Who Have Sex With Men in Belgium %A Platteau,Tom %A Fransen,Katrien %A Apers,Ludwig %A Kenyon,Chris %A Albers,Laura %A Vermoesen,Tine %A Loos,Jasna %A Florence,Eric %+ Institute of Tropical Medicine, Department of Clinical Sciences, Nationalestraat 155, Antwerp, 2000, Belgium, 32 3 2476433, tplatteau@itg.be %K HIV %K men who have sex with men %K MSM %K self-sampling %K oral fluid %K online testing %D 2015 %7 01.09.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: As HIV remains a public health concern, increased testing among those at risk for HIV acquisition is important. Men who have sex with men (MSM) are the most important group for targeted HIV testing in Europe. Several new strategies have been developed and implemented to increase HIV-testing uptake in this group, among them the Swab2know project. Objective: In this project, we aim to assess the acceptability and feasibility of outreach and online HIV testing using oral fluid samples as well as Web-based delivery of test results. Methods: Sample collection happened between December 2012 and April 2014 via outreach and online sampling among MSM. Test results were communicated through a secured website. HIV tests were executed in the laboratory. Each reactive sample needed to be confirmed using state-of-the-art confirmation procedures on a blood sample. Close follow-up of participants who did not pick up their results, and those with reactive results, was included in the protocol. Participants were asked to provide feedback on the methodology using a short survey. Results: During 17 months, 1071 tests were conducted on samples collected from 898 men. Over half of the samples (553/1071, 51.63%) were collected during 23 outreach sessions. During an 8-month period, 430 samples out of 1071 (40.15%) were collected from online sampling. Additionally, 88 samples out of 1071 (8.22%) were collected by two partner organizations during face-to-face consultations with MSM and male sex workers. Results of 983 out of 1071 tests (91.78%) had been collected from the website. The pickup rate was higher among participants who ordered their kit online (421/430, 97.9%) compared to those participating during outreach activities (559/641, 87.2%; P<.001). MSM participating during outreach activities versus online participants were more likely to have never been tested before (17.3% vs 10.0%; P=.001) and reported more sexual partners in the 6 months prior to participation in the project (mean 7.18 vs 3.23; P<.001). A total of 20 participants out of 898 (2.2%) were confirmed HIV positive and were linked to care. Out of 1071 tests, 28 (2.61%) with a weak reactive result could not be confirmed, and were thereby classified as false reactive results. Most of the 388 participants who completed posttest surveys (388/983, 39.5%) were very positive about their experience. The vast majority (371/388, 95.6%) were very satisfied, while 17 out of 388 (4.4%) reported mixed feelings. Conclusions: Despite a high yield and a considerable number of false reactive results, satisfaction was high among participants. The project helped us to reach the target population, both in numbers of tests executed and in newly diagnosed HIV infections. Further optimization should be considered in the accuracy of the test, the functionalities of the website (including an online counseling tool), and in studying the cost effectiveness of the methodology. %M 26330138 %R 10.2196/jmir.4384 %U http://www.jmir.org/2015/9/e213/ %U https://doi.org/10.2196/jmir.4384 %U http://www.ncbi.nlm.nih.gov/pubmed/26330138 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 8 %P e207 %T Using Information and Communication Technologies for Family Communication and Its Association With Family Well-Being in Hong Kong: FAMILY Project %A Wang,Man Ping %A Chu,Joanna TW %A Viswanath,Kasisomayajula %A Wan,Alice %A Lam,Tai Hing %A Chan,Sophia S %+ The University of Hong Kong, School of Public Health, 21 Sassoon Road, Pokfulam, Hong Kong, , China (Hong Kong), 852 2819 9287, hrmrlth@hku.hk %K information and communication technologies %K family well-being %K family communication %K Chinese %D 2015 %7 24.08.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Family communication is central to the family and its functioning. It is a mutual process in which family members create, share, and regulate meaning. Advancement and proliferation of information and communication technologies (ICTs) continues to change methods of family communication. However, little is known about the use of different methods for family communication and the influence on family well-being. Objective: We investigated the sociodemographic factors associated with different methods of family communication and how they are associated with perceived family harmony, happiness, and health (3Hs) among Chinese adults in Hong Kong. Methods: Data came from a territory-wide probability-based telephone survey using the Family and Health Information Trend survey (FHInTs). Frequency of family communication using different methods (ie, face-to-face, phone, instant messaging [IM], social media sites, and email) were recoded and classified as frequent (always/sometimes) and nonfrequent (seldom/never) use. Family well-being was measured using 3 questions of perceived family harmony, happiness, and health with higher scores indicating better family well-being. Adjusted odds ratios for family communication methods by sociodemographic characteristics and adjusted beta coefficients for family well-being by communication methods were calculated. Results: A total of 1502 adults were surveyed. Face-to-face (94.85%, 1408/1484) was the most frequent means of communication followed by phone (78.08%, 796/1484), IM (53.64%, 796/1484), social media sites (17.60%, 261/1484), and email (13.39%, 198/1484). Younger age was associated with the use of phone, IM, and social media sites for family communication. Higher educational attainment was associated with more frequent use of all modes of communication, whereas higher family income was only significantly associated with more frequent use of IM and email (P=.001). Face-to-face (beta 0.65, 95% CI 0.33-0.97) and phone use (beta 0.20, 95% CI 0.02-0.38) for family communication were associated with significantly higher levels of perceived family well-being. Conclusions: Socioeconomic disparities in using these information and communication technologies (ICT) methods for family communication were observed. Although traditional methods remain as the main platform for family communication and were associated with better family well-being, a notable proportion of respondents are using new ICT methods, which were not associated with perceived family well-being. Because ICTs will continue to diversify modes of family communication, more research is needed to understand the impact of ICTs on family communication and well-being. %M 26303434 %R 10.2196/jmir.4722 %U http://www.jmir.org/2015/8/e207/ %U https://doi.org/10.2196/jmir.4722 %U http://www.ncbi.nlm.nih.gov/pubmed/26303434 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 3 %P e58 %T Patient Use of Email for Health Care Communication Purposes Across 14 European Countries: An Analysis of Users According to Demographic and Health-Related Factors %A Newhouse,Nikki %A Lupiáñez-Villanueva,Francisco %A Codagnone,Cristiano %A Atherton,Helen %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Gibson Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 (0)1865617770, nicola.newhouse@phc.ox.ac.uk %K eHealth %K patient-doctor communication %K electronic mail %K Internet %K Europe %K chronic illness %K patient activation %K health services %K survey %D 2015 %7 06.03.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of the Internet for health purposes is growing steadily, yet the use of asynchronous communication tools for health care purposes remains undeveloped. The introduction of email as a method of communication in health care has the potential to impact on both patients and health care professionals. Objective: This study aims to describe the characteristics of people who have sent or received an email to or from their doctor, nurse, or health care organization, by country and in relation to demographics, health care resource use, and health status factors. Methods: We conducted a secondary analysis of data (N=14,000) collected from the online Citizens and Information Communication Technology for Health survey, a project undertaken in 2011 by the Institute for Prospective Technology Studies of the European Commission’s Joint Research Centre. The survey was developed to understand and characterize European citizens’ use of information communication technologies for health. Descriptive and statistical analyses of association were used to interpret the data. Results: Denmark reported the highest level of emails sent/received (507/1000, 50.70%). The lowest level reported was by participants in France (187/1000, 18.70%). Men used email communication for health care more than women, as did respondents in the 16-24 age group and those educated to tertiary level or still within the education system. As self-reported health state worsens, the proportion of people reporting having sent or received an email within the context of health care increases. Email use, poor health, multimorbidity, and number of visits to a physician are positively correlated. Conclusions: The use of email communication within the context of European health care is extremely varied. The relationship between high email use, poor health, doctor visits, and multimorbidity is especially pertinent: provision of asynchronous communication for such groups is favored by policymakers. Low reported email use by country may not necessarily reflect low interest in using email for health care: local health policies and technical infrastructures may be significant factors in the delay in implementation of alternative forms of routine health communication. %M 25798912 %R 10.2196/jmir.3700 %U http://www.jmir.org/2015/3/e58/ %U https://doi.org/10.2196/jmir.3700 %U http://www.ncbi.nlm.nih.gov/pubmed/25798912 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 1 %P e28 %T A Participatory Approach to Designing and Enhancing Integrated Health Information Technology Systems for Veterans: Protocol %A Haun,Jolie N %A Nazi,Kim M %A Chavez,Margeaux %A Lind,Jason D %A Antinori,Nicole %A Gosline,Robert M %A Martin,Tracey L %+ HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, 8900 Grand Oak Circle, Tampa, FL, 33637-1022, United States, 1 813 558 7622, joliehaun@gmail.com %K veterans %K patient-provider communication %K Department of Veterans Affairs %K mixed methods %K patient-centered care %D 2015 %7 27.02.2015 %9 Protocol %J JMIR Res Protoc %G English %X Background: The Department of Veterans Affairs (VA) has developed health information technologies (HIT) and resources to improve veteran access to health care programs and services, and to support a patient-centered approach to health care delivery. To improve VA HIT access and meaningful use by veterans, it is necessary to understand their preferences for interacting with various HIT resources to accomplish health management related tasks and to exchange information. Objective: The objective of this paper was to describe a novel protocol for: (1) developing a HIT Digital Health Matrix Model; (2) conducting an Analytic Hierarchy Process called pairwise comparison to understand how and why veterans want to use electronic health resources to complete tasks related to health management; and (3) developing visual modeling simulations that depict veterans’ preferences for using VA HIT to manage their health conditions and exchange health information. Methods: The study uses participatory research methods to understand how veterans prefer to use VA HIT to accomplish health management tasks within a given context, and how they would like to interact with HIT interfaces (eg, look, feel, and function) in the future. This study includes two rounds of veteran focus groups with self-administered surveys and visual modeling simulation techniques. This study will also convene an expert panel to assist in the development of a VA HIT Digital Health Matrix Model, so that both expert panel members and veteran participants can complete an Analytic Hierarchy Process, pairwise comparisons to evaluate and rank the applicability of electronic health resources for a series of health management tasks. Results: This protocol describes the iterative, participatory, and patient-centered process for: (1) developing a VA HIT Digital Health Matrix Model that outlines current VA patient-facing platforms available to veterans, describing their features and relevant contexts for use; and (2) developing visual model simulations based on direct veteran feedback that depict patient preferences for enhancing the synchronization, integration, and standardization of VA patient-facing platforms. Focus group topics include current uses, preferences, facilitators, and barriers to using electronic health resources; recommendations for synchronizing, integrating, and standardizing VA HIT; and preferences on data sharing and delegation within the VA system. Conclusions: This work highlights the practical, technological, and personal factors that facilitate and inhibit use of current VA HIT, and informs an integrated system redesign. The Digital Health Matrix Model and visual modeling simulations use knowledge of veteran preferences and experiences to directly inform enhancements to VA HIT and provide a more holistic and integrated user experience. These efforts are designed to support the adoption and sustained use of VA HIT to support patient self-management and clinical care coordination in ways that are directly aligned with veteran preferences. %M 25803324 %R 10.2196/resprot.3815 %U http://www.researchprotocols.org/2015/1/e28/ %U https://doi.org/10.2196/resprot.3815 %U http://www.ncbi.nlm.nih.gov/pubmed/25803324 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 2 %P e49 %T Advantages and Disadvantages of Educational Email Alerts for Family Physicians: Viewpoint %A Badran,Hani %A Pluye,Pierre %A Grad,Roland %+ Information Technology Primary Healthcare Research Group, Department of Family Medicine, McGill University, 5858, chemin de la Côte-des-Neige, 3rd floor, Montreal, QC, H3S 1Z1, Canada, 1 (514) 398 8483, pierre.pluye@mcgill.ca %K theory of planned behavior %K continuing medical education %K educational email alerts %K electronic knowledge resources %K family physicians %K health informatics %K knowledge translation %K primary health care %D 2015 %7 27.02.2015 %9 Viewpoint %J J Med Internet Res %G English %X Background: Electronic knowledge resources constitute an important channel for accredited Continuing Medical Education (CME) activities. However, email usage for educational purposes is controversial. On the one hand, family physicians become aware of new information, confirm what they already know, and obtain reassurance by reading educational email alerts. Email alerts can also encourage physicians to search Web-based resources. On the other hand, technical difficulties and privacy issues are common obstacles. Objective: The purpose of this discussion paper, informed by a literature review and a small qualitative study, was to understand family physicians’ knowledge, attitudes, and behavior in regard to email in general and educational emails in particular, and to explore the advantages and disadvantages of educational email alerts. In addition, we documented participants’ suggestions to improve email alert services for CME. Methods: We conducted a qualitative descriptive study using the “Knowledge, Attitude, Behavior” model. We conducted semi-structured face-to-face interviews with 15 family physicians. We analyzed the collected data using inductive-deductive thematic qualitative data analysis. Results: All 15 participants scanned and prioritized their email, and 13 of them checked their email daily. Participants mentioned (1) advantages of educational email alerts such as saving time, convenience and valid information, and (2) disadvantages such as an overwhelming number of emails and irrelevance. They offered suggestions to improve educational email. Conclusions: The advantages of email alerts seem to compensate for their disadvantages. Suggestions proposed by family physicians can help to improve educational email alerts. %M 25803184 %R 10.2196/jmir.3773 %U http://www.jmir.org/2015/2/e49/ %U https://doi.org/10.2196/jmir.3773 %U http://www.ncbi.nlm.nih.gov/pubmed/25803184 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 2 %P e47 %T Predictors for Assessing Electronic Messaging Between Nurses and General Practitioners as a Useful Tool for Communication in Home Health Care Services: A Cross-Sectional Study %A Lyngstad,Merete %A Hofoss,Dag %A Grimsmo,Anders %A Hellesø,Ragnhild %+ Institute of Health and Society, Department of Nursing Science, University of Oslo, PO 1130 Blindern, Oslo, 0318, Norway, 47 92625044, Merete.Lyngstad@medisin.uio.no %K electronic mail %K home healthcare nursing %K collaborating %K general practitioners %D 2015 %7 17.02.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Nurses providing home health care services are dependent on access to patient information and communicating with general practitioners (GPs) to deliver safe and effective health care to patients. Information and communication technology (ICT) systems are viewed as powerful tools for this purpose. In Norway, a standardized electronic messaging (e-messaging) system is currently being established in health care. Objective: The aim of this study was to explore home health care nurses’ assessments of the utility of the e-messaging system for communicating with GPs and identify elements that influence the assessment of e-messaging as a useful communication tool. Methods: The data were collected using a self-developed questionnaire based on variables identified by focus group interviews with home health care nurses (n=425) who used e-messaging and existing research. Data were analyzed using logistic regression analyses. Results: Over two-thirds (425/632, 67.2%) of the home health care nurses returned the questionnaire. A high proportion (388/399, 97.2%) of the home health care nurses who returned the questionnaire found the e-messaging system to be a useful tool for communication with GPs. The odds of reporting that e-messaging was a useful tool were over five times higher (OR 5.1, CI 2.489-10.631, P<.001) if the nurses agreed or strongly agreed that e-messaging was easy to use. The odds of finding e-messaging easy to use were nearly seven times higher (OR 6.9, CI 1.713-27.899, P=.007) if the nurses did not consider the system functionality poor. If the nurses had received training in the use of e-messaging, the odds were over six times higher (OR 6.6, CI 2.515-17.437, P<.001) that they would consider e-messaging easy to use. The odds that a home health care nurse would experience e-messaging as easy to use increased as the full-time equivalent percentage of the nurses increased (OR 1.032, CI 1.001-1.064, P=.045). Conclusions: This study has shown that technical (ease of use and system functionality), organizational (training), and individual (full-time equivalent percentage) elements had an impact on home health care nurses’ assessments of using e-messaging to communicate with GPs. By identifying these elements, it is easier to determine which interventions are the most important for the development and implementation of ICT systems in home health care services. %M 25691234 %R 10.2196/jmir.4056 %U http://www.jmir.org/2015/2/e47/ %U https://doi.org/10.2196/jmir.4056 %U http://www.ncbi.nlm.nih.gov/pubmed/25691234 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 12 %P e295 %T Comparing Effects in Regular Practice of E-Communication and Web-Based Self-Management Support Among Breast Cancer Patients: Preliminary Results From a Randomized Controlled Trial %A Børøsund,Elin %A Cvancarova,Milada %A Moore,Shirley M %A Ekstedt,Mirjam %A Ruland,Cornelia M %+ Centre for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, Oslo, 0424, Norway, 47 23075460, cornelia.ruland@rr-research.no %K Web-based intervention %K electronic mail %K Internet %K eHealth %K cancer %K patient-centered care %K symptom management %K professional-patient relations %K randomized controlled trial %D 2014 %7 18.12.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: While Web-based interventions have been shown to assist a wide range of patients successfully in managing their illness, few studies have examined the relative contribution of different Web-based components to improve outcomes. Further efficacy trials are needed to test the effects of Web support when offered as a part of routine care. Objective: Our aim was to compare in regular care the effects of (1) an Internet-based patient provider communication service (IPPC), (2) WebChoice, a Web-based illness management system for breast cancer patients (IPPC included), and (3) usual care on symptom distress, anxiety, depression, (primary outcomes), and self-efficacy (secondary outcome). This study reports preliminary findings from 6 months’ follow-up data in a 12-month trial. Methods: We recruited 167 patients recently diagnosed with breast cancer and undergoing treatment from three Norwegian hospitals. The nurse-administered IPPC allowed patients to send secure e-messages to and receive e-messages from health care personnel at the hospital where they were treated. In addition to the IPPC, WebChoice contains components for symptom monitoring, tailored information and self-management support, a diary, and communication with other patients. A total of 20 care providers (11 nurses, 6 physicians, and 3 social workers) were trained to answer questions from patients. Outcomes were measured with questionnaires at study entry and at study months 2, 4, and 6. Linear mixed models for repeated measures were fitted to compare effects on outcomes over time. Results: Patients were randomly assigned to the WebChoice group (n=64), the IPPC group (n=45), or the usual care group (n=58). Response rates to questionnaires were 73.7% (123/167) at 2 months, 65.9 (110/167) at 4 months, and 62.3% (104/167) at 6 months. Attrition was similar in all study groups. Among those with access to WebChoice, 64% (41/64) logged on more than once and 39% (25/64) sent e-messages to care providers. In the IPPC group, 40% (18/45) sent e-messages. Linear mixed models analyses revealed that the WebChoice group reported significantly lower symptom distress (mean difference 0.16, 95% CI 0.06-0.25, P=.001), anxiety (mean difference 0.79, 95% CI 0.09-1.49, P=.03), and depression (mean difference 0.79, 95% CI 0.09-1.49, P=.03) compared with the usual care group. The IPPC group reported significant lower depression scores compared with the usual care group (mean difference 0.69, 95% CI 0.05-1.32, P=.03), but no differences were observed for symptom distress or anxiety. No significant differences in self-efficacy were found among the study groups. Conclusions: In spite of practice variations and moderate use of the interventions, our results suggest that offering Web support as part of regular care can be a powerful tool to help patients manage their illness. Our finding that a nurse-administered IPPC alone can significantly reduce depression is particularly promising. However, the multicomponent intervention WebChoice had additional positive effects. Trial Registration: Clinicaltrials.gov:NCT00971009; http://clinicaltrials.gov/show/NCT00971009 (Archived by WebCite at http://www.webcitation.org/6USKezP0Y). %M 25525672 %R 10.2196/jmir.3348 %U http://www.jmir.org/2014/12/e295/ %U https://doi.org/10.2196/jmir.3348 %U http://www.ncbi.nlm.nih.gov/pubmed/25525672 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 5 %P e141 %T Effectiveness of a Web-Based Solution-Focused Brief Chat Treatment for Depressed Adolescents and Young Adults: Randomized Controlled Trial %A Kramer,Jeannet %A Conijn,Barbara %A Oijevaar,Pien %A Riper,Heleen %+ Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Post Office Box 725, Utrecht, 3500 AS, Netherlands, 31 (0)30 2959380, jkramer@trimbos.nl %K depression %K randomized controlled trial %K Internet %K Solution Focused Brief Therapy %K young adults %D 2014 %7 29.05.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Up to 9% of young people suffer from depression. Unfortunately, many in need of help remain untreated. The Internet offers anonymous ways to help depressed youth, especially those who are reluctant to search for help because of fear of stigma. Objective: Our goal was to evaluate the effectiveness of an individual chat treatment based on Solution-Focused Brief Therapy (SFBT) to young individuals aged 12-22 years with depressive symptoms by comparing it to a waiting list control group. Methods: For this study, 263 young people with depressive symptoms were randomized to the Web-based SFBT intervention, PratenOnline, or to a waiting list control condition. The chat treatment was delivered by trained professionals. Groups were compared on depressive complaints as measured by the Center for Epidemiologic Studies Depression Scale (CES-D) after 9 weeks and 4.5 months. For the chat group only, changes in depressive symptoms at 7.5 months after baseline were explored. Results: The experimental SFBT condition (n=131) showed significantly greater improvement than the waiting list condition (n=132) in depressive symptoms at 9 weeks and 4.5 months on the CES-D, with a small between group effect size at 9 weeks (d=0.18, 95% CI -0.10 to 0.47) and a large effect size at 4.5 months (d=0.79, 95% CI 0.45-1.08). The percentage of participants showing a reliable and clinically significant change in depression was significantly larger for the SFBT intervention at 4.5 months only (28.2% vs 11.4% for the waiting list, P<.001, number needed to treat=6). At 7.5 months, the SFBT group showed further improvements. However, results have to be considered carefully because of high attrition rates. Conclusions: The Web-based SFBT chat intervention of PratenOnline was more effective than a waiting list control group in reducing depressive symptoms, and effects were larger at follow-up then at post-treatment. More studies are needed to find out if outcomes will be replicated, especially for those younger than 18 year old. Trial Registration: Netherlands Trial Register: NTR 1696; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1696 (Archived by WebCite at http://www.webcitation.org/6DspeYWrJ). %M 24874006 %R 10.2196/jmir.3261 %U http://www.jmir.org/2014/5/e141/ %U https://doi.org/10.2196/jmir.3261 %U http://www.ncbi.nlm.nih.gov/pubmed/24874006 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 3 %P e75 %T Evaluating User Experiences of the Secure Messaging Tool on the Veterans Affairs’ Patient Portal System %A Haun,Jolie N %A Lind,Jason D %A Shimada,Stephanie L %A Martin,Tracey L %A Gosline,Robert M %A Antinori,Nicole %A Stewart,Max %A Simon,Steven R %+ Department of Veterans Affairs, HSR&D/RR&D Center of Innovation on Disability and Rehabilitation Research, James A Haley VA Medical Center, 8900 Grand Oak Cir (151R), Tampa, FL, 33637-1022, United States, 1 813 558 7622, Jolie.Haun@va.gov %K veterans %K secure messaging %K patient-provider communication %K Department of Veterans Affairs %K usability testing %K mixed methods %K patient-centered care %D 2014 %7 06.03.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: The United States Department of Veterans Affairs has implemented an electronic asynchronous “Secure Messaging” tool within a Web-based patient portal (ie, My HealtheVet) to support patient-provider communication. This electronic resource promotes continuous and coordinated patient-centered care, but to date little research has evaluated patients’ experiences and preferences for using Secure Messaging. Objective: The objectives of this mixed-methods study were to (1) characterize veterans’ experiences using Secure Messaging in the My HealtheVet portal over a 3-month period, including system usability, (2) identify barriers to and facilitators of use, and (3) describe strategies to support veterans’ use of Secure Messaging. Methods: We recruited 33 veterans who had access to and had previously used the portal’s Secure Messaging tool. We used a combination of in-depth interviews, face-to-face user-testing, review of transmitted secure messages between veterans and staff, and telephone interviews three months following initial contact. We assessed participants’ computer and health literacy during initial and follow-up interviews. We used a content-analysis approach to identify dominant themes in the qualitative data. We compared inferences from each of the data sources (interviews, user-testing, and message review) to identify convergent and divergent data trends. Results: The majority of veterans (27/33, 82%) reported being satisfied with Secure Messaging at initial interview; satisfaction ratings increased to 97% (31/32, 1 missing) during follow-up interviews. Veterans noted Secure Messaging to be useful for communicating with their primary care team to manage health care needs (eg, health-related questions, test requests and results, medication refills and questions, managing appointments). Four domains emerged from interviews: (1) perceived benefits of using Secure Messaging, (2) barriers to using Secure Messaging, (3) facilitators for using Secure Messaging, and (4) suggestions for improving Secure Messaging. Veterans identified and demonstrated impediments to successful system usage that can be addressed with education, skill building, and system modifications. Analysis of secure message content data provided insights to reasons for use that were not disclosed by participants during interviews, specifically sensitive health topics such as erectile dysfunction and sexually transmitted disease inquiries. Conclusions: Veterans perceive Secure Messaging in the My HealtheVet patient portal as a useful tool for communicating with health care teams. However, to maximize sustained utilization of Secure Messaging, marketing, education, skill building, and system modifications are needed. Data from this study can inform a large-scale quantitative assessment of Secure Messaging users’ experiences in a representative sample to validate qualitative findings. %M 24610454 %R 10.2196/jmir.2976 %U http://www.jmir.org/2014/3/e75/ %U https://doi.org/10.2196/jmir.2976 %U http://www.ncbi.nlm.nih.gov/pubmed/24610454 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e19 %T The Effects on Health Behavior and Health Outcomes of Internet-Based Asynchronous Communication Between Health Providers and Patients With a Chronic Condition: A Systematic Review %A de Jong,Catharina Carolina %A Ros,Wynand JG %A Schrijvers,Guus %+ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, PO Box 85500, Utrecht, 3508 GA, Netherlands, 31 623908387, c.c.dejong-8@umcutrecht.nl %K chronic disease %K telecommunications %K Internet %K telemedicine %K health services %K delivery of health care %K medical informatics %K electronic mail %K self-care %K self-efficacy %D 2014 %7 16.01.2014 %9 Review %J J Med Internet Res %G English %X Background: In support of professional practice, asynchronous communication between the patient and the provider is implemented separately or in combination with Internet-based self-management interventions. This interaction occurs primarily through electronic messaging or discussion boards. There is little evidence as to whether it is a useful tool for chronically ill patients to support their self-management and increase the effectiveness of interventions. Objective: The aim of our study was to review the use and usability of patient-provider asynchronous communication for chronically ill patients and the effects of such communication on health behavior, health outcomes, and patient satisfaction. Methods: A literature search was performed using PubMed and Embase. The quality of the articles was appraised according to the National Institute for Health and Clinical Excellence (NICE) criteria. The use and usability of the asynchronous communication was analyzed by examining the frequency of use and the number of users of the interventions with asynchronous communication, as well as of separate electronic messaging. The effectiveness of asynchronous communication was analyzed by examining effects on health behavior, health outcomes, and patient satisfaction. Results: Patients’ knowledge concerning their chronic condition increased and they seemed to appreciate being able to communicate asynchronously with their providers. They not only had specific questions but also wanted to communicate about feeling ill. A decrease in visits to the physician was shown in two studies (P=.07, P=.07). Increases in self-management/self-efficacy for patients with back pain, dyspnea, and heart failure were found. Positive health outcomes were shown in 12 studies, where the clinical outcomes for diabetic patients (HbA1c level) and for asthmatic patients (forced expiratory volume [FEV]) improved. Physical symptoms improved in five studies. Five studies generated a variety of positive psychosocial outcomes. Conclusions: The effect of asynchronous communication is not shown unequivocally in these studies. Patients seem to be interested in using email. Patients are willing to participate and are taking the initiative to discuss health issues with their providers. Additional testing of the effects of asynchronous communication on self-management in chronically ill patients is needed. %M 24434570 %R 10.2196/jmir.3000 %U http://www.jmir.org/2014/1/e19/ %U https://doi.org/10.2196/jmir.3000 %U http://www.ncbi.nlm.nih.gov/pubmed/24434570 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 12 %P e264 %T Aligning Medication Reconciliation and Secure Messaging: Qualitative Study of Primary Care Providers’ Perspectives %A Heyworth,Leonie %A Clark,Justice %A Marcello,Thomas B %A Paquin,Allison M %A Stewart,Max %A Archambeault,Cliona %A Simon,Steven R %+ Veterans Affairs Boston Healthcare System, Section of General Internal Medicine, 150 South Huntington Ave, Mailstop 152G, Boston, MA, 02130, United States, 1 617 826 5319, lheyworth@gmail.com %K medication reconciliation %K secure messaging %K secure email, primary care %K provider experiences %K health information technology (HIT) %D 2013 %7 02.12.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Virtual (non-face-to-face) medication reconciliation strategies may reduce adverse drug events (ADEs) among vulnerable ambulatory patients. Understanding provider perspectives on the use of technology for medication reconciliation can inform the design of patient-centered solutions to improve ambulatory medication safety. Objective: The aim of the study was to describe primary care providers’ experiences of ambulatory medication reconciliation and secure messaging (secure email between patients and providers), and to elicit perceptions of a virtual medication reconciliation system using secure messaging (SM). Methods: This was a qualitative study using semi-structured interviews. From January 2012 to May 2012, we conducted structured observations of primary care clinical activities and interviewed 15 primary care providers within a Veterans Affairs Healthcare System in Boston, Massachusetts (USA). We carried out content analysis informed by the grounded theory. Results: Of the 15 participating providers, 12 were female and 11 saw 10 or fewer patients in a typical workday. Experiences and perceptions elicited from providers during in-depth interviews were organized into 12 overarching themes: 4 themes for experiences with medication reconciliation, 3 themes for perceptions on how to improve ambulatory medication reconciliation, and 5 themes for experiences with SM. Providers generally recognized medication reconciliation as a valuable component of primary care delivery and all agreed that medication reconciliation following hospital discharge is a key priority. Most providers favored delegating the responsibility for medication reconciliation to another member of the staff, such as a nurse or a pharmacist. The 4 themes related to ambulatory medication reconciliation were (1) the approach to complex patients, (2) the effectiveness of medication reconciliation in preventing ADEs, (3) challenges to completing medication reconciliation, and (4) medication reconciliation during transitions of care. Specifically, providers emphasized the importance of medication reconciliation at the post-hospital visit. Providers indicated that assistance from a caregiver (eg, a family member) for medication reconciliation was helpful for complex or elderly patients and that patients’ social or cognitive factors often made medication reconciliation challenging. Regarding providers’ use of SM, about half reported using SM frequently, but all felt that it improved their clinical workflow and nearly all providers were enthusiastic about a virtual medication reconciliation system, such as one using SM. All providers thought that such a system could reduce ADEs. Conclusions: Although providers recognize the importance and value of ambulatory medication reconciliation, various factors make it difficult to execute this task effectively, particularly among complex or elderly patients and patients with complicated social circumstances. Many providers favor enlisting the support of pharmacists or nurses to perform medication reconciliation in the outpatient setting. In general, providers are enthusiastic about the prospect of using secure messaging for medication reconciliation, particularly during transitions of care, and believe a system of virtual medication reconciliation could reduce ADEs. %M 24297865 %R 10.2196/jmir.2793 %U http://www.jmir.org/2013/12/e264/ %U https://doi.org/10.2196/jmir.2793 %U http://www.ncbi.nlm.nih.gov/pubmed/24297865 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 2 %N 2 %P e52 %T Adult Willingness to Use Email and Social Media for Peer-to-Peer Cancer Screening Communication: Quantitative Interview Study %A Cutrona,Sarah L %A Roblin,Douglas W %A Wagner,Joann L %A Gaglio,Bridget %A Williams,Andrew E %A Torres Stone,Rosalie %A Field,Terry S %A Mazor,Kathleen M %+ University of Massachusetts Medical School, 377 Plantation Street, Biotech IV, Suite 315, Worcester, MA, 01605, United States, 1 508 856 3086, Sarah.Cutrona@umassmemorial.org %K colorectal neoplasms %K electronic mail %K social media %K breast neoplasms %K early detection of cancer %K communication %K health promotion %K Internet %K peer group %K social support %D 2013 %7 28.11.2013 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Adults over age 40 are increasing their use of email and social media, raising interest in use of peer-to-peer Internet-based messaging to promote cancer screening. Objective: The objective of our study was to assess current practices and attitudes toward use of email and other e-communication for peer-to-peer dialogues on cancer screening. Methods: We conducted in-person interviews with 438 insured adults ages 42-73 in Georgia, Hawaii, and Massachusetts. Participants reported on use of email and other e-communication including social media to discuss with peers routine health topics including breast and colorectal cancer (CRC). We ascertained willingness to share personal CRC screening experiences via conversation, postcard, email, or other e-communication. Health literacy scores were measured. Results: Email had been used by one-third (33.8%, 148/438) to discuss routine health topics, by 14.6% (64/438) to discuss breast cancer screening, and by 12.6% (55/438) to discuss CRC screening. Other e-communication was used to discuss routine health topics (11.6%, 51/438), screening for breast cancer (3.9%, 17/438), and CRC (2.3%, 10/438). In the preceding week, 84.5% (370/438) of participants had used email, 55.9% (245/438) had used e-communication of some type; 44.3% (194/438) text, 32.9% (144/438) Facebook, 12.3% (54/438) instant message, 7.1% (31/438) video chat, and 4.8% (21/438) Twitter. Many participants were willing to share their CRC screening experiences via email (32.4%, 142/438 might be willing; 36.3%, 159/438 very willing) and via other e-communication (15.8%, 69/438 might be willing; 14.4%, 63/438 very willing). Individuals willing to send CRC screening emails scored significantly higher on tests of health literacy compared to those willing to send only postcards (P<.001). Conclusions: Many adults are willing to use email and e-communication to promote cancer screening to peers. Optimal approaches for encouraging peer-to-peer transmission of accurate and appropriate cancer screening messages must be studied. %M 24287495 %R 10.2196/resprot.2886 %U http://www.researchprotocols.org/2013/2/e52/ %U https://doi.org/10.2196/resprot.2886 %U http://www.ncbi.nlm.nih.gov/pubmed/24287495 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 11 %P e246 %T Patients’ Reported Reasons for Non-Use of an Internet-Based Patient-Provider Communication Service: Qualitative Interview Study %A Varsi,Cecilie %A Gammon,Deede %A Wibe,Torunn %A Ruland,Cornelia M %+ Center for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, Forskningsveien 2b, PO Box 4950 Nydalen, Oslo, 0424, Norway, 47 23075466, cecilie.varsi@rr-research.no %K communication %K email %K Internet %K interviews as topic %K patient dropouts %K patient non-use %K patient preference %K professional-patient relations %K qualitative research %D 2013 %7 11.11.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: The adoption of Internet-based patient–provider communication services (IPPC) in health care has been slow. Patients want electronic communication, and the quality of health care can be improved by offering such IPPCs. However, the rate of enrollment in such services remains low, and the reasons for this are unclear. Knowledge about the barriers to use is valuable during implementation of IPPCs in the health care services, and it can help timing, targeting, and tailoring IPPCs to different groups of patients. Objective: The goal of our study was to investigate patients’ views of an IPPC that they could use from home to pose questions to nurses and physicians at their treatment facility, and their reported reasons for non-use of the service. Methods: This qualitative study was based on individual interviews with 22 patients who signed up for, but did not use, the IPPC. Results: Patients appreciated the availability and the possibility of using the IPPC as needed, even if they did not use it. Their reported reasons for not using the IPPC fell into three main categories: (1) they felt that they did not need the IPPC and had sufficient access to information elsewhere, (2) they preferred other types of communication such as telephone or face-to-face contact, or (3) they were hindered by IPPC attributes such as login problems. Conclusions: Patients were satisfied with having the opportunity to send messages to health care providers through an IPPC, even if they did not use the service. IPPCs should be offered to the patients at an appropriate time in the illness trajectory, both when they need the service and when they are receptive to information about the service. A live demonstration of the IPPC at the point of enrollment might have increased its use. Trial Registration: ClinicalTrials.gov NCT00971139; http://clinicaltrial.gov/ct2/show/NCT00971139 (Archived by WebCite at http://www.webcitation.org/6KlOiYJrW). %M 24220233 %R 10.2196/jmir.2683 %U http://www.jmir.org/2013/11/e246/ %U https://doi.org/10.2196/jmir.2683 %U http://www.ncbi.nlm.nih.gov/pubmed/24220233 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 10 %P e228 %T Pediatric Caregiver Attitudes Toward Email Communication: Survey in an Urban Primary Care Setting %A Dudas,Robert Arthur %A Crocetti,Michael %+ Johns Hopkins Bayview Medical Center, Department of Pediatrics, Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, MD, 21224, United States, 1 410 550 0963, rdudas@jhmi.edu %K electronic mail %K email %K primary health care %K communication %K health care disparities %K pediatrics %D 2013 %7 23.10.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Overall usage of email communication between patients and physicians continues to increase, due in part to expanding the adoption of electronic health records and patient portals. Unequal access and acceptance of these technologies has the potential to exacerbate disparities in care. Little is known about the attitudes of pediatric caregivers with regard to their acceptance of email as a means to communicate with their health care providers. Objective: We conducted a survey to assess pediatric caregiver access to and attitudes toward the use of electronic communication modalities to communicate with health care providers in an urban pediatric primary care clinic. Methods: Participants were pediatric caregivers recruited from an urban pediatric primary care clinic in Baltimore, Maryland, who completed a 35-item questionnaire in this cross-sectional study. Results: Of the 229 caregivers who completed the survey (91.2% response rate), 171 (74.6%) reported that they use email to communicate with others. Of the email users, 145 respondents (86.3%) stated that they would like to email doctors, although only 18 (10.7%) actually do so. Among email users, African-American caregivers were much less likely to support the expanded use of email communication with health care providers (adjusted OR 0.34, 95% CI 0.14-0.82) as were those with annual incomes less than US $30,000 (adjusted OR 0.26, 95% CI 0.09-0.74). Conclusions: Caregivers of children have access to email and many would be interested in communicating with health care providers. However, African-Americans and those in lower socioeconomic groups were much less likely to have positive attitudes toward email. %M 24152542 %R 10.2196/jmir.2738 %U http://www.jmir.org/2013/10/e228/ %U https://doi.org/10.2196/jmir.2738 %U http://www.ncbi.nlm.nih.gov/pubmed/24152542 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 5 %P e135 %T Use and Acceptance of Electronic Communication by Patients With Multiple Sclerosis: A Multicenter Questionnaire Study %A Haase,Rocco %A Schultheiss,Thorsten %A Kempcke,Raimar %A Thomas,Katja %A Ziemssen,Tjalf %+ Multiple Sclerosis Centre Dresden, Department of Neurology, University of Technology Dresden, Fetscherstrasse 74, Dresden, 01307, Germany, 49 351 458 4465, Rocco.Haase@uniklinikum-dresden.de %K Multiple sclerosis %K computers %K email %K mobile phone %K health information seeking %K disease management %K communications media %K health information technology %D 2012 %7 15.10.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of multiple sclerosis (MS) information websites, online communities, and Web-based health education programs has been increasing. However, MS patients’ willingness to use new ways of communication, such as websites, mobile phone application, short message service, or email with their physician, remains unknown. Objectives: We designed a questionnaire to evaluate the a priori use of electronic communication methods by MS patients and to assess their acceptance of such tools for communication with their health care providers. Methods: We received complete data from 586 MS patients aged between 17 and 73 years. Respondents were surveyed in outpatient clinics across Germany using a novel paper-and-pencil questionnaire. In addition to demographics, the survey items queried frequency of use of, familiarity with, and comfort with using computers, websites, email, and mobile phones. Results: About 90% of all MS patients used a personal computer (534/586) and the Internet (527/586) at least once a week, 87.0% (510/586) communicated by email, and 85.6% (488/570) communicated by mobile phone. When asked about their comfort with using electronic communication methods for communication with health care providers, 20.5% (120/586) accepted communication by mobile Internet application or short message service via mobile phone, 41.0% (240/586) by websites, 54.3% (318/586) by email service, and 67.8% (397/586) by at least one type of electronic communication. The level of a priori use was the best predictor for the acceptance of electronic communication with health care providers. Patients who reported already searching online for health information (odds ratio 2.4, P < .001) and who had already communicated with a physician through a website (odds ratio 3.3, P = .03) reported higher acceptance for Web-based communication. Patients who already scheduled appointments with their mobile phones (odds ratio 2.1, P = .002) were more likely to accept the use of mobile phone applications or short message service for communicating with their physician. Conclusions: The majority of MS patients seen at specialist centers already use modern communication technology regularly. New forms of electronic communication appear to have high levels of acceptance for exchanging information about MS between patients and health care providers. Such methods should be integrated into eHealth services such as electronic health records and patient relationship management systems. %M 23069209 %R 10.2196/jmir.2133 %U http://www.jmir.org/2012/5/e135/ %U https://doi.org/10.2196/jmir.2133 %U http://www.ncbi.nlm.nih.gov/pubmed/23069209 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 4 %P e79 %T Physician Response Time When Communicating With Patients Over the Internet %A Kummervold,Per Egil %A Johnsen,Jan-Are K %+ Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway HF, P.O. Box 6060, Tromsø, 9038, Norway, 47 07766, per.egil.kummervold@telemed.no %K Electronic mail %K Internet %K patients %K physicians %K patient communication %K health communication %D 2011 %7 01.11.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients want to use electronic communication to access health services more easily. Health authorities in several countries see this as a way to improve health care. Physicians appear to have conflicting opinions regarding the suitability of electronic communication in clinical settings. Objectives: The aim of our study was to measure how long it actually takes physicians to answer questions from patients through an electronic communication channel, and whether some of the questions are especially time consuming. Methods: We monitored electronic patient–physician communication. A total of 1113 messages from 14 participating physicians from 7 medical offices were analyzed. The length of questions and answers, and the time physicians spent answering the questions were recorded and analyzed. Results: Physicians spent an average of 2.3 minutes (median 2 minutes) answering questions from patients. The patients’ questions had an average length of 507.1 characters (95% CI 487.4–526.9, SD 336.2), while physicians’ answers averaged 119.9 characters (95% CI 189.8–210.0, SD 172.6). The results show that the influence of patient question length on time spent responding was negligible. For the shortest 25% of the questions the answer time was 2.1 minutes (95% CI 1.9–2.3), while it was 2.4 minutes (95% CI 2.2–2.7) for the longest 25%. Even extremely long questions had a minimal impact on the time spent answering them. A threefold increase in question length from patients resulted in only an 18% increase in physician response time. Conclusions: The study shows the potential clinical usefulness of electronic communication between patients and health care services by demonstrating the potential for saving time. %M 22044909 %R 10.2196/jmir.1583 %U http://www.jmir.org/2011/4/e79/ %U https://doi.org/10.2196/jmir.1583 %U http://www.ncbi.nlm.nih.gov/pubmed/22044909 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 1 %P e23 %T The Use of Physician-Patient Email: A Follow-up Examination of Adoption and Best-Practice Adherence 2005-2008 %A Menachemi,Nir %A Prickett,Charles T %A Brooks,Robert G %+ School of Public Health, University of Alabama at Birmingham, 1530 3rd Ave South, Ryals Bdg #320, Birmingham, AL, 35294, United States, 1 205 934 7192, nmenachemi@uab.edu %K email %K physician-patient relationship %D 2011 %7 25.02.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: Improved communication from physician- patient emailing is an important element of patient centeredness. Physician-patient email use has been low; and previous data from Florida suggest that physicians who email with patients rarely implement best-practice guidelines designed to protect physicians and patients. Objective: Our objective was to examine whether email use with patients has changed over time (2005-2008) by using two surveys of Florida physicians, and to determine whether physicians have more readily embraced the best-practice guidelines in 2008 versus 2005. Lastly, we explored the 2008 factors associated with email use with patients and determined whether these factors changed relative to 2005. Methods: Our pooled time-series design used results from a 2005 survey (targeting 14,921 physicians) and a separate 2008 survey (targeting 7003 different physicians). In both years, physicians practicing in the outpatient setting were targeted with proportionally identical sampling strategies. Combined data from questions focusing on email use were analyzed using chi-square analysis, Fisher exact test, and logistic regression. Results: A combined 6260 responses were available for analyses, representing a participation rate of 28.2% (4203/14,921) in 2005 and 29.4% (2057/7003) in 2008. Relative to 2005, respondents in 2008 were more likely to indicate that they personally used email with patients (690/4148, 16.6% vs 408/2001, 20.4%, c21 = 13.0, P < .001). However, physicians who reported frequently using email with patients did not change from 2005 to 2008 (2.9% vs 59/2001, 2.9%). Interest among physicians in future email use with patients was lower in 2008 (58.4% vs 52.8%, c22 = 16.6, P < .001). Adherence to email best practices remained low in 2008. When comparing 2005 and 2008 adherences with each of the individual guidelines, rates decreased over time in each category and were significantly lower for 4 of the 13 guidelines. Physician characteristics in 2008 that predicted email use with patients were different from 2005. Specifically, in multivariate analysis female physicians (OR 1.48, 95% CI 1.12-1.95), specialist physicians (OR 1.43, 95% CI 1.12-1.84), and those in a multispecialty practice (OR 1.76, 95% CI 1.30-2.37) were more likely than their counterparts to email with patients. Additionally, self-reported computer competency levels (on a 5-point Likert scale) among physicians predicted email use at every level of response. Conclusions: Email use between physicians and patients has changed little between 2005 and 2008. However, future physician interest in using email with patients has decreased. More troubling is the decrease in adherence to best practices designed to protect physicians and patients when using email. Policy makers wanting to harness the potential benefits of physician-patient email should devise plans to encourage adherence to best practices. These plans should also educate physicians on the existence of best practices and methods to incorporate these guidelines into routine workflows. %M 21447468 %R 10.2196/jmir.1578 %U http://www.jmir.org/2011/1/e23/ %U https://doi.org/10.2196/jmir.1578 %U http://www.ncbi.nlm.nih.gov/pubmed/21447468