%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69004 %T Breaking Digital Health Barriers Through a Large Language Model–Based Tool for Automated Observational Medical Outcomes Partnership Mapping: Development and Validation Study %A Adams,Meredith CB %A Perkins,Matthew L %A Hudson,Cody %A Madhira,Vithal %A Akbilgic,Oguz %A Ma,Da %A Hurley,Robert W %A Topaloglu,Umit %+ , Department of Anesthesiology, Artificial Intelligence, Translational Neuroscience, and Public Health Sciences, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, United States, 1 13367162255, meradams@wakehealth.edu %K large language model %K artificial intelligence %K common data model %K data harmonization %K clinical trials %K electronic health record %K registry data %D 2025 %7 15.5.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The integration of diverse clinical data sources requires standardization through models such as Observational Medical Outcomes Partnership (OMOP). However, mapping data elements to OMOP concepts demands significant technical expertise and time. While large health care systems often have resources for OMOP conversion, smaller clinical trials and studies frequently lack such support, leaving valuable research data siloed. Objective: This study aims to develop and validate a user-friendly tool that leverages large language models to automate the OMOP conversion process for clinical trials, electronic health records, and registry data. Methods: We developed a 3-tiered semantic matching system using GPT-3 embeddings to transform heterogeneous clinical data to the OMOP Common Data Model. The system processes input terms by generating vector embeddings, computing cosine similarity against precomputed Observational Health Data Sciences and Informatics vocabulary embeddings, and ranking potential matches. We validated the system using two independent datasets: (1) a development set of 76 National Institutes of Health Helping to End Addiction Long-term Initiative clinical trial common data elements for chronic pain and opioid use disorders and (2) a separate validation set of electronic health record concepts from the National Institutes of Health National COVID Cohort Collaborative COVID-19 enclave. The architecture combines Unified Medical Language System semantic frameworks with asynchronous processing for efficient concept mapping, made available through an open-source implementation. Results: The system achieved an area under the receiver operating characteristic curve of 0.9975 for mapping clinical trial common data element terms. Precision ranged from 0.92 to 0.99 and recall ranged from 0.88 to 0.97 across similarity thresholds from 0.85 to 1.0. In practical application, the tool successfully automated mappings that previously required manual informatics expertise, reducing the technical barriers for research teams to participate in large-scale, data-sharing initiatives. Representative mappings demonstrated high accuracy, such as demographic terms achieving 100% similarity with corresponding Logical Observation Identifiers Names and Codes concepts. The implementation successfully processes diverse data types through both individual term mapping and batch processing capabilities. Conclusions: Our validated large language model–based tool effectively automates the transformation of clinical data into the OMOP format while maintaining high accuracy. The combination of semantic matching capabilities and a researcher-friendly interface makes data harmonization accessible to smaller research teams without requiring extensive informatics support. This has direct implications for accelerating clinical research data standardization and enabling broader participation in initiatives such as the National Institutes of Health Helping to End Addiction Long-term Initiative Data Ecosystem. %M 40146872 %R 10.2196/69004 %U https://www.jmir.org/2025/1/e69004 %U https://doi.org/10.2196/69004 %U http://www.ncbi.nlm.nih.gov/pubmed/40146872 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66161 %T AI-Assisted Hypothesis Generation to Address Challenges in Cardiotoxicity Research: Simulation Study Using ChatGPT With GPT-4o %A Li,Yilan %A Gu,Tianshu %A Yang,Chengyuan %A Li,Minghui %A Wang,Congyi %A Yao,Lan %A Gu,Weikuan %A Sun,DianJun %+ The Second Affiliated Hospital of Harbin Medical University, Centre for Endemic Disease Control, Chinese Centre for Disease Control and Prevention, Harbin Medical University, Key Laboratory of Etiologic Epidemiology, Education Bureau of Heilongjiang Province & Ministry of Health, Nangang District, Harbin, 150081, China, 86 0451 86664762, hrbmusdj@163.com %K cardiotoxicity %K ChatGPT with GPT-4o %K artificial intelligence %K AI %K heart %K hypothesis generation %D 2025 %7 15.5.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Cardiotoxicity is a major concern in heart disease research because it can lead to severe cardiac damage, including heart failure and arrhythmias. Objective: This study aimed to explore the ability of ChatGPT with GPT-4o to generate innovative research hypotheses to address 5 major challenges in cardiotoxicity research: the complexity of mechanisms, variability among patients, the lack of detection sensitivity, the lack of reliable biomarkers, and the limitations of animal models. Methods: ChatGPT with GPT-4o was used to generate multiple hypotheses for each of the 5 challenges. These hypotheses were then independently evaluated by 3 experts for novelty and feasibility. ChatGPT with GPT-4o subsequently selected the most promising hypothesis from each category and provided detailed experimental plans, including background, rationale, experimental design, expected outcomes, potential pitfalls, and alternative approaches. Results: ChatGPT with GPT-4o generated 96 hypotheses, of which 13 (14%) were rated as highly novel and 62 (65%) as moderately novel. The average group score of 3.85 indicated a strong level of innovation in these hypotheses. Literature searching identified at least 1 relevant publication for 28 (29%) of the 96 hypotheses. The selected hypotheses included using single-cell RNA sequencing to understand cellular heterogeneity, integrating artificial intelligence with genetic profiles for personalized cardiotoxicity risk prediction, applying machine learning to electrocardiogram data for enhanced detection sensitivity, using multi-omics approaches for biomarker discovery, and developing 3D bioprinted heart tissues to overcome the limitations of animal models. Our group’s evaluation of the 30 dimensions of the experimental plans for the 5 hypotheses selected by ChatGPT with GPT-4o revealed consistent strengths in the background, rationale, and alternative approaches, with most of the hypotheses (20/30, 67%) receiving scores of ≥4 in these areas. While the hypotheses were generally well received, the experimental designs were often deemed overly ambitious, highlighting the need for more practical considerations. Conclusions: Our study demonstrates that ChatGPT with GPT-4o can generate innovative and potentially impactful hypotheses for overcoming critical challenges in cardiotoxicity research. These findings suggest that artificial intelligence–assisted hypothesis generation could play a crucial role in advancing the field of cardiotoxicity, leading to more accurate predictions, earlier detection, and better patient outcomes. %M 40373295 %R 10.2196/66161 %U https://www.jmir.org/2025/1/e66161 %U https://doi.org/10.2196/66161 %U http://www.ncbi.nlm.nih.gov/pubmed/40373295 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70122 %T A Practical Guide and Assessment on Using ChatGPT to Conduct Grounded Theory: Tutorial %A Yue,Yongjie %A Liu,Dong %A Lv,Yilin %A Hao,Junyi %A Cui,Peixuan %+ , School of Journalism and Communication, Renmin University of China, No. 59 Zhongguancun Street, Beijing, 100872, China, 86 13693388506, bnuliudong@gmail.com %K grounded theory %K ChatGPT %K manual coding %K computer-assisted software %K performance %K human-AI collaboration %D 2025 %7 14.5.2025 %9 Tutorial %J J Med Internet Res %G English %X Generative large language models (LLMs), such as ChatGPT, have significant potential for qualitative data analysis. This paper aims to provide an early insight into how LLMs can enhance the efficiency of text coding and qualitative analysis, and evaluate their reliability. Using a dataset of semistructured interviews with blind gamers, this study provides a step-by-step tutorial on applying ChatGPT 4-Turbo to the grounded theory approach. The performance of ChatGPT 4-Turbo is evaluated by comparing its coding results with manual coding results assisted by qualitative analysis software. The results revealed that ChatGPT 4-Turbo and manual coding methods exhibited reliability in many aspects. The application of ChatGPT 4-Turbo in grounded theory enhanced the efficiency and diversity of coding and updated the overall grounded theory process. Compared with manual coding, ChatGPT showed shortcomings in depth, context, connections, and coding organization. Limitations and recommendations for applying artificial intelligence in qualitative research were also discussed. %M 40367510 %R 10.2196/70122 %U https://www.jmir.org/2025/1/e70122 %U https://doi.org/10.2196/70122 %U http://www.ncbi.nlm.nih.gov/pubmed/40367510 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e71873 %T Advancing the Use of Longitudinal Electronic Health Records: Tutorial for Uncovering Real-World Evidence in Chronic Disease Outcomes %A Huang,Feiqing %A Hou,Jue %A Zhou,Ningxuan %A Greco,Kimberly %A Lin,Chenyu %A Sweet,Sara Morini %A Wen,Jun %A Shen,Lechen %A Gonzalez,Nicolas %A Zhang,Sinian %A Liao,Katherine P %A Cai,Tianrun %A Xia,Zongqi %A Bourgeois,Florence T %A Cai,Tianxi %+ Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA, 02115, United States, 1 6174324923, tcai@hsph.harvard.edu %K real-world evidence %K electronic health records %K chronic disease outcomes %K longitudinal disease activity %K machine learning %K causal inference %K data imputation %K calibration %D 2025 %7 12.5.2025 %9 Tutorial %J J Med Internet Res %G English %X Managing chronic diseases requires ongoing monitoring of disease activity and therapeutic responses to optimize treatment plans. With the growing availability of disease-modifying therapies, it is crucial to investigate comparative effectiveness and long-term outcomes beyond those available from randomized clinical trials. We introduce a comprehensive pipeline for generating reproducible and generalizable real-world evidence on disease outcomes by leveraging electronic health record data. The pipeline first generates scalable disease outcomes by linking electronic health record data with registry data containing a small sample of labeled outcomes. It then applies causal analysis using these scalable outcomes to evaluate therapies for chronic diseases. The implementation of the pipeline is illustrated in a case study based on multiple sclerosis. Our approach addresses challenges in real-world evidence generation for disease activity of chronic conditions, specifically the lack of direct observations on key outcomes and biases arising from imperfect or incomplete data. We present advanced machine learning techniques such as semisupervised and ensemble methods to impute missing outcome data, further incorporating steps for calibrated causal analyses and bias correction. %M 40357530 %R 10.2196/71873 %U https://www.jmir.org/2025/1/e71873 %U https://doi.org/10.2196/71873 %U http://www.ncbi.nlm.nih.gov/pubmed/40357530 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 9 %N %P e66436 %T Augmenting Engagement in Decentralized Clinical Trials for Atrial Fibrillation: Development and Implementation of a Programmatic Architecture %A Omole,Toluwa Daniel %A Mrkva,Andrew %A Ferry,Danielle %A Shepherd,Erin %A Caratelli,Jessica %A Davis,Noah %A Akatue,Richmond %A Bickmore,Timothy %A Paasche-Orlow,Michael K %A Magnani,Jared W %K atrial fibrillation %K rurality %K diversity %K mobile health intervention %K mobile health %K mhealth %K chronic cardiovascular condition %K cardiovascular %K cardio %K heart %K vascular %K medication %K self-monitoring %K digital health %K programmatic architecture %K effectiveness %K smartphone-based %K smartphone %K telehealth %K telemedicine %K digital technology %K application %K digital literacy %K clinical trial %K cardiovascular trials %D 2025 %7 12.5.2025 %9 %J JMIR Cardio %G English %X Background: Atrial fibrillation (AF) is a chronic cardiovascular condition that requires long-term adherence to medications and self-monitoring. Clinical trials for AF have had limited diversity by sex, race and ethnicity, and rural residence, thereby compromising the integrity and generalizability of trial findings. Digital technology coupled with remote strategies has the potential to increase recruitment of individuals from underrepresented demographic and geographic populations, resulting in increased trial diversity, and improvement in the generalizability of interventions for complex diseases such as AF. Objective: This study aimed to summarize the architecture of a research program using remote methods to enhance geographic and demographic diversity in mobile health trials to improve medication adherence. Methods: We developed a programmatic architecture to conduct remote recruitment and assessments of individuals with AF in 2 complementary randomized clinical trials, funded by the National Institutes of Health, to test the effectiveness of a smartphone-based relational agent on adherence to oral anticoagulation. The study team engaged individuals with either rural or metropolitan residences receiving care for AF at health care settings who then provided consent, and underwent baseline assessments and randomization during a remotely conducted telephone visit. Participants were randomized to receive the relational agent intervention or control and subsequently received a study smartphone with installed apps by mail. Participants received a telephone-based training session on device and app usage accompanied by a booklet with pictures and instructions accessible for any level of health or digital literacy. The program included remote methods by mail and telephone to promote retention at 4-, 8-, and 12-month visits and incentivized return of the smartphone following study participation. The program demonstrated excellent participant engagement and retention throughout the duration of the clinical trials. Results: The trials enrolled 513 participants, surpassing recruitment goals for the rural (n=270; target n=264) and metropolitan (n=243; target n=240) studies. A total of 62% (319/513) were women; 31% (75/243) of participants in the metropolitan study were African American, Asian, American Indian or Alaskan native or other races or ethnicities, in contrast to 5% (12/270) in the rural study. Among all participants, 56% (286/513) had less than an associate’s degree and 44% (225/513) were characterized as having limited health literacy. Intervention recipients receiving the relational agent used the agent median of 95‐98 (IQR, 56‐109) days across both studies. Retention exceeded 89% (457/513) at 12 months with study phones used for median 3.3 (IQR, 1‐5) participants. Conclusions: We report here the development and implementation of a programmatic architecture for the remote conduct of clinical trials. Our program successfully enhanced trial diversity and composition while providing an innovative mobile health intervention for medication adherence in AF. Our methods provide a model for enhanced recruitment and engagement of diverse participants in cardiovascular trials. Trial Registration: Clinicaltrials.gov NCT04076020; https://clinicaltrials.gov/study/NCT04076020 and Clinicaltrials.gov NCT04075994; https://clinicaltrials.gov/study/NCT04075994 %R 10.2196/66436 %U https://cardio.jmir.org/2025/1/e66436 %U https://doi.org/10.2196/66436 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62884 %T Development and Validation of the Media Health Literacy Scale: Assessment Tool Development Study %A Shin,Sangyoon %A Kim,Seungyeon %A Song,Youngshin %A Jeong,Hyesun %A Yu,Yun Mi %A Lee,Euni %+ Research Institute of Pharmaceutical Sciences, Natural Products Research Institute, College of Pharmacy, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 2 740 8588, eunilee@snu.ac.kr %K media %K internet %K media health literacy %K ehealth literacy %K survey development %K validation %K health-related information %K communication %D 2025 %7 5.5.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Advancements in IT have transformed methods for accessing and conveying health-related information. While technical advancements offer more options for people to choose their preferred information sources, injudicious dissemination of incorrect or unverified health-related information by internet-based media poses a threat to society. The concepts of media health literacy (MeHlit) and eHealth literacy have emerged for assessing one’s ability to understand and use health-related information from media sources. However, tools to evaluate the level of MeHlit within the domain of communication or follow a solid validation process are scarce. Objective: This study aimed to develop a validated tool to evaluate the level of MeHlit in adults in South Korea. Methods: A 2-step tool development process, including item development and validation processes, was carried out. At first, tool development studies were identified by a systematic review of the literature. A conceptual framework was established from the review by constructing an affinity diagram, and an item pool was generated. Face validation was conducted to assess whether the items measured MeHlit properly. Content validation was conducted to assess the overall relationship between domains by calculating the content validity index. Construct validation processes, including exploratory and confirmatory factor analyses, were completed with 1000 adults. Internal consistency of the Media Health Literacy Scale (MHLS) was assessed with Cronbach α. Concurrent validation was conducted to validate the MHLS’s performance by comparing it with an established tool, the Korean version of the eHealth Literacy scale (K-eHEALS). Results: A total of 13 published studies from the systematic review was used to develop the conceptual framework and an item pool of 65 items was created, including 3 domains (access, critical evaluation, and communication) and 9 subdomains. Through face and content validation processes, the MHLS was refined to comprise 3 domains, 6 subdomains, and 29 items. A total of 1000 participants were recruited for exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Five subdomains were identified through EFA, and CFA demonstrated a good model fit (chi-square [Cmin χ2/df] under 2.659, root mean square error of approximation=0.058 [90% CI 0.053-0.062], comparative fit index=0.927, and standard root mean residual under 0.067). Following the EFA and CFA, Cronbach α scores of 0.915 and 0.932, respectively, were obtained, indicating that the tool had good reliability. A positive correlation was found between the MHLS and K-eHEALS from the concurrent validity evaluation, indicating that the MHLS can assess the target concept similarly as the K-eHEALS (Pearson correlation coefficient=0.736, P<.001). Conclusions: The MHLS was developed and validated in a step-by-step process to assess individuals’ ability to access, critically evaluate, and communicate health-related information through media platforms. This validated tool can serve in identifying deficiencies in specific MHLS areas and subsequently providing targeted education. %M 40323645 %R 10.2196/62884 %U https://www.jmir.org/2025/1/e62884 %U https://doi.org/10.2196/62884 %U http://www.ncbi.nlm.nih.gov/pubmed/40323645 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67948 %T Translation, Cross-Cultural Adaptation, and Psychometric Validation of the Health Information Technology Usability Evaluation Scale in China: Instrument Validation Study %A Guo,Rongrong %A Zheng,Ziling %A Yang,Fangyu %A Wu,Ying %+ School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Feng-tai District, Beijing, 100069, China, 86 1391 078 9837, helenywu@vip.163.com %K cross-cultural adaptation %K digital health application %K reliability %K translation %K usability %K validity %D 2025 %7 2.5.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The dramatic growth of digital health apps highlights an urgent need for rigorous usability evaluation tools. While the Health Information Technology Usability Evaluation Scale (Health-ITUES) has gained validation, a Chinese version has not yet been developed and validated. Objective: This study aimed to translate and culturally adapt the Health-ITUES into Chinese, customize it for both service consumers and professional health care providers, and evaluate its reliability and validity in the Chinese context. Methods: Following the Guidelines for the Process of Cross-Cultural Adaptation of Self-report measures, the Health-ITUES was meticulously translated and culturally adapted into Chinese version following 2 rounds of expert consultation. Subsequently, based on the SMART system, an intelligent and integrated older adult care model, the Chinese version of the Health-ITUES was customized into the care receiver version (Health-ITUES-R) and professional health care provider version (Health-ITUES-P). Older individuals and nurses participated in the validation testing conducted between December 2020 and February 2021, facilitated by the improvement of the COVID-19 pandemic and the timing preceding the Spring Festival, which ensured feasible recruitment and a sufficient sample size. In addition, the pandemic-driven increase in digital health app usage allowed us to assess usability in a relevant real-world health care setting. Content validity, internal consistency reliability, construct validity, convergent validity, discriminant validity, and criterion validity were used to evaluate the psychometric attributes of the Health-ITUES-R and Health-ITUES-P. Results: A Chinese version of the Health-ITUES comprising 20 items across 4 dimensions was formulated, informing the customization of the Health-ITUES-R and Health-ITUES-P. In total, 110 and 124 eligible older adults and nurses validated the customized Health-ITUES-R and Health-ITUES-P, respectively. Both versions exhibited satisfactory content validity (content validity index of items=0.83-1.00; content validity index of scale=0.99) and adequate internal consistency reliability (Cronbach α and McDonald ω>0.80 for the overall scale; >0.75 for individual items). Confirmatory factor analysis confirmed a 4D structure with acceptable construct validity, as indicated by model fit indices. Both the Health-ITUES-R and Health-ITUES-P showed satisfactory convergent validity (average variance extracted [AVE] value>0.5, composite reliability value>0.7), except for a slightly lower AVE value (0.478) for the second dimension of the Health-ITUES-R. Discriminant validity was supported, with the square root of AVE values exceeding correlation coefficients and the Hetereotrait-Monotrait ratio below 0.85. Furthermore, Pearson correlation coefficients for the perceived usefulness dimension, perceived ease of use dimension, and overall scale of the Health-ITUES-R and patient acceptance questionnaire for mobile health application were 0.587, 0.647, and 0.743 (all P<.01), demonstrating a significant correlation. Conclusions: The Chinese version of the Health-ITUES can be used as a valid and reliable tool to evaluate the usability of digital health apps for both care receivers and professional health care providers in the Chinese context. %M 40315454 %R 10.2196/67948 %U https://www.jmir.org/2025/1/e67948 %U https://doi.org/10.2196/67948 %U http://www.ncbi.nlm.nih.gov/pubmed/40315454 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59476 %T Potential Harms of Feedback After Web-Based Depression Screening: Secondary Analysis of Negative Effects in the Randomized Controlled DISCOVER Trial %A Sikorski,Franziska %A Löwe,Bernd %A Daubmann,Anne %A Kohlmann,Sebastian %+ Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, 20246, Germany, 49 6221 56 32878, s.kohlmann@uke.de %K randomized controlled trial %K depressive disorder %K screening %K negative effects %K harms %K web-based %K mental health %K misdiagnosis %K overdiagnosis %D 2025 %7 30.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based depression screening followed by automated feedback of results is frequently used and promoted by mental health care providers. However, criticism points to potential associated harms. Systematic empirical evidence on postulated negative effects is missing. Objective: We aimed to examine whether automated feedback after web-based depression screening is associated with misdiagnosis, mistreatment, deterioration in depression severity, deterioration in emotional response to symptoms, and deterioration in suicidal ideation at 1 and 6 months after screening. Methods: This is a secondary analysis of the German-wide, web-based, randomized controlled DISCOVER trial. Affected but undiagnosed individuals screening positive for depression (9-item Patient Health Questionnaire [PHQ-9] ≥10 points) were randomized 1:1:1 to receive nontailored feedback, tailored feedback, or no feedback on their screening result. Misdiagnosis and mistreatment were operationalized as having received a depression diagnosis by a health professional and as having started guideline-based depression treatment since screening (self-report), respectively, while not having met the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-V) criteria of a major depressive disorder at baseline (Structured Clinical Interview for DSM-V Disorders). Deterioration in depression severity was defined as a pre-post change of ≥4.4 points in the PHQ-9, deterioration in emotional response to symptoms as a pre-post change of ≥3.1 points in a composite scale of the Brief Illness Perception Questionnaire, and deterioration in suicidal ideation as a pre-post change of ≥1 point in the PHQ-9 suicide item. Outcome rates were compared between each feedback arm and the no feedback arm in terms of relative risks (RRs). Results: In the per protocol sample of 948 participants (n=685, 72% female; mean age of 37.3, SD 14.1 years), there was no difference in rates of misdiagnosis (ranging from 3.5% to 4.9% across all study arms), mistreatment (7.2%-8.3%), deterioration in depression severity (2%-6.8%), deterioration in emotional response (0.7%-2.9%), and deterioration in suicidal ideation at 6 months (6.8%-13.1%) between the feedback arms and the no feedback arm (RRs ranging from 0.46 to 1.96; P values ≥.13). The rate for deterioration in suicidal ideation at 1 month was increased in the nontailored feedback arm (RR 1.92; P=.01) but not in the tailored feedback arm (RR 1.26; P=.43), with rates of 12.3%, 8.1%, and 6.4% in the nontailored, tailored, and no feedback arms, respectively. All but 1 sensitivity analyses as well as subgroup analyses for false-positive screens supported the findings. Conclusions: The results indicate that feedback after web-based depression screening is not associated with negative effects such as misdiagnosis, mistreatment, and deterioration in depression severity or in emotional response to symptoms. However, it cannot be ruled out that nontailored feedback may increase the risk of deterioration in suicidal ideation. Robust prospective research on negative effects and particularly suicidal ideation is needed and should inform current practice. Trial Registration: ClinicalTrials.gov NCT04633096; https://clinicaltrials.gov/study/NCT04633096; Open Science Framework 10.17605/OSF.IO/TZYRD; https://osf.io/tzyrd %M 40305104 %R 10.2196/59476 %U https://www.jmir.org/2025/1/e59476 %U https://doi.org/10.2196/59476 %U http://www.ncbi.nlm.nih.gov/pubmed/40305104 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e59519 %T Use of Behavior Change Techniques in Digital HIV Prevention Programs for Adolescents and Young People: Systematic Review %A Mo,Phoenix Kit-han %A Xie,Luyao %A Lee,Tsz Ching %A Li,Angela Yuen Chun %+ Center for Health Behaviours Research, JC School of Public Health and Primary Care, Chinese University of Hong Kong, No. 30-32 Ngan Shing Street, Hong Kong, China (Hong Kong), 852 22528765, phoenix.mo@cuhk.edu.hk %K HIV %K prevention %K adolescent %K young adult %K behavior change techniques %D 2025 %7 28.4.2025 %9 Review %J JMIR Public Health Surveill %G English %X Background: HIV infections have caused severe public health and economic burdens to the world. Adolescents and young people continue to constitute a large proportion of newly diagnosed HIV cases. Digital health interventions have been increasingly used to prevent the rising HIV epidemic. Behavior change techniques (BCTs) are intervention components designed to modify the underlying processes that regulate behavior. The BCT taxonomy offers a systematic approach to identifying, extracting, and coding these components, providing valuable insights into effective intervention strategies. However, few reviews have comprehensively identified the use of BCTs in digital HIV interventions among adolescents and young people. Objective: This study aimed to synthesize existing evidence on the commonly used BCTs in effective digital HIV prevention programs targeting adolescents and young people. Methods: In total, 4 databases (PubMed, Embase, Cochrane Library, and APA PsycINFO) were searched, and studies from January 2008 to November 2024 were screened. Reference lists of relevant review studies were reviewed to identify any additional sources. Eligible randomized controlled trials with 1 of 3 HIV prevention outcomes (ie, HIV knowledge, condom-use self-efficacy, and condom use) were included. Basic study characteristics, intervention strategies, and study results were extracted and compared for data analysis. For the included interventions, BCTs were identified according to the BCT taxonomy proposed by Abraham and Michie in 2008, and the frequencies of BCTs used in these interventions were counted. Results: Searches yielded 383 studies after duplicates were removed, with 34 (8.9%) publications finally included in this review. The most frequently used BCTs included prompting intention formation (34/34, 100%), providing information about behavior-health link (33/34, 97%), providing information on consequences (33/34, 97%), and providing instruction (33/34, 97%). Interventions with significant improvements in HIV knowledge (11/34, 32%) more frequently used BCTs with a provision nature, such as providing information about behavior-health link (11/11, 100%), information on consequences (11/11, 100%), encouragement (10/11, 91%), and instruction (10/11, 91%). Those with significant increases in condom-use self-efficacy (7/34, 20%) used BCTs toward initiating actions, such as prompts for intention formation (7/7, 100%), barrier identification (7/7, 100%), and practice (5/7, 71%). In addition, studies showing significant improvements in condom use (14/34, 41%) included BCTs focused not only on provision and initiation but also on behavioral management and maintenance, such as use follow-up prompts (5/14, 36%), relapse prevention (4/14, 29%), prompt self-monitoring of behavior (3/14, 21%), and prompt review of behavioral goals (3/14, 21%). Conclusions: This is the first systematic review that examined the use of BCTs in digital HIV prevention interventions for adolescents and young adults. The identified BCTs offer important reference for developing more effective digital interventions, with implications for enhancing their HIV knowledge, condom-use self-efficacy, and condom use in youth. %M 40293783 %R 10.2196/59519 %U https://publichealth.jmir.org/2025/1/e59519 %U https://doi.org/10.2196/59519 %U http://www.ncbi.nlm.nih.gov/pubmed/40293783 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66034 %T Family Caregiver Perspectives on Digital Methods to Measure Stress: Qualitative Descriptive Study %A Rose,Louise %A Saha,Sian %A Flowers,Emily %A Ang,Chee Siang %A Casson,Alexander J %A Condell,Joan %A Matcham,Faith %A Robinson,Tony %A Rooksby,John %+ Faculty of Nursing Midwifery & Palliative Care, King's College London, Rm 1.13, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, United Kingdom, 44 7846044447, louise.rose@kcl.ac.uk %K psychological stress %K qualitative research %K family caregivers %K digital stress monitoring %K caregiver burden %K biosensing technologies %K descriptive study %K qualitative study %K semistructured interview %K ecological momentary assessment %K remote monitoring %K smartwatches %K fluid biosensors %K framework approach %K wearables %K digital technologies %K digital health %D 2025 %7 24.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Family caregivers provide essential care in the home to millions of individuals around the globe annually. However, family caregiving results in considerable burden, financial hardship, stress, and psychological morbidity. Identifying and managing stress in caregivers is important as they have a dual role in managing their own health as well as that of the person they care for. If stress becomes overwhelming, a caregiver may no longer be able to perform this essential role. Digital methods of stress monitoring may be 1 strategy for identifying effective interventions to relieve caregiver burden and stress. Objective: This study aims to explore the perceived acceptability, challenges, and opportunities of using digital and biosensing technologies to measure caregiver stress. Methods: We conducted a descriptive qualitative study using semistructured interviews with an interview guide structured to obtain qualitative data addressing our study aims. We used reflexive thematic analysis methods. We recruited adult family caregivers (aged 18 years and older) currently or previously caring for an adult in the home with significant health issues. Interview questions focused on stress monitoring more generally and on ecological momentary assessment, remote monitoring technologies such as smartwatches, and fluid biosensors. Results: We recruited 27 family caregivers of whom 19 (70%) were currently in a caregiving role, and the remainder were previously in a caregiving role. We identified 3 themes with 10 subthemes addressing elements of acceptability, challenges, and opportunities of using digital and biosensing technologies to measure caregiver stress The themes comprised “providing meaningful data” with subthemes of “monitoring without action is pointless,” “monitoring that enables self-management,” and “seeing the bigger picture”; “low-burden monitoring” with subthemes of “low effort,” “practical alongside daily routines,” and “retaining control over monitoring”; and “inadvertent harms of stress monitoring” with subthemes of “stigma of stress,” “need for discretion,” “contributing to stress,” and “trust.” Conclusions: In this descriptive qualitative study examining the perspectives of a diverse sample of family caregivers on methods of stress monitoring, we identified 3 themes addressing elements of acceptability, challenges, and opportunities. These provide useful considerations for the use of stress monitoring and implementation of interventions to ameliorate family caregivers’ stress of relevance to social care and community teams, researchers, and policy makers. These include providing meaningful situationally specific data resulting in action, that does not contribute to caregiver burden, or inadvertent harm to either the caregiver or the care recipient. %M 40273447 %R 10.2196/66034 %U https://www.jmir.org/2025/1/e66034 %U https://doi.org/10.2196/66034 %U http://www.ncbi.nlm.nih.gov/pubmed/40273447 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60041 %T Validation of an Adaptive Assessment of Executive Functions (Adaptive Cognitive Evaluation-Explorer): Longitudinal and Cross-Sectional Analyses of Cognitive Task Performance %A O'Laughlin,Kristine D %A Cheng,Britte Haugan %A Volponi,Joshua J %A Lorentz,John David A %A Obregon,Sophia A %A Younger,Jessica Wise %A Gazzaley,Adam %A Uncapher,Melina R %A Anguera,Joaquin A %+ Neuroscape, Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, United States, 1 4157024322, joaquin.anguera@ucsf.edu %K executive functions %K serious games %K validation %K computerized assessment %K cognitive assessment %D 2025 %7 21.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Executive functions (EFs) predict positive life outcomes and educational attainment. Consequently, it is imperative that our measures of EF constructs are both reliable and valid, with advantages for research tools that offer efficiency and remote capabilities. Objective: The objective of this study was to evaluate reliability and validity evidence for a mobile, adaptive measure of EFs called Adaptive Cognitive Evaluation-Explorer (ACE-X). Methods: We collected data from 2 cohorts of participants: a test-retest sample (N=246, age: mean 35.75, SD 11.74 y) to assess consistency of ACE-X task performance over repeated administrations and a validation sample involving child or adolescent (5436/6052, 89.82%; age: mean 12.78, SD 1.60 years) and adult participants (484/6052, 8%; age: mean 38.11, SD 14.96 years) to examine consistency of metrics, internal structures, and invariance of ACE-X task performance. A subset of participants (132/6052, 2.18%; age: mean 37.04, SD 13.23 years) also completed a similar set of cognitive tasks using the Inquisit platform to assess the concurrent validity of ACE-X. Results: Intraclass correlation coefficients revealed most ACE-X tasks were moderately to very reliable across repeated assessments (intraclass correlation coefficient=0.45-0.79; P<.001). Moreover, in comparisons of internal structures of ACE-X task performance, model fit indices suggested that a network model based on partial correlations was the best fit to the data (χ228=40.13; P=.06; comparative fit index=0.99; root mean square error of approximation=0.03, 90% CI 0.00-0.05; Bayesian information criterion=5075.87; Akaike information criterion=4917.71) and that network edge weights are invariant across both younger and older adult participants. A Spinglass community detection algorithm suggested ACE-X task performance can be described by 3 communities (selected in 85% of replications): set reconfiguration, attentional control, and interference resolution. On the other hand, Pearson correlation coefficients indicated mixed results for the concurrent validity comparisons between ACE-X and Inquisit (r=–.05-.62, P<.001-.76). Conclusions: These findings suggest that ACE-X is a reliable and valid research tool for understanding EFs and their relations to outcome measures. %M 40258271 %R 10.2196/60041 %U https://www.jmir.org/2025/1/e60041 %U https://doi.org/10.2196/60041 %U http://www.ncbi.nlm.nih.gov/pubmed/40258271 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e59511 %T Italian Medical Professionals' Practices, Attitudes, and Knowledge in Travel Medicine: Protocol for a National Survey %A Baglivo,Francesco %A De Angelis,Luigi %A Vannini,Federico %A Agostini,Antonello %A Todaro,Antonio %A Torri,Eleonora %A Gianolio Lopez,Giulio Alberto %A Fui,Margherita %A Tomasi,Alberto %A Rizzo,Caterina %+ , Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35, Pisa, 56123, Italy, 39 3288348649, francesco.baglivo@phd.unipi.it %K travel medicine %K Italy %K cross-sectional %K survey %K KAP %K medical professional %K medical professionals %K Italian %K global health %K epidemiology %K scoping review %K power analysis %K dissemination %K healthcare service %K healthcare services %K survey protocol %K awareness %K assessment %D 2025 %7 21.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The evolving global health landscape highlights the importance of travel medicine, making it necessary for health care professionals to understand the epidemiologic profiles among varied traveler populations and keep themselves updated in this rapidly changing field. However, in Italy, travel medicine clinics have significant gaps in resource allocation, staff training, and infrastructure. Objective: This protocol of a cross-sectional study aims to create and validate a questionnaire to assess the knowledge, attitudes, and practices of health care professionals in travel medicine in Italy. The final goal is to provide a tool to evaluate the state of travel medicine, guide training initiatives, and be able to monitor trends over time. Methods: The study population consists of health care professionals who practice travel medicine in Italy. The questionnaire will be developed by adapting an existing English survey and conducting a scoping review to align the questionnaire with contemporary scientific discourse. The validation process includes face validity, content validity, and expert evaluation. The sample size, determined through power analysis, ranges from 218 to 278 participants. The questionnaire will undergo a pilot test on a smaller sample size (10% of the total) to identify and address any issues. Statistical analysis will include central tendency and dispersion measures, categorical summaries, group comparisons, and regressions. This research received ethical approval, and informed consent will be obtained from all participants. Results: As of July 2024, we completed the questionnaire validation involving 9 experts. The validated version of the questionnaire includes 86 items. Furthermore, we conducted a pilot test on 53 individuals during the SIMVIM (Italian Society of Travel Medicine and Migrations) course on travel medicine held in Lucca, Italy, on June 14, 2024. Conclusions: This cross-sectional study will guide strategic planning and targeting training and awareness activities in areas deemed most critical or lacking. The study’s structured approach and periodic assessments will facilitate the identification of educational gaps, the dissemination of best practices, and the overall improvement of health care services for travelers in Italy. International Registered Report Identifier (IRRID): DERR1-10.2196/59511 %M 40258265 %R 10.2196/59511 %U https://www.researchprotocols.org/2025/1/e59511 %U https://doi.org/10.2196/59511 %U http://www.ncbi.nlm.nih.gov/pubmed/40258265 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62786 %T The Added Value of Digital Body Chart Pain Surface Assessment as an Objective Biomarker: Multicohort Study %A Billot,Maxime %A Ounajim,Amine %A Moens,Maarten %A Goudman,Lisa %A Deneuville,Jean-Philippe %A Roulaud,Manuel %A Nivole,Kévin %A Many,Mathilde %A Baron,Sandrine %A Lorgeoux,Bertille %A Bouche,Bénédicte %A Lampert,Lucie %A David,Romain %A Rigoard,Philippe %+ PRISMATICS Lab, CHU de Poitiers, 2 Rue de la Milétrie, Poitiers, 86000, France, 33 05 49 44 32 24, maxime.billot@chu-poitiers.fr %K chronic pain %K neuropathic pain %K mechanical pain %K assessment tool %K digital body chart %K pain assessment %K pain treatment %K digital tool %K quality of life %K financial burdens %K machine learning %K pain management %K digital health biomarker %K pain typology %K neuropathic %K nociceptive %D 2025 %7 16.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Although it has been well-documented that pain intensity alone is not sufficient to assess chronic pain, the objective pain surface encapsulated in a digital tool might present a major interest in the objective assessment of pain. Objective: This study aims to determine the potential added value of pain surface measurement by determining the correlation between pain surface and pain intensity in chronic pain patients. Methods: Two databases from observational prospective and retrospective longitudinal studies including patients with chronic pain were used in this research. Pain intensity was assessed by the Numeric Pain Rating Scale. Pain surface (cm²) and pain typology (neuropathic vs mechanical components) were measured by a specific pain mapping digital tool (PRISMap, Poitiers University Hospital). Patients were asked to draw their pain surface on a computerized tactile interface in a predetermined body (adapted from the patient’s BMI). A color code was used to represent pain intensity (very intense, intense, moderate, and low). Simple linear regression was used to assess the proportion of variance in pain surface explained by pain intensity. Results: The final analysis included 637 patients with chronic pain. The percentage of variance of the pain surface explained by pain intensity was 1.24% (R²=0.0124; 95% CI 0.11%-6.3%). In addition, 424 (66.6%) patients used more than 1 intensity or color, among whom 218 (34.2%) used 2 intensities or colors, 155 (24.3%) used 3 intensities or colors, and 51 (8%) used 4 intensities or colors. Conclusions: This study showed that pain intensity and pain surface provide complementary and distinct information that would help to improve pain assessment. Two-thirds of the cohort used 2 or more intensities to describe their pain. Combining pain intensity and pain surface should be strongly considered as a means of improving daily practice assessment of patients with chronic pain in primary and secondary care. Trial Registration: ClinicalTrials.gov NCT02964130; https://clinicaltrials.gov/study/NCT02964130?term=PREDIBACK&rank=2 %M 40239206 %R 10.2196/62786 %U https://www.jmir.org/2025/1/e62786 %U https://doi.org/10.2196/62786 %U http://www.ncbi.nlm.nih.gov/pubmed/40239206 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e67248 %T Effectiveness of The Umbrella Collaboration Versus Traditional Umbrella Reviews for Evidence Synthesis in Health Care: Protocol for a Validation Study %A Carrillo,Beltran %A Rubinos-Cuadrado,Marta %A Parellada-Martin,Jazmin %A Palacios-López,Alejandra %A Carrillo-Rubinos,Beltran %A Canillas-Del Rey,Fernando %A Baztán-Cortes,Juan Jose %A Gómez-Pavon,Javier %+ The Umbrella Collaboration, C/ Ferraz, 49 - 1º izq, Madrid, 28008, Spain, 34 915422945, bcm@theumbrellacollaboration.org %K tertiary evidence synthesis %K The Umbrella Collaboration %K umbrella reviews %K health research methodology %K AI-assisted synthesis %K AI-assisted %K evidence-based decision making %K machine learning %K ML %K artificial intelligence %K AI %K algorithms %K models %K analytics %K digital health %K digital technology %K digital interventions %D 2025 %7 14.4.2025 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The synthesis of evidence in health care is essential for informed decision-making and policy development. This study aims to validate The Umbrella Collaboration (TU), an innovative, semiautomatic tertiary evidence synthesis methodology, by comparing it with Traditional Umbrella Reviews (TUR), which are currently the gold standard. Objective: This study aimed to evaluate whether TU, an artificial intelligence—assisted, software-driven system for tertiary evidence synthesis, can achieve comparable effectiveness to TURs, while offering a more timely, efficient, and comprehensive approach. In addition, as a secondary objective, the study aims to assess the accessibility and comprehensibility of TU’s outputs to ensure its usability and practical applicability for health care professionals. Methods: This protocol outlines a comparative study divided into 2 main parts. The first part involves a quantitative comparison of results obtained using TU and TURs in geriatrics. We will evaluate the identification, size effect, direction, statistical significance, and certainty of outcomes, as well as the time and resources required for each methodology. Data for TURs will be sourced from Medline (via PubMed), while TU will use artificial intelligence—assisted informatics to replicate the research questions of the selected TURs. The second part of the study assesses the ease of use and comprehension of TU through an online survey directed at health professionals, using interactive features and detailed data access. Results: Expected results include the assessment of concordance in identifying outcomes, the size effect, direction and significance of these outcomes, and the certainty of evidence. In addition, we will measure the operational efficiency of each methodology by evaluating the time taken to complete projects. User perceptions of the ease of use and comprehension of TU will be gathered through detailed surveys. The implementation of new methodologies in evidence synthesis requires validation. This study will determine whether TU can match the accuracy and comprehensiveness of TURs while offering benefits in terms of efficiency and user accessibility. The comparative study is designed to address the inherent challenges in validating a new methodology against established standards. Conclusions: If TU proves as effective as TURs but more time-efficient, accessible, and easily updatable, it could significantly enhance the process of evidence synthesis, facilitating informed decision-making and improving health care. This study represents a step toward integrating innovative technologies into routine evidence synthesis practice, potentially transforming health research. International Registered Report Identifier (IRRID): PRR1-10.2196/67248 %M 40057944 %R 10.2196/67248 %U https://www.researchprotocols.org/2025/1/e67248 %U https://doi.org/10.2196/67248 %U http://www.ncbi.nlm.nih.gov/pubmed/40057944 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64174 %T A New Mobile App to Train Attention Processes in People With Traumatic Brain Injury: Logical and Ecological Content Validation Study %A Laverdière,Roxanne %A Jackson,Philip L %A Banville,Frédéric %+ , Department of Health Sciences, Université du Québec à Rimouski, 300, allée des Ursulines, Rimouski, QC, G5L 3A1, Canada, 1 418 723 1986 ext 1931, frederic_banville@uqar.ca %K mobile app %K attention training %K cognitive remediation %K mindfulness %K psychometric properties %K content validation %D 2025 %7 9.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Attention is at the base of more complex cognitive processes, and its deficits can significantly impact safety and health. Attention can be impaired by neurodevelopmental and acquired disorders. One validated theoretical model to explain attention processes and their deficits is the hierarchical model of Sohlberg and Mateer. This model guides intervention development to improve attention following an acquired disorder. Another way to stimulate attention functions is to engage in the daily practice of mindfulness, a multicomponent concept that can be explained by the theoretical model of Baer and colleagues. Mobile apps offer great potential for practicing mindfulness daily as they can easily be used during daily routines, thus facilitating transfer. Laverdière and colleagues have developed such a mobile app called Focusing, which is aimed at attention training using mindfulness-inspired attentional exercises. However, this app has not been scientifically validated. Objective: This research aims to analyze the logical content validity and ecological content validity of the Focusing app. Methods: Logical content validation was performed by 7 experts in neuropsychology and mindfulness. Using an online questionnaire, they determined whether the content of the attention training app exercises is representative of selected constructs, namely the theoretical model of attention by Sohlberg and Mateer and the theoretical model of mindfulness by Baer and colleagues. A focus group was subsequently held with the experts to discuss items that did not reach consensus in order to change or remove them. Ecological content validation was performed with 10 healthy adults. Participants had to explore all sections of the app and assess the usability, relevance, satisfaction, quality, attractiveness, and cognitive load associated with each section of the app, using online questionnaires. Results: Logical content validation results demonstrated a high content validity index (CVI) of the attention training app. Excellent scores (CVI ≥0.78) in both the attention and mindfulness models were obtained for all exercises in the app, except 2 exercises. One of these exercises was subsequently modified to include expert feedback, and one was removed. Regarding ecological content validation, the results showed that workload, quality, user experience, satisfaction, and relevance of the app were adequate. The Mobile Application Rating Scale questionnaire showed an average quality rating between 3.75/5 (SD 0.41) (objective quality) and 3.65/5 (SD 0.36) (subjective quality), indicating acceptable quality. The mean global attractiveness rating from the AttrakDiff questionnaire was 2.36/3 (SD 0.57), which represents one of the strengths of the app.  Conclusions: Logical and ecological content validation showed that Focusing is theoretically valid, with a high level of agreement among experts and healthy participants. This tool can be tested to train attention processes after a neurological insult such as traumatic brain injury. %M 40202789 %R 10.2196/64174 %U https://formative.jmir.org/2025/1/e64174 %U https://doi.org/10.2196/64174 %U http://www.ncbi.nlm.nih.gov/pubmed/40202789 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e64720 %T The Color of Drinking Survey Questionnaire for Measuring the Secondhand Impacts of High-Risk Drinking in College Settings: Validation Study %A Marconi,Agustina %A Washington,Reonda %A Jovaag,Amanda %A Blomme,Courtney %A Knobeloch,Ashley %A Irazola,Vilma %A Muros Cortés,Carolina %A Gutierrez,Laura %A Elorriaga,Natalia %K validation study %K alcohol drinking in college %K microaggression %K university %K student %K young adult %K undergraduate %K survey %K questionnaire %K reliability %K consistency %D 2025 %7 7.4.2025 %9 %J Interact J Med Res %G English %X Background: The “Color of Drinking” is a study conducted at the University of Wisconsin-Madison. It examines the secondhand harms of high-risk drinking on college students of color and explores the connection between alcohol use and the campus racial climate. Since its findings were released in 2018, this study has received significant attention from other college settings around the country. Objective: This study aims to describe the development of the most recent version of the Color of Drinking questionnaire and to assess its internal consistency, test-retest reliability, and construct validity in a sample of undergraduate students attending the University of Wisconsin-Madison. Methods: This is an observational, analytic study. Questionnaire design experts revised the original instrument, and in-depth cognitive interviews with students were conducted to evaluate comprehensibility and acceptability. The revised questionnaire was administered 2 times, 3 to 4 weeks apart, in a sample of undergraduate students. The following properties were studied: internal consistency in 4 sets of items (Cronbach α), test-retest reliability among closed-ended questions (κ statistics and intraclass correlation coefficient), and construct validity (associations with other validated instruments, such as the Alcohol Use Disorders Identification Test). For a section of questions showing low reliability, the answers to open questions and other in-depth interviews were carried out, and online surveys were conducted with another sample of undergraduate students to evaluate reliability after changes. Results: Eight students participated in the in-depth interviews, 177 responses from the online survey were included for the analysis of internal consistency, 115 for test-retest reliability, and 98 for construct validity. The 4 sets of items (sections) evaluated (“impact of alcohol consumption on academics,” “impact of microaggressions,” “witnessing microaggressions and alcohol intoxication,” and “bystanders’ interventions on alcohol intoxication”) presented good internal consistency (Cronbach α between 0.723 and 0.898). Most items showed moderate to substantial test-retest reliability; agreement was from 68.1% to 95.2%, and κ coefficients ranged from 0.214 to 0.8. For construct validity, correlations between the number of drinking days, the maximum number of drinks in a day and the Alcohol Use Disorders Identification Test score were moderate to high, r=0.630 (95% CI 0.533-0.719) and r=0.647 (95% CI 0.548-0.741), respectively. Due to low reliability, a section regarding “health impacts” has been redesigned, including 8 items for the personal consumption of alcohol and the consumption of others (Cronbach α 0.735 and 0.855, respectively; agreement between the first and the second time the questionnaire was administered were 83.4% and 99.1%, and most of the items with κ coefficient from 0.476 to 0.877). Conclusions: The revised version of the Color of Drinking questionnaire showed acceptable to adequate reliability and construct validity. %R 10.2196/64720 %U https://www.i-jmr.org/2025/1/e64720 %U https://doi.org/10.2196/64720 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e68454 %T Clinical Benefits and Risks of Antiamyloid Antibodies in Sporadic Alzheimer Disease: Systematic Review and Network Meta-Analysis With a Web Application %A Jeremic,Danko %A Navarro-Lopez,Juan D %A Jimenez-Diaz,Lydia %+ Neurophysiology & Behavior Lab, Institute of Biomedicine (IB-UCLM) and Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Faculty of Medicine of Ciudad Real, University of Castilla-La Mancha, Camino Moledores s/n, Ciudad Real, 13071, Spain, 34 926295300, lydia.jimenez@uclm.es %K Alzheimer disease %K antibodies %K donanemab %K aducanumab %K lecanemab %D 2025 %7 7.4.2025 %9 Review %J J Med Internet Res %G English %X Background: Despite the increasing approval of antiamyloid antibodies for Alzheimer disease (AD), their clinical relevance and risk-benefit profile remain uncertain. The heterogeneity of AD and the limited availability of long-term clinical data make it difficult to establish a clear rationale for selecting one treatment over another. Objective: The aim of this work was to assess and compare the efficacy and safety of antiamyloid antibodies through an interactive online meta-analytic approach by performing conventional pair-wise meta-analyses and frequentist and Bayesian network meta-analyses of phase II and III clinical trial results. To achieve this, we developed AlzMeta.app 2.0, a freely accessible web application that enables researchers and clinicians to evaluate the relative and absolute risks and benefits of these therapies in real time, incorporating different prior choices and assumptions of baseline risks of disease progression and adverse events. Methods: We adhered to PRISMA-NMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for reporting of systematic reviews with network meta-analysis) and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) guidelines for reporting and rating the certainty of evidence. Clinical trial reports (until September 30, 2024) were retrieved from PubMed, Google Scholar, and clinical trial databases (including ClinicalTrials.gov). Studies with <20 sporadic AD patients and a modified Jadad score <3 were excluded. Risk of bias was assessed with the RoB-2 tool. Relative risks and benefits have been expressed as risk ratios and standardized mean differences, with confidence, credible, and prediction intervals calculated for all outcomes. For significant results, the intervention effects were ranked in frequentist and Bayesian frameworks, and their clinical relevance was determined by the absolute risk per 1000 people and number needed to treat (NNT) for a wide range of control responses. Results: Among 7 treatments tested in 21,236 patients (26 studies with low risk of bias or with some concerns), donanemab was the best-ranked treatment on cognitive and functional measures, and it was almost 2 times more effective than aducanumab and lecanemab and significantly more beneficial than other treatments on the global (cognitive and functional) Clinical Dementia Rating Scale-Sum of Boxes (NNT=10, 95% CI 8-16). Special caution is required regarding cerebral edema and microbleeding due to the clinically relevant risks of edema for donanemab (NNT=8, 95% CI 5-16), aducanumab (NNT=10, 95% CI 6-17), and lecanemab (NNT=14, 95% CI 7-31), which may outweigh the benefits. Conclusions: Our results showed that donanemab is more effective and has a safety profile similar to aducanumab and lecanemab, highlighting the need for treatment options with improved safety. Potential bias may have been introduced in the included trials due to unblinding caused by frequent cerebral edema and microbleeds, as well as the impact of the COVID-19 pandemic. %M 40194268 %R 10.2196/68454 %U https://www.jmir.org/2025/1/e68454 %U https://doi.org/10.2196/68454 %U http://www.ncbi.nlm.nih.gov/pubmed/40194268 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63090 %T Investigating Measurement Equivalence of Smartphone Sensor–Based Assessments: Remote, Digital, Bring-Your-Own-Device Study %A Kriara,Lito %A Dondelinger,Frank %A Capezzuto,Luca %A Bernasconi,Corrado %A Lipsmeier,Florian %A Galati,Adriano %A Lindemann,Michael %+ , F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Basel, CH-4070, Switzerland, 41 61 687 10 20, lito.kriara@roche.com %K Floodlight Open %K multiple sclerosis %K smartphone %K sensors %K mobile phone %K wearable electronic devices %K digital health %K equivalence %K device equivalence %K cognition %K gait %K upper extremity function %K hand motor function %K balance %K digital biomarker %K variability %K mHealth %K mobile health %K autoimmune disease %K motor %K digital assessment %D 2025 %7 3.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Floodlight Open is a global, open-access, fully remote, digital-only study designed to understand the drivers and barriers in deployment and persistence of use of a smartphone app for measuring functional impairment in a naturalistic setting and broad study population. Objective: This study aims to assess measurement equivalence properties of the Floodlight Open app across operating system (OS) platforms, OS versions, and smartphone device models. Methods: Floodlight Open enrolled adult participants with and without self-declared multiple sclerosis (MS). The study used the Floodlight Open app, a “bring-your-own-device” (BYOD) solution that remotely measured MS-related functional ability via smartphone sensor–based active tests. Measurement equivalence was assessed in all evaluable participants by comparing the performance on the 6 active tests (ie, tests requiring active input from the user) included in the app across OS platforms (iOS vs Android), OS versions (iOS versions 11-15 and separately Android versions 8-10; comparing each OS version with the other OS versions pooled together), and device models (comparing each device model with all remaining device models pooled together). The tests in scope were Information Processing Speed, Information Processing Speed Digit-Digit (measuring reaction speed), Pinching Test (PT), Static Balance Test, U-Turn Test, and 2-Minute Walk Test. Group differences were assessed by permutation test for the mean difference after adjusting for age, sex, and self-declared MS disease status. Results: Overall, 1976 participants using 206 different device models were included in the analysis. Differences in test performance between subgroups were very small or small, with percent differences generally being ≤5% on the Information Processing Speed, Information Processing Speed Digit-Digit, U-Turn Test, and 2-Minute Walk Test; <20% on the PT; and <30% on the Static Balance Test. No statistically significant differences were observed between OS platforms other than on the PT (P<.001). Similarly, differences across iOS or Android versions were nonsignificant after correcting for multiple comparisons using false discovery rate correction (all adjusted P>.05). Comparing the different device models revealed a statistically significant difference only on the PT for 4 out of 17 models (adjusted P≤.001-.03). Conclusions: Consistent with the hypothesis that smartphone sensor–based measurements obtained with different devices are equivalent, this study showed no evidence of a systematic lack of measurement equivalence across OS platforms, OS versions, and device models on 6 active tests included in the Floodlight Open app. These results are compatible with the use of smartphone-based tests in a bring-your-own-device setting, but more formal tests of equivalence would be needed. %M 40179369 %R 10.2196/63090 %U https://www.jmir.org/2025/1/e63090 %U https://doi.org/10.2196/63090 %U http://www.ncbi.nlm.nih.gov/pubmed/40179369 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59878 %T Validation of Ecological Momentary Assessment With Reference to Accelerometer Data: Repeated-Measures Panel Study With Multilevel Modeling %A Noh,Jung Min %A Im,SongHyun %A Park,JooYong %A Kim,Jae Myung %A Lee,Miyoung %A Choi,Ji-Yeob %+ Department of Biomedical Sciences, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 02 740 8922, jiyeob.choi@gmail.com %K telemedicine %K wearable electronic devices %K physical activity %K mobile phone %K wearables %K smartphones %K ecological momentary assessment %K EMA %K global physical activity questionnaire %K GPAQ %K Bouchard’s physical activity %K multilevel modeling %K females %K women %K males %K men %K sensors %K evaluation %K comparative %K South Korea %D 2025 %7 1.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: There is growing interest in the real-time assessment of physical activity (PA) and physiological variables. Acceleration, particularly those collected through wearable sensors, has been increasingly adopted as an objective measure of physical activity. However, sensor-based measures often pose challenges for large-scale studies due to their associated costs, inability to capture contextual information, and restricted user populations. Smartphone-delivered ecological momentary assessment (EMA) offers an unobtrusive and undemanding means to measure PA to address these limitations. Objective: This study aimed to evaluate the usability of EMA by comparing its measurement outcomes with 2 self-report assessments of PA: Global Physical Activity Questionnaire (GPAQ) and a modified version of Bouchard Physical Activity Record (BAR). Methods: A total of 235 participants (137 female, 98 male, and 94 repeated) participated in one or more 7-day studies. Waist-worn sensors provided by ActiGraph captured accelerometer data while participants completed 3 self-report measures of PA. The multilevel modeling method was used with EMA, GPAQ, and BAR as separate measures, with 6 subdomains of physiological activity (overall PA, overall excluding occupational, transport, exercise, occupational, and sedentary) to model accelerometer data. In addition, EMA and GPAQ were further compared with 6 domains of PA from the BAR as outcome measures. Results: Among the 3 self-reporting instruments, EMA and BAR exhibited better overall performance in modeling the accelerometer data compared to GPAQ (eg EMA daily: β=.387, P<.001; BAR daily: β=.394, P<.001; GPAQ: β=.281, P<.001, based on repeated-only participants with step counts from accelerometer as dependent variables). Conclusions: Multilevel modeling on 3 self-report assessments of PA indicates that smartphone-delivered EMA is a valid and efficient method for assessing PA. %M 40168069 %R 10.2196/59878 %U https://www.jmir.org/2025/1/e59878 %U https://doi.org/10.2196/59878 %U http://www.ncbi.nlm.nih.gov/pubmed/40168069 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65903 %T Exploring the Capacity of Large Language Models to Assess the Chronic Pain Experience: Algorithm Development and Validation %A Amidei,Jacopo %A Nieto,Rubén %A Kaltenbrunner,Andreas %A Ferreira De Sá,Jose Gregorio %A Serrat,Mayte %A Albajes,Klara %+ eHealth Lab Research Group, Faculty of Psychology and Educational Sciences, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, Barcelona, 08018, Spain, 34 933263538, rnietol@uoc.edu %K large language models %K fibromyalgia %K chronic pain %K written narratives %K pain narratives %K automated assessment %K pain severity %K pain disability %D 2025 %7 31.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic pain, affecting more than 20% of the global population, has an enormous pernicious impact on individuals as well as economic ramifications at both the health and social levels. Accordingly, tools that enhance pain assessment can considerably impact people suffering from pain and society at large. In this context, assessment methods based on individuals’ personal experiences, such as written narratives (WNs), offer relevant insights into understanding pain from a personal perspective. This approach can uncover subjective, intricate, and multifaceted aspects that standardized questionnaires can overlook. However, WNs can be time-consuming for clinicians. Therefore, a tool that uses WNs while reducing the time required for their evaluation could have a significantly beneficial impact on people's pain assessment. Objective: This study is the first evaluation of the potential of applying large language models (LLMs) to assist clinicians in assessing patients’ pain expressed through WNs. Methods: We performed an experiment based on 43 WNs made by people with fibromyalgia and qualitatively evaluated in a prior study. Focusing on pain severity and disability, we prompt GPT-4 (with temperature parameter settings 0 or 1) to assign scores and scores’ explanations, to these WNs. Then, we quantitatively compare GPT-4 scores with experts’ scores of the same narratives, using statistical measures such as Pearson correlations, root mean squared error, the weighted version of the Gwet agreement coefficient, and Krippendorff α. Additionally, 2 experts specialized in chronic pain conducted a qualitative analysis of the scores’ explanation to assess their accuracy and potential applicability of GPT’s analysis for future pain narrative evaluations. Results: Our analysis reveals that GPT-4’s performance in assessing pain narratives yielded promising results. GPT-4 was comparable in terms of agreement with experts (with a weighted percentage agreement higher than 0.95), correlations with standardized measurements (for example in the range of 0.43 and 0.49 between the Revised Fibromyalgia Impact Questionnaire and GTP-4 with temperatures 1), and low error rates (root mean squared error of 1.20 for severity and 1.44 for disability). Moreover, experts generally deemed the ratings provided by GPT-4, as well as the scores’ explanation, to be adequate. However, we observe that GPT has a slight tendency to overestimate pain severity and disability with a lower SD than expert estimates. Conclusions: These findings underline the potential of LLMs in facilitating the assessment of WNs of people with fibromyalgia, offering a novel approach to understanding and evaluating patient pain experiences. Integrating automated assessments through LLMs presents opportunities for streamlining and enhancing the assessment process, paving the way for improved patient care and tailored interventions in the chronic pain management field. %M 40163858 %R 10.2196/65903 %U https://www.jmir.org/2025/1/e65903 %U https://doi.org/10.2196/65903 %U http://www.ncbi.nlm.nih.gov/pubmed/40163858 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60887 %T Automatic Human Embryo Volume Measurement in First Trimester Ultrasound From the Rotterdam Periconception Cohort: Quantitative and Qualitative Evaluation of Artificial Intelligence %A Bastiaansen,Wietske A P %A Klein,Stefan %A Hojeij,Batoul %A Rubini,Eleonora %A Koning,Anton H J %A Niessen,Wiro %A Steegers-Theunissen,Régine P M %A Rousian,Melek %+ Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Dr Molewaterplein 40, Rotterdam, 3000 CA, The Netherlands, 31 10 703 82 5, w.bastiaansen@erasmusmc.nl %K first trimester, artificial intelligence, embryo, ultrasound, biometry %K US %K Rotterdam %K The Netherlands %K Cohort %K quantitative %K qualitative %K evaluation %K noninvasive %K pregnancy %K embryonic growth %K algorithm %K embryonic volume %K monitoring %K development %D 2025 %7 31.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Noninvasive volumetric measurements during the first trimester of pregnancy provide unique insight into human embryonic growth and development. However, current methods, such as semiautomatic (eg, virtual reality [VR]) or manual segmentation (eg, VOCAL) are not used in routine care due to their time-consuming nature, requirement for specialized training, and introduction of inter- and intrarater variability. Objective: This study aimed to address the challenges of manual and semiautomatic measurements, our objective is to develop an automatic artificial intelligence (AI) algorithm to segment the region of interest and measure embryonic volume (EV) and head volume (HV) during the first trimester of pregnancy. Methods: We used 3D ultrasound datasets from the Rotterdam Periconception Cohort, collected between 7 and 11 weeks of gestational age. We measured the EV in gestational weeks 7, 9 and 11, and the HV in weeks 9 and 11. To develop the AI algorithms for measuring EV and HV, we used nnU-net, a state-of-the-art segmentation algorithm that is publicly available. We tested the algorithms on 164 (EV) and 92 (HV) datasets, both acquired before 2020. The AI algorithm’s generalization to data acquired in the future was evaluated by testing on 116 (EV) and 58 (HV) datasets from 2020. The performance of the model was assessed using the intraclass correlation coefficient (ICC) between the volume obtained using AI and using VR. In addition, 2 experts qualitatively rated both VR and AI segmentations for the EV and HV. Results: We found that segmentation of both the EV and HV using AI took around a minute additionally, rating took another minute, hence in total, volume measurement took 2 minutes per ultrasound dataset, while experienced raters needed 5-10 minutes using a VR tool. For both the EV and HV, we found an ICC of 0.998 on the test set acquired before 2020 and an ICC of 0.996 (EV) and 0.997 (HV) for data acquired in 2020. During qualitative rating for the EV, a comparable proportion (AI: 42%, VR: 38%) were rated as excellent; however, we found that major errors were more common with the AI algorithm, as it more frequently missed limbs. For the HV, the AI segmentations were rated as excellent in 79% of cases, compared with only 17% for VR. Conclusions: We developed 2 fully automatic AI algorithms to accurately measure the EV and HV in the first trimester on 3D ultrasound data. In depth qualitative analysis revealed that the quality of the measurement for AI and VR were similar. Since automatic volumetric assessment now only takes a couple of minutes, the use of these measurements in pregnancy for monitoring growth and development during this crucial period, becomes feasible, which may lead to better screening, diagnostics, and treatment of developmental disorders in pregnancy. %M 40163035 %R 10.2196/60887 %U https://www.jmir.org/2025/1/e60887 %U https://doi.org/10.2196/60887 %U http://www.ncbi.nlm.nih.gov/pubmed/40163035 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58366 %T The AI Reviewer: Evaluating AI’s Role in Citation Screening for Streamlined Systematic Reviews %A Ghossein,Jamie %A Hryciw,Brett N %A Ramsay,Tim %A Kyeremanteng,Kwadwo %K article screening %K artificial intelligence %K systematic review %K AI %K large language model %K LLM %K screening %K analysis %K reviewer %K app %K ChatGPT 3.5 %K chatbot %K dataset %K data %K adoption %D 2025 %7 28.3.2025 %9 %J JMIR Form Res %G English %X %R 10.2196/58366 %U https://formative.jmir.org/2025/1/e58366 %U https://doi.org/10.2196/58366 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e69001 %T Convergent and Known-Groups Validity and Sensitivity to Change of the Virtual Performance Measure in Patients With Hip and Knee Osteoarthritis: Longitudinal Study %A Razmjou,Helen %A Denis,Suzanne %A Robarts,Susan %A Wainwright,Amy %A Dickson,Patricia %A Murnaghan,John %+ Sunnybrook Health Science Centre, University of Toronto, 43 Wellesley Street East, Toronto, ON, M4Y 1H1, Canada, helen.razmjou@sunnybrook.ca %K virtual %K video-based outcome %K longitudinal validity %K sensitivity to change %K osteoarthritis %D 2025 %7 28.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Subsequent to the COVID-19 pandemic in 2020, a different approach to health care utilization was required to improve safety and efficiency. In the postpandemic era, virtual care and remote assessment of musculoskeletal conditions has become more common, and examining the accuracy of these remote encounters remains vital. In 2023, an innovative, video-based tool—the Virtual Performance Measure (VPM)—was introduced to assess the functional difficulties of patients with osteoarthritis of the knee joint. Further validation of this tool is warranted to expand its application longitudinally and in more diverse populations. Objective: This study examined the longitudinal validity of the VPM, a digitally based outcome tool, in patients with osteoarthritis of the hip and knee joints who had undergone arthroplasty. Methods: Patients completed a web-based survey after watching 40 videos that demonstrated 10 functional tasks with increasing difficulty, prior to and at approximately 3-5 months following surgery. The Lower Extremity Functional Scale (LEFS) was used as the reference measure. Longitudinal convergent and known-groups validity as well as sensitivity to change were assessed. Results: The data of 120 patients (n=80, 67% female; mean age 67, SD 9 years; n=58, 48% with hip osteoarthritis and n=62, 52% with knee osteoarthritis) were examined. There was a statistically significant improvement in both LEFS (t119=16.04, P<.001) and VPM total scores (t119=13.92, P<.001) over time. The correlation between the postoperative LEFS and VPM scores was higher (r=0.66; P<.001) than the correlation between the change scores of these measures (r=0.51; P<.001). The area under the curve value for the VPM’s ability to differentiate between urgent and nonurgent candidates for surgery was 0.71 (95% CI 0.57-0.84). Sensitivity to change as measured by the standardized response mean was 1.27 (95% CI 1.09-1.45), indicating good ability to detect change over time. Conclusions: The VPM demonstrated sufficient longitudinal convergent and known-groups validity as well as sensitivity to change in patients with hip and knee osteoarthritis following arthroplasty. This tool has a potential to improve the delivery of care by increasing access, reducing the frequency of in-person visits, and improving the overall efficiency of the health care system following a major surgery. %M 40153784 %R 10.2196/69001 %U https://formative.jmir.org/2025/1/e69001 %U https://doi.org/10.2196/69001 %U http://www.ncbi.nlm.nih.gov/pubmed/40153784 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66123 %T Toward Unsupervised Capacity Assessments for Gait in Neurorehabilitation: Validation Study %A Naef,Aileen C %A Duarte,Guichande %A Neumann,Saskia %A Shala,Migjen %A Branscheidt,Meret %A Easthope Awai,Chris %+ Data Analytics & Rehabilitation Technology (DART), Lake Lucerne Institute, Rubistrasse 9, Vitznau, Switzerland, 41 77 466 81 35, chris.awai@llui.org %K gait analysis %K gait rehabilitation %K 10-meter walk test %K stroke %K unsupervised assessments %K supervised assessments %K sensors %K motivation %K capacity %K monitoring %K wearables %K stroke survivors %K quality of life %D 2025 %7 26.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Gait impairments are common in stroke survivors, negatively impacting their overall quality of life. Therefore, gait rehabilitation is often targeted during in-clinic rehabilitation. While standardized assessments are available for inpatient evaluation, the literature often reports variable results when these assessments are conducted in a home environment. Several factors, such as the presence of an observer, the environment itself, or the technology used, may contribute to these differing results. Therefore, it is relevant to establish unsupervised capacity assessments for both in-clinic use and across the continuum of care. Objective: This study aimed to investigate the effect of supervision on the outcomes of a sensor-based 10-meter walk test conducted in a clinical setting, maintaining a controlled environment and setup. Methods: In total, 21 stroke survivors (10 female, 11 male; age: mean 63.9, SD 15.5 years) were assigned alternately to one of two data collection sequences and tested over 4 consecutive days, alternating between supervised test (ST) and unsupervised test (UST) assessments. For both assessments, participants were required to walk a set distance of 10 meters as fast as possible while data were collected using a single wearable sensor (Physilog 5) attached to each shoe. After each walking assessment, the participants completed the Intrinsic Motivation Inventory. Statistical analyses were conducted to examine the mean speed, stride length, and cadence, across repeated measurements and between assessment conditions. Results: The intraclass correlation coefficient indicated good to excellent reliability for speed (ST: κ=0.93, P<.001; UST: κ=0.93, P<.001), stride length (ST: κ=0.92, P<.001; UST: κ=0.88, P<.001), and cadence (ST: κ=0.91, P<.001; UST: κ=0.95, P<.001) across repeated measurements for both ST and UST assessments. There was no significant effect of testing order (ie, sequence A vs B). Comparing ST and UST, there were no significant differences in speed (t39=–0.735, P=.47, 95% CI 0.06-0.03), stride length (z=0.835, P=.80), or cadence (t39=–0.501, P=.62, 95% CI 3.38-2.04) between the 2 assessments. The overall motivation did not show any significant differences between the ST and UST conditions (P>.05). However, the self-reported perceived competence increased during the unsupervised assessment from the first to the second measurement. Conclusions: Unsupervised gait capacity assessments offer a reliable alternative to supervised assessments in a clinical environment, showing comparable results for gait speed, stride length, and cadence, with no differences in overall motivation between the two. Future work should build upon these findings to extend unsupervised assessment of both capacity and performance in home environments. Such assessments could allow improved and more specific tracking of rehabilitation progress across the continuum of care. %M 40138688 %R 10.2196/66123 %U https://www.jmir.org/2025/1/e66123 %U https://doi.org/10.2196/66123 %U http://www.ncbi.nlm.nih.gov/pubmed/40138688 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65767 %T Impact of a Sensorimotor Integration and Hyperstimulation Program on Global Motor Skills in Moroccan Children With Autism Spectrum Disorder: Exploratory Clinical Quasi-Experimental Study %A Touali,Rachid %A Zerouaoui,Jamal %A Chakir,El Mahjoub %A Bui,Hung Tien %A Leone,Mario %A Allisse,Maxime %+ , Faculty of Physical Activity Sciences, University of Sherbrooke, 2500 Boulevard de l'Université, Sherbrooke, QC, J1K 2R1, Canada, 1 819 821 8000 ext 63875, maxime.allisse@usherbrooke.ca %K classical physical education %K children with a neurotypical profile %K children with ASD %K UQAC-UQAM test battery %K University of Québec in Chicoutimi-University of Québec in Montréal %K sensorimotor integration %K hyperstimulation %K Morocco %K sensorimotor %K integration %K motor skill %K Moroccan children %K Moroccan %K children %K autism spectrum disorder %K ASD %K exploratory study %K autism %K mental health %K young %K youth %K feasibility %D 2025 %7 26.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Children with autism spectrum disorders (ASDs) often struggle with processing information, which can impact their coordination, balance, and other motor skills. Studies have demonstrated that intervention programs based on sensory integration can enhance motor performance in these children. Objective: The objective of this study is to evaluate the applicability of a standardized battery of gross motor skill tests for Moroccan children aged 6 to 12 years with ASD. The objective is to assess the potential efficacy of an innovative pedagogical approach focused on sensorimotor integration and hyperstimulation. This approach will be compared to traditional physical education (PE) sessions to determine its feasibility and potential to bridge the developmental gaps in motor skills between children with ASD and those with a neurotypical profile. Methods: A convenience sample of 14 Moroccan children with ASD aged 6 to 12 years participated in this exploratory study. Children with ASD were divided into an experimental group (n=7) and a control group (n=7) based on age, sex, motor performance, and socioeconomic status. The control group followed the standard PE program, while the experimental group underwent a specialized program combining sensorimotor integration and hyperstimulation for a period of 15 weeks. All participants were classified as level 2 (moderate) on the Autism Severity Rating Scale based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) criteria. Gross motor skills were measured at baseline and after 15 weeks of intervention using the UQAC-UQAM (University of Québec in Chicoutimi-University of Québec in Montréal) test battery protocol, which includes 10 items. Results: At baseline (T1), no significant difference was observed between the control and experimental groups of children with ASD. Following the 15-week intervention, the group participating in traditional PE showed an overall improvement in motor skills of approximately 14.5%. Conversely, the results of the ASD experimental group suggest a more substantial improvement of 44.5%. Additionally, the experimental group exhibited significant better performance across all motor skill variables compared to the control group (minimum P values of <.02) with large effect sizes (>0.80). In this regard, a 2-way repeated measures ANOVA confirms the efficiency of the program implemented within the experimental group, demonstrating significant effects associated with both group and time factors as well as a clinically highly significant group×time interaction across all measured variables (η2p>0.14). Conclusions: The results of this study suggest that the approach that emphasizes sensorimotor integration and management of hyperstimulation was more effective in improving motor skills in this population. However, other more exhaustive studies will need to be carried out in order to be able to more precisely measure the full potential of this approach. %M 40137439 %R 10.2196/65767 %U https://formative.jmir.org/2025/1/e65767 %U https://doi.org/10.2196/65767 %U http://www.ncbi.nlm.nih.gov/pubmed/40137439 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64591 %T Development and Validation of the Digital Health Literacy Questionnaire for Stroke Survivors: Exploratory Sequential Mixed Methods Study %A Ye,Qin %A Wang,Wei %A Zeng,Xuan %A Kuang,Yuxian %A Geng,Bingbing %A Zhou,Song %A Liu,Ning %+ Department of Basic Teaching and Research in General Medicine, Department of Fundamentals, Department of Nursing of Zunyi Medical University Zhuhai Campus, No. 368, Jinwan Road, Jinwan District, Zhuhai, 519041, China, 86 13631295806, ln761066906@163.com %K stroke survivors %K digital health literacy %K validation %K reliability %K mixed methods study %D 2025 %7 25.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: In China, there is limited research on digital health literacy (DHL) among patients with stroke. This is mainly due to the lack of validated tools, which hinders the precision and sustainability of our country’s digital transformation. Objective: This study aimed to develop and validate a DHL scale specifically for stroke survivors in China. Methods: We used a sequential, exploratory, mixed methods approach to develop a DHL questionnaire for stroke survivors. This study comprised 418 patients with stroke aged 18 years and older. To evaluate the questionnaire’s psychometric qualities, we randomly assigned individuals to 2 groups (subsample 1: n=118, subsample 2: n=300). Construct validity was evaluated through internal consistency analysis, exploratory and confirmatory factor analyses, hypothesis testing for structural validity, measurement invariance assessments using the eHealth Literacy Scale, and Rasch analyses to determine the questionnaire’s validity and reliability. Results: This study underwent 4 stages of systematic development. The initial pool of items contained 25 items, 5 of which were eliminated after content validity testing; 19 items were subsequently retained through cognitive interviews. After an interitem correlation analysis, 2 more items were excluded, leaving 17 items for exploratory factor analysis. Finally, 2 items were excluded by Rasch analysis, resulting in a final version of the questionnaire containing 15 items. The total score range of the scale was 15-75, with higher scores indicating greater DHL competence. Results showed that principal component analysis confirmed the theoretical structure of the questionnaire (69.212% explained variance). The factor model fit was good with χ24=1.669; root mean square error of approximation=0.047; Tucker-Lewis Index=0.973; and Comparative Fit Index=0.977. In addition, hypothesis-testing construct validity with the eHealth Literacy Scale revealed a strong correlation (r=0.853). The internal consistency (Cronbach α) coefficient was 0.937. The retest reliability coefficient was 0.941. Rasch analysis demonstrated the item separation index was 3.81 (reliability 0.94) and the individual separation index was 2.91 (reliability 0.89). Conclusions: The DHL Questionnaire for Stroke Survivors is a reliable and valid measure to assess DHL among stroke survivors in China. %R 10.2196/64591 %U https://www.jmir.org/2025/1/e64591 %U https://doi.org/10.2196/64591 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60215 %T Customizing Computerized Adaptive Test Stopping Rules for Clinical Settings Using the Negative Affect Subdomain of the NIH Toolbox Emotion Battery: Simulation Study %A Amagai,Saki %A Kaat,Aaron J %A Fox,Rina S %A Ho,Emily H %A Pila,Sarah %A Kallen,Michael A %A Schalet,Benjamin D %A Nowinski,Cindy J %A Gershon,Richard C %K computerized adaptive testing %K CAT %K stopping rules %K NIH Toolbox %K reliability %K test burden %K clinical setting %K patient-reported outcome %K clinician %D 2025 %7 21.3.2025 %9 %J JMIR Form Res %G English %X Background: Patient-reported outcome measures are crucial for informed medical decisions and evaluating treatments. However, they can be burdensome for patients and sometimes lack the reliability clinicians need for clear clinical interpretations. Objective: We aimed to assess the extent to which applying alternative stopping rules can increase reliability for clinical use while minimizing the burden of computerized adaptive tests (CATs). Methods: CAT simulations were conducted on 3 adult item banks in the NIH Toolbox for Assessment of Neurological and Behavioral Function Emotion Battery; the item banks were in the Negative Affect subdomain (ie, Anger Affect, Fear Affect, and Sadness) and contained at least 8 items. In the originally applied NIH Toolbox CAT stopping rules, the CAT was stopped if the score SE reached <0.3 before 12 items were administered. We first contrasted this with a SE-change rule in a planned simulation analysis. We then contrasted the original rules with fixed-length CATs (4‐12 items), a reduction of the maximum number of items to 8, and other modifications in post hoc analyses. Burden was measured by the number of items administered per simulation, precision by the percentage of assessments yielding reliability cutoffs (0.85, 0.90, and 0.95), and accurate score recovery by the root mean squared error between the generating θ and the CAT-estimated “expected a posteriori”–based θ. Results: In general, relative to the original rules, the alternative stopping rules slightly decreased burden while also increasing the proportion of assessments achieving high reliability for the adult banks; however, the SE-change rule and fixed-length CATs with 8 or fewer items also notably increased assessments yielding reliability <0.85. Among the alternative rules explored, the reduced maximum stopping rule best balanced precision and parsimony, presenting another option beyond the original rules. Conclusions: Our findings demonstrate the challenges in attempting to reduce test burden while also achieving score precision for clinical use. Stopping rules should be modified in accordance with the context of the study population and the purpose of the study. %R 10.2196/60215 %U https://formative.jmir.org/2025/1/e60215 %U https://doi.org/10.2196/60215 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e67322 %T A Smartphone-Based Timed Up and Go Test Self-Assessment for Older Adults: Validity and Reliability Study %A Böttinger,Melissa Johanna %A Mellone,Sabato %A Klenk,Jochen %A Jansen,Carl-Philipp %A Stefanakis,Marios %A Litz,Elena %A Bredenbrock,Anastasia %A Fischer,Jan-Philipp %A Bauer,Jürgen M %A Becker,Clemens %A Gordt-Oesterwind,Katharina %K timed up and go test %K self-assessment %K instrumented assessment %K technology-based assess-ment %K physical capacity %K mobility %K aged %K mobile applications %K smartphone %K diagnostic self evaluation %D 2025 %7 21.3.2025 %9 %J JMIR Aging %G English %X Background: The Timed Up and Go test (TUG) is recommended as an evidence-based tool for measuring physical capacity. Instrumented TUG (iTUG) approaches expand classical supervised clinical applications offering the potential of self-assessment for older adults. Objective: This study aimed to evaluate the concurrent validity and test-retest reliability of a smartphone-based TUG self-assessment “up&go app.” Methods: A total of 52 community-dwelling older adults (>67 years old) were recruited. A validated and medically certified system attached with a belt at the lower back was used as a reference system to validate the “up&go app” algorithm. The participants repeated the TUG 5 times wearing, a smartphone with the “up&go app” in their front trouser pocket and an inertial sensor to test the concurrent validity. A subsample of 37 participants repeated the “up&go app” measurement 2 weeks later to examine the test-retest reliability. Results: The correlation between the “up&go app” and the reference measurement was r=0.99 for the total test duration and r=0.97 for the 5 single repetitions. Agreement between the 5 repetitions was intraclass correlation coefficient (ICC)=0.9 (0.84‐0.94). Leaving out the first repetition, the agreement was ICC=0.95 (0.92‐0.97). Test-retest agreement had an ICC=0.79 (0.53‐0.9). Conclusions: The duration of 5 repetitions of the TUG test, measured with the pocket-worn “up&go app,” was very consistent with the results of a lower-back sensor system, indicating excellent concurrent validity. Participants walked slower in the first round than in the other 4 repetitions within a test run. Test-retest reliability was also excellent. The “up&go app” provides a useful smartphone-based approach to measure 5 repetitions of the TUG. The app could be used by older adults as a self-screening and monitoring tool of physical capacity at home and thereby help to early identify functional limitations and take interventions when necessary. %R 10.2196/67322 %U https://aging.jmir.org/2025/1/e67322 %U https://doi.org/10.2196/67322 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65567 %T Trust and Acceptance Challenges in the Adoption of AI Applications in Health Care: Quantitative Survey Analysis %A Kauttonen,Janne %A Rousi,Rebekah %A Alamäki,Ari %+ Digital Transition and AI, Haaga-Helia University of Applied Sciences, Ratapihantie 13, Helsinki, 00520, Finland, 358 400 230 404, janne.kauttonen@haaga-helia.fi %K artificial intelligence %K AI %K health care technology %K technology adoption %K predictive modeling %K user trust %K user acceptance %D 2025 %7 21.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Artificial intelligence (AI) has potential to transform health care, but its successful implementation depends on the trust and acceptance of consumers and patients. Understanding the factors that influence attitudes toward AI is crucial for effective adoption. Despite AI’s growing integration into health care, consumer and patient acceptance remains a critical challenge. Research has largely focused on applications or attitudes, lacking a comprehensive analysis of how factors, such as demographics, personality traits, technology attitudes, and AI knowledge, affect and interact across different health care AI contexts. Objective: We aimed to investigate people’s trust in and acceptance of AI across health care use cases and determine how context and perceived risk affect individuals’ propensity to trust and accept AI in specific health care scenarios. Methods: We collected and analyzed web-based survey data from 1100 Finnish participants, presenting them with 8 AI use cases in health care: 5 (62%) noninvasive applications (eg, activity monitoring and mental health support) and 3 (38%) physical interventions (eg, AI-controlled robotic surgery). Respondents evaluated intention to use, trust, and willingness to trade off personal data for these use cases. Gradient boosted tree regression models were trained to predict responses based on 33 demographic-, personality-, and technology-related variables. To interpret the results of our predictive models, we used the Shapley additive explanations method, a game theory–based approach for explaining the output of machine learning models. It quantifies the contribution of each feature to individual predictions, allowing us to determine the relative importance of various demographic-, personality-, and technology-related factors and their interactions in shaping participants’ trust in and acceptance of AI in health care. Results: Consumer attitudes toward technology, technology use, and personality traits were the primary drivers of trust and intention to use AI in health care. Use cases were ranked by acceptance, with noninvasive monitors being the most preferred. However, the specific use case had less impact in general than expected. Nonlinear dependencies were observed, including an inverted U-shaped pattern in positivity toward AI based on self-reported AI knowledge. Certain personality traits, such as being more disorganized and careless, were associated with more positive attitudes toward AI in health care. Women seemed more cautious about AI applications in health care than men. Conclusions: The findings highlight the complex interplay of factors influencing trust and acceptance of AI in health care. Consumer trust and intention to use AI in health care are driven by technology attitudes and use rather than specific use cases. AI service providers should consider demographic factors, personality traits, and technology attitudes when designing and implementing AI systems in health care. The study demonstrates the potential of using predictive AI models as decision-making tools for implementing and interacting with clients in health care AI applications. %M 40116853 %R 10.2196/65567 %U https://www.jmir.org/2025/1/e65567 %U https://doi.org/10.2196/65567 %U http://www.ncbi.nlm.nih.gov/pubmed/40116853 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64193 %T Digital Health Literacy Questionnaire for Older Adults: Instrument Development and Validation Study %A Wang,Xinxin %A Zhang,Chengrui %A Qi,Yue %A Xing,Ying %A Liu,Yawen %A Sun,Jiayi %A Luan,Wei %+ Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Number 528, Zhangheng Road, Pudong New Area, Shanghai, China, 86 15921317982, luanwei_shuguang@126.com %K digital health literacy %K digital literacy %K older adults %K instruments %K reliability %K psychological measures %K questionnaire %K China %D 2025 %7 19.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The integration of digital technology into older adult health and care has enhanced the intelligence of health and older adult care products and services while also transforming how seniors acquire and share health information. Assessing older adults’ digital health literacy (DHL) is crucial for developing targeted interventions. Objective: This study aims to develop and validate a DHL assessment questionnaire for older adults. It also seeks to evaluate the questionnaire’s scientific validity and feasibility among community-dwelling older adults in China, providing a reliable tool for assessing their level of DHL. Methods: A literature review, focus group discussions, and the Delphi method were used to construct the questionnaire item pool and perform item screening. Item analysis was conducted for comprehensive evaluation, and questionnaire validity was assessed through construct validity (exploratory factor analysis, confirmatory factor analysis, convergent validity, and discriminant validity), content validity, and criterion-related validity. Reliability was analyzed using Cronbach alpha coefficient, split-half reliability, and test-retest reliability. Results: The study included 710 participants. Item analysis indicated that the questionnaire had strong discriminant validity. Correlation coefficient analysis showed that the item-total correlation coefficients ranged from 0.497 to 0.920 (P<.01). After multiple exploratory factor analyses, 6 common factors were extracted, with a cumulative variance contribution rate of 73.745%. Confirmatory factor analysis demonstrated a good model fit (χ2/df=2.803, root-mean-square error of approximation=0.071, comparative fit index=0.907, goodness-of-fit index=0.773, incremental fit index=0.908, Tucker-Lewis index=0.901, normed fit index=0.863). The questionnaire demonstrated favorable convergent validity, content validity, and criterion-related validity. The total Cronbach α coefficient was 0.976, with dimension-specific Cronbach α coefficients ranging from 0.819 to 0.952, indicating satisfactory internal consistency. Additionally, the test-retest reliability coefficient for the total questionnaire was 0.925, demonstrating good stability over time. Conclusions: This study developed a questionnaire specifically designed to assess DHL in older adults through a scientifically rigorous and systematic process. The questionnaire demonstrates strong psychometric properties and can serve as an empirical tool for health professionals to design personalized intervention policies and enhance health service delivery. %M 40106815 %R 10.2196/64193 %U https://www.jmir.org/2025/1/e64193 %U https://doi.org/10.2196/64193 %U http://www.ncbi.nlm.nih.gov/pubmed/40106815 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54803 %T Synthetic Data-Driven Approaches for Chinese Medical Abstract Sentence Classification: Computational Study %A Li,Jiajia %A Wang,Zikai %A Yu,Longxuan %A Liu,Hui %A Song,Haitao %K medical abstract sentence classification %K large language models %K synthetic datasets %K deep learning %K Chinese medical %K dataset %K traditional Chinese medicine %K global medical research %K algorithm %K robustness %K efficiency %K accuracy %D 2025 %7 19.3.2025 %9 %J JMIR Form Res %G English %X Background: Medical abstract sentence classification is crucial for enhancing medical database searches, literature reviews, and generating new abstracts. However, Chinese medical abstract classification research is hindered by a lack of suitable datasets. Given the vastness of Chinese medical literature and the unique value of traditional Chinese medicine, precise classification of these abstracts is vital for advancing global medical research. Objective: This study aims to address the data scarcity issue by generating a large volume of labeled Chinese abstract sentences without manual annotation, thereby creating new training datasets. Additionally, we seek to develop more accurate text classification algorithms to improve the precision of Chinese medical abstract classification. Methods: We developed 3 training datasets (dataset #1, dataset #2, and dataset #3) and a test dataset to evaluate our model. Dataset #1 contains 15,000 abstract sentences translated from the PubMed dataset into Chinese. Datasets #2 and #3, each with 15,000 sentences, were generated using GPT-3.5 from 40,000 Chinese medical abstracts in the CSL database. Dataset #2 used titles and keywords for pseudolabeling, while dataset #3 aligned abstracts with category labels. The test dataset includes 87,000 sentences from 20,000 abstracts. We used SBERT embeddings for deeper semantic analysis and evaluated our model using clustering (SBERT-DocSCAN) and supervised methods (SBERT-MEC). Extensive ablation studies and feature analyses were conducted to validate the model’s effectiveness and robustness. Results: Our experiments involved training both clustering and supervised models on the 3 datasets, followed by comprehensive evaluation using the test dataset. The outcomes demonstrated that our models outperformed the baseline metrics. Specifically, when trained on dataset #1, the SBERT-DocSCAN model registered an impressive accuracy and F1-score of 89.85% on the test dataset. Concurrently, the SBERT-MEC algorithm exhibited comparable performance with an accuracy of 89.38% and an identical F1-score. Training on dataset #2 yielded similarly positive results for the SBERT-DocSCAN model, achieving an accuracy and F1-score of 89.83%, while the SBERT-MEC algorithm recorded an accuracy of 86.73% and an F1-score of 86.51%. Notably, training with dataset #3 allowed the SBERT-DocSCAN model to attain the best with an accuracy and F1-score of 91.30%, whereas the SBERT-MEC algorithm also showed robust performance, obtaining an accuracy of 90.39% and an F1-score of 90.35%. Ablation analysis highlighted the critical role of integrated features and methodologies in improving classification efficiency. Conclusions: Our approach addresses the challenge of limited datasets for Chinese medical abstract classification by generating novel datasets. The deployment of SBERT-DocSCAN and SBERT-MEC models significantly enhances the precision of classifying Chinese medical abstracts, even when using synthetic datasets with pseudolabels. %R 10.2196/54803 %U https://formative.jmir.org/2025/1/e54803 %U https://doi.org/10.2196/54803 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70112 %T eHealth Literacy 3.0: Updating the Norman and Skinner 2006 Model %A Milanti,Ariesta %A Norman,Cameron %A Chan,Dorothy Ngo Sheung %A So,Winnie Kwok Wei %A Skinner,Harvey %+ The Nethersole School of Nursing, The Chinese University of Hong Kong, 7/F, Esther Lee Building, Hong Kong, China (Hong Kong), 852 3943 1072, winnieso@cuhk.edu.hk %K eHealth literacy %K eHealth literacy definition %K eHealth literacy model %K eHealth literacy measurement %D 2025 %7 11.3.2025 %9 Research Letter %J J Med Internet Res %G English %X This paper advances the “eHealth Literacy 3.0” model following Norman and Skinner’s 2006 original eHealth literacy 1.0 model and Norman’s 2011 2.0 update, and introduces a corresponding revision to the eHealth Literacy Scale (eHEALS) measurement instrument (eHEALS-R). %M 40068166 %R 10.2196/70112 %U https://www.jmir.org/2025/1/e70112 %U https://doi.org/10.2196/70112 %U http://www.ncbi.nlm.nih.gov/pubmed/40068166 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e60156 %T Transcultural Adaptation, Validation, Psychometric Analysis, and Interpretation of the 22-Item Thai Senior Technology Acceptance Model for Mobile Health Apps: Cross-Sectional Study %A Buawangpong,Nida %A Siviroj,Penprapa %A Pinyopornpanish,Kanokporn %A Sirikul,Wachiranun %+ Department of Community Medicine, Faculty of Medicine, Chiang Mai University, 110 Intrawarorot road, Sriphum, Mueng, Chiang Mai, 50200, Thailand, 66 53935472, wachiranun.sir@cmu.ac.th %K STAM %K senior technology acceptance model %K validity %K reliability %K mHealth %K older adult %K technology acceptance %K mobile health %K app %K transcultural adaptation %K psychometric analysis %K geriatrics %K cross-sectional study %K Thai %K theory analysis %K Cronbach α %K McDonald ω %K quality of life %K well-being %K social media %K telehealth %K health informatics %K eHealth %K mobile phone %D 2025 %7 11.3.2025 %9 Original Paper %J JMIR Aging %G English %X Background: The rapid advancement of technology has made mobile health (mHealth) a promising tool to mitigate health problems, particularly among older adults. Despite the numerous benefits of mHealth, assessing individual acceptance is required to address the specific needs of older people and promote their intention to use mHealth. Objective: This study aims to adapt and validate the senior technology acceptance model (STAM) questionnaire for assessing mHealth acceptance in the Thai context. Methods: In this cross-sectional study, we adapted the original, 38-item, English version of the STAM using a 10-point Likert scale for mHealth acceptability among the Thai population. We translated the mHealth STAM into Thai using forward and backward translation. A total of 15 older adults and experts completed the pilot questionnaire and were interviewed to assess its validity. The pilot items of the Thai mHealth STAM were then reworded and revised for better comprehension and cross-cultural compatibility. The construct validity of the Thai mHealth STAM was evaluated by a multidimensional approach, including exploratory and confirmatory factor analysis and nonparametric item response theory analysis. Discriminative indices consisting of sensitivity, specificity, and area under the receiver operating characteristic (AUROC) were used to determine appropriate banding and discriminant validity for the intention to use mHealth. Internal consistency was assessed using Cronbach α and McDonald ω coefficients. Results: Out of the 1100 participants with a mean age of 62.3 (SD 8.8) years, 360 (32.7%) were adults aged 45-59 years, and 740 (67.3%) were older adults aged 60 years and older. Of the 40-item pilot questionnaire, exploratory factor analysis identified 22 items with factor loadings >0.4 across 7 principal components, explaining 91.45% of the variance. Confirmatory factor analysis confirmed that 9-dimensional sets of 22 items had satisfactory fit indices (comparative fit index=0.976, Tucker-Lewis index=0.968, root mean square error of approximation=0.043, standardized root mean squared residual=0.044, and R2 for each item>0.30). The score banding D (low≤151, moderate 152-180, and high≥181) was preferred as the optimal 22-item Thai mHealth STAM cutoff score based on the highest sensitivity of 89% (95% CI 86.1%-91.5%) and AUROC of 72.4% (95% CI 70%-74.8%) for predicting the intention to use mHealth. The final Thai mHealth STAM, consisting of 22 items, exhibited remarkable internal consistency, as evidenced by a Cronbach α of 0.88 (95% CI 0.87-0.89) and a McDonald ω of 0.85 (95% CI 0.83-0.87). For all 22 items, the corrected item-total correlations ranged between 0.26 and 0.71. Conclusions: The 22-item Thai mHealth STAM demonstrated satisfactory psychometric properties in both validity and reliability. The questionnaire has the potential to serve as a practical questionnaire in assessing the acceptance and intention to use mHealth among pre-older and older adults. %M 40068149 %R 10.2196/60156 %U https://aging.jmir.org/2025/1/e60156 %U https://doi.org/10.2196/60156 %U http://www.ncbi.nlm.nih.gov/pubmed/40068149 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e51975 %T FRAILSURVEY—an mHealth App for Self-Assessment of Frailty Based on the Portuguese Version of the Groningen Frailty Indicator: Validation and Reliability Study %A Midao,Luis %A Duarte,Mafalda %A Sampaio,Rute %A Almada,Marta %A Dias,Cláudia Camila %A Paúl,Constança %A Costa,Elísio %+ RISE-Health, Biochemistry Lab, Faculty of Pharmacy, University of Porto, R. Jorge de Viterbo Ferreira 228, Porto, 4050-313, Portugal, 351 22 042 8500, luismidao@gmail.com %K frailty %K mHealth %K assessment %K validation %K GFI %K reliability %K self-assessment %K Groningen Frailty Indicator %K FRAILSURVEY %K mobile phone %D 2025 %7 7.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Portugal is facing the challenge of population ageing, with a notable increase in the proportion of older individuals. This has positioned the country among those in Europe with a high prevalence of frailty. Frailty, a geriatric syndrome characterized by diminished physiological reserve and heightened vulnerability to stressors, imposes a substantial burden on public health. Objective: This study seeks to address two primary objectives: (1) translation and psychometric evaluation of the European Portuguese version of the Groningen Frailty Indicator (GFI); and (2) development and evaluation of the FRAILSURVEY app, a novel assessment tool for frailty based on the GFI. By achieving these objectives, the study aims to enhance the accuracy and reliability of frailty assessment in the Portuguese context, ultimately contributing to improved health care outcomes for older individuals in the region. Methods: To accomplish the objectives of the study, a comprehensive research methodology was used. The study comprised 2 major phases: the initial translation and validation of the GFI into European Portuguese and the development of the FRAILSURVEY app. Following this, an extensive examination of the app’s validity and reliability was conducted compared with the conventional paper version of the GFI. A randomized repeated crossover design was used to ensure rigorous evaluation of both assessment methods, using both the paper form of the GFI and the smartphone-based app FRAILSURVEY. Results: The findings of the study revealed promising outcomes in line with the research objectives. The meticulous translation process yielded a final version of the GFI with robust psychometric properties, ensuring clarity and comprehensibility for participants. The study included 522 participants, predominantly women (367/522, 70.3%), with a mean age of 73.7 (SD 6.7) years. Psychometric evaluation of the European Portuguese GFI in paper form demonstrates good reliability (internal consistency: Cronbach a value of 0.759; temporal stability: intraclass correlation coefficient=0.974) and construct validity (revealing a 4D structure explaining 56% of variance). Evaluation of the app-based European Portuguese GFI indicates good reliability (interinstrument reliability: Cohen k=0.790; temporal stability: intraclass correlation coefficient=0.800) and concurrent validity (r=0.694; P<.001). Conclusions: Both the smartphone-based app and the paper version of the GFI were feasible and acceptable for use. The findings supported that FRAILSURVEY exhibited comparable validity and reliability to its paper counterpart. FRAILSURVEY uses a standardized and validated assessment tool, offering objective and consistent measurements while eliminating subjective biases, enhancing accuracy, and ensuring reliability. This app holds promising potential for aiding health care professionals in identifying frailty in older individuals, enabling early intervention, and improving the management of adverse health outcomes associated with this syndrome. Its integration with electronic health records and other data may lead to personalized interventions, improving frailty management and health outcomes for at-risk individuals. %M 40053720 %R 10.2196/51975 %U https://formative.jmir.org/2025/1/e51975 %U https://doi.org/10.2196/51975 %U http://www.ncbi.nlm.nih.gov/pubmed/40053720 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65343 %T Association of Screen Content With Early Development Among Preschoolers in Shanghai: 7-Day Monitoring Study With Auto Intelligent Technology %A Chen,Hao %A Sun,Yi %A Luo,Sha %A Ma,Yingyan %A Li,Chenshu %A Xiao,Yingcheng %A Zhang,Yimeng %A Lin,Senlin %A Jia,Yingnan %+ Preventive Medicine and Health Education Department, School of Public Health, Fudan University, No 138 Yixueyuan Road, Shanghai, 200032, China, 86 13764665540, jyn@fudan.edu.cn %K types of screen content %K screen time %K intelligent technology %K early development %K preschool %D 2025 %7 5.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: It is unclear how exposure to different types of screen content is associated with early development among preschool children. Objective: This study aims to precisely evaluate the screen exposure time across different content types and to explore the associations with the Ages and Stages Questionnaire, Third Edition (ASQ-3) score and 5 capacity domains in children aged 34.5-66 months. Methods: This monitoring study used intelligent technology to collect data on the 7-day screen time and the time spent viewing each content type. The participants were 2 groups of Shanghai kindergarten kids. The data were collected between March 2023 and July 2023. Screen exposure data (total daily time and time for each type of content) were collected from children aged between 34.5 and 66 months. A self-designed questionnaire and the Healthy Screen Viewing for Children intelligent technology app were used to assess screen exposure to all media and tablets. The ASQ-3 was used to assess early development in children aged 34.5-66 months. Results: In the 535-child sample, the results of linear regression analysis indicated that both screen time of more than 60 minutes and exposure to smartphones and tablets were negatively associated with ASQ-3 score. Among 365 participants with data collected by the Healthy Screen Viewing for Children app, median regression showed that the median total ASQ-3 score was negatively associated with screen time for noneducational content (β=–.055; 95% CI –0.148 to –0.006; P=.03), screen time for both educational and noneducational content (β=–.042; 95% CI –0.081 to –0.007; P=.001), and fast-paced content (β=–.034; 95% CI –0.062 to –0.011; P=.049). The median gross motor score was negatively associated with screen time for parental guidance-13–rated content (β=–.015; 95% CI –0.022 to 0.009; P=.03), educational and noneducational content (β=–.018, 95% CI –0.038 to –0.001; P=.02), static content (β=–.022; 95% CI –0.050 to 0.007; P=.02). This study also revealed that the median fine motor score was negatively associated with screen time for guidance–rated content (β=–.032, 95% CI –0.057 to –0.003; P=.006), parental guidance (PG) rated content (β=–.020; 95% CI –0.036 to –0.007; P=.004), noneducational content (β=–.026; 95% CI –0.067 to –0.003; P=.01), both educational and noneducational content (β=–.020; 95% CI –0.034 to –0.001; P<.001), fast-paced content (β=–.022; 95% CI –0.033 to –0.014; P<.001), static content (β=–.034; 95% CI –0.050 to 0.018; P<.001), animated content (β=–.038; 95% CI –0.069 to –0.001; P=.004), and screen use during the daytime (β=–.026; 95% CI –0.043 to 0.005; P=.005). Conclusions: The results indicated that the time spent viewing noneducational, static, fast-paced, and animated content was negatively associated with early development among preschool children. Limiting screen time in relevant aspects is recommended. %M 40053802 %R 10.2196/65343 %U https://www.jmir.org/2025/1/e65343 %U https://doi.org/10.2196/65343 %U http://www.ncbi.nlm.nih.gov/pubmed/40053802 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66341 %T Assessing Short-Video Dependence for e-Mental Health: Development and Validation Study of the Short-Video Dependence Scale %A Jiang,AnHang %A Li,Shuang %A Wang,HuaBin %A Ni,HaoSen %A Chen,HongAn %A Dai,JunHong %A Xu,XueFeng %A Li,Mei %A Dong,Guang-Heng %+ Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, No. 2318, Yuhangtang Rd, Yuhang District, Hangzhou, 311121, China, 86 15968849698, maylee530@126.com %K short-video dependence %K problematic short-video use %K cutoff point %K scale development %K mental health %K short video %K internet addiction %K latent profile analysis %K exploratory factor analysis %K confirmatory factor analysis %D 2025 %7 4.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Short-video dependence (SVD) has become a significant mental health issue around the world. The lack of scientific tools to assess SVD hampers further advancement in this area. Objective: This study aims to develop and validate a scientific tool to measure SVD levels, ensuring a scientifically determined cutoff point. Methods: We initially interviewed 115 highly engaged short-video users aged 15 to 63 years. Based on the summary of the interview and references to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for behavioral addictions, we proposed the first version of the short-video dependence scale (SVDS). We then screened the items through item analysis (second version) and extracted common factors using exploratory factor analysis (third version) and confirmatory factor analysis (final version). Convergent validity was tested with other scales (Chinese Internet Addiction Scale [CIAS] and DSM-5). Finally, we tested the validity of the final version in 16,038 subjects and set the diagnostic cutoff point through latent profile analysis and receiver operating characteristic curve analysis. Results: The final version of the SVDS contained 20 items and 4 dimensions, which showed strong structural validity (Kaiser-Meyer-Olkin value=0.94) and internal consistency (Cronbach α=.93), and good convergent validity (rCIAS=0.61 and rDSM-5=0.68), sensitivity (0.77, 0.83, 0.87, and 0.62 for each of the 4 dimensions), and specificity (0.75, 0.87, 0.80, and 0.79 for each of the 4 dimensions). Additionally, an SVDS score of 58 was determined as the best cutoff score, and latent profile analysis identified a 5-class model for SVD. Conclusions: We developed a tool to measure SVD levels and established a threshold to differentiate dependent users from highly engaged nondependent users. The findings provide opportunities for further research on the impacts of short-video use. %M 40053762 %R 10.2196/66341 %U https://www.jmir.org/2025/1/e66341 %U https://doi.org/10.2196/66341 %U http://www.ncbi.nlm.nih.gov/pubmed/40053762 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e51598 %T How to Design Electronic Case Report Form (eCRF) Questions to Maximize Semantic Interoperability in Clinical Research %A Rinaldi,Eugenia %A Stellmach,Caroline %A Thun,Sylvia %K case report form %K CRF %K interoperability %K standard data model %K data format %K metadata %K core data elements %K data quality %D 2025 %7 3.3.2025 %9 %J Interact J Med Res %G English %X Case report forms (CRFs) are the instruments used by research organizations worldwide to collect information about patients and study participants with the purpose of answering specific questions, assessing the efficacy and safety of medical products, and in general improving prevention and treatment in health care. To obtain significant research results out of the collected data, CRFs should be designed following the recommendations issued by regulatory authorities. However, we believe that semantic interoperability in CRFs has not yet been properly addressed. Within an international consortium comprising several COVID-19 cohorts, we scrutinized the questions included in the different CRFs with the purpose of establishing semantic interoperability across the different study data elements so that data could be merged and jointly analyzed. We realized that similar concepts were structured very differently across the different CRFs, making it hard to find and match the information. Based on the experience acquired, we developed 5 guiding principles on how to design CRFs to support semantic interoperability and increase data quality while also facilitating the sharing of data. Our aim in this viewpoint is to provide general suggestions that, in our opinion, should support researchers in designing CRFs. We conclude by urging authorities to establish an international coordination board for standards and interoperable clinical study data with competence in clinical data, interoperability standards, and data protection as part of a preparedness plan for future pandemics or other health threats. %R 10.2196/51598 %U https://www.i-jmr.org/2025/1/e51598 %U https://doi.org/10.2196/51598 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e60096 %T Understanding Appropriation of Digital Self-Monitoring Tools in Mental Health Care: Qualitative Analysis %A de Thurah,Lena %A Kiekens,Glenn %A Weermeijer,Jeroen %A Uyttebroek,Lotte %A Wampers,Martien %A Bonnier,Rafaël %A Myin-Germeys,Inez %K digital self-monitoring %K technology appropriation %K experience sampling method %K mental health care %K mental health %K self-monitoring %K digital health %K adoption %K implementation %K thematic %K usability %K interview %K experience %K attitude %K opinion %K perception %K perspective %K acceptance %D 2025 %7 3.3.2025 %9 %J JMIR Hum Factors %G English %X Background: Digital self-monitoring tools, such as the experience sampling method (ESM), enable individuals to collect detailed information about their mental health and daily life context and may help guide and support person-centered mental health care. However, similar to many digital interventions, the ESM struggles to move from research to clinical integration. To guide the implementation of self-monitoring tools in mental health care, it is important to understand why and how clinicians and clients adopted, adapted, and incorporated these tools in practice. Objective: Therefore, this study examined how clinicians and clients within a psychiatric center appropriated an ESM-based self-monitoring tool within their therapy. Methods: Twelve clinicians and 24 clients participated in the piloting of the ESM tool, IMPROVE. After utilizing the tool, 7 clinicians and 11 clients took part in semistructured interviews. A thematic framework analysis was performed focusing on participants’ prior knowledge and expectations, actual use in practice, and potential future use of ESM tools. Results: Many participants experienced that the ESM tool provided useful information about clients’ mental health, especially when clinicians and clients engaged in collaborative data interpretation. However, clinicians experienced several mismatches between system usability and their technical competencies, and many clients found it difficult to comply with the self-assessments. Importantly, most participants wanted to use digital self-monitoring tools in the future. Conclusions: Clinicians’ and clients’ choice to adopt and integrate self-monitoring tools in their practice seems to depend upon the perceived balance between the added benefits and the effort required to achieve them. Enhancing user support or redesigning ESM tools to reduce workload and data burden could help overcome implementation barriers. Future research should involve end users in the development of ESM self-monitoring tools for mental health care and further investigate the perspectives of nonadopters. %R 10.2196/60096 %U https://humanfactors.jmir.org/2025/1/e60096 %U https://doi.org/10.2196/60096 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e57802 %T Gamified mHealth System for Evaluating Upper Limb Motor Performance in Children: Cross-Sectional Feasibility Study %A Mia,Md Raihan %A Ahamed,Sheikh Iqbal %A Nemanich,Samuel %+ Department of Occupational Therapy, Marquette University, 1700 West Wells St, Milwaukee, WI, 53233, United States, 1 4142883243, sam.nemanich@marquette.edu %K mobile health %K mHealth %K digital health %K mobile apps %K smartphones %K iPad %K gamification %K serious games %K digital interventions %K digital technology %K spatiotemporal %K upper limb movement %K motor performance %K motor skills %K pediatrics %K toddler %K children %K youth %D 2025 %7 28.2.2025 %9 Original Paper %J JMIR Serious Games %G English %X Background: Approximately 17% of children in the United States have been diagnosed with a developmental or neurological disorder that affects upper limb (UL) movements needed for completing activities of daily living. Gold-standard laboratory assessments of the UL are objective and precise but may not be portable, while clinical assessments can be time-intensive. We developed MoEvGame, a mobile health (mHealth) gamification software system for the iPad, as a potential advanced technology to assess UL motor functions. Objective: This feasibility study examines whether MoEvGame can assess children’s whole-limb movement, fine motor skills, manual dexterity, and bimanual coordination. The specific aims were to (1) design and develop novel mHealth gamified software tools to examine theory-driven features of UL movement, (2) analyze spatiotemporal game data with new algorithms and statistical techniques to quantify movement performance as a parameter of speed, accuracy, and precision, and (3) validate assessment methods with healthy participants from schools. Methods: Elementary school children (N=31, median 9.0, IQR 4.0-14.0 years old) participated by playing 5 games. The game tasks were focused on key features of skilled motor control: (1) whole limb reaching, (2) fine motor control and manual dexterity, and (3) bilateral coordination. Spatiotemporal game data were transferred and stored in a cloud-based data management server for further processing and analysis. We applied change point detection (ie, the pruned exact linear time method), signal processing techniques, and other algorithms to calculate movement speed and accuracy from spatiotemporal parameters. Different statistical methods (ie, Pearson correlation, mean, standard deviation, P value, 95% confidence interval) were used to compare speed-accuracy tradeoffs and evaluate the relationship between age and motor performance. Results: A negative correlation was identified between speed and accuracy in the whole limb movement (r=–0.30 to –0.42). Significant relationships between age and upper limb performance were found: older participants exhibited lower errors with faster completion times compared to younger participants. Significant differences in bimanual coordination were found related to phase synchronization (in-phase congruent [mean 28.85, SD 18.97] vs antiphase congruent [mean 112.64, SD 25.82] and in-phase mirrored [mean 23.78, SD 16.07] vs antiphase mirrored [mean 121.39, SD 28.19]). Moreover, the average speed (revolutions per second) and travel distance (m) of the in-phase mode were significantly higher than those of the antiphase coordination. Conclusions: Results of this feasibility study show that spatiotemporal data captured from the mHealth app can quantify motor performance. Moving beyond traditional assessments, MoEvGame incorporates gamification into ubiquitous and accessible technology as a fast, flexible, and objective tool for UL motor assessment. %M 40053722 %R 10.2196/57802 %U https://games.jmir.org/2025/1/e57802 %U https://doi.org/10.2196/57802 %U http://www.ncbi.nlm.nih.gov/pubmed/40053722 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60672 %T Validation of the Nociception Level Index for the Detection of Nociception and Pain in Critically Ill Adults: Protocol for an Observational Study %A Gélinas,Céline %A Shahiri T,Shiva %A Wang,Han Ting %A Gallani,Maria Cecilia %A Oulehri,Walid %A Laporta,Denny %A Richebé,Philippe %+ Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Sherbrooke West St, Suite 1800, Montreal, QC, H3A 2M7, Canada, 1 514 398 4144, celine.gelinas@mcgill.ca %K validation %K NOL %K Nociception Level %K nociception %K pain %K intensive care unit %K ICU %K critical care %K protocol %D 2025 %7 28.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the intensive care unit (ICU), many patients are unable to communicate their pain through self-reporting or behaviors due to their critical care condition, mechanical ventilation, and medication (eg, heavily sedated or chemically paralyzed). Therefore, alternative pain assessment methods are urgently needed for this vulnerable patient population. The Nociception Level (NOL) index is a multiparameter technology initially developed for the monitoring of nociception and related pain in anesthetized patients, and its use in the ICU is new. Objective: This study aims to validate the NOL for the assessment of nociception and related pain in critically ill adults in the ICU. Specific objectives are to examine the ability of the NOL to: (1) detect pain using standard criteria (ie, self-report and behavioral measures), (2) discriminate between nociceptive and nonnociceptive procedures, and (3) generate consistent values when patients are at rest. Methods: The NOL will be monitored in three ICU patient groups: (1) Group A, participants able to self-report their pain (the reference standard criterion using the 0-10 Faces Pain Thermometer) and express behaviors; (2) Group B, participants unable to self-report but able to express behaviors (the alternative standard criterion using the Critical-Care Pain Observation Tool); and (3) Group C, participants unable to self-report and express behaviors. The NOL will be tested before, during, and after two types of standard care procedures: (1) nonnociceptive (eg, cuff inflation to measure blood pressure, soft touch) and (2) nociceptive (eg, tube or drain removal, endotracheal or tracheal suctioning). Receiver operating characteristic curve analysis of the NOL will be performed for Groups A and B using pain standard measures as reference criteria. Mixed linear models for repeated measures will be used to compare time points, procedures, and their interaction in each group (A, B, and C). Based on power analyses and considering an attrition rate of 25%, a total sample size of 146 patients (68 in Group A, 62 in Group B, and 16 in Group C) is targeted. Results: This study was funded in April 2020 but could not be launched until 2022 due to the COVID-19 pandemic. Recruitment and data collection began at the primary site in July 2022 and has been implemented at the secondary sites in 2023 and 2024 and is planned to continue until 2026. Conclusions: The primary strength of this study protocol is that it is based on rigorous validation strategies with the use of pain standard criteria (ie, self-report and behavioral measures). If found to be valid, the NOL could be used as an alternative physiologic measure of pain in critically ill adults for whom no other pain assessment methods are available. Trial Registration: ClinicalTrials.gov NCT05339737; https://clinicaltrials.gov/study/NCT05339737 International Registered Report Identifier (IRRID): DERR1-10.2196/60672 %M 40053798 %R 10.2196/60672 %U https://www.researchprotocols.org/2025/1/e60672 %U https://doi.org/10.2196/60672 %U http://www.ncbi.nlm.nih.gov/pubmed/40053798 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e65292 %T Performance of a Digital Cognitive Assessment in Predicting Dementia Stages Delineated by the Dementia Severity Rating Scale: Retrospective Study %A Huynh,Duong %A Sun,Kevin %A Patterson,Mary %A Hosseini Ghomi,Reza %A Huang,Bin %K stage %K severity %K progression %K correlation %K association %K cognitive impairment %K functional activities %K cognitive assessment %K BrainCheck %K dementia %K Alzheimer disease %K gerontology %K geriatric %K old %K elderly %K aging %K retrospective analysis %K digital assessment %K patient assessment %K digital cognitive assessment %K digital health %K neurodegeneration %K memory loss %K memory function %K risk factors %D 2025 %7 26.2.2025 %9 %J JMIR Aging %G English %X Background: Dementia is characterized by impairments in an individual’s cognitive and functional abilities. Digital cognitive assessments have been shown to be effective in detecting mild cognitive impairment and dementia, but whether they can stage the disease remains to be studied. Objective: In this study, we examined (1) the correlation between scores obtained from BrainCheck standard battery of cognitive assessments (BC-Assess), a digital cognitive assessment, and scores obtained from the Dementia Severity Rating Scale (DSRS), and (2) the accuracy of using the BC-Assess score to predict dementia stage delineated by the DSRS score. We also explored whether BC-Assess can be combined with information from the Katz Index of Independence in activities of daily living (ADL) to obtain enhanced accuracy. Methods: Retrospective analysis was performed on a BrainCheck dataset containing 1751 patients with dementia with different cognitive and functional assessments completed for cognitive care planning, including the DSRS, the ADL, and the BC-Assess. The patients were staged according to their DSRS total score (DSRS-TS): 982 mild (DSRS-TS 10‐18), 656 moderate (DSRS-TS 19-26), and 113 severe (DSRS-TS 37-54) patients. Pearson correlation was used to assess the associations between BC-Assess overall score (BC-OS), ADL total score (ADL-TS), and DSRS-TS. Logistic regression was used to evaluate the possibility of using patients’ BC-OS and ADL-TS to predict their stage. Results: We found moderate Pearson correlations between DSRS-TS and BC-OS (r=−0.53), between DSRS-TS and ADL-TS (r=−0.55), and a weak correlation between BC-OS and ADL-TS (r=0.37). Both BC-OS and ADL-TS significantly decreased with increasing severity. BC-OS demonstrated to be a good predictor of dementia stages, with an area under the receiver operating characteristic curve (ROC-AUC) of classification using logistic regression ranging from .733 to .917. When BC-Assess was combined with ADL, higher prediction accuracies were achieved, with an ROC-AUC ranging from 0.786 to 0.961. Conclusions: Our results suggest that BC-Assess could serve as an effective alternative tool to DSRS for grading dementia severity, particularly in cases where DSRS, or other global assessments, may be challenging to obtain due to logistical and time constraints. %R 10.2196/65292 %U https://aging.jmir.org/2025/1/e65292 %U https://doi.org/10.2196/65292 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e51502 %T Assessing Preparedness for Self-Management of Oral Anticoagulation in Adults With the PERSONAE Scale: Protocol for a Development and Validation Study %A Caruso,Rosario %A Conte,Gianluca %A Castelvecchio,Serenella %A Baroni,Irene %A Paglione,Giulia %A De Angeli,Giada %A Pasek,Malgorzata %A Magon,Arianna %+ Health Professions Research and Development Unit, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 2, San Donato Milanese, 20097, Italy, 39 025277 ext 4940, rosario.caruso@unimi.it %K self-monitoring %K self-management %K oral anticoagulation %K vitamin K antagonists %K preparedness %K validation %D 2025 %7 26.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Optimal anticoagulation using vitamin K antagonists prevents strokes associated with atrial fibrillation and heart valve replacements. Preparedness for self-monitoring and self-management could improve outcomes, but this remains a challenge. Objective: This study aimed to outline the methodology for developing and validating the PERSONAE scale, a self-report measure designed to assess the preparedness for self-monitoring and self-management of oral anticoagulation in adult patients. Methods: This study comprises 2 main phases, and it adheres to the “COnsensus-based Standards for the selection of health Measurement INstruments” (COSMIN) guidelines for instrument development. The first phase involved the conceptualization of the PERSONAE scale, where a comprehensive literature review and a consensus meeting among experts were conducted to draft the initial items. Face and content validity were then established through an expert panel review. In the second phase (ongoing), a detailed sampling methodology will be used, targeting adult Italian patients on long-term oral anticoagulation. According to a performed simulation-based power analysis, the study aims to recruit a sample size of approximately 500 participants by using a combination of convenience and snowball sampling. Data collection will be facilitated through web-based surveys distributed through social media and patient networks, ensuring a wide and representative sample. Analytical procedures will include Mokken scaling analysis for item selection and confirmatory factor analysis to validate the scale’s structure. In addition, internal consistency will be assessed using Molenaar Sijtsma statistics. Results: The scale’s content derived from phase 1 (process completed in December 2023) is grounded in a comprehensive literature review and based on the assessments of a panel of 12 health care expert professionals. The PERSONAE scale derived from phase 1 encompasses 20 items reflecting essential behaviors needed to assess the preparedness for self-monitoring and self-management of oral anticoagulation. Each item obtained a content validity ratio higher than 0.67, which is the critical content validity ratio indicating the minimum level of agreement among the experts for an item to be considered essential beyond the level of chance at a significance level of .05 for a 1-tailed test. From January 2024 to May 2024, we conducted the initial round of data collection and use Mokken scaling analysis to select items. A second round of data collection for confirmatory factor analysis was scheduled from June 2024 to September 2024, which will validate the scale’s unidimensional structure. We expect to achieve robust psychometric properties, including high internal consistency and validated constructs. Conclusions: The PERSONAE scale will be a valuable tool to assess patients’ preparedness for self-monitoring and self-management of oral anticoagulation. The study’s insights into technology-assisted learning preferences will inform the design of future educational interventions to enhance preparedness in adult patients. Trial Registration: ClinicalTrials.gov NCT05973240; https://clinicaltrials.gov/study/NCT05973240 International Registered Report Identifier (IRRID): PRR1-10.2196/51502 %M 40009845 %R 10.2196/51502 %U https://www.researchprotocols.org/2025/1/e51502 %U https://doi.org/10.2196/51502 %U http://www.ncbi.nlm.nih.gov/pubmed/40009845 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e53958 %T French Versions of 4 English Questionnaires on Problematic Smartphone Use: Cross-Cultural Linguistic Translation and Adaptation Study %A El Boudi,Islam %A Riant,Mathilde %A Bellier,Alexandre %A Vuillerme,Nicolas %+ Faculty of Medicine, AGEIS, Grenoble Alpes University, Jean Roget Bldg, 3rd Fl., Grenoble, 38000, France, 33 695685616, islam.el-boudi@univ-grenoble-alpes.fr %K problematic use %K smartphone %K French questionnaire %K linguistic translation %K forward/backward process %K mobile phone %D 2025 %7 26.2.2025 %9 Original Paper %J Interact J Med Res %G English %X Background: Excessive use of smartphones is recognized as a major problem in our modern society and can have dramatic consequences on the health of adolescents and young adults. Measuring problematic smartphone use in research and clinical practice is generally operationalized with self-reported questionnaires. In order to comprehensively assess the issue of problematic smartphone usage within the French population, it is imperative to employ validated French-language questionnaires. However, at this point, existing questionnaires are primarily available in English. Furthermore, to the best of our knowledge, these English questionnaires have yet to undergo validation processes for French-speaking cohorts. Objective: The aim of this study was to perform a cross-cultural translation of the Smartphone Addiction Scale, Nomophobia Questionnaire, Problematic Use of Mobile Phones scale, and Smartphone Addiction Proneness Scale to French. Methods: The translation process was performed using the forward/backward method. The first translation phase involved asking 4 independent French translators to translate the original English version of the questionnaires into French. In the second phase, the French version was backtranslated to English by a native English speaker. In the third phase, 2 concept experts were asked to comment and suggest modifications to the statements if necessary. Finally, the last version of the translated questionnaires was presented to 18 participants to assess the clarity, intelligibility, and acceptability of the translations. Results: During the forward translation step, the translation differences were minor. During the backward translation, the English native speaker correctly backtranslated 18 of the 33 items of the Smartphone Addiction Scale, 17 of the 20 items of the Problematic Use of Mobile Phones scale, and 13 of the 15 items of the Smartphone Addiction Proneness Scale. Backtranslation for the Nomophobia Questionnaire was less satisfactory, with only 10 out of 20 items that were correctly backtranslated. The linguistic verification step revealed a minimal modification for the 4 questionnaires. The participants also suggested few improvements that we have considered for the final version. We produced the final version directly after this step. Conclusions: We successfully adapted and effectively translated 4 questionnaires that assess problematic smartphone use to French. This step is a prerequisite for the validation of the French questionnaires. These adapted measures can serve as valuable research instruments for investigating and addressing issues related to problematic smartphone use in French-speaking countries and for making international comparisons. %M 40009839 %R 10.2196/53958 %U https://www.i-jmr.org/2025/1/e53958 %U https://doi.org/10.2196/53958 %U http://www.ncbi.nlm.nih.gov/pubmed/40009839 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57730 %T Psychometric Analysis of the eHealth Literacy Scale in Portuguese Older Adults (eHEALS-PT24): Instrument Development and Validation %A Luz,Sara %A Nogueira,Paulo %A Costa,Andreia %A Henriques,Adriana %+ , Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon (ESEL), Av. Dom João II, Lote 4.69.01, Lisbon, 1990-096, Portugal, 351 217913400, sara.luz@esel.pt %K eHealth %K health literacy %K older adults %K psychometric properties %K public health %D 2025 %7 26.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: In this era of digitalization, eHealth interventions are used to engage patients in health care and help them manage their health. Previous studies showed that this can be particularly interesting for chronic disease self-management and self-care in older adults. Despite older adults becoming increasingly active on the internet, they continue to struggle in using eHealth information due to inadequate eHealth literacy. Thus, assessing and monitoring eHealth literacy is critical to support eHealth interventions. Objective: This study aimed to describe the translation, adaptation, and validation process of the eHealth Literacy Scale (eHEALS) in Portuguese older adults. Methods: The cross-cultural adaption followed the steps of forward and blinded backward translations, evaluation of the translations by a committee of judges, pilot-testing, and full psychometric testing. We tested the psychometric properties of the eHEALS by carrying out two studies: general psychometric analysis (study 1) and confirmatory factor analysis (study 2). Study 1 included 80 older adults conveniently selected from a Health Family Unit. Data were collected by in-person questionnaires between May and July 2022. Study 2 included 301 older adults randomly selected from two distinct Health Family Units. Data were collected by in-person questionnaires between May and July 2023. Results: We tested stability, reliability, construct validity (exploratory and confirmatory factor analyses and known groups), and model fit. Study 1 had 58.8% (47/80) male and 41.3% (33/80) female respondents (mean age 71.20, SD 5.26 years). Study 2 had 56.5% (170/301) male and 43.5% (131/301) female respondents (mean age 71.77, SD 5.15 years). Moderate and strong correlations were identified in the scale items (study 1: 0.42≤r≤0.91 and study 2: 0.81≤r≤0.96; P<.001). The scale showed good internal consistency for study 1 (α=.92) and study 2 (α=.98), with high correlations between items. The exploratory factor analysis yielded a single-factor structure, explaining 58.3% of the variance in study 1 and 86.4% in study 2. In the confirmatory analysis (study 2), the model fit was mixed (χ²20=265, P<.001; comparative fit index=0.94; Tucker-Lewis Index=0.91; root mean square error of approximation=0.20). Thus, we compared 1-, 2-, and 3-factor structures, deciding on the unidimensional one. In study 1, the eHEALS-PT24 (Portuguese version of the eHealth Literacy Scale for older adults) mean score was 27.25 (SD 5.61), with 43.8% (35/80) and 11.3% (9/80) of participants showing low and high eHealth literacy levels, respectively. In study 2, the eHEALS-PT24 mean score was 23.31 (SD 9.53), with 38.2% (115/301) and 23.6% (71/301) of participants showing low and high eHealth literacy levels, respectively. The known-groups analysis showed statistically significant differences between eHealth literacy and demographic variables (P<.001). Conclusions: The findings suggest that the eHEALS-PT24 is a reliable and valid tool to assess eHealth literacy in Portuguese older adults. Therefore, this instrument can be integrated to support the implementation process of eHealth interventions. %M 40009846 %R 10.2196/57730 %U https://www.jmir.org/2025/1/e57730 %U https://doi.org/10.2196/57730 %U http://www.ncbi.nlm.nih.gov/pubmed/40009846 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66718 %T Improving the User Interface and Guiding the Development of Effective Training Material for a Clinical Research Recruitment and Retention Dashboard: Usability Testing Study %A Gardner,Leah Leslie %A Raeisian Parvari,Pezhman %A Seidman,Mark %A Holden,Richard J %A Fowler,Nicole R %A Zarzaur,Ben L %A Summanwar,Diana %A Barboi,Cristina %A Boustani,Malaz %K recruitment strategies %K clinical research %K research subject recruitment %K agile science %K agile implementation %K human-computer interaction %D 2025 %7 24.2.2025 %9 %J JMIR Form Res %G English %X Background: Participant recruitment and retention are critical to the success of clinical trials, yet challenges such as low enrollment rates and high attrition remain ongoing obstacles. RecruitGPS is a scalable dashboard with integrated control charts to address these issues by providing real-time data monitoring and analysis, enabling researchers to better track and improve recruitment and retention. Objective: This study aims to identify the challenges and inefficiencies users encounter when interacting with the RecruitGPS dashboard. By identifying these issues, the study aims to inform strategies for improving the dashboard’s user interface and create targeted, effective instructional materials that address user needs. Methods: Twelve clinical researchers from the Midwest region of the United States provided feedback through a 10-minute, video-recorded usability test session, during which participants were instructed to explore the various tabs of the dashboard, identify challenges, and note features that worked well while thinking aloud. Following the video session, participants took a survey on which they answered System Usability Scale (SUS) questions, ease of navigation questions, and a Net Promoter Score (NPS) question. Results: A quantitative analysis of survey responses revealed an average SUS score of 61.46 (SD 23.80; median 66.25) points, indicating a need for improvement in the user interface. The NPS was 8, with 4 of 12 (33%) respondents classified as promoters and 3 of 12 (25%) as detractors, indicating a slightly positive satisfaction. When participants compared RecruitGPS to other recruitment and study management tools they had used, 8 of 12 (67%) of participants rated RecruitGPS as better or much better. Only 1 of 12 (8%) participants rated RecruitGPS as worse but not much worse. A qualitative analysis of participants’ interactions with the dashboard diagnosed a confusing part of the dashboard that could be eliminated or made optional and provided valuable insight for the development of instructional videos and documentation. Participants liked the dashboard’s data visualization capabilities, including intuitive graphs and trend tracking; progress indicators, such as color-coded status indicators and comparison metrics; and the overall dashboard’s layout and design, which consolidated relevant data on a single page. Users also valued the accuracy and real-time updates of data, especially the integration with external sources like Research Electronic Data Capture (REDCap). Conclusions: RecruitGPS demonstrates significant potential to improve the efficiency of clinical trials by providing researchers with real-time insights into participant recruitment and retention. This study offers valuable recommendations for targeted refinements to enhance the user experience and maximize the dashboard’s effectiveness. Additionally, it highlights navigation challenges that can be addressed through the development of clear and focused instructional videos. %R 10.2196/66718 %U https://formative.jmir.org/2025/1/e66718 %U https://doi.org/10.2196/66718 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 6 %N %P e65565 %T Checklist Approach to Developing and Implementing AI in Clinical Settings: Instrument Development Study %A Owoyemi,Ayomide %A Osuchukwu,Joanne %A Salwei,Megan E %A Boyd,Andrew %K artificial intelligence %K machine learning %K algorithm %K model %K analytics %K AI deployment %K human-AI interaction %K AI integration %K checklist %K clinical workflow %K clinical setting %K literature review %D 2025 %7 20.2.2025 %9 %J JMIRx Med %G English %X Background: The integration of artificial intelligence (AI) in health care settings demands a nuanced approach that considers both technical performance and sociotechnical factors. Objective: This study aimed to develop a checklist that addresses the sociotechnical aspects of AI deployment in health care and provides a structured, holistic guide for teams involved in the life cycle of AI systems. Methods: A literature synthesis identified 20 relevant studies, forming the foundation for the Clinical AI Sociotechnical Framework checklist. A modified Delphi study was then conducted with 35 global health care professionals. Participants assessed the checklist’s relevance across 4 stages: “Planning,” “Design,” “Development,” and “Proposed Implementation.” A consensus threshold of 80% was established for each item. IQRs and Cronbach α were calculated to assess agreement and reliability. Results: The initial checklist had 45 questions. Following participant feedback, the checklist was refined to 34 items, and a final round saw 100% consensus on all items (mean score >0.8, IQR 0). Based on the outcome of the Delphi study, a final checklist was outlined, with 1 more question added to make 35 questions in total. Conclusions: The Clinical AI Sociotechnical Framework checklist provides a comprehensive, structured approach to developing and implementing AI in clinical settings, addressing technical and social factors critical for adoption and success. This checklist is a practical tool that aligns AI development with real-world clinical needs, aiming to enhance patient outcomes and integrate smoothly into health care workflows. %R 10.2196/65565 %U https://xmed.jmir.org/2025/1/e65565 %U https://doi.org/10.2196/65565 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e64716 %T Digital Migration of the Loewenstein Acevedo Scales for Semantic Interference and Learning (LASSI-L): Development and Validation Study in Older Participants %A Harvey,Philip %A Curiel-Cid,Rosie %A Kallestrup,Peter %A Mueller,Annalee %A Rivera-Molina,Andrea %A Czaja,Sara %A Crocco,Elizabeth %A Loewenstein,David %K mild cognitive impairment %K cognitive challenge tests %K elder %K aging %K amyloid biomarkers %K cognition %K cognitive decline %K deterioration %K semantic interference %K Alzheimer disease %K self-administered %K voice recognition %K technology %K assessment study %K accuracy %K artificial intelligence %K treatment %K medication %K mental health %K biomarkers %K amnesia %K neurodegeneration %K patient health %K health monitoring %K digital mental health %K neuroscience %K neurotechnology %K Loewenstein Acevedo Scales for Semantic Interference and Learning %K LASSI-L %K digital Loewenstein-Acevedo Scales for Semantic Interference %K LASSI-D %D 2025 %7 19.2.2025 %9 %J JMIR Ment Health %G English %X Background: The early detection of mild cognitive impairment is crucial for providing treatment before further decline. Cognitive challenge tests such as the Loewenstein-Acevedo Scales for Semantic Interference and Learning (LASSI-L) can identify individuals at highest risk for cognitive deterioration. Performance on elements of the LASSI-L, particularly proactive interference, correlate with the presence of critical Alzheimer disease biomarkers. However, in-person paper tests require skilled testers and are not practical in many community settings or for large-scale screening in prevention. Objective: This study reports on the development and initial validation of a self-administered computerized version of the Loewenstein-Acevedo Scales for Semantic Interference (LASSI), the digital LASSI (LASSI-D). A self-administered digital version, with an artificial intelligence–generated avatar assistant, was the migrated assessment. Methods: Cloud-based software was developed, using voice recognition technology, for English and Spanish versions of the LASSI-D. Participants were assessed with either the LASSI-L or LASSI-D first, in a sequential assessment study. Participants with amnestic mild cognitive impairment (aMCI; n=54) or normal cognition (NC; n=58) were also tested with traditional measures such as the Alzheimer Disease Assessment Scale-Cognition. We examined group differences in performance across the legacy and digital versions of the LASSI, as well as correlations between LASSI performance and other measures across the versions. Results: Differences on recall and intrusion variables between aMCI and NC samples on both versions were all statistically significant (all P<.001), with at least medium effect sizes (d>0.68). There were no statistically significant performance differences in these variables between legacy and digital administration in either sample (all P<.13). There were no language differences in any variables (P>.10), and correlations between LASSI variables and other cognitive variables were statistically significant (all P<.01). The most predictive legacy variables, proactive interference and failure to recover from proactive interference, were identical across legacy and migrated versions within groups and were identical to results of previous studies with the legacy LASSI-L. Classification accuracy was 88% for NC and 78% for aMCI participants. Conclusions: The results for the digital migration of the LASSI-D were highly convergent with the legacy LASSI-L. Across all indices of similarity, including sensitivity, criterion validity, classification accuracy, and performance, the versions converged across languages. Future studies will present additional validation data, including correlations with blood-based Alzheimer disease biomarkers and alternative forms. The current data provide convincing evidence of the use of a fully self-administered digitally migrated cognitive challenge test. %R 10.2196/64716 %U https://mental.jmir.org/2025/1/e64716 %U https://doi.org/10.2196/64716 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e55316 %T Snowball Group Usability Testing for Rapid and Iterative Multisite Tool Development: Method Development Study %A Dauber-Decker,Katherine L %A Feldstein,David %A Hess,Rachel %A Mann,Devin %A Kim,Eun Ji %A Gautam-Goyal,Pranisha %A Solomon,Jeffrey %A Khan,Sundas %A Malik,Fatima %A Xu,Lynn %A Huffman,Ainsley %A Smith,Paul D %A Halm,Wendy %A Yuroff,Alice %A Richardson,Safiya %K clinical decision support %K CDS %K decision aid %K clinical aid %K cough %K sore throat %K strep pharyngitis %K snowball group usability testing %K snowball group %K usability testing %D 2025 %7 18.2.2025 %9 %J JMIR Form Res %G English %X Background: Usability testing is valuable for assessing a new tool or system’s usefulness and ease-of-use. Several established methods of usability testing exist, including think-aloud testing. Although usability testing has been shown to be crucial for successful clinical decision support (CDS) tool development, it is often difficult to conduct across multisite development projects due to its time- and labor-intensiveness, cost, and the skills required to conduct the testing. Objective: Our objective was to develop a new method of usability testing that would enable efficient acquisition and dissemination of results among multiple sites. We sought to address the existing barriers to successfully completing usability testing during CDS tool development. Methods: We combined individual think-aloud testing and focus groups into one session and performed sessions serially across 4 sites (snowball group usability testing) to assess the usability of two CDS tools designed for use by nurses in primary and urgent care settings. We recorded each session and took notes in a standardized format. Each site shared feedback from their individual sessions with the other sites in the study so that they could incorporate that feedback into their tools prior to their own testing sessions. Results: The group testing and snowballing components of our new usability testing method proved to be highly beneficial. We identified 3 main benefits of snowball group usability testing. First, by interviewing several participants in a single session rather than individuals over the course of weeks, each site was able to quickly obtain their usability feedback. Second, combining the individualized think-aloud component with a focus group component in the same session helped study teams to more easily notice similarities in feedback among participants and to discuss and act upon suggestions efficiently. Third, conducting usability testing in series across sites allowed study teams to incorporate feedback based on previous sites’ sessions prior to conducting their own testing. Conclusions: Snowball group usability testing provides an efficient method of obtaining multisite feedback on newly developed tools and systems, while addressing barriers typically associated with traditional usability testing methods. This method can be applied to test a wide variety of tools, including CDS tools, prior to launch so that they can be efficiently optimized. Trial Registration: Clinicaltrials.gov NCT04255303; https://clinicaltrials.gov/study/NCT04255303 %R 10.2196/55316 %U https://formative.jmir.org/2025/1/e55316 %U https://doi.org/10.2196/55316 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58451 %T A 4-Site Public Deliberation Project on the Acceptability of Youth Self-Consent in Biomedical HIV Prevention Trials: Assessment of Facilitator Fidelity to Key Principles %A Draucker,Claire Burke %A Carrión,Andrés %A Ott,Mary A %A Hicks,Ariel I %A Knopf,Amelia %+ Indiana University, 111 Middle Drive, Indianapolis, IN, 46202, United States, 1 317 274 4139, cdraucke@iu.edu %K public deliberation %K deliberative democracy %K bioethics %K ethical conflict %K biomedical %K HIV prevention %K HIV research %K group facilitation %K fidelity assessment %K content analysis %D 2025 %7 13.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Public deliberation is an approach used to engage persons with diverse perspectives in discussions and decision-making about issues affecting the public that are controversial or value laden. Because experts have identified the need to evaluate facilitator performance, our research team developed a framework to assess the fidelity of facilitator remarks to key principles of public deliberation. Objective: This report describes how the framework was used to assess facilitator fidelity in a 4-site public deliberation project on the acceptability of minor self-consent in biomedical HIV prevention research. Methods: A total of 88 individuals participated in 4 deliberation sessions held in 4 cities throughout the United States. The sessions, facilitated by 18 team members, were recorded and transcribed verbatim. Facilitator remarks were highlighted, and predetermined coding rules were used to code the remarks to 1 of 6 principles of quality deliberations. A variety of display tables were used to organize the codes and calculate the number of facilitator remarks that were consistent or inconsistent with each principle during each session across all sites. A content analysis was conducted on the remarks to describe how facilitator remarks aligned or failed to align with each principle. Results: In total, 735 remarks were coded to one of the principles; 516 (70.2%) were coded as consistent with a principle, and 219 (29.8%) were coded as inconsistent. A total of 185 remarks were coded to the principle of equal participation (n=138, 74.6% as consistent; n=185, 25.4% as inconsistent), 158 were coded to expression of diverse opinions (n=110, 69.6% as consistent; n=48, 30.4% as inconsistent), 27 were coded to respect for others (n=27, 100% as consistent), 24 were coded to adoption of a societal perspective (n=11, 46% as consistent; n=13, 54% as inconsistent), 99 were coded to reasoned justification of ideas (n=81, 82% as consistent; n=18, 18% as inconsistent), and 242 were coded to compromise or movement toward consensus (n=149, 61.6% as consistent; n=93, 38.4% as inconsistent). Therefore, the counts provided affirmation that most of the facilitator remarks were aligned with the principles of deliberation, suggesting good facilitator fidelity. By considering how the remarks aligned or failed to align with the principles, areas where facilitator fidelity can be strengthened were identified. The results indicated that facilitators should focus more on encouraging quieter members to participate, refraining from expressing personal opinions, promoting the adoption of a societal perspective and reasoned justification of opinions, and inviting deliberants to articulate their areas of common ground. Conclusions: The results provide an example of how a framework for assessing facilitator fidelity was used in a 4-site deliberation project. The framework will be refined to better address issues related to balancing personal and public perspectives, managing plurality, and mitigating social inequalities. %M 39946717 %R 10.2196/58451 %U https://formative.jmir.org/2025/1/e58451 %U https://doi.org/10.2196/58451 %U http://www.ncbi.nlm.nih.gov/pubmed/39946717 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e55741 %T Novel Procedures for Evaluating Autism Online in a Culturally Diverse Population of Children: Protocol for a Mixed Methods Pathway Development Study %A Mirzaei,Venus %A Wolstencroft,Jeanne %A Lockwood Estrin,Georgia %A Buckley,Eleanor %A Sayani,Shermina %A Katakis,Panos %A Anand,Reena %A Squire,Tessa %A Short,Eleanor %A Frankson,Paige %A Skuse,David %A Heys,Michelle %+ Great Ormond Street Institute of Child Health, University College London, 30 Guilford St, London, WC1N 1EH, United Kingdom, 44 07964630290, j.wolstencroft@ucl.ac.uk %K autism %K child %K telehealth %K co-development %K feasibility %K acceptability %K assessment %K diagnosis %K online %K evaluation %K diagnostic %K intervention %K pilot implementation evaluation study %D 2025 %7 11.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Current autism assessment procedures are costly and resource-intensive. The COVID-19 pandemic accelerated the adoption of telemedicine, highlighting the benefits of innovative diagnostic tools. Telemedicine-based pathways could enhance accessibility and equity in autism diagnostics. Objective: The Children with Autism Technology Enabled Assessment (CHATA) project aims to develop and pilot an open-source autism diagnostic pathway for children up to 5 years old, delivered through telemedicine. The pathway is designed to be culturally and linguistically adaptable, increasing its applicability to diverse populations and integrating with existing National Health Service digital systems. Methods: Initial pathway development was informed by systematic evidence reviews, coproduction, and mixed methods usability. CHATA comprises 2 key elements: online self-completed standardized autism questionnaires and a structured online interview and observation by a trained clinician. Out of 60 families near the top of the local waiting list will be invited to participate in the pilot evaluation, assessed using both the CHATA and usual assessment pathways. Sensitivity and specificity will be calculated by comparing the diagnosis of autism through CHATA with usual care. Quantitative usability assessment will be gathered from all families using the System Usability Scale (where a mean above 68 indicates above-average usability). A subset of CHATA assessments will be reviewed for interrater reliability (measured by the Cohen κ for categorical data [diagnosis present or absent], with values indicating the level of agreement; eg, <0 indicating no agreement, 0.61-0.80 indicating substantial agreement). Qualitative data on acceptability, feasibility, and usability will be gathered from semistructured interviews with a subset of families and health care providers. We will recruit 60 families for the main pilot study (including the usability testing) and 10-15 participants for the qualitative substudy. Data will estimate CHATA’s diagnostic accuracy, validity, reliability, usability, and acceptability. Patient and public involvement will be integral throughout. The study will take place in a socio-economically deprived, ethnically diverse inner-London Borough within a community-based child health National health service responsible for the Autism assessment of children and young people up to the age of 13 years. Results: Ethics approval was received in June 2023 (Research Ethics Committee reference 22/LO/0751; IRAS project ID 320499). Data collection commenced in April 2023 and completed in October 2024. Project end date is March 2025. As of November 2024, we had enrolled 57 participants to the pilot study and 12 to the qualitative substudy. Conclusions: The CHATA project aims to establish a novel, culturally sensitive, equitable, and accurate online autism assessment pathway. By addressing geographical and linguistic barriers, this pathway seeks to reduce service costs, shorten waiting times, and promote equity in autism diagnosis. The procedures developed are expected to be generalized to other populations nationwide. International Registered Report Identifier (IRRID): DERR1-10.2196/55741 %M 39932780 %R 10.2196/55741 %U https://www.researchprotocols.org/2025/1/e55741 %U https://doi.org/10.2196/55741 %U http://www.ncbi.nlm.nih.gov/pubmed/39932780 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e62776 %T NutriDiary, a Smartphone-Based Dietary Record App: Description and Usability Evaluation %A Klasen,Linda %A Koch,Stefanie Anna Julia %A Benz,Maike Elena %A Conrad,Johanna %A Alexy,Ute %A Blaszkiewicz,Konrad %A Andone,Ionut %A Nöthlings,Ute %K dietary assessment %K food record %K barcode scanning %K app %K mobile phone %D 2025 %7 10.2.2025 %9 %J JMIR Hum Factors %G English %X Background: Repeated applications of short-term dietary assessment instruments are recommended for estimating usual dietary intake. For this purpose, NutriDiary, a smartphone app for collecting weighed dietary records (WDRs) in the German population, was developed. Objective: We aim to describe NutriDiary and evaluate its usability and acceptability. Methods: NutriDiary was developed as a WDR, allowing users to enter food items via text search, barcode scanning, or free text entry. The sample for the evaluation study included 74 participants (n=51, 69% female, aged 18‐64 years), including 27 (37.5%) experts and 47 (63.5%) laypersons (including n=22, 30%, nutrition students). Participants completed a 1-day WDR and entered a predefined sample meal (n=17 foods) the following day by using NutriDiary. An evaluation questionnaire was answered from which the system usability scale (SUS) score (0‐100) was calculated. A backward selection procedure (PROC REG in SAS; SAS Institute) was used to identify potential predictors for the SUS score (age, sex, status [expert or laypersons], and operating system [iOS or Android]). Results: The median SUS score of 75 (IQR 63‐88) indicated good usability. Age was the only characteristic identified as a potential predictor for a lower SUS score (P<.001). The median completion time for an individual WDR was 35 (IQR 19‐52) minutes. Older participants took longer to enter the data than younger ones (18‐30 y: median 1.5, IQR 1.1‐2.0 min/item vs 45‐64 y: median 1.8, IQR 1.3‐2.3 min/item). Most participants expressed a preference for NutriDiary over the traditional paper-based method. Conclusions: Good usability and acceptability make NutriDiary promising for use in epidemiological studies. %R 10.2196/62776 %U https://humanfactors.jmir.org/2025/1/e62776 %U https://doi.org/10.2196/62776 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 8 %N %P e66440 %T Agreement Between Provider-Completed and Patient-Completed Preoperative Frailty Screening Using the Clinical Risk Analysis Index: Cross-Sectional Questionnaire Study %A Khalighi,Mehraneh %A Thomas,Amy C %A Brown,Karl J %A Ritchey,Katherine C %+ Hospital and Specialty Medicine, VA Puget Sound Health Care System, 1660 South Columbian Way, S-112-SDU, Seattle, WA, 98108, United States, 1 206 764 2183, mehraneh.khalighi@va.gov %K Risk Analysis Index %K preoperative screening %K questionnaire %K frailty %K self-reported %K veteran %K hip %K knee %K arthroplasty %K elective surgery %K cross-sectional %K quality improvement %D 2025 %7 10.2.2025 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Frailty is associated with postoperative morbidity and mortality. Preoperative screening and management of persons with frailty improves postoperative outcomes. The Clinical Risk Analysis Index (RAI-C) is a validated provider-based screening tool for assessing frailty in presurgical populations. Patient self-screening for frailty may provide an alternative to provider-based screening if resources are limited; however, the agreement between these 2 methods has not been previously explored. Objective: The objective of our study was to examine provider-completed versus patient-completed RAI-C assessments to identify areas of disagreement between the 2 methods and inform best practices for RAI-C screening implementation. Methods: Orthopedic physicians and physician assistants completed the RAI-C assessment on veterans aged 65 years and older undergoing elective total joint arthroplasty (eg, total hip or knee arthroplasty) and documented scores into the electronic health record during their preoperative clinic evaluation. Participants were then mailed the same RAI-C form after preoperative evaluation and returned responses to study coordinators. Agreement between provider-completed and patient-completed RAI-C assessments and differences within individual domains were compared. Results: A total of 49 participants aged 65 years and older presenting for total joint arthroplasty underwent RAI-C assessment between November 2022 and August 2023. In total, 41% (20/49) of participants completed and returned an independent postvisit RAI-C assessment before surgery and within 180 days of their initial evaluation. There was a moderate but statistically significant correlation between provider-completed and patient-completed RAI-C assessments (r=0.62; 95% CI 0.25-0.83; P=.003). Provider-completed and patient-completed RAI-C assessments resulted in the same frailty classification in 60% (12/20) of participants, but 40% (8/20) of participants were reclassified to a more frail category based on patient-completed assessment. Agreement was the lowest between provider-completed and patient-completed screening questions regarding memory and activities of daily living. Conclusions: RAI-C had moderate agreement when completed by providers versus the participants themselves, with more than a third of patient-completed screens resulting in a higher frailty classification. Future studies will need to explore the differences between and accuracy of RAI-C screening approaches to inform best practices for preoperative RAI-C assessment implementation. %M 39928399 %R 10.2196/66440 %U https://periop.jmir.org/2025/1/e66440 %U https://doi.org/10.2196/66440 %U http://www.ncbi.nlm.nih.gov/pubmed/39928399 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 17 %N %P e52380 %T Expansion and Assessment of a Web-Based 24-Hour Dietary Recall Tool, Foodbook24, for Use Among Diverse Populations Living in Ireland: Comparative Analysis %A Bennett,Grace %A Yang,Shuhua %A Bardon,Laura A %A Timon,Claire M %A Gibney,Eileen R %+ UCD Institute of Food and Health, University College Dublin, Science Centre South, Belfield, Dublin, 4, Ireland, 353 17161147, eileen.gibney@ucd.ie %K dietary assessment %K ethnic diets %K dietary records %K web-based tools %K diverse intake %D 2025 %7 7.2.2025 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Currently, the methods used to collect dietary intake data in Ireland are inflexible to the needs of certain populations, who are poorly represented in nutrition and health data as a result. As the Irish population is becoming increasingly diverse, there is an urgent need to understand the habitual food intake and diet quality of multiple population subgroups, including different nationalities and ethnic minorities, in Ireland. Foodbook24 is an existing web-based 24-hour dietary recall tool, which has previously been validated for use within the general Irish adult population. Because of its design, Foodbook24 can facilitate the improved inclusion of dietary intake assessment in Ireland. Objective: We aimed to examine the suitability of expanding the Foodbook24 tool, improving the reliability and accuracy of dietary intake data collected among prominent nationalities in Ireland. Methods: This study consisted of three distinct parts: (1) expansion of Foodbook24, (2) testing its usability (ie, acceptability study), and (3) examining the accuracy (ie, comparison study) of the updated Foodbook24 tool. To expand Foodbook24, national survey data from Brazil and Poland were reviewed and commonly consumed food items were added to the food list. All foods were translated into Polish and Portuguese. The acceptability study used a qualitative approach whereby participants provided a visual record of their habitual diet. The comparison study consisted of one 24-hour dietary recall using Foodbook24 and one interviewer-led recall completed on the same day, repeated again 2 weeks later. Comparison study data were analyzed using Spearman rank correlations, Mann-Whitney U tests, and κ coefficients. Results: The expansion of the Foodbook24 food list resulted in 546 additional foods. The acceptability study reported that 86.5% (302/349) of foods listed by participants were available in the updated food list. From the comparison study, strong and positive correlations across 8 food groups (44% of a total of 18 food groups) and 15 nutrients (58% of a total of 26 nutrients) were identified (r=0.70-0.99). Only intakes of potatoes and potato dishes and nuts, herbs, and seeds significantly differed across methods of assessment, where correlations across these food groups were low (r=0.56 and r=0.47, respectively). The incidence of food omissions varied across samples, with Brazilian participants omitting a higher percentage of foods in self-administered recalls than other samples (6/25, 24% among the Brazilian vs 5/38, 13% among the Irish cohort). Conclusions: The updated food list is representative of most foods consumed by Brazilian, Irish, and Polish adults in Ireland. Dietary intake data reported in Foodbook24 are not largely different from food groups and nutrient intakes reported via traditional methods. This study has demonstrated that Foodbook24 may be appropriate for use in future research investigating the dietary intakes of Brazilian, Irish, and Polish groups in Ireland. %M 39919284 %R 10.2196/52380 %U https://ojphi.jmir.org/2025/1/e52380 %U https://doi.org/10.2196/52380 %U http://www.ncbi.nlm.nih.gov/pubmed/39919284 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58956 %T A Hierarchical Framework for Selecting Reference Measures for the Analytical Validation of Sensor-Based Digital Health Technologies %A Bakker,Jessie P %A McClenahan,Samantha J %A Fromy,Piper %A Turner,Simon %A Peterson,Barry T %A Vandendriessche,Benjamin %A Goldsack,Jennifer C %+ Digital Medicine Society, 90 Canal Street, Boston, MA, 02114, United States, 1 7652343463, benjamin.vandendriessche@dimesociety.org %K digital health technologies %K analytical validation %K digital medicine %K reference measures %K fit-for-purpose digital clinical measures %D 2025 %7 7.2.2025 %9 Viewpoint %J J Med Internet Res %G English %X Sensor-based digital health technologies (sDHTs) are increasingly used to support scientific and clinical decision-making. The digital clinical measures they generate offer enormous benefits, including providing more patient-relevant data, improving patient access, reducing costs, and driving inclusion across health care ecosystems. Scientific best practices and regulatory guidance now provide clear direction to investigators seeking to evaluate sDHTs for use in different contexts. However, the quality of the evidence reported for analytical validation of sDHTs—evaluation of algorithms converting sample-level sensor data into a measure that is clinically interpretable—is inconsistent and too often insufficient to support a particular digital measure as fit-for-purpose. We propose a hierarchical framework to address challenges related to selecting the most appropriate reference measure for conducting analytical validation and codify best practices and an approach that will help capture the greatest value of sDHTs for public health, patient care, and medical product development. %M 39918870 %R 10.2196/58956 %U https://www.jmir.org/2025/1/e58956 %U https://doi.org/10.2196/58956 %U http://www.ncbi.nlm.nih.gov/pubmed/39918870 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65492 %T Measuring Digital Health Literacy in Older Adults: Development and Validation Study %A Kim,SungMin %A Park,Choonghee %A Park,Sunghyeon %A Kim,Dai-Jin %A Bae,Ye-Seul %A Kang,Jae-Heon %A Chun,Ji-Won %+ Department of Medical Informatics, Seoul St. Mary’s Hospital, The Catholic University of Korea College of Medicine, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea, 82 2 3147 9727, jwchun@catholic.ac.kr %K digital health care %K older adults %K digital health literacy %K exploratory factor analysis %K confirmatory factor analysis %K mobile phone %D 2025 %7 5.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: New health care services such as smart health care and digital therapeutics have greatly expanded. To effectively use these services, digital health literacy skills, involving the use of digital devices to explore and understand health information, are important. Older adults, requiring consistent health management highlight the need for enhanced digital health literacy skills. To address this issue, it is imperative to develop methods to assess older adults’ digital health literacy levels. Objective: This study aimed to develop a tool to measure digital health literacy. To this end, it reviewed existing literature to identify the components of digital health literacy, drafted preliminary items, and developed a scale using a representative sample. Methods: We conducted a primary survey targeting 600 adults aged 55-75 years and performed an exploratory factor analysis on 74 preliminary items. Items with low factor loadings were removed, and their contents were modified to enhance their validity. Then, we conducted a secondary survey with 400 participants to perform exploratory and confirmatory factor analyses. Results: A digital health literacy scale consisting of 25 items was developed, comprising 4 subfactors: use of digital devices, understanding health information, use and decision regarding health information, and use intention. The model fit indices indicated excellent structural validity (Tucker-Lewis Index=0.924, comparative fit index=0.916, root-mean-square error of approximation=0.088, standardized root-mean-square residual=0.044). High convergent validity (average variance extracted>0.5) and reliability (composite reliability>0.7) were observed within each factor. Discriminant validity was also confirmed as the square root of the average variance extracted was greater than the correlation coefficients between the factors. This scale demonstrates high reliability and excellent structural validity. Conclusions: This study is a significant first step toward enhancing digital health literacy among older adults by developing an appropriate tool for measuring digital health literacy. We expect this study to contribute to the future provision of tailored education and treatment based on individual literacy levels. %M 39908081 %R 10.2196/65492 %U https://www.jmir.org/2025/1/e65492 %U https://doi.org/10.2196/65492 %U http://www.ncbi.nlm.nih.gov/pubmed/39908081 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e64033 %T Association of Subjective Cognitive Concerns With Performance on Mobile App–Based Cognitive Assessment in Cognitively Normal Older Adults: Observational Study %A Nester,Caroline O %A De Vito,Alyssa N %A Prieto,Sarah %A Kunicki,Zachary J %A Strenger,Jennifer %A Harrington,Karra D %A Roque,Nelson %A Sliwinski,Martin J %A Rabin,Laura A %A Thompson,Louisa I %K subjective cognitive concerns %K subjective cognitive decline %K digital cognitive assessment %K mobile app %K app-based %K preclinical Alzheimer disease %K mild cognitive impairment %K MCI %K preclinical dementia %K mobile monitoring of cognitive change %K Cognitive Function Instrument %K mHealth %K mobile health %K applications %K cognition %K assessment %K remote %K geriatrics %K gerontology %K aging %K memory %K older adult %K elderly %K digital health %K mobile phone %D 2025 %7 4.2.2025 %9 %J JMIR Aging %G English %X Background: Subjective cognitive concerns (SCCs) may be among the earliest clinical symptoms of dementia. There is growing interest in applying a mobile app–based cognitive assessment to remotely screen for cognitive status in preclinical dementia, but the relationship between SCC and relevant mobile assessment metrics is uncertain. Objective: This study aimed to characterize the relationship between SCC and adherence, satisfaction, and performance on mobile app assessments in cognitively unimpaired older adults. Methods: Participants (N=122; Meanage=68.85 [SD 4.93] years; Meaneducation=16.85 [SD 2.39] years; female: n=82, 66.7%; White:n=106, 86.2%) completed 8 assessment days using Mobile Monitoring of Cognitive Change (M2C2), an app-based testing platform, with brief daily sessions within morning, afternoon, and evening time windows (24 total testing sessions). M2C2 includes digital working memory, processing speed, and episodic memory tasks. Participants provided feedback about their satisfaction and motivation related to M2C2 upon study completion. SCC was assessed using the Cognitive Function Instrument. Regression analyses evaluated the association between SCC and adherence, satisfaction, and performance on M2C2, controlling for age, sex, depression, and loneliness. Linear-mixed effects models evaluated whether SCC predicted M2C2 subtest performance over the 8-day testing period, controlling for covariates. Results: SCC was not associated with app satisfaction or protocol motivation, but it was significantly associated with lower rates of protocol adherence (ß=−.20, P=.37, 95% CI −.65 to −.02). Higher SCC endorsement significantly predicted worse overall episodic memory performance (ß=−.20, P=.02, 95% CI −.02 to −.01), but not working memory or processing speed. There was a main effect of SCC on working memory performance at day 1 (estimate=−1.05, SE=0.47, P=.03) and a significant interaction between SCC and working memory over the 8-day period (estimate=0.05, SE=0.02, P=.03), such that SCC was associated with initially worse, then progressively better working memory performance. Conclusions: SCCs are associated with worse overall memory performance on mobile app assessments, patterns of cognitive inefficiency (variable working memory), and mildly diminished adherence across an 8-day assessment period. Findings suggest that mobile app assessments may be sensitive to subtle cognitive changes, with important implications for early detection and treatment for individuals at risk for dementia. %R 10.2196/64033 %U https://aging.jmir.org/2025/1/e64033 %U https://doi.org/10.2196/64033 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e51689 %T Cross-Platform Ecological Momentary Assessment App (JTrack-EMA+): Development and Usability Study %A Sahandi Far,Mehran %A Fischer,Jona M %A Senge,Svea %A Rathmakers,Robin %A Meissner,Thomas %A Schneble,Dominik %A Narava,Mamaka %A Eickhoff,Simon B %A Dukart,Juergen %+ Research Centre Jülich, Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Wilhelm-Johnen-Straße, Jülich, 52428, Germany, 49 17636977109, m.sahandi.far@fz-juelich.de %K digital biomarkers %K mobile health %K remote monitoring %K smartphone %K mobile phone %K monitoring %K biomarker %K ecological momentary assessment %K application %K costly %K user experience %K data management %K mobility %D 2025 %7 28.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Traditional in-clinic methods of collecting self-reported information are costly, time-consuming, subjective, and often limited in the quality and quantity of observation. However, smartphone-based ecological momentary assessments (EMAs) provide complementary information to in-clinic visits by collecting real-time, frequent, and longitudinal data that are ecologically valid. While these methods are promising, they are often prone to various technical obstacles. However, despite the potential of smartphone-based EMAs, they face technical obstacles that impact adaptability, availability, and interoperability across devices and operating systems. Deficiencies in these areas can contribute to selection bias by excluding participants with unsupported devices or limited digital literacy, increase development and maintenance costs, and extend deployment timelines. Moreover, these limitations not only impede the configurability of existing solutions but also hinder their adoption for addressing diverse clinical challenges. Objective: The primary aim of this research was to develop a cross-platform EMA app that ensures a uniform user experience and core features across various operating systems. Emphasis was placed on maximizing the integration and adaptability to various study designs, all while maintaining strict adherence to security and privacy protocols. JTrack-EMA+ was designed and implemented per the FAIR (findable, accessible, interpretable, and reusable) principles in both its architecture and data management layers, thereby reducing the burden of integration for clinicians and researchers. Methods: JTrack-EMA+ was built using the Flutter framework, enabling it to run seamlessly across different platforms. This platform comprises two main components. JDash (Research Centre Jülich, Institute of Neuroscience and Medicine, Brain and Behaviour [INM-7]) is an online management tool created using Python (Python Software Foundation) with the Django (Django Software Foundation) framework. This online dashboard offers comprehensive study management tools, including assessment design, user administration, data quality control, and a reminder casting center. The JTrack-EMA+ app supports a wide range of question types, allowing flexibility in assessment design. It also has configurable assessment logic and the ability to include supplementary materials for a richer user experience. It strongly commits to security and privacy and complies with the General Data Protection Regulations to safeguard user data and ensure confidentiality. Results: We investigated our platform in a pilot study with 480 days of follow-up to assess participants’ compliance. The 6-month average compliance was 49.3%, significantly declining (P=.004) from 66.7% in the first month to 42% in the sixth month. Conclusions: The JTrack-EMA+ platform prioritizes platform-independent architecture, providing an easy entry point for clinical researchers to deploy EMA in their respective clinical studies. Remote and home-based assessments of EMA using this platform can provide valuable insights into patients’ daily lives, particularly in a population with limited mobility or inconsistent access to health care services. %M 39874571 %R 10.2196/51689 %U https://www.jmir.org/2025/1/e51689 %U https://doi.org/10.2196/51689 %U http://www.ncbi.nlm.nih.gov/pubmed/39874571 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e53503 %T A New Smartphone-Based Cognitive Screening Battery for Multiple Sclerosis (icognition): Validation Study %A Denissen,Stijn %A Van Laethem,Delphine %A Baijot,Johan %A Costers,Lars %A Descamps,Annabel %A Van Remoortel,Ann %A Van Merhaegen-Wieleman,Annick %A D’hooghe,Marie %A D'Haeseleer,Miguel %A Smeets,Dirk %A Sima,Diana M %A Van Schependom,Jeroen %A Nagels,Guy %+ AIMS Lab, Center for Neurosciences, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, 1090, Belgium, 32 2 477 41 02, stijn.denissen@vub.be %K multiple sclerosis %K telemedicine %K cognition %K memory %K information processing speed %K mobile phone %D 2025 %7 20.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive deterioration is common in multiple sclerosis (MS) and requires regular follow-up. Currently, cognitive status is measured in clinical practice using paper-and-pencil tests, which are both time-consuming and costly. Remote monitoring of cognitive status could offer a solution because previous studies on telemedicine tools have proved its feasibility and acceptance among people with MS. However, existing smartphone-based apps include designs that are prone to motor interference and focus primarily on information processing speed, although memory is also commonly affected. Objective: This study aims to validate a smartphone-based cognitive screening battery, icognition, to detect deterioration in both memory and information processing speed. Methods: The icognition screening battery consists of 3 tests: the Symbol Test for information processing speed, the Dot Test for visuospatial short-term memory and learning, and the visual Backward Digit Span (vBDS) for working memory. These tests are based on validated paper-and-pencil tests: the Symbol Digit Modalities Test, the 10/36 Spatial Recall Test, and the auditory Backward Digit Span, respectively. To establish the validity of icognition, 101 people with MS and 82 healthy participants completed all tests. Of the 82 healthy participants, 20 (24%) repeated testing 2 to 3 weeks later. For each icognition test, validity was established by the correlation with its paper-and-pencil equivalent (concurrent validity), the correlation and intraclass correlation coefficient (ICC) between baseline and follow-up testing (test-retest reliability), the difference between people with MS and healthy participants, and the correlation with other clinical parameters such as the Expanded Disability Status Scale. Results: All icognition tests correlated well with their paper-and-pencil equivalents (Symbol Test: r=0.67; P<.001; Dot Test: r=0.31; P=.002; vBDS: r=0.69; P<.001), negatively correlated with the Expanded Disability Status Scale (Symbol Test: ρ=–0.34; P<.001; Dot Test: ρ=−0.32; P=.003; vBDS: ρ=−0.21; P=.04), and showed moderate test-retest reliability (Symbol Test: ICC=0.74; r=0.85; P<.001; Dot Test: ICC=0.71; r=0.74; P<.001; vBDS: ICC=0.72; r=0.83; P<.001). Test performance was comparable between people with MS and healthy participants for all cognitive tests, both in icognition (Symbol Test: U=4431; P=.42; Dot Test: U=3516; P=.32; vBDS: U=3708; P=.27) and the gold standard paper-and-pencil tests (Symbol Digit Modalities Test: U=4060.5, P=.82; 10/36 Spatial Recall Test: U=3934; P=.74; auditory Backward Digit Span: U=3824.5, P=.37). Conclusions: icognition is a valid tool to remotely screen cognitive performance in people with MS. It is planned to be included in a digital health platform that includes volumetric brain analysis and patient-reported outcome measures. Future research should establish the usability and psychometric properties of icognition in a remote setting. %M 39832354 %R 10.2196/53503 %U https://www.jmir.org/2025/1/e53503 %U https://doi.org/10.2196/53503 %U http://www.ncbi.nlm.nih.gov/pubmed/39832354 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69742 %T Advantages and Inconveniences of a Multi-Agent Large Language Model System to Mitigate Cognitive Biases in Diagnostic Challenges %A Bousquet,Cedric %A Beltramin,Divà %+ Laboratory of Medical Informatics and Knowledge Engineering in e-Health, Inserm, Sorbonne University, 15 rue de l'école de Médecine, Paris, F-75006, France, 33 0477127974, cedric.bousquet@chu-st-etienne.fr %K large language model %K multi-agent system %K diagnostic errors %K cognition %K clinical decision-making %K cognitive bias %K generative artificial intelligence %D 2025 %7 20.1.2025 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 39832364 %R 10.2196/69742 %U https://www.jmir.org/2025/1/e69742 %U https://doi.org/10.2196/69742 %U http://www.ncbi.nlm.nih.gov/pubmed/39832364 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e57669 %T Applicability of Retrospective and Prospective Gender Scores for Clinical and Health Data: Protocol for a Scoping Review %A Schindler,Lea %A Beelich,Hilke %A Röll,Selina %A Katsari,Elpiniki %A Stracke,Sylvia %A Waltemath,Dagmar %+ Medical Informatics Laboratory, University Medicine Greifswald, Walther-Rathenau-Straße 48, Greifswald, 17475, Germany, 49 03834 86 ext 8370, dagmar.waltemath@med.uni-greifswald.de %K gender score %K gender medicine %K medical informatics %K data integration %K gender health gap %D 2025 %7 20.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Gender is known to have a strong influence on human health and disease. Despite its relevance to treatment and outcome, gender is insufficiently considered in current health research. One hindering factor is the poor representation of gender information in clinical and health (meta) data. Objective: We aim to conduct a scoping review of the literature describing gender scores. The review will provide insights into the current application of gender scores in clinical and health settings. The protocol describes how relevant literature will be identified and how gender scores will be evaluated concerning applicability and usability in scientific investigations. Methods: Our scoping review follows the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A title and abstract screening was conducted on PubMed, followed by a full-text screening. The inclusion and exclusion criteria were discussed by a team of 5 domain experts, and a data-charting form was developed. The charted data will be categorized, summarized, and analyzed based on the research questions during the scoping review. Results: We will report our research results according to the PRISMA-ScR guidelines. The literature retrieval was carried out on June 13, 2024, and resulted in 1202 matches. As of July 2024, the scoping review is in the data extraction phase and we expect to complete and publish the results in the first quarter of 2025. Conclusions: The scoping review lays the foundation for a retrospective gender assessment by identifying scores that can be applied to existing large-scale datasets. Moreover, it will help to formulate recommendations for standardized gender scores in future investigations. International Registered Report Identifier (IRRID): DERR1-10.2196/57669 %M 39832171 %R 10.2196/57669 %U https://www.researchprotocols.org/2025/1/e57669 %U https://doi.org/10.2196/57669 %U http://www.ncbi.nlm.nih.gov/pubmed/39832171 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e64210 %T Swedish Version of the System Usability Scale: Translation, Adaption, and Psychometric Evaluation %A Åvik Persson,Helene %A Castor,Charlotte %A Andersson,Nilla %A Hylén,Mia %K application %K Swedish %K System Usability Scale %K usability %K validation %D 2025 %7 16.1.2025 %9 %J JMIR Hum Factors %G English %X Background: The Swedish health care system is undergoing a transformation. eHealth technologies are increasingly being used. The System Usability Scale is a widely used tool, offering a standardized and reliable measure for assessing the usability of digital health solutions. However, despite the existence of several translations of the System Usability Scale into Swedish, none have undergone psychometric validation. This highlights the urgent need for a validated and standardized Swedish version of the System Usability Scale to ensure accurate and reliable usability evaluations. Objective: The aim of the study was to translate and psychometrically evaluate a Swedish version of the System Usability Scale. Methods: The study utilized a 2-phase design. The first phase translated the System Usability Scale into Swedish and the second phase tested the scale’s psychometric properties. A total of 62 participants generated a total of 82 measurements. Descriptive statistics were used to visualize participants’ characteristics. The psychometric evaluation consisted of data quality, scaling assumptions, and acceptability. Construct validity was evaluated by convergent validity, and reliability was evaluated by internal consistency. Results: The Swedish version of the System Usability Scale demonstrated high conformity with the original version. The scale showed high internal consistency with a Cronbach α of .852 and corrected item-total correlations ranging from 0.454 to 0.731. The construct validity was supported by a significant positive correlation between the System Usability Scale and domain 5 of the eHealth Literacy Questionnaire (P=.001). Conclusions: The Swedish version of the System Usability Scale demonstrated satisfactory psychometric properties. It can be recommended for use in a Swedish context. The positive correlation with domain 5 of the eHealth Literacy Questionnaire further supports the construct validity of the Swedish version of the System Usability Scale, affirming its suitability for evaluating digital health solutions. Additional tests of the Swedish version of the System Usability Scale, for example, in the evaluation of more complex eHealth technology, would further validate the scale. Trial Registration: ClinicalTrials.gov NCT04150120; https://clinicaltrials.gov/study/NCT04150120 %R 10.2196/64210 %U https://humanfactors.jmir.org/2025/1/e64210 %U https://doi.org/10.2196/64210 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e52385 %T A Digital Tool for Clinical Evidence–Driven Guideline Development by Studying Properties of Trial Eligible and Ineligible Populations: Development and Usability Study %A Mumtaz,Shahzad %A McMinn,Megan %A Cole,Christian %A Gao,Chuang %A Hall,Christopher %A Guignard-Duff,Magalie %A Huang,Huayi %A McAllister,David A %A Morales,Daniel R %A Jefferson,Emily %A Guthrie,Bruce %+ Division of Population Health and Genomics, School of Medicine, University of Dundee, The Health Informatics Centre, Ninewells Hospital and Medical School, Dundee, DD2 1FD, United Kingdom, 44 01382383943, e.r.jefferson@dundee.ac.uk %K multimorbidity %K clinical practice guideline %K gout %K Trusted Research Environment %K National Institute for Health and Care Excellence %K Scottish Intercollegiate Guidelines Network %K clinical practice %K development %K efficacy %K validity %K epidemiological data %K epidemiology %K epidemiological %K digital tool %K tool %K age %K gender %K ethnicity %K mortality %K feedback %K availability %D 2025 %7 16.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinical guideline development preferentially relies on evidence from randomized controlled trials (RCTs). RCTs are gold-standard methods to evaluate the efficacy of treatments with the highest internal validity but limited external validity, in the sense that their findings may not always be applicable to or generalizable to clinical populations or population characteristics. The external validity of RCTs for the clinical population is constrained by the lack of tailored epidemiological data analysis designed for this purpose due to data governance, consistency of disease or condition definitions, and reduplicated effort in analysis code. Objective: This study aims to develop a digital tool that characterizes the overall population and differences between clinical trial eligible and ineligible populations from the clinical populations of a disease or condition regarding demography (eg, age, gender, ethnicity), comorbidity, coprescription, hospitalization, and mortality. Currently, the process is complex, onerous, and time-consuming, whereas a real-time tool may be used to rapidly inform a guideline developer’s judgment about the applicability of evidence. Methods: The National Institute for Health and Care Excellence—particularly the gout guideline development group—and the Scottish Intercollegiate Guidelines Network guideline developers were consulted to gather their requirements and evidential data needs when developing guidelines. An R Shiny (R Foundation for Statistical Computing) tool was designed and developed using electronic primary health care data linked with hospitalization and mortality data built upon an optimized data architecture. Disclosure control mechanisms were built into the tool to ensure data confidentiality. The tool was deployed within a Trusted Research Environment, allowing only trusted preapproved researchers to conduct analysis. Results: The tool supports 128 chronic health conditions as index conditions and 161 conditions as comorbidities (33 in addition to the 128 index conditions). It enables 2 types of analyses via the graphic interface: overall population and stratified by user-defined eligibility criteria. The analyses produce an overview of statistical tables (eg, age, gender) of the index condition population and, within the overview groupings, produce details on, for example, electronic frailty index, comorbidities, and coprescriptions. The disclosure control mechanism is integral to the tool, limiting tabular counts to meet local governance needs. An exemplary result for gout as an index condition is presented to demonstrate the tool’s functionality. Guideline developers from the National Institute for Health and Care Excellence and the Scottish Intercollegiate Guidelines Network provided positive feedback on the tool. Conclusions: The tool is a proof-of-concept, and the user feedback has demonstrated that this is a step toward computer-interpretable guideline development. Using the digital tool can potentially improve evidence-driven guideline development through the availability of real-world data in real time. %M 39819848 %R 10.2196/52385 %U https://www.jmir.org/2025/1/e52385 %U https://doi.org/10.2196/52385 %U http://www.ncbi.nlm.nih.gov/pubmed/39819848 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63489 %T Evaluating Online and Offline Health Information With the Patient Education Materials Assessment Tool: Protocol for a Systematic Review %A Furukawa,Emi %A Okuhara,Tsuyoshi %A Liu,Mingxin %A Okada,Hiroko %A Kiuchi,Takahiro %+ , University hospital Medical Information Network (UMIN) Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, 81 3 5800 9754, efurukawa-tho@umin.ac.jp %K patient education %K health communication %K health information %K behavior change %K understandability %K actionability Patient Education Materials Assessment Tool %K PEMAT %K medical information %K health literacy %K patient education materials %D 2025 %7 15.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The Patient Education Materials Assessment Tool (PEMAT) is a reliable and validated instrument for assessing the understandability and actionability of patient education materials. It has been applied across diverse cultural and linguistic contexts, enabling cross-field and cross-national material quality comparisons. Accumulated evidence from studies using the PEMAT over the past decade underscores its potential impact on patient and public action. Objective: This systematic review aims to investigate how the quality of patient education materials has been assessed using the PEMAT. Methods: This review protocol follows PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), APA PsycInfo, and Web of Science Core Collection will be searched systematically for articles published since September 2014. Two independent reviewers will conduct the search to yield a list of relevant studies based on the inclusion and exclusion criteria. Rayyan QCRI software will be used for screening and data extraction. Results: The results will be included in the full systematic review, which is expected to start in September 2024 and be completed to be submitted for publication by early 2025. Conclusions: The findings are expected to identify the quality of materials evaluated by the PEMAT and the areas under evaluation. This review can also highlight gaps that exist in research and practice for improving the understandability and actionability of the materials, offering deeper insights into how existing materials can facilitate patient and public action. International Registered Report Identifier (IRRID): PRR1-10.2196/63489 %M 39813665 %R 10.2196/63489 %U https://www.researchprotocols.org/2025/1/e63489 %U https://doi.org/10.2196/63489 %U http://www.ncbi.nlm.nih.gov/pubmed/39813665 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55828 %T Development and Validation of the Digital Sensitivity Scale for Adults: Cross-Sectional Observational Study %A Park,Hae In %A Jeon,Minjeong %A Ahn,Ji Seon %A Chung,Kyungmi %A Park,Jin Young %+ Department of Psychiatry, Yongin Severance Hospital, 363, Dongbaekjukjeon-daero, Giheung-gu, Yongin, 16995, Republic of Korea, 82 5189 8148, empathy@yuhs.ac %K information literacy %K health literacy %K computer literacy %K self-efficacy %K attitude %K digital divide %D 2025 %7 10.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has accelerated the digitalization of modern society, extending digital transformation to daily life and psychological evaluation and treatment. However, the development of competencies and literacy in handling digital technology has not kept pace, resulting in a significant disparity among individuals. Existing measurements of digital literacy were developed before widespread information and communications technology device adoption, mainly focusing on one’s perceptions of their proficiency and the utility of device operation. In the contemporary landscape, digital transformation is evolving within specialized domains, necessitating a comprehensive evaluation of digital competencies, attitudes, and proficiency in technology application to bridge the digital divide and ensure digital compliance. Objective: This study was designed to address the shortcomings of existing scales and formulate a digital sensitivity scale tailored to the requirements of today’s society. Methods: Initial items of the Yongin Severance Digital Sensitivity Scale (YI-DSS) were collected through a literature review, and expert opinions were gathered to ensure content validity. An exploratory and confirmatory factor analysis included 986 adult participants evaluating 14 digital literacy items and 6 digital efficacy items. The Cronbach α confirmed internal consistency reliability, and 2-tailed t tests, ANOVAs, and post hoc tests analyzed demographic differences in digital literacy and efficacy. Results: A robust 4-factor digital literacy solution was identified: digital application, digital communication, critical thinking, and digital ethics (Kaiser-Meyer-Olkin=0.891; Bartlett × 2=9829.713; P<.001; Cronbach α=0.782-0.947). A 2-factor solution defined digital efficacy: digital confidence and digital anxiety (Kaiser-Meyer-Olkin=0.735; Bartlett × 2=3282.217; P<.001; Cronbach α=0.787-0.912). Confirmatory factor analysis was conducted for each model (digital literacy model: χ271=676.0, comparative fit index=0.938, Tucker-Lewis index=0.921, standardized root mean square residual=0.73, and root mean square error of approximation=0.093; digital efficacy model: χ28=81.9, comparative fit index=0.977, Tucker-Lewis index=0.958, standardized root mean square residual=0.73, and root mean square error of approximation=0.097), which indicated a good fit. The YI-DSS also showed high correlation with the previously developed Digital Literacy Scale (r=0.809; P<.001). Conclusions: The YI-DSS, as a self-assessment tool, has the potential to bridge the generational information gap by promoting acceptance, motivation, and adaptation to digital technology. Furthermore, given the remote nature of digital therapeutics, an individual’s familiarity with required technologies and digital communication strongly influences their acceptance of digital treatments and the efficacy thereof. This scale can play a pivotal role in enhancing compliance with digital therapeutics by preemptively assessing individuals’ technological literacy and competency. %M 39793004 %R 10.2196/55828 %U https://www.jmir.org/2025/1/e55828 %U https://doi.org/10.2196/55828 %U http://www.ncbi.nlm.nih.gov/pubmed/39793004 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59261 %T Analysis of Social Performance and Action Units During Social Skills Training: Focus Group Study of Adults With Autism Spectrum Disorder and Schizophrenia %A Tanaka,Hiroki %A Miyamoto,Kana %A Hamet Bagnou,Jennifer %A Prigent,Elise %A Clavel,Céline %A Martin,Jean-Claude %A Nakamura,Satoshi %K social performance rating scale %K social skills training %K autism spectrum disorder %K schizophrenia %K facial expressions %K social %K autism %K training %K communication %K trainers %K tool %K neurological %D 2025 %7 10.1.2025 %9 %J JMIR Form Res %G English %X Background: Social communication is a crucial factor influencing human social life. Quantifying the degree of difficulty faced in social communication is necessary for understanding developmental and neurological disorders and for creating systems used in automatic symptom screening and assistive methods such as social skills training (SST). SST by a human trainer is a well-established method. Previous SST used a modified roleplay test to evaluate human social communication skills. However, there are no widely accepted evaluation criteria or social behavioral markers to quantify social performance during SST. Objective: This paper has 2 objectives. First, we propose applying the Social Performance Rating Scale (SPRS) to SST data to measure social communication skills. We constructed a Japanese version of the SPRS already developed in English and French. Second, we attempt to quantify action units during SST for people with autism spectrum disorder (ASD) or schizophrenia. Methods: We used videos of interactions between trainers, adults with ASD (n=16) or schizophrenia (n=15), and control participants (n=19) during SST sessions. Two raters applied the proposed scale to annotate the collected data. We investigated the differences between roleplay tasks and participant groups (ASD, schizophrenia, and control). Furthermore, the intensity of action units on the OpenFace toolkit was measured in terms of mean and SD during SST roleplaying. Results: We found significantly greater gaze scores in adults with ASD than in adults with schizophrenia. Differences were also found between the ratings of different tasks in the adults with schizophrenia and the control participants. Action units numbered AU06 and AU12 were significantly deactivated in people with schizophrenia compared with the control group. Moreover, AU02 was significantly activated in people with ASD compared with the other groups. Conclusions: The results suggest that the SPRS can be a useful tool for assessing social communication skills in different cultures and different pathologies when used with the modified roleplay test. Furthermore, facial expressions could provide effective social and behavioral markers to characterize psychometric properties. Possible future directions include using the SPRS for assessing social behavior during interaction with a digital agent. %R 10.2196/59261 %U https://formative.jmir.org/2025/1/e59261 %U https://doi.org/10.2196/59261 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65448 %T Longitudinal Changes in Pitch-Related Acoustic Characteristics of the Voice Throughout the Menstrual Cycle: Observational Study %A Kaufman,Jaycee %A Jeon,Jouhyun %A Oreskovic,Jessica %A Thommandram,Anirudh %A Fossat,Yan %K menstrual cycle %K women's health %K voice %K acoustic analysis %K longitudinal observational study %K fertility tracking %K fertility %K reproductive health %K feasibility %K voice recording %K vocal pitch %K follicular %K luteal phase %K fertility status %K mobile phone %D 2025 %7 9.1.2025 %9 %J JMIR Form Res %G English %X Background: Identifying subtle changes in the menstrual cycle is crucial for effective fertility tracking and understanding reproductive health. Objective: The aim of the study is to explore how fundamental frequency features vary between menstrual phases using daily voice recordings. Methods: This study analyzed smartphone-collected voice recordings from 16 naturally cycling female participants, collected every day for 1 full menstrual cycle. Fundamental frequency features (mean, SD, 5th percentile, and 95th percentile) were extracted from each voice recording. Ovulation was estimated using luteinizing hormone urine tests taken every morning. The analysis included comparisons of these features between the follicular and luteal phases and the application of changepoint detection algorithms to assess changes and pinpoint the day in which the shifts in vocal pitch occur. Results: The fundamental frequency SD was 9.0% (SD 2.9%) lower in the luteal phase compared to the follicular phase (95% CI 3.4%‐14.7%; P=.002), and the 5th percentile of the fundamental frequency was 8.8% (SD 3.6%) higher (95% CI 1.7%‐16.0%; P=.01). No significant differences were found between phases in mean fundamental frequency or the 95th percentile of the fundamental frequency (P=.65 and P=.07). Changepoint detection, applied separately to each feature, identified the point in time when vocal frequency behaviors shifted. For the fundamental frequency SD and 5th percentile, 81% (n=13) of participants exhibited shifts within the fertile window (P=.03). In comparison, only 63% (n=10; P=.24) and 50% (n=8; P=.50) of participants had shifts in the fertile window for the mean and 95th percentile of the fundamental frequency, respectively. Conclusions: These findings indicate that subtle variations in vocal pitch may reflect changes associated with the menstrual cycle, suggesting the potential for developing a noninvasive and convenient method for monitoring reproductive health. Changepoint detection may provide a promising avenue for future work in longitudinal fertility analysis. %R 10.2196/65448 %U https://formative.jmir.org/2025/1/e65448 %U https://doi.org/10.2196/65448 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e54871 %T Reliability and Accuracy of the Fitbit Charge 4 Photoplethysmography Heart Rate Sensor in Ecological Conditions: Validation Study %A Ceugniez,Maxime %A Devanne,Hervé %A Hermand,Eric %K photoplethysmography %K physical activity %K ecological conditions %K accuracy %K reliability %K Fitbit Charge 4 %K Fitbit %K exercise %K ecological %K wrist-worn device %K device %K sensor %K wearables %K usefulness %K variability %K sensitivity %K heart rate %K heart rate sensor %D 2025 %7 8.1.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Wrist-worn photoplethysmography (PPG) sensors allow for continuous heart rate (HR) measurement without the inconveniences of wearing a chest belt. Although green light PPG technology reduces HR measurement motion artifacts, only a limited number of studies have investigated the reliability and accuracy of wearables in non–laboratory-controlled conditions with actual specific and various physical activity movements. Objective: The purpose of this study was to (1) assess the reliability and accuracy of the PPG-based HR sensor of the Fitbit Charge 4 (FC4) in ecological conditions and (2) quantify the potential variability caused by the nature of activities. Methods: We collected HR data from participants who performed badminton, tennis, orienteering running, running, cycling, and soccer while simultaneously wearing the FC4 and the Polar H10 chest belt (criterion sensor). Skin tone was assessed with the Fitzpatrick Skin Scale. Once data from the FC4 and criterion data were synchronized, accuracy and reliability analyses were performed, using intraclass correlation coefficients (ICCs), Lin concordance correlation coefficients (CCCs), mean absolute percentage errors (MAPEs), and Bland-Altman tests. A linear univariate model was also used to evaluate the effect of skin tone on bias. All analyses were stratified by activity and pooled activity types (racket sports and running sports). Results: A total of 77.5 hours of HR recordings from 26 participants (age: mean 21.1, SD 5.8 years) were analyzed. The highest reliability was found for running sports, with ICCs and CCCs of 0.90 and 0.99 for running and 0.80 and 0.93 for orienteering running, respectively, whereas the ICCs and CCCs were 0.37 and 0.78, 0.42 and 0.88, 0.65 and 0.97, and 0.49 and 0.81 for badminton, tennis, cycling, and soccer, respectively. We found the highest accuracy for running (bias: 0.1 beats per minute [bpm]; MAPE 1.2%, SD 4.6%) and the lowest for badminton (bias: −16.5 bpm; MAPE 16.2%, SD 14.4%) and soccer (bias: −16.5 bpm; MAPE 17.5%, SD 20.8%). Limit of agreement (LOA) width and artifact rate followed the same trend. No effect of skin tone was observed on bias. Conclusions: LOA width, bias, and MAPE results found for racket sports and soccer suggest a high sensitivity to motion artifacts for activities that involve “sharp” and random arm movements. In this study, we did not measure arm motion, which limits our results. However, whereas individuals might benefit from using the FC4 for casual training in aerobic sports, we cannot recommend the use of the FC4 for specific purposes requiring high reliability and accuracy, such as research purposes. %R 10.2196/54871 %U https://mhealth.jmir.org/2025/1/e54871 %U https://doi.org/10.2196/54871 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e63703 %T Patients’ Experienced Usability and Satisfaction With Digital Health Solutions in a Home Setting: Instrument Validation Study %A Oudbier,Susan J %A Smets,Ellen M A %A Nieuwkerk,Pythia T %A Neal,David P %A Nurmohamed,S Azam %A Meij,Hans J %A Dusseljee-Peute,Linda W %K digital health solutions %K questionnaire development %K usability instruments %K self-management %K home setting %K validation %K reliability %D 2025 %7 8.1.2025 %9 %J JMIR Med Inform %G English %X Background: The field of digital health solutions (DHS) has grown tremendously over the past years. DHS include tools for self-management, which support individuals to take charge of their own health. The usability of DHS, as experienced by patients, is pivotal to adoption. However, well-known questionnaires that evaluate usability and satisfaction use complex terminology derived from human-computer interaction and are therefore not well suited to assess experienced usability of patients using DHS in a home setting. Objective: This study aimed to develop, validate, and assess an instrument that measures experienced usability and satisfaction of patients using DHS in a home setting. Methods: The development of the “Experienced Usability and Satisfaction with Self-monitoring in the Home Setting” (GEMS) questionnaire followed several steps. Step I consisted of assessing the content validity, by conducting a literature review on current usability and satisfaction questionnaires, collecting statements and discussing these in an expert meeting, and translating each statement and adjusting it to the language level of the general population. This phase resulted in a draft version of the GEMS. Step II comprised assessing its face validity by pilot testing with Amsterdam University Medical Center’s patient panel. In step III, psychometric analysis was conducted and the GEMS was assessed for reliability. Results: A total of 14 items were included for psychometric analysis and resulted in 4 reliable scales: convenience of use, perceived value, efficiency of use, and satisfaction. Conclusions: Overall, the GEMS questionnaire demonstrated its reliability and validity in assessing experienced usability and satisfaction of DHS in a home setting. Further refinement of the instrument is necessary to confirm its applicability in other patient populations in order to promote the development of a steering mechanism that can be applied longitudinally throughout implementation, and can be used as a benchmarking instrument. %R 10.2196/63703 %U https://medinform.jmir.org/2025/1/e63703 %U https://doi.org/10.2196/63703 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65684 %T Older Adults’ Experiences With an Online Survey %A Weir,Kristie Rebecca %A Maitah,Yehya %A Vordenberg,Sarah E %+ Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, City Road, Sydney, NSW 2006, Australia, 61 293512222, kristie.weir@sydney.edu.au %K older adults %K gerontology %K geriatric %K older %K aging %K online %K internet %K survey %K questionnaire %K research engagement %K engagement %K study subject %K participant %K medication decisions %D 2025 %7 8.1.2025 %9 Research Letter %J JMIR Hum Factors %G English %X The study explored older adults' perceptions after participating in an online survey about medication decisions, finding that approximately 80% of participants provided positive feedback about the research methodology and their experience. %M 39773887 %R 10.2196/65684 %U https://humanfactors.jmir.org/2025/1/e65684 %U https://doi.org/10.2196/65684 %U http://www.ncbi.nlm.nih.gov/pubmed/39773887 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e62740 %T Measuring Bound Attention During Complex Liver Surgery Planning: Feasibility Study %A Schneider,Tim %A Cetin,Timur %A Uppenkamp,Stefan %A Weyhe,Dirk %A Muender,Thomas %A Reinschluessel,Anke V %A Salzmann,Daniela %A Uslar,Verena %+ University Hospital for Visceral Surgery, PIUS-Hospital, Department for Human Medicine, Faculty VI, University of Oldenburg, Ammerländer Heerstraße 114-118, Oldenburg, 26129, Germany, 49 4412292922, tim.schneider@uol.de %K workload measurement %K virtual reality %K VR %K augmented reality %K AR %K electroencephalography %K EEG %K event-related potential %K ERP %K auditory evoked potential %K AEP %K oddball experiment %K National Aeronautics and Space Administration Task Load Index %K NASA-TLX %K surgical planning %D 2025 %7 8.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The integration of advanced technologies such as augmented reality (AR) and virtual reality (VR) into surgical procedures has garnered significant attention. However, the introduction of these innovations requires thorough evaluation in the context of human-machine interaction. Despite their potential benefits, new technologies can complicate surgical tasks and increase the cognitive load on surgeons, potentially offsetting their intended advantages. It is crucial to evaluate these technologies not only for their functional improvements but also for their impact on the surgeon’s workload in clinical settings. A surgical team today must increasingly navigate advanced technologies such as AR and VR, aiming to reduce surgical trauma and enhance patient safety. However, each innovation needs to be evaluated in terms of human-machine interaction. Even if an innovation appears to bring advancements to the field it is applied in, it may complicate the work and increase the surgeon’s workload rather than benefiting the surgeon. Objective: This study aims to establish a method for objectively determining the additional workload generated using AR or VR glasses in a clinical context for the first time. Methods: Electroencephalography (EEG) signals were recorded using a passive auditory oddball paradigm while 9 participants performed surgical planning for liver resection across 3 different conditions: (1) using AR glasses, (2) VR glasses, and (3) the conventional planning software on a computer. Results: The electrophysiological results, that is, the potentials evoked by the auditory stimulus, were compared with the subjectively perceived stress of the participants, as determined by the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) questionnaire. The AR condition had the highest scores for mental demand (median 75, IQR 70-85), effort (median 55, IQR 30-65), and frustration (median 40, IQR 15-75) compared with the VR and PC conditions. The analysis of the EEG revealed a trend toward a lower amplitude of the N1 component as well as for the P3 component at the central electrodes in the AR condition, suggesting a higher workload for participants when using AR glasses. In addition, EEG components in the VR condition did not reveal any noticeable differences compared with the EEG components in the conventional planning condition. For the P1 component, the VR condition elicited significantly earlier latencies at the Fz electrode (mean 75.3 ms, SD 25.8 ms) compared with the PC condition (mean 99.4 ms, SD 28.6 ms). Conclusions: The results suggest a lower stress level when using VR glasses compared with AR glasses, likely due to the 3D visualization of the liver model. Additionally, the alignment between subjectively determined results and objectively determined results confirms the validity of the study design applied in this research. %M 39773449 %R 10.2196/62740 %U https://formative.jmir.org/2025/1/e62740 %U https://doi.org/10.2196/62740 %U http://www.ncbi.nlm.nih.gov/pubmed/39773449 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e59562 %T Simplified Medication Adherence Questionnaire (SMAQ) for People Living With HIV in a National Hospital in Mexico: Instrument Validation Study %A Del Moral Trinidad,Luis Eduardo %A González Hernández,Luz Alicia %A Andrade Villanueva,Jaime Federico %A Martínez-Ayala,Pedro %A Valle Rodríguez,Adriana %A Ruíz Herrera,Vida Veronica %A Vizcaíno Résendiz,José Adán %A Herrera Godina,Melva Guadalupe %A Dominguez-Lara,Sergio %+ Research Institute, Facultad de Ciencias de la Comunicación, Turismo y Psicología, University of San Martín de Porres, Avenue Tomás Marsano 242 (5th floor), Lima, 15048, Peru, 51 5136300, sdominguezmpcs@gmail.com %K treatment adherence %K HIV %K Mexico %K validation %K Spanish %K Hispanic %K cross sectional %K surveys %K questionnaires %K scales %K adherence %K viral load %K sexually transmitted infection %K STI %K drugs %K pharmacotherapy %K medication %K simplified medication adherence questionnaire %K SMAQ %D 2025 %7 7.1.2025 %9 Original Paper %J Interact J Med Res %G English %X Background: Adherence to antiretroviral therapy is a critical component in achieving viral suppression in people living with HIV in addition to increasing overall quality of life. Several indirect methods have been used to measure adherence including the Simplified Medication Adherence Questionnaire (SMAQ). Objective: The objective of this study is to evaluate the reliability and validity of the SMAQ in men living with HIV/AIDS attending a Mexican national hospital. Methods: A cross-sectional analytical design study was carried out in a Mexican National Hospital in Jalisco, including men aged >18 years with at least 3 months of antiretroviral treatment, excluding those with cognitive difficulties in answering the survey. A minimum sample size was calculated to detect the contribution of the variables within the model. The analysis included descriptive tests, confirmatory factor analysis, reliability and validity assessment, correlation between adherence and viral load, and association between viral load and adherence. Results: The final analysis included a total of 260 patients with a mean age of 43 (SD 12) years and an average of 8.97 (SD 6.33) years on antiretroviral treatment. The SMAQ showed sufficient structural validity (comparative fit index=1, root-mean-square error of approximation=0, 90% CI 0-0.085) with satisfactory factor loadings on most questions except item 2 (Do you always take your medication at the prescribed time?). The reliability of the scale is acceptable (Cronbach α=0.702, ω=0.718). Adherence correlated with viral load significantly but not with recent TCD4 lymphocyte levels. Patients classified as adherent were three times more likely to be undetectable than nonadherent patients (odds ratio 3.31, 95% CI 1.13-9.64, P=.04). Conclusions: The SMAQ represents an adequate tool to assess adherence in men living with HIV in the Mexican context, this will contribute to this study and compression of adherence to establish future intervention programs. %M 39773472 %R 10.2196/59562 %U https://www.i-jmr.org/2025/1/e59562 %U https://doi.org/10.2196/59562 %U http://www.ncbi.nlm.nih.gov/pubmed/39773472 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e49844 %T The Virtual Client Experience Survey for Mental Health and Addictions: Revalidation of a Survey to Measure Client and Family Experiences of Virtual Care %A Crawford,Allison %A Kirvan,Anne %A Sanches,Marcos %A Gambin,Amanda %A Canso,Denise %A Serhal,Eva %+ Centre for Addiction and Mental Health, 60 White Squirrel Way, Office 223, Toronto, ON, M6J1H4, Canada, 1 416 535 8501, allison.crawford@utoronto.ca %K virtual care %K digital health %K mental health %K client satisfaction %K health care quality %K Virtual Client Experience Survey %K telehealth %K telemedicine %K eHealth %D 2025 %7 3.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The onset of the COVID-19 pandemic precipitated a rapid shift to virtual care in health care settings, inclusive of mental health care. Understanding clients’ perspectives on virtual mental health care quality will be critical to informing future policies and practices. Objective: This study aimed to outline the process of redesigning and validating the Virtual Client Experience Survey (VCES), which can be used to evaluate client and family experiences of virtual care, specifically virtual mental health and addiction care. Methods: The VCES was adapted from a previously validated telepsychiatry survey. All items were reviewed and updated, with particular attention to the need to ensure relevance across mental health care sectors and settings. The survey was then revalidated using the 6 domains of health care quality of the Institute of Medicine (IOM) as a guiding framework. These 6 domains include being safe, effective, patient-centered, efficient, timely, and equitable. The VCES was piloted with a convenience sample of clients and family members accessing outpatient care at the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario, through video or telephone. A confirmatory factor analysis (CFA) was conducted in MPlus and used to test the factorial structures of the VCES, with minor respecification of the model based on modification indices, factor loadings, reliability, and item-total correlation. The respecifications were checked for alignment with the construct definitions and item interpretation. The reliability of the constructs was estimated by the Cronbach α coefficient. Results: The survey was completed 181 times. The construct reliability was generally high. Timely was the only subscale with an α lower than 0.7; all others were above 0.8. In all cases, the corrected item-total correlation was higher than 0.3. For the CFA, the model was adjusted after multiple imputations with 20 datasets. The mean chi-square value was 437.5, with df=199 (P<.001). The mean root mean square error of approximation (RMSEA) was 0.08 (SD 0.002), the mean confirmatory fit index (CFI) was 0.987 (SD 0.001), the mean Tucker-Lewis Index (TLI) was 0.985 (SD 0.001), and the mean standardized root mean square residual (SRMR) was 0.04 (SD 0.001). Conclusions: This study describes the validation of the VCES to evaluate client and family experiences of virtual mental health and addictions care. Given the widespread uptake of virtual care, this survey has broad applicability across settings that provide mental health and addiction care. The VCES can be used to guide targeted quality improvement initiatives across health care quality domains. By effectively addressing challenges as they emerge, it is anticipated that we will continue to move toward hybrid modalities of practice that leverage the strengths and benefits of telephone, video, and in-person care to effectively respond to unique client and family needs and circumstances. %M 39752192 %R 10.2196/49844 %U https://www.jmir.org/2025/1/e49844 %U https://doi.org/10.2196/49844 %U http://www.ncbi.nlm.nih.gov/pubmed/39752192 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51786 %T Challenges and Lessons Learned in Managing Web-Based Survey Fraud for the Garnering Effective Outreach and Research in Georgia for Impact Alliance–Community Engagement Alliance Survey Administrations %A Craig,Leslie S %A Evans,Christina L %A Taylor,Brittany D %A Patterson,Jace %A Whitfield,Kaleb %A Hill,Mekhi %A Nwagwu,Michelle %A Mubasher,Mohamed %A Bednarczyk,Robert A %A McCray,Gail G %A Gaddis,Cheryl L R %A Taylor,Natasha %A Thompson,Emily %A Douglas,Ursula %A Latimer,Saundra K %A Spivey,Sedessie G %A Henry Akintobi,Tabia %A Quarells,Rakale Collins %K web-based survey research %K data quality %K data integrity %K COVID-19 %K Georgia %K data collection %K scientists %K integrity %K transparency %K public health %K deception %K disinformation %K survey fraud %K legitimate data %D 2024 %7 24.12.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Convenience, privacy, and cost-effectiveness associated with web-based data collection have facilitated the recent expansion of web-based survey research. Importantly, however, practical benefits of web-based survey research, to scientists and participants alike, are being overshadowed by the dramatic rise in suspicious and fraudulent survey submissions. Misinformation associated with survey fraud compromises data quality and data integrity with important implications for scientific conclusions, clinical practice, and social benefit. Transparency in reporting on methods used to prevent and manage suspicious and fraudulent submissions is key to protecting the veracity of web-based survey data; yet, there is limited discussion on the use of antideception strategies during all phases of survey research to detect and eliminate low-quality and fraudulent responses. Objective: This study aims to contribute to an evolving evidence base on data integrity threats associated with web-based survey research by describing study design strategies and antideception tools used during the web-based administration of the Garnering Effective Outreach and Research in Georgia for Impact Alliance–Community Engagement Alliance (GEORGIA CEAL) Against COVID-19 Disparities project surveys. Methods: GEORGIA CEAL was established in response to the COVID-19 pandemic and the need for rapid, yet, valid, community-informed, and community-owned research to guide targeted responses to a dynamic, public health crisis. GEORGIA CEAL Surveys I (April 2021 to June 2021) and II (November 2021 to January 2022) received institutional review board approval from the Morehouse School of Medicine and adhered to the CHERRIES (Checklist for Reporting Results of Internet E-Surveys). Results: A total of 4934 and 4905 submissions were received for Surveys I and II, respectively. A small proportion of surveys (Survey I: n=1336, 27.1% and Survey II: n=1024, 20.9%) were excluded due to participant ineligibility, while larger proportions (Survey I: n=1516, 42.1%; Survey II: n=1423, 36.7%) were flagged and removed due to suspicious activity; 2082 (42.2%) and 2458 (50.1%) of GEORGIA CEAL Surveys I and II, respectively, were retained for analysis. Conclusions: Suspicious activity during GEORGIA CEAL Survey I administration prompted the inclusion of additional security tools during Survey II design and administration (eg, hidden questions, Completely Automated Public Turing Test to Tell Computers and Humans Apart verification, and security questions), which proved useful in managing and detecting fraud and resulted in a higher retention rate across survey waves. By thorough discussion of experiences, lessons learned, and future directions for web-based survey research, this study outlines challenges and best practices for designing and implementing a robust defense against survey fraud. Finally, we argue that, in addition to greater transparency and discussion, community stakeholders need to be intentionally and mindfully engaged, via approaches grounded in community-based participatory research, around the potential for research to enable scientific discoveries in order to accelerate investment in quality, legitimate survey data. %R 10.2196/51786 %U https://publichealth.jmir.org/2024/1/e51786 %U https://doi.org/10.2196/51786 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63866 %T Building a Human Digital Twin (HDTwin) Using Large Language Models for Cognitive Diagnosis: Algorithm Development and Validation %A Sprint,Gina %A Schmitter-Edgecombe,Maureen %A Cook,Diane %+ School of Electrical Engineering and Computer Science, Washington State University, Box 642752, Pullman, WA, 99164-2752, United States, 1 509 335 4985, djcook@wsu.edu %K human digital twin %K cognitive health %K cognitive diagnosis %K large language models %K artificial intelligence %K machine learning %K digital behavior marker %K interview marker %K health information %K chatbot %K digital twin %K smartwatch %D 2024 %7 23.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Human digital twins have the potential to change the practice of personalizing cognitive health diagnosis because these systems can integrate multiple sources of health information and influence into a unified model. Cognitive health is multifaceted, yet researchers and clinical professionals struggle to align diverse sources of information into a single model. Objective: This study aims to introduce a method called HDTwin, for unifying heterogeneous data using large language models. HDTwin is designed to predict cognitive diagnoses and offer explanations for its inferences. Methods: HDTwin integrates cognitive health data from multiple sources, including demographic, behavioral, ecological momentary assessment, n-back test, speech, and baseline experimenter testing session markers. Data are converted into text prompts for a large language model. The system then combines these inputs with relevant external knowledge from scientific literature to construct a predictive model. The model’s performance is validated using data from 3 studies involving 124 participants, comparing its diagnostic accuracy with baseline machine learning classifiers. Results: HDTwin achieves a peak accuracy of 0.81 based on the automated selection of markers, significantly outperforming baseline classifiers. On average, HDTwin yielded accuracy=0.77, precision=0.88, recall=0.63, and Matthews correlation coefficient=0.57. In comparison, the baseline classifiers yielded average accuracy=0.65, precision=0.86, recall=0.35, and Matthews correlation coefficient=0.36. The experiments also reveal that HDTwin yields superior predictive accuracy when information sources are fused compared to single sources. HDTwin’s chatbot interface provides interactive dialogues, aiding in diagnosis interpretation and allowing further exploration of patient data. Conclusions: HDTwin integrates diverse cognitive health data, enhancing the accuracy and explainability of cognitive diagnoses. This approach outperforms traditional models and provides an interface for navigating patient information. The approach shows promise for improving early detection and intervention strategies in cognitive health. %M 39715540 %R 10.2196/63866 %U https://formative.jmir.org/2024/1/e63866 %U https://doi.org/10.2196/63866 %U http://www.ncbi.nlm.nih.gov/pubmed/39715540 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51615 %T Efficient Screening in Obstructive Sleep Apnea Using Sequential Machine Learning Models, Questionnaires, and Pulse Oximetry Signals: Mixed Methods Study %A Kuo,Nai-Yu %A Tsai,Hsin-Jung %A Tsai,Shih-Jen %A Yang,Albert C %+ Digital Medicine and Smart Healthcare Research Center, National Yang Ming Chiao Tung University, No. 155 Sec. 2 Linong Street, Beitou District, Taipei, 11221, Taiwan, 886 02 28267000 ext 66555, accyang@gmail.com %K sleep apnea %K machine learning %K questionnaire %K oxygen saturation %K polysomnography %K screening %K sleep disorder %K insomnia %K utilization %K dataset %K training %K diagnostic %D 2024 %7 19.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Obstructive sleep apnea (OSA) is a prevalent sleep disorder characterized by frequent pauses or shallow breathing during sleep. Polysomnography, the gold standard for OSA assessment, is time consuming and labor intensive, thus limiting diagnostic efficiency. Objective: This study aims to develop 2 sequential machine learning models to efficiently screen and differentiate OSA. Methods: We used 2 datasets comprising 8444 cases from the Sleep Heart Health Study (SHHS) and 1229 cases from Taipei Veterans General Hospital (TVGH). The Questionnaire Model (Model-Questionnaire) was designed to distinguish OSA from primary insomnia using demographic information and Pittsburgh Sleep Quality Index questionnaires, while the Saturation Model (Model-Saturation) categorized OSA severity based on multiple blood oxygen saturation parameters. The performance of the sequential machine learning models in screening and assessing the severity of OSA was evaluated using an independent test set derived from TVGH. Results: The Model-Questionnaire achieved an F1-score of 0.86, incorporating demographic data and the Pittsburgh Sleep Quality Index. Model-Saturation training by the SHHS dataset displayed an F1-score of 0.82 when using the power spectrum of blood oxygen saturation signals and reached the highest F1-score of 0.85 when considering all saturation-related parameters. Model-saturation training by the TVGH dataset displayed an F1-score of 0.82. The independent test set showed stable results for Model-Questionnaire and Model-Saturation training by the TVGH dataset, but with a slightly decreased F1-score (0.78) in Model-Saturation training by the SHHS dataset. Despite reduced model accuracy across different datasets, precision remained at 0.89 for screening moderate to severe OSA. Conclusions: Although a composite model using multiple saturation parameters exhibits higher accuracy, optimizing this model by identifying key factors is essential. Both models demonstrated adequate at-home screening capabilities for sleep disorders, particularly for patients unsuitable for in-laboratory sleep studies. %M 39699950 %R 10.2196/51615 %U https://www.jmir.org/2024/1/e51615 %U https://doi.org/10.2196/51615 %U http://www.ncbi.nlm.nih.gov/pubmed/39699950 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57592 %T Evaluating Bard Gemini Pro and GPT-4 Vision Against Student Performance in Medical Visual Question Answering: Comparative Case Study %A Roos,Jonas %A Martin,Ron %A Kaczmarczyk,Robert %K medical education %K visual question answering %K image analysis %K large language model %K LLM %K student %K performance %K comparative %K case study %K artificial intelligence %K AI %K ChatGPT %K effectiveness %K diagnostic %K training %K accuracy %K utility %K image-based %K question %K image %K AMBOSS %K English %K German %K question and answer %K Python %K AI in health care %K health care %D 2024 %7 17.12.2024 %9 %J JMIR Form Res %G English %X Background: The rapid development of large language models (LLMs) such as OpenAI’s ChatGPT has significantly impacted medical research and education. These models have shown potential in fields ranging from radiological imaging interpretation to medical licensing examination assistance. Recently, LLMs have been enhanced with image recognition capabilities. Objective: This study aims to critically examine the effectiveness of these LLMs in medical diagnostics and training by assessing their accuracy and utility in answering image-based questions from medical licensing examinations. Methods: This study analyzed 1070 image-based multiple-choice questions from the AMBOSS learning platform, divided into 605 in English and 465 in German. Customized prompts in both languages directed the models to interpret medical images and provide the most likely diagnosis. Student performance data were obtained from AMBOSS, including metrics such as the “student passed mean” and “majority vote.” Statistical analysis was conducted using Python (Python Software Foundation), with key libraries for data manipulation and visualization. Results: GPT-4 1106 Vision Preview (OpenAI) outperformed Bard Gemini Pro (Google), correctly answering 56.9% (609/1070) of questions compared to Bard’s 44.6% (477/1070), a statistically significant difference (χ2₁=32.1, P<.001). However, GPT-4 1106 left 16.1% (172/1070) of questions unanswered, significantly higher than Bard’s 4.1% (44/1070; χ2₁=83.1, P<.001). When considering only answered questions, GPT-4 1106’s accuracy increased to 67.8% (609/898), surpassing both Bard (477/1026, 46.5%; χ2₁=87.7, P<.001) and the student passed mean of 63% (674/1070, SE 1.48%; χ2₁=4.8, P=.03). Language-specific analysis revealed both models performed better in German than English, with GPT-4 1106 showing greater accuracy in German (282/465, 60.65% vs 327/605, 54.1%; χ2₁=4.4, P=.04) and Bard Gemini Pro exhibiting a similar trend (255/465, 54.8% vs 222/605, 36.7%; χ2₁=34.3, P<.001). The student majority vote achieved an overall accuracy of 94.5% (1011/1070), significantly outperforming both artificial intelligence models (GPT-4 1106: χ2₁=408.5, P<.001; Bard Gemini Pro: χ2₁=626.6, P<.001). Conclusions: Our study shows that GPT-4 1106 Vision Preview and Bard Gemini Pro have potential in medical visual question-answering tasks and to serve as a support for students. However, their performance varies depending on the language used, with a preference for German. They also have limitations in responding to non-English content. The accuracy rates, particularly when compared to student responses, highlight the potential of these models in medical education, yet the need for further optimization and understanding of their limitations in diverse linguistic contexts remains critical. %R 10.2196/57592 %U https://formative.jmir.org/2024/1/e57592 %U https://doi.org/10.2196/57592 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 8 %N %P e67928 %T Emotional Touch Nursing Competencies Model of the Fourth Industrial Revolution: Instrument Validation Study %A Jung,Sun-Young %A Lee,Ji-Hyeon %+ College of Nursing, Daegu University, Seongdang-ro 50-gil 33, Nam-gu, Daegu, 42601, Republic of Korea, 82 536508016, jihyeonnlee@naver.com %K nurse %K therapeutic touch %K clinical competence %K factor analysis %K statistical %K reliability %K scale %K tool %K nursing %K industrial revolution %K competencies %K health care %K emotional %K interview %K collaborative practice %K learning agility %K professional commitment %K positive self-worth %K compliance %K ethics %K practice ability %K relationship ability %K nursing sensitivity %D 2024 %7 16.12.2024 %9 Original Paper %J Asian Pac Isl Nurs J %G English %X Background: The Fourth Industrial Revolution is transforming the health care sector through advanced technologies such as artificial intelligence, the Internet of Things, and big data, leading to new expectations for rapid and accurate treatment. While the integration of technology in nursing tasks is on the rise, there remains a critical need to balance technological efficiency with empathy and emotional connection. This study aims to develop and validate a competency model for emotional touch nursing that responds to the evolving demands of the changing health care environment. Objective: The aims of our study are to develop an emotional touch nursing competencies model and to verify its reliability and validity. Methods: A conceptual framework and construct factors were developed based on an extensive literature review and in-depth interviews with nurses. The potential competencies were confirmed by 20 experts, and preliminary questions were prepared. The final version of the scale was verified through exploratory factor analysis (n=255) and confirmatory factor analysis (n=256) to assess its validity and reliability. Results: From the exploratory analysis, 8 factors and 38 items (client-centered collaborative practice, learning agility for nursing, nursing professional commitment, positive self-worth, compliance with ethics and roles, nursing practice competence, nurse-client relationship, and nursing sensitivity) were extracted. These items were verified through convergent and discriminant validity testing. The internal consistency reliability was acceptable (Cronbach α=0.95). Conclusions: The findings from this study confirmed that this scale has sufficient validity and reliability to measure emotional touch nursing competencies. It is expected to be used to build a knowledge and educational system for emotional touch nursing. %M 39680900 %R 10.2196/67928 %U https://apinj.jmir.org/2024/1/e67928 %U https://doi.org/10.2196/67928 %U http://www.ncbi.nlm.nih.gov/pubmed/39680900 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 9 %N %P e57373 %T Validation of a Wearable Sensor Prototype for Measuring Heart Rate to Prescribe Physical Activity: Cross-Sectional Exploratory Study %A Loro,Fernanda Laís %A Martins,Riane %A Ferreira,Janaína Barcellos %A de Araujo,Cintia Laura Pereira %A Prade,Lucio Rene %A Both,Cristiano Bonato %A Nobre,Jéferson Campos Nobre %A Monteiro,Mariane Borba %A Dal Lago,Pedro %+ Department of Physical Therapy, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA, Rua Sarmento Leite, 245, Porto Alegre, 90050170, Brazil, 55 51999617331, pdallago@ufcspa.edu.br %K heart rate %K wearable device %K HR %K biosensor %K physiological monitor %K wearable system %K medical device %K mobile phone %D 2024 %7 11.12.2024 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Wearable sensors are rapidly evolving, particularly in health care, due to their ability to facilitate continuous or on-demand physiological monitoring. Objective: This study aimed to design and validate a wearable sensor prototype incorporating photoplethysmography (PPG) and long-range wide area network technology for heart rate (HR) measurement during a functional test. Methods: We conducted a transversal exploratory study involving 20 healthy participants aged between 20 and 30 years without contraindications for physical exercise. Initially, our laboratory developed a pulse wearable sensor prototype for HR monitoring. Following this, the participants were instructed to perform the Incremental Shuttle Walk Test while wearing the Polar H10 HR chest strap sensor (the reference for HR measurement) and the wearable sensor. This test allowed for real-time comparison of HR responses between the 2 devices. Agreement between these measurements was determined using the intraclass correlation coefficient (ICC3.1) and Lin concordance correlation coefficient. The mean absolute percentage error was calculated to evaluate reliability or validity. Cohen d was used to calculate the agreement’s effect size. Results: The mean differences between the Polar H10 and the wearable sensor during the test were –2.6 (95% CI –3.5 to –1.8) for rest HR, –4.1 (95% CI –5.3 to –3) for maximum HR, –2.4 (95% CI –3.5 to –1.4) for mean test HR, and –2.5 (95% CI –3.6 to –1.5) for mean recovery HR. The mean absolute percentage errors were –3% for rest HR, –2.2% for maximum HR, –1.8% for mean test HR, and –1.6% for recovery HR. Excellent agreement was observed between the Polar H10 and the wearable sensor for rest HR (ICC3.1=0.96), mean test HR (ICC3.1=0.92), and mean recovery HR (ICC3.1=0.96). The agreement for maximum HR (ICC3.1=0.78) was considered good. By the Lin concordance correlation coefficient, the agreement was found to be substantial for rest HR (rc=0.96) and recovery HR (rc=0.96), moderate for mean test HR (rc=0.92), and poor for maximum HR (rc=0.78). The power of agreement between the Polar H10 and the wearable sensor prototype was large for baseline HR (Cohen d=0.97), maximum HR (Cohen d=1.18), and mean recovery HR (Cohen d=0.8) and medium for mean test HR (Cohen d= 0.76). Conclusions: The pulse-wearable sensor prototype tested in this study proves to be a valid tool for monitoring HR at rest, during functional tests, and during recovery compared with the Polar H10 reference device used in the laboratory setting. %M 39661434 %R 10.2196/57373 %U https://biomedeng.jmir.org/2024/1/e57373 %U https://doi.org/10.2196/57373 %U http://www.ncbi.nlm.nih.gov/pubmed/39661434 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55827 %T Evaluation of RMES, an Automated Software Tool Utilizing AI, for Literature Screening with Reference to Published Systematic Reviews as Case-Studies: Development and Usability Study %A Sugiura,Ayaka %A Saegusa,Satoshi %A Jin,Yingzi %A Yoshimoto,Riki %A Smith,Nicholas D %A Dohi,Koji %A Higuchi,Tadashi %A Kozu,Tomotake %+ Deloitte Analytics, Deloitte Tohmatsu Risk Advisory LLC, 3-2-3 Marunouchi, Chiyoda-ku, Tokyo, 100-0005, Japan, 81 80 3456 4991, yingzi.jin@tohmatsu.co.jp %K artificial intelligence %K automated literature screening %K natural language processing %K randomized controlled trials %K Rapid Medical Evidence Synthesis %K RMES %K systematic reviews %K text mining %D 2024 %7 9.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Systematic reviews and meta-analyses are important to evidence-based medicine, but the information retrieval and literature screening procedures are burdensome tasks. Rapid Medical Evidence Synthesis (RMES; Deloitte Tohmatsu Risk Advisory LLC) is a software designed to support information retrieval, literature screening, and data extraction for evidence-based medicine. Objective: This study aimed to evaluate the accuracy of RMES for literature screening with reference to published systematic reviews. Methods: We used RMES to automatically screen the titles and abstracts of PubMed-indexed articles included in 12 systematic reviews across 6 medical fields, by applying 4 filters: (1) study type; (2) study type + disease; (3) study type + intervention; and (4) study type + disease + intervention. We determined the numbers of articles correctly included by each filter relative to those included by the authors of each systematic review. Only PubMed-indexed articles were assessed. Results: Across the 12 reviews, the number of articles analyzed by RMES ranged from 46 to 5612. The number of PubMed-cited articles included in the reviews ranged from 4 to 47. The median (range) percentage of articles correctly labeled by RMES using filters 1-4 were: 80.9% (57.1%-100%), 65.2% (34.1%-81.8%), 70.5% (0%-100%), and 58.6% (0%-81.8%), respectively. Conclusions: This study demonstrated good performance and accuracy of RMES for the initial screening of the titles and abstracts of articles for use in systematic reviews. RMES has the potential to reduce the workload involved in the initial screening of published studies. %M 39652380 %R 10.2196/55827 %U https://formative.jmir.org/2024/1/e55827 %U https://doi.org/10.2196/55827 %U http://www.ncbi.nlm.nih.gov/pubmed/39652380 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59045 %T Intersection of Performance, Interpretability, and Fairness in Neural Prototype Tree for Chest X-Ray Pathology Detection: Algorithm Development and Validation Study %A Chen,Hongbo %A Alfred,Myrtede %A Brown,Andrew D %A Atinga,Angela %A Cohen,Eldan %+ Department of Mechanical and Industrial Engineering, University of Toronto, 27 King's College Cir, Toronto, ON, Canada, 1 416 978 4184, ecohen@mie.utoronto.ca %K explainable artificial intelligence %K deep learning %K chest x-ray %K thoracic pathology %K fairness %K interpretability %D 2024 %7 5.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: While deep learning classifiers have shown remarkable results in detecting chest X-ray (CXR) pathologies, their adoption in clinical settings is often hampered by the lack of transparency. To bridge this gap, this study introduces the neural prototype tree (NPT), an interpretable image classifier that combines the diagnostic capability of deep learning models and the interpretability of the decision tree for CXR pathology detection. Objective: This study aimed to investigate the utility of the NPT classifier in 3 dimensions, including performance, interpretability, and fairness, and subsequently examined the complex interaction between these dimensions. We highlight both local and global explanations of the NPT classifier and discuss its potential utility in clinical settings. Methods: This study used CXRs from the publicly available Chest X-ray 14, CheXpert, and MIMIC-CXR datasets. We trained 6 separate classifiers for each CXR pathology in all datasets, 1 baseline residual neural network (ResNet)–152, and 5 NPT classifiers with varying levels of interpretability. Performance, interpretability, and fairness were measured using the area under the receiver operating characteristic curve (ROC AUC), interpretation complexity (IC), and mean true positive rate (TPR) disparity, respectively. Linear regression analyses were performed to investigate the relationship between IC and ROC AUC, as well as between IC and mean TPR disparity. Results: The performance of the NPT classifier improved as the IC level increased, surpassing that of ResNet-152 at IC level 15 for the Chest X-ray 14 dataset and IC level 31 for the CheXpert and MIMIC-CXR datasets. The NPT classifier at IC level 1 exhibited the highest degree of unfairness, as indicated by the mean TPR disparity. The magnitude of unfairness, as measured by the mean TPR disparity, was more pronounced in groups differentiated by age (chest X-ray 14 0.112, SD 0.015; CheXpert 0.097, SD 0.010; MIMIC 0.093, SD 0.017) compared to sex (chest X-ray 14 0.054 SD 0.012; CheXpert 0.062, SD 0.008; MIMIC 0.066, SD 0.013). A significant positive relationship between interpretability (ie, IC level) and performance (ie, ROC AUC) was observed across all CXR pathologies (P<.001). Furthermore, linear regression analysis revealed a significant negative relationship between interpretability and fairness (ie, mean TPR disparity) across age and sex subgroups (P<.001). Conclusions: By illuminating the intricate relationship between performance, interpretability, and fairness of the NPT classifier, this research offers insightful perspectives that could guide future developments in effective, interpretable, and equitable deep learning classifiers for CXR pathology detection. %M 39636692 %R 10.2196/59045 %U https://formative.jmir.org/2024/1/e59045 %U https://doi.org/10.2196/59045 %U http://www.ncbi.nlm.nih.gov/pubmed/39636692 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60805 %T Development and Validation of a Novel Tool to Measure Medication Adherence for Noncommunicable Diseases in India: Protocol for an Exploratory Sequential Mixed Methods Multicentric Study %A Thomas,Joe %A Jose,Maria %A Rajmohan,Priyanka %A Fathima,Farah Naaz %A Moosan,Hisham %A Jose,Nisha K %A Anish,Thekkumkara Surendran %A Bairwa,Mohan %A Goswami Mahanta,Tulika %A Apte,Aditi %A Cherian,Jerin Jose %A Kuttichira,Praveenlal %A Varma P,Ravi Prasad %+ Department of Community Medicine, Jubilee Mission Medical College and Research Institute, East fort, Thrissur, 680005, India, 91 8593841000, cmicmrsrum@gmail.com %K medication adherence %K noncommunicable diseases %K self-report %K psychometric properties %K validation %K reproducibility of results %D 2024 %7 3.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In high-income countries, only 50% of patients treated for chronic diseases adhere to the prescribed treatment. This issue is even more pronounced in resource-limited countries. Medication adherence scales are simple, low-cost approaches to identify nonadherence in clinical practice. In India, nonadherence to medication varies from 18.7% to 74%, assessed using scales validated in the Western population, as there is no validated medication adherence tool contextualized to the Indian setting. The phrasing of questions in scales validated elsewhere and its interpretations may vary when applied in Indian patients unless accounting for the unique cultural, social, and economic factors influencing medication adherence in India. This could result in inaccurate reports of adherence behavior. Objective: This study aims to develop and validate a novel medication adherence tool for select noncommunicable diseases (diabetes mellitus, hypertension, chronic obstructive pulmonary disease, bronchial asthma, and coronary artery disease) in the Indian population. Methods: An exploratory sequential mixed methods design will be used, beginning with a qualitative phase where the construct of the scale is defined and preliminary items are generated through a scoping review, focus group discussions, and in-depth interviews. This will be followed by the tool’s development phase, including an expert panel review and item revision. Finally, a quantitative phase in 4 zones in India (North, South, East, and West) will be conducted to confirm and validate the newly developed scale. Results: In the first phase, we will frame the construct definition and develop an inventory of potential items for the proposed medication adherence tool. In the second phase, item-level and scale-level content validity indices, along with content validity ratio, will be estimated. In the third phase, we will conduct an item reduction analysis and determine the scoring matrix and item weightage after expert review. We will assess the tool's psychometric properties, plot the receiver operating characteristic (ROC) curve to set an adherence cut-off score, and compute the construct validity and test-retest reliability from the quantitative survey. Conclusions: A medication adherence tool for noncommunicable diseases, developed after ensuring it is ethnically, culturally, and linguistically appropriate incorporating stakeholder perspectives and validated in community settings, would offer a real-world perspective of adherence. The tool will have 2 versions for clinical practice and research, aiding policy makers in adopting tailored adherence policies. International Registered Report Identifier (IRRID): PRR1-10.2196/60805 %M 39625743 %R 10.2196/60805 %U https://www.researchprotocols.org/2024/1/e60805 %U https://doi.org/10.2196/60805 %U http://www.ncbi.nlm.nih.gov/pubmed/39625743 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e63195 %T Dynamic Simulation Models of Suicide and Suicide-Related Behaviors: Systematic Review %A Gariepy,Genevieve %A Zahan,Rifat %A Osgood,Nathaniel D %A Yeoh,Benjamin %A Graham,Eva %A Orpana,Heather %+ Centre for Surveillance and Applied Research, Public Health Agency of Canada, 785 Carling Avenue, Ottawa, ON, K1A 0K9, Canada, 1 6139527608, genevieve.gariepy@phac-aspc.gc.ca %K suicide %K agent-based modeling %K complex system %K complexity science %K discrete-event simulation %K dynamic modeling %K microsimulation %K system dynamics %K systems science %K qualitative study %K dynamic simulation %K database %K depression %K mental state %K systematic review %K stress %D 2024 %7 2.12.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: Suicide remains a public health priority worldwide with over 700,000 deaths annually, ranking as a leading cause of death among young adults. Traditional research methodologies have often fallen short in capturing the multifaceted nature of suicide, focusing on isolated risk factors rather than the complex interplay of individual, social, and environmental influences. Recognizing these limitations, there is a growing recognition of the value of dynamic simulation modeling to inform suicide prevention planning. Objective: This systematic review aims to provide a comprehensive overview of existing dynamic models of population-level suicide and suicide-related behaviors, and to summarize their methodologies, applications, and outcomes. Methods: Eight databases were searched, including MEDLINE, Embase, PsycINFO, Scopus, Compendex, ACM Digital Library, IEEE Xplore, and medRxiv, from inception to July 2023. We developed a search strategy in consultation with a research librarian. Two reviewers independently conducted the title and abstract and full-text screenings including studies using dynamic modeling methods (eg, System Dynamics and agent-based modeling) for suicide or suicide-related behaviors at the population level, and excluding studies on microbiology, bioinformatics, pharmacology, nondynamic modeling methods, and nonprimary modeling reports (eg, editorials and reviews). Reviewers extracted the data using a standardized form and assessed the quality of reporting using the STRESS (Strengthening the Reporting of Empirical Simulation Studies) guidelines. A narrative synthesis was conducted for the included studies. Results: The search identified 1574 studies, with 22 studies meeting the inclusion criteria, including 15 System Dynamics models, 6 agent-based models, and 1 microsimulation model. The studies primarily targeted populations in Australia and the United States, with some focusing on hypothetical scenarios. The models addressed various interventions ranging from specific clinical and health service interventions, such as mental health service capacity increases, to broader social determinants, including employment programs and reduction in access to means of suicide. The studies demonstrated the utility of dynamic models in identifying the synergistic effects of combined interventions and understanding the temporal dynamics of intervention impacts. Conclusions: Dynamic modeling of suicide and suicide-related behaviors, though still an emerging area, is expanding rapidly, adapting to a range of questions, settings, and contexts. While the quality of reporting was overall adequate, some studies lacked detailed reporting on model transparency and reproducibility. This review highlights the potential of dynamic modeling as a tool to support decision-making and to further our understanding of the complex dynamics of suicide and its related behaviors. Trial Registration: PROSPERO CRD42022346617; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346617 %M 39622024 %R 10.2196/63195 %U https://publichealth.jmir.org/2024/1/e63195 %U https://doi.org/10.2196/63195 %U http://www.ncbi.nlm.nih.gov/pubmed/39622024 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e53304 %T Common Physical Performance Tests for Evaluating Health in Older Adults: Cross-Sectional Study %A Banarjee,Chitra %A Choudhury,Renoa %A Park,Joon-Hyuk %A Xie,Rui %A Fukuda,David %A Stout,Jeffrey %A Thiamwong,Ladda %+ Department of Mechanical Engineering, University of Central Flordia, 12760 Pegasus Drive, Orlando, FL, 32816, United States, 1 4078232416, joonpark@ucf.edu %K functional capacity %K physical activity %K fear of falling %K physical performance tests %K Short Physical Performance Battery %K 6-minute walk test %K Incremental Shuttle Walk Test %K geriatrics %K aging %D 2024 %7 29.11.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Interdisciplinary evaluation of older adults’ health care is a priority in the prevention of chronic health conditions and maintenance of daily functioning. While many studies evaluate different physical performance tests (PPTs) from a retrospective view in predicting mortality or cardiopulmonary health, it remains unclear which of the commonly used PPTs is the most effective at evaluating the current health of older adults. Additionally, the time and participant burden for each PPT must be considered when planning and implementing them for clinical or research purposes. Objective: This cross-sectional study aimed to determine how elements of overall physical capacity, performance, and other nongait factors in older adults affect the results of 3 commonly used tests: the Short Physical Performance Battery (SPPB), 6-minute walk test (6MWT), and Incremental Shuttle Walk Test (ISWT). Methods: A total of 53 community-dwelling older adults met the inclusion and exclusion criteria (mean age 77.47, SD 7.25 years; n=41, 77% female; and n=21, 40% Hispanic). This study evaluated older adults using 3 different PPTs including the SPPB, 6MWT, and ISWT, as well as constructed multiple linear regression models with measures of physical activity, static balance, and fear of falling (FoF). The nongait measures included 7 days of physical activity monitoring using the ActiGraph GT9X Link instrument, objective measurement of static balance using the BTrackS Balance System, and FoF using the short Fall Efficacy Scale-International. Results: The models revealed that the complete SPPB provided the most comprehensive value, as indicated by a greater R2 value (0.523), and that performance on the SPPB was predicted by both moderate to vigorous physical activity (P=.01) and FoF (P<.001). The ISWT was predicted by moderate to vigorous physical activity (P=.02), BMI (P=.02), and FoF (P=.006) and had a similar R2 value (0.517), whereas the gait component of the SPPB (P=.001) and 6MWT (P<.001) was predicted by only FoF and had lower R2 values (0.375 and 0.228, respectively). Conclusions: The results indicated the value of a multicomponent, comprehensive test, such as the SPPB, in evaluating the health of older adults. Additionally, a comparison of the 2 field walking tests (ISWT and 6MWT) further distinguished the ISWT as more responsive to overall health in older adults. In comparing these commonly used PPTs, clinicians and researchers in the field can determine and select the most optimal test to evaluate older adults in communities and research settings. %M 39612490 %R 10.2196/53304 %U https://www.i-jmr.org/2024/1/e53304 %U https://doi.org/10.2196/53304 %U http://www.ncbi.nlm.nih.gov/pubmed/39612490 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e63032 %T Comparing Health Survey Data Cost and Quality Between Amazon’s Mechanical Turk and Ipsos’ KnowledgePanel: Observational Study %A Herman,Patricia M %A Slaughter,Mary E %A Qureshi,Nabeel %A Azzam,Tarek %A Cella,David %A Coulter,Ian D %A DiGuiseppi,Graham %A Edelen,Maria Orlando %A Kapteyn,Arie %A Rodriguez,Anthony %A Rubinstein,Max %A Hays,Ron D %+ RAND, 1776 Main Street, Santa Monica, CA, 90407, United States, 1 3103930411 ext 7129, pherman@rand.org %K data collection %K probability panel %K convenience sample %K data quality %K weighting %K back pain %K misrepresentation %K Amazon %K Mechanical Turk %K MTurk %K convenience panel %K KnowledgePanel %D 2024 %7 29.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Researchers have many options for web-based survey data collection, ranging from access to curated probability-based panels, where individuals are selectively invited to join based on their membership in a representative population, to convenience panels, which are open for anyone to join. The mix of respondents available also varies greatly regarding representation of a population of interest and in motivation to provide thoughtful and accurate responses. Despite the additional dataset-building labor required of the researcher, convenience panels are much less expensive than probability-based panels. However, it is important to understand what may be given up regarding data quality for those cost savings. Objective: This study examined the relative costs and data quality of fielding equivalent surveys on Amazon’s Mechanical Turk (MTurk), a convenience panel, and KnowledgePanel, a nationally representative probability-based panel. Methods: We administered the same survey measures to MTurk (in 2021) and KnowledgePanel (in 2022) members. We applied several recommended quality assurance steps to enhance the data quality achieved using MTurk. Ipsos, the owner of KnowledgePanel, followed their usual (industry standard) protocols. The survey was designed to support psychometric analyses and included >60 items from the Patient-Reported Outcomes Measurement Information System (PROMIS), demographics, and a list of health conditions. We used 2 fake conditions (“syndomitis” and “chekalism”) to identify those more likely to be honest respondents. We examined the quality of each platform’s data using several recommended metrics (eg, consistency, reliability, representativeness, missing data, and correlations) including and excluding those respondents who had endorsed a fake condition and examined the impact of weighting on representativeness. Results: We found that prescreening in the MTurk sample (removing those who endorsed a fake health condition) improved data quality but KnowledgePanel data quality generally remained superior. While MTurk’s unweighted point estimates for demographics exhibited the usual mismatch with national averages (younger, better educated, and lower income), weighted MTurk data matched national estimates. KnowledgePanel’s point estimates better matched national benchmarks even before poststratification weighting. Correlations between PROMIS measures and age and income were similar in MTurk and KnowledgePanel; the mean absolute value of the difference between each platform’s 137 correlations was 0.06, and 92% were <0.15. However, correlations between PROMIS measures and educational level were dramatically different; the mean absolute value of the difference across these 17 correlation pairs was 0.15, the largest difference was 0.29, and the direction of more than half of these relationships in the MTurk sample was the opposite from that expected from theory. Therefore, caution is needed if using MTurk for studies where educational level is a key variable. Conclusions: The data quality of our MTurk sample was often inferior to that of the KnowledgePanel sample but possibly not so much as to negate the benefits of its cost savings for some uses. International Registered Report Identifier (IRRID): RR2-10.1186/s12891-020-03696-2 %M 39612505 %R 10.2196/63032 %U https://www.jmir.org/2024/1/e63032 %U https://doi.org/10.2196/63032 %U http://www.ncbi.nlm.nih.gov/pubmed/39612505 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e60031 %T Practical Recommendations for Navigating Digital Tools in Hospitals: Qualitative Interview Study %A Wosny,Marie %A Strasser,Livia Maria %A Kraehenmann,Simone %A Hastings,Janna %+ School of Medicine, University of St Gallen (HSG), St Jakob-Strasse 21, St.Gallen, 9000, Switzerland, 41 712 243 249, mariejohanna.wosny@unisg.ch %K health care %K hospital %K information system %K information technology %K technology implementation %K training %K medical education %K digital literacy %K curriculum development %K health care workforce development %K mobile phone %D 2024 %7 27.11.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: The digitalization of health care organizations is an integral part of a clinician’s daily life, making it vital for health care professionals (HCPs) to understand and effectively use digital tools in hospital settings. However, clinicians often express a lack of preparedness for their digital work environments. Particularly, new clinical end users, encompassing medical and nursing students, seasoned professionals transitioning to new health care environments, and experienced practitioners encountering new health care technologies, face critically intense learning periods, often with a lack of adequate time for learning digital tools, resulting in difficulties in integrating and adopting these digital tools into clinical practice. Objective: This study aims to comprehensively collect advice from experienced HCPs in Switzerland to guide new clinical end users on how to initiate their engagement with health ITs within hospital settings. Methods: We conducted qualitative interviews with 52 HCPs across Switzerland, representing 24 medical specialties from 14 hospitals. The interviews were transcribed verbatim and analyzed through inductive thematic analysis. Codes were developed iteratively, and themes and aggregated dimensions were refined through collaborative discussions. Results: Ten themes emerged from the interview data, namely (1) digital tool understanding, (2) peer-based learning strategies, (3) experimental learning approaches, (4) knowledge exchange and support, (5) training approaches, (6) proactive innovation, (7) an adaptive technology mindset, (8) critical thinking approaches, (9) dealing with emotions, and (10) empathy and human factors. Consequently, we devised 10 recommendations with specific advice to new clinical end users on how to approach new health care technologies, encompassing the following: take time to get to know and understand the tools you are working with; proactively ask experienced colleagues; simply try it out and practice; know where to get help and information; take sufficient training; embrace curiosity and pursue innovation; maintain an open and adaptable mindset; keep thinking critically and use your knowledge base; overcome your fears, and never lose the human and patient focus. Conclusions: Our study emphasized the importance of comprehensive training and learning approaches for health care technologies based on the advice and recommendations of experienced HCPs based in Swiss hospitals. Moreover, these recommendations have implications for medical educators and clinical instructors, providing advice on effective methods to instruct and support new end users, enabling them to use novel technologies proficiently. Therefore, we advocate for new clinical end users, health care institutions and clinical instructors, academic institutions and medical educators, and regulatory bodies to prioritize effective training and cultivating technological readiness to optimize IT use in health care. %M 39602211 %R 10.2196/60031 %U https://mededu.jmir.org/2024/1/e60031 %U https://doi.org/10.2196/60031 %U http://www.ncbi.nlm.nih.gov/pubmed/39602211 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 9 %N %P e63434 %T Four New Patient-Reported Outcome Measures Examining Health-Seeking Behavior in Persons With Type 2 Diabetes Mellitus (REDD-CAT): Instrument Development Study %A Mitchell,Suzanne E %A Kallen,Michael A %A Troost,Jonathan P %A De La Cruz,Barbara A %A Bragg,Alexa %A Martin-Howard,Jessica %A Moldovan,Ioana %A Miner,Jennifer A %A Jack,Brian W %A Carlozzi,Noelle E %+ Department of Physical Medicine and Rehabilitation, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI, 48109, United States, 1 7347638917, carlozzi@med.umich.edu %K diabetes mellitus %K social determinants of health %K patient-reported outcome measures %K outcomes assessment %K health care %K patient reported %K health-seeking behavior %K type 2 diabetes %K hospitalization %K diabetes computer adaptive test %K primary care %K socioeconomic %K assessments %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Diabetes %G English %X Background: The management of type 2 diabetes mellitus (T2DM) includes mastery of complex care activities, self-management skills, and routine health care encounters to optimize glucose control and achieve good health. Given the lifelong course of T2DM, patients are faced with navigating complex medical and disease-specific information. This health-seeking behavior is a driver of health disparities and is associated with hospitalization and readmission. Given that health-seeking behavior is a potentially intervenable social determinant of health, a better understanding of how people navigate these complex systems is warranted. Objective: To address this need, we aimed to develop new patient-reported outcome (PRO) measures that evaluate health-seeking behavior in persons with T2DM. These new PROs were designed to be included in the Re-Engineered Discharge for Diabetes-Computer Adaptive Test (REDD-CAT) measurement system, which includes several other PROs that capture the importance of social determinants of health. Methods: Overall, 225 participants with T2DM completed 56 self-report items that examined health-seeking behaviors. Classical Test Theory and Item Response Theory were used for measurement development. Exploratory factor analysis (EFA; criterion ratio of eigenvalue 1 to eigenvalue 2 being >4; variance for eigenvalue 1 ≥40%) and confirmatory factor analysis (CFA; criterion 1-factor CFA loading <.50; 1-factor CFA residual correlation >.20; comparative fit index ≥0.90; Tucker-Lewis index ≥0.90; root mean square error of approximation <0.15) were used to determine unidimensional sets of items. Items with sparse responses, low-adjusted total score correlations, nonmonotonicity, low factor loading, and high residual correlations of high error modification indices were candidates for exclusion. A constrained graded response model was used to examine item misfit, and differential item functioning was examined to identify item bias. Cronbach α was used to examine internal consistency reliability for the new PROs (criterion ≥0.70), and floor and ceiling effects were examined (criterion ≤20%). Results: Four unidimensional sets of items were supported by EFA (all EFA eigenvalue ratios >4; variance for eigenvalue 1=41.4%-67.3%) and CFA (fit statistics all exceeded criterion values). This included (1) “Health-Seeking Behavior: PCP-Specific” (6 items); (2) “Health-Seeking Behavior: General Beliefs” (13 items); (3) “Health-Seeking Behavior: Family or Friends-Specific” (5 items); and (4) “Health-Seeking Behavior: Internet-Specific” (4 items). All items were devoid of differential item functioning for age, sex, education, or socioeconomic status factors. “Health-Seeking Behavior: General Beliefs” was developed to include both a computer adaptive test and a 6-item short form version; all other PROs were developed as static short forms. The psychometric reliability of these new PROs was supported; internal consistency ranged from acceptable to excellent (Cronbach α=.78-.91), and measures were free of significant floor or ceiling effects (floor effects range: 0%-8.9%; ceiling effects range: 0%-8.4%). Conclusions: The new REDD-CAT Health-Seeking Behavior PROs provide reliable assessments of health-seeking behaviors among those with T2DM. %M 39576685 %R 10.2196/63434 %U https://diabetes.jmir.org/2024/1/e63434 %U https://doi.org/10.2196/63434 %U http://www.ncbi.nlm.nih.gov/pubmed/39576685 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57747 %T Short-Form Video Informed Consent Compared With Written Consent for Adolescents and Young Adults: Randomized Experiment %A Afolabi,Aliyyat %A Cheung,Elaine %A Lyu,Joanne Chen %A Ling,Pamela M %+ Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366, San Francisco, CA, 94143-1390, United States, 1 4155148627, Pamela.Ling@ucsf.edu %K health communication %K video informed consent %K randomized experiment %K informed consent %K adolescent %K video %K consent %K e-cigarette %K vaping %K health research %K social media %K vaping cessation %K smoking cessation %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents and young adults have the highest prevalence of e-cigarette use (“vaping”), but they are difficult to enroll in health research studies. Previous studies have found that video consent can improve comprehension and make informed consent procedures more accessible, but the videos in previous studies are much longer than videos on contemporary social media platforms that are popular among young people. Objective: This study aimed to examine the effectiveness of a short-form (90-second) video consent compared with a standard written consent for a vaping cessation study for adolescents and young adults. Methods: We conducted a web-based experiment with 435 adolescents and young adults (aged 13-24 years) recruited by a web-based survey research provider. Each participant was randomly assigned to view either a short-form video consent or a written consent form describing a behavioral study of a social media–based vaping cessation program. Participants completed a postexposure survey measuring three outcomes: (1) comprehension of the consent information, (2) satisfaction with the consent process, and (3) willingness to participate in the described study. Independent sample 2-tailed t tests and chi-square tests were conducted to compare the outcomes between the 2 groups. Results: In total, 435 cases comprised the final analytic sample (video: n=215, 49.4%; written: n=220, 50.6%). There was no significant difference in characteristics between the 2 groups (all P>.05). Participants who watched the short-form video completed the consent review and postconsent survey process in less time (average 4.5 minutes) than those in the written consent group (5.1 minutes). A total of 83.2% (179/215) of the participants in the video consent condition reported satisfaction with the overall consent process compared with 76.3% (168/220) in the written consent condition (P=.047). There was no difference in the ability to complete consent unassisted and satisfaction with the amount of time between study conditions. There was no difference in the composite measure of overall comprehension, although in individual measures, participants who watched the short-form video consent performed better in 4 measures of comprehension about risk, privacy, and procedures, while participants who read the written document consent had better comprehension of 2 measures of study procedures. There was no difference between the groups in willingness to participate in the described study. Conclusions: Short-form informed consent videos had similar comprehension and satisfaction with the consent procedure among adolescents and young adults. Short-form informed consent videos may be a feasible and acceptable alternative to the standard written consent process, although video and written consent forms have different strengths with respect to comprehension. Because they match how young people consume media, short-form videos may be particularly well suited for adolescents and young adults participating in research. %M 39576682 %R 10.2196/57747 %U https://formative.jmir.org/2024/1/e57747 %U https://doi.org/10.2196/57747 %U http://www.ncbi.nlm.nih.gov/pubmed/39576682 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59439 %T Mitigating Cognitive Biases in Clinical Decision-Making Through Multi-Agent Conversations Using Large Language Models: Simulation Study %A Ke,Yuhe %A Yang,Rui %A Lie,Sui An %A Lim,Taylor Xin Yi %A Ning,Yilin %A Li,Irene %A Abdullah,Hairil Rizal %A Ting,Daniel Shu Wei %A Liu,Nan %+ Centre for Quantitative Medicine, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore, 65 66016503, liu.nan@duke-nus.edu.sg %K clinical decision-making %K cognitive bias %K generative artificial intelligence %K large language model %K multi-agent %D 2024 %7 19.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive biases in clinical decision-making significantly contribute to errors in diagnosis and suboptimal patient outcomes. Addressing these biases presents a formidable challenge in the medical field. Objective: This study aimed to explore the role of large language models (LLMs) in mitigating these biases through the use of the multi-agent framework. We simulate the clinical decision-making processes through multi-agent conversation and evaluate its efficacy in improving diagnostic accuracy compared with humans. Methods: A total of 16 published and unpublished case reports where cognitive biases have resulted in misdiagnoses were identified from the literature. In the multi-agent framework, we leveraged GPT-4 (OpenAI) to facilitate interactions among different simulated agents to replicate clinical team dynamics. Each agent was assigned a distinct role: (1) making the final diagnosis after considering the discussions, (2) acting as a devil’s advocate to correct confirmation and anchoring biases, (3) serving as a field expert in the required medical subspecialty, (4) facilitating discussions to mitigate premature closure bias, and (5) recording and summarizing findings. We tested varying combinations of these agents within the framework to determine which configuration yielded the highest rate of correct final diagnoses. Each scenario was repeated 5 times for consistency. The accuracy of the initial diagnoses and the final differential diagnoses were evaluated, and comparisons with human-generated answers were made using the Fisher exact test. Results: A total of 240 responses were evaluated (3 different multi-agent frameworks). The initial diagnosis had an accuracy of 0% (0/80). However, following multi-agent discussions, the accuracy for the top 2 differential diagnoses increased to 76% (61/80) for the best-performing multi-agent framework (Framework 4-C). This was significantly higher compared with the accuracy achieved by human evaluators (odds ratio 3.49; P=.002). Conclusions: The multi-agent framework demonstrated an ability to re-evaluate and correct misconceptions, even in scenarios with misleading initial investigations. In addition, the LLM-driven, multi-agent conversation framework shows promise in enhancing diagnostic accuracy in diagnostically challenging medical scenarios. %M 39561363 %R 10.2196/59439 %U https://www.jmir.org/2024/1/e59439 %U https://doi.org/10.2196/59439 %U http://www.ncbi.nlm.nih.gov/pubmed/39561363 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e65199 %T Measuring Technology-Facilitated Sexual Violence and Abuse in the Chinese Context: Development Study and Content Validity Analysis %A Pak,Sharon Hoi Lam %A Wu,Chanchan %A Choi,Kitty Wai Ying %A Choi,Edmond Pui Hang %+ School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 5/F, Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 39176972, h0714919@connect.hku.hk %K technology-facilitated sexual violence and abuse %K TFSVA %K image-based sexual abuse %K sexual abuse %K content validity %K measurement %K questionnaire %K China %D 2024 %7 19.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Technology-facilitated sexual violence and abuse (TFSVA) encompasses a range of behaviors where digital technologies are used to enable both virtual and in-person sexual violence. Given that TFSVA is an emerging and continually evolving form of sexual abuse, it has been challenging to establish a universally accepted definition or to develop standardized measures for its assessment. Objective: This study aimed to address the significant gap in research on TFSVA within the Chinese context. Specifically, it sought to develop a TFSVA measurement tool with robust content validity, tailored for use in subsequent epidemiological studies within the Chinese context. Methods: The first step in developing the measurement approach for TFSVA victimization and perpetration was to conduct a thorough literature review of existing empirical research on TFSVA and relevant measurement tools. After the initial generation of items, all the items were reviewed by an expert panel to assess the face validity. The measurement items were further reviewed by potential research participants, who were recruited through snowball sampling via online platforms. The assessment results were quantified by computing the content validity index (CVI). The participants were asked to rate each scale item in terms of its relevance, appropriateness, and clarity regarding the topic. Results: The questionnaire was reviewed by 24 lay experts, with a mean age of 27.96 years. They represented different genders and sexual orientations. The final questionnaire contained a total of 89 items. Three key domains were identified to construct the questionnaire, which included image-based sexual abuse, nonimage-based TFSVA, and online-initiated physical sexual violence. The overall scale CVI values of relevance, appropriateness, and clarity for the scale were 0.90, 0.96, and 0.97, respectively, which indicated high content validity for all the instrument items. To ensure the measurement accurately reflects the experiences of diverse demographic groups, the content validity was further analyzed by gender and sexual orientation. This analysis revealed variations in item validity among participants from different genders and sexual orientations. For instance, heterosexual male respondents showed a particularly low CVI for relevance of 0.20 in the items related to nudity, including “male’s chest/nipples are visible” and “the person is sexually suggestive.” This underscored the importance of an inclusive approach when developing a measurement for TFSVA. Conclusions: This study greatly advances the assessment of TFSVA by examining the content validity of our newly developed measurement. The findings revealed that our measurement tool demonstrated adequate content validity, thereby providing a strong foundation for assessing TFSVA within the Chinese context. Implementing this tool is anticipated to enhance our understanding of TFSVA and aid in the development of effective interventions to combat this form of abuse. %M 39561365 %R 10.2196/65199 %U https://formative.jmir.org/2024/1/e65199 %U https://doi.org/10.2196/65199 %U http://www.ncbi.nlm.nih.gov/pubmed/39561365 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e60692 %T Cocreating First Steps, a Toolkit to Improve Adolescent Sexual and Reproductive Health Services: Qualitative Human-Centered Design Study With Hispanic and Black Adolescent Mothers in New York City %A Gerchow,Lauren %A Lanier,Yzette %A Fayard,Anne-Laure %A Squires,Allison %+ Rory Meyers College of Nursing, New York University, 433 1st Ave, 6th Floor, New York, NY, 10010, United States, 1 212 998 5300, lmg490@nyu.edu %K adolescent %K reproductive health %K sexual health %K cocreation %K co-design %K human-centered design %D 2024 %7 19.11.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Adolescent voices are frequently excluded from sexual and reproductive health (SRH) research. Despite progressive policies and access to SRH care, adolescents in New York City who live in neighborhoods with high poverty and those who identify as Black or Hispanic experience poor SRH outcomes, including high rates of unplanned pregnancies and sexually transmitted infections. Objective: This qualitative study aims to guide Black and Hispanic adolescent mothers in identifying problem areas in SRH care and cocreate health service recommendations with input from health care stakeholders to address those problems and improve SRH experiences. Methods: Through ethnographic interview methods, adolescent mothers in New York City shared their experiences from before pregnancy through parenting and identified problem areas in adolescent SRH services and education. Data were analyzed inductively and using situational analysis. Adolescent participants attended 2 cocreation workshops. In the first workshop, they confirmed interview findings, set priorities, and created rough prototypes. Following the first workshop, health care providers were interviewed to inform refinement of the rough prototypes. Adolescents further developed prototypes in the second cocreation workshop and named the resulting toolkit. Results: A total of 16 adolescent mothers participated in 47 interviews, and 10 (63%) participants attended at least 1 cocreation workshop. They highlighted deficiencies in sexual health education and emphasized the roles of health care providers and parents, rather than schools, in improving it. Adolescent participants designed recommendations for adolescents and health care providers to support quality conversations between adolescents, parents, and health care providers and created a preappointment checklist to help young patients initiate conversations with health care providers. Young participants stressed that sex education should address topics beyond sexually transmitted infections and pregnancy, such as emotional health and relationships. They created guidelines for health care providers outlining communication strategies to provide respectful, unbiased care and contraceptive counseling that encourages adolescent autonomy. Participants shared specific suggestions for how to support young parents respectfully. Health care stakeholders recommended adding information on confidential care; supporting lesbian, gay, bisexual, transgender, and queer youth; and focusing on improving communication between health care providers and patients rather than creating educational materials. In the second workshop, adolescent participants revised the prototypes based on feedback from health care stakeholders and named the toolkit of recommendations First Steps. Conclusions: This study highlighted the important roles that parents and health care workers play in adolescent sexual health education. Cocreated toolkits offer a practical approach for health care providers to engage adolescents and their parents in meaningful, adolescent-centered conversations that can promote health, safety, and well-being. %M 39560978 %R 10.2196/60692 %U https://pediatrics.jmir.org/2024/1/e60692 %U https://doi.org/10.2196/60692 %U http://www.ncbi.nlm.nih.gov/pubmed/39560978 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58537 %T Exploring the Qualitative Experiences of Administering and Participating in Remote Research via Telephone Using the Montreal Cognitive Assessment-Blind: Cross-Sectional Study of Older Adults %A Dumassais,Shirley %A Grewal,Karl Singh %A Aubin,Gabrielle %A O'Connell,Megan %A Phillips,Natalie A %A Wittich,Walter %+ École d'Optométrie, Université de Montréal, 3744 Jean Brillant Street, Montréal, QC, H3T 1P1, Canada, 1 514 343 6471, shirley.dumassais@umontreal.ca %K neuropsychological tests %K telemedicine %K social inclusion %K telehealth %K remote %K qualitative %K neuropsychological %K cognitive %K screening %K assessment %K perception %K perspective %K telephone %K cross-sectional %K thematic %K mobile phone %K Montreal Cognitive Assessment %K MoCA %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic caused a drastic shift in the practice of research and clinical services. It has been noted that cognition measured via in-person versus remote methods differ substantially, and it is possible that subjective and experiential differences exist between modalities. Objective: The aim of the study is to explore the perceptions of both researchers and older adult participants on the experience of remotely conducted research using a cognitive screener. Methods: We conducted a thematic analysis of the experience of engaging in remote research from both the participant (n=10) and researcher (n=4) perspectives. The research interaction was framed through teleadministration of the Montreal Cognitive Assessment-Blind (suitable for telephone administration) and administration of a subsequent semistructured debriefing interview. Participant perspectives were garnered during debriefing interviews, while researcher insights were collected via self-reported qualitative field notes completed following each research session. Results: Data aggregated into themes of barriers and facilitators from the lenses of both participants and researchers. Participants noted facilitators including short instrument length, convenience, and presession contact; barriers included the length of the interaction, some tasks being more challenging on the phone, and the potential for participant dishonesty. Research assistants noted several facilitators: instrument length, rapport building, ability to prepare for and record sessions, and comfort with the protocol; barriers were items with too many response options, telephone issues (eg, response delays), and concerns about participant comprehension. Conclusions: These results suggest remote telephone-delivered cognitive screening tools as a feasible and acceptable method of research inquiry. The findings provide a starting point for the inclusion of diverse populations in research to capture underrepresented groups whose input would immensely benefit our understanding of remotely delivered cognitive screening measures. Further, we offer materials (eg, checklists), which can be used in future investigations to promote future inclusive research and increase generalizability. %M 39546346 %R 10.2196/58537 %U https://formative.jmir.org/2024/1/e58537 %U https://doi.org/10.2196/58537 %U http://www.ncbi.nlm.nih.gov/pubmed/39546346 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56158 %T Barriers and Facilitators Associated With Remote Concussion Physical Assessments From the Perspectives of Clinicians and People Living With Workplace Concussions: Focus Group Study %A Barnes,Keely %A Sveistrup,Heidi %A Karimijashni,Motahareh %A Bayley,Mark %A Egan,Mary %A Bilodeau,Martin %A Rathbone,Michel %A Taljaard,Monica %A Marshall,Shawn %+ School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 200 Lees Ave., Ottawa, ON, K1N 6N5, Canada, 1 6136126127, kbarn076@uottawa.ca %K remote care %K mild traumatic brain injury %K telehealth %K assessment %K workplace injury %K concussion %K telemedicine %K brain injury %D 2024 %7 13.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Evaluating the clinical status of concussions using virtual platforms has become increasingly common. While virtual approaches to care are useful, there is limited information regarding the barriers and facilitators associated with a virtual concussion assessment. Objective: This study aims to identify the barriers and facilitators associated with engaging in virtual concussion assessments from the perspective of people living with workplace concussions; identify the barriers and facilitators to completing virtual concussion assessments from the perspectives of clinicians; and identify the clinical measures related to 4 clinical domains that would be most appropriate in virtual practice: general neurological examination and vestibular, oculomotor, and cervical spine assessment. We also evaluated effort. Methods: Separate online focus groups were conducted with expert concussion clinicians and people living with workplace concussions. A moderator led the focus groups using a semistructured interview guide that targeted a discussion of participants’ experiences with virtual assessments. The discussions were recorded, transcribed, and analyzed by 2 reviewers using content analysis. Barriers and facilitators associated with completing the physical concussion examination were categorized based on the domain of the concussion examination and more general barriers and facilitators. Clinician-selected measures believed to work best in a virtual practice were described using frequency counts. Results: A total of 4 focus groups with 15 people living with workplace concussions and 3 focus groups with 14 clinicians were completed using Microsoft Teams. Barriers were identified, such as triggering of symptoms associated with completing an assessment over video (mentioned 13/162 (8%) and 9/201 (4%) of the time for patient and clinician participants, respectively); challenges with location and setup (mentioned 16/162 (10%) of the time for patient participants); communication (mentioned 34/162 (21%) and 9/201 (4%) of the time for patient and clinician participants, respectively); and safety concerns (mentioned 11/162 (7%) of the time for patient and 15/201 (7%) for clinician participants). Facilitators were identified, such as having access to support (mentioned 42/154 (27%) and 21/151 (14%) of the time for patient and clinician participants, respectively); implementing symptom management strategies throughout the assessment (mentioned 11/154 (7%) of the time for patient participants); and having access to resources (mentioned 25/151 (17%) of the time for clinician participants). From the perspective of the clinician participants included in this study, the clinical measures recommended most for a virtual practice were finger to nose testing; balance testing; the Vestibular/Ocular Motor Screening tool; saccades; and cervical spine range of motion within their respective domains (ie, neurological examination, vestibular, oculomotor, and cervical spine assessment). Conclusions: Virtual assessments appear to be useful for both people living with workplace concussions and clinicians. While barriers were identified, such as challenges associated with exposure to screens, virtual assessments have benefits such as improved access to care. The clinician-selected measures that were considered best in a virtual practice will be investigated in an upcoming evaluative study. International Registered Report Identifier (IRRID): RR2-10.2196/40446 %M 39536308 %R 10.2196/56158 %U https://www.jmir.org/2024/1/e56158 %U https://doi.org/10.2196/56158 %U http://www.ncbi.nlm.nih.gov/pubmed/39536308 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e59293 %T Developing and Validating the Health Literacy Scale for Migrant Workers: Instrument Development and Validation Study %A Kang,Soo Jin %A Oh,Hye-Kyung %A Han,Hae-Ra %K transients and migrants %K psychometrics %K scale development %K health literacy %K validation study %K Rasch model %D 2024 %7 13.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Research concerning health literacy among migrant workers in South Korea has been limited, especially given the lack of validated instruments and the lack of focus on the cultural diversity of migrant workers. Objective: This study aimed to develop and validate a health literacy scale for unskilled migrant workers (HLS-MW) in South Korea. Methods: We first generated a pool of potential items based on a literature review and in-depth interviews with 23 migrant workers. Subsequently, we reviewed empirical referents from the first step to select relevant medical terminologies and passages, ultimately choosing 709 words. The study team initially generated 35 items with 709 health-related terms through empirical referent reviews. After content validity testing by an expert panel, 28 items comprising 89 terms on the 2 subscales of prose and documents were selected for psychometric testing. Overall, 402 unskilled migrant workers in South Korea completed a web-based survey between August and September 2021, with 334 responses included in the final analysis. We used multiple analytic approaches, including exploratory factor analysis, Rasch analysis (item response theory), and descriptive analysis, to examine the new scale’s validity and reliability. Results: The final sample primarily included young male workers from South Asian countries. The HLS-MW yielded 2 factors: prose and documents. The item difficulty scores ranged from −1.36 to 2.56. The scale was reduced to 13 items (10 prose and 3 document items), with the final version exhibiting good internal reliability (Kuder-Richardson index=0.88; intraclass correlation coefficient=0.94, 95% CI 0.93‐0.95) and test-retest reliability (r=0.74, 95% CI 0.57‐0.92). HLS-MW scores differed significantly by Korean language proficiency (F2,331=3.54, P=.004). Conclusions: The HLS-MW is a reliable and valid measure to assess health literacy among migrant workers in South Korea. Further studies are needed to test the psychometric properties of the HLS-MW in diverse migrant groups in South Korea while also establishing cutoffs to help identify those in need of health literacy support. %R 10.2196/59293 %U https://publichealth.jmir.org/2024/1/e59293 %U https://doi.org/10.2196/59293 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 12 %N %P e60655 %T Completion Rate and Satisfaction With Online Computer-Assisted History Taking Questionnaires in Orthopedics: Multicenter Implementation Report %A Craamer,Casper %A Timmers,Thomas %A Siebelt,Michiel %A Kool,Rudolf Bertijn %A Diekerhof,Carel %A Caron,Jan Jacob %A Gosens,Taco %A van der Weegen,Walter %K computer-assisted history taking %K history taking %K digital medical interview %K orthopedics %K digital health %K computer-assisted %K cohort study %K orthopedic %K outpatient %K satisfaction %K patient engagement %K medical record %D 2024 %7 13.11.2024 %9 %J JMIR Med Inform %G English %X Background: Collecting the medical history during a first outpatient consultation plays an important role in making a diagnosis. However, it is a time-consuming process, and time is scarce in today’s health care environment. The computer-assisted history taking (CAHT) systems allow patients to share their medical history electronically before their visit. Although multiple advantages of CAHT have been demonstrated, adoption in everyday medical practice remains low, which has been attributed to various barriers. Objective: This study aimed to implement a CAHT questionnaire for orthopedic patients in preparation for their first outpatient consultation and analyze its completion rate and added value. Methods: A multicenter implementation study was conducted in which all patients who were referred to the orthopedic department were invited to self-complete the CAHT questionnaire. The primary outcome of the study is the completion rate of the questionnaire. Secondary outcomes included patient and physician satisfaction. These were assessed via surveys and semistructured interviews. Implementation (Results): In total, 5321 patients were invited, and 4932 (92.7%) fully completed the CAHT questionnaire between April 2022 and July 2022. On average, participants (n=224) rated the easiness of completing the questionnaire at 8.0 (SD 1.9; 0‐10 scale) and the satisfaction of the consult at 8.0 (SD 1.7; 0‐10 scale). Satisfaction with the outpatient consultation was higher in cases where the given answers were used by the orthopedic surgeon during this consultation (median 8.3, IQR 8.0‐9.1 vs median 8.0, IQR 7.0‐8.5; P<.001). Physicians (n=15) scored the average added value as 7.8 (SD 1.7; 0‐10 scale) and unanimously recognized increased efficiency, better patient engagement, and better medical record completeness. Implementing the patient’s answers into the electronic health record was deemed necessary. Conclusions: In this study, we have shown that previously recognized barriers to implementing and adapting CAHT can now be effectively overcome. We demonstrated that almost all patients completed the CAHT questionnaire. This results in reported improvements in both the efficiency and personalization of outpatient consultations. Given the pressing need for personalized health care delivery in today’s time-constrained medical environment, we recommend implementing CAHT systems in routine medical practice. %R 10.2196/60655 %U https://medinform.jmir.org/2024/1/e60655 %U https://doi.org/10.2196/60655 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54335 %T Early Identification of Cognitive Impairment in Community Environments Through Modeling Subtle Inconsistencies in Questionnaire Responses: Machine Learning Model Development and Validation %A Gao,Hongxin %A Schneider,Stefan %A Hernandez,Raymond %A Harris,Jenny %A Maupin,Danny %A Junghaenel,Doerte U %A Kapteyn,Arie %A Stone,Arthur %A Zelinski,Elizabeth %A Meijer,Erik %A Lee,Pey-Jiuan %A Orriens,Bart %A Jin,Haomiao %+ School of Health Sciences, University of Surrey, Kate Granger Building, 30 Priestley Road, Guildford, GU2 7YH, United Kingdom, 44 7438534086, h.jin@surrey.ac.uk %K machine learning %K artificial intelligence %K cognitive impairments %K surveys and questionnaires %K community health services %K public health %K early identification %K elder care %K dementia %D 2024 %7 13.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The underdiagnosis of cognitive impairment hinders timely intervention of dementia. Health professionals working in the community play a critical role in the early detection of cognitive impairment, yet still face several challenges such as a lack of suitable tools, necessary training, and potential stigmatization. Objective: This study explored a novel application integrating psychometric methods with data science techniques to model subtle inconsistencies in questionnaire response data for early identification of cognitive impairment in community environments. Methods: This study analyzed questionnaire response data from participants aged 50 years and older in the Health and Retirement Study (waves 8-9, n=12,942). Predictors included low-quality response indices generated using the graded response model from four brief questionnaires (optimism, hopelessness, purpose in life, and life satisfaction) assessing aspects of overall well-being, a focus of health professionals in communities. The primary and supplemental predicted outcomes were current cognitive impairment derived from a validated criterion and dementia or mortality in the next ten years. Seven predictive models were trained, and the performance of these models was evaluated and compared. Results: The multilayer perceptron exhibited the best performance in predicting current cognitive impairment. In the selected four questionnaires, the area under curve values for identifying current cognitive impairment ranged from 0.63 to 0.66 and was improved to 0.71 to 0.74 when combining the low-quality response indices with age and gender for prediction. We set the threshold for assessing cognitive impairment risk in the tool based on the ratio of underdiagnosis costs to overdiagnosis costs, and a ratio of 4 was used as the default choice. Furthermore, the tool outperformed the efficiency of age or health-based screening strategies for identifying individuals at high risk for cognitive impairment, particularly in the 50- to 59-year and 60- to 69-year age groups. The tool is available on a portal website for the public to access freely. Conclusions: We developed a novel prediction tool that integrates psychometric methods with data science to facilitate “passive or backend” cognitive impairment assessments in community settings, aiming to promote early cognitive impairment detection. This tool simplifies the cognitive impairment assessment process, making it more adaptable and reducing burdens. Our approach also presents a new perspective for using questionnaire data: leveraging, rather than dismissing, low-quality data. %M 39536306 %R 10.2196/54335 %U https://formative.jmir.org/2024/1/e54335 %U https://doi.org/10.2196/54335 %U http://www.ncbi.nlm.nih.gov/pubmed/39536306 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52788 %T Acceptance and Use of eHealth in Support and Psychological Therapy for People With Intellectual Disabilities: Two Cross-Sectional Studies of Health Care Professionals %A Oudshoorn,Cathelijn %A Frielink,Noud %A Riper,Heleen %A Embregts,Petri %+ Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan 125, 5037 DB, Tilburg, Netherlands, 31 0134662969, c.e.m.oudshoorn@tilburguniversity.edu %K acceptance %K health care professionals %K intellectual disabilities %K eHealth %K disability %K psychological therapy %K support %K cross-sectional survey %D 2024 %7 12.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Acceptance of health care professionals is of paramount importance for the uptake and implementation of eHealth. The Unified Theory of Acceptance and Use of Technology (UTAUT) model is a widely used framework for studying health care professionals’ acceptance and actual use of eHealth among general client populations. However, there is limited understanding of the eHealth acceptance of health care professionals working with people with intellectual disabilities (ID). Objective: This study aimed to explore the applicability of the UTAUT model toward understanding the acceptance, intention to use, and actual use of eHealth among support staff and therapists working with people with ID. Methods: A total of 2 cross-sectional survey studies were conducted among health care professionals from 5 health care organizations for people with ID in the Netherlands in 2018 (n=311) and in 2021 during the COVID-19 pandemic (n=326). In addition to confirmatory and exploratory factor analyses to evaluate both the original UTAUT model and an extended version, descriptive analysis was used to explore participants’ characteristics, acceptance levels, and eHealth usage. Moderator analysis and multiple regression analysis were also used. Results: A confirmatory factor analysis indicated a poor fit for both the original 4-factor UTAUT model and the extended version. An exploratory factor analysis was then conducted, resulting in a more satisfactory 5-factor model after removing 1 item with a factor loading <.40. Internal consistency of the 5 factors ranged from acceptable to good (Cronbach α=.76-.85). Collectively, all factors predicted the intention to use eHealth in 2018 (R2=0.47; F5,305=54.885; P<.001) and in 2021 (R2=0.43; F5,320=49.32; P<.001). Participants scored moderately on all 5 acceptance factors in both 2018 and 2021. Moderator analysis indicated that age and voluntariness influence the relationship between factors that determined acceptance and intention to use eHealth. Conclusions: The findings from 2 cross-sectional studies conducted in 2018 and 2021, using an extended UTAUT model, gave a deeper understanding of eHealth acceptance among health care professionals who work with people with ID. %M 39531275 %R 10.2196/52788 %U https://formative.jmir.org/2024/1/e52788 %U https://doi.org/10.2196/52788 %U http://www.ncbi.nlm.nih.gov/pubmed/39531275 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 16 %N %P e54841 %T Assessing the Quality of an Online Democratic Deliberation on COVID-19 Pandemic Triage Protocols for Access to Critical Care in an Extreme Pandemic Context: Mixed Methods Study %A Calderon Ramirez,Claudia Lucrecia %A Farmer,Yanick %A Downar,James %A Frolic,Andrea %A Opatrny,Lucie %A Poirier,Diane %A Bravo,Gina %A L'Espérance,Audrey %A Gaucher,Nathalie %A Payot,Antoine %A Dahine,Joseph %A Tanuseputro,Peter %A Rousseau,Louis-Martin %A Dumez,Vincent %A Descôteaux,Annie %A Dallaire,Clara %A Laporte,Karell %A Bouthillier,Marie-Eve %+ Université de Montréal, 2900 Bd Édouard-Montpetit, Montréal, QC, H3T 1J4, Canada, 1 (450) 668 1010 ext 24228, marie-eve.bouthillier@umontreal.ca %K quality assessment %K online democratic deliberation %K COVID-19 triage or prioritization %K critical care %K clinical ethics %D 2024 %7 11.11.2024 %9 Original Paper %J J Particip Med %G English %X Background: Online democratic deliberation (ODD) may foster public engagement in new health strategies by providing opportunities for knowledge exchange between experts, policy makers, and the public. It can favor decision-making by generating new points of view and solutions to existing problems. Deliberation experts recommend gathering feedback from participants to optimize future implementation. However, this online modality has not been frequently evaluated. Objective: This study aims to (1) assess the quality of an ODD held in Quebec and Ontario, Canada, on the topic of COVID-19 triage protocols for access to critical care in an extreme pandemic context and (2) determine its transformative aspect according to the perceptions of participants. Methods: We conducted a simultaneous ODD in Quebec and Ontario on May 28 and June 4, 2022, with a diversified target audience not working in the health care system. We used a thematic analysis for the transcripts of the deliberation and the written comments of the participants related to the quality of the process. Participants responded to a postdeliberation questionnaire to assess the quality of the ODD and identify changes in their perspectives on COVID-19 pandemic triage protocols after the deliberation exercise. Descriptive statistics were used. An index was calculated to determine equality of participation. Results: The ODD involved 47 diverse participants from the public (n=20, 43% from Quebec and n=27, 57% from Ontario). Five themes emerged: (1) process appreciation, (2) learning experience, (3) reflecting on the common good, (4) technological aspects, and (5) transformative aspects. A total of 46 participants responded to the questionnaire. Participants considered the quality of the ODD satisfactory in terms of process, information shared, reasoning, and videoconferencing. A total of 4 (80%) of 5 participants reported at least 1 change of perspective on some of the criteria and values discussed. Most participants reported that the online modality was accessible and user-friendly. We found low polarization when calculating equal participation. Improvements identified were measures to replace participants when unable to connect and optimization of time during discussions. Conclusions: Overall, the participants perceived the quality of ODD as satisfactory. Some participants self-reported a change of opinion after deliberation. The online modality may be an acceptable alternative for democratic deliberation but with some organizational adaptations. %M 39527811 %R 10.2196/54841 %U https://jopm.jmir.org/2024/1/e54841 %U https://doi.org/10.2196/54841 %U http://www.ncbi.nlm.nih.gov/pubmed/39527811 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e58771 %T Dropout in a Longitudinal Survey of Amazon Mechanical Turk Workers With Low Back Pain: Observational Study %A Qureshi,Nabeel %A Hays,Ron D %A Herman,Patricia M %+ RAND Health Care, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, United States, 1 3103930411 ext 6054, nqureshi@rand.org %K chronic low back pain %K Mechanical Turk %K MTurk %K survey attrition %K survey weights %K Amazon %K occupational health %K manual labor %D 2024 %7 11.11.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Surveys of internet panels such as Amazon’s Mechanical Turk (MTurk) are common in health research. Nonresponse in longitudinal studies can limit inferences about change over time. Objective: This study aimed to (1) describe the patterns of survey responses and nonresponse among MTurk members with back pain, (2) identify factors associated with survey response over time, (3) assess the impact of nonresponse on sample characteristics, and (4) assess how well inverse probability weighting can account for differences in sample composition. Methods: We surveyed adult MTurk workers who identified as having back pain. We report participation trends over 3 survey waves and use stepwise logistic regression to identify factors related to survey participation in successive waves. Results: A total of 1678 adults participated in wave 1. Of those, 983 (59%) participated in wave 2 and 703 (42%) in wave 3. Participants who did not drop out took less time to complete previous surveys (30 min vs 35 min in wave 1, P<.001; 24 min vs 26 min in wave 2, P=.02) and reported having fewer health conditions (5.88 vs 6.6, P<.001). In multivariate models predicting responding at wave 2, lower odds of participation were associated with more time to complete the baseline survey (odds ratio [OR] 0.98, 95% CI 0.97-0.99), being Hispanic (compared with non-Hispanic, OR 0.69, 95% CI 0.49-0.96), having a bachelor’s degree as their terminal degree (compared with all other levels of education, OR 0.58, 95% CI 0.46-0.73), having more pain interference and intensity (OR 0.75, 95% CI 0.64-0.89), and having more health conditions. In contrast, older respondents (older than 45 years age compared with 18-24 years age) were more likely to respond to the wave 2 survey (OR 2.63 and 3.79, respectively) and those whose marital status was divorced (OR 1.81) and separated (OR 1.77) were also more likely to respond to the wave 2 survey. Weighted analysis showed slight differences in sample demographics and conditions and larger differences in pain assessments, particularly for those who responded to wave 2. Conclusions: Longitudinal studies on MTurk have large, differential dropouts between waves. This study provided information about the individuals more likely to drop out over time, which can help researchers prepare for future surveys. %M 39527103 %R 10.2196/58771 %U https://www.i-jmr.org/2024/1/e58771 %U https://doi.org/10.2196/58771 %U http://www.ncbi.nlm.nih.gov/pubmed/39527103 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60673 %T Sensor-Derived Measures of Motor and Cognitive Functions in People With Multiple Sclerosis Using Unsupervised Smartphone-Based Assessments: Proof-of-Concept Study %A Scaramozza,Matthew %A Ruet,Aurélie %A Chiesa,Patrizia A %A Ahamada,Laïtissia %A Bartholomé,Emmanuel %A Carment,Loïc %A Charre-Morin,Julie %A Cosne,Gautier %A Diouf,Léa %A Guo,Christine C %A Juraver,Adrien %A Kanzler,Christoph M %A Karatsidis,Angelos %A Mazzà,Claudia %A Penalver-Andres,Joaquin %A Ruiz,Marta %A Saubusse,Aurore %A Simoneau,Gabrielle %A Scotland,Alf %A Sun,Zhaonan %A Tang,Minao %A van Beek,Johan %A Zajac,Lauren %A Belachew,Shibeshih %A Brochet,Bruno %A Campbell,Nolan %+ Biogen, 225 Binney St, Cambridge, MA, 02142, United States, 1 781 464 2000, matt.scaramozza@biogen.com %K multiple sclerosis %K sensor-derived measure %K smartphone %K cognitive function %K motor function %K digital biomarkers %K mobile phone %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphones and wearables are revolutionizing the assessment of cognitive and motor function in neurological disorders, allowing for objective, frequent, and remote data collection. However, these assessments typically provide a plethora of sensor-derived measures (SDMs), and selecting the most suitable measure for a given context of use is a challenging, often overlooked problem. Objective: This analysis aims to develop and apply an SDM selection framework, including automated data quality checks and the evaluation of statistical properties, to identify robust SDMs that describe the cognitive and motor function of people with multiple sclerosis (MS). Methods: The proposed framework was applied to data from a cross-sectional study involving 85 people with MS and 68 healthy participants who underwent in-clinic supervised and remote unsupervised smartphone-based assessments. The assessment provided high-quality recordings from cognitive, manual dexterity, and mobility tests, from which 47 SDMs, based on established literature, were extracted using previously developed and publicly available algorithms. These SDMs were first separately and then jointly screened for bias and normality by 2 expert assessors. Selected SDMs were then analyzed to establish their reliability, using an intraclass correlation coefficient and minimal detectable change at 95% CI. The convergence of selected SDMs with in-clinic MS functional measures and patient-reported outcomes was also evaluated. Results: A total of 16 (34%) of the 47 SDMs passed the selection framework. All selected SDMs demonstrated moderate-to-good reliability in remote settings (intraclass correlation coefficient 0.5-0.85; minimal detectable change at 95% CI 19%-35%). Selected SDMs extracted from the smartphone-based cognitive test demonstrated good-to-excellent correlation (Spearman correlation coefficient, |ρ|>0.75) with the in-clinic Symbol Digit Modalities Test and fair correlation with Expanded Disability Status Scale (EDSS) scores (0.25≤|ρ|<0.5). SDMs extracted from the manual dexterity tests showed either fair correlation (0.25≤|ρ|<0.5) or were not correlated (|ρ|<0.25) with the in-clinic 9-hole peg test and EDSS scores. Most selected SDMs from mobility tests showed fair correlation with the in-clinic timed 25-foot walk test and fair to moderate-to-good correlation (0.5<|ρ|≤0.75) with EDSS scores. SDM correlations with relevant patient-reported outcomes varied by functional domain, ranging from not correlated (cognitive test SDMs) to good-to-excellent correlation (|ρ|>0.75) for mobility test SDMs. Overall, correlations were similar when smartphone-based tests were performed in a clinic or remotely. Conclusions: Reported results highlight that smartphone-based assessments are suitable tools to remotely obtain high-quality SDMs of cognitive and motor function in people with MS. The presented SDM selection framework promises to increase the interpretability and standardization of smartphone-based SDMs in people with MS, paving the way for their future use in interventional trials. %M 39515815 %R 10.2196/60673 %U https://formative.jmir.org/2024/1/e60673 %U https://doi.org/10.2196/60673 %U http://www.ncbi.nlm.nih.gov/pubmed/39515815 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58466 %T Identifying and Estimating Frailty Phenotypes by Vocal Biomarkers: Cross-Sectional Study %A Lin,Yu-Chun %A Yan,Huang-Ting %A Lin,Chih-Hsueh %A Chang,Hen-Hong %+ Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, No 91, Hsueh-Shih Road, North District, Taichung, 40402, Taiwan, 886 22053366 ext 3609, tcmchh55@gmail.com %K frailty phenotypes %K older adults %K successful aging %K vocal biomarkers %K frailty %K phenotype %K vocal biomarker %K cross-sectional %K gerontology %K geriatrics %K older adult %K Taiwan %K energy-based %K hybrid-based %K sarcopenia %D 2024 %7 8.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Researchers have developed a variety of indices to assess frailty. Recent research indicates that the human voice reflects frailty status. Frailty phenotypes are seldom discussed in the literature on the aging voice. Objective: This study aims to examine potential phenotypes of frail older adults and determine their correlation with vocal biomarkers. Methods: Participants aged ≥60 years who visited the geriatric outpatient clinic of a teaching hospital in central Taiwan between 2020 and 2021 were recruited. We identified 4 frailty phenotypes: energy-based frailty, sarcopenia-based frailty, hybrid-based frailty–energy, and hybrid-based frailty–sarcopenia. Participants were asked to pronounce a sustained vowel “/a/” for approximately 1 second. The speech signals were digitized and analyzed. Four voice parameters—the average number of zero crossings (A1), variations in local peaks and valleys (A2), variations in first and second formant frequencies (A3), and spectral energy ratio (A4)—were used for analyzing changes in voice. Logistic regression was used to elucidate the prediction model. Results: Among 277 older adults, an increase in A1 values was associated with a lower likelihood of energy-based frailty (odds ratio [OR] 0.81, 95% CI 0.68-0.96), whereas an increase in A2 values resulted in a higher likelihood of sarcopenia-based frailty (OR 1.34, 95% CI 1.18-1.52). Respondents with larger A3 and A4 values had a higher likelihood of hybrid-based frailty–sarcopenia (OR 1.03, 95% CI 1.002-1.06) and hybrid-based frailty–energy (OR 1.43, 95% CI 1.02-2.01), respectively. Conclusions: Vocal biomarkers might be potentially useful in estimating frailty phenotypes. Clinicians can use 2 crucial acoustic parameters, namely A1 and A2, to diagnose a frailty phenotype that is associated with insufficient energy or reduced muscle function. The assessment of A3 and A4 involves a complex frailty phenotype. %M 39515817 %R 10.2196/58466 %U https://www.jmir.org/2024/1/e58466 %U https://doi.org/10.2196/58466 %U http://www.ncbi.nlm.nih.gov/pubmed/39515817 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e57510 %T Uncovering the Daily Experiences of People Living With Advanced Cancer Using an Experience Sampling Method Questionnaire: Development, Content Validation, and Optimization Study %A Geeraerts,Joran %A Pivodic,Lara %A Rosquin,Lise %A Naert,Eline %A Crombez,Geert %A De Ridder,Mark %A Van den Block,Lieve %+ End-of-Life Care Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, 1090, Belgium, 32 2 477 47 57, joran.geeraerts@vub.be %K cancer %K quality of life %K ecological momentary assessment %K experience sampling method %K telemedicine %K mHealth %K eHealth %K patient outcome assessment %K validated instruments %D 2024 %7 5.11.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: The experience sampling method (ESM), a self-report method that typically uses multiple assessments per day, can provide detailed knowledge of the daily experiences of people with cancer, potentially informing oncological care. The use of the ESM among people with advanced cancer is limited, and no validated ESM questionnaires have been developed specifically for oncology. Objective: This study aims to develop, content validate, and optimize the digital Experience Sampling Method for People Living With Advanced Cancer (ESM-AC) questionnaire, covering multidimensional domains and contextual factors. Methods: A 3-round mixed methods study was designed in accordance with the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) and the European Organization for Research and Treatment of Cancer guidelines. The study included semistructured interviews with 43 people with stage IV breast cancer or stage III to IV lung cancer and 8 health care professionals. Round 1 assessed the appropriateness, relative importance, relevance, and comprehensiveness of an initial set of ESM items that were developed based on the existing questionnaires. Round 2 tested the comprehensibility of ESM items. Round 3 tested the usability of the digital ESM-AC questionnaire using the m-Path app. Analyses included descriptive statistics and qualitative content analysis. Results: Following the first round, we developed an initial core set of 68 items (to be used with all patients) and a supplementary set (optional; patients select items), both covering physical, psychological, social, spiritual-existential, and global well-being domains and concurrent contexts in which experiences occur. We categorized items to be assessed multiple times per day as momentary items (eg, “At this moment, I feel tired”), once a day in the morning as morning items (eg, “Last night, I slept well”), or once a day in the evening as evening items (eg, “Today, I felt hopeful”). We used participants’ evaluations to optimize the questionnaire items, the digital app, and its onboarding manual. This resulted in the ESM-AC questionnaire, which comprised a digital core questionnaire containing 31 momentary items, 2 morning items, and 7 evening items and a supplementary set containing 39 items. Participants largely rated the digital questionnaire as “easy to use,” with an average score of 4.5 (SD 0.5) on a scale from 1 (“completely disagree”) to 5 (“completely agree”). Conclusions: We developed the ESM-AC questionnaire, a content-validated digital questionnaire for people with advanced breast or lung cancer. It showed good usability when administered on smartphone devices. Future research should evaluate the potential of this ESM tool to uncover daily experiences of people with advanced breast or lung cancer, explore its clinical utility, and extend its validation to other populations with advanced diseases. %M 39499557 %R 10.2196/57510 %U https://cancer.jmir.org/2024/1/e57510 %U https://doi.org/10.2196/57510 %U http://www.ncbi.nlm.nih.gov/pubmed/39499557 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59247 %T Discriminant Power of Smartphone-Derived Keystroke Dynamics for Mild Cognitive Impairment Compared to a Neuropsychological Screening Test: Cross-Sectional Study %A Park,Jin-Hyuck %+ Department of Occupational Therapy, College of Medical Science, Soonchunhyang University, Room 1401, Medical Science, 22, Soonchunhayng-ro, Shinchang-myeon, Asan, 31538, Republic of Korea, 82 41 530 4773, roophy@naver.com %K digital biomarker %K motor function %K digital device %K neuropsychological screening %K screening tools %K cognitive assessment %K mild cognitive impairment %K keystroke dynamics %D 2024 %7 30.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Conventional neuropsychological screening tools for mild cognitive impairment (MCI) face challenges in terms of accuracy and practicality. Digital health solutions, such as unobtrusively capturing smartphone interaction data, offer a promising alternative. However, the potential of digital biomarkers as a surrogate for MCI screening remains unclear, with few comparisons between smartphone interactions and existing screening tools. Objective: This study aimed to investigate the effectiveness of smartphone-derived keystroke dynamics, captured via the Neurokeys keyboard app, in distinguishing patients with MCI from healthy controls (HCs). This study also compared the discriminant performance of these digital biomarkers against the Korean version of the Montreal Cognitive Assessment (MoCA-K), which is widely used for MCI detection in clinical settings. Methods: A total of 64 HCs and 47 patients with MCI were recruited. Over a 1-month period, participants generated 3530 typing sessions, with 2740 (77.6%) analyzed for this study. Keystroke metrics, including hold time and flight time, were extracted. Receiver operating characteristics analysis was used to assess the sensitivity and specificity of keystroke dynamics in discriminating between HCs and patients with MCI. This study also explored the correlation between keystroke dynamics and MoCA-K scores. Results: Patients with MCI had significantly higher keystroke latency than HCs (P<.001). In particular, latency between key presses resulted in the highest sensitivity (97.9%) and specificity (96.9%). In addition, keystroke dynamics were significantly correlated with the MoCA-K (hold time: r=–.468; P<.001; flight time: r=–.497; P<.001), further supporting the validity of these digital biomarkers. Conclusions: These findings highlight the potential of smartphone-derived keystroke dynamics as an effective and ecologically valid tool for screening MCI. With higher sensitivity and specificity than the MoCA-K, particularly in measuring flight time, keystroke dynamics can serve as a noninvasive, scalable, and continuous method for early cognitive impairment detection. This novel approach could revolutionize MCI screening, offering a practical alternative to traditional tools in everyday settings. Trial Registration: Thai Clinical Trials Registry TCTR20220415002; https://www.thaiclinicaltrials.org/show/TCTR20220415002 %M 39475819 %R 10.2196/59247 %U https://www.jmir.org/2024/1/e59247 %U https://doi.org/10.2196/59247 %U http://www.ncbi.nlm.nih.gov/pubmed/39475819 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56898 %T Critical Success Factors and Acceptance of the Casemix System Implementation Within the Total Hospital Information System: Exploratory Factor Analysis of a Pilot Study %A Mustafa,Noor Khairiyah %A Ibrahim,Roszita %A Aizuddin,Azimatun Noor %A Aljunid,Syed Mohamed %A Awang,Zainudin %+ Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 6th Floor, Pre-Clinical Block, Cheras, 56000, Malaysia, 60 391455887 ext 5888, roszita@ppukm.ukm.edu.my %K critical success factors %K exploratory factor analysis %K Casemix system %K acceptance %K Total Hospital Information System %D 2024 %7 29.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The health care landscape is evolving rapidly due to rising costs, an aging population, and the increasing prevalence of diseases. To address these challenges, the Ministry of Health of Malaysia implemented transformation strategies such as the Casemix system and hospital information system to enhance health care quality, resource allocation, and cost-effectiveness. However, successful implementation relies not just on the technology itself but on the acceptance and engagement of the users involved. Objective: This study aims to develop and refine items of a quantitative instrument measuring the critical success factors influencing acceptance of Casemix system implementation within the Ministry of Health’s Total Hospital Information System (THIS). Methods: A cross-sectional pilot study collected data from medical doctors at a hospital equipped with the THIS in the federal territory of Putrajaya, Malaysia. This pilot study’s minimum sample size was 125, achieved through proportionate stratified random sampling. Data were collected using a web-based questionnaire adapted from the human, organization, and technology-fit evaluation framework and the technology acceptance model. The pilot data were analyzed using exploratory factor analysis (EFA), and the Cronbach α assessed internal reliability. Both analyses were conducted in SPSS (version 25.0; IBM Corp). Results: This study obtained 106 valid responses, equivalent to an 84.8% (106/125) response rate. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.859, and the Bartlett test of sphericity yielded statistically significant results (P<.001). Principal component analysis identified 9 components explaining 84.07% of the total variance, surpassing the minimum requirement of 60%. In total, 9 unique slopes indicated the identification of 9 components through EFA. While no new components emerged from the other 7 constructs, only the organizational factors construct was divided into 2 components, later named organizational structure and organizational environment. In total, 98% (41/42) of the items had factor loadings of >0.6, leading to the removal of 1 item for the final instrument for the field study. EFA ultimately identified 8 main constructs influencing Casemix implementation within the THIS: system quality, information quality, service quality, organizational characteristics, perceived ease of use, perceived usefulness, intention to use, and acceptance. Internal reliability measured using the Cronbach α ranged from 0.914 to 0.969, demonstrating high reliability. Conclusions: This study provides insights into the complexities of EFA and the distinct dimensions underlying the constructs that influence Casemix system acceptance in the THIS. While the findings align with extensive technology acceptance literature, the results accentuate the necessity for further research to develop a consensus regarding the most critical factors for successful Casemix adoption. The developed instrument is a substantial step toward better understanding the multidimensional challenges of health care system transformations in Malaysia, postulating an underpinning for future fieldwork and broader application across other hospitals. %M 39470697 %R 10.2196/56898 %U https://formative.jmir.org/2024/1/e56898 %U https://doi.org/10.2196/56898 %U http://www.ncbi.nlm.nih.gov/pubmed/39470697 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e54839 %T Using Existing Clinical Data to Measure Older Adult Inpatients’ Frailty at Admission and Discharge: Hospital Patient Register Study %A Wernli,Boris %A Verloo,Henk %A von Gunten,Armin %A Pereira,Filipa %+ University of Applied Sciences and Arts Western Switzerland (HES-SO), 5 Chemin de l'Agasse, Sion, 1950, Switzerland, 41 0787698990, henk.verloo@hevs.ch %K frailty %K frailty assessment %K electronic patient records %K functional independence measure %K routinely collected data %K hospital register %K patient records %K medical records %K clinical data %K older adults %K cluster analysis %K hierarchical clustering %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Frailty is a widespread geriatric syndrome among older adults, including hospitalized older inpatients. Some countries use electronic frailty measurement tools to identify frailty at the primary care level, but this method has rarely been investigated during hospitalization in acute care hospitals. An electronic frailty measurement instrument based on population-based hospital electronic health records could effectively detect frailty, frailty-related problems, and complications as well be a clinical alert. Identifying frailty among older adults using existing patient health data would greatly aid the management and support of frailty identification and could provide a valuable public health instrument without additional costs. Objective: We aim to explore a data-driven frailty measurement instrument for older adult inpatients using data routinely collected at hospital admission and discharge. Methods: A retrospective electronic patient register study included inpatients aged ≥65 years admitted to and discharged from a public hospital between 2015 and 2017. A dataset of 53,690 hospitalizations was used to customize this data-driven frailty measurement instrument inspired by the Edmonton Frailty Scale developed by Rolfson et al. A 2-step hierarchical cluster procedure was applied to compute e-Frail-CH (Switzerland) scores at hospital admission and discharge. Prevalence, central tendency, comparative, and validation statistics were computed. Results: Mean patient age at admission was 78.4 (SD 7.9) years, with more women admitted (28,018/53,690, 52.18%) than men (25,672/53,690, 47.81%). Our 2-step hierarchical clustering approach computed 46,743 inputs of hospital admissions and 47,361 for discharges. Clustering solutions scored from 0.5 to 0.8 on a scale from 0 to 1. Patients considered frail comprised 42.02% (n=19,643) of admissions and 48.23% (n=22,845) of discharges. Within e-Frail-CH’s 0-12 range, a score ≥6 indicated frailty. We found a statistically significant mean e-Frail-CH score change between hospital admission (5.3, SD 2.6) and discharge (5.75, SD 2.7; P<.001). Sensitivity and specificity cut point values were 0.82 and 0.88, respectively. The area under the receiver operating characteristic curve was 0.85. Comparing the e-Frail-CH instrument to the existing Functional Independence Measure (FIM) instrument, FIM scores indicating severe dependence equated to e-Frail-CH scores of ≥9, with a sensitivity and specificity of 0.97 and 0.88, respectively. The area under the receiver operating characteristic curve was 0.92. There was a strong negative association between e-Frail-CH scores at hospital discharge and FIM scores (rs=–0.844; P<.001). Conclusions: An electronic frailty measurement instrument was constructed and validated using patient data routinely collected during hospitalization, especially at admission and discharge. The mean e-Frail-CH score was higher at discharge than at admission. The routine calculation of e-Frail-CH scores during hospitalization could provide very useful clinical alerts on the health trajectories of older adults and help select interventions for preventing or mitigating frailty. %M 39467281 %R 10.2196/54839 %U https://aging.jmir.org/2024/1/e54839 %U https://doi.org/10.2196/54839 %U http://www.ncbi.nlm.nih.gov/pubmed/39467281 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e63776 %T French Version of the User Mobile Application Rating Scale: Adaptation and Validation Study %A Saliasi,Ina %A Lan,Romain %A Rhanoui,Maryem %A Fraticelli,Laurie %A Viennot,Stéphane %A Tardivo,Delphine %A Clément,Céline %A du Sartz de Vigneulles,Benjamin %A Bernard,Sandie %A Darlington-Bernard,Adeline %A Dussart,Claude %A Bourgeois,Denis %A Carrouel,Florence %K mHealth %K mobile health %K mobile health apps %K eHealth %K Mobile Application Rating Scale, user version %K mobile apps %K quality assessment tool %K uMARS %D 2024 %7 24.10.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Managing noncommunicable diseases effectively requires continuous coordination and monitoring, often facilitated by eHealth technologies like mobile health (mHealth) apps. The end-user version of the Mobile Application Rating Scale is a valuable tool for assessing the quality of mHealth apps from the user perspective. However, the absence of a French version restricts its use in French-speaking countries, where the evaluation and regulation of mHealth apps are still lacking, despite the increasing number of apps and their strong relevance in health care. Objective: This study aims to translate and culturally adapt a French version of the user Mobile Application Rating Scale (uMARS-F) and to test its overall and internal reliability. Methods: Cross-cultural adaptation and translation followed the universalist approach. The uMARS-F was evaluated as part through a cohort study using the French mHealth app “MonSherpa” (Qare). Participants were French-speaking adults with Apple or Android phones, excluding those with difficulty understanding French, prior app use, or physical limitations. They assessed the app using the uMARS-F twice (T1 and T2) 1 week apart. Scores for each section and overall were assessed for normal distribution using the Shapiro-Wilk test and presented as mean (SD), and potential floor or ceiling effects were calculated accordingly. Overall reliability was evaluated using intraclass correlation coefficients and internal reliability using Cronbach α. Concordance between the 3 subscales (objective quality, subjective quality, and perceived impact), 4 sections, and 26 items at T1 and T2 was evaluated using the paired t test (2-tailed) and Pearson correlation. Results: In total, 167 participants assessed the app at both T1 and T2 (100% compliance). Among them, 49.7% (n=83) were female, and 50.3% (n=84) were male, with a mean age of 43 (SD 16) years. The uMARS-F intraclass correlation coefficients were excellent for objective quality (0.959), excellent for subjective quality (0.993), and moderate for perceived impact (0.624). Cronbach α was good for objective quality (0.881), acceptable for subjective quality (0.701), and excellent for perceived impact (0.936). The paired t tests (2-tailed) demonstrated similar scores between the 2 assessments (P>.05), and the Pearson correlation coefficient indicated high consistency in each subscale, section, and item (r>0.76 and P<.001). The reliability and validity of the measures were similar to those found in the original English version as well as in the Spanish, Japanese, Italian, Greek, and Turkish versions that have already been translated and validated. Conclusions: The uMARS-F is a valid tool for end users to assess the quality of mHealth apps in French-speaking countries. The uMARS-F used in combination with the French version of the Mobile Application Rating Scale could enable health care professionals and public health authorities to identify reliable, high-quality, and valid apps for patients and should be part of French health care education programs. %R 10.2196/63776 %U https://mhealth.jmir.org/2024/1/e63776 %U https://doi.org/10.2196/63776 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59950 %T Evaluating the Psychometric Properties of a Physical Activity and Sedentary Behavior Identity Scale: Survey Study With Two Independent Samples of Adults in the United States %A Wen,Cheng K Fred %A Schneider,Stefan %A Junghaenel,Doerte U %A Toledo,Meynard John L %A Lee,Pey-Jiuan %A Smyth,Joshua M %A Stone,Arthur A %+ Dornsife Center for Self-Report Science, University of Southern California, 635 Downey Way, Los Angeles, CA, 90089-3332, United States, 1 213 821 1850, chengkuw@usc.edu %K physical activity %K sedentary behavior %K geriatrics %K exercise %K lifestyle %K physical health %K mental health %K social-cognitive approach %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Emerging evidence suggests a positive association between relevant aspects of one’s psychological identity and physical activity engagement, but the current understanding of this relationship is primarily based on scales designed to assess identity as a person who exercises, leaving out essential aspects of physical activities (eg, incidental and occupational physical activity) and sedentary behavior. Objective: The goal of this study is to evaluate the validity of a new physical activity and sedentary behavior (PA/SB) identity scale using 2 independent samples of US adults. Methods: In study 1, participants answered 21 candidate items for the PA/SB identity scale and completed the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Study 2 participants completed the same PA/SB identity items twice over a 1-week interval and completed the IPAQ-SF at the end. We performed factor analyses to evaluate the structure of the PA/SB identity scale, evaluated convergent validity and test-retest reliability (in study 2) of the final scale scores, and examined their discriminant validity using tests for differences in dependent correlations. Results: The final PA/SB identity measure was comprised of 3 scales: physical activity role identity (F1), physical activity belief (F2), and sedentary behavior role identity (F3). The scales had high test-retest reliability (Pearson correlation coefficient: F1, r=0.87; F2, r=0.75; F3, r=0.84; intraclass correlation coefficient [ICC]: F1: ICC=0.85; F2: ICC=0.75; F3: ICC=0.84). F1 and F2 were positively correlated with each other (study 1, r=0.76; study 2, r=0.69), while both were negatively correlated with F3 (Pearson correlation coefficient between F1 and F3: r=–0.58 for study 1 and r=–0.73 for study 2; F2 and F3: r=–0.46 for studies 1 and 2). Data from both studies also demonstrated adequate discriminant validity of the scale developed. Significantly larger correlations with time in vigorous and moderate activities and time walking and sitting assessed by IPAQ-SF with F1, compared with F2, were observed. Significantly larger correlations with time in vigorous and moderate activities with F1, compared with F3, were also observed. Similarly, a larger correlation with time in vigorous activities and a smaller correlation with time walking were observed with F2, compared with F3. Conclusions: This study provided initial empirical evidence from 2 independent studies on the reliability and validity of the PA/SB identity scales for adults. %M 39446463 %R 10.2196/59950 %U https://formative.jmir.org/2024/1/e59950 %U https://doi.org/10.2196/59950 %U http://www.ncbi.nlm.nih.gov/pubmed/39446463 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50023 %T True Mitotic Count Prediction in Gastrointestinal Stromal Tumors: Bayesian Network Model and PROMETheus (Preoperative Mitosis Estimator Tool) Application Development %A Renne,Salvatore Lorenzo %A Cammelli,Manuela %A Santori,Ilaria %A Tassan-Mangina,Marta %A Samà,Laura %A Ruspi,Laura %A Sicoli,Federico %A Colombo,Piergiuseppe %A Terracciano,Luigi Maria %A Quagliuolo,Vittorio %A Cananzi,Ferdinando Carlo Maria %+ Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, 20072, Italy, 39 0282247743, salvatore.renne@hunimed.eu %K GIST mitosis %K risk classification %K mHealth %K mobile health %K neoadjuvant therapy %K patient stratification %K Gastrointestinal Stroma %K preoperative risk %D 2024 %7 22.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Gastrointestinal stromal tumors (GISTs) present a complex clinical landscape, where precise preoperative risk assessment plays a pivotal role in guiding therapeutic decisions. Conventional methods for evaluating mitotic count, such as biopsy-based assessments, encounter challenges stemming from tumor heterogeneity and sampling biases, thereby underscoring the urgent need for innovative approaches to enhance prognostic accuracy. Objective: The primary objective of this study was to develop a robust and reliable computational tool, PROMETheus (Preoperative Mitosis Estimator Tool), aimed at refining patient stratification through the precise estimation of mitotic count in GISTs. Methods: Using advanced Bayesian network methodologies, we constructed a directed acyclic graph (DAG) integrating pertinent clinicopathological variables essential for accurate mitotic count prediction on the surgical specimen. Key parameters identified and incorporated into the model encompassed tumor size, location, mitotic count from biopsy specimens, surface area evaluated during biopsy, and tumor response to therapy, when applicable. Rigorous testing procedures, including prior predictive simulations, validation utilizing synthetic data sets were employed. Finally, the model was trained on a comprehensive cohort of real-world GIST cases (n=80), drawn from the repository of the Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Humanitas Research Hospital, with a total of 160 cases analyzed. Results: Our computational model exhibited excellent diagnostic performance on synthetic data. Different model architecture were selected based on lower deviance and robust out-of-sample predictive capabilities. Posterior predictive checks (retrodiction) further corroborated the model’s accuracy. Subsequently, PROMETheus was developed. This is an intuitive tool that dynamically computes predicted mitotic count and risk assessment on surgical specimens based on tumor-specific attributes, including size, location, surface area, and biopsy-derived mitotic count, using posterior probabilities derived from the model. Conclusions: The deployment of PROMETheus represents a potential advancement in preoperative risk stratification for GISTs, offering clinicians a precise and reliable means to anticipate mitotic counts on surgical specimens and a solid base to stratify patients for clinical studies. By facilitating tailored therapeutic strategies, this innovative tool is poised to revolutionize clinical decision-making paradigms, ultimately translating into improved patient outcomes and enhanced prognostic precision in the management of GISTs. %M 39437385 %R 10.2196/50023 %U https://www.jmir.org/2024/1/e50023 %U https://doi.org/10.2196/50023 %U http://www.ncbi.nlm.nih.gov/pubmed/39437385 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e58035 %T Digital Health Readiness: Making Digital Health Care More Inclusive %A Bober,Timothy %A Rollman,Bruce L %A Handler,Steven %A Watson,Andrew %A Nelson,Lyndsay A %A Faieta,Julie %A Rosland,Ann-Marie %+ Division of General Internal Medicine, University of Pittsburgh School of Medicine, UPMC Montefiore Hospital, Suite W933, Pittsburgh, PA, 15213, United States, 1 412 692 4821, bobertm@upmc.edu %K digital health %K digital health literacy %K informatics %K digital disparities %K digital health readiness %K inclusivity %K digital health tool %K literacy %K patient support %K health system %D 2024 %7 9.10.2024 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X This paper proposes an approach to assess digital health readiness in clinical settings to understand how prepared, experienced, and equipped individual people are to participate in digital health activities. Existing digital health literacy and telehealth prediction tools exist but do not assess technological aptitude for particular tasks or incorporate available electronic health record data to improve efficiency and efficacy. As such, we propose a multidomain digital health readiness assessment that incorporates a person’s stated goals and motivations for use of digital health, a focused digital health literacy assessment, passively collected data from the electronic health record, and a focused aptitude assessment for critical skills needed to achieve a person’s goals. This combination of elements should allow for easy integration into clinical workflows and make the assessment as actionable as possible for health care providers and in-clinic digital health navigators. Digital health readiness profiles could be used to match individuals with support interventions to promote the use of digital tools like telehealth, mobile apps, and remote monitoring, especially for those who are motivated but do not have adequate experience. Moreover, while effective and holistic digital health readiness assessments could contribute to increased use and greater equity in digital health engagement, they must also be designed with inclusivity in mind to avoid worsening known disparities in digital health care. %M 39383524 %R 10.2196/58035 %U https://mhealth.jmir.org/2024/1/e58035 %U https://doi.org/10.2196/58035 %U http://www.ncbi.nlm.nih.gov/pubmed/39383524 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e58079 %T Italian Version of the mHealth App Usability Questionnaire (Ita-MAUQ): Translation and Validation Study in People With Multiple Sclerosis %A Podda,Jessica %A Grange,Erica %A Susini,Alessia %A Tacchino,Andrea %A Di Antonio,Federica %A Pedullà,Ludovico %A Brichetto,Giampaolo %A Ponzio,Michela %K mHealth %K multiple sclerosis %K cognitive assessment %K questionnaire validation %K usability %K mHealth app %K mHealth application %K validation study %K MAUQ %K app usability %K telemedicine %K disability %K usability questionnaire %K mobile health %D 2024 %7 30.9.2024 %9 %J JMIR Hum Factors %G English %X Background: Telemedicine and mobile health (mHealth) apps have emerged as powerful tools in health care, offering convenient access to services and empowering participants in managing their health. Among populations with chronic and progressive disease such as multiple sclerosis (MS), mHealth apps hold promise for enhancing self-management and care. To be used in clinical practice, the validity and usability of mHealth tools should be tested. The most commonly used method for assessing the usability of electronic technologies are questionnaires. Objective: This study aimed to translate and validate the English version of the mHealth App Usability Questionnaire into Italian (ita-MAUQ) in a sample of people with MS. Methods: The 18-item mHealth App Usability Questionnaire was forward- and back-translated from English into Italian by an expert panel, following scientific guidelines for translation and cross-cultural adaptation. The ita-MAUQ (patient version for stand-alone apps) comprises 3 subscales, which are ease of use, interface and satisfaction, and usefulness. After interacting with DIGICOG-MS (Digital Assessment of Cognitive Impairment in Multiple Sclerosis), a novel mHealth app for cognitive self-assessment in MS, people completed the ita-MAUQ and the System Usability Scale, included to test construct validity of the translated questionnaire. Confirmatory factor analysis, internal consistency, test-retest reliability, and construct validity were assessed. Known-groups validity was examined based on disability levels as indicated by the Expanded Disability Status Scale (EDSS) score and gender. Results: In total, 116 people with MS (female n=74; mean age 47.2, SD 14 years; mean EDSS 3.32, SD 1.72) were enrolled. The ita-MAUQ demonstrated acceptable model fit, good internal consistency (Cronbach α=0.92), and moderate test-retest reliability (intraclass coefficient correlation 0.84). Spearman coefficients revealed significant correlations between the ita-MAUQ total score; the ease of use (5 items), interface and satisfaction (7 items), and usefulness subscales; and the System Usability Scale (all P values <.05). Known-group analysis found no difference between people with MS with mild and moderate EDSS (all P values >.05), suggesting that ambulation ability, mainly detected by the EDSS, did not affect the ita-MAUQ scores. Interestingly, a statistical difference between female and male participants concerning the ease of use ita-MAUQ subscale was found (P=.02). Conclusions: The ita-MAUQ demonstrated high reliability and validity and it might be used to evaluate the usability, utility, and acceptability of mHealth apps in people with MS. %R 10.2196/58079 %U https://humanfactors.jmir.org/2024/1/e58079 %U https://doi.org/10.2196/58079 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58202 %T Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies Using AI (QUADAS-AI): Protocol for a Qualitative Study %A Guni,Ahmad %A Sounderajah,Viknesh %A Whiting,Penny %A Bossuyt,Patrick %A Darzi,Ara %A Ashrafian,Hutan %+ Institute of Global Health Innovation, Imperial College London, 10th Floor QEQM Building, St Mary’s Hospital, Praed St, London, W2 1NY, United Kingdom, 44 2075895111, h.ashrafian@imperial.ac.uk %K artificial intelligence %K AI %K AI-specific quality assessment of diagnostic accuracy studies %K QUADAS-AI %K AI-driven %K diagnostics %K evidence synthesis %K quality assessment %K evaluation %K diagnostic %K accuracy %K bias %K translation %K clinical practice %K assessment tool %K diagnostic service %D 2024 %7 18.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Quality assessment of diagnostic accuracy studies (QUADAS), and more recently QUADAS-2, were developed to aid the evaluation of methodological quality within primary diagnostic accuracy studies. However, its current form, QUADAS-2 does not address the unique considerations raised by artificial intelligence (AI)–centered diagnostic systems. The rapid progression of the AI diagnostics field mandates suitable quality assessment tools to determine the risk of bias and applicability, and subsequently evaluate translational potential for clinical practice. Objective: We aim to develop an AI-specific QUADAS (QUADAS-AI) tool that addresses the specific challenges associated with the appraisal of AI diagnostic accuracy studies. This paper describes the processes and methods that will be used to develop QUADAS-AI. Methods: The development of QUADAS-AI can be distilled into 3 broad stages. Stage 1—a project organization phase had been undertaken, during which a project team and a steering committee were established. The steering committee consists of a panel of international experts representing diverse stakeholder groups. Following this, the scope of the project was finalized. Stage 2—an item generation process will be completed following (1) a mapping review, (2) a meta-research study, (3) a scoping survey of international experts, and (4) a patient and public involvement and engagement exercise. Candidate items will then be put forward to the international Delphi panel to achieve consensus for inclusion in the revised tool. A modified Delphi consensus methodology involving multiple online rounds and a final consensus meeting will be carried out to refine the tool, following which the initial QUADAS-AI tool will be drafted. A piloting phase will be carried out to identify components that are considered to be either ambiguous or missing. Stage 3—once the steering committee has finalized the QUADAS-AI tool, specific dissemination strategies will be aimed toward academic, policy, regulatory, industry, and public stakeholders, respectively. Results: As of July 2024, the project organization phase, as well as the mapping review and meta-research study, have been completed. We aim to complete the item generation, including the Delphi consensus, and finalize the tool by the end of 2024. Therefore, QUADAS-AI will be able to provide a consensus-derived platform upon which stakeholders may systematically appraise the methodological quality associated with AI diagnostic accuracy studies by the beginning of 2025. Conclusions: AI-driven systems comprise an increasingly significant proportion of research in clinical diagnostics. Through this process, QUADAS-AI will aid the evaluation of studies in this domain in order to identify bias and applicability concerns. As such, QUADAS-AI may form a key part of clinical, governmental, and regulatory evaluation frameworks for AI diagnostic systems globally. International Registered Report Identifier (IRRID): DERR1-10.2196/58202 %M 39293047 %R 10.2196/58202 %U https://www.researchprotocols.org/2024/1/e58202 %U https://doi.org/10.2196/58202 %U http://www.ncbi.nlm.nih.gov/pubmed/39293047 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55324 %T Design and Psychometric Evaluation of Nurses’ Mobile Health Device Acceptance Scale (NMHDA-Scale): Application of the Expectation-Confirmation Theory %A Mirabootalebi,Narjes %A Meidani,Zahra %A Akbari,Hossein %A Rangraz Jeddi,Fatemeh %A Tagharrobi,Zahra %A Swoboda,Walter %A Holl,Felix %+ Trauma Nursing Research Centre, Kashan University of Medical Sciences, Isfahan Province, Kashan, 2C74+M7F, Iran, 98 9131613899, Tagharrobi_z@kaums.ac.ir %K mobile health %K acceptance %K psychometric evaluation %K nursing %K Expectation-Confirmation Theory %K smartphone %D 2024 %7 17.9.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The use of mobile tools in nursing care is indispensable. Given the importance of nurses’ acceptance of these tools in delivering effective care, this issue requires greater attention. Objective: This study aims to design the Mobile Health Tool Acceptance Scale for Nurses based on the Expectation-Confirmation Theory and to evaluate it psychometrically. Methods: Using a Waltz-based approach grounded in existing tools and the constructs of the Expectation-Confirmation Theory, the initial version of the scale was designed and evaluated for face and content validity. Construct validity was examined through exploratory factor analysis, concurrent validity, and known-group comparison. Reliability was assessed using measures of internal consistency and stability. Results: The initial version of the scale consisted of 33 items. During the qualitative and quantitative content validity stage, 1 item was added and 1 item was removed. Exploratory factor analysis, retaining 33 items, identified 5 factors that explained 70.53% of the variance. A significant positive correlation was found between the scores of the designed tool and nurses’ attitudes toward using mobile-based apps in nursing care (r=0.655, P<.001). The intraclass correlation coefficient, Cronbach α, and ω coefficient were 0.938, 0.953, and 0.907, respectively. Conclusions: The 33-item scale developed is a valid and reliable instrument for measuring nurses’ acceptance of mobile health tools. %M 39288375 %R 10.2196/55324 %U https://humanfactors.jmir.org/2024/1/e55324 %U https://doi.org/10.2196/55324 %U http://www.ncbi.nlm.nih.gov/pubmed/39288375 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54859 %T Integrating Health and Disability Data Into Academic Information Systems: Workflow Optimization Study %A Jabour,Abdulrahman %K disability %K health data %K student health %K health measures %K disability data %K university setting %K university system %K student system %K academic system %K health informatics %K health-related %K health information %K support %K well-being %K user-centered %K data collection %K analysis %K development %K privacy %K confidentiality %K timely communication %K task automation %K resources %K quality of life %K wellness %K advisor %K advisors %K support system %K interview %K interviews %K administrative staff %K admin staff %K physician %K physicians %K faculty %K student %K students %K thematic analysis %K focus group %D 2024 %7 4.9.2024 %9 %J JMIR Hum Factors %G English %X Background: Integrating health information into university information systems holds significant potential for enhancing student support and well-being. Despite the growing body of research highlighting issues faced by university students, including stress, depression, and disability, little has been done in the informatics field to incorporate health technologies at the institutional level. Objective: This study aims to investigate the current state of health information integration within university systems and provide design recommendations to address existing gaps and opportunities. Methods: We used a user-centered approach to conduct interviews and focus group sessions with stakeholders to gather comprehensive insights and requirements for the system. The methodology involved data collection, analysis, and the development of a suggested workflow. Results: The findings of this study revealed the shortcomings in the current process of handling health and disability data within university information systems. In our results, we discuss some requirements identified for integrating health-related information into student information systems, such as privacy and confidentiality, timely communication, task automation, and disability resources. We propose a workflow that separates the process into 2 distinct components: a health and disability system and measures of quality of life and wellness. The proposed workflow highlights the vital role of academic advisors in facilitating support and enhancing coordination among stakeholders. Conclusions: To streamline the workflow, it is vital to have effective coordination among stakeholders and redesign the university information system. However, implementing the new system will require significant capital and resources. We strongly emphasize the importance of increased standardization and regulation to support the information system requirements for health and disability. Through the adoption of standardized practices and regulations, we can ensure the smooth and effective implementation of the required support system. %R 10.2196/54859 %U https://humanfactors.jmir.org/2024/1/e54859 %U https://doi.org/10.2196/54859 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58497 %T Development and Validation of a Mobile-Centered Digital Health Readiness Scale (mDiHERS): Health Literacy and Equity Scale %A Kim,Hana %A Schnall,Rebecca %A Yoon,Nagyeom %A Koh,Seong-Joon %A Lee,Jisan %A Cheon,Jae Hee %+ Department of Nursing, Gangneung-Wonju National University, Department of Nursing, Gangneung-Wonju National University, Wonju, 26403, Republic of Korea, 82 337608646, saan2mari@gmail.com %K digital health %K health literacy %K health equity %K inflammatory bowel diseases %K telemedicine %K patient participation %K validation %K validate %K IBD %K bowel %K inflammatory %K inflammation %K gastrointestinal %K GI %K internal medicine %K gastroenterology %K scale %K readiness %K adoption %K measure %K measures %K measurement %K measurements %K assessment %K assessments %K scales %K eHealth %K e-health %K literacy %K mHealth %K mobile health %K chronic %K mobile phone %D 2024 %7 13.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: There has been a rapid expansion of digital health care services, making the need for measuring and improving digital health readiness a priority. In response, our study team developed the Mobile-Centered Digital Health Readiness: Health Literacy and Equity Scale (mDiHERS) to measure digital health readiness. Objective: We aim to develop and validate a scale that assesses digital health readiness, encompassing literacy and equity, and to ensure the effective use of mobile-centered digital health services. Methods: This study was conducted from October 2021 to October 2022 to develop and validate the mDiHERS. Participants included patients with inflammatory bowel disease, which is a chronic condition requiring continuous management, and experts in medical and nursing informatics. The scale development involved a literature review, focus group interviews, and content validity evaluations. A total of 440 patients with inflammatory bowel disease were recruited for the validation phase, with 403 completing the survey. The scale’s validity and reliability were assessed through exploratory factor analysis and Cronbach α. The scale was translated into English by translators and bilingual and native researchers, ensuring its applicability in diverse settings. Results: The mDiHERS consists of 36 items across 6 domains, with a 5-point Likert scale for responses. The validation process confirmed the scale’s construct validity, with 4 factors explaining 65.05% of the total variance. The scale’s reliability was established with Cronbach α values ranging from 0.84 to 0.91. The scale’s development considered the technical proficiency necessary for engaging with health mobile apps and devices, reflecting the importance of subjective confidence and objective skills in digital health literacy. Conclusions: The mDiHERS is a validated tool for measuring patients’ readiness and ability to use digital health services. The mDiHERS assesses user characteristics, digital accessibility, literacy, and equity to contribute to the effective use of digital health services and improve accessibility. The development and validation of the mDiHERS emphasize the importance of confidence and competence in managing health digitally. Continuous improvements are necessary to ensure that all patients can benefit from digital health care. %M 39137409 %R 10.2196/58497 %U https://www.jmir.org/2024/1/e58497 %U https://doi.org/10.2196/58497 %U http://www.ncbi.nlm.nih.gov/pubmed/39137409 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e54762 %T Development, Feasibility, and Acceptability of the Electronic Patient Benefit Index for Psoriasis in Clinical Practice: Mixed Methods Study %A Otten,Marina %A Djamei,Vahid %A Augustin,Matthias %+ German Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, Hamburg, 20246, Germany, 49 40741059369, m.otten@uke.de %K patient-reported outcomes %K Patient Benefit Index %K dermatology %K psoriasis %K feasibility %K acceptability %K eHealth %K digital health %K dermatologist %K dermatologists %K skin %K mobile health %K app %K apps %K application %K applications %K digital technology %K digital intervention %K digital interventions %K smartphone %K smartphones %K mobile phone %D 2024 %7 9.8.2024 %9 Original Paper %J JMIR Dermatol %G English %X Background: Patient-reported outcomes are relevant in clinical practice showing patient benefits, supporting clinicians’ decision-making, and contributing to the delivery of high standards of care. Digital monitoring of patient-reported outcomes is still rare. The Patient Benefit Index (PBI) measures benefits and goals from patients’ views and may be relevant for regular documentation and shared decision-making. Objective: This study aimed to develop electronic versions of the PBI to examine their feasibility and acceptability in clinical practice for patients with psoriasis. Methods: We developed an app and a web version of the existing, valid PBI using focus groups and cognitive debriefings with patients before conducting a quantitative survey on its feasibility and acceptability. Conduction took part in an outpatient dermatology care unit in Germany. Descriptive and subgroup analyses were conducted. Results: A total of 139 patients completed the electronic PBIs (ePBIs) and took part in the survey. The ePBI was understandable (n=129-137, 92.8%-98.6%) and feasible, for example, easy to read (n=135, 97.1%) and simple to handle (n=137, 98.5%). Acceptability was also high, for example, patients can imagine using and discussing the ePBI data in practice (n=91, 65.5%) and documenting it regularly (n=88, 63.3%). They believe it could support treatment decisions (n=118, 84.9%) and improve communication with their physician (n=112, 81.3%). They can imagine filling in electronic questionnaires regularly (n=118, 84.9%), even preferring electronic over paper versions (n=113, 81.2%). Older and less educated people show less feasibility, but the latter expected the relationship with their physician to improve and would be more willing to invest time or effort. Conclusions: The app and web version of the PBI are usable and acceptable for patients offering comprehensive documentation and patient participation in practice. An implementation strategy should consider patients’ needs, barriers, and facilitators but also physicians’ attitudes and requirements from the health care system. %M 39121470 %R 10.2196/54762 %U https://derma.jmir.org/2024/1/e54762 %U https://doi.org/10.2196/54762 %U http://www.ncbi.nlm.nih.gov/pubmed/39121470 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e57658 %T Evaluating the Construct Validity of the Charité Alarm Fatigue Questionnaire using Confirmatory Factor Analysis %A Wunderlich,Maximilian Markus %A Krampe,Henning %A Fuest,Kristina %A Leicht,Dominik %A Probst,Moriz Benedikt %A Runge,Julian %A Schmid,Sebastian %A Spies,Claudia %A Weiß,Björn %A Balzer,Felix %A Poncette,Akira-Sebastian %A , %K patient monitoring %K intensive care unit %K alarm %K alarms %K validity %K validation %K safety %K intensive %K care %K alarm fatigue %K alarm management %K patient safety %K ICU %K alarm system %K alarm system quality %K medical devices %K clinical alarms %K questionnaire %K questionnaires %K warning %K factor analysis %D 2024 %7 8.8.2024 %9 %J JMIR Hum Factors %G English %X Background: The Charité Alarm Fatigue Questionnaire (CAFQa) is a 9-item questionnaire that aims to standardize how alarm fatigue in nurses and physicians is measured. We previously hypothesized that it has 2 correlated scales, one on the psychosomatic effects of alarm fatigue and the other on staff’s coping strategies in working with alarms. Objective: We aimed to validate the hypothesized structure of the CAFQa and thus underpin the instrument’s construct validity. Methods: We conducted 2 independent studies with nurses and physicians from intensive care units in Germany (study 1: n=265; study 2: n=1212). Responses to the questionnaire were analyzed using confirmatory factor analysis with the unweighted least-squares algorithm based on polychoric covariances. Convergent validity was assessed by participants’ estimation of their own alarm fatigue and exposure to false alarms as a percentage. Results: In both studies, the χ2 test reached statistical significance (study 1: χ226=44.9; P=.01; study 2: χ226=92.4; P<.001). Other fit indices suggested a good model fit (in both studies: root mean square error of approximation <0.05, standardized root mean squared residual <0.08, relative noncentrality index >0.95, Tucker-Lewis index >0.95, and comparative fit index >0.995). Participants’ mean scores correlated moderately with self-reported alarm fatigue (study 1: r=0.45; study 2: r=0.53) and weakly with self-perceived exposure to false alarms (study 1: r=0.3; study 2: r=0.33). Conclusions: The questionnaire measures the construct of alarm fatigue as proposed in our previous study. Researchers and clinicians can rely on the CAFQa to measure the alarm fatigue of nurses and physicians. Trial Registration: ClinicalTrials.gov NCT04994600; https://www.clinicaltrials.gov/study/NCT04994600 %R 10.2196/57658 %U https://humanfactors.jmir.org/2024/1/e57658 %U https://doi.org/10.2196/57658 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52058 %T A Multidimensional Approach for Evaluating Reality in Social Media: Mixed Methods Study %A Cho,HyunYi %A Li,Wenbo %A Lopez,Rachel %+ The Ohio State University, 154 N Oval Mall, Columbus, OH, 43210, United States, 1 6142923400, cho.919@osu.edu %K fake %K fact %K misinformation %K reality %K social media %K scale %K measure %K instrument %K user-centric %K tailoring %K digital media literacy %D 2024 %7 6.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Misinformation is a threat to public health. The effective countering of misinformation may require moving beyond the binary classification of fake versus fact to capture the range of schemas that users employ to evaluate social media content. A more comprehensive understanding of user evaluation schemas is necessary. Objective: The goal of this research was to advance the current understanding of user evaluations of social media information and to develop and validate a measurement instrument for assessing social media realism. Methods: This research involved a sequence of 2 studies. First, we used qualitative focus groups (n=48). Second, building on the first study, we surveyed a national sample of social media users (n=442). The focus group data were analyzed using the constant comparison approach. The survey data were analyzed using confirmatory factor analyses and ordinary least squares regression. Results: The findings showed that social media reality evaluation involves 5 dimensions: falsity, naturality, authenticity, resonance, and social assurance. These dimensions were differentially mapped onto patterns of social media use. Authenticity was strongly associated with the existing global measure of social media realism (P<.001). Naturality, or the willingness to accept artificiality and engineered aspects of social media representations, was linked to hedonic enjoyment (P<.001). Resonance predicted reflective thinking (P<.001), while social assurance was strongly related to addictive use (P<.001). Falsity, the general belief that much of what is on social media is not real, showed a positive association with both frequency (P<.001) and engagement with (P=.003) social media. These results provide preliminary validity data for a social media reality measure that encompasses multiple evaluation schemas for social media content. Conclusions: The identification of divergent schemas expands the current focus beyond fake versus fact, while the goals, contexts, and outcomes of social media use associated with these schemas can guide future digital media literacy efforts. Specifically, the social media reality measure can be used to develop tailored digital media literacy interventions for addressing diverse public health issues. %M 39106092 %R 10.2196/52058 %U https://www.jmir.org/2024/1/e52058 %U https://doi.org/10.2196/52058 %U http://www.ncbi.nlm.nih.gov/pubmed/39106092 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58928 %T Development of a Video Consultation Patient-Satisfaction Questionnaire (vCare-PSQ): A Cross-Sectional Explorative Study %A Larrabee Sonderlund,Anders %A Quirina Bang Van Sas,Tessa %A Wehberg,Sonja %A Huibers,Linda %A Nielsen,Jesper Bo %A Søndergaard,Jens %A Assing Hvidt,Elisabeth %+ Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark, 45 65503994, asonderlund@health.sdu.dk %K video consultation %K patient satisfaction %K patient-physician relationship %K telehealth %K general practice %K pilot-testing %K COVID-19 %K SARS-CoV-2 %K pandemic %K primary care %K healthcare %K health professional %K health professionals %K Danish %K adult %K adults %K IT-literacy %K methodological %K vCare-PSQ %K COSMIN %D 2024 %7 2.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Since the COVID-19 pandemic, the use of video consultation (VC) in primary care has expanded considerably in many countries. VC and other telehealth formats are often touted as a solution to improved health care access, with numerous studies showing high satisfaction with this care format among health professionals and patients. However, operationalization and measurement of patient satisfaction with VC varies across studies and often lacks consideration of dynamic contextual factors (eg, convenience, ease-of-use, or privacy) and doctor-patient relational variables that may influence patient satisfaction. Objective: We aim to develop a comprehensive and evidence-based questionnaire for assessing patient satisfaction with VC in general practice. Methods: The vCare Patient-Satisfaction Questionnaire (the vCare-PSQ) was developed according to the COSMIN (Consensus-Based Standards for the Selection of Health Measurement Instruments) guidelines. To achieve our overall objective, we pursued three aims: (1) a validation analysis of an existing patient-satisfaction scale (the PS-14), (2) an assessment of extrinsic contextual factors that may impact patient satisfaction, and (3) an assessment of pertinent intrinsic and relational satisfaction correlates (eg, health anxiety, information technology literacy, trust in the general practitioner, or convenience). For validation purposes, the questionnaire was filled out by a convenience sample of 188 Danish adults who had attended at least 1 VC. Results: Our validation analysis of the PS-14 in a Danish population produced reliable results, indicating that the PS-14 is an appropriate measure of patient satisfaction with VC in Danish patient populations. Regressing situational and doctor-patient relational factors onto patient satisfaction further suggested that patient satisfaction is contingent on several factors not measured by the PS-14. These include information technology literacy and patient trust in the general practitioner, as well as several contextual pros and cons. Conclusions: Supplementing the PS-14 with dynamic measures of situational and doctor-patient relational factors may provide a more comprehensive understanding of patient satisfaction with VC. The vCare-PSQ may thus contribute to an enhanced methodological approach to assessing patient satisfaction with VC. We hope that the vCare-PSQ format may be useful for future research and implementation efforts regarding VC in a general practice setting. %M 39094110 %R 10.2196/58928 %U https://formative.jmir.org/2024/1/e58928 %U https://doi.org/10.2196/58928 %U http://www.ncbi.nlm.nih.gov/pubmed/39094110 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52019 %T Summary Measure of Health-Related Quality of Life and Its Related Factors Based on the Chinese Version of the Core Healthy Days Measures: Cross-Sectional Study %A Shi,Yulin %A Wang,Baohua %A Zhao,Jian %A Wang,Chunping %A Li,Ning %A Chen,Min %A Wan,Xia %K health-related quality of life %K Healthy Days %K summary measure %K health status indicators %K exploratory factor analyses %K confirmatory factor analyses %D 2024 %7 31.7.2024 %9 %J JMIR Public Health Surveill %G English %X Background: The core Healthy Days measures were used to track the population-level health status in the China Chronic Disease and Risk Factor Surveillance; however, they were not easily combined to create a summary of the overall health-related quality of life (HRQOL), limiting this indicator’s use. Objective: This study aims to develop a summary score based on the Chinese version of the core Healthy Days measures (HRQOL-5) and apply it to estimate HRQOL and its determinants in a Chinese population. Methods: From November 2018 to May 2019, a multistage stratified cluster survey was conducted to examine population health status and behavioral risk factors among the resident population older than 15 years in Weifang City, Shandong Province, China. Both exploratory factor analyses and confirmatory factor analyses were performed to reveal the underlying latent construct of HRQOL-5 and then to quantify the overall HRQOL by calculating its summary score. Tobit regression models were finally carried out to identify the influencing factors of the summary score. Results: A total of 26,269 participants (male: n=13,571, 51.7%; mean age 55.9, SD 14.9 years) were included in this study. A total of 71% (n=18,663) of respondents reported that they had excellent or very good general health. One summary factor was extracted to capture overall HRQOL using exploratory factor analysis. The confirmatory factor analysis further confirmed this one-factor model (Tucker-Lewis index, comparative fit index, and goodness-of-fit index >0.90; root mean square error of approximation 0.02). Multivariate Tobit regression analysis showed that age (β=–0.06), educational attainments (primary school: β=0.72; junior middle school: β=1.46; senior middle school or more: β=2.58), average income (≥¥30,000 [US $4200]: β=0.69), physical activity (β=0.75), alcohol use (β=0.46), self-reported disease (β=−6.36), and self-reported injury (β=–5.00) were the major influencing factors on the summary score of the HRQOL-5. Conclusions: This study constructs a summary score from the HRQOL-5, providing a comprehensive representation of population-level HRQOL. Differences in summary scores of different subpopulations may help set priorities for health planning in China to improve population HRQOL. %R 10.2196/52019 %U https://publichealth.jmir.org/2024/1/e52019 %U https://doi.org/10.2196/52019 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e48516 %T Measuring Relationship Influences on Romantic Couples’ Cancer-Related Behaviors During the COVID-19 Pandemic: Protocol for a Longitudinal Online Study of Dyads and Cancer Survivors %A Bowers,Jennifer M %A Huelsnitz,Chloe O %A Dwyer,Laura A %A Gibson,Laurel P %A Agurs-Collins,Tanya %A Ferrer,Rebecca A %A Acevedo,Amanda M %+ Behavioral Research Program, National Cancer Institute, National Institutes of Health, 9609 Medical Center Dr, Rockville, MD, 20850, United States, 1 2402765478, amanda.acevedo@nih.gov %K cancer prevention %K COVID-19 %K risk perceptions %K dyads %K romantic relationships %K cancer %K oncology %K survivor %K survivors %K dyad %K spouse %K spousal %K partner %K health behavior %K health behaviors %K cohabiting %K cohabit %K study design %K recruit %K recruitment %K methodology %K methods %K enrol %K enrolment %K enroll %K enrollment %D 2024 %7 31.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Research has established the effects of romantic relationships on individuals’ morbidity and mortality. However, the interplay between relationship functioning, affective processes, and health behaviors has been relatively understudied. During the COVID-19 pandemic, relational processes may influence novel health behaviors such as social distancing and masking. Objective: We describe the design, recruitment, and methods of the relationships, risk perceptions, and cancer-related behaviors during the COVID-19 pandemic study. This study was developed to understand how relational and affective processes influence romantic partners’ engagement in cancer prevention behaviors as well as health behaviors introduced or exacerbated by the COVID-19 pandemic. Methods: The relationships, risk perceptions, and cancer-related behaviors during the COVID-19 pandemic study used online survey methods to recruit and enroll 2 cohorts of individuals involved in cohabiting romantic relationships, including 1 cohort of dyads (n=223) and 1 cohort of cancer survivors (n=443). Survey assessments were completed over 2 time points that were 5.57 (SD 3.14) weeks apart on average. Health behaviors assessed included COVID-19 vaccination and social distancing, physical activity, diet, sleep, alcohol use, and smoking behavior. We also examined relationship factors, psychological distress, and household chaos. Results: Data collection occurred between October 2021 and August 2022. During that time, a total of 926 participants were enrolled, of which about two-thirds were from the United Kingdom (n=622, 67.8%) and one-third were from the United States (n=296, 32.2%); about two-thirds were married (n=608, 66.2%) and one-third were members of unmarried couples (n=294, 32%). In cohorts 1 and 2, the mean age was about 34 and 50, respectively. Out of 478 participants in cohort 1, 19 (4%) identified as Hispanic or Latino/a, 79 (17%) as non-Hispanic Asian, 40 (9%) as non-Hispanic Black or African American, and 306 (64%) as non-Hispanic White; 62 (13%) participants identified their sexual orientation as bisexual or pansexual, 359 (75.1%) as heterosexual or straight, and 53 (11%) as gay or lesbian. In cohort 2, out of 440 participants, 13 (3%) identified as Hispanic or Latino/a, 8 (2%) as non-Hispanic Asian, 5 (1%) as non-Hispanic Black or African American, and 398 (90.5%) as non-Hispanic White; 41 (9%) participants identified their sexual orientation as bisexual or pansexual, 384 (87.3%) as heterosexual or straight, and 13 (3%) as gay or lesbian. The overall enrollment rate for individuals was 66.14% and the overall completion rate was 80.08%. Conclusions: We discuss best practices for collecting online survey data for studies examining relationships and health, challenges related to the COVID-19 pandemic, recruitment of underrepresented populations, and enrollment of dyads. Recommendations include conducting pilot studies, allowing for extra time in the data collection timeline for marginalized or underserved populations, surplus screening to account for expected attrition within dyads, as well as planning dyad-specific data quality checks. International Registered Report Identifier (IRRID): DERR1-10.2196/48516 %M 39083795 %R 10.2196/48516 %U https://www.researchprotocols.org/2024/1/e48516 %U https://doi.org/10.2196/48516 %U http://www.ncbi.nlm.nih.gov/pubmed/39083795 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45780 %T Cerebral Microbleeds in Different Brain Regions and Their Associations With the Digital Clock-Drawing Test: Secondary Analysis of the Framingham Heart Study %A Akhter-Khan,Samia C %A Tao,Qiushan %A Ang,Ting Fang Alvin %A Karjadi,Cody %A Itchapurapu,Indira Swetha %A Libon,David J %A Alosco,Michael %A Mez,Jesse %A Qiu,Wei Qiao %A Au,Rhoda %+ Framingham Heart Study, Boston University School of Medicine, 72 East Concord Street, R-623D, Boston, MA, 02118, United States, 1 6176384336, wqiu67@bu.edu %K cerebral microbleeds %K CMB %K digital clock-drawing test %K DCT %K Alzheimer disease %K dementia %K early screening %K Boston Process Approach %K cerebral microbleed %K neuroimaging %K cerebrovascular diseases %K aging %K MRI %K magnetic resonance imaging %K clock-drawing test %K cognitive function %D 2024 %7 29.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Cerebral microbleeds (CMB) increase the risk for Alzheimer disease. Current neuroimaging methods that are used to detect CMB are costly and not always accessible. Objective: This study aimed to explore whether the digital clock-drawing test (DCT) may provide a behavioral indicator of CMB. Methods: In this study, we analyzed data from participants in the Framingham Heart Study offspring cohort who underwent both brain magnetic resonance imaging scans (Siemens 1.5T, Siemens Healthcare Private Limited; T2*-GRE weighted sequences) for CMB diagnosis and the DCT as a predictor. Additionally, paper-based clock-drawing tests were also collected during the DCT. Individuals with a history of dementia or stroke were excluded. Robust multivariable linear regression models were used to examine the association between DCT facet scores with CMB prevalence, adjusting for relevant covariates. Receiver operating characteristic (ROC) curve analyses were used to evaluate DCT facet scores as predictors of CMB prevalence. Sensitivity analyses were conducted by further including participants with stroke and dementia. Results: The study sample consisted of 1020 (n=585, 57.35% female) individuals aged 45 years and older (mean 72, SD 7.9 years). Among them, 64 (6.27%) participants exhibited CMB, comprising 46 with lobar-only, 11 with deep-only, and 7 with mixed (lobar+deep) CMB. Individuals with CMB tended to be older and had a higher prevalence of mild cognitive impairment and higher white matter hyperintensities compared to those without CMB (P<.05). While CMB were not associated with the paper-based clock-drawing test, participants with CMB had a lower overall DCT score (CMB: mean 68, SD 23 vs non-CMB: mean 76, SD 20; P=.009) in the univariate comparison. In the robust multiple regression model adjusted for covariates, deep CMB were significantly associated with lower scores on the drawing efficiency (β=–0.65, 95% CI –1.15 to –0.15; P=.01) and simple motor (β=–0.86, 95% CI –1.43 to –0.30; P=.003) domains of the command DCT. In the ROC curve analysis, DCT facets discriminated between no CMB and the CMB subtypes. The area under the ROC curve was 0.76 (95% CI 0.69-0.83) for lobar CMB, 0.88 (95% CI 0.78-0.98) for deep CMB, and 0.98 (95% CI 0.96-1.00) for mixed CMB, where the area under the ROC curve value nearing 1 indicated an accurate model. Conclusions: The study indicates a significant association between CMB, especially deep and mixed types, and reduced performance in drawing efficiency and motor skills as assessed by the DCT. This highlights the potential of the DCT for early detection of CMB and their subtypes, providing a reliable alternative for cognitive assessment and making it a valuable tool for primary care screening before neuroimaging referral. %M 39073857 %R 10.2196/45780 %U https://www.jmir.org/2024/1/e45780 %U https://doi.org/10.2196/45780 %U http://www.ncbi.nlm.nih.gov/pubmed/39073857 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57663 %T Reliability and Sensitivity of a Virtual Assessment Developed for Workplace Concussions: Protocol for a Method-Comparison Study %A Barnes,Keely %A Sveistrup,Heidi %A Bayley,Mark %A Rathbone,Michel %A Taljaard,Monica %A Egan,Mary %A Bilodeau,Martin %A Karimijashni,Motahareh %A Marshall,Shawn %+ School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Health Sciences Building (FHS) 200 Lees Avenue, Ottawa, ON, K1N 6N5, Canada, 1 6136126127, kbarn076@uottawa.ca %K telehealth %K virtual care %K concussion %K mTBI %K mild traumatic brain injury %K assessment %K examination %D 2024 %7 26.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Workplace mild traumatic brain injuries are frequently associated with persistent symptoms, leading to a reduction in productivity at work or even disability. People who sustain workplace injuries frequently need rehabilitation and support, and the challenges of delivering these services was heightened during the COVID-19 pandemic as injured workers had to be cared for remotely. Currently, clinicians are conducting both in-person and virtual (remote) concussion assessments; however, the measures that are being used to complete these assessments have undocumented psychometric properties. Objective: This study will document the psychometric properties of the clinical measures that are being used remotely and their ability to produce similar results to in-person assessments. Specifically, through this method-comparison study, we aim to (1) evaluate the sensitivity of the measures included in a virtual assessment toolkit when compared to an in-person assessment and (2) determine the interrater and intrarater reliabilities of the measures included in a virtual assessment toolkit. Methods: Patient participants (people living with acquired brain injuries) will attend two assessments (in person and virtual) at the Ottawa Hospital. The two assessments will be identical, consisting of the measures included in our previously developed virtual concussion assessment toolkit, which includes finger-to-nose testing, the Vestibular/Ocular Motor Screening tool, balance testing, cervical spine range of motion, saccades testing, and evaluation of effort. All virtual assessments will occur using the Microsoft Teams platform and will be audio/video-recorded. The clinician assessor and patient participant will complete a feedback form following completion of the assessments. A different clinician will also document the findings on observed videos of the virtual assessment shortly after completion of both in-person and virtual assessments and approximately 1 month later. Interrater reliability will be assessed by comparing the second clinician’s observation with the first clinician’s initial virtual assessment. Intrarater reliability will be evaluated by comparing the second clinician’s observation with their own assessment approximately 1 month later. Sensitivity will be documented by comparing the findings (identification of abnormality) of the in-person assessment completed by the initial clinician assessor with those of the second clinician assessor on the observation of the recording of the virtual assessment. Results: As of May 2024, we have recruited 7 clinician assessors and completed study assessments with 39 patient participants. The study recruitment is expected to be completed by September 2024. Conclusions: Currently, it is unknown if completing concussion assessments virtually produces similar results to the in-person assessment. This work will serve as a first step to determining the similarity of the virtual assessment to the matching in-person assessment and will provide information on the reliability of the virtual assessment. International Registered Report Identifier (IRRID): DERR1-10.2196/57663 %M 39059009 %R 10.2196/57663 %U https://www.researchprotocols.org/2024/1/e57663 %U https://doi.org/10.2196/57663 %U http://www.ncbi.nlm.nih.gov/pubmed/39059009 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52101 %T Equivalence of Alcohol Use Disorder Symptom Assessments in Routine Clinical Care When Completed Remotely via Online Patient Portals Versus In Clinic via Paper Questionnaires: Psychometric Evaluation %A Matson,Theresa E %A Lee,Amy K %A Oliver,Malia %A Bradley,Katharine A %A Hallgren,Kevin A %+ Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1360, Seattle, WA, 98101, United States, 1 2062872699, tessa.e.matson@kp.org %K alcohol %K alcohol use disorder %K assessment %K symptom checklist %K electronic health record %K patient portal %K item response theory %K differential item functioning %K alcohol use %K patient portals %K in-clinic %K psychometric evaluation %K alcoholism %K cross-sectional %K United States %D 2024 %7 22.7.2024 %9 Short Paper %J J Med Internet Res %G English %X Background: The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends the paper-based or computerized Alcohol Symptom Checklist to assess alcohol use disorder (AUD) symptoms in routine care when patients report high-risk drinking. However, it is unknown whether Alcohol Symptom Checklist response characteristics differ when it is administered online (eg, remotely via an online electronic health record [EHR] patient portal before an appointment) versus in clinic (eg, on paper after appointment check-in). Objective: This study evaluated the psychometric performance of the Alcohol Symptom Checklist when completed online versus in clinic during routine clinical care. Methods: This cross-sectional, psychometric study obtained EHR data from the Alcohol Symptom Checklist completed by adult patients from an integrated health system in Washington state. The sample included patients who had a primary care visit in 2021 at 1 of 32 primary care practices, were due for annual behavioral health screening, and reported high-risk drinking on the behavioral health screen (Alcohol Use Disorder Identification Test–Consumption score ≥7). After screening, patients with high-risk drinking were typically asked to complete the Alcohol Symptom Checklist—an 11-item questionnaire on which patients self-report whether they had experienced each of the 11 AUD criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) over a past-year timeframe. Patients could complete the Alcohol Symptom Checklist online (eg, on a computer, smartphone, or tablet from any location) or in clinic (eg, on paper as part of the rooming process at clinical appointments). We examined sample and measurement characteristics and conducted differential item functioning analyses using item response theory to examine measurement consistency across these 2 assessment modalities. Results: Among 3243 patients meeting eligibility criteria for this secondary analysis (2313/3243, 71% male; 2271/3243, 70% White; and 2014/3243, 62% non-Hispanic), 1640 (51%) completed the Alcohol Symptom Checklist online while 1603 (49%) completed it in clinic. Approximately 46% (752/1640) and 48% (764/1603) reported ≥2 AUD criteria (the threshold for AUD diagnosis) online and in clinic (P=.37), respectively. A small degree of differential item functioning was observed for 4 of 11 items. This differential item functioning produced only minimal impact on total scores used clinically to assess AUD severity, affecting total criteria count by a maximum of 0.13 criteria (on a scale ranging from 0 to 11). Conclusions: Completing the Alcohol Symptom Checklist online, typically prior to patient check-in, performed similarly to an in-clinic modality typically administered on paper by a medical assistant at the time of the appointment. Findings have implications for using online AUD symptom assessments to streamline workflows, reduce staff burden, reduce stigma, and potentially assess patients who do not receive in-person care. Whether modality of DSM-5 assessment of AUD differentially impacts treatment is unknown. %M 39038284 %R 10.2196/52101 %U https://www.jmir.org/2024/1/e52101 %U https://doi.org/10.2196/52101 %U http://www.ncbi.nlm.nih.gov/pubmed/39038284 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57804 %T Measurement of Daily Actions Associated With Mental Health Using the Things You Do Questionnaire–15-Item: Questionnaire Development and Validation Study %A Bisby,Madelyne A %A Jones,Michael P %A Staples,Lauren %A Dear,Blake %A Titov,Nickolai %+ MindSpot Clinic, MQ Health, Macquarie University, 16 University Avenue, Macquarie Park, 2109, Australia, 61 298508724, madelyne.bisby@mq.edu.au %K daily actions %K depression %K anxiety %K psychometric %K mental health %K questionnaire %K activities %K goals %K plans %K healthy habits %K habits %K psychometric %K treatment-seeking %K treatment %K confirmatory factor analysis %K survey %K adult %K adult %K assessment %K digital psychology service %K digital %K psychology %K depression symptoms %K anxiety symptoms %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: A large number of modifiable and measurable daily actions are thought to impact mental health. The “Things You Do” refers to 5 types of daily actions that have been associated with mental health: healthy thinking, meaningful activities, goals and plans, healthy habits, and social connections. Previous studies have reported the psychometric properties of the Things You Do Questionnaire (TYDQ)–21-item (TYDQ21). The 21-item version, however, has an uneven distribution of items across the 5 aforementioned factors and may be lengthy to administer on a regular basis. Objective: This study aimed to develop and evaluate a brief version of the TYDQ. To accomplish this, we identified the top 10 and 15 items on the TYDQ21 and then evaluated the performance of the 10-item and 15-item versions of the TYDQ in community and treatment-seeking samples. Methods: Using confirmatory factor analysis, the top 2 or 3 items were used to develop the 10-item and 15-item versions, respectively. Model fit, reliability, and validity were examined for both versions in 2 samples: a survey of community adults (n=6070) and adults who completed an assessment at a digital psychology service (n=14,878). Treatment responsivity was examined in a subgroup of participants (n=448). Results: Parallel analysis supported the 5-factor structure of the TYDQ. The brief (10-item and 15-item) versions were associated with better model fit than the 21-item version, as revealed by its comparative fit index, root-mean-square error of approximation, and Tucker-Lewis index. Configural, metric, and scalar invariance were supported. The 15-item version explained more variance in the 21-item scores than the 10-item version. Internal consistency was appropriate (eg, the 15-item version had a Cronbach α of >0.90 in both samples) and there were no marked differences between how the brief versions correlated with validated measures of depression or anxiety symptoms. The measure was responsive to treatment. Conclusions: The 15-item version is appropriate for use as a brief measure of daily actions associated with mental health while balancing brevity and clinical utility. Further research is encouraged to replicate our psychometric evaluation in other settings (eg, face-to-face services). Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12613000407796; https://tinyurl.com/2s67a6ps %M 39038286 %R 10.2196/57804 %U https://formative.jmir.org/2024/1/e57804 %U https://doi.org/10.2196/57804 %U http://www.ncbi.nlm.nih.gov/pubmed/39038286 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52314 %T Associations Between Sociodemographic Characteristics, eHealth Literacy, and Health-Promoting Lifestyle Among University Students in Taipei: Cross-Sectional Validation Study of the Chinese Version of the eHealth Literacy Scale %A Chao,Dan-Ping %+ Department of Tourism and Leisure Management, China University of Technology, 3 Xinglong Road, Wunshan District, Taipei, 11695, Taiwan, 886 2 2931 3416 ext 2264, chaodp39@cute.edu.tw %K college students %K online health information %K eHealth literacy %K search literacy %K usage literacy %K evaluation literacy %K health-promoting behavior %D 2024 %7 18.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The popularization of the internet and rapid development of mobile devices have led to an increased inclination and opportunities to obtain health-related information online. The eHealth Literacy Scale (eHEALS), widely used for measuring eHealth literacy, assesses an individual’s ability to search, understand, appraise, and use eHealth information. However, the Chinese version of the eHEALS multiple-factor model remains to be validated, and the correlation between eHEALS and the health-promoting lifestyle profile (HPLP) among university students is rarely explored in Taiwan. Objective: This study aimed to examine the fit, validity, and reliability of the Chinese eHEALS multiple-factor model and to clarify the predictive effects of eHEALS on the HPLP among university students. Methods: University students in Taipei, the capital of Taiwan, were recruited, and 406 valid questionnaires including sociodemographic characteristics, eHEALS, and HPLP responses were collected. Confirmatory factor analysis was performed to validate the Chinese eHEALS. Independent sample t test, 1-way ANOVA, and multiple linear regression analyses were conducted to examine the relationship between sociodemographic variables and the HPLP. Pearson product-moment correlation and binary logistic regression analyses were performed to ascertain the predictive effects of eHEALS on the HPLP. Results: The Chinese eHEALS exhibited an optimal fit when delineated into the search, usage, and evaluation 3-factor model (comparative fit index=0.991, Tucker-Lewis index=0.984, root mean square error of approximation=0.062), and its validity and reliability were confirmed. The mean eHEALS score of university students was 3.17/4.00 (SD 0.48) points, and the score for the evaluation subscale was the lowest (mean 3.08, SD 0.56 points). Furthermore, there were significant sex, institution orientation, daily reading time, daily screen time, primary information channel, and perceived health status differences in the HPLP: male participants (t404=2.346, P=.02), participants attending general university (t404=2.564, P=.01), those reading ≥1 hour daily (F2,403=17.618, P<.001), those spending <3 hours on mobile devices or computers daily (F2,403=7.148, P<.001), those acquiring information from others (t404=3.892, P<.001), and those with a good perceived health status (F2,403=24.366, P<.001) had a significantly higher score. After adjusting for sociodemographic variables, the eHEALS score remained an independent predictor of the HPLP. Compared to students with relatively high eHEALS scores, those with relatively low eHEALS scores had a 3.37 times risk of a negative HPLP (adjusted odds ratio [OR]=3.37, 95% CI 1.49-7.61), which could explain 14.7%-24.4% of the variance (Cox-Snell R2=0.147, Nagelkerke R2=0.244, P=.004). Conclusions: There is room for improvement in eHealth literacy among university students in Taipei. eHEALS may be used to screen students who require HPLP improvement, thereby providing appropriate eHealth literacy training programs, particularly those targeting evaluation literacy. Additionally, the 3-factor model of the Chinese eHEALS used in this study results in more definite scale content, thus increasing the practicality and applicability of this scale in health-promoting studies. %M 39024006 %R 10.2196/52314 %U https://www.jmir.org/2024/1/e52314 %U https://doi.org/10.2196/52314 %U http://www.ncbi.nlm.nih.gov/pubmed/39024006 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e50284 %T Validation and Refinement of the Sense of Coherence Scale for a French Population: Observational Study %A Sebo,Paul %A Tudrej,Benoit %A Bernard,Augustin %A Delaunay,Bruno %A Dupuy,Alexandra %A Malavergne,Claire %A Maisonneuve,Hubert %+ Institut universitaire de Médecine de Famille et de l'Enfance (University Institute for Primary Care), University of Geneva, Rue Michel Servet 1, Geneva, 1211, Switzerland, 41 22 379 50 61, paulsebo@hotmail.com %K French %K sense of coherence %K salutogenesis %K SOC %K Sense of Coherence scale %K validation %K validscale %K well-being %K promoting %K resilience %K validity %K reliability %K primary care patients %K manageability %D 2024 %7 16.7.2024 %9 Short Paper %J Interact J Med Res %G English %X Background: Salutogenesis focuses on understanding the factors that contribute to positive health outcomes. At the core of the model lies the sense of coherence (SOC), which plays a crucial role in promoting well-being and resilience. Objective: Using the validscale Stata command, we aimed to assess the psychometric properties of the French version of the 3-dimension 13-item SOC questionnaire (SOC-13), encompassing the comprehensibility, manageability, and meaningfulness dimensions. We also aimed to determine if a refined scale, assessed through this method, exhibits superior psychometric properties compared to the SOC-13. Methods: A sample of 880 consecutive primary care patients recruited from 35 French practices were asked to complete the SOC-13. We tested for internal consistency and scalability using the Cronbach α and Loevinger H coefficients, respectively, and we tested for construct validity using confirmatory factor analysis and goodness-of-fit indices (root mean square error of approximation [RMSEA] and comparative fit index [CFI]). Results: Of the 880 eligible patients, 804 (91.4%) agreed to participate (n=527, 65.6% women; median age 51 years). Cronbach α and Loevinger H coefficients for the SOC-13 were all <0.70 and <0.30, respectively, indicating poor internal consistency and poor scalability (0.64 and 0.29 for comprehensibility, 0.56 and 0.26 for manageability, and 0.46 and 0.17 for meaningfulness, respectively). The RMSEA and CFI were >0.06 (0.09) and <0.90 (0.83), respectively, indicating a poor fit. By contrast, the psychometric properties of a unidimensional 8-item version of the SOC questionnaire (SOC-8) were excellent (Cronbach α=0.82, Loevinger H=0.38, RMSEA=0.05, and CFI=0.97). Conclusions: The psychometric properties of the 3-dimension SOC-13 were poor, unlike the unidimensional SOC-8. A questionnaire built only with these 8 items could be a good candidate to measure the SOC. However, further validation studies are needed before recommending its use in research. %M 39012689 %R 10.2196/50284 %U https://www.i-jmr.org/2024/1/e50284 %U https://doi.org/10.2196/50284 %U http://www.ncbi.nlm.nih.gov/pubmed/39012689 %0 Journal Article %@ 2369-3762 %I %V 10 %N %P e58126 %T Use of Multiple-Choice Items in Summative Examinations: Questionnaire Survey Among German Undergraduate Dental Training Programs %A Rössler,Lena %A Herrmann,Manfred %A Wiegand,Annette %A Kanzow,Philipp %K alternate-choice %K assessment %K best-answer %K dental %K dental schools %K dental training %K education %K educational assessment %K educational measurement %K examination %K German %K Germany %K k of n %K Kprim %K K’ %K medical education %K medical student %K MTF %K Multiple-True-False %K multiple choice %K multiple-select %K Pick-N %K scoring %K scoring system %K single choice %K single response %K test %K testing %K true/false %K true-false %K Type A %K Type K %K Type K’ %K Type R %K Type X %K undergraduate %K undergraduate curriculum %K undergraduate education %D 2024 %7 27.6.2024 %9 %J JMIR Med Educ %G English %X Background: Multiple-choice examinations are frequently used in German dental schools. However, details regarding the used item types and applied scoring methods are lacking. Objective: This study aims to gain insight into the current use of multiple-choice items (ie, questions) in summative examinations in German undergraduate dental training programs. Methods: A paper-based 10-item questionnaire regarding the used assessment methods, multiple-choice item types, and applied scoring methods was designed. The pilot-tested questionnaire was mailed to the deans of studies and to the heads of the Department of Operative/Restorative Dentistry at all 30 dental schools in Germany in February 2023. Statistical analysis was performed using the Fisher exact test (P<.05). Results: The response rate amounted to 90% (27/30 dental schools). All respondent dental schools used multiple-choice examinations for summative assessments. Examinations were delivered electronically by 70% (19/27) of the dental schools. Almost all dental schools used single-choice Type A items (24/27, 89%), which accounted for the largest number of items in approximately half of the dental schools (13/27, 48%). Further item types (eg, conventional multiple-select items, Multiple-True-False, and Pick-N) were only used by fewer dental schools (≤67%, up to 18 out of 27 dental schools). For the multiple-select item types, the applied scoring methods varied considerably (ie, awarding [intermediate] partial credit and requirements for partial credit). Dental schools with the possibility of electronic examinations used multiple-select items slightly more often (14/19, 74% vs 4/8, 50%). However, this difference was statistically not significant (P=.38). Dental schools used items either individually or as key feature problems consisting of a clinical case scenario followed by a number of items focusing on critical treatment steps (15/27, 56%). Not a single school used alternative testing methods (eg, answer-until-correct). A formal item review process was established at about half of the dental schools (15/27, 56%). Conclusions: Summative assessment methods among German dental schools vary widely. Especially, a large variability regarding the use and scoring of multiple-select multiple-choice items was found. %R 10.2196/58126 %U https://mededu.jmir.org/2024/1/e58126 %U https://doi.org/10.2196/58126 %0 Journal Article %@ 2373-6658 %I JMIR Publications %V 8 %N %P e57128 %T Association Between Gestational Weeks, Initial Maternal Perception of Fetal Movement, and Individual Interoceptive Differences in Pregnant Women: Cross-Sectional Study %A Furusho,Miku %A Noda,Minami %A Sato,Yoko %A Suetsugu,Yoshiko %A Morokuma,Seiichi %+ Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan, 81 926426708, morokuma.seiichi.845@m.kyushu-u.ac.jp %K fetal movement %K gestational weeks %K gestation %K gestational %K heartbeat counting task %K interoception %K pregnancy %K pregnant %K maternal %K fetus %K fetal %K association %K associations %K correlation %K correlations %K obstetric %K obstetrics %K interoceptive %K perception %K perceptions %K awareness %K sense %K sensing %K senses %K internal stimulus %K internal stimuli %D 2024 %7 26.6.2024 %9 Original Paper %J Asian Pac Isl Nurs J %G English %X Background: Interoception encompasses the conscious awareness of homeostasis in the body. Given that fetal movement awareness is a component of interoception in pregnant women, the timing of initial detection of fetal movement may indicate individual differences in interoceptive sensitivity. Objective: The aim of this study is to determine whether the association between the gestational week of initial movement awareness and interoception can be a convenient evaluation index for interoception in pregnant women. Methods: A cross-sectional study was conducted among 32 pregnant women aged 20 years or older at 22-29 weeks of gestation with stable hemodynamics in the Obstetric Outpatient Department. Interoception was assessed using the heartbeat-counting task, with gestational weeks at the first awareness of fetal movement recorded via a questionnaire. Spearman rank correlation was used to compare the gestational weeks at the first awareness of fetal movement and heartbeat-counting task scores. Results: A significant negative correlation was found between the gestational weeks at the first fetal movement awareness and heartbeat-counting task performance among all participants (r=–0.43, P=.01) and among primiparous women (r=–0.53, P=.03) but not among multiparous women. Conclusions: Individual differences in interoception appear to correlate with the differences observed in the timing of the first awareness of fetal movement. %M 38924785 %R 10.2196/57128 %U https://apinj.jmir.org/2024/1/e57128 %U https://doi.org/10.2196/57128 %U http://www.ncbi.nlm.nih.gov/pubmed/38924785 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48777 %T Detection of Mild Cognitive Impairment Through Hand Motor Function Under Digital Cognitive Test: Mixed Methods Study %A Li,Aoyu %A Li,Jingwen %A Chai,Jiali %A Wu,Wei %A Chaudhary,Suamn %A Zhao,Juanjuan %A Qiang,Yan %+ College of Computer Science and Technology (College of Data Science), Taiyuan University of Technology, No. 209, University Street, Yuji District, Shanxi Province, Jinzhong, 030024, China, 86 18635168680, qiangyan@tyut.edu.cn %K mild cognitive impairment %K movement kinetics %K digital cognitive test %K dual task %K mobile phone %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Early detection of cognitive impairment or dementia is essential to reduce the incidence of severe neurodegenerative diseases. However, currently available diagnostic tools for detecting mild cognitive impairment (MCI) or dementia are time-consuming, expensive, or not widely accessible. Hence, exploring more effective methods to assist clinicians in detecting MCI is necessary. Objective: In this study, we aimed to explore the feasibility and efficiency of assessing MCI through movement kinetics under tablet-based “drawing and dragging” tasks. Methods: We iteratively designed “drawing and dragging” tasks by conducting symposiums, programming, and interviews with stakeholders (neurologists, nurses, engineers, patients with MCI, healthy older adults, and caregivers). Subsequently, stroke patterns and movement kinetics were evaluated in healthy control and MCI groups by comparing 5 categories of features related to hand motor function (ie, time, stroke, frequency, score, and sequence). Finally, user experience with the overall cognitive screening system was investigated using structured questionnaires and unstructured interviews, and their suggestions were recorded. Results: The “drawing and dragging” tasks can detect MCI effectively, with an average accuracy of 85% (SD 2%). Using statistical comparison of movement kinetics, we discovered that the time- and score-based features are the most effective among all the features. Specifically, compared with the healthy control group, the MCI group showed a significant increase in the time they took for the hand to switch from one stroke to the next, with longer drawing times, slow dragging, and lower scores. In addition, patients with MCI had poorer decision-making strategies and visual perception of drawing sequence features, as evidenced by adding auxiliary information and losing more local details in the drawing. Feedback from user experience indicates that our system is user-friendly and facilitates screening for deficits in self-perception. Conclusions: The tablet-based MCI detection system quantitatively assesses hand motor function in older adults and further elucidates the cognitive and behavioral decline phenomenon in patients with MCI. This innovative approach serves to identify and measure digital biomarkers associated with MCI or Alzheimer dementia, enabling the monitoring of changes in patients’ executive function and visual perceptual abilities as the disease advances. %M 38924786 %R 10.2196/48777 %U https://mhealth.jmir.org/2024/1/e48777 %U https://doi.org/10.2196/48777 %U http://www.ncbi.nlm.nih.gov/pubmed/38924786 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52801 %T Feasibility of a 2-Part Substance Use Screener Self-Administered by Patients on Paper: Observational Study %A Kramer,Joanna %A Wilens,Timothy E %A Rao,Vinod %A Villa,Richard %A Yule,Amy M %+ Department of Psychiatry, Boston Medical Center, Crosstown Building 408, 801 Massachusetts Avenue, Boston, MA, 02118, United States, 1 6174141936, amy.yule@bmc.org %K patient reported outcome measures %K patient reported outcomes %K substance use screening %K paper and pencil screening %K screening %K tobacco %K prescription medication %K medication %K substance use %K care %K mental health %K symptoms %D 2024 %7 25.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Measurement-based care in behavioral health uses patient-reported outcome measures (PROMs) to screen for mental health symptoms and substance use and to assess symptom change over time. While PROMs are increasingly being integrated into electronic health record systems and administered electronically, paper-based PROMs continue to be used. It is unclear if it is feasible to administer a PROM on paper when the PROM was initially developed for electronic administration. Objective: This study aimed to examine the feasibility of patient self-administration of a 2-part substance use screener—the Tobacco, Alcohol, Prescription medications, and other Substances (TAPS)—on paper. This screener was originally developed for electronic administration. It begins with a limited number of questions and branches to either skip or reflex to additional questions based on an individual’s responses. In this study, the TAPS was adapted for paper use due to barriers to electronic administration within an urgent care behavioral health clinic at an urban health safety net hospital. Methods: From August 2021 to March 2022, research staff collected deidentified paper TAPS responses and tracked TAPS completion rates and adherence to questionnaire instructions. A retrospective chart review was subsequently conducted to obtain demographic information for the patients who presented to the clinic between August 2021 and March 2022. Since the initial information collected from TAPS responses was deidentified, demographic information was not linked to the individual TAPS screeners that were tracked by research staff. Results: A total of 507 new patients were seen in the clinic with a mean age of 38.7 (SD 16.6) years. In all, 258 (50.9%) patients were male. They were predominantly Black (n=212, 41.8%), White (n=152, 30%), and non-Hispanic or non-Latino (n=403, 79.5%). Most of the patients were publicly insured (n=411, 81.1%). Among these 507 patients, 313 (61.7%) completed the TAPS screener. Of these 313 patients, 76 (24.3%) adhered to the instructions and 237 (75.7%) did not follow the instructions correctly. Of the 237 respondents who did not follow the instructions correctly, 166 (70%) answered more questions and 71 (30%) answered fewer questions than required in TAPS part 2. Among the 237 patients who did not adhere to questionnaire instructions, 44 (18.6%) responded in a way that contradicted their response in part 1 of the screener and ultimately affected their overall TAPS score. Conclusions: It was challenging for patients to adhere to questionnaire instructions when completing a substance use screener on paper that was originally developed for electronic use. When selecting PROMs for measurement-based care, it is important to consider the structure of the questionnaire and how the PROM will be administered to determine if additional support for PROM self-administration needs to be implemented. %M 38916950 %R 10.2196/52801 %U https://formative.jmir.org/2024/1/e52801 %U https://doi.org/10.2196/52801 %U http://www.ncbi.nlm.nih.gov/pubmed/38916950 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55597 %T Instruments for Measuring Psychological Dimensions in Human-Robot Interaction: Systematic Review of Psychometric Properties %A Vagnetti,Roberto %A Camp,Nicola %A Story,Matthew %A Ait-Belaid,Khaoula %A Mitra,Suvobrata %A Zecca,Massimiliano %A Di Nuovo,Alessandro %A Magistro,Daniele %+ Department of Sport Science, School of Science and Technology, Nottingham Trent University, College Drive, Clifton, Nottingham, NG11 8NS, United Kingdom, 44 115 848 3522, daniele.magistro@ntu.ac.uk %K psychometric %K human-robot interaction %K psychological dimensions %K robot %K assessment %K systematic review %D 2024 %7 5.6.2024 %9 Review %J J Med Internet Res %G English %X Background: Numerous user-related psychological dimensions can significantly influence the dynamics between humans and robots. For developers and researchers, it is crucial to have a comprehensive understanding of the psychometric properties of the available instruments used to assess these dimensions as they indicate the reliability and validity of the assessment. Objective: This study aims to provide a systematic review of the instruments available for assessing the psychological aspects of the relationship between people and social and domestic robots, offering a summary of their psychometric properties and the quality of the evidence. Methods: A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines across different databases: Scopus, PubMed, and IEEE Xplore. The search strategy encompassed studies meeting the following inclusion criteria: (1) the instrument could assess psychological dimensions related to social and domestic robots, including attitudes, beliefs, opinions, feelings, and perceptions; (2) the study focused on validating the instrument; (3) the study evaluated the psychometric properties of the instrument; (4) the study underwent peer review; and (5) the study was in English. Studies focusing on industrial robots, rescue robots, or robotic arms or those primarily concerned with technology validation or measuring anthropomorphism were excluded. Independent reviewers extracted instrument properties and the methodological quality of their evidence following the Consensus-Based Standards for the Selection of Health Measurement Instruments guidelines. Results: From 3828 identified records, the search strategy yielded 34 (0.89%) articles that validated and examined the psychometric properties of 27 instruments designed to assess individuals’ psychological dimensions in relation to social and domestic robots. These instruments encompass a broad spectrum of psychological dimensions. While most studies predominantly focused on structural validity (24/27, 89%) and internal consistency (26/27, 96%), consideration of other psychometric properties was frequently inconsistent or absent. No instrument evaluated measurement error and responsiveness despite their significance in the clinical context. Most of the instruments (17/27, 63%) were targeted at both adults and older adults (aged ≥18 years). There was a limited number of instruments specifically designed for children, older adults, and health care contexts. Conclusions: Given the strong interest in assessing psychological dimensions in the human-robot relationship, there is a need to develop new instruments using more rigorous methodologies and consider a broader range of psychometric properties. This is essential to ensure the creation of reliable and valid measures for assessing people’s psychological dimensions regarding social and domestic robots. Among its limitations, this review included instruments applicable to both social and domestic robots while excluding those for other specific types of robots (eg, industrial robots). %M 38682783 %R 10.2196/55597 %U https://www.jmir.org/2024/1/e55597 %U https://doi.org/10.2196/55597 %U http://www.ncbi.nlm.nih.gov/pubmed/38682783 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52457 %T Electronic Health Literacy Scale-Web3.0 for Older Adults with Noncommunicable Diseases: Validation Study %A Cai,Wenfei %A Liang,Wei %A Liu,Huaxuan %A Zhou,Rundong %A Zhang,Jie %A Zhou,Lin %A Su,Ning %A Zhu,Hanxiao %A Yang,Yide %+ School of Physical Education, Shenzhen University, 3688 Nanhai Road, Nanshan District, Shenzhen, 518060, China, 86 15217940540, wliang1020@szu.edu.cn %K eHealth literacy %K measurement %K Web 3.0 %K psychometric properties %K NCD %K older adults %K noncommunicable diseases %K Electronic Health Literacy %K health literacy %K eHealth %K reliability %K validity %D 2024 %7 3.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In the current digital era, eHealth literacy plays an indispensable role in health care and self-management among older adults with noncommunicable diseases (NCDs). Measuring eHealth literacy appropriately and accurately ensures the successful implementation and evaluation of pertinent research and interventions. However, existing eHealth literacy measures focus mainly on individuals’ abilities of accessing and comprehending eHealth information (Web1.0), whereas the capabilities for web-based interaction (Web2.0) and using eHealth information (Web3.0) have not been adequately evaluated. Objective: This study aimed to examine the reliability, validity, and measurement invariance of the eHealth Literacy Scale-Web3.0 (eHLS-Web3.0) among older adults with NCDs. Methods: A total of 642 Chinese older adults with NCDs (mean age 65.78, SD 3.91 years; 55.8% female) were recruited in the baseline assessment, of whom 134 (mean age 65.63, SD 3.99 years; 58.2% female) completed the 1-month follow-up assessment. Baseline measures included the Chinese version of the 24-item 3D eHLS-Web3.0, the Chinese version of the 8-item unidimensional eHealth Literacy Scale (eHEALS), and demographic information. Follow-up measures included the 24-item eHLS-Web3.0 and accelerometer-measured physical activity and sedentary behavior. A series of statistical analyses, for example, Cronbach α, composite reliability coefficient (CR), confirmatory factor analysis (CFA), and multigroup CFA, were performed to examine the internal consistency and test-retest reliabilities, as well as the construct, concurrent, convergent, discriminant, and predictive validities, and the measurement invariance of the eHLS-Web3.0 across gender, education level, and residence. Results: Cronbach α and CR were within acceptable ranges of 0.89-0.94 and 0.90-0.97, respectively, indicating adequate internal consistency of the eHLS-Web3.0 and its subscales. The eHLS-Web3.0 also demonstrated cross-time stability, with baseline and follow-up measures showing a significant intraclass correlation of 0.81-0.91. The construct validity of the 3D structure model of the eHLS-Web3.0 was supported by confirmatory factor analyses. The eHLS-Web3.0 exhibited convergent validity with an average variance extracted value of 0.58 and a CR value of 0.97. Discriminant validity was supported by CFA results for a proposed 4-factor model integrating the 3 eHLS-Web3.0 subscales and eHEALS. The predictive validity of the eHLS-Web3.0 for health behaviors was supported by significant associations of the eHLS-Web3.0 with light physical activity (β=.36, P=.004), moderate to vigorous physical activity (β=.49, P<.001), and sedentary behavior (β=–.26, P=.002). Finally, the measurement invariance of the eHLS-Web3.0 across gender, education level, and residence was supported by the establishment of configural, metric, strong, and strict invariances. Conclusions: The present study provides timely empirical evidence on the reliability, validity, and measurement invariance of the eHLS-Web3.0, suggesting that the 24-item 3D eHLS-Web3.0 is an appropriate and valid tool for measuring eHealth literacy among older adults with NCDs within the Web3.0 sphere. %M 38830207 %R 10.2196/52457 %U https://www.jmir.org/2024/1/e52457 %U https://doi.org/10.2196/52457 %U http://www.ncbi.nlm.nih.gov/pubmed/38830207 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49907 %T Controlling Inputter Variability in Vignette Studies Assessing Web-Based Symptom Checkers: Evaluation of Current Practice and Recommendations for Isolated Accuracy Metrics %A Meczner,András %A Cohen,Nathan %A Qureshi,Aleem %A Reza,Maria %A Sutaria,Shailen %A Blount,Emily %A Bagyura,Zsolt %A Malak,Tamer %+ Healthily, 167-169 Great Portland Street, London, W1W 5PF, United Kingdom, meczner@gmail.com %K symptom checker %K accuracy %K vignette studies %K variability %K methods %K triage %K evaluation %K vignette %K performance %K metrics %K mobile phone %D 2024 %7 31.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The rapid growth of web-based symptom checkers (SCs) is not matched by advances in quality assurance. Currently, there are no widely accepted criteria assessing SCs’ performance. Vignette studies are widely used to evaluate SCs, measuring the accuracy of outcome. Accuracy behaves as a composite metric as it is affected by a number of individual SC- and tester-dependent factors. In contrast to clinical studies, vignette studies have a small number of testers. Hence, measuring accuracy alone in vignette studies may not provide a reliable assessment of performance due to tester variability. Objective: This study aims to investigate the impact of tester variability on the accuracy of outcome of SCs, using clinical vignettes. It further aims to investigate the feasibility of measuring isolated aspects of performance. Methods: Healthily’s SC was assessed using 114 vignettes by 3 groups of 3 testers who processed vignettes with different instructions: free interpretation of vignettes (free testers), specified chief complaints (partially free testers), and specified chief complaints with strict instruction for answering additional symptoms (restricted testers). κ statistics were calculated to assess agreement of top outcome condition and recommended triage. Crude and adjusted accuracy was measured against a gold standard. Adjusted accuracy was calculated using only results of consultations identical to the vignette, following a review and selection process. A feasibility study for assessing symptom comprehension of SCs was performed using different variations of 51 chief complaints across 3 SCs. Results: Intertester agreement of most likely condition and triage was, respectively, 0.49 and 0.51 for the free tester group, 0.66 and 0.66 for the partially free group, and 0.72 and 0.71 for the restricted group. For the restricted group, accuracy ranged from 43.9% to 57% for individual testers, averaging 50.6% (SD 5.35%). Adjusted accuracy was 56.1%. Assessing symptom comprehension was feasible for all 3 SCs. Comprehension scores ranged from 52.9% and 68%. Conclusions: We demonstrated that by improving standardization of the vignette testing process, there is a significant improvement in the agreement of outcome between testers. However, significant variability remained due to uncontrollable tester-dependent factors, reflected by varying outcome accuracy. Tester-dependent factors, combined with a small number of testers, limit the reliability and generalizability of outcome accuracy when used as a composite measure in vignette studies. Measuring and reporting different aspects of SC performance in isolation provides a more reliable assessment of SC performance. We developed an adjusted accuracy measure using a review and selection process to assess data algorithm quality. In addition, we demonstrated that symptom comprehension with different input methods can be feasibly compared. Future studies reporting accuracy need to apply vignette testing standardization and isolated metrics. %M 38820578 %R 10.2196/49907 %U https://formative.jmir.org/2024/1/e49907 %U https://doi.org/10.2196/49907 %U http://www.ncbi.nlm.nih.gov/pubmed/38820578 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53071 %T Electronic Immunization Registry in Rwanda: Qualitative Study of Health Worker Experiences %A Uwera,Thaoussi %A Venkateswaran,Mahima %A Bhutada,Kiran %A Papadopoulou,Eleni %A Rukundo,Enock %A K Tumusiime,David %A Frøen,J Frederik %+ Centre of Excellence in Biomedical Engineering and eHealth, University of Rwanda, KG 11 Ave Gasabo, Kigali, Rwanda, 250 788229321, uwera04@gmail.com %K childhood immunization %K electronic immunization registry %K digital health interventions %D 2024 %7 28.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Monitoring childhood immunization programs is essential for health systems. Despite the introduction of an electronic immunization registry called e-Tracker in Rwanda, challenges such as lacking population denominators persist, leading to implausible reports of coverage rates of more than 100%. Objective: This study aimed to assess the extent to which the immunization e-Tracker responds to stakeholders’ needs and identify key areas for improvement. Methods: In-depth interviews were conducted with all levels of e-Tracker users including immunization nurses, data managers, and supervisors from health facilities in 5 districts of Rwanda. We used an interview guide based on the constructs of the Human, Organization, and Technology–Fit (HOT-Fit) framework, and we analyzed and summarized our findings using the framework. Results: Immunization nurses reported using the e-Tracker as a secondary data entry tool in addition to paper-based forms, which resulted in considerable dissatisfaction among nurses. While users acknowledged the potential of a digital tool compared to paper-based systems, they also reported the need for improvement of functionalities to support their work, such as digital client appointment lists, lists of defaulters, search and register functions, automated monthly reports, and linkages to birth notifications and the national identity system. Conclusions: Reducing dual documentation for users can improve e-Tracker use and user satisfaction. Our findings can help identify additional digital health interventions to support and strengthen the health information system for the immunization program. %M 38805254 %R 10.2196/53071 %U https://humanfactors.jmir.org/2024/1/e53071 %U https://doi.org/10.2196/53071 %U http://www.ncbi.nlm.nih.gov/pubmed/38805254 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56889 %T Reliability of a Smartphone App to Objectively Monitor Performance Outcomes in Degenerative Cervical Myelopathy: Observational Study %A Yanez Touzet,Alvaro %A Houhou,Tatiana %A Rahic,Zerina %A Kolias,Angelos %A Yordanov,Stefan %A Anderson,David B %A Laufer,Ilya %A Li,Maggie %A Grahovac,Gordan %A Kotter,Mark RN %A Davies,Benjamin M %A , %+ Department of Clinical Neurosciences, University of Cambridge, Level 3, A Block, Box 165, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, United Kingdom, 44 01223746454, bd375@cam.ac.uk %K reproducibility of results %K patient outcome assessment %K smartphone %K neurology %K psychometrics %K spinal cord compression %K mobile phone %D 2024 %7 24.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Developing new clinical measures for degenerative cervical myelopathy (DCM) is an AO Spine RECODE-DCM Research, an international and multi-stakeholder partnership, priority. Difficulties in detecting DCM and its changes cause diagnostic and treatment delays in clinical settings and heightened costs in clinical trials due to elevated recruitment targets. Digital outcome measures can tackle these challenges due to their ability to measure disease remotely, repeatedly, and more economically. Objective: The aim of this study is to assess the reliability of the MoveMed battery of performance outcome measures. Methods: A prospective observational study in decentralized secondary care was performed in England, United Kingdom. The primary outcome was to determine the test-retest reliability of the MoveMed performance outcomes using the intraclass correlation (ICC) of agreement . The secondary outcome was to determine the measurement error of the MoveMed performance outcomes using both the SE of the mean (SEM) of agreement and the smallest detectable change (SDC) of agreement . Criteria from the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) manual were used to determine adequate reliability (ie, ICC of agreement ≥0.7) and risk of bias. Disease stability was controlled using 2 minimum clinically important difference (MCID) thresholds obtained from the literature on the patient-derived modified Japanese Orthopaedic Association (p-mJOA) score, namely, MCID ≤1 point and MCID ≤2 points. Results: In total, 7 adults aged 59.5 (SD 12.4) years who live with DCM and possess an approved smartphone participated in the study. All tests demonstrated moderate to excellent test-retest coefficients and low measurement errors. In the MCID ≤1 group, ICC of agreement values were 0.84-0.94 in the fast tap test, 0.89-0.95 in the hold test, 0.95 in the typing test, and 0.98 in the stand and walk test. SEM of agreement values were ±1 tap, ±1%-3% stability score points, ±0.06 keys per second, and ±10 steps per minute, respectively. SDC of agreement values were ±3 taps, ±4%-7% stability score points, ±0.2 keys per second, and ±27 steps per minute, respectively. In the MCID ≤2 group, ICC of agreement values were 0.61-0.91, 0.75-0.77, 0.98, and 0.62, respectively; SEM of agreement values were ±1 tap, ±2%-4% stability score points, ±0.06 keys per second, and ±10 steps per minute, respectively; and SDC of agreement values were ±3-7 taps, ±7%-10% stability score points, ±0.2 keys per second, and ±27 steps per minute, respectively. Furthermore, the fast tap, hold, and typing tests obtained sufficient ratings (ICC of agreement ≥0.7) in both MCID ≤1 and MCID ≤2 groups. No risk of bias factors from the COSMIN Risk of Bias checklist were recorded. Conclusions: The criteria from COSMIN provide “very good” quality evidence of the reliability of the MoveMed tests in an adult population living with DCM. %M 38787602 %R 10.2196/56889 %U https://formative.jmir.org/2024/1/e56889 %U https://doi.org/10.2196/56889 %U http://www.ncbi.nlm.nih.gov/pubmed/38787602 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51013 %T Using a Semiautomated Procedure (CleanADHdata.R Script) to Clean Electronic Adherence Monitoring Data: Tutorial %A Bandiera,Carole %A Pasquier,Jérôme %A Locatelli,Isabella %A Schneider,Marie P %+ School of Pharmaceutical Sciences, University of Geneva, Rue Michel-Servet 1, Geneva, 1205, Switzerland, 41 223795316, marie.schneider@unige.ch %K medication adherence %K digital technology %K digital pharmacy %K electronic adherence monitoring %K data management %K data cleaning %K research methodology %K algorithms %K R %K semiautomated %K code %K coding %K computer science %K computer programming %K medications %K computer script %D 2024 %7 22.5.2024 %9 Tutorial %J JMIR Form Res %G English %X Background: Patient adherence to medications can be assessed using interactive digital health technologies such as electronic monitors (EMs). Changes in treatment regimens and deviations from EM use over time must be characterized to establish the actual level of medication adherence. Objective: We developed the computer script CleanADHdata.R to clean raw EM adherence data, and this tutorial is a guide for users. Methods: In addition to raw EM data, we collected adherence start and stop monitoring dates and identified the prescribed regimens, the expected number of EM openings per day based on the prescribed regimen, EM use deviations, and patients’ demographic data. The script formats the data longitudinally and calculates each day’s medication implementation. Results: We provided a simulated data set for 10 patients, for which 15 EMs were used over a median period of 187 (IQR 135-342) days. The median patient implementation before and after EM raw data cleaning was 83.3% (IQR 71.5%-93.9%) and 97.3% (IQR 95.8%-97.6%), respectively (Δ+14%). This difference is substantial enough to consider EM data cleaning to be capable of avoiding data misinterpretation and providing a cleaned data set for the adherence analysis in terms of implementation and persistence. Conclusions: The CleanADHdata.R script is a semiautomated procedure that increases standardization and reproducibility. This script has broader applicability within the realm of digital health, as it can be used to clean adherence data collected with diverse digital technologies. %M 38776539 %R 10.2196/51013 %U https://formative.jmir.org/2024/1/e51013 %U https://doi.org/10.2196/51013 %U http://www.ncbi.nlm.nih.gov/pubmed/38776539 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e49916 %T Psychometric Assessment of an Item Bank for Adaptive Testing on Patient-Reported Experience of Care Environment for Severe Mental Illness: Validation Study %A Fernandes,Sara %A Brousse,Yann %A Zendjidjian,Xavier %A Cano,Delphine %A Riedberger,Jérémie %A Llorca,Pierre-Michel %A Samalin,Ludovic %A Dassa,Daniel %A Trichard,Christian %A Laprevote,Vincent %A Sauvaget,Anne %A Abbar,Mocrane %A Misdrahi,David %A Berna,Fabrice %A Lancon,Christophe %A Coulon,Nathalie %A El-Hage,Wissam %A Rozier,Pierre-Emmanuel %A Benoit,Michel %A Giordana,Bruno %A Caqueo-Urízar,Alejandra %A Yon,Dong Keon %A Tran,Bach %A Auquier,Pascal %A Fond,Guillaume %A Boyer,Laurent %+ Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, 27, Boulevard Jean-Moulin, Marseille, 13385, France, 33 660185077, sarah.fernandes@ap-hm.fr %K psychiatry %K public mental health %K schizophrenia %K major depressive disorders %K bipolar disorders %K patient-reported experience measures %K quality of care %K health services research %K computerized adaptive testing %K real-world data %D 2024 %7 16.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: The care environment significantly influences the experiences of patients with severe mental illness and the quality of their care. While a welcoming and stimulating environment enhances patient satisfaction and health outcomes, psychiatric facilities often prioritize staff workflow over patient needs. Addressing these challenges is crucial to improving patient experiences and outcomes in mental health care. Objective: This study is part of the Patient-Reported Experience Measure for Improving Quality of Care in Mental Health (PREMIUM) project and aims to establish an item bank (PREMIUM-CE) and to develop computerized adaptive tests (CATs) to measure the experience of the care environment of adult patients with schizophrenia, bipolar disorder, or major depressive disorder. Methods: We performed psychometric analyses including assessments of item response theory (IRT) model assumptions, IRT model fit, differential item functioning (DIF), item bank validity, and CAT simulations. Results: In this multicenter cross-sectional study, 498 patients were recruited from outpatient and inpatient settings. The final PREMIUM-CE 13-item bank was sufficiently unidimensional (root mean square error of approximation=0.082, 95% CI 0.067-0.097; comparative fit index=0.974; Tucker-Lewis index=0.968) and showed an adequate fit to the IRT model (infit mean square statistic ranging between 0.7 and 1.0). DIF analysis revealed no item biases according to gender, health care settings, diagnosis, or mode of study participation. PREMIUM-CE scores correlated strongly with satisfaction measures (r=0.69-0.78; P<.001) and weakly with quality-of-life measures (r=0.11-0.21; P<.001). CAT simulations showed a strong correlation (r=0.98) between CAT scores and those of the full item bank, and around 79.5% (396/498) of the participants obtained a reliable score with the administration of an average of 7 items. Conclusions: The PREMIUM-CE item bank and its CAT version have shown excellent psychometric properties, making them reliable measures for evaluating the patient experience of the care environment among adults with severe mental illness in both outpatient and inpatient settings. These measures are a valuable addition to the existing landscape of patient experience assessment, capturing what truly matters to patients and enhancing the understanding of their care experiences. Trial Registration: ClinicalTrials.gov NCT02491866; https://clinicaltrials.gov/study/NCT02491866 %M 38753416 %R 10.2196/49916 %U https://mental.jmir.org/2024/1/e49916 %U https://doi.org/10.2196/49916 %U http://www.ncbi.nlm.nih.gov/pubmed/38753416 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49227 %T Spanish and Catalan Versions of the eHealth Literacy Questionnaire: Translation, Cross-Cultural Adaptation, and Validation Study %A Hernández Encuentra,Eulàlia %A Robles,Noemí %A Angulo-Brunet,Ariadna %A Cullen,David %A del Arco,Ignacio %+ Faculty of Psychology and Education, Universitat Oberta de Catalunya, Campus UOC. Rambla Poblenou, 156, Barcelona, 08018, Spain, 34 933263898, ehernandez@uoc.edu %K eHealth literacy %K eHealth %K digital health %K health literacy %K questionnaire %K eHealth Literacy Questionnaire %K eHLQ %K validation %D 2024 %7 10.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The rise of digital health services, especially following the outbreak of COVID-19, has led to a need for health literacy policies that respond to people’s needs. Spain is a country with a highly developed digital health infrastructure, but there are currently no tools available to measure digital health literacy fully. A well-thought-through questionnaire with strong psychometric properties such as the eHealth Literacy Questionnaire (eHLQ) is important to assess people’s eHealth literacy levels, especially in the context of a fast-growing field such as digital health. Objective: This study aims to adapt the eHLQ and gather evidence of its psychometric quality in 2 of Spain’s official languages: Spanish and Catalan. Methods: A systematic cultural adaptation process was followed. Data from Spanish-speaking (n=400) and Catalan-speaking (n=400) people were collected. Confirmatory factor analysis was used to confirm the previously established factor structure. For reliability, the Cronbach α and categorical ω were obtained for every subscale. Evidence of convergent and discriminant validity was provided through the correlation with the total score of the eHealth Literacy Scale. Evidence based on relations to other variables was evaluated by examining extreme values for educational level, socioeconomic level, and use of technology variables. Results: Regarding the confirmatory factor analysis, the 7-factor correlated model and the 7 one-factor models had adequate goodness-of-fit indexes for both Spanish and Catalan. Moreover, measurement invariance was established between the Spanish and Catalan versions. Reliability estimates were considered adequate as all the scales in both versions had values of >0.80. For convergent and discriminant validity evidence, the eHealth Literacy Scale showed moderate correlation with eHLQ scales in both versions (Spanish: range 0.57-0.76 and P<.001; Catalan: range 0.41-0.64 and P<.001). According to the relationship with external variables, all the eHLQ scales in both languages could discriminate between the maximum and minimum categories in level of education, socioeconomic level, and level of technology use. Conclusions: The Spanish and Catalan versions of the eHLQ appear to be psychometrically sound questionnaires for assessing digital health literacy. They could both be useful tools in Spain and Catalonia for researchers, policy makers, and health service managers to explore people’s needs, skills, and competencies and provide interesting insights into their interactions and engagement regarding their own experiences with digital health services, especially in the context of digital health growth in Spain. %M 38728072 %R 10.2196/49227 %U https://www.jmir.org/2024/1/e49227 %U https://doi.org/10.2196/49227 %U http://www.ncbi.nlm.nih.gov/pubmed/38728072 %0 Journal Article %@ 2291-9694 %I %V 12 %N %P e51274 %T Evaluation of SNOMED CT Grouper Accuracy and Coverage in Organizing the Electronic Health Record Problem List by Clinical System: Observational Study %A Senior,Rashaud %A Tsai,Timothy %A Ratliff,William %A Nadler,Lisa %A Balu,Suresh %A Malcolm,Elizabeth %A McPeek Hinz,Eugenia %K electronic health record %K problem List %K problem list organization %K problem list management %K SNOMED CT %K SNOMED CT Groupers %K Systematized Nomenclature of Medicine %K clinical term %K ICD-10 %K International Classification of Diseases %D 2024 %7 9.5.2024 %9 %J JMIR Med Inform %G English %X Background: The problem list (PL) is a repository of diagnoses for patients’ medical conditions and health-related issues. Unfortunately, over time, our PLs have become overloaded with duplications, conflicting entries, and no-longer-valid diagnoses. The lack of a standardized structure for review adds to the challenges of clinical use. Previously, our default electronic health record (EHR) organized the PL primarily via alphabetization, with other options available, for example, organization by clinical systems or priority settings. The system’s PL was built with limited groupers, resulting in many diagnoses that were inconsistent with the expected clinical systems or not associated with any clinical systems at all. As a consequence of these limited EHR configuration options, our PL organization has poorly supported clinical use over time, particularly as the number of diagnoses on the PL has increased. Objective: We aimed to measure the accuracy of sorting PL diagnoses into PL system groupers based on Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) concept groupers implemented in our EHR. Methods: We transformed and developed 21 system- or condition-based groupers, using 1211 SNOMED CT hierarchal concepts refined with Boolean logic, to reorganize the PL in our EHR. To evaluate the clinical utility of our new groupers, we extracted all diagnoses on the PLs from a convenience sample of 50 patients with 3 or more encounters in the previous year. To provide a spectrum of clinical diagnoses, we included patients from all ages and divided them by sex in a deidentified format. Two physicians independently determined whether each diagnosis was correctly attributed to the expected clinical system grouper. Discrepancies were discussed, and if no consensus was reached, they were adjudicated by a third physician. Descriptive statistics and Cohen κ statistics for interrater reliability were calculated. Results: Our 50-patient sample had a total of 869 diagnoses (range 4-59; median 12, IQR 9-24). The reviewers initially agreed on 821 system attributions. Of the remaining 48 items, 16 required adjudication with the tie-breaking third physician. The calculated κ statistic was 0.7. The PL groupers appropriately associated diagnoses to the expected clinical system with a sensitivity of 97.6%, a specificity of 58.7%, a positive predictive value of 96.8%, and an F1-score of 0.972. Conclusions: We found that PL organization by clinical specialty or condition using SNOMED CT concept groupers accurately reflects clinical systems. Our system groupers were subsequently adopted by our vendor EHR in their foundation system for PL organization. %R 10.2196/51274 %U https://medinform.jmir.org/2024/1/e51274 %U https://doi.org/10.2196/51274 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57963 %T Serbian Version of the eHealth Literacy Questionnaire (eHLQ): Translation, Cultural Adaptation, and Validation Study Among Primary Health Care Users %A Vujkovic,Branko %A Brkovic,Voin %A Pajičić,Ana %A Pavlovic,Vedrana %A Stanisavljevic,Dejana %A Krajnović,Dušanka %A Jovic Vranes,Aleksandra %+ Institute of Public Health of Sabac, 1 Jovana Cvijica, Sabac, 15000, 381 648623647, vujkovicb@gmail.com %K eHealth %K digital health %K eHLQ %K eHealth Literacy Questionnaire %K digital health literacy %K primary healthcare %K Serbia %K questionnaire %K technology %K communication %D 2024 %7 9.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: As digital health services are increasingly developing and becoming more interactive in Serbia, a comprehensive instrument for measuring eHealth literacy (EHL) is needed. Objective: This study aimed to translate, culturally adapt, and investigate the psychometric properties of the Serbian version of the eHealth Literacy Questionnaire (eHLQ); to evaluate EHL in the population of primary health care (PHC) users in Serbia; and to explore factors associated with their EHL. Methods: The validation study was conducted in 8 PHC centers in the territory of the Mačva district in Western Serbia. A stratified sampling method was used to obtain a representative sample. The Translation Integrity Procedure was followed to adapt the questionnaire to the Serbian language. The psychometric properties of the Serbian version of the eHLQ were analyzed through the examination of factorial structure, internal consistency, and test-retest reliability. Descriptive statistics were calculated to determine participant characteristics. Differences between groups were tested by the 2-tailed Students t test and ANOVA. Univariable and multivariable linear regression analyses were used to determine factors related to EHL. Results: A total of 475 PHC users were enrolled. The mean age was 51.0 (SD 17.3; range 19-94) years, and most participants were female (328/475, 69.1%). Confirmatory factor analysis validated the 7-factor structure of the questionnaire. Values for incremental fit index (0.96) and comparative fit index (0.95) were above the cutoff of ≥0.95. The root mean square error of approximation value of 0.05 was below the suggested value of ≤0.06. Cronbach α of the entire scale was 0.95, indicating excellent scale reliability, with Cronbach α ranging from 0.81 to 0.90 for domains. The intraclass correlation coefficient ranged from 0.63 to 0.82, indicating moderate to good test-retest reliability. The highest EHL mean scores were obtained for the understanding of health concepts and language (mean 2.86, SD 0.32) and feel safe and in control (mean 2.89, SD 0.33) domains. Statistically significant differences (all P<.05) for all 7 eHLQ scores were observed for age, education, perceived material status, perceived health status, searching for health information on the internet, and occupation (except domain 4). In multivariable regression models, searching for health information on the internet and being aged younger than 65 years were associated with higher values of all domain scores except the domain feel safe and in control for variable age. Conclusions: This study demonstrates that the Serbian version of the eHLQ can be a useful tool in the measurement of EHL and in the planning of digital health interventions at the population and individual level due to its strong psychometric properties in the Serbian context. %M 38722675 %R 10.2196/57963 %U https://www.jmir.org/2024/1/e57963 %U https://doi.org/10.2196/57963 %U http://www.ncbi.nlm.nih.gov/pubmed/38722675 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e49903 %T Content Validity and Psychometric Properties of the German Version of the Holm and Cordoba Urinary Tract Infection Score for Uncomplicated Urinary Tract Infections in Women: Protocol for a Validation Study %A Piontek,Katharina %A Nestler,Sophie %A Holm,Anne %A Brodersen,John Brandt %A Apfelbacher,Christian %+ Institute of Social Medicine and Health Systems Research, Medical Faculty Magdeburg, Leipziger Straße 44, Magdeburg, 39120, Germany, 49 391 67 24307, katharina.piontek@med.ovgu.de %K uncomplicated urinary tract infections %K patient-reported outcome measures %K PROM %K PROMs %K content validity %K psychometric properties %K patient reported %K validity %K validation %K urology %K urinary %K urinary tract infection %K UTI %K psychometric %K scale %K score %K scoring %K assessment %K women’s health %K internal medicine %K women %K urinary tract infections %K bacterial infection %K primary care %K infection %D 2024 %7 7.5.2024 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Uncomplicated urinary tract infections (UTIs) in women are among the most common bacterial infections in primary care. Given the health threats related to the overuse of antibiotics, alternative options are of increasing importance. Patient-reported outcome measures are valuable tools for including the patients’ perspective when evaluating the efficacy of these strategies. Aiming to identify a suitable instrument to measure the severity and bothersomeness of UTI symptoms in women, we performed a systematic review of the literature and identified the Holm and Cordoba Urinary Tract Infection Score (HCUTI), which measures the severity, bothersomeness, and impact of uncomplicated UTIs on daily activities. This instrument showed sufficient content validity but needs translation and further validation before it can be used in German research. Objective: For use in the German setting, we aim (1) to perform translation and linguistic validation of the HCUTI and (2) to evaluate content validity and psychometric properties of the German version of the HCUTI in a population of women with uncomplicated UTIs. Methods: The HCUTI will be translated and linguistically validated using the dual-panel method. This process involves a bilingual translation panel and a lay panel to check the comprehensibility of the translation. Content validity of the translated questionnaire will be assessed using cognitive interviews according to the criteria for good content validity as recommended by the COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) group involving women with uncomplicated UTIs and health care professionals. Subsequent psychometric validation of the German version of the HCUTI in a population of women with uncomplicated UTIs will include the assessment of structural validity, internal consistency, test-retest reliability, construct validity, responsiveness, and interpretability. Results: Results of the translation and linguistic validation process and the results of the content validity study were obtained in September 2023 and will be published separately. Data on the psychometric properties of the German version of the HCUTI are anticipated in mid-2024. Conclusions: We expect that data from the content validity study will provide important suggestions for potential modifications of the HCUTI for use in the German setting. The final version of the questionnaire will be used for the assessment of its psychometric properties in a large population of women with uncomplicated UTIs. International Registered Report Identifier (IRRID): PRR1-10.2196/49903 %M 38713509 %R 10.2196/49903 %U https://www.researchprotocols.org/2024/1/e49903 %U https://doi.org/10.2196/49903 %U http://www.ncbi.nlm.nih.gov/pubmed/38713509 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52499 %T Using Large Language Models to Support Content Analysis: A Case Study of ChatGPT for Adverse Event Detection %A Leas,Eric C %A Ayers,John W %A Desai,Nimit %A Dredze,Mark %A Hogarth,Michael %A Smith,Davey M %+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, Mail Code: 0725, La Jolla, CA, 92093, United States, 1 951 346 9131, ecleas@ucsd.edu %K adverse events %K artificial intelligence %K AI %K text analysis %K annotation %K ChatGPT %K LLM %K large language model %K cannabis %K delta-8-THC %K delta-8-tetrahydrocannabiol %D 2024 %7 2.5.2024 %9 Research Letter %J J Med Internet Res %G English %X This study explores the potential of using large language models to assist content analysis by conducting a case study to identify adverse events (AEs) in social media posts. The case study compares ChatGPT’s performance with human annotators’ in detecting AEs associated with delta-8-tetrahydrocannabinol, a cannabis-derived product. Using the identical instructions given to human annotators, ChatGPT closely approximated human results, with a high degree of agreement noted: 94.4% (9436/10,000) for any AE detection (Fleiss κ=0.95) and 99.3% (9931/10,000) for serious AEs (κ=0.96). These findings suggest that ChatGPT has the potential to replicate human annotation accurately and efficiently. The study recognizes possible limitations, including concerns about the generalizability due to ChatGPT’s training data, and prompts further research with different models, data sources, and content analysis tasks. The study highlights the promise of large language models for enhancing the efficiency of biomedical research. %M 38696245 %R 10.2196/52499 %U https://www.jmir.org/2024/1/e52499 %U https://doi.org/10.2196/52499 %U http://www.ncbi.nlm.nih.gov/pubmed/38696245 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53442 %T Digital Food Frequency Questionnaire Assessing Adherence to the Norwegian Food–Based Dietary Guidelines and Other National Lifestyle Recommendations: Instrument Validation Study %A Henriksen,Hege Berg %A Knudsen,Markus Dines %A Hjartåker,Anette %A Blomhoff,Rune %A Carlsen,Monica Hauger %+ Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Sognsvannsveien 9, PO Box 1046, Blindern, Oslo, 0372, Norway, 47 99459673, h.b.henriksen@medisin.uio.no %K digital food frequency questionnaire %K lifestyle assessment tool %K relative validity %K physical activity %K Norwegian food–based dietary guidelines %K Norway %K Norwegian %K food %K foods %K diet %K dietary %K lifestyle %K assessment %K digital questionnaire %K investigation %K food intake %K dietary intake %K dietary intakes %K observation %K monitoring %K youths %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %K cross-sectional study %D 2024 %7 30.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Valid assessment tools are needed when investigating adherence to national dietary and lifestyle guidelines. Objective: The relative validity of the new digital food frequency questionnaire, the DIGIKOST-FFQ, against 7-day weighed food records and activity sensors was investigated. Methods: In total, 77 participants were included in the validation study and completed the DIGIKOST-FFQ and the weighed food record, and of these, 56 (73%) also used the activity sensors. The DIGIKOST-FFQ estimates the intake of foods according to the Norwegian food–based dietary guidelines (FBDGs) in addition to lifestyle factors. Results: At the group level, the DIGIKOST-FFQ showed good validity in estimating intakes according to the Norwegian FBDG. The median differences were small and well below portion sizes for all foods except “water” (median difference 230 g/day). The DIGIKOST-FFQ was able to rank individual intakes for all foods (r=0.2-0.7). However, ranking estimates of vegetable intakes should be interpreted with caution. Between 69% and 88% of the participants were classified into the same or adjacent quartile for foods and between 71% and 82% for different activity intensities. The Bland-Altman plots showed acceptable agreements between DIGIKOST-FFQ and the reference methods. The absolute amount of time in “moderate to vigorous intensity” was underestimated with the DIGIKOST-FFQ. However, estimated time in “moderate to vigorous intensity,” “vigorous intensity,” and “sedentary time” showed acceptable correlations and good agreement between the methods. The DIGIKOST-FFQ was able to identify adherence to the Norwegian FBDG and physical activity recommendations. Conclusions: The DIGIKOST-FFQ gave valid estimates of dietary intakes and was able to identify individuals with different degrees of adherence to the Norwegian FBDG and physical activity recommendations. Moderate physical activity was underreported, water was overreported, and vegetables showed poor correlation, which are important to consider when interpreting the data. Good agreement was observed between the methods in estimating dietary intakes and time in “moderate to vigorous physical activity,” “sedentary time,” and “sleep.” %M 38687986 %R 10.2196/53442 %U https://www.jmir.org/2024/1/e53442 %U https://doi.org/10.2196/53442 %U http://www.ncbi.nlm.nih.gov/pubmed/38687986 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52189 %T Assessing Electronic Health Literacy in Individuals With the Post–COVID-19 Condition Using the German Revised eHealth Literacy Scale: Validation Study %A Marsall,Matthias %A Dinse,Hannah %A Schröder,Julia %A Skoda,Eva-Maria %A Teufel,Martin %A Bäuerle,Alexander %+ Institute for Patient Safety, University Hospital Bonn, Venusberg-Campus 1, Bonn, 53127, Germany, 49 228 287 ext 11595, matthias.marsall@ukbonn.de %K eHealth literacy %K eHEALS %K factor analysis %K measurement invariance %K psychometric properties %K infodemic %D 2024 %7 25.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The eHealth Literacy Scale (eHEALS) is a widely used instrument for measuring eHealth literacy (eHL). However, little is known so far about whether the instrument is valid for the assessment of eHL in persons who are affected by the post–COVID-19 condition. This is particularly important as people with the post–COVID-19 condition are frequently affected by false information from the internet. Objective: The objective of our study was to evaluate the validity and reliability of the German Revised eHealth Literacy Scale (GR-eHEALS) in individuals with the post–COVID-19 condition. Methods: A cross-sectional study was conducted from January to May 2022. The self-assessment survey consisted of the GR-eHEALS, health status– and internet use–related variables, sociodemographic data, and (post)–COVID-19–related medical data. Confirmatory factor analysis (CFA), correlational analyses, and tests of measurement invariance were deployed. Results: In total, 330 participants were included in the statistical analyses. CFA revealed that the 2-factor model reached an excellent model fit (comparative fit index=1.00, Tucker–Lewis index=0.99, root mean square error of approximation=0.036, standardized root mean square residual=0.038). Convergent validity was confirmed by significant positive correlations between eHL and knowledge of internet-based health promotion programs, experience in using these programs, and the duration of private internet use. In addition, a significantly negative relationship of eHL with internet anxiety supported convergent validity. Further, significant relationships of eHL with mental health status and internal health locus of control confirmed the criterion validity of the instrument. However, relationships of eHL with physical health status and quality of life could not be confirmed. The 2-factor model was fully measurement invariant regarding gender. Regarding age and educational level, partial measurement invariance was confirmed. The subscales as well as the overall GR-eHEALS reached good-to-excellent reliability (Cronbach α≥.86). Conclusions: The GR-eHEALS is a reliable and largely valid instrument for assessing eHL in individuals with the post–COVID-19 condition. Measurement invariance regarding gender was fully confirmed and allows the interpretation of group differences. Regarding age and educational level, group differences should be interpreted with caution. Given the high likelihood that individuals with the post–COVID-19 condition will be confronted with misinformation on the Internet, eHL is a core competency that is highly relevant in this context, in both research and clinical practice. Therefore, future research should also explore alternative instruments to capture eHL to overcome shortcomings in the validity of the GR-eHEALS. %M 38662429 %R 10.2196/52189 %U https://formative.jmir.org/2024/1/e52189 %U https://doi.org/10.2196/52189 %U http://www.ncbi.nlm.nih.gov/pubmed/38662429 %0 Journal Article %@ 2291-9694 %I %V 12 %N %P e49646 %T A Scalable Pseudonymization Tool for Rapid Deployment in Large Biomedical Research Networks: Development and Evaluation Study %A Abu Attieh,Hammam %A Neves,Diogo Telmo %A Guedes,Mariana %A Mirandola,Massimo %A Dellacasa,Chiara %A Rossi,Elisa %A Prasser,Fabian %K biomedical research %K research network %K data sharing %K data protection %K privacy %K pseudonymization %D 2024 %7 23.4.2024 %9 %J JMIR Med Inform %G English %X Background: The SARS-CoV-2 pandemic has demonstrated once again that rapid collaborative research is essential for the future of biomedicine. Large research networks are needed to collect, share, and reuse data and biosamples to generate collaborative evidence. However, setting up such networks is often complex and time-consuming, as common tools and policies are needed to ensure interoperability and the required flows of data and samples, especially for handling personal data and the associated data protection issues. In biomedical research, pseudonymization detaches directly identifying details from biomedical data and biosamples and connects them using secure identifiers, the so-called pseudonyms. This protects privacy by design but allows the necessary linkage and reidentification. Objective: Although pseudonymization is used in almost every biomedical study, there are currently no pseudonymization tools that can be rapidly deployed across many institutions. Moreover, using centralized services is often not possible, for example, when data are reused and consent for this type of data processing is lacking. We present the ORCHESTRA Pseudonymization Tool (OPT), developed under the umbrella of the ORCHESTRA consortium, which faced exactly these challenges when it came to rapidly establishing a large-scale research network in the context of the rapid pandemic response in Europe. Methods: To overcome challenges caused by the heterogeneity of IT infrastructures across institutions, the OPT was developed based on programmable runtime environments available at practically every institution: office suites. The software is highly configurable and provides many features, from subject and biosample registration to record linkage and the printing of machine-readable codes for labeling biosample tubes. Special care has been taken to ensure that the algorithms implemented are efficient so that the OPT can be used to pseudonymize large data sets, which we demonstrate through a comprehensive evaluation. Results: The OPT is available for Microsoft Office and LibreOffice, so it can be deployed on Windows, Linux, and MacOS. It provides multiuser support and is configurable to meet the needs of different types of research projects. Within the ORCHESTRA research network, the OPT has been successfully deployed at 13 institutions in 11 countries in Europe and beyond. As of June 2023, the software manages data about more than 30,000 subjects and 15,000 biosamples. Over 10,000 labels have been printed. The results of our experimental evaluation show that the OPT offers practical response times for all major functionalities, pseudonymizing 100,000 subjects in 10 seconds using Microsoft Excel and in 54 seconds using LibreOffice. Conclusions: Innovative solutions are needed to make the process of establishing large research networks more efficient. The OPT, which leverages the runtime environment of common office suites, can be used to rapidly deploy pseudonymization and biosample management capabilities across research networks. The tool is highly configurable and available as open-source software. %R 10.2196/49646 %U https://medinform.jmir.org/2024/1/e49646 %U https://doi.org/10.2196/49646 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e45985 %T Psychometric Properties of the Metacognitions About Online Gaming Scale in the Chinese Population and Its Relationship With Internet Gaming Disorder: Cross-Sectional Study %A Lin,Shuhong %A Chen,Xinxin %A Tan,Linxiang %A Liao,Zhenjiang %A Li,Yifan %A Tang,Ying %A Huang,Qiuping %A Shen,Hongxian %+ Department of Psychiatry, Second Xiangya Hospital of Central South University, 139 Renmin Road, Changsha, 410000, China, 86 13875970393, shenhx2018@csu.edu.cn %K metacognition %K metacognitions about online gaming %K Internet Gaming Disorder %K psychometric properties %K Chinese %D 2024 %7 22.4.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Metacognitions about online gaming have been shown to be correlated with Internet Gaming Disorder (IGD). Knowledge of metacognitions about online gaming can help to understand IGD. The Metacognitions about Online Gaming Scale (MOGS) is a reliable and valid tool to measure specific metacognitions about online gaming in both adults and adolescents, which is lacking in China. Objective: This study was conducted to assess the psychometric properties of the Chinese version of the MOGS (C-MOGS) and its relationship with IGD in the Chinese population. Methods: A total of 772 Chinese individuals (age: mean 21.70, SD 8.81 years; age range: 13-57 years; 458/772, 59.3% male) completed a web-based questionnaire survey, including the C-MOGS and a battery of validated scales measuring IGD, gaming motives, depression, and anxiety. Results: Through exploratory and confirmatory factor analyses, the 3-factor structure was confirmed to have adequate model fit and internal consistency reliability (Cronbach α≥.799, Guttman split-half coefficients≥0.754). Concurrent validity of the C-MOGS was supported by its correlations with IGD (P<.001), gaming motives (P<.001), depression (P<.001), and anxiety (P<.001). Furthermore, the incremental validity analysis showed that the C-MOGS predicted 13% of the variance in IGD while controlling for gender, age, weekly gaming hours, gaming motives, depression, and anxiety. Conclusions: This study provides evidence that the psychometric properties of the C-MOGS are appropriate and emphasizes its positive association with IGD. The C-MOGS is a reliable and valid instrument for mental health workers to assess metacognitions about online gaming in the Chinese population. %M 38648634 %R 10.2196/45985 %U https://games.jmir.org/2024/1/e45985 %U https://doi.org/10.2196/45985 %U http://www.ncbi.nlm.nih.gov/pubmed/38648634 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56883 %T Psychometric Evaluation of a Tablet-Based Tool to Detect Mild Cognitive Impairment in Older Adults: Mixed Methods Study %A McMurray,Josephine %A Levy,AnneMarie %A Pang,Wei %A Holyoke,Paul %+ Lazaridis School of Business & Economics, Wilfrid Laurier University, 73 George St, Brantford, ON, N3T3Y3, Canada, 1 548 889 4492, jmcmurray@wlu.ca %K cognitive dysfunction %K dementia neuropsychological tests %K evaluation study %K technology %K aged %K mobile phone %D 2024 %7 19.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: With the rapid aging of the global population, the prevalence of mild cognitive impairment (MCI) and dementia is anticipated to surge worldwide. MCI serves as an intermediary stage between normal aging and dementia, necessitating more sensitive and effective screening tools for early identification and intervention. The BrainFx SCREEN is a novel digital tool designed to assess cognitive impairment. This study evaluated its efficacy as a screening tool for MCI in primary care settings, particularly in the context of an aging population and the growing integration of digital health solutions. Objective: The primary objective was to assess the validity, reliability, and applicability of the BrainFx SCREEN (hereafter, the SCREEN) for MCI screening in a primary care context. We conducted an exploratory study comparing the SCREEN with an established screening tool, the Quick Mild Cognitive Impairment (Qmci) screen. Methods: A concurrent mixed methods, prospective study using a quasi-experimental design was conducted with 147 participants from 5 primary care Family Health Teams (FHTs; characterized by multidisciplinary practice and capitated funding) across southwestern Ontario, Canada. Participants included health care practitioners, patients, and FHT administrative executives. Individuals aged ≥55 years with no history of MCI or diagnosis of dementia rostered in a participating FHT were eligible to participate. Participants were screened using both the SCREEN and Qmci. The study also incorporated the Geriatric Anxiety Scale–10 to assess general anxiety levels at each cognitive screening. The SCREEN’s scoring was compared against that of the Qmci and the clinical judgment of health care professionals. Statistical analyses included sensitivity, specificity, internal consistency, and test-retest reliability assessments. Results: The study found that the SCREEN’s longer administration time and complex scoring algorithm, which is proprietary and unavailable for independent analysis, presented challenges. Its internal consistency, indicated by a Cronbach α of 0.63, was below the acceptable threshold. The test-retest reliability also showed limitations, with moderate intraclass correlation coefficient (0.54) and inadequate κ (0.15) values. Sensitivity and specificity were consistent (63.25% and 74.07%, respectively) between cross-tabulation and discrepant analysis. In addition, the study faced limitations due to its demographic skew (96/147, 65.3% female, well-educated participants), the absence of a comprehensive gold standard for MCI diagnosis, and financial constraints limiting the inclusion of confirmatory neuropsychological testing. Conclusions: The SCREEN, in its current form, does not meet the necessary criteria for an optimal MCI screening tool in primary care settings, primarily due to its longer administration time and lower reliability. As the number of digital health technologies increases and evolves, further testing and refinement of tools such as the SCREEN are essential to ensure their efficacy and reliability in real-world clinical settings. This study advocates for continued research in this rapidly advancing field to better serve the aging population. International Registered Report Identifier (IRRID): RR2-10.2196/25520 %M 38640480 %R 10.2196/56883 %U https://www.jmir.org/2024/1/e56883 %U https://doi.org/10.2196/56883 %U http://www.ncbi.nlm.nih.gov/pubmed/38640480 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56655 %T Quality of Answers of Generative Large Language Models Versus Peer Users for Interpreting Laboratory Test Results for Lay Patients: Evaluation Study %A He,Zhe %A Bhasuran,Balu %A Jin,Qiao %A Tian,Shubo %A Hanna,Karim %A Shavor,Cindy %A Arguello,Lisbeth Garcia %A Murray,Patrick %A Lu,Zhiyong %+ School of Information, Florida State University, 142 Collegiate Loop, Tallahassee, FL, 32306, United States, 1 8506445775, zhe@fsu.edu %K large language models %K generative artificial intelligence %K generative AI %K ChatGPT %K laboratory test results %K patient education %K natural language processing %D 2024 %7 17.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Although patients have easy access to their electronic health records and laboratory test result data through patient portals, laboratory test results are often confusing and hard to understand. Many patients turn to web-based forums or question-and-answer (Q&A) sites to seek advice from their peers. The quality of answers from social Q&A sites on health-related questions varies significantly, and not all responses are accurate or reliable. Large language models (LLMs) such as ChatGPT have opened a promising avenue for patients to have their questions answered. Objective: We aimed to assess the feasibility of using LLMs to generate relevant, accurate, helpful, and unharmful responses to laboratory test–related questions asked by patients and identify potential issues that can be mitigated using augmentation approaches. Methods: We collected laboratory test result–related Q&A data from Yahoo! Answers and selected 53 Q&A pairs for this study. Using the LangChain framework and ChatGPT web portal, we generated responses to the 53 questions from 5 LLMs: GPT-4, GPT-3.5, LLaMA 2, MedAlpaca, and ORCA_mini. We assessed the similarity of their answers using standard Q&A similarity-based evaluation metrics, including Recall-Oriented Understudy for Gisting Evaluation, Bilingual Evaluation Understudy, Metric for Evaluation of Translation With Explicit Ordering, and Bidirectional Encoder Representations from Transformers Score. We used an LLM-based evaluator to judge whether a target model had higher quality in terms of relevance, correctness, helpfulness, and safety than the baseline model. We performed a manual evaluation with medical experts for all the responses to 7 selected questions on the same 4 aspects. Results: Regarding the similarity of the responses from 4 LLMs; the GPT-4 output was used as the reference answer, the responses from GPT-3.5 were the most similar, followed by those from LLaMA 2, ORCA_mini, and MedAlpaca. Human answers from Yahoo data were scored the lowest and, thus, as the least similar to GPT-4–generated answers. The results of the win rate and medical expert evaluation both showed that GPT-4’s responses achieved better scores than all the other LLM responses and human responses on all 4 aspects (relevance, correctness, helpfulness, and safety). LLM responses occasionally also suffered from lack of interpretation in one’s medical context, incorrect statements, and lack of references. Conclusions: By evaluating LLMs in generating responses to patients’ laboratory test result–related questions, we found that, compared to other 4 LLMs and human answers from a Q&A website, GPT-4’s responses were more accurate, helpful, relevant, and safer. There were cases in which GPT-4 responses were inaccurate and not individualized. We identified a number of ways to improve the quality of LLM responses, including prompt engineering, prompt augmentation, retrieval-augmented generation, and response evaluation. %M 38630520 %R 10.2196/56655 %U https://www.jmir.org/2024/1/e56655 %U https://doi.org/10.2196/56655 %U http://www.ncbi.nlm.nih.gov/pubmed/38630520 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55795 %T Examining and Comparing the Validity and Reproducibility of Scales to Determine the Variety of Vegetables Consumed: Validation Study %A Ominami,Kaya %A Kushida,Osamu %+ Department of Nutrition and Life Sciences, School of Food and Nutritional Sciences, University of Shizuoka, 52-1 Yada, Suruga-ku, Shizuoka, 422-8526, Japan, 81 542645832, kushida@u-shizuoka-ken.ac.jp %K vegetable %K variety %K scale %K validity %K reproducibility %K dietary records %K nutrition %D 2024 %7 11.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Previous studies have reported that vegetable variety reduces the risk for noncommunicable diseases independent of the amount consumed. Objective: This study aimed to examine and compare the validity and reproducibility of several scales to determine vegetable variety. Methods: In total, 23 nutrition students in Japan reported their vegetable intake over the past month using a self-administered questionnaire between July and August 2021. Specifically, four scales were used: (1) a single question regarding the number of vegetables consumed (scale A); (2) a scale containing 9 vegetable subgroups included in the brief-type self-administered diet history questionnaire (scale B); (3) a scale containing 19 vegetable items included in a self-administered diet history questionnaire (scale C); and (4) a scale containing 20 vegetable items from the Ranking of Vegetable Consumers in Japan, which was analyzed based on a report on the National Health and Nutrition Survey in Japan (scale D). Scale validity was assessed by correlation with the number of vegetables consumed, which was collected from dietary records for 7 consecutive days. Reproducibility was assessed by test-retest reliability. Results: Regarding the validity of the 4 scales, significant correlations were found between scales C (ρ=0.51) and D (ρ=0.44) with vegetable variety based on dietary records, but scales A (ρ=0.28) and B (ρ=0.22) were not significantly correlated. Reproducibility showed a significant correlation in scale B (ρ=0.45) and strong correlations in scales C (ρ=0.73) and D (ρ=0.75). Conclusions: The scales for vegetable items have acceptable validity and reproducibility compared to the scales that used a single question or vegetable subgroup and, therefore, may determine the variety of vegetables consumed. %M 38603775 %R 10.2196/55795 %U https://formative.jmir.org/2024/1/e55795 %U https://doi.org/10.2196/55795 %U http://www.ncbi.nlm.nih.gov/pubmed/38603775 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e55988 %T Assessing the Alignment of Large Language Models With Human Values for Mental Health Integration: Cross-Sectional Study Using Schwartz’s Theory of Basic Values %A Hadar-Shoval,Dorit %A Asraf,Kfir %A Mizrachi,Yonathan %A Haber,Yuval %A Elyoseph,Zohar %+ Department of Brain Sciences, Faculty of Medicine, Imperial College London, Fulham Palace Rd, London, W6 8RF, United Kingdom, 44 547836088, Zohar.j.a@gmail.com %K large language models %K LLMs %K large language model %K LLM %K machine learning %K ML %K natural language processing %K NLP %K deep learning %K ChatGPT %K Chat-GPT %K chatbot %K chatbots %K chat-bot %K chat-bots %K Claude %K values %K Bard %K artificial intelligence %K AI %K algorithm %K algorithms %K predictive model %K predictive models %K predictive analytics %K predictive system %K practical model %K practical models %K mental health %K mental illness %K mental illnesses %K mental disease %K mental diseases %K mental disorder %K mental disorders %K mobile health %K mHealth %K eHealth %K mood disorder %K mood disorders %D 2024 %7 9.4.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Large language models (LLMs) hold potential for mental health applications. However, their opaque alignment processes may embed biases that shape problematic perspectives. Evaluating the values embedded within LLMs that guide their decision-making have ethical importance. Schwartz’s theory of basic values (STBV) provides a framework for quantifying cultural value orientations and has shown utility for examining values in mental health contexts, including cultural, diagnostic, and therapist-client dynamics. Objective: This study aimed to (1) evaluate whether the STBV can measure value-like constructs within leading LLMs and (2) determine whether LLMs exhibit distinct value-like patterns from humans and each other. Methods: In total, 4 LLMs (Bard, Claude 2, Generative Pretrained Transformer [GPT]-3.5, GPT-4) were anthropomorphized and instructed to complete the Portrait Values Questionnaire—Revised (PVQ-RR) to assess value-like constructs. Their responses over 10 trials were analyzed for reliability and validity. To benchmark the LLMs’ value profiles, their results were compared to published data from a diverse sample of 53,472 individuals across 49 nations who had completed the PVQ-RR. This allowed us to assess whether the LLMs diverged from established human value patterns across cultural groups. Value profiles were also compared between models via statistical tests. Results: The PVQ-RR showed good reliability and validity for quantifying value-like infrastructure within the LLMs. However, substantial divergence emerged between the LLMs’ value profiles and population data. The models lacked consensus and exhibited distinct motivational biases, reflecting opaque alignment processes. For example, all models prioritized universalism and self-direction, while de-emphasizing achievement, power, and security relative to humans. Successful discriminant analysis differentiated the 4 LLMs’ distinct value profiles. Further examination found the biased value profiles strongly predicted the LLMs’ responses when presented with mental health dilemmas requiring choosing between opposing values. This provided further validation for the models embedding distinct motivational value-like constructs that shape their decision-making. Conclusions: This study leveraged the STBV to map the motivational value-like infrastructure underpinning leading LLMs. Although the study demonstrated the STBV can effectively characterize value-like infrastructure within LLMs, substantial divergence from human values raises ethical concerns about aligning these models with mental health applications. The biases toward certain cultural value sets pose risks if integrated without proper safeguards. For example, prioritizing universalism could promote unconditional acceptance even when clinically unwise. Furthermore, the differences between the LLMs underscore the need to standardize alignment processes to capture true cultural diversity. Thus, any responsible integration of LLMs into mental health care must account for their embedded biases and motivation mismatches to ensure equitable delivery across diverse populations. Achieving this will require transparency and refinement of alignment techniques to instill comprehensive human values. %M 38593424 %R 10.2196/55988 %U https://mental.jmir.org/2024/1/e55988 %U https://doi.org/10.2196/55988 %U http://www.ncbi.nlm.nih.gov/pubmed/38593424 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e51298 %T Design of a Remote Multiparametric Tool to Assess Mental Well-Being and Distress in Young People (mHealth Methods in Mental Health Research Project): Protocol for an Observational Study %A Castro Ribeiro,Thais %A García Pagès,Esther %A Ballester,Laura %A Vilagut,Gemma %A García Mieres,Helena %A Suárez Aragonès,Víctor %A Amigo,Franco %A Bailón,Raquel %A Mortier,Philippe %A Pérez Sola,Víctor %A Serrano-Blanco,Antoni %A Alonso,Jordi %A Aguiló,Jordi %+ CIBER de Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Instituto de Salud Carlos III, Calle Monforte de Lemos, 3-5, Pabellón 11, Madrid, 28029, Spain, 34 935868430, thais.castro@uab.cat %K mental health %K mental well-being %K mobile health %K mHealth %K remote monitoring %K physiological variables %K experimental protocol %K depression %K anxiety %D 2024 %7 29.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mental health conditions have become a substantial cause of disability worldwide, resulting in economic burden and strain on the public health system. Incorporating cognitive and physiological biomarkers using noninvasive sensors combined with self-reported questionnaires can provide a more accurate characterization of the individual’s well-being. Biomarkers such as heart rate variability or those extracted from the electrodermal activity signal are commonly considered as indices of autonomic nervous system functioning, providing objective indicators of stress response. A model combining a set of these biomarkers can constitute a comprehensive tool to remotely assess mental well-being and distress. Objective: This study aims to design and validate a remote multiparametric tool, including physiological and cognitive variables, to objectively assess mental well-being and distress. Methods: This ongoing observational study pursues to enroll 60 young participants (aged 18-34 years) in 3 groups, including participants with high mental well-being, participants with mild to moderate psychological distress, and participants diagnosed with depression or anxiety disorder. The inclusion and exclusion criteria are being evaluated through a web-based questionnaire, and for those with a mental health condition, the criteria are identified by psychologists. The assessment consists of collecting mental health self-reported measures and physiological data during a baseline state, the Stroop Color and Word Test as a stress-inducing stage, and a final recovery period. Several variables related to heart rate variability, pulse arrival time, breathing, electrodermal activity, and peripheral temperature are collected using medical and wearable devices. A second assessment is carried out after 1 month. The assessment tool will be developed using self-reported questionnaires assessing well-being (short version of Warwick-Edinburgh Mental Well-being Scale), anxiety (Generalized Anxiety Disorder-7), and depression (Patient Health Questionnaire-9) as the reference. We will perform correlation and principal component analysis to reduce the number of variables, followed by the calculation of multiple regression models. Test-retest reliability, known-group validity, and predictive validity will be assessed. Results: Participant recruitment is being carried out on a university campus and in mental health services. Recruitment commenced in October 2022 and is expected to be completed by June 2024. As of July 2023, we have recruited 41 participants. Most participants correspond to the group with mild to moderate psychological distress (n=20, 49%), followed by the high mental well-being group (n=13, 32%) and those diagnosed with a mental health condition (n=8, 20%). Data preprocessing is currently ongoing, and publication of the first results is expected by September 2024. Conclusions: This study will establish an initial framework for a comprehensive mental health assessment tool, taking measurements from sophisticated devices, with the goal of progressing toward a remotely accessible and objectively measured approach that maintains an acceptable level of accuracy in clinical practice and epidemiological studies. Trial Registration: OSF Registries N3GCH; https://doi.org/10.17605/OSF.IO/N3GCH International Registered Report Identifier (IRRID): DERR1-10.2196/51298 %M 38551647 %R 10.2196/51298 %U https://www.researchprotocols.org/2024/1/e51298 %U https://doi.org/10.2196/51298 %U http://www.ncbi.nlm.nih.gov/pubmed/38551647 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46820 %T Assessing a GPS-Based 6-Minute Walk Test for People With Persistent Pain: Validation Study %A Simmich,Joshua %A Andrews,Nicole Emma %A Claus,Andrew %A Murdoch,Megan %A Russell,Trevor Glen %+ RECOVER Injury Research Centre, Faculty of Health and Behavioural Sciences, The University of Queensland, 296 Herston Road, Herston, Brisbane, 4029, Australia, 61 7 3365 5560, j.simmich@uq.edu.au %K GPS %K mobile apps %K exercise test %K pain %K chronic pain %K mobile phone %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The 6-minute walk test (6MWT) is a commonly used method to assess the exercise capacity of people with many health conditions, including persistent pain. However, it is conventionally performed with in-person supervision in a hospital or clinic, therefore requiring staff resources. It may also be difficult when in-person supervision is unavailable, such as during the COVID-19 pandemic, or when the person is geographically remote. A potential solution to these issues could be to use GPS to measure walking distance. Objective: The primary aim of this study was to assess the validity of a GPS-based smartphone app to measure walking distance as an alternative to the conventional 6MWT in a population with persistent pain. The secondary aim of this study was to estimate the difference between the pain evoked by the 2 test methods. Methods: People with persistent pain (N=36) were recruited to complete a conventional 6MWT on a 30-m shuttle track and a 6MWT assessed by a smartphone app using GPS, performed on outdoor walking circuits. Tests were performed in random order, separated by a 15-minute rest. The 95% limits of agreement were calculated using the Bland-Altman method, with a specified maximum allowable difference of 100 m. Pain was assessed using an 11-point numerical rating scale before and after each walk test. Results: The mean 6-minute walk distance measured by the GPS-based smartphone app was 13.2 (SD 46; 95% CI −2.7 to 29.1) m higher than that assessed in the conventional manner. The 95% limits of agreement were 103.9 (95% CI 87.4-134.1) m and −77.6 (95% CI −107.7 to −61) m, which exceeded the maximum allowable difference. Pain increased in the conventional walk test by 1.1 (SD 1.0) points, whereas pain increased in the app test by 0.8 (SD 1.4) points. Conclusions: In individuals with persistent pain, the 2 methods of assessing the 6MWT may not be interchangeable due to limited validity. Potential reasons for the differences between the 2 methods might be attributed to the variation in track layout (shuttle track vs continuous circuit); poor GPS accuracy; deviations from the 30-m shuttle track; human variability in walking speed; and the potential impact of a first test on the second test due to fatigue, pain provocation, or a learning effect. Future research is needed to improve the accuracy of the GPS-based approach. Despite its limitations, the GPS-based 6MWT may still have value as a tool for remote monitoring that could allow individuals with persistent pain to self-administer frequent assessments of their functional capacity in their home environment. %M 38498031 %R 10.2196/46820 %U https://formative.jmir.org/2024/1/e46820 %U https://doi.org/10.2196/46820 %U http://www.ncbi.nlm.nih.gov/pubmed/38498031 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e45987 %T A Web-Based Tool to Assess Social Inclusion and Support Care Planning in Mental Health Supported Accommodation: Development and Preliminary Test Study %A Eager,Sharon %A Killaspy,Helen %A C,Joanna %A Mezey,Gillian %A McPherson,Peter %A Downey,Megan %A Thompson,Georgina %A Lloyd-Evans,Brynmor %+ Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom, 44 (0)20 7679 9428, b.lloyd-evans@ucl.ac.uk %K social inclusion %K supported accommodation %K mental health %K digital health %K care planning %D 2024 %7 13.3.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Individuals with severe mental illness living in supported accommodation are often socially excluded. Social inclusion is an important aspect of recovery-based practice and quality of life. The Social Inclusion Questionnaire User Experience (SInQUE) is a measure of social inclusion that has been validated for use with people with mental health problems. Previous research has suggested that the SInQUE could also help support care planning focused on enabling social inclusion in routine mental health practice. Objective: This study aims to develop a web-based version of the SInQUE for use in mental health supported accommodation services, examine its acceptability and perceived usefulness as a tool to support care planning with service users, determine the extent of uptake of the tool in supported accommodation settings, and develop a program theory and logic model for the online SInQUE. Methods: This study involved a laboratory-testing stage to assess the acceptability of the SInQUE tool through “think-aloud” testing with 6 supported accommodation staff members and a field-testing stage to assess the acceptability, utility, and use of the SInQUE tool over a 5-month period. An implementation strategy was used in 1 London borough to encourage the use of the SInQUE. Qualitative interviews with 12 service users and 12 staff members who used the tool were conducted and analyzed using thematic analysis. The use of the SInQUE was compared with that in 2 other local authority areas, 1 urban and 1 rural, where the tool was made available for use but no implementation strategy was used. Results: Overall, 17 staff members used the SInQUE with 28 different service users during the implementation period (approximately 10% of all service users living in supported accommodation in the study area). The staff and service users interviewed felt that the SInQUE was collaborative, comprehensive, user-friendly, and relevant. Although some staff were concerned that particular questions might be too personal, service users did not echo this view. Participants generally felt that the SInQUE could help identify individuals’ priorities regarding different aspects of social inclusion by prompting in-depth conversations and tailoring specific support to address service users’ inclusion goals. Some interviewees also suggested that the tool could highlight areas of unmet or unmeetable needs across the borough that could feed into service planning. The SInQUE was not used in the comparison areas that had no implementation strategy. Conclusions: The online SInQUE is an acceptable and potentially useful tool that can be recommended to assess and support care planning to enable social inclusion of people living in mental health supported accommodation services. Despite this, uptake rates were modest during the study period. A concerted implementation strategy is key to embedding its use in usual care, including proactive endorsement by senior leaders and service managers. %M 38477978 %R 10.2196/45987 %U https://www.i-jmr.org/2024/1/e45987 %U https://doi.org/10.2196/45987 %U http://www.ncbi.nlm.nih.gov/pubmed/38477978 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e54393 %T Capability of GPT-4V(ision) in the Japanese National Medical Licensing Examination: Evaluation Study %A Nakao,Takahiro %A Miki,Soichiro %A Nakamura,Yuta %A Kikuchi,Tomohiro %A Nomura,Yukihiro %A Hanaoka,Shouhei %A Yoshikawa,Takeharu %A Abe,Osamu %+ Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, 81 358008666, tanakao-tky@umin.ac.jp %K AI %K artificial intelligence %K LLM %K large language model %K language model %K language models %K ChatGPT %K GPT-4 %K GPT-4V %K generative pretrained transformer %K image %K images %K imaging %K response %K responses %K exam %K examination %K exams %K examinations %K answer %K answers %K NLP %K natural language processing %K chatbot %K chatbots %K conversational agent %K conversational agents %K medical education %D 2024 %7 12.3.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: Previous research applying large language models (LLMs) to medicine was focused on text-based information. Recently, multimodal variants of LLMs acquired the capability of recognizing images. Objective: We aim to evaluate the image recognition capability of generative pretrained transformer (GPT)-4V, a recent multimodal LLM developed by OpenAI, in the medical field by testing how visual information affects its performance to answer questions in the 117th Japanese National Medical Licensing Examination. Methods: We focused on 108 questions that had 1 or more images as part of a question and presented GPT-4V with the same questions under two conditions: (1) with both the question text and associated images and (2) with the question text only. We then compared the difference in accuracy between the 2 conditions using the exact McNemar test. Results: Among the 108 questions with images, GPT-4V’s accuracy was 68% (73/108) when presented with images and 72% (78/108) when presented without images (P=.36). For the 2 question categories, clinical and general, the accuracies with and those without images were 71% (70/98) versus 78% (76/98; P=.21) and 30% (3/10) versus 20% (2/10; P≥.99), respectively. Conclusions: The additional information from the images did not significantly improve the performance of GPT-4V in the Japanese National Medical Licensing Examination. %M 38470459 %R 10.2196/54393 %U https://mededu.jmir.org/2024/1/e54393 %U https://doi.org/10.2196/54393 %U http://www.ncbi.nlm.nih.gov/pubmed/38470459 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49411 %T Machine Learning–Based Approach for Identifying Research Gaps: COVID-19 as a Case Study %A Abd-alrazaq,Alaa %A Nashwan,Abdulqadir J %A Shah,Zubair %A Abujaber,Ahmad %A Alhuwail,Dari %A Schneider,Jens %A AlSaad,Rawan %A Ali,Hazrat %A Alomoush,Waleed %A Ahmed,Arfan %A Aziz,Sarah %+ AI Center for Precision Health, Weill Cornell Medicine-Qatar, A031, Weill Cornell Medicine-Qatar, Education City, Al Luqta St, Doha, 23435, Qatar, 974 55708599, aaa4027@qatar-med.cornell.edu %K research gaps %K research gap %K research topic %K research topics %K scientific literature %K literature review %K machine learning %K COVID-19 %K BERTopic %K topic clustering %K text analysis %K BERT %K NLP %K natural language processing %K review methods %K review methodology %K SARS-CoV-2 %K coronavirus %K COVID %D 2024 %7 5.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Research gaps refer to unanswered questions in the existing body of knowledge, either due to a lack of studies or inconclusive results. Research gaps are essential starting points and motivation in scientific research. Traditional methods for identifying research gaps, such as literature reviews and expert opinions, can be time consuming, labor intensive, and prone to bias. They may also fall short when dealing with rapidly evolving or time-sensitive subjects. Thus, innovative scalable approaches are needed to identify research gaps, systematically assess the literature, and prioritize areas for further study in the topic of interest. Objective: In this paper, we propose a machine learning–based approach for identifying research gaps through the analysis of scientific literature. We used the COVID-19 pandemic as a case study. Methods: We conducted an analysis to identify research gaps in COVID-19 literature using the COVID-19 Open Research (CORD-19) data set, which comprises 1,121,433 papers related to the COVID-19 pandemic. Our approach is based on the BERTopic topic modeling technique, which leverages transformers and class-based term frequency-inverse document frequency to create dense clusters allowing for easily interpretable topics. Our BERTopic-based approach involves 3 stages: embedding documents, clustering documents (dimension reduction and clustering), and representing topics (generating candidates and maximizing candidate relevance). Results: After applying the study selection criteria, we included 33,206 abstracts in the analysis of this study. The final list of research gaps identified 21 different areas, which were grouped into 6 principal topics. These topics were: “virus of COVID-19,” “risk factors of COVID-19,” “prevention of COVID-19,” “treatment of COVID-19,” “health care delivery during COVID-19,” “and impact of COVID-19.” The most prominent topic, observed in over half of the analyzed studies, was “the impact of COVID-19.” Conclusions: The proposed machine learning–based approach has the potential to identify research gaps in scientific literature. This study is not intended to replace individual literature research within a selected topic. Instead, it can serve as a guide to formulate precise literature search queries in specific areas associated with research questions that previous publications have earmarked for future exploration. Future research should leverage an up-to-date list of studies that are retrieved from the most common databases in the target area. When feasible, full texts or, at minimum, discussion sections should be analyzed rather than limiting their analysis to abstracts. Furthermore, future studies could evaluate more efficient modeling algorithms, especially those combining topic modeling with statistical uncertainty quantification, such as conformal prediction. %M 38441952 %R 10.2196/49411 %U https://formative.jmir.org/2024/1/e49411 %U https://doi.org/10.2196/49411 %U http://www.ncbi.nlm.nih.gov/pubmed/38441952 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e54401 %T Development of a Clinical Simulation Video to Evaluate Multiple Domains of Clinical Competence: Cross-Sectional Study %A Shikino,Kiyoshi %A Nishizaki,Yuji %A Fukui,Sho %A Yokokawa,Daiki %A Yamamoto,Yu %A Kobayashi,Hiroyuki %A Shimizu,Taro %A Tokuda,Yasuharu %+ Department of Community-Oriented Medical Education, Chiba University Graduate School of Medicine, 1-8-1, Inohana, Chiba, 2608677, Japan, 81 43 222 7171, kshikino@gmail.com %K discrimination index %K General Medicine In-Training Examination %K clinical simulation video %K postgraduate medical education %K video %K videos %K training %K examination %K examinations %K medical education %K resident %K residents %K postgraduate %K postgraduates %K simulation %K simulations %K diagnosis %K diagnoses %K diagnose %K general medicine %K general practice %K general practitioner %K skill %K skills %D 2024 %7 29.2.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: Medical students in Japan undergo a 2-year postgraduate residency program to acquire clinical knowledge and general medical skills. The General Medicine In-Training Examination (GM-ITE) assesses postgraduate residents’ clinical knowledge. A clinical simulation video (CSV) may assess learners’ interpersonal abilities. Objective: This study aimed to evaluate the relationship between GM-ITE scores and resident physicians’ diagnostic skills by having them watch a CSV and to explore resident physicians’ perceptions of the CSV’s realism, educational value, and impact on their motivation to learn. Methods: The participants included 56 postgraduate medical residents who took the GM-ITE between January 21 and January 28, 2021; watched the CSV; and then provided a diagnosis. The CSV and GM-ITE scores were compared, and the validity of the simulations was examined using discrimination indices, wherein ≥0.20 indicated high discriminatory power and >0.40 indicated a very good measure of the subject’s qualifications. Additionally, we administered an anonymous questionnaire to ascertain participants’ views on the realism and educational value of the CSV and its impact on their motivation to learn. Results: Of the 56 participants, 6 (11%) provided the correct diagnosis, and all were from the second postgraduate year. All domains indicated high discriminatory power. The (anonymous) follow-up responses indicated that the CSV format was more suitable than the conventional GM-ITE for assessing clinical competence. The anonymous survey revealed that 12 (52%) participants found the CSV format more suitable than the GM-ITE for assessing clinical competence, 18 (78%) affirmed the realism of the video simulation, and 17 (74%) indicated that the experience increased their motivation to learn. Conclusions: The findings indicated that CSV modules simulating real-world clinical examinations were successful in assessing examinees’ clinical competence across multiple domains. The study demonstrated that the CSV not only augmented the assessment of diagnostic skills but also positively impacted learners’ motivation, suggesting a multifaceted role for simulation in medical education. %M 38421691 %R 10.2196/54401 %U https://mededu.jmir.org/2024/1/e54401 %U https://doi.org/10.2196/54401 %U http://www.ncbi.nlm.nih.gov/pubmed/38421691 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e50156 %T Measuring e-Professional Behavior of Doctors of Medicine and Dental Medicine on Social Networking Sites: Indexes Construction With Formative Indicators %A Marelić,Marko %A Klasnić,Ksenija %A Vukušić Rukavina,Tea %+ Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Rockfeller Street 4, Zagreb, 10000, Croatia, 385 14590126, tvukusic@snz.hr %K e-professionalism %K social media %K formative index %K social networking %K doctors %K medical %K dental medicine %D 2024 %7 27.2.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: Previous studies have predominantly measured e-professionalism through perceptions or attitudes, yet there exists no validated measure specifically targeting the actual behaviors of health care professionals (HCPs) in this realm. This study addresses this gap by constructing a normative framework, drawing from 3 primary sources to define e-professional behavior across 6 domains. Four domains pertain to the dangers of social networking sites (SNSs), encompassing confidentiality, privacy, patient interaction, and equitable resource allocation. Meanwhile, 2 domains focus on the opportunities of SNSs, namely, the proactive dissemination of public health information and maintaining scientific integrity. Objective: This study aims to develop and validate 2 new measures assessing the e-professional behavior of doctors of medicine (MDs) and doctors of dental medicine (DMDs), focusing on both the dangers and opportunities associated with SNSs. Methods: The study used a purposive sample of MDs and DMDs in Croatia who were users of at least one SNS. Data collection took place in 2021 through an online survey. Validation of both indexes used a formative approach, which involved a 5-step methodology: content specification, indicators definition with instructions for item coding and index construction, indicators collinearity check using the variance inflation factor (VIF), external validity test using multiple indicators multiple causes (MIMIC) model, and external validity test by checking the relationships of the indexes with the scale of attitude toward SNSs using Pearson correlation coefficients. Results: A total of 753 responses were included in the analysis. The first e-professionalism index, assessing the dangers associated with SNSs, comprises 14 items. During the indicators collinearity check, all indicators displayed acceptable VIF values below 2.5. The MIMIC model showed good fit (χ213=9.4, P=.742; χ2/df=0.723; root-mean-square error of approximation<.001; goodness-of-fit index=0.998; comparative fit index=1.000). The external validity of the index is supported by a statistically significant negative correlation with the scale measuring attitudes toward SNSs (r=–0.225, P<.001). Following the removal of 1 item, the second e-professionalism index, focusing on the opportunities associated with SNSs, comprises 5 items. During the indicators collinearity check, all indicators exhibited acceptable VIF values below 2.5. Additionally, the MIMIC model demonstrated a good fit (χ24=2.5, P=.718; χ2/df=0.637; root-mean-square error of approximation<0.001; goodness-of-fit index=0.999; comparative fit index=1.000). The external validity of the index is supported by a statistically significant positive correlation with the scale of attitude toward SNSs (r=0.338; P<.001). Conclusions: Following the validation process, the instrument designed for gauging the e-professional behavior of MDs and DMDs consists of 19 items, which contribute to the formation of 2 distinct indexes: the e-professionalism index, focusing on the dangers associated with SNSs, comprising 14 items, and the e-professionalism index, highlighting the opportunities offered by SNSs, consisting of 5 items. These indexes serve as valid measures of the e-professional behavior of MDs and DMDs, with the potential for further refinement to encompass emerging forms of unprofessional behavior that may arise over time. %M 38412021 %R 10.2196/50156 %U https://mededu.jmir.org/2024/1/e50156 %U https://doi.org/10.2196/50156 %U http://www.ncbi.nlm.nih.gov/pubmed/38412021 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48954 %T Designing and Validating a Novel Method for Assessing Delay Discounting Associated With Health Behaviors: Ecological Momentary Assessment Study %A Luken,Amanda %A Rabinowitz,Jill A %A Wells,Jonathan L %A Sosnowski,David W %A Strickland,Justin C %A Thrul,Johannes %A Kirk,Gregory D %A Maher,Brion S %+ Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, 624 N Broadway, Baltimore, MD, 212055, United States, 1 4432878287, brion@jhu.edu %K delay discounting %K measurement %K Monetary Choice Questionnaire %K ecological momentary assessment %K substance use %K substance abuse %K questionnaire %K validity %K validation %K measurement %K monetary %K reward %K rewards %K survey %K mobile phone %D 2024 %7 27.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Delay discounting quantifies an individual’s preference for smaller, short-term rewards over larger, long-term rewards and represents a transdiagnostic factor associated with numerous adverse health outcomes. Rather than a fixed trait, delay discounting may vary over time and place, influenced by individual and contextual factors. Continuous, real-time measurement could inform adaptive interventions for various health conditions. Objective: The goals of this paper are 2-fold. First, we present and validate a novel, short, ecological momentary assessment (EMA)–based delay discounting scale we developed. Second, we assess this tool’s ability to reproduce known associations between delay discounting and health behaviors (ie, substance use and craving) using a convenience-based sample. Methods: Participants (N=97) were adults (age range 18-71 years), recruited on social media. In phase 1, data were collected on participant sociodemographic characteristics, and delay discounting was evaluated via the traditional Monetary Choice Questionnaire (MCQ) and our novel method (ie, 7-item time-selection and 7-item monetary-selection scales). During phase 2 (approximately 6 months later), participants completed the MCQ, our novel delay discounting measures, and health outcomes questions. The correlations between our method and the traditional MCQ within and across phases were examined. For scale reduction, a random number of items were iteratively selected, and the correlation between the full and random scales was assessed. We then examined the association between our time- and monetary-selection scales assessed during phase 2 and the percentage of assessments that participants endorsed using or craving alcohol, tobacco, or cannabis. Results: In total, 6 of the 7 individual time-selection items were highly correlated with the full scale (r>0.89). Both time-selection (r=0.71; P<.001) and monetary-selection (r=0.66; P<.001) delay discounting rates had high test-retest reliability across phases 1 and 2. Phase 1 MCQ delay discounting function highly correlated with phase 1 (r=0.76; P<.001) and phase 2 (r=0.45; P<.001) time-selection delay discounting scales. One or more randomly chosen time-selection items were highly correlated with the full scale (r>0.94). Greater delay discounting measured via the time-selection measure (adjusted mean difference=5.89, 95% CI 1.99-9.79), but not the monetary-selection scale (adjusted mean difference=–0.62, 95% CI –3.57 to 2.32), was associated with more past-hour tobacco use endorsement in follow-up surveys. Conclusions: This study evaluated a novel EMA-based scale’s ability to validly and reliably assess delay discounting. By measuring delay discounting with fewer items and in situ via EMA in natural environments, researchers may be better able to identify individuals at risk for poor health outcomes. %M 38412027 %R 10.2196/48954 %U https://formative.jmir.org/2024/1/e48954 %U https://doi.org/10.2196/48954 %U http://www.ncbi.nlm.nih.gov/pubmed/38412027 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54194 %T Measurement of Head Circumference Using a Smartphone: Feasibility Cohort Study %A Yordanov,Stefan %A Akhter,Kalsoom %A Quan Teh,Jye %A Naushahi,Jawad %A Jalloh,Ibrahim %+ Academic Division of Neurosurgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Hills Rd, Cambridge, CB2 0QQ, United Kingdom, 44 01223 805000 ext 348134, yordanov.stefan@yahoo.com %K head circumference %K HC %K hydrocephalus %K neurosurgery %K pediatric neurosurgery %K paediatric neurosurgery %K neurology %K neuro %K neurosurgeon %K neurologist %K mobile health %K mHealth %K app %K apps %K application %K applications %K digital health %K smartphone %K smartphones %K pediatric %K pediatrics %K paediatric %K paediatrics %K infant %K infants %K infancy %K baby %K babies %K neonate %K neonates %K neonatal %K toddler %K toddlers %K child %K children %D 2024 %7 14.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Accurate head circumference (HC) measurement is essential when assessing neonates and infants. Tape measure HC measurements are prone to errors, particularly when performed by parents/guardians, due to individual differences in head shape, hair style and texture, subject cooperation, and examiner techniques, including tape measure placement and tautness. There is, therefore, the need for a more reliable method. Objective: The primary objective of this study was to evaluate the validity, reliability, and consistency of HC app measurement compared to the current standard of practice, serving as a proof-of-concept for use by health care professionals. Methods: We recruited infants attending the neurosurgery clinic, and parents/guardians were approached and consented to participate in the study. Along with the standard head circumference measurement, measurements were taken with the head circumference app (HC app) developed in-house, and we also collected baseline medical history and characteristics. For the statistical analysis, we used RStudio (version 4.1.1). In summary, we analyzed covariance and intraclass correlation coefficient (ICC) to compare the measurement's within-rater and interrater reliability. The F test was used to analyze the variance between measurements and the Bland-Altman agreement, t test, and correlation coefficients were used to compare the tape measurement to the measures taken by the HC app. We also used nonvalidated questionnaires to explore parental or guardians’ experiences, assess their views on app utility, and collect feedback. Results: The total number of recruited patients was 37. Comparison between the app measurements and the measurements with a tape measure showed poor reliability (ICC=0.177) and wide within-app variations (ICC=0.341). The agreement between the measurements done by parents/guardians and the tape measurements done by the researcher was good (ICC=0.901). Parental/guardian feedback was overall very positive, with most of the parents/guardians reporting that the app was easy to use (n=31, 84%) and that they are happy to use the app in an unsupervised setting, provided that they are assured of the measurement quality. Conclusions: We developed this project as a proof-of-concept study, and as such, the app has shown great potential to be used both in a clinical setting and by parents/guardians in their own homes. %M 38354022 %R 10.2196/54194 %U https://formative.jmir.org/2024/1/e54194 %U https://doi.org/10.2196/54194 %U http://www.ncbi.nlm.nih.gov/pubmed/38354022 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50839 %T mHealth App Usability Questionnaire for Stand-Alone mHealth Apps Used by Health Care Providers: Canadian French Translation, Cross-Cultural Adaptation, and Validation (Part 1) %A Gagnon,Julie %A Probst,Sebastian %A Chartrand,Julie %A Lalonde,Michelle %+ School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8L1, Canada, 1 613 562 5700, jgagn156@uottawa.ca %K cross-cultural adaptation %K French language %K mHealth App Usability Questionnaire %K MAUQ %K mobile health %K mHealth %K mobile app %K questionnaire translation %K usability %K validation %K health care providers %K French translation %D 2024 %7 13.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: An increasing number of health care professionals are using mobile apps. The mHealth App Usability Questionnaire (MAUQ) was designed to evaluate the usability of mobile health apps by patients and providers. However, this questionnaire is not available in French. Objective: This study aims to translate (from English to Canadian French), cross-culturally adapt, and initiate the validation of the original version of MAUQ for stand-alone mobile health apps used by French-speaking health care providers. Methods: A cross-cultural research study using a well-established method was conducted to translate MAUQ to Canadian French by certified translators and subsequently review it with a translation committee. It was then back translated to English. The back translations were compared with the original by the members of the committee to reach consensus regarding the prefinal version. A pilot test of the prefinal version was conducted with a sample of 49 potential users and 10 experts for content validation. Results: The statements are considered clear, with interrater agreement of 99.14% among potential users and 90% among experts. Of 21 statements, 5 (24%) did not exceed the 80% interrater agreement of the experts regarding clarity. Following the revisions, interrater agreement exceeded 80%. The content validity index of the items varied from 0.90 to 1, and the overall content validity index was 0.981. Individual Fleiss multirater κ of each item was between 0.89 and 1, showing excellent agreement and increasing confidence in the questionnaire’s content validity. Conclusions: This process of translation and cultural adaptation produced a new version of MAUQ that was validated for later use among the Canadian French–speaking population. An upcoming separate study will investigate the psychometric properties of the adapted questionnaire. %M 38349710 %R 10.2196/50839 %U https://formative.jmir.org/2024/1/e50839 %U https://doi.org/10.2196/50839 %U http://www.ncbi.nlm.nih.gov/pubmed/38349710 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52096 %T The Development and Use of a New Visual Tool (REVISIT) to Support Participant Recall: Web-Based Interview Study Among Older Adults %A Dryden,Eileen M %A Anwar,Chitra %A Conti,Jennifer %A Boudreau,Jacqueline H %A Kennedy,Meaghan A %A Hung,William W %A Nearing,Kathryn A %A Pimentel,Camilla B %A Moo,Lauren %+ Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Veterans Health Administration, 200 Springs Road, Bedford, MA, 01730, United States, 1 781 506 2369, eileen.dryden@va.gov %K qualitative interviews %K visual recall aid %K older adults %K health services research %K web-based methods %K visual tool %K recall %K qualitative interview %K experience %K perspective %K motivation %K patient %K recall capacity %K medical information %K visual appointment %K geriatric %K older people %K telemedicine %K videoconference %K e-consultation %K e-medicine %K internet medicine %K REVISIT %K Remembering Healthcare Encounters Visually and Interactively %K mobile phone %D 2024 %7 1.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Qualitative health services research often relies on semistructured or in-depth interviews to develop a deeper understanding of patient experiences, motivations, and perspectives. The quality of data gathered is contingent upon a patient’s recall capacity; yet, studies have shown that recall of medical information is low. Threats to generating rich and detailed interview data may be more prevalent when interviewing older adults. Objective: We developed and studied the feasibility of using a tool, Remembering Healthcare Encounters Visually and Interactively (REVISIT), which has been created to aid the recall of a specific telemedicine encounter to provide health services research teams with a visual tool, to improve qualitative interviews with older adults. Methods: The REVISIT visual appointment summary was developed to facilitate web-based interviews with our participants as part of an evaluation of a geriatric telemedicine program. Our primary aims were to aid participant recall, maintain focus on the index visit, and establish a shared understanding of the visit between participants and interviewers. The authors’ experiences and observations developing REVISIT and using it during videoconference interviews (N=16) were systematically documented and synthesized. We discuss these experiences with REVISIT and suggest considerations for broader implementation and future research to expand upon this preliminary work. Results: REVISIT enhanced the interview process by providing a focus and catalyst for discussion and supporting rapport-building with participants. REVISIT appeared to support older patients’ and caregivers’ recollection of a clinical visit, helping them to share additional details about their experience. REVISIT was difficult to read for some participants, however, and could not be used for phone interviews. Conclusions: REVISIT is a promising tool to enhance the quality of data collected during interviews with older, rural adults and caregivers about a health care encounter. This novel tool may aid recall of health care experiences for those groups for whom it may be more challenging to collect accurate, rich qualitative data (eg, those with cognitive impairment or complex medical care), allowing health services research to include more diverse patient experiences. %M 38300691 %R 10.2196/52096 %U https://formative.jmir.org/2024/1/e52096 %U https://doi.org/10.2196/52096 %U http://www.ncbi.nlm.nih.gov/pubmed/38300691 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49347 %T Evaluation of Eligibility Criteria Relevance for the Purpose of IT-Supported Trial Recruitment: Descriptive Quantitative Analysis %A Blasini,Romina %A Strantz,Cosima %A Gulden,Christian %A Helfer,Sven %A Lidke,Jakub %A Prokosch,Hans-Ulrich %A Sohrabi,Keywan %A Schneider,Henning %+ Institute of Medical Informatics, Justus Liebig University, Rudolf-Buchheim-Strasse 6, Giessen, 35392, Germany, 49 06419941386, romina.blasini@informatik.med.uni-giessen.de %K CTRSS %K clinical trial recruitment support system %K PRS %K patient recruitment system %K clinical trials %K classifications %K data groups %K data elements %K data classification %K criteria %K relevance %K automated clinical trials %K participants %K clinical trial %D 2024 %7 31.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinical trials (CTs) are crucial for medical research; however, they frequently fall short of the requisite number of participants who meet all eligibility criteria (EC). A clinical trial recruitment support system (CTRSS) is developed to help identify potential participants by performing a search on a specific data pool. The accuracy of the search results is directly related to the quality of the data used for comparison. Data accessibility can present challenges, making it crucial to identify the necessary data for a CTRSS to query. Prior research has examined the data elements frequently used in CT EC but has not evaluated which criteria are actually used to search for participants. Although all EC must be met to enroll a person in a CT, not all criteria have the same importance when searching for potential participants in an existing data pool, such as an electronic health record, because some of the criteria are only relevant at the time of enrollment. Objective: In this study, we investigated which groups of data elements are relevant in practice for finding suitable participants and whether there are typical elements that are not relevant and can therefore be omitted. Methods: We asked trial experts and CTRSS developers to first categorize the EC of their CTs according to data element groups and then to classify them into 1 of 3 categories: necessary, complementary, and irrelevant. In addition, the experts assessed whether a criterion was documented (on paper or digitally) or whether it was information known only to the treating physicians or patients. Results: We reviewed 82 CTs with 1132 unique EC. Of these 1132 EC, 350 (30.9%) were considered necessary, 224 (19.8%) complementary, and 341 (30.1%) total irrelevant. To identify the most relevant data elements, we introduced the data element relevance index (DERI). This describes the percentage of studies in which the corresponding data element occurs and is also classified as necessary or supplementary. We found that the query of “diagnosis” was relevant for finding participants in 79 (96.3%) of the CTs. This group was followed by “date of birth/age” with a DERI of 85.4% (n=70) and “procedure” with a DERI of 35.4% (n=29). Conclusions: The distribution of data element groups in CTs has been heterogeneously described in previous works. Therefore, we recommend identifying the percentage of CTs in which data element groups can be found as a more reliable way to determine the relevance of EC. Only necessary and complementary criteria should be included in this DERI. %M 38294862 %R 10.2196/49347 %U https://formative.jmir.org/2024/1/e49347 %U https://doi.org/10.2196/49347 %U http://www.ncbi.nlm.nih.gov/pubmed/38294862 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54747 %T Machine Learning and Symptom Patterns in Degenerative Cervical Myelopathy: Web-Based Survey Study %A Touzet,Alvaro Yanez %A Rujeedawa,Tanzil %A Munro,Colin %A Margetis,Konstantinos %A Davies,Benjamin M %+ University of Cambridge, The Old Schools, Trinity Ln, Cambridge, Cambridge, CB2 1TN, United Kingdom, 44 01223 337733, bd375@cam.ac.uk %K cervical %K myelopathy %K machine learning %K cluster %K clusters %K clustering %K spine %K spinal %K compression %K neck %K degenerative %K k-means %K patient reported %K degenerative cervical myelopathy %D 2024 %7 25.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Degenerative cervical myelopathy (DCM), a progressive spinal cord injury caused by spinal cord compression from degenerative pathology, often presents with neck pain, sensorimotor dysfunction in the upper or lower limbs, gait disturbance, and bladder or bowel dysfunction. Its symptomatology is very heterogeneous, making early detection as well as the measurement or understanding of the underlying factors and their consequences challenging. Increasingly, evidence suggests that DCM may consist of subgroups of the disease, which are yet to be defined. Objective: This study aimed to explore whether machine learning can identify clinically meaningful groups of patients based solely on clinical features. Methods: A survey was conducted wherein participants were asked to specify the clinical features they had experienced, their principal presenting complaint, and time to diagnosis as well as demographic information, including disease severity, age, and sex. K-means clustering was used to divide respondents into clusters according to their clinical features using the Euclidean distance measure and the Hartigan-Wong algorithm. The clinical significance of groups was subsequently explored by comparing their time to presentation, time with disease severity, and other demographics. Results: After a review of both ancillary and cluster data, it was determined by consensus that the optimal number of DCM response groups was 3. In Cluster 1, there were 40 respondents, and the ratio of male to female participants was 13:21. In Cluster 2, there were 92 respondents, with a male to female participant ratio of 27:65. Cluster 3 had 57 respondents, with a male to female participant ratio of 9:48. A total of 6 people did not report biological sex in Cluster 1. The mean age in this Cluster was 56.2 (SD 10.5) years; in Cluster 2, it was 54.7 (SD 9.63) years; and in Cluster 3, it was 51.8 (SD 8.4) years. Patients across clusters significantly differed in the total number of clinical features reported, with more clinical features in Cluster 3 and the least clinical features in Cluster 1 (Kruskal-Wallis rank sum test: χ22=159.46; P<.001). There was no relationship between the pattern of clinical features and severity. There were also no differences between clusters regarding time since diagnosis and time with DCM. Conclusions: Using machine learning and patient-reported experience, 3 groups of patients with DCM were defined, which were different in the number of clinical features but not in the severity of DCM or time with DCM. Although a clearer biological basis for the clusters may have been missed, the findings are consistent with the emerging observation that DCM is a heterogeneous disease, difficult to diagnose or stratify. There is a place for machine learning methods to efficiently assist with pattern recognition. However, the challenge lies in creating quality data sets necessary to derive benefit from such approaches. %M 38271070 %R 10.2196/54747 %U https://formative.jmir.org/2024/1/e54747 %U https://doi.org/10.2196/54747 %U http://www.ncbi.nlm.nih.gov/pubmed/38271070 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51200 %T Dentists’ Information Needs and Opinions on Accessing Patient Information via Health Information Exchange: Survey Study %A Li,Shuning %A Felix Gomez,Grace Gomez %A Xu,Huiping %A Rajapuri,Anushri Singh %A Dixon,Brian E %A Thyvalikakath,Thankam %+ Department of Dental Public Health and Dental Informatics, Indiana University School of Dentistry, 415 Lansing St, Indianapolis, IN, 46201, United States, 1 3172745460, tpt@iu.edu %K dentistry %K medical history %K integrated medical and dental records %K health information exchange %K medical record %K dental record %K dental %K medical information %K dental care %K adverse drug effect %K medication %K allergies %K cost %K data safety %K data accuracy %D 2024 %7 11.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The integration of medical and dental records is gaining significance over the past 2 decades. However, few studies have evaluated the opinions of practicing dentists on patient medical histories. Questions remain on dentists’ information needs; their perception of the reliability of patient-reported medical history; satisfaction with the available information and the methods to gather this information; and their attitudes to other options, such as a health information exchange (HIE) network, to collect patient medical history. Objective: This study aims to determine Indiana dentists’ information needs regarding patients’ medical information and their opinions about accessing it via an HIE. Methods: We administered a web-based survey to Indiana Dental Association members to assess their current medical information-retrieval approaches, the information critical for dental care, and their willingness to access or share information via an HIE. We used descriptive statistics to summarize survey results and multivariable regression to examine the associations between survey respondents’ characteristics and responses. Results: Of the 161 respondents (161/2148, 7.5% response rate), 99.5% (n=160) respondents considered patients’ medical histories essential to confirm no contraindications, including allergies or the need for antibiotic prophylaxis during dental care and other adverse drug events. The critical information required were medical conditions or diagnosis, current medications, and allergies, which were gathered from patient reports. Furthermore, 88.2% (n=142) of respondents considered patient-reported histories reliable; however, they experienced challenges obtaining information from patients and physicians. Additionally, 70.2% (n=113) of respondents, especially those who currently access an HIE or electronic health record, were willing to use an HIE to access or share their patient’s information, and 91.3% (n=147) shared varying interests in such a service. However, usability, data accuracy, data safety, and cost are the driving factors in adopting an HIE. Conclusions: Patients’ medical histories are essential for dentists to optimize dental care, especially for those with chronic conditions. In addition, most dentists are interested in using an HIE to access patient medical histories. The findings from this study can provide an alternative option for improving communications between dental and medical professionals and help the health information technology system or tool developers identify critical requirements for more user-friendly designs. %M 38206667 %R 10.2196/51200 %U https://formative.jmir.org/2024/1/e51200 %U https://doi.org/10.2196/51200 %U http://www.ncbi.nlm.nih.gov/pubmed/38206667 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e47802 %T Diversity Among American Dermatological Association Members by Sex and Geographic Region %A Rodriguez,Ramiro %A Anderson,Lachlan %A Woolhiser,Emily %A Balmorez,Timothy %A Cook,Bailey %A Hauptman,Megan %A Kirk,Jessica %A Keime,Noah %A Dellavalle,Robert P %+ Dermatology Service, US Department of Veterans Affairs Rocky Mountain Regional Medical Center, Rm E1-342, 1700 N Wheeling St, Aurora, CO, 80045, United States, 1 303 399 8020, robert.dellavalle@cuanschutz.edu %K American Dermatological Association %K disparity %K representation %K dermatology %K urban %K rural %K dermatological society %K diversity %K inclusion %K equity %K sex %K membership %K acquisition %K demographic %D 2024 %7 10.1.2024 %9 Research Letter %J JMIR Dermatol %G English %X %M 38198199 %R 10.2196/47802 %U https://derma.jmir.org/2024/1/e47802 %U https://doi.org/10.2196/47802 %U http://www.ncbi.nlm.nih.gov/pubmed/38198199 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51125 %T Selecting an Ecological Momentary Assessment Platform: Tutorial for Researchers %A Henry,Lauren M %A Hansen,Eleanor %A Chimoff,Justin %A Pokstis,Kimberly %A Kiderman,Miryam %A Naim,Reut %A Kossowsky,Joe %A Byrne,Meghan E %A Lopez-Guzman,Silvia %A Kircanski,Katharina %A Pine,Daniel S %A Brotman,Melissa A %+ Emotion and Development Branch, National Institute of Mental Health, 9000 Rockville Pike, Building 15K, Bethesda, MD, 20892, United States, 1 301 480 3895, lauren.henry@nih.gov %K ecological momentary assessment %K methodology %K psychology and psychiatry %K child and adolescent %K in vivo and real time %D 2024 %7 4.1.2024 %9 Tutorial %J J Med Internet Res %G English %X Background: Although ecological momentary assessment (EMA) has been applied in psychological research for decades, delivery methods have evolved with the proliferation of digital technology. Technological advances have engendered opportunities for enhanced accessibility, convenience, measurement precision, and integration with wearable sensors. Notwithstanding, researchers must navigate novel complexities in EMA research design and implementation. Objective: In this paper, we aimed to provide guidance on platform selection for clinical scientists launching EMA studies. Methods: Our team includes diverse specialties in child and adolescent behavioral and mental health with varying expertise on EMA platforms (eg, users and developers). We (2 research sites) evaluated EMA platforms with the goal of identifying the platform or platforms with the best fit for our research. We created a list of extant EMA platforms; conducted a web-based review; considered institutional security, privacy, and data management requirements; met with developers; and evaluated each of the candidate EMA platforms for 1 week. Results: We selected 2 different EMA platforms, rather than a single platform, for use at our 2 research sites. Our results underscore the importance of platform selection driven by individualized and prioritized laboratory needs; there is no single, ideal platform for EMA researchers. In addition, our project generated 11 considerations for researchers in selecting an EMA platform: (1) location; (2) developer involvement; (3) sample characteristics; (4) onboarding; (5) survey design features; (6) sampling scheme and scheduling; (7) viewing results; (8) dashboards; (9) security, privacy, and data management; (10) pricing and cost structure; and (11) future directions. Furthermore, our project yielded a suggested timeline for the EMA platform selection process. Conclusions: This study will guide scientists initiating studies using EMA, an in vivo, real-time research tool with tremendous promise for facilitating advances in psychological assessment and intervention. %M 38175682 %R 10.2196/51125 %U https://www.jmir.org/2024/1/e51125 %U https://doi.org/10.2196/51125 %U http://www.ncbi.nlm.nih.gov/pubmed/38175682 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45998 %T Differences in Psychological Inflexibility Among Men With Erectile Dysfunction Younger and Older Than 40 Years: Web-Based Cross-Sectional Study %A Saito,Junichi %A Kumano,Hiroaki %A Ghazizadeh,Mohammad %A Shimokawa,Chigusa %A Tanemura,Hideki %+ Comprehensive Research Organization, Waseda University, 2-579-15, Mikajima, Tokorozawa, Saitama, 359-1192, Japan, 81 429498113, tekuteke@aoni.waseda.jp %K erectile dysfunction %K acceptance and commitment therapy %K psychological inflexibility %K depression %K anxiety %K men %K cross-sectional study %K psychological %K utility %K psychosocial %K men %K therapy %K impotence %K erection %D 2024 %7 3.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychological inflexibility is a core concept of acceptance and commitment therapy (ACT), which is a comprehensive, transdiagnostic interpretation of mental health symptoms. Erectile dysfunction (ED) is a condition that affects male sexual performance, involving the inability to achieve and maintain a penile erection sufficient for satisfactory sexual activity. Psychosocial factors primarily influence ED in men younger than 40 years, whereas biological factors are more likely to be the underlying cause in older men. Objective: This web-based cross-sectional study examined differences in depression, anxiety, and psychological inflexibility among men with ED younger and older than 40 years in a Japanese population. Methods: We used a web-based survey to gather data from various community samples. ED was assessed by the International Index of Erectile Function‐5 (IIEF-5) questionnaire, while depression, anxiety, and psychological inflexibility were evaluated by the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Acceptance and Action Questionnaire-II (AAQ-II), Cognitive Fusion Questionnaire (CFQ), and Valuing Questionnaire–Obstacle Subscale (VQ-OB) questionnaires. The chi‐square test estimated the scores of PHQ-9 and GAD-7 among men with ED, comparing those younger than 40 years and those older than 40 years. Additionally, a two-way ANOVA was conducted with ED severity and age group as independent variables, assessing psychological inflexibility. Results: Valid responses from 643 individuals (mean age 36.19, SD 7.54 years) were obtained. Of these, 422 were younger than 40 years (mean age 31.76, SD 5.00 years), and 221 were older than 40 years (mean age 44.67, SD 2.88 years). There was a statistical difference in the prevalence of depression as judged by PHQ≥10 between men with ED younger and older than 40 years (P<.001). On the other hand, there was no difference in the prevalence of anxiety as judged by GAD≥10 (P=.12). The two-way ANOVA revealed that the interactions for CFQ (P=.04) and VQ-OB (P=.01) were significant. The simple main effect was that men with ED younger than 40 years had significantly higher CFQ (P=.01; d=0.62) and VQ-OB (P<.001; d=0.87) scores compared to those older than 40 years in moderate ED and severe ED. Additionally, it was found that men younger than 40 years with moderate to severe ED had significantly higher CFQ (P=.01; d=0.42) and VQ-OB (P=.02; d=0.38) scores compared to men younger than 40 years without ED. On the other hand, no interaction was found for AAQ-II (P=.16) scores. Conclusions: To the best of our knowledge, this web-based cross-sectional study is the first to examine the relationship between psychological inflexibility and ED. We conclude that men with moderate and severe ED younger than 40 years have higher psychological inflexibility and might be eligible for ACT. %M 38170587 %R 10.2196/45998 %U https://formative.jmir.org/2024/1/e45998 %U https://doi.org/10.2196/45998 %U http://www.ncbi.nlm.nih.gov/pubmed/38170587 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e50865 %T Evaluation of GPT-4’s Chest X-Ray Impression Generation: A Reader Study on Performance and Perception %A Ziegelmayer,Sebastian %A Marka,Alexander W %A Lenhart,Nicolas %A Nehls,Nadja %A Reischl,Stefan %A Harder,Felix %A Sauter,Andreas %A Makowski,Marcus %A Graf,Markus %A Gawlitza,Joshua %+ Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, Munich, 81675, Germany, 49 1759153694, ga89rog@mytum.de %K generative model %K GPT %K medical imaging %K artificial intelligence %K imaging %K radiology %K radiological %K radiography %K diagnostic %K chest %K x-ray %K x-rays %K generative %K multimodal %K impression %K impressions %K image %K images %K AI %D 2023 %7 22.12.2023 %9 Research Letter %J J Med Internet Res %G English %X Exploring the generative capabilities of the multimodal GPT-4, our study uncovered significant differences between radiological assessments and automatic evaluation metrics for chest x-ray impression generation and revealed radiological bias. %M 38133918 %R 10.2196/50865 %U https://www.jmir.org/2023/1/e50865 %U https://doi.org/10.2196/50865 %U http://www.ncbi.nlm.nih.gov/pubmed/38133918 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48044 %T Examining Human-Smartphone Interaction as a Proxy for Circadian Rhythm in Patients With Insomnia: Cross-Sectional Study %A Lin,Chen %A Chen,I-Ming %A Chuang,Hai-Hua %A Wang,Zih-Wen %A Lin,Hsiao-Han %A Lin,Yu-Hsuan %+ Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 35053, Taiwan, 886 37206166 ext 36383, yuhsuanlin@nhri.edu.tw %K actigraphy %K circadian rhythm %K digital biomarkers %K human-smartphone interaction %K insomnia %K intradaily variability %K mobile apps %D 2023 %7 15.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The sleep and circadian rhythm patterns associated with smartphone use, which are influenced by mental activities, might be closely linked to sleep quality and depressive symptoms, similar to the conventional actigraphy-based assessments of physical activity. Objective: The primary objective of this study was to develop app-defined circadian rhythm and sleep indicators and compare them with actigraphy-derived measures. Additionally, we aimed to explore the clinical correlations of these indicators in individuals with insomnia and healthy controls. Methods: The mobile app “Rhythm” was developed to record smartphone use time stamps and calculate circadian rhythms in 33 patients with insomnia and 33 age- and gender-matched healthy controls, totaling 2097 person-days. Simultaneously, we used standard actigraphy to quantify participants’ sleep-wake cycles. Sleep indicators included sleep onset, wake time (WT), wake after sleep onset (WASO), and the number of awakenings (NAWK). Circadian rhythm metrics quantified the relative amplitude, interdaily stability, and intradaily variability based on either smartphone use or physical activity data. Results: Comparisons between app-defined and actigraphy-defined sleep onsets, WTs, total sleep times, and NAWK did not reveal any significant differences (all P>.05). Both app-defined and actigraphy-defined sleep indicators successfully captured clinical features of insomnia, indicating prolonged WASO, increased NAWK, and delayed sleep onset and WT in patients with insomnia compared with healthy controls. The Pittsburgh Sleep Quality Index scores were positively correlated with WASO and NAWK, regardless of whether they were measured by the app or actigraphy. Depressive symptom scores were positively correlated with app-defined intradaily variability (β=9.786, SD 3.756; P=.01) and negatively correlated with actigraphy-based relative amplitude (β=–21.693, SD 8.214; P=.01), indicating disrupted circadian rhythmicity in individuals with depression. However, depressive symptom scores were negatively correlated with actigraphy-based intradaily variability (β=–7.877, SD 3.110; P=.01) and not significantly correlated with app-defined relative amplitude (β=–3.859, SD 12.352; P=.76). Conclusions: This study highlights the potential of smartphone-derived sleep and circadian rhythms as digital biomarkers, complementing standard actigraphy indicators. Although significant correlations with clinical manifestations of insomnia were observed, limitations in the evidence and the need for further research on predictive utility should be considered. Nonetheless, smartphone data hold promise for enhancing sleep monitoring and mental health assessments in digital health research. %M 38100195 %R 10.2196/48044 %U https://www.jmir.org/2023/1/e48044 %U https://doi.org/10.2196/48044 %U http://www.ncbi.nlm.nih.gov/pubmed/38100195 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49685 %T Development and Formative Evaluation of a Virtual Exercise Platform for a Community Fitness Center Serving Individuals With Physical Disabilities: Mixed Methods Study %A Mohanraj,Sangeetha %A Malone,Laurie A %A Mendonca,Christen J %A Thirumalai,Mohanraj %+ Department of Health Services Administration, School of Health Professions, The University of Alabama at Birmingham, 1716, 9th Avenue S, SHP # 590 D, Birmingham, AL, 35233, United States, 1 2059347189, mohanraj@uab.edu %K web-based exercise %K user experience %K community health %K fitness facility %K tele-exercise %K physical disability %K physical activity %K exercise %K fitness %K virtual %K interface %K disability %K disabilities %K accessibility %K telehealth %K telemedicine %K eHealth %K digital health %K mixed methods study %D 2023 %7 15.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: People with disabilities experience numerous barriers to being physically active, such as transportation issues, a lack of trained exercise professionals who understand disabilities, and facility access. The use of a virtual exercise platform (VEP) may provide an alternative and limit certain barriers. Objective: The aim of this mixed method study was to evaluate user interaction (effectiveness, efficiency, and satisfaction), the strengths and weaknesses of the user interface, and the user experience with a VEP. Methods: Participants were recruited from a community fitness facility that offers programs for people with disabilities. Inclusion criteria were being older than 18 years, fluent in English, and availability of internet access. Features of the VEP included articles, prerecorded videos, live Zoom classes, web-based class registration, weekly progress tracking, incentives, and surveys. A one-on-one Zoom session was scheduled with each participant, during which they completed certain tasks: (1) create an account or login, (2) register for class, (3) join class, (4) add to calendar, and (5) complete surveys. As participants completed tasks, quantitative observations (time on task, task success, rate of task completion, and number of errors by users, which determined task difficulty), qualitative observations were made and interviews were conducted at the end of the session. The “concurrent think-aloud” method was encouraged by the moderator to gauge participants’ thoughts as they worked through testing. Participants also completed the System Usability Scale (SUS) and Questionnaire for User Interface Satisfaction (QUIS). Results: A total of 5 people with disabilities (3 male, 2 female), aged 36-78 (mean 54) years, with education levels from high school to PhD, were recruited. Devices used for testing included a laptop (n=3), a Chromebook (n=1), and a desktop (n=1). All participants completed tasks #1 and #2 without errors but could not complete task #4. One participant completed task #5 with difficulty and another completed task #3 with difficulty. The average time to complete each task was: (1) 82 seconds (55-110), (2) 11 seconds (4-21), (3) 9 seconds (5-27), and (4) 921.5 seconds (840-958). The mean SUS score was 86.5/100, and the mean user QUIS score was 8.08 out of 10. Qualitative observations indicated that the system was simple, user-friendly, and accessible. Conclusions: People with disabilities reported high usability and user satisfaction with the web-based exercise platform, and the system appears to be an efficient and effective physical activity option. %M 38100173 %R 10.2196/49685 %U https://formative.jmir.org/2023/1/e49685 %U https://doi.org/10.2196/49685 %U http://www.ncbi.nlm.nih.gov/pubmed/38100173 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e51616 %T Everyday Digital Literacy Questionnaire for Older Adults: Instrument Development and Validation Study %A Choi,JiYeon %A Choi,Seongmi %A Song,Kijun %A Baek,Jiwon %A Kim,Heejung %A Choi,Mona %A Kim,Yesol %A Chu,Sang Hui %A Shin,Jiyoung %+ Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 3323, jyshin214@yuhs.ac %K aging %K older adults %K digital literacy %K instrument %K validation %K psychometrics %K European Commission’s Digital Competence framework %D 2023 %7 14.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The need for digital literacy in aging populations is increasing in the digitalizing society. Digital literacy involves the identification, evaluation, and communication of information through various digital devices or relevant programs. Objective: The aims of this study were to develop an Everyday Digital Literacy Questionnaire (EDLQ), a digital literacy assessment scale, and subsequently evaluate its psychometric properties using a population of community-dwelling older adults in South Korea. Methods: The EDLQ was developed using an instrument development design. A nationwide survey was conducted, and the study included 1016 community-dwelling older adults (age ≥60 years). To evaluate the psychometric properties, the participants were randomly divided into 2 groups (n=508 each), and the internal consistency (Cronbach α and McDonald ω), structural validity (exploratory factor analysis and confirmatory factor analysis), hypothesis-testing construct validity using the eHealth Literacy Scale (eHEALS), and measurement invariance were analyzed. Results: Among the initial 30 items of the EDLQ, 22 items with a 3-factor solution had a total explained variance of 77%. The domains included “information and communication” (9 items), “content creation and management” (4 items), and “safety and security” (9 items). Confirmatory factor analysis was conducted with this 3-factor solution (χ2206=345.1; normed χ2206=1.7; comparative fit index=0.997; Tucker-Lewis index=0.997; root-mean-square error of approximation=0.036; standardized root-mean-square residual=0.050; composite reliability=0.903-0.959; average variance extracted=0.699-0.724; R2=0.616-0.773). Hypothesis-testing construct validity with the eHEALS revealed a strong correlation (r=0.75). Cronbach α and McDonald ω coefficients were .98 and 0.98, respectively. The fit indices for measurement invariance, including the configural, metric, and scalar invariance models, demonstrated a satisfactory fit to the data. Our findings suggest that the psychometric properties of the 22-item EDLQ are valid and reliable for assessing digital literacy among older Korean adults. Conclusions: In this study, we developed a digital literacy measure with strong psychometric properties that made it suitable for assessing the digital literacy of community-dwelling older adults in Korea. To broaden its applicability, however, further assessment of its feasibility for use with different languages and cultures is necessary. Moreover, more empirical research on digital literacy and related factors in older adults can facilitate the development of personalized digital health care services and educational interventions in the digital society. %M 38095999 %R 10.2196/51616 %U https://www.jmir.org/2023/1/e51616 %U https://doi.org/10.2196/51616 %U http://www.ncbi.nlm.nih.gov/pubmed/38095999 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e51336 %T Comparison of Polysomnography, Single-Channel Electroencephalogram, Fitbit, and Sleep Logs in Patients With Psychiatric Disorders: Cross-Sectional Study %A Kawai,Keita %A Iwamoto,Kunihiro %A Miyata,Seiko %A Okada,Ippei %A Fujishiro,Hiroshige %A Noda,Akiko %A Nakagome,Kazuyuki %A Ozaki,Norio %A Ikeda,Masashi %+ Department of Psychiatry, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa, Nagoya, 466-8550, Japan, 81 52 744 2282, iwamoto@med.nagoya-u.ac.jp %K consumer sleep-tracking device %K polysomnography %K portable sleep EEG monitor %K electroencephalography %K EEG %K psychiatric disorders %K sleep logs %K sleep state misperception %K polysomnography %K sleep study %K wearable %K psychiatric disorder %K sleep %K disturbances %K quality of sleep %K Fitbit %K mHealth %K wearables %K psychiatry %K electroencephalogram %D 2023 %7 13.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Sleep disturbances are core symptoms of psychiatric disorders. Although various sleep measures have been developed to assess sleep patterns and quality of sleep, the concordance of these measures in patients with psychiatric disorders remains relatively elusive. Objective: This study aims to examine the degree of agreement among 3 sleep recording methods and the consistency between subjective and objective sleep measures, with a specific focus on recently developed devices in a population of individuals with psychiatric disorders. Methods: We analyzed 62 participants for this cross-sectional study, all having data for polysomnography (PSG), Zmachine, Fitbit, and sleep logs. Participants completed questionnaires on their symptoms and estimated sleep duration the morning after the overnight sleep assessment. The interclass correlation coefficients (ICCs) were calculated to evaluate the consistency between sleep parameters obtained from each instrument. Additionally, Bland-Altman plots were used to visually show differences and limits of agreement for sleep parameters measured by PSG, Zmachine, Fitbit, and sleep logs. Results: The findings indicated a moderate agreement between PSG and Zmachine data for total sleep time (ICC=0.46; P<.001), wake after sleep onset (ICC=0.39; P=.002), and sleep efficiency (ICC=0.40; P=.006). In contrast, Fitbit demonstrated notable disagreement with PSG (total sleep time: ICC=0.08; wake after sleep onset: ICC=0.18; sleep efficiency: ICC=0.10) and exhibited particularly large discrepancies from the sleep logs (total sleep time: ICC=–0.01; wake after sleep onset: ICC=0.05; sleep efficiency: ICC=–0.02). Furthermore, subjective and objective concordance among PSG, Zmachine, and sleep logs appeared to be influenced by the severity of the depressive symptoms and obstructive sleep apnea, while these associations were not observed between the Fitbit and other sleep instruments. Conclusions: Our study results suggest that Fitbit accuracy is reduced in the presence of comorbid clinical symptoms. Although user-friendly, Fitbit has limitations that should be considered when assessing sleep in patients with psychiatric disorders. %M 38090797 %R 10.2196/51336 %U https://www.jmir.org/2023/1/e51336 %U https://doi.org/10.2196/51336 %U http://www.ncbi.nlm.nih.gov/pubmed/38090797 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48838 %T Structural Validation and Measurement Invariance Testing of the Chinese Version of the eHealth Literacy Scale Among Undergraduates: Cross-Sectional Study %A Long,Chen %A Zheng,Lin %A Liu,Runhua %A Duan,Zhongxian %+ School of Public Management, Guizhou University, No. 2708, South Section of Huaxi Avenue, Huaxi District, Guiyang, 550025, China, 86 187 9883 8878, zxduan@gzu.edu.cn %K eHealth literacy %K eHEALS %K factor structure %K measurement invariance %K undergraduates %K health literacy %K cross-sectional survey %K digital health literacy %K measurement %D 2023 %7 13.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The eHealth Literacy Scale (eHEALS) was introduced in China in 2013 as one of the most important electronic health literacy measurement instruments. After a decade of development in China, it has received widespread attention, although its theoretical underpinnings have been challenged, thus demanding more robust research evidence of factorial validity and multigroup measurement properties. Objective: This study aimed to evaluate the Chinese version of the eHEALS in terms of its measurement properties. Methods: A cross-sectional survey was conducted in a university setting in China. Item statistics were checked for response distributions and floor and ceiling effects. Internal consistency reliability was confirmed with Cronbach α, split-half reliability, Cronbach α if an item was deleted, and item-total correlation. A total of 5 representative eHEALS factor structures were examined and contrasted using confirmatory factor analysis. The study used the item-level content validity index (I-CVI) and the average of the I-CVI scores of all items on the scale to assess the content validity of the dominance model. Furthermore, the validated dominance model was subsequently used to evaluate the relevance and representation of elements in the instrument and to assess measurement invariance across genders. Results: A total of 972 respondents were identified, with a Cronbach α of .92, split-half reliability of 0.88, and item-total score correlation coefficients ranging from 0.715 to 0.781. Cronbach α if an item was deleted showed that all items should be retained. Acceptable content validity was supported by I-CVIs ≥0.80. The confirmatory factor analysis confirmed that the 3-factor model was acceptable. The measurement model met all relevant fit indices: average variance extracted from 0.663 to 0.680, composite reliability from 0.810 to 0.857, chi-square divided by the df of 4.768, root mean square error of approximation of 0.062, standardized root mean squared residual of 0.020, comparative fit index (CFI) of 0.987, and Tucker-Lewis index of 0.979. In addition, the scale demonstrated error variance invariance (Δnormed fit index=−0.016, Δincremental fit index=−0.012, ΔTucker-Lewis index=0.005, Δcomparative fit index=−0.012, Δrelative fit index=0.005, and Δroot mean square error of approximation=0.005). Conclusions: A 3-factor model of the Chinese version of the eHEALS fits best, and our findings provide evidence for the strict measurement invariance of the instrument regarding gender. %M 37990370 %R 10.2196/48838 %U https://www.jmir.org/2023/1/e48838 %U https://doi.org/10.2196/48838 %U http://www.ncbi.nlm.nih.gov/pubmed/37990370 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e46678 %T Optimizing Digital Tools for the Field of Substance Use and Substance Use Disorders: Backcasting Exercise %A Scheibein,Florian %A Caballeria,Elsa %A Taher,Md Abu %A Arya,Sidharth %A Bancroft,Angus %A Dannatt,Lisa %A De Kock,Charlotte %A Chaudhary,Nazish Idrees %A Gayo,Roberto Perez %A Ghosh,Abhishek %A Gelberg,Lillian %A Goos,Cees %A Gordon,Rebecca %A Gual,Antoni %A Hill,Penelope %A Jeziorska,Iga %A Kurcevič,Eliza %A Lakhov,Aleksey %A Maharjan,Ishwor %A Matrai,Silvia %A Morgan,Nirvana %A Paraskevopoulos,Ilias %A Puharić,Zrinka %A Sibeko,Goodman %A Stola,Jan %A Tiburcio,Marcela %A Tay Wee Teck,Joseph %A Tsereteli,Zaza %A López-Pelayo,Hugo %+ Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Calle Rosselló, 149-153, Barcelona, 08036, Spain, 34 932275400 ext 4160, caballeria@recerca.clinic.cat %K substance use %K substance use disorders %K addictions %K telemedicine %K eHealth %K digital tools %K backcasting exercise %K drug addiction %K ethical frameworks %K digital health %D 2023 %7 12.12.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Substance use trends are complex; they often rapidly evolve and necessitate an intersectional approach in research, service, and policy making. Current and emerging digital tools related to substance use are promising but also create a range of challenges and opportunities. Objective: This paper reports on a backcasting exercise aimed at the development of a roadmap that identifies values, challenges, facilitators, and milestones to achieve optimal use of digital tools in the substance use field by 2030. Methods: A backcasting exercise method was adopted, wherein the core elements are identifying key values, challenges, facilitators, milestones, cornerstones and a current, desired, and future scenario. A structured approach was used by means of (1) an Open Science Framework page as a web-based collaborative working space and (2) key stakeholders’ collaborative engagement during the 2022 Lisbon Addiction Conference. Results: The identified key values were digital rights, evidence-based tools, user-friendliness, accessibility and availability, and person-centeredness. The key challenges identified were ethical funding, regulations, commercialization, best practice models, digital literacy, and access or reach. The key facilitators identified were scientific research, interoperable infrastructure and a culture of innovation, expertise, ethical funding, user-friendly designs, and digital rights and regulations. A range of milestones were identified. The overarching identified cornerstones consisted of creating ethical frameworks, increasing access to digital tools, and continuous trend analysis. Conclusions: The use of digital tools in the field of substance use is linked to a range of risks and opportunities that need to be managed. The current trajectories of the use of such tools are heavily influenced by large multinational for-profit companies with relatively little involvement of key stakeholders such as people who use drugs, service providers, and researchers. The current funding models are problematic and lack the necessary flexibility associated with best practice business approaches such as lean and agile principles to design and execute customer discovery methods. Accessibility and availability, digital rights, user-friendly design, and person-focused approaches should be at the forefront in the further development of digital tools. Global legislative and technical infrastructures by means of a global action plan and strategy are necessary and should include ethical frameworks, accessibility of digital tools for substance use, and continuous trend analysis as cornerstones. %M 38085569 %R 10.2196/46678 %U https://humanfactors.jmir.org/2023/1/e46678 %U https://doi.org/10.2196/46678 %U http://www.ncbi.nlm.nih.gov/pubmed/38085569 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 11 %N %P e50017 %T Extending cBioPortal for Therapy Recommendation Documentation in Molecular Tumor Boards: Development and Usability Study %A Renner,Christopher %A Reimer,Niklas %A Christoph,Jan %A Busch,Hauke %A Metzger,Patrick %A Boerries,Melanie %A Ustjanzew,Arsenij %A Boehm,Dominik %A Unberath,Philipp %+ Chair of Medical Informatics, Friedrich-Alexander University Erlangen-Nuremberg, Wetterkreuz 15, Erlangen, 91058, Germany, 49 1733735424, philipp.unberath@fau.de %K molecular tumor board %K documentation platform %K usability evaluation %K cBioPortal %K precision medicine %K genomics %K health information interoperability %K tumor %K implementation %K cancer %K tool %K platform %K development %K precision %K use %K user-centered %D 2023 %7 11.12.2023 %9 Original Paper %J JMIR Med Inform %G English %X Background: In molecular tumor boards (MTBs), patients with rare or advanced cancers are discussed by a multidisciplinary team of health care professionals. Software support for MTBs is lacking; in particular, tools for preparing and documenting MTB therapy recommendations need to be developed. Objective: We aimed to implement an extension to cBioPortal to provide a tool for the documentation of therapy recommendations from MTB sessions in a secure and standardized manner. The developed extension should be embedded in the patient view of cBioPortal to enable easy documentation during MTB sessions. The resulting architecture for storing therapy recommendations should be integrable into various hospital information systems. Methods: On the basis of a requirements analysis and technology analysis for authentication techniques, a prototype was developed and iteratively refined through a user-centered development process. In conclusion, the tool was evaluated via a usability evaluation, including interviews, structured questionnaires, and the System Usability Scale. Results: The patient view of cBioPortal was extended with a new tab that enables users to document MTB sessions and therapy recommendations. The role-based access control was expanded to allow for a finer distinction among the rights to view, edit, and delete data. The usability evaluation showed overall good usability and a System Usability Scale score of 83.57. Conclusions: This study demonstrates how cBioPortal can be extended to not only visualize MTB patient data but also be used as a documentation platform for therapy recommendations. %M 38079196 %R 10.2196/50017 %U https://medinform.jmir.org/2023/1/e50017 %U https://doi.org/10.2196/50017 %U http://www.ncbi.nlm.nih.gov/pubmed/38079196 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e52202 %T Performance Comparison of ChatGPT-4 and Japanese Medical Residents in the General Medicine In-Training Examination: Comparison Study %A Watari,Takashi %A Takagi,Soshi %A Sakaguchi,Kota %A Nishizaki,Yuji %A Shimizu,Taro %A Yamamoto,Yu %A Tokuda,Yasuharu %+ Department of Medicine, University of Michigan Medical School, 2215 Fuller Road, Ann Arbor, MI, 48105, United States, 1 734 769 7100, wataritari@gmail.com %K ChatGPT %K artificial intelligence %K medical education %K clinical training %K non-English language %K ChatGPT-4 %K Japan %K Japanese %K Asia %K Asian %K exam %K examination %K exams %K examinations %K NLP %K natural language processing %K LLM %K language model %K language models %K performance %K response %K responses %K answer %K answers %K chatbot %K chatbots %K conversational agent %K conversational agents %K reasoning %K clinical %K GM-ITE %K self-assessment %K residency programs %D 2023 %7 6.12.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: The reliability of GPT-4, a state-of-the-art expansive language model specializing in clinical reasoning and medical knowledge, remains largely unverified across non-English languages. Objective: This study aims to compare fundamental clinical competencies between Japanese residents and GPT-4 by using the General Medicine In-Training Examination (GM-ITE). Methods: We used the GPT-4 model provided by OpenAI and the GM-ITE examination questions for the years 2020, 2021, and 2022 to conduct a comparative analysis. This analysis focused on evaluating the performance of individuals who were concluding their second year of residency in comparison to that of GPT-4. Given the current abilities of GPT-4, our study included only single-choice exam questions, excluding those involving audio, video, or image data. The assessment included 4 categories: general theory (professionalism and medical interviewing), symptomatology and clinical reasoning, physical examinations and clinical procedures, and specific diseases. Additionally, we categorized the questions into 7 specialty fields and 3 levels of difficulty, which were determined based on residents’ correct response rates. Results: Upon examination of 137 GM-ITE questions in Japanese, GPT-4 scores were significantly higher than the mean scores of residents (residents: 55.8%, GPT-4: 70.1%; P<.001). In terms of specific disciplines, GPT-4 scored 23.5 points higher in the “specific diseases,” 30.9 points higher in “obstetrics and gynecology,” and 26.1 points higher in “internal medicine.” In contrast, GPT-4 scores in “medical interviewing and professionalism,” “general practice,” and “psychiatry” were lower than those of the residents, although this discrepancy was not statistically significant. Upon analyzing scores based on question difficulty, GPT-4 scores were 17.2 points lower for easy problems (P=.007) but were 25.4 and 24.4 points higher for normal and difficult problems, respectively (P<.001). In year-on-year comparisons, GPT-4 scores were 21.7 and 21.5 points higher in the 2020 (P=.01) and 2022 (P=.003) examinations, respectively, but only 3.5 points higher in the 2021 examinations (no significant difference). Conclusions: In the Japanese language, GPT-4 also outperformed the average medical residents in the GM-ITE test, originally designed for them. Specifically, GPT-4 demonstrated a tendency to score higher on difficult questions with low resident correct response rates and those demanding a more comprehensive understanding of diseases. However, GPT-4 scored comparatively lower on questions that residents could readily answer, such as those testing attitudes toward patients and professionalism, as well as those necessitating an understanding of context and communication. These findings highlight the strengths and limitations of artificial intelligence applications in medical education and practice. %M 38055323 %R 10.2196/52202 %U https://mededu.jmir.org/2023/1/e52202 %U https://doi.org/10.2196/52202 %U http://www.ncbi.nlm.nih.gov/pubmed/38055323 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e51603 %T How Can the Clinical Aptitude of AI Assistants Be Assayed? %A Thirunavukarasu,Arun James %+ Oxford University Clinical Academic Graduate School, University of Oxford, John Radcliffe Hospital, Level 3, Oxford, OX3 9DU, United Kingdom, 44 1865 289 467, ajt205@cantab.ac.uk %K artificial intelligence %K AI %K validation %K clinical decision aid %K artificial general intelligence %K foundation models %K large language models %K LLM %K language model %K ChatGPT %K chatbot %K chatbots %K conversational agent %K conversational agents %K pitfall %K pitfalls %K pain point %K pain points %K implementation %K barrier %K barriers %K challenge %K challenges %D 2023 %7 5.12.2023 %9 Viewpoint %J J Med Internet Res %G English %X Large language models (LLMs) are exhibiting remarkable performance in clinical contexts, with exemplar results ranging from expert-level attainment in medical examination questions to superior accuracy and relevance when responding to patient queries compared to real doctors replying to queries on social media. The deployment of LLMs in conventional health care settings is yet to be reported, and there remains an open question as to what evidence should be required before such deployment is warranted. Early validation studies use unvalidated surrogate variables to represent clinical aptitude, and it may be necessary to conduct prospective randomized controlled trials to justify the use of an LLM for clinical advice or assistance, as potential pitfalls and pain points cannot be exhaustively predicted. This viewpoint states that as LLMs continue to revolutionize the field, there is an opportunity to improve the rigor of artificial intelligence (AI) research to reward innovation, conferring real benefits to real patients. %M 38051572 %R 10.2196/51603 %U https://www.jmir.org/2023/1/e51603 %U https://doi.org/10.2196/51603 %U http://www.ncbi.nlm.nih.gov/pubmed/38051572 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49147 %T A Stable and Scalable Digital Composite Neurocognitive Test for Early Dementia Screening Based on Machine Learning: Model Development and Validation Study %A Gu,Dongmei %A Lv,Xiaozhen %A Shi,Chuan %A Zhang,Tianhong %A Liu,Sha %A Fan,Zili %A Tu,Lihui %A Zhang,Ming %A Zhang,Nan %A Chen,Liming %A Wang,Zhijiang %A Wang,Jing %A Zhang,Ying %A Li,Huizi %A Wang,Luchun %A Zhu,Jiahui %A Zheng,Yaonan %A Wang,Huali %A Yu,Xin %A , %+ Clinical Research Division, Dementia Care and Research Center, Peking University Institute of Mental Health (Sixth Hospital), Huayuanbei Road 51, Haidian District, Beijing, 100191, China, 86 10 82801999, yuxin@bjmu.edu.cn %K mild cognitive impairment %K digital cognitive assessment %K machine learning %K neurocognitive test %K cognitive screening %K dementia %D 2023 %7 1.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Dementia has become a major public health concern due to its heavy disease burden. Mild cognitive impairment (MCI) is a transitional stage between healthy aging and dementia. Early identification of MCI is an essential step in dementia prevention. Objective: Based on machine learning (ML) methods, this study aimed to develop and validate a stable and scalable panel of cognitive tests for the early detection of MCI and dementia based on the Chinese Neuropsychological Consensus Battery (CNCB) in the Chinese Neuropsychological Normative Project (CN-NORM) cohort. Methods: CN-NORM was a nationwide, multicenter study conducted in China with 871 participants, including an MCI group (n=327, 37.5%), a dementia group (n=186, 21.4%), and a cognitively normal (CN) group (n=358, 41.1%). We used the following 4 algorithms to select candidate variables: the F-score according to the SelectKBest method, the area under the curve (AUC) from logistic regression (LR), P values from the logit method, and backward stepwise elimination. Different models were constructed after considering the administration duration and complexity of combinations of various tests. Receiver operating characteristic curve and AUC metrics were used to evaluate the discriminative ability of the models via stratified sampling cross-validation and LR and support vector classification (SVC) algorithms. This model was further validated in the Alzheimer’s Disease Neuroimaging Initiative phase 3 (ADNI-3) cohort (N=743), which included 416 (56%) CN subjects, 237 (31.9%) patients with MCI, and 90 (12.1%) patients with dementia. Results: Except for social cognition, all other domains in the CNCB differed between the MCI and CN groups (P<.008). In feature selection results regarding discrimination between the MCI and CN groups, the Hopkins Verbal Learning Test-5 minutes Recall had the best performance, with the highest mean AUC of up to 0.80 (SD 0.02) and an F-score of up to 258.70. The scalability of model 5 (Hopkins Verbal Learning Test-5 minutes Recall and Trail Making Test-B) was the lowest. Model 5 achieved a higher level of discrimination than the Hong Kong Brief Cognitive test score in distinguishing between the MCI and CN groups (P<.05). Model 5 also provided the highest sensitivity of up to 0.82 (range 0.72-0.92) and 0.83 (range 0.75-0.91) according to LR and SVC, respectively. This model yielded a similar robust discriminative performance in the ADNI-3 cohort regarding differentiation between the MCI and CN groups, with a mean AUC of up to 0.81 (SD 0) according to both LR and SVC algorithms. Conclusions: We developed a stable and scalable composite neurocognitive test based on ML that could differentiate not only between patients with MCI and controls but also between patients with different stages of cognitive impairment. This composite neurocognitive test is a feasible and practical digital biomarker that can potentially be used in large-scale cognitive screening and intervention studies. %M 38039074 %R 10.2196/49147 %U https://www.jmir.org/2023/1/e49147 %U https://doi.org/10.2196/49147 %U http://www.ncbi.nlm.nih.gov/pubmed/38039074 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e48138 %T Reconsidering the Use of Population Health Surveys for Monitoring of Mental Health %A Arias de la Torre,Jorge %A Vilagut,Gemma %A Ronaldson,Amy %A Bakolis,Ioannis %A Dregan,Alex %A Navarro-Mateu,Fernando %A Pérez,Katherine %A Szücs,Anna %A Bartoll-Roca,Xavier %A Molina,Antonio J %A Elices,Matilde %A Pérez-Solá,Víctor %A Martín,Vicente %A Serrano-Blanco,Antoni %A Valderas,Jose M %A Alonso,Jordi %+ University of Exeter, Magdalen Road, Smeall Building, Exeter, EX12LU, United Kingdom, 44 6772 3874, jmvalderas@nus.edu.sg %K mental health %K public heath %K burden %K health surveys %K monitoring %K status %K data collection %K electronic health record %K challenges %K assessment tool %K population %K population health survey %D 2023 %7 23.11.2023 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Monitoring of the mental health status of the population and assessment of its determinants are 2 of the most relevant pillars of public mental health, and data from population health surveys could be instrumental to support them. Although these surveys could be an important and suitable resource for these purposes, due to different limitations and challenges, they are often relegated to the background behind other data sources, such as electronic health records. These limitations and challenges include those related to measurement properties and cross-cultural validity of the tools used for the assessment of mental disorders, their degree of representativeness, and possible difficulties in the linkage with other data sources. Successfully addressing these limitations could significantly increase the potential of health surveys in the monitoring of mental disorders and ultimately maximize the impact of the relevant policies to reduce their burden at the population level. The widespread use of data from population health surveys, ideally linked to electronic health records data, would enhance the quality of the information available for research, public mental health decision-making, and ultimately addressing the growing burden of mental disorders. %M 37995112 %R 10.2196/48138 %U https://publichealth.jmir.org/2023/1/e48138 %U https://doi.org/10.2196/48138 %U http://www.ncbi.nlm.nih.gov/pubmed/37995112 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43368 %T German Version of the Mobile Agnew Relationship Measure: Translation and Validation Study %A von Wulffen,Clemens %A Marciniak,Marta Anna %A Rohde,Judith %A Kalisch,Raffael %A Binder,Harald %A Tuescher,Oliver %A Kleim,Birgit %+ Department of Psychology, University of Zurich, Lenggstrasse 31, Zürich, 8032, Switzerland, 41 583842436, marta.marciniak@uzh.ch %K therapeutic alliance %K digital therapeutic alliance %K mental health apps %K mHealth %K mobile health %K translation %K validation %K mobile phone %D 2023 %7 13.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The mobile Agnew Relationship Measure (mARM) is a self-report questionnaire for the evaluation of digital mental health interventions and their interactions with users. With the global increase in digital mental health intervention research, translated measures are required to conduct research with local populations. Objective: The aim of this study was to translate and validate the original English version of the mARM into a German version (mARM-G). Methods: A total of 2 native German speakers who spoke English as their second language conducted forward translation of the original items. This version was then back translated by 2 native German speakers with a fluent knowledge of English. An independent bilingual reviewer then compared these drafts and created a final German version. The mARM-G was validated by 15 experts in the field of mobile app development and 15 nonexperts for content validity and face validity; 144 participants were recruited to conduct reliability testing as well as confirmatory factor analysis. Results: The content validity index of the mARM-G was 0.90 (expert ratings) and 0.79 (nonexperts). The face validity index was 0.89 (experts) and 0.86 (nonexperts). Internal consistency for the entire scale was Cronbach α=.91. Confirmatory factor analysis results were as follows: the chi-square statistic to df ratio was 1.66. Comparative Fit Index was 0.87 and the Tucker-Lewis Index was 0.86. The root mean square error of approximation was 0.07. Conclusions: The mARM-G is a valid and reliable tool that can be used for future studies in German-speaking countries. %M 37955952 %R 10.2196/43368 %U https://www.jmir.org/2023/1/e43368 %U https://doi.org/10.2196/43368 %U http://www.ncbi.nlm.nih.gov/pubmed/37955952 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e50767 %T Conversational Agents in Health Care: Expert Interviews to Inform the Definition, Classification, and Conceptual Framework %A Martinengo,Laura %A Lin,Xiaowen %A Jabir,Ahmad Ishqi %A Kowatsch,Tobias %A Atun,Rifat %A Car,Josip %A Tudor Car,Lorainne %+ Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Level 18, Singapore, 308232, Singapore, 65 69047155, lorainne.tudor.car@ntu.edu.sg %K conceptual framework %K conversational agent %K chatbot %K mobile health %K mHealth %K digital health %K expert interview %K mobile phone %D 2023 %7 1.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Conversational agents (CAs), or chatbots, are computer programs that simulate conversations with humans. The use of CAs in health care settings is recent and rapidly increasing, which often translates to poor reporting of the CA development and evaluation processes and unreliable research findings. We developed and published a conceptual framework, designing, developing, evaluating, and implementing a smartphone-delivered, rule-based conversational agent (DISCOVER), consisting of 3 iterative stages of CA design, development, and evaluation and implementation, complemented by 2 cross-cutting themes (user-centered design and data privacy and security). Objective: This study aims to perform in-depth, semistructured interviews with multidisciplinary experts in health care CAs to share their views on the definition and classification of health care CAs and evaluate and validate the DISCOVER conceptual framework. Methods: We conducted one-on-one semistructured interviews via Zoom (Zoom Video Communications) with 12 multidisciplinary CA experts using an interview guide based on our framework. The interviews were audio recorded, transcribed by the research team, and analyzed using thematic analysis. Results: Following participants’ input, we defined CAs as digital interfaces that use natural language to engage in a synchronous dialogue using ≥1 communication modality, such as text, voice, images, or video. CAs were classified by 13 categories: response generation method, input and output modalities, CA purpose, deployment platform, CA development modality, appearance, length of interaction, type of CA-user interaction, dialogue initiation, communication style, CA personality, human support, and type of health care intervention. Experts considered that the conceptual framework could be adapted for artificial intelligence–based CAs. However, despite recent advances in artificial intelligence, including large language models, the technology is not able to ensure safety and reliability in health care settings. Finally, aligned with participants’ feedback, we present an updated iteration of the conceptual framework for health care conversational agents (CHAT) with key considerations for CA design, development, and evaluation and implementation, complemented by 3 cross-cutting themes: ethics, user involvement, and data privacy and security. Conclusions: We present an expanded, validated CHAT and aim at guiding researchers from a variety of backgrounds and with different levels of expertise in the design, development, and evaluation and implementation of rule-based CAs in health care settings. %M 37910153 %R 10.2196/50767 %U https://www.jmir.org/2023/1/e50767 %U https://doi.org/10.2196/50767 %U http://www.ncbi.nlm.nih.gov/pubmed/37910153 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e51090 %T German Version of the mHealth App Usability Questionnaire in a Cohort of Patients With Cancer: Translation and Validation Study %A Moorthy,Preetha %A Weinert,Lina %A Harms,Bendix Christian %A Anders,Carolin %A Siegel,Fabian %+ Department of Biomedical Informatics, Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany, 49 621 383 8078, preetha.moorthy@medma.uni-heidelberg.de %K usability %K mobile health %K mHealth app %K questionnaire validation %K questionnaire translation %K mHealth App Usability Questionnaire %K MAUQ %K mobile phone %D 2023 %7 1.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Good usability is important for the adoption and continued use of mobile health (mHealth) apps. In particular, high usability can support intuitive use by patients, which improves compliance and increases the app’s effectiveness. However, many usability studies do not use adequate tools to measure perceived usability. The mHealth App Usability Questionnaire (MAUQ) was developed specifically for end users in a medical context. MAUQ is a relatively new but increasingly used questionnaire to evaluate mHealth apps, but it is not yet available in German. Objective: This study aims to translate MAUQ into German and determine its internal consistency, reliability, and construct validity. Methods: This validation study was conducted as part of a usability evaluation project for an mHealth app used as a therapy support tool during breast cancer chemotherapy. MAUQ was translated into German through a rigorous forward-backward translation process, ensuring semantic and conceptual equivalence. Patient responses to MAUQ and System Usability Scale (SUS) were analyzed for validation. Descriptive analysis was performed for the MAUQ subscales and SUS standard scores. Significance tests and correlation coefficients assessed the relationship between the SUS and MAUQ results, confirming construct validity. Internal consistency was assessed for item reliability and consistency in measuring the target construct. Free-text questions assessed translation comprehensibility, with responses analyzed descriptively and qualitatively using content analysis. Results: In this study, 133 participants responded to the questionnaire, and the validation analysis showed substantially positive correlations between the overall MAUQ score and its subscales: ease of use (r=0.56), interface and satisfaction (r=0.75), and usefulness (r=0.83). These findings support the construct validity of MAUQ and emphasize the importance of these subscales in assessing the usability of the Enable app. The correlation coefficients ranging from 0.39 to 0.68 for the items further validate the questionnaire by aligning with the overall score and capturing the intended concept. The high internal consistency reliability of MAUQ (Cronbach α=.81) and its subscales further enhances the instrument’s robustness in accurately evaluating the usability of mHealth apps. Conclusions: We successfully validated the German translation of the MAUQ for stand-alone apps using a standardized approach in a cohort of patients with breast cancer. In our validation study, MAUQ exhibited strong internal consistency reliability (Cronbach α=.81) across its subscales, indicating reliable and consistent measurement. Furthermore, a significant positive correlation (P<.001) was found between the subscales and the overall score, supporting their consistent measurement of the intended construct. Therefore, MAUQ can be considered a reliable instrument for assessing the usability of mHealth apps among German-speaking adults. The availability of the German version of MAUQ will help other researchers in conducting usability studies of mHealth apps in German-speaking cohorts and allow for international comparability of their results. %M 37910144 %R 10.2196/51090 %U https://humanfactors.jmir.org/2023/1/e51090 %U https://doi.org/10.2196/51090 %U http://www.ncbi.nlm.nih.gov/pubmed/37910144 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47563 %T Behavioral Changes Associated With COVID-19 Vaccination: Cross-National Online Survey %A De Gaetano,Alessandro %A Bajardi,Paolo %A Gozzi,Nicolò %A Perra,Nicola %A Perrotta,Daniela %A Paolotti,Daniela %+ ISI Foundation, Via Chisola 5, Turin, 10126, Italy, 39 011 6603090, alessandro.degaetano@isi.it %K COVID-19 %K vaccines %K social behaviors %K online surveys %K nonpharmaceutical interventions %K survey %K vaccination %K behavior %K NPIs %K prevention %D 2023 %7 31.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: During the initial phases of the vaccination campaign worldwide, nonpharmaceutical interventions (NPIs) remained pivotal in the fight against the COVID-19 pandemic. In this context, it is important to understand how the arrival of vaccines affected the adoption of NPIs. Indeed, some individuals might have seen the start of mass vaccination campaigns as the end of the emergency and, as a result, relaxed their COVID-safe behaviors, facilitating the spread of the virus in a delicate epidemic phase such as the initial rollout. Objective: The aim of this study was to collect information about the possible relaxation of protective behaviors following key events of the vaccination campaign in four countries and to analyze possible associations of these behavioral tendencies with the sociodemographic characteristics of participants. Methods: We developed an online survey named “COVID-19 Prevention and Behavior Survey” that was conducted between November 26 and December 22, 2021. Participants were recruited using targeted ads on Facebook in four different countries: Brazil, Italy, South Africa, and the United Kingdom. We measured the onset of relaxation of protective measures in response to key events of the vaccination campaign, namely personal vaccination and vaccination of the most vulnerable population. Through calculation of odds ratios (ORs) and regression analysis, we assessed the strength of association between compliance with NPIs and sociodemographic characteristics of participants. Results: We received 2263 questionnaires from the four countries. Participants reported the most significant changes in social activities such as going to a restaurant or the cinema and visiting relatives and friends. This is in good agreement with validated psychological models of health-related behavioral change such as the Health Belief Model, according to which activities with higher costs and perceived barriers (eg, social activities) are more prone to early relaxation. Multivariate analysis using a generalized linear model showed that the two main determinants of the drop of social NPIs were (1) having previously tested positive for COVID-19 (after the second vaccine dose: OR 2.46, 95% CI 1.73-3.49) and (2) living with people at risk (after the second vaccine dose: OR 1.57, 95% CI 1.22-2.03). Conclusions: This work shows that particular caution has to be taken during vaccination campaigns. Indeed, people might relax their safe behaviors regardless of the dynamics of the epidemic. For this reason, it is crucial to maintain high compliance with NPIs to avoid hindering the beneficial effects of the vaccine. %M 37906219 %R 10.2196/47563 %U https://www.jmir.org/2023/1/e47563 %U https://doi.org/10.2196/47563 %U http://www.ncbi.nlm.nih.gov/pubmed/37906219 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e49500 %T A Digital Tool for the Self-Assessment of Homes to Increase Age-Friendliness: Validity Study %A Aclan,Roslyn %A George,Stacey %A Laver,Kate %+ College of Medicine and Public Health, Flinders University of South Australia, Flinders Drive, Bedford Park, Adelaide, 5001, Australia, 61 0425730839, roslyn.dalistan@flinders.edu.au %K age-friendliness %K aging %K home environment %K self-assessment %K digital %K tool %D 2023 %7 26.10.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Age-friendly environments in homes and communities play an important role in optimizing the health and well-being of society. Older people have strong preferences for remaining at home as they age. Home environment assessment tools that enable older people to assess their homes and prepare for aging in place may be beneficial. Objective: This study aims to establish the validity of a digital self-assessment tool by assessing it against the current gold standard, an occupational therapy home assessment. Methods: A cohort of adults aged ≥60 years living in metropolitan Adelaide, South Australia, Australia, assessed their homes using a digital self-assessment tool with 89 questions simultaneously with an occupational therapist. Adults who were living within their homes and did not have significant levels of disabilities were recruited. Cohen κ and Gwet AC1 were used to assess validity. Results: A total of 61 participants (age: mean 71.2, SD 7.03 years) self-assessed their own homes using the digital self-assessment tool. The overall levels of agreement were high, supporting the validity of the tool in identifying potential hazards. Lower levels of agreement were found in the following domains: steps (77% agreement, Gwet AC1=0.56), toilets (56% agreement, κ=0.10), bathrooms (64% agreement, κ=0.46), and backyards (55% agreement, κ=0.24). Conclusions: Older people were able to self-assess their homes using a digital self-assessment tool. Digital health tools enable older people to start thinking about their future housing needs. Innovative tools that can identify problems and generate solutions may improve the age-friendliness of the home environment. %M 37883134 %R 10.2196/49500 %U https://aging.jmir.org/2023/1/e49500 %U https://doi.org/10.2196/49500 %U http://www.ncbi.nlm.nih.gov/pubmed/37883134 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42202 %T Development, Reliability, and Structural Validity of the Scale for Knowledge, Attitude, and Practice in Ethics Implementation Among AI Researchers: Cross-Sectional Study %A Zhang,Xiaobo %A Gu,Ying %A Yin,Jie %A Zhang,Yuejie %A Jin,Cheng %A Wang,Weibing %A Li,Albert Martin %A Wang,Yingwen %A Su,Ling %A Xu,Hong %A Ge,Xiaoling %A Ye,Chengjie %A Tang,Liangfeng %A Shen,Bing %A Fang,Jinwu %A Wang,Daoyang %A Feng,Rui %+ School of Computer Science Fudan University, Room D5011, Interdisciplinary Academic Building, Jiangwan Campus, 2005 Songhu Road, Shanghai, 200438, China, 86 21 51355534, fengrui@fudan.edu.cn %K medical artificial intelligence %K ethics implementation %K Knowledge-Attitude-Practice model %K reliability %K validity %K measure %K artificial intelligence %K development %K attitude %K ethics %D 2023 %7 26.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Medical artificial intelligence (AI) has significantly contributed to decision support for disease screening, diagnosis, and management. With the growing number of medical AI developments and applications, incorporating ethics is considered essential to avoiding harm and ensuring broad benefits in the lifecycle of medical AI. One of the premises for effectively implementing ethics in Medical AI research necessitates researchers' comprehensive knowledge, enthusiastic attitude, and practical experience. However, there is currently a lack of an available instrument to measure these aspects. Objective: The aim of this study was to develop a comprehensive scale for measuring the knowledge, attitude, and practice of ethics implementation among medical AI researchers, and to evaluate its measurement properties. Methods: The construct of the Knowledge-Attitude-Practice in Ethics Implementation (KAP-EI) scale was based on the Knowledge-Attitude-Practice (KAP) model, and the evaluation of its measurement properties was in compliance with the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN) reporting guidelines for studies on measurement instruments. The study was conducted in 2 phases. The first phase involved scale development through a systematic literature review, qualitative interviews, and item analysis based on a cross-sectional survey. The second phase involved evaluation of structural validity and reliability through another cross-sectional study. Results: The KAP-EI scale had 3 dimensions including knowledge (10 items), attitude (6 items), and practice (7 items). The Cronbach α for the whole scale reached .934. Confirmatory factor analysis showed that the goodness-of-fit indices of the scale were satisfactory (χ2/df ratio:=2.338, comparative fit index=0.949, Tucker Lewis index=0.941, root-mean-square error of approximation=0.064, and standardized root-mean-square residual=0.052). Conclusions: The results show that the scale has good reliability and structural validity; hence, it could be considered an effective instrument. This is the first instrument developed for this purpose. %M 37883175 %R 10.2196/42202 %U https://formative.jmir.org/2023/1/e42202 %U https://doi.org/10.2196/42202 %U http://www.ncbi.nlm.nih.gov/pubmed/37883175 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48245 %T Preliminary Clinical Outcomes of the Hello Sunday Morning Alcohol and Wellbeing Self-Assessment: Feasibility and Acceptability Study %A Fletcher,Kathryn %A Moran-Pryor,Alex %A Robert-Hendren,Dominique %+ Hello Sunday Morning, 103 Alexander Street Crows Nest NSW, Sydney, 2065, Australia, 61 1300 403 196, kat.fletcher@hellosundaymorning.org %K web-based %K screening %K alcohol use %K brief intervention %K well-being %K psychological distress %K digital health %D 2023 %7 24.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol-related injuries and diseases are a leading cause of morbidity and mortality worldwide. Early intervention is essential given the chronic, relapsing nature of alcohol use disorders. There is significant potential for widely accessible web-based screening tools to help individuals determine where they stand in terms of alcohol use and provide support recommendations. Screening and brief interventions (SBIs) provide individuals with a stigma-free opportunity to learn and think about the potential risks of drinking and prompt help-seeking behavior by incorporating behavior change techniques. Furthermore, as excessive alcohol use and mental health problems often occur concurrently, SBIs for both conditions simultaneously can potentially address a critical gap in alcohol and mental health treatment. Objective: We investigated the feasibility, acceptability, and clinical outcomes of participants completing the Alcohol and Wellbeing Self-assessment (A&WS), a web-based SBI. Methods: The A&WS is freely available on the Hello Sunday Morning website as part of an uncontrolled observational prospective study. Feasibility was assessed based on the number of respondents who commenced and subsequently completed the A&WS. Acceptability was measured via participant feedback to determine overall satisfaction, perceived helpfulness, and likelihood of recommending the A&WS to others. Clinical outcomes were measured in two ways: (1) self-reported changes in alcohol consumption (Alcohol Use Disorders Identification Test score) or psychological distress (Kessler Psychological Distress Scale score) over time and (2) help seeking—both self-reported and immediate web-based help seeking. Preliminary baseline data collected for the first 9 months (March 2022 to December 2022) of the study were reported, including the 3-month follow-up outcomes. Results: A total of 17,628 participants commenced the A&WS, and of these, 14,419 (81.8%) completed it. Of those 14,419 who completed the A&WS, 1323 (9.18%) agreed to participate in the follow-up research. Acceptability was high, with 78.46% (1038/1323) reporting high satisfaction levels overall; 95.62% (1265/1323) found the A&WS easy to use and would recommend the tool to others. The 1-, 2-, and 3-month follow-ups were completed by 28.57% (378/1323), 21.09% (279/1323), and 17.61% (233/1323) of the participants, respectively. Significant reductions in the Alcohol Use Disorders Identification Test Consumption subscale (P<.001) and Kessler Psychological Distress Scale scores (P<.001) were observed over the 3-month follow-up period. Conclusions: Our results suggest that the A&WS is a highly feasible and acceptable digital SBI that may support individuals in making changes to their alcohol consumption and improve their psychological well-being. In the absence of a control group, positive clinical outcomes cannot be attributed to the A&WS, which should now be subjected to a randomized controlled trial. This scalable, freely available tool has the potential to reach a large number of adults who might not otherwise access help while complementing the alcohol and mental health treatment ecosystem. %M 37874615 %R 10.2196/48245 %U https://formative.jmir.org/2023/1/e48245 %U https://doi.org/10.2196/48245 %U http://www.ncbi.nlm.nih.gov/pubmed/37874615 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e48444 %T Patient Health Questionnaire-9 Item Pairing Predictiveness for Prescreening Depressive Symptomatology: Machine Learning Analysis %A Glavin,Darragh %A Grua,Eoin Martino %A Nakamura,Carina Akemi %A Scazufca,Marcia %A Ribeiro dos Santos,Edinilza %A Wong,Gloria H Y %A Hollingworth,William %A Peters,Tim J %A Araya,Ricardo %A Van de Ven,Pepijn %+ Department of Electronic and Computer Engineering, University of Limerick, Plassey Park Road, Limerick, V94 T9PX, Ireland, 353 87 260 7623, Darragh.Glavin@ul.ie %K Patient Health Questionnaire-2 %K PHQ-2 %K Patient Health Questionnaire-9 %K PHQ-9 items %K depressive symptomatology %K ultrabrief questionnaires %K prescreening %K machine learning %K cardinal symptoms %K low energy %K psychomotor dysfunction %K depressed mood %D 2023 %7 19.10.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Anhedonia and depressed mood are considered the cardinal symptoms of major depressive disorder. These are the first 2 items of the Patient Health Questionnaire (PHQ)–9 and comprise the ultrabrief PHQ-2 used for prescreening depressive symptomatology. The prescreening performance of alternative PHQ-9 item pairings is rarely compared with that of the PHQ-2. Objective: This study aims to use machine learning (ML) with the PHQ-9 items to identify and validate the most predictive 2-item depressive symptomatology ultrabrief questionnaire and to test the generalizability of the best pairings found on the primary data set, with 6 external data sets from different populations to validate their use as prescreening instruments. Methods: All 36 possible PHQ-9 item pairings (each yielding scores of 0-6) were investigated using ML-based methods with logistic regression models. Their performances were evaluated based on the classification of depressive symptomatology, defined as PHQ-9 scores ≥10. This gave each pairing an equal opportunity and avoided any bias in item pairing selection. Results: The ML-based PHQ-9 items 2 and 4 (phq2&4), the depressed mood and low-energy item pairing, and PHQ-9 items 2 and 8 (phq2&8), the depressed mood and psychomotor retardation or agitation item pairing, were found to be the best on the primary data set training split. They generalized well on the primary data set test split with area under the curves (AUCs) of 0.954 and 0.946, respectively, compared with an AUC of 0.942 for the PHQ-2. The phq2&4 had a higher AUC than the PHQ-2 on all 6 external data sets, and the phq2&8 had a higher AUC than the PHQ-2 on 3 data sets. The phq2&4 had the highest Youden index (an unweighted average of sensitivity and specificity) on 2 external data sets, and the phq2&8 had the highest Youden index on another 2. The PHQ-2≥2 cutoff also had the highest Youden index on 2 external data sets, joint highest with the phq2&4 on 1, but its performance fluctuated the most. The PHQ-2≥3 cutoff had the highest Youden index on 1 external data set. The sensitivity and specificity achieved by the phq2&4 and phq2&8 were more evenly balanced than the PHQ-2≥2 and ≥3 cutoffs. Conclusions: The PHQ-2 did not prove to be a more effective prescreening instrument when compared with other PHQ-9 item pairings. Evaluating all item pairings showed that, compared with alternative partner items, the anhedonia item underperformed alongside the depressed mood item. This suggests that the inclusion of anhedonia as a core symptom of depression and its presence in ultrabrief questionnaires may be incompatible with the empirical evidence. The use of the PHQ-2 to prescreen for depressive symptomatology could result in a greater number of misclassifications than alternative item pairings. %M 37856186 %R 10.2196/48444 %U https://mental.jmir.org/2023/1/e48444 %U https://doi.org/10.2196/48444 %U http://www.ncbi.nlm.nih.gov/pubmed/37856186 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47254 %T The BioRef Infrastructure, a Framework for Real-Time, Federated, Privacy-Preserving, and Personalized Reference Intervals: Design, Development, and Application %A Blatter,Tobias Ueli %A Witte,Harald %A Fasquelle-Lopez,Jules %A Nakas,Christos Theodoros %A Raisaro,Jean Louis %A Leichtle,Alexander Benedikt %+ University Institute of Clinical Chemistry, University Hospital Bern, Freiburgstrasse 10, Bern, 3010, Switzerland, 41 31 632 83 30, harald.witte@extern.insel.ch %K personalized health %K laboratory medicine %K reference interval %K research infrastructure %K sensitive data %K confidential data %K data security %K differential privacy %K precision medicine %D 2023 %7 18.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Reference intervals (RIs) for patient test results are in standard use across many medical disciplines, allowing physicians to identify measurements indicating potentially pathological states with relative ease. The process of inferring cohort-specific RIs is, however, often ignored because of the high costs and cumbersome efforts associated with it. Sophisticated analysis tools are required to automatically infer relevant and locally specific RIs directly from routine laboratory data. These tools would effectively connect clinical laboratory databases to physicians and provide personalized target ranges for the respective cohort population. Objective: This study aims to describe the BioRef infrastructure, a multicentric governance and IT framework for the estimation and assessment of patient group–specific RIs from routine clinical laboratory data using an innovative decentralized data-sharing approach and a sophisticated, clinically oriented graphical user interface for data analysis. Methods: A common governance agreement and interoperability standards have been established, allowing the harmonization of multidimensional laboratory measurements from multiple clinical databases into a unified “big data” resource. International coding systems, such as the International Classification of Diseases, Tenth Revision (ICD-10); unique identifiers for medical devices from the Global Unique Device Identification Database; type identifiers from the Global Medical Device Nomenclature; and a universal transfer logic, such as the Resource Description Framework (RDF), are used to align the routine laboratory data of each data provider for use within the BioRef framework. With a decentralized data-sharing approach, the BioRef data can be evaluated by end users from each cohort site following a strict “no copy, no move” principle, that is, only data aggregates for the intercohort analysis of target ranges are exchanged. Results: The TI4Health distributed and secure analytics system was used to implement the proposed federated and privacy-preserving approach and comply with the limitations applied to sensitive patient data. Under the BioRef interoperability consensus, clinical partners enable the computation of RIs via the TI4Health graphical user interface for query without exposing the underlying raw data. The interface was developed for use by physicians and clinical laboratory specialists and allows intuitive and interactive data stratification by patient factors (age, sex, and personal medical history) as well as laboratory analysis determinants (device, analyzer, and test kit identifier). This consolidated effort enables the creation of extremely detailed and patient group–specific queries, allowing the generation of individualized, covariate-adjusted RIs on the fly. Conclusions: With the BioRef-TI4Health infrastructure, a framework for clinical physicians and researchers to define precise RIs immediately in a convenient, privacy-preserving, and reproducible manner has been implemented, promoting a vital part of practicing precision medicine while streamlining compliance and avoiding transfers of raw patient data. This new approach can provide a crucial update on RIs and improve patient care for personalized medicine. %M 37851984 %R 10.2196/47254 %U https://www.jmir.org/2023/1/e47254 %U https://doi.org/10.2196/47254 %U http://www.ncbi.nlm.nih.gov/pubmed/37851984 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e48381 %T Three-Dimensional Virtual Reconstructions of Shoulder Movements Using Computed Tomography Images: Model Development %A Kim,Yu-Hee %A Park,In %A Cho,Soo Buem %A Yang,Seoyon %A Kim,Il %A Lee,Kyong-Ha %A Choi,Kwangnam %A Han,Seung-Ho %+ Department of Anatomy, Ewha Womans University College of Medicine, 25 Magokdong-ro 2-gil, Gangseo-gu, Seoul, 07804, Republic of Korea, 82 2 6986 2601, sanford@ewha.ac.kr %K human digital twin %K musculoskeletal twin %K shoulder movement %K visualization application %K digital twin %K musculoskeletal %K visualization %K movement %K joint %K shoulder %K tomography %K development %K animation %K animated %K anatomy %K anatomical %K digital health %K representation %K simulation %K virtual %D 2023 %7 5.10.2023 %9 Research Letter %J Interact J Med Res %G English %X %M 37796554 %R 10.2196/48381 %U https://www.i-jmr.org/2023/1/e48381 %U https://doi.org/10.2196/48381 %U http://www.ncbi.nlm.nih.gov/pubmed/37796554 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44170 %T Evaluating the Acceptability and Feasibility of a Sexual Health–Focused Contraceptive Decision Aid for Diverse Young Adults: User-Centered Usability Study %A Goueth,Rose %A Darney,Blair %A Hoffman,Aubri %A Eden,Karen B %+ Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, United States, 1 5034944502, gouethr@ochin.org %K decision aid %K contraception %K decision-making %K user-centered design %K young adults %K pilot study %K feasibility %K acceptability %K development %K support %K tool %K survey %K sexual health %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Young adults with low sexual health literacy levels may find it difficult to make informed decisions about contraceptive methods. We developed and pilot-tested a web-based decision aid—Healthy Sex Choices—designed to support diverse young adults with their contraceptive decision-making. Objective: This pilot study aimed to evaluate whether the Healthy Sex Choices decision aid is acceptable and feasible to patients and clinicians. Methods: We used the Ottawa Decision Support Framework and the International Patient Decision Aid Standards to develop and pilot the decision tool. We first conducted a needs assessment with our advisory panel (5 clinicians and 2 patients) that informed decision aid development. All panelists participated in semistructured interviews about their experience with contraceptive counseling. Clinicians also completed a focus group session centered around the development of sex education content for the tool. Before commencing the pilot study, 5 participants from ResearchMatch (Vanderbilt University Medical Center) assessed the tool and suggested improvements. Results: Participants were satisfied with the tool, rating the acceptability as “good.” Interviewees revealed that the tool made contraceptive decision-making easier and would recommend the tool to a family member or friend. Participants had a nonsignificant change in knowledge scores (53% before vs 45% after; P=.99). Overall, decisional conflict scores significantly decreased (16.1 before vs 2.8 after; P<.001) with the informed subscale (patients feeling more informed) having the greatest decline (23.1 vs 4.7; mean difference 19.0, SD 27.1). Subanalyses of contraceptive knowledge and decisional conflict illustrated that participants of color had lower knowledge scores (48% vs 55%) and higher decisional conflict (20.0 vs 14.5) at baseline than their white counterparts. Conclusions: Participants found Healthy Sex Choices to be acceptable and reported reduced decisional conflict after using the tool. The development and pilot phases of this study provided a foundation for creating reproductive health decision aids that acknowledge and provide guidance for diverse patient populations. %M 37788070 %R 10.2196/44170 %U https://formative.jmir.org/2023/1/e44170 %U https://doi.org/10.2196/44170 %U http://www.ncbi.nlm.nih.gov/pubmed/37788070 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46521 %T Assessment of Upper Extremity Function in Multiple Sclerosis: Feasibility of a Digital Pinching Test %A Graves,Jennifer S %A Elantkowski,Marcin %A Zhang,Yan-Ping %A Dondelinger,Frank %A Lipsmeier,Florian %A Bernasconi,Corrado %A Montalban,Xavier %A Midaglia,Luciana %A Lindemann,Michael %+ F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Basel, 4070, Switzerland, 41 61 687 79 09, florian.lipsmeier@roche.com %K multiple sclerosis %K smartphone sensor %K digital health technology tools %K upper extremity function %K hand-motor dexterity %D 2023 %7 2.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The development of touchscreen-based assessments of upper extremity function could benefit people with multiple sclerosis (MS) by allowing convenient, quantitative assessment of their condition. The Pinching Test forms a part of the Floodlight smartphone app (F. Hoffmann-La Roche Ltd, Basel, Switzerland) for people with MS and was designed to capture upper extremity function. Objective: This study aimed to evaluate the Pinching Test as a tool for remotely assessing upper extremity function in people with MS. Methods: Using data from the 24-week, prospective feasibility study investigating the Floodlight Proof-of-Concept app for remotely assessing MS, we examined 13 pinching, 11 inertial measurement unit (IMU)–based, and 13 fatigability features of the Pinching Test. We assessed the test-retest reliability using intraclass correlation coefficients [second model, first type; ICC(2,1)], age- and sex-adjusted cross-sectional Spearman rank correlation, and known-groups validity (data aggregation: median [all features], SD [fatigability features]). Results: We evaluated data from 67 people with MS (mean Expanded Disability Status Scale [EDSS]: 2.4 [SD 1.4]) and 18 healthy controls. In this cohort of early MS, pinching features were reliable [ICC(2,1)=0.54-0.81]; correlated with standard clinical assessments, including the Nine-Hole Peg Test (9HPT) (|r|=0.26-0.54; 10/13 features), EDSS (|r|=0.25-0.36; 7/13 features), and the arm items of the 29-item Multiple Sclerosis Impact Scale (MSIS-29) (|r|=0.31-0.52; 7/13 features); and differentiated people with MS-Normal from people with MS-Abnormal (area under the curve: 0.68-0.78; 8/13 features). IMU-based features showed similar test-retest reliability [ICC(2,1)=0.47-0.84] but showed little correlations with standard clinical assessments. In contrast, fatigability features (SD aggregation) correlated with 9HPT time (|r|=0.26-0.61; 10/13 features), EDSS (|r|=0.26-0.41; 8/13 features), and MSIS-29 arm items (|r|=0.32-0.46; 7/13 features). Conclusions: The Pinching Test provides a remote, objective, and granular assessment of upper extremity function in people with MS that can potentially complement standard clinical evaluation. Future studies will validate it in more advanced MS. Trial Registration: ClinicalTrials.gov NCT02952911; https://clinicaltrials.gov/study/NCT02952911 %M 37782540 %R 10.2196/46521 %U https://formative.jmir.org/2023/1/e46521 %U https://doi.org/10.2196/46521 %U http://www.ncbi.nlm.nih.gov/pubmed/37782540 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e48425 %T Validation of a Brief Internet-Based Self-Report Measure of Maladaptive Personality and Interpersonal Schema: Confirmatory Factor Analysis %A Kim,Hyeonseong %A Jeong,Seohyun %A Hwang,Inae %A Sung,Kiyoung %A Moon,Woori %A Shin,Min-Sup %+ Psychiatry Department, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 6th Floor, Seoul, 03080, Republic of Korea, 82 0220720725, shinms@snu.ac.kr %K maladaptive schema %K measure of schema %K self-report measure %K internet-based measure %K digital mental health care %K interpersonal schema %D 2023 %7 29.9.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Existing digital mental health interventions mainly focus on the symptoms of specific mental disorders, but do not focus on Maladaptive Personalities and Interpersonal Schemas (MPISs). As an initial step toward considering personalities and schemas in intervention programs, there is a need for the development of tools for measuring core personality traits and interpersonal schemas known to cause psychological discomfort among potential users of digital mental health interventions. Thus, the MPIS was developed. Objective: The objectives of this study are to validate the MPIS by comparing 2 models of the MPIS factor structure and to understand the characteristics of the MPIS by assessing its correlations with other measures. Methods: Data were collected from 234 participants who were using web-based community sites in South Korea, including university students, graduate students, working professionals, and homemakers. All the data were gathered through web-based surveys. Confirmatory factor analysis was used to compare a single-factor model with a 5-factor model. Reliability and correlation analyses with other scales were performed. Results: The results of confirmatory factor analysis indicated that the 5-factor model (χ2550=1278.1; Tucker-Lewis index=0.80; comparative fit index=0.81; and Root Mean Square Error of Approximation=0.07) was more suitable than the single-factor model (χ2560=2341.5; Tucker-Lewis index=0.52; comparative fit index=0.54; and Root Mean Square Error of Approximation=0.11) for measuring maladaptive personality traits and interpersonal relationship patterns. The internal consistency of each factor of the MPIS was good (Cronbach α=.71-.88), and the correlations with existing measures were statistically significant. The MPIS is a validated 35-item tool for measuring 5 essential personality traits and interpersonal schemas in adults aged 18-39 years. Conclusions: This study introduced the MPIS, a concise and effective questionnaire capable of measuring maladaptive personality traits and interpersonal relationship schemas. Through analysis, the MPIS was shown to reliably assess these psychological constructs and validate them. Its web-based accessibility and reduced item count make it a valuable tool for mental health assessment. Future applications include its integration into digital mental health care services, allowing easy web-based administration and aiding in the classification of psychological therapy programs based on the obtained results. Trial Registration: ClinicalTrials.gov NCT05952063; https://www.clinicaltrials.gov/study/NCT05952063 %M 37773606 %R 10.2196/48425 %U https://www.i-jmr.org/2023/1/e48425 %U https://doi.org/10.2196/48425 %U http://www.ncbi.nlm.nih.gov/pubmed/37773606 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45980 %T Novel Psychosocial Correlates of COVID-19 Vaccine Hesitancy: Cross-Sectional Survey %A Bacon,Elizabeth %A An,Lawrence %A Yang,Penny %A Hawley,Sarah %A Van Horn,M Lee %A Resnicow,Ken %+ Center for Health Communications Research, Rogel Cancer Center, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, United States, 1 734 763 6099, embacon@med.umich.edu %K COVID-19 vaccination %K health communication %K psychological predictors %K psychology %K public health %K conspiracy beliefs %K vaccine misinformation %K religious beliefs %K anti-vaccination beliefs %K reactance %K dogmatism %K political beliefs %K health care system distrust %K gender roles %K gender %K online survey %K USA %K adults %K death %K illness %K virus %K psychosocial %D 2023 %7 27.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Effective COVID-19 vaccines have been available since early 2021 yet many Americans refuse or delayed uptake. As of mid-2022, still around 30% of US adults remain unvaccinated against COVID-19. The majority (81%) of these unvaccinated adults say they will “definitely not” be getting the COVID-19 vaccine. Understanding the determinants of COVID-19 vaccine uptake is critical to reducing death and illness from the virus, as well as to inform future vaccine efforts, such as the more recent bivalent (omicron) booster. Objective: This study aimed to expand our understanding of psychosocial determinants of COVID-19 vaccine uptake. We focus on both COVID-19–specific factors, such as COVID-19 conspiracy beliefs, as well as more global personality attributes such as dogmatism, reactance, gender roles, political beliefs, and religiosity. Methods: We conducted a web-based survey in mid-2021 of a representative sample of 1376 adults measuring both COVID-19–specific beliefs and attitudes, as well as global personality attributes. COVID-19 vaccination status is reported at 3 levels: vaccinated; unvaccinated-may-get-it; unvaccinated-hard-no. Results: Our analyses focused on the correlation of COVID-19 vaccination status with 10 psychosocial attributes: COVID-19-specific conspiracy theory beliefs; COVID-19 vaccine misinformation; COVID-19–related Rapture beliefs; general antivaccination beliefs; trait reactance; trait dogmatism; belief in 2020 election fraud; belief in a QAnon conspiracy; health care system distrust; and identification with traditional gender roles. We used a multivariate analysis of covariance to examine mean differences across vaccine status groups for each of the correlates while holding constant the effects of age, gender, race, income, education, political party, and Evangelicalism. Across the 10 psychosocial correlates, several different response scales were used. To allow for comparison of effects across correlates, measures of effect size were computed by converting correlates to z scores and then examining adjusted mean differences in z scores between the groups. We found that all 10 psychosocial variables were significantly associated with vaccination status. After general antivaccination beliefs, COVID-19 misinformation beliefs and COVID-19 conspiracy beliefs had the largest effect on vaccine uptake. Conclusions: The association of these psychosocial factors with COVID-19 vaccine hesitancy may help explain why vaccine uptake has not shifted much among the unvaccinated-hard-no group since vaccines became available. These findings deepen our understanding of those who remain resistant to getting vaccinated and can guide more effective tailored communications to reach them. Health communication professionals may apply lessons learned from countering related beliefs and personality attributes around issues such as climate change and other forms of vaccine hesitancy. For example, using motivational interviewing strategies that are equipped to handle resistance and provide correct information in a delicate manner that avoids reactance. %M 37756115 %R 10.2196/45980 %U https://formative.jmir.org/2023/1/e45980 %U https://doi.org/10.2196/45980 %U http://www.ncbi.nlm.nih.gov/pubmed/37756115 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46675 %T Cardiff Online Cognitive Assessment in a National Sample: Cross-Sectional Web-Based Study %A Lynham,Amy Joanne %A Jones,Ian R %A Walters,James T R %+ Division of Psychological Medicine, School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, United Kingdom, 44 2920688434, waltersjt@cardiff.ac.uk %K cognition %K digital assessment %K mental health %K mobile phone %K normative data %K web-based %K cognitive assessment %K CONCA %D 2023 %7 13.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Psychiatric disorders are associated with cognitive impairment. We have developed a web-based, 9-task cognitive battery to measure the core domains affected in people with psychiatric disorders. To date, this assessment has been used to collect data on a clinical sample of participants with psychiatric disorders. Objective: The aims of this study were (1) to establish a briefer version of the battery (called the Cardiff Online Cognitive Assessment [CONCA]) that can give a valid measure of cognitive ability (“g”) and (2) to collect normative data and demonstrate CONCA’s application in a health population sample. Methods: Based on 6 criteria and data from our previous study, we selected 5 out of the original 9 tasks to include in CONCA. These included 3 core tasks that were sufficient to derive a measure of “g” and 2 optional tasks. Participants from a web-based national cohort study (HealthWise Wales) were invited to complete CONCA. Completion rates, sample characteristics, performance distributions, and associations between cognitive performance and demographic characteristics and mental health measures were examined. Results: A total of 3679 participants completed at least one CONCA task, of which 3135 completed all 3 core CONCA tasks. Performance on CONCA was associated with age (B=–0.05, SE 0.002; P<.001), device (tablet computer: B=–0.26, SE 0.05; P<.001; smartphone: B=–0.46, SE 0.05; P<.001), education (degree: B=1.68, SE 0.14; P<.001), depression symptoms (B=–0.04, SE 0.01; P<.001), and anxiety symptoms (B=–0.04, SE 0.01; P<.001). Conclusions: CONCA provides a valid measure of “g,” which can be derived using as few as 3 tasks that take no more than 15 minutes. Performance on CONCA showed associations with demographic characteristics in the expected direction and was associated with current depression and anxiety symptoms. The effect of device on cognitive performance is an important consideration for research using web-based assessments. %M 37703073 %R 10.2196/46675 %U https://www.jmir.org/2023/1/e46675 %U https://doi.org/10.2196/46675 %U http://www.ncbi.nlm.nih.gov/pubmed/37703073 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44897 %T Construction of an Emotional Lexicon of Patients With Breast Cancer: Development and Sentiment Analysis %A Li,Chaixiu %A Fu,Jiaqi %A Lai,Jie %A Sun,Lijun %A Zhou,Chunlan %A Li,Wenji %A Jian,Biao %A Deng,Shisi %A Zhang,Yujie %A Guo,Zihan %A Liu,Yusheng %A Zhou,Yanni %A Xie,Shihui %A Hou,Mingyue %A Wang,Ru %A Chen,Qinjie %A Wu,Yanni %+ Nanfang Hospital, Southern Medical University, No 1838 Guangzhou Avenue North, Baiyun District, Guangdong Province, Guangzhou, 510515, China, 86 020 61641192, yanniwuSMU@126.com %K breast cancer %K lexicon construction %K domain emotional lexicon %K sentiment analysis %K natural language processing %D 2023 %7 12.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The innovative method of sentiment analysis based on an emotional lexicon shows prominent advantages in capturing emotional information, such as individual attitudes, experiences, and needs, which provides a new perspective and method for emotion recognition and management for patients with breast cancer (BC). However, at present, sentiment analysis in the field of BC is limited, and there is no emotional lexicon for this field. Therefore, it is necessary to construct an emotional lexicon that conforms to the characteristics of patients with BC so as to provide a new tool for accurate identification and analysis of the patients’ emotions and a new method for their personalized emotion management. Objective: This study aimed to construct an emotional lexicon of patients with BC. Methods: Emotional words were obtained by merging the words in 2 general sentiment lexicons, the Chinese Linguistic Inquiry and Word Count (C-LIWC) and HowNet, and the words in text corpora acquired from patients with BC via Weibo, semistructured interviews, and expressive writing. The lexicon was constructed using manual annotation and classification under the guidance of Russell’s valence-arousal space. Ekman’s basic emotional categories, Lazarus’ cognitive appraisal theory of emotion, and a qualitative text analysis based on the text corpora of patients with BC were combined to determine the fine-grained emotional categories of the lexicon we constructed. Precision, recall, and the F1-score were used to evaluate the lexicon’s performance. Results: The text corpora collected from patients in different stages of BC included 150 written materials, 17 interviews, and 6689 original posts and comments from Weibo, with a total of 1,923,593 Chinese characters. The emotional lexicon of patients with BC contained 9357 words and covered 8 fine-grained emotional categories: joy, anger, sadness, fear, disgust, surprise, somatic symptoms, and BC terminology. Experimental results showed that precision, recall, and the F1-score of positive emotional words were 98.42%, 99.73%, and 99.07%, respectively, and those of negative emotional words were 99.73%, 98.38%, and 99.05%, respectively, which all significantly outperformed the C-LIWC and HowNet. Conclusions: The emotional lexicon with fine-grained emotional categories conforms to the characteristics of patients with BC. Its performance related to identifying and classifying domain-specific emotional words in BC is better compared to the C-LIWC and HowNet. This lexicon not only provides a new tool for sentiment analysis in the field of BC but also provides a new perspective for recognizing the specific emotional state and needs of patients with BC and formulating tailored emotional management plans. %M 37698914 %R 10.2196/44897 %U https://www.jmir.org/2023/1/e44897 %U https://doi.org/10.2196/44897 %U http://www.ncbi.nlm.nih.gov/pubmed/37698914 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44772 %T Psychometric Evaluation of the Modes of Health Information Acquisition, Sharing, and Use Questionnaire: Prospective Cross-Sectional Observational Study %A Jones,Lenette M %A Piscotty Jr,Ronald J %A Sullivan,Stephen %A Manzor Mitrzyk,Beatriz %A Ploutz-Snyder,Robert J %A Ghosh,Bidisha %A Veinot,Tiffany %+ School of Nursing, University of Michigan, Room 2180, 400 N. Ingalls, Ann Arbor, MI, 48109, United States, 1 17347631371, lenettew@umich.edu %K psychometric evaluation %K health information behavior %K construct validity %K reliability %K chronic illness %K MHIASU %K hypertension %D 2023 %7 11.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Health information is a critical resource for individuals with health concerns and conditions, such as hypertension. Enhancing health information behaviors may help individuals to better manage chronic illness. The Modes of Health Information Acquisition, Sharing, and Use (MHIASU) is a 23-item questionnaire that measures how individuals with health risks or chronic illness acquire, share, and use health information. Yet this measure has not been psychometrically evaluated in a large national sample. Objective: The objective of this study was to evaluate the psychometric properties of the self-administered MHIASU in a large, diverse cohort of individuals living with a chronic illness. Methods: Sharing Information, a prospective, observational study, was launched in August 2018 and used social media campaigns to advertise to Black women. Individuals who were interested in participating clicked on the advertisements and were redirected to a Qualtrics eligibility screener. To meet eligibility criteria individuals had to self-identify as a Black woman, be diagnosed with hypertension by a health care provider, and live in the United States. A total of 320 Black women with hypertension successfully completed the eligibility screener and then completed a web-based version of the MHIASU questionnaire. We conducted a psychometric evaluation of the MHIASU using exploratory factor analysis. The evaluation included item review, construct validity, and reliability. Results: Construct validity was established using exploratory factor analysis with principal axis factoring. The analysis was constricted to the expected domains. Interitem correlations were examined for possible item extraction. There were no improvements in factor structure with the removal of items with high interitem correlation (n=3), so all items of the MHIASU were retained. As anticipated, the instrument was found to have 3 subscales: acquisition, sharing, and use. Reliability was high for all 3 subscales, as evidenced by Cronbach α scores of .81 (acquisition), .81 (sharing), and .93 (use). Factor 3 (use of health information) explained the maximum variance (74%). Conclusions: Construct validity and reliability of the web-based, self-administered MHIASU was demonstrated in a large national cohort of Black women with hypertension. Although this sample was highly educated and may have had higher digital literacy compared to other samples not recruited via social media, the population captured (Black women living with hypertension) are often underrepresented in research and are particularly vulnerable to this chronic condition. Future studies can use the MHIASU to examine health information behavior in other diverse populations managing health concerns and conditions. %M 37695669 %R 10.2196/44772 %U https://www.jmir.org/2023/1/e44772 %U https://doi.org/10.2196/44772 %U http://www.ncbi.nlm.nih.gov/pubmed/37695669 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e47035 %T Remote Recruitment Strategy and Structured E-Parenting Support (STEPS) App: Feasibility and Usability Study %A Kostyrka-Allchorne,Katarzyna %A Chu,Petrina %A Ballard,Claire %A Lean,Nancy %A French,Blandine %A Hedstrom,Ellen %A Byford,Sarah %A Cortese,Samuele %A Daley,David %A Downs,Johnny %A Glazebrook,Cristine %A Goldsmith,Kimberley %A Hall,Charlotte L %A Kovshoff,Hanna %A Kreppner,Jana %A Sayal,Kapil %A Shearer,James %A Simonoff,Emily %A Thompson,Margaret %A Sonuga-Barke,Edmund J S %+ Department of Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE58AF, United Kingdom, 44 02078483682, edmund.sonuga-barke@kcl.ac.uk %K parenting intervention %K mobile app %K attention-deficit/hyperactivity disorder %K ADHD %K behavior problems %K mobile health %K mHealth %K children %K usability %K mobile phone %D 2023 %7 11.9.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The Structured E-Parenting Support (STEPS) app provides support for parents of children with elevated hyperactivity, impulsivity, inattention, and conduct problems who are awaiting clinical assessment. STEPS will be evaluated in a randomized controlled trial (RCT) within the Online Parent Training for the Initial Management of ADHD Referrals (OPTIMA) research program in the United Kingdom. Phase 1 of the OPTIMA tested the feasibility of participants’ recruitment and the app’s usability. Objective: This study aimed to adapt a digital routine clinical monitoring system, myHealthE, for research purposes to facilitate waitlist recruitment; test using remote methods to screen and identify participants quickly and systematically; pilot the acceptability of the recruitment and assessment protocol; and explore the usability of STEPS. Methods: myHealthE was adapted to screen patients’ data. Parents’ and clinicians’ feedback on myHealthE was collected, and information governance reviews were conducted in clinical services planning to host the RCT. Potential participants for the observational feasibility study were identified from new referrals using myHealthE and non-myHealthE methods. Descriptive statistics were used to summarize the demographic and outcome variables. We estimated whether the recruitment rate would meet the planned RCT sample size requirement (n=352). In addition to the feasibility study participants, another group of parents was recruited to assess the STEPS usability. They completed the adapted System Usability Scale and responded to open-ended questions about the app, which were coded using the Enlight quality construct template. Results: Overall, 124 potential participants were identified as eligible: 121 (97.6%) via myHealthE and 3 (2.4%) via non-myHealthE methods. In total, 107 parents were contacted, and 48 (44.9%) consented and were asked if, hypothetically, they would be willing to participate in the OPTIMA RCT. Of the 28 feasibility study participants who provided demographic data, 21 (75%) identified as White. Their children had an average age of 8.4 (SD 1.7) years and 65% (31/48) were male. During the primary recruitment period (June to July 2021) when 45 participants had consented, 38 (84%) participants agreed hypothetically to take part in the RCT (rate of 19/mo, 95% CI 13.5-26.1), meeting the stop-go criterion of 18 participants per month to proceed with the RCT. All parents were satisfied or very satisfied with the study procedures. Parents (n=12) recruited to assess STEPS’ usability described it as easy to navigate and use and as having an attractive combination of colors and visual design. They described the content as useful, pitched at the right level, and sensitively presented. Suggested improvements included adding captions to videos or making the recorded reflections editable. Conclusions: Remote recruitment and study procedures for testing a parenting intervention app are feasible and acceptable for parents. The parents felt that STEPS was a useful and easy-to-use digital parenting support tool. International Registered Report Identifier (IRRID): RR2-10.1186/s40814-021-00959-0 %M 37695667 %R 10.2196/47035 %U https://pediatrics.jmir.org/2023/1/e47035 %U https://doi.org/10.2196/47035 %U http://www.ncbi.nlm.nih.gov/pubmed/37695667 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e48254 %T Assessing Health Students' Attitudes and Usage of ChatGPT in Jordan: Validation Study %A Sallam,Malik %A Salim,Nesreen A %A Barakat,Muna %A Al-Mahzoum,Kholoud %A Al-Tammemi,Ala'a B %A Malaeb,Diana %A Hallit,Rabih %A Hallit,Souheil %+ Department of Pathology, Microbiology and Forensic Medicine, School of Medicine, The University of Jordan, Queen Rania Al-Abdullah Street-Aljubeiha, Amman, 11942, Jordan, 962 0791845186, malik.sallam@ju.edu.jo %K artificial intelligence %K machine learning %K education %K technology %K healthcare %K survey %K opinion %K knowledge %K practices %K KAP %D 2023 %7 5.9.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: ChatGPT is a conversational large language model that has the potential to revolutionize knowledge acquisition. However, the impact of this technology on the quality of education is still unknown considering the risks and concerns surrounding ChatGPT use. Therefore, it is necessary to assess the usability and acceptability of this promising tool. As an innovative technology, the intention to use ChatGPT can be studied in the context of the technology acceptance model (TAM). Objective: This study aimed to develop and validate a TAM-based survey instrument called TAME-ChatGPT (Technology Acceptance Model Edited to Assess ChatGPT Adoption) that could be employed to examine the successful integration and use of ChatGPT in health care education. Methods: The survey tool was created based on the TAM framework. It comprised 13 items for participants who heard of ChatGPT but did not use it and 23 items for participants who used ChatGPT. Using a convenient sampling approach, the survey link was circulated electronically among university students between February and March 2023. Exploratory factor analysis (EFA) was used to assess the construct validity of the survey instrument. Results: The final sample comprised 458 respondents, the majority among them undergraduate students (n=442, 96.5%). Only 109 (23.8%) respondents had heard of ChatGPT prior to participation and only 55 (11.3%) self-reported ChatGPT use before the study. EFA analysis on the attitude and usage scales showed significant Bartlett tests of sphericity scores (P<.001) and adequate Kaiser-Meyer-Olkin measures (0.823 for the attitude scale and 0.702 for the usage scale), confirming the factorability of the correlation matrices. The EFA showed that 3 constructs explained a cumulative total of 69.3% variance in the attitude scale, and these subscales represented perceived risks, attitude to technology/social influence, and anxiety. For the ChatGPT usage scale, EFA showed that 4 constructs explained a cumulative total of 72% variance in the data and comprised the perceived usefulness, perceived risks, perceived ease of use, and behavior/cognitive factors. All the ChatGPT attitude and usage subscales showed good reliability with Cronbach α values >.78 for all the deduced subscales. Conclusions: The TAME-ChatGPT demonstrated good reliability, validity, and usefulness in assessing health care students’ attitudes toward ChatGPT. The findings highlighted the importance of considering risk perceptions, usefulness, ease of use, attitudes toward technology, and behavioral factors when adopting ChatGPT as a tool in health care education. This information can aid the stakeholders in creating strategies to support the optimal and ethical use of ChatGPT and to identify the potential challenges hindering its successful implementation. Future research is recommended to guide the effective adoption of ChatGPT in health care education. %M 37578934 %R 10.2196/48254 %U https://mededu.jmir.org/2023/1/e48254 %U https://doi.org/10.2196/48254 %U http://www.ncbi.nlm.nih.gov/pubmed/37578934 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43883 %T Comparative Effectiveness of eConsent: Systematic Review %A Cohen,Edwin %A Byrom,Bill %A Becher,Anja %A Jörntén-Karlsson,Magnus %A Mackenzie,Andrew K %+ AstraZeneca BV, Prinses Beatrixlaan, 582, The Hague, 2595 BM, Netherlands, 31 79 363 2546, edwin.cohen@astrazeneca.com %K acceptability %K clinical trial %K comprehension %K digital consent %K eConsent %K effectiveness %K electronic consent %K informed consent form %K patient engagement %K usability %D 2023 %7 1.9.2023 %9 Review %J J Med Internet Res %G English %X Background: Providing informed consent means agreeing to participate in a clinical trial and having understood what is involved. Flawed informed consent processes, including missing dates and signatures, are common regulatory audit findings. Electronic consent (eConsent) uses digital technologies to enable the consenting process. It aims to improve participant comprehension and engagement with study information and to address data quality concerns. Objective: This systematic literature review aimed to assess the effectiveness of eConsent in terms of patient comprehension, acceptability, usability, and study enrollment and retention rates, as well as the effects of eConsent on the time patients took to perform the consenting process (“cycle time”) and on-site workload in comparison with traditional paper-based consenting. Methods: The systematic review was conducted and reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Ovid Embase and Ovid MEDLINE were systematically searched for publications reporting original, comparative data on the effectiveness of eConsent in terms of patient comprehension, acceptability, usability, enrollment and retention rates, cycle time, and site workload. The methodological validity of the studies that compared outcomes for comprehension, acceptability, and usability across paper consent and eConsent was assessed. Study methodologies were categorized as having “high” validity if comprehensive assessments were performed using established instruments. Results: Overall, 37 publications describing 35 studies (13,281 participants) were included. All studies comparing eConsenting and paper-based consenting for comprehension (20/35, 57% of the studies; 10 with “high” validity), acceptability (8/35, 23% of the studies; 1 with “high” validity), and usability (5/35, 14% of the studies; 1 with “high” validity) reported significantly better results with eConsent, better results but without significance testing, or no significant differences in overall results. None of the studies reported better results with paper than with eConsent. Among the “high” validity studies, 6 studies on comprehension reported significantly better understanding of at least some concepts, the study on acceptability reported statistically significant higher satisfaction scores, and the study on usability reported statistically significant higher usability scores with eConsent than with paper (P<.05 for all). Cycle times were increased with eConsent, potentially reflecting greater patient engagement with the content. Data on enrollment and retention were limited. Comparative data from site staff and other study researchers indicated the potential for reduced workload and lower administrative burden with eConsent. Conclusions: This systematic review showed that compared with patients using paper-based consenting, patients using eConsent had a better understanding of the clinical trial information, showed greater engagement with content, and rated the consenting process as more acceptable and usable. eConsent solutions thus have the potential to enhance understanding, acceptability, and usability of the consenting process while inherently being able to address data quality concerns, including those related to flawed consenting processes. %M 37656499 %R 10.2196/43883 %U https://www.jmir.org/2023/1/e43883 %U https://doi.org/10.2196/43883 %U http://www.ncbi.nlm.nih.gov/pubmed/37656499 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44950 %T Checkpoint Travel Numbers as a Proxy Variable in Population-Based Studies During the COVID-19 Pandemic: Validation Study %A Kreslake,Jennifer M %A Aarvig,Kathleen %A Muller-Tabanera,Hope %A Vallone,Donna M %A Hair,Elizabeth C %+ Schroeder Institute, Truth Initiative, 900 G Street Northwest, Floor 4, Washington, DC, 20001, United States, 1 2024545782, jkreslake@truthinitiative.org %K research methods %K public health %K data quality %K psychosocial factors %K history %K COVID-19 %K social %K behavioral %K validation %K social distancing %K tracking survey %K survey %K pandemic %D 2023 %7 29.8.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic had wide-ranging systemic impacts, with implications for social and behavioral factors in human health. The pandemic may introduce history bias in population-level research studies of other health topics during the COVID-19 period. Objective: We sought to identify and validate an accessible, flexible measure to serve as a covariate in research spanning the COVID-19 pandemic period. Methods: Transportation Security Administration checkpoint travel numbers were used to calculate a weekly sum of daily passengers and validated against two measures with strong face validity: (1) a self-reported item on social distancing practices drawn from a continuous tracking survey among a national sample of youths and young adults (15-24 years) in the United States (N=45,080, approximately 280 unique respondents each week); and (2) Google’s Community Mobility Reports, which calculate daily values at the national level to represent rates of change in visits and length of stays to public spaces. For the self-reported survey data, an aggregated week-level variable was calculated as the proportion of respondents who did not practice social distancing that week (January 1, 2019, to May 31, 2022). For the community mobility data, a weekly estimate of change was calculated using daily values compared to a 5-week prepandemic baseline period (January 3, 2020, to February 6, 2020). Spearman rank correlation coefficients were calculated for each comparison. Results: Checkpoint travel data ranged from 668,719 travelers in the week of April 8, 2020, to nearly 15.5 million travelers in the week of May 18, 2022. The weekly proportion of survey respondents who did not practice social distancing ranged from 18.1% (n=42; week of April 15, 2020) to 70.9% (n=213; week of May 25, 2022). The measures were strongly correlated from January 2019 to May 2022 (ρ=0.90, P<.001) and March 2020 to May 2022 (ρ=0.87, P<.001). Strong correlations were observed when analyses were restricted to age groups (15-17 years: ρ=0.90; P<.001; 18-20 years: ρ=0.87; P<.001; 21-24 years: ρ=0.88; P<.001), racial or ethnic minorities (ρ=0.86, P<.001), and respondents with lower socioeconomic status (ρ=0.88, P<.001). There were also strong correlations between the weekly change from the baseline period for checkpoint travel data and community mobility data for transit stations (ρ=0.92, P<.001) and retail and recreation (ρ=0.89, P<.001), and moderate significant correlations for grocery and pharmacy (ρ=0.68, P<.001) and parks (ρ=0.62, P<.001). A strong negative correlation was observed for places of residence (ρ=−0.78, P<.001), and a weak but significant positive correlation was found for workplaces (ρ=0.24, P<.001). Conclusions: The Transportation Security Administration’s travel checkpoint data provide a publicly available flexible time-varying metric to control for history bias introduced by the pandemic in research studies spanning the COVID-19 period in the United States. %M 37191643 %R 10.2196/44950 %U https://publichealth.jmir.org/2023/1/e44950 %U https://doi.org/10.2196/44950 %U http://www.ncbi.nlm.nih.gov/pubmed/37191643 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48496 %T A Comprehensive, Valid, and Reliable Tool to Assess the Degree of Responsibility of Digital Health Solutions That Operate With or Without Artificial Intelligence: 3-Phase Mixed Methods Study %A Lehoux,Pascale %A Rocha de Oliveira,Robson %A Rivard,Lysanne %A Silva,Hudson Pacifico %A Alami,Hassane %A Mörch,Carl Maria %A Malas,Kathy %+ Department of Health Management, Evaluation and Policy, Université de Montréal; Center for Public Health Research, 7101, Avenue du Parc, Montréal, QC, H3N 1X9, Canada, 1 5143437978, pascale.lehoux@umontreal.ca %K Responsible Innovation in Health %K digital health policy %K artificial intelligence ethics %K responsible research and innovation %K mixed methods %K e-Delphi %K interrater agreement %K mobile phone %D 2023 %7 28.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinicians’ scope of responsibilities is being steadily transformed by digital health solutions that operate with or without artificial intelligence (DAI solutions). Most tools developed to foster ethical practices lack rigor and do not concurrently capture the health, social, economic, and environmental issues that such solutions raise. Objective: To support clinical leadership in this field, we aimed to develop a comprehensive, valid, and reliable tool that measures the responsibility of DAI solutions by adapting the multidimensional and already validated Responsible Innovation in Health Tool. Methods: We conducted a 3-phase mixed methods study. Relying on a scoping review of available tools, phase 1 (concept mapping) led to a preliminary version of the Responsible DAI solutions Assessment Tool. In phase 2, an international 2-round e-Delphi expert panel rated on a 5-level scale the importance, clarity, and appropriateness of the tool’s components. In phase 3, a total of 2 raters independently applied the revised tool to a sample of DAI solutions (n=25), interrater reliability was measured, and final minor changes were made to the tool. Results: The mapping process identified a comprehensive set of responsibility premises, screening criteria, and assessment attributes specific to DAI solutions. e-Delphi experts critically assessed these new components and provided comments to increase content validity (n=293), and after round 2, consensus was reached on 85% (22/26) of the items surveyed. Interrater agreement was substantial for a subcriterion and almost perfect for all other criteria and assessment attributes. Conclusions: The Responsible DAI solutions Assessment Tool offers a comprehensive, valid, and reliable means of assessing the degree of responsibility of DAI solutions in health. As regulation remains limited, this forward-looking tool has the potential to change practice toward more equitable as well as economically and environmentally sustainable digital health care. %M 37639297 %R 10.2196/48496 %U https://www.jmir.org/2023/1/e48496 %U https://doi.org/10.2196/48496 %U http://www.ncbi.nlm.nih.gov/pubmed/37639297 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44414 %T A Novel, Expert-Endorsed, Neurocognitive Digital Assessment Tool for Addictive Disorders: Development and Validation Study %A Lee,Rico S C %A Albertella,Lucy %A Christensen,Erynn %A Suo,Chao %A Segrave,Rebecca A %A Brydevall,Maja %A Kirkham,Rebecca %A Liu,Chang %A Fontenelle,Leonardo F %A Chamberlain,Samuel R %A Rotaru,Kristian %A Yücel,Murat %+ QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, 4006, Australia, 61 412494834, muratyucel40@gmail.com %K cognitive neuroscience %K addictive behaviors %K mental health %K gaming %K gamified %K gamification %K development %K assessment %K software %K addiction %K mental disorder %K neurocognition %K neurocognitive %K brain health %K gamified task %K psychometric %K game developer %K game development %K validation %K validate %K validity %D 2023 %7 25.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Many people with harmful addictive behaviors may not meet formal diagnostic thresholds for a disorder. A dimensional approach, by contrast, including clinical and community samples, is potentially key to early detection, prevention, and intervention. Importantly, while neurocognitive dysfunction underpins addictive behaviors, established assessment tools for neurocognitive assessment are lengthy and unengaging, difficult to administer at scale, and not suited to clinical or community needs. The BrainPark Assessment of Cognition (BrainPAC) Project sought to develop and validate an engaging and user-friendly digital assessment tool purpose-built to comprehensively assess the main consensus-driven constructs underpinning addictive behaviors. Objective: The purpose of this study was to psychometrically validate a gamified battery of consensus-based neurocognitive tasks against standard laboratory paradigms, ascertain test-retest reliability, and determine their sensitivity to addictive behaviors (eg, alcohol use) and other risk factors (eg, trait impulsivity). Methods: Gold standard laboratory paradigms were selected to measure key neurocognitive constructs (Balloon Analogue Risk Task [BART], Stop Signal Task [SST], Delay Discounting Task [DDT], Value-Modulated Attentional Capture [VMAC] Task, and Sequential Decision-Making Task [SDT]), as endorsed by an international panel of addiction experts; namely, response selection and inhibition, reward valuation, action selection, reward learning, expectancy and reward prediction error, habit, and compulsivity. Working with game developers, BrainPAC tasks were developed and validated in 3 successive cohorts (total N=600) and a separate test-retest cohort (N=50) via Mechanical Turk using a cross-sectional design. Results: BrainPAC tasks were significantly correlated with the original laboratory paradigms on most metrics (r=0.18-0.63, P<.05). With the exception of the DDT k function and VMAC total points, all other task metrics across the 5 tasks did not differ between the gamified and nongamified versions (P>.05). Out of 5 tasks, 4 demonstrated adequate to excellent test-retest reliability (intraclass correlation coefficient 0.72-0.91, P<.001; except SDT). Gamified metrics were significantly associated with addictive behaviors on behavioral inventories, though largely independent of trait-based scales known to predict addiction risk. Conclusions: A purpose-built battery of digitally gamified tasks is sufficiently valid for the scalable assessment of key neurocognitive processes underpinning addictive behaviors. This validation provides evidence that a novel approach, purported to enhance task engagement, in the assessment of addiction-related neurocognition is feasible and empirically defensible. These findings have significant implications for risk detection and the successful deployment of next-generation assessment tools for substance use or misuse and other mental disorders characterized by neurocognitive anomalies related to motivation and self-regulation. Future development and validation of the BrainPAC tool should consider further enhancing convergence with established measures as well as collecting population-representative data to use clinically as normative comparisons. %M 37624635 %R 10.2196/44414 %U https://www.jmir.org/2023/1/e44414 %U https://doi.org/10.2196/44414 %U http://www.ncbi.nlm.nih.gov/pubmed/37624635 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e47315 %T A Developmental Surveillance Score for Quantitative Monitoring of Early Childhood Milestone Attainment: Algorithm Development and Validation %A Bilu,Yonatan %A Amit,Guy %A Sudry,Tamar %A Akiva,Pinchas %A Avgil Tsadok,Meytal %A Zimmerman,Deena R %A Baruch,Ravit %A Sadaka,Yair %+ KI Research Institute, Hazayit 11, Kfar Malal, 4592000, Israel, 972 99797788, yonatan@kinstitute.org.il %K child development %K risk scores %K scoring methods %K language delay %K motor skills delay %K developmental %K surveillance %K developmental delays %K developmental milestones %K young children %K intervention %K child %D 2023 %7 18.8.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Developmental surveillance, conducted routinely worldwide, is fundamental for timely identification of children at risk of developmental delays. It is typically executed by assessing age-appropriate milestone attainment and applying clinical judgment during health supervision visits. Unlike developmental screening and evaluation tools, surveillance typically lacks standardized quantitative measures, and consequently, its interpretation is often qualitative and subjective. Objective: Herein, we suggested a novel method for aggregating developmental surveillance assessments into a single score that coherently depicts and monitors child development. We described the procedure for calculating the score and demonstrated its ability to effectively capture known population-level associations. Additionally, we showed that the score can be used to describe longitudinal patterns of development that may facilitate tracking and classifying developmental trajectories of children. Methods: We described the Developmental Surveillance Score (DSS), a simple-to-use tool that quantifies the age-dependent severity level of a failure at attaining developmental milestones based on the recently introduced Israeli developmental surveillance program. We evaluated the DSS using a nationwide cohort of >1 million Israeli children from birth to 36 months of age, assessed between July 1, 2014, and September 1, 2021. We measured the score’s ability to capture known associations between developmental delays and characteristics of the mother and child. Additionally, we computed series of the DSS in consecutive visits to describe a child’s longitudinal development and applied cluster analysis to identify distinct patterns of these developmental trajectories. Results: The analyzed cohort included 1,130,005 children. The evaluation of the DSS on subpopulations of the cohort, stratified by known risk factors of developmental delays, revealed expected relations between developmental delay and characteristics of the child and mother, including demographics and obstetrics-related variables. On average, the score was worse for preterm children compared to full-term children and for male children compared to female children, and it was correspondingly worse for lower levels of maternal education. The trajectories of scores in 6 consecutive visits were available for 294,000 children. The clustering of these trajectories revealed 3 main types of developmental patterns that are consistent with clinical experience: children who successfully attain milestones, children who initially tend to fail but improve over time, and children whose failures tend to increase over time. Conclusions: The suggested score is straightforward to compute in its basic form and can be easily implemented as a web-based tool in its more elaborate form. It highlights known and novel relations between developmental delay and characteristics of the mother and child, demonstrating its potential usefulness for surveillance and research. Additionally, it can monitor the developmental trajectory of a child and characterize it. Future work is needed to calibrate the score vis-a-vis other screening tools, validate it worldwide, and integrate it into the clinical workflow of developmental surveillance. %M 37489583 %R 10.2196/47315 %U https://publichealth.jmir.org/2023/1/e47315 %U https://doi.org/10.2196/47315 %U http://www.ncbi.nlm.nih.gov/pubmed/37489583 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45118 %T Development and Evaluation of eHealth Services Regarding Accessibility: Scoping Literature Review %A Jonsson,Marika %A Johansson,Stefan %A Hussain,Dena %A Gulliksen,Jan %A Gustavsson,Catharina %+ School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Lindstedtsvägen 3, Stockholm, 114 28, Sweden, 46 72 459 02 82, marikjo@kth.se %K accessibility %K digital inclusion %K disability %K eHealth %K Web Content Accessibility Guidelines %K scoping literature review %K universal design %D 2023 %7 17.8.2023 %9 Review %J J Med Internet Res %G English %X Background: Accessibility is acknowledged as a key to inclusion in the Convention of Rights for People with Disabilities. An inaccessible design can result in exclusion from eHealth and cause disability among people who have impairments. Objective: This scoping literature review aimed to investigate how eHealth services have been developed and evaluated regarding accessibility for people with impairments. Methods: In line with Arksey and O’Malley’s framework for scoping studies and using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), we conducted a search in 4 databases (PubMed, Scopus, IEEE, and Web of Science) in October 2020 and an update of the search in June 2022. The search strategy was structured according to the PICO model as follows: Population/Problem, digital accessibility for users with impairment; Intervention, health care delivered by any digital solution; Comparison, not applicable; Outcome, use of and adherence to (1) Web Content Accessibility Guidelines (WCAG), (2) other accessibility guidelines, and (3) other means, for designing or evaluating accessibility in eHealth services. A Boolean search was conducted by combining terms related to accessibility and eHealth. All authors participated in screening abstracts according to the eligibility criteria. Each publication, containing a potentially relevant abstract, was read (full text) and assessed for eligibility by 2 authors independently and pairwise. Publications deemed eligible were read by all authors and discussed for consensus. Results: A total of 8643 publications were identified. After abstract screening, 131 publications remained for full-text reading. Of those, 116 publications were excluded as they did not meet the eligibility criteria. Fifteen publications involving studies of 12 eHealth services were included in the study. Of the 15 publications, 2 provided a definition of accessibility, 5 provided an explanation of accessibility, and 8 did not provide any explanation. Five publications used the WCAG to evaluate accessibility when developing eHealth services. One publication used International Organization for Standardization (ISO) 29138, ISO 2941, and ISO/International Electrotechnical Commission (IEC) 30071-1 standards together with the Spanish Association for Standardization (UNE) 139803 standard. Eleven publications used other means to address accessibility, including text-level grading; literature review about accessibility; user tests, focus groups, interviews, and design workshops with target groups of patients, relatives, and health care professionals; and comparative analysis of existing technical solutions to provide information about useful requirements. Conclusions: Although a clear definition of accessibility can enhance operationalization and thus measurability when evaluating accessibility in eHealth services, accessibility was insufficiently defined in most of the included studies. Further, accessibility guidelines and standards were used to a very limited extent in the development and evaluation of eHealth services. Guidelines for developing complex interventions that include guidance for accessibility are motivated to ensure that accessibility will be considered systematically in eHealth services. %M 37590050 %R 10.2196/45118 %U https://www.jmir.org/2023/1/e45118 %U https://doi.org/10.2196/45118 %U http://www.ncbi.nlm.nih.gov/pubmed/37590050 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e45079 %T The Use of a Decision Support System (MyFood) to Assess Dietary Intake Among Free-Living Older Adults in Norway: Evaluation Study %A Severinsen,Frida %A Andersen,Lene Frost %A Paulsen,Mari Mohn %+ Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Postboks 1046, Blindern, Oslo, 0317, Norway, 47 95772048, m.m.paulsen@medisin.uio.no %K dietary assessment %K malnutrition %K eHealth %K validation study %K older adults %K mobile phone %D 2023 %7 3.8.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The proportion of older adults in the world is constantly increasing, and malnutrition is a common challenge among the older adults aged ≥65 years. This poses a need for better tools to prevent, assess, and treat malnutrition among older adults. MyFood is a decision support system developed with the intention to prevent and treat malnutrition. Objective: This study aimed to evaluate the ability of the MyFood app to estimate the intake of energy, protein, fluids, and food and beverage items among free-living older adults aged ≥65 years, primarily at an individual level and secondarily at a group level. In addition, the aim was to measure the experiences of free-living older adults using the app. Methods: Participants were instructed to record their dietary intake in the MyFood app for 4 consecutive days. In addition, each participant completed two 24-hour recalls, which were used as a reference method to evaluate the dietary assessment function in the MyFood app. Differences in the estimations of energy, protein, fluid, and food groups were analyzed at both the individual and group levels, by comparing the recorded intake in MyFood with the 2 corresponding recalls and by comparing the mean of all 4 recording days with the mean of the 2 recalls, respectively. A short, study-specific questionnaire was used to measure the participants’ experiences with the app. Results: This study included 35 free-living older adults residing in Norway. Approximately half of the participants had ≥80% agreement between MyFood and the 24-hour recalls for energy intake on both days. For protein and fluids, approximately 60% of the participants had ≥80% agreement on the first day of comparison. Dinner was the meal with the lowest agreement between the methods, at both the individual and group levels. MyFood tended to underestimate the intake of energy, protein, fluid, and food items at both the individual and group levels. The food groups that achieved the greatest agreement between the 2 methods were eggs, yogurt, self-composed dinner, and hot beverages. All participants found the app easy to use, and 74% (26/35) of the participants reported that the app was easy to navigate. Conclusions: The results showed that the MyFood app tended to underestimate the participants’ dietary intake compared with the 24-hour recalls at both the individual and group levels. The app’s ability to estimate intake within food groups was greater for eggs, yogurt, and self-composed dinner than for spreads, mixed meals, vegetables, and snacks. The app was well accepted among the study participants and may be a useful tool among free-living older adults, given that the users are provided follow-up and support in how to record their dietary intake. %M 37535420 %R 10.2196/45079 %U https://mhealth.jmir.org/2023/1/e45079 %U https://doi.org/10.2196/45079 %U http://www.ncbi.nlm.nih.gov/pubmed/37535420 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 10 %N %P e41993 %T The Usability of a Touchpad Active Video Game Controller for Individuals With Impaired Mobility: Observational Study %A Mendonca,Christen J %A Malone,Laurie A %A Mohanraj,Sangeetha %A Thirumalai,Mohanraj %+ School of Health Professions, The University of Alabama at Birmingham, SHPB 331, 1720 2nd Ave S, Birmingham, AL, 35294-3361, United States, 1 205 975 6415, christenjm@uab.edu %K active video games %K exergames %K usability %K enjoyment %K disability %K mobility limitation %K mobility impairment %D 2023 %7 3.8.2023 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Video games are a popular sedentary activity among people with impaired mobility; however, active video game hardware typically lacks accessibility and customization options for individuals with mobility impairments. A touchpad video game system can elicit moderate physical activity in healthy adults; however, it is unclear if this system is usable by adults with impaired mobility. Objective: The purpose of this study was to assess the usability of a touchpad video game controller system adapted for adults with impaired mobility. Additional outcomes explored were enjoyment, perceived exertion, self-efficacy, participant feedback, and researcher observations of gameplay. Methods: Participants played several video game titles for 20 minutes with a touchpad video game controller as they stood or sat in a chair or their wheelchair. Usability was assessed with the System Usability Scale (SUS) and the Health Information Technology Usability Evaluation Scale (Health-ITUES) surveys after gameplay. After each video game, participants reported enjoyment using a visual analog scale (0 to 100 mm) and a rating of perceived exertion using the OMNI 0 to 10 scale. Self-efficacy was measured before and after gameplay. Participants provided feedback at the end of their session. Results: In total, 21 adults (6 females and 15 males) with a mean age of 48.8 (SD 13.8) years with various mobility impairments participated in this study. The touchpads received mean usability scores on the SUS 80.1 (SD 18.5) and Health-ITUES 4.23 (SD 0.67). Conclusions: The SUS scores reported suggest the touchpad system is “usable”; however, the Health-ITUES scores were slightly below a suggested benchmark. Participants reported moderate to high enjoyment but perceived the exertion as “somewhat easy.” Self-efficacy was moderate to high and did not differ pre- to postgame play. The participants regarded the touchpads as novel, fun, and entertaining. The generalizability of our results is limited due to the heterogenous sample; however, our participants identified several areas of improvement for future iteration. %M 37535411 %R 10.2196/41993 %U https://rehab.jmir.org/2023/1/e41993 %U https://doi.org/10.2196/41993 %U http://www.ncbi.nlm.nih.gov/pubmed/37535411 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42017 %T Assessment of Frailty by the French Version of the Vulnerable Elders Survey-13 on Digital Tablet: Validation Study %A Zolnowski-Kolp,Victoria %A Um Din,Nathavy %A Havreng-Théry,Charlotte %A Pariel,Sylvie %A Veyron,Jacques-Henri %A Lafuente-Lafuente,Carmelo %A Belmin,Joel %+ LivingLab Pratiques en santé dans le grand âge, Hôpital Charles Foix, 7 avenue de la République, Ivry-sur-Seine, 94200, France, 33 0149594565, j.belmin@aphp.fr %K frailty %K Vulnerable Elders Survey-13 (VES-13) %K elderly %K older people %K family caregivers %K French version %K electronic assessment %K digital technology %K digital health %K eHealth %K tablet %K validity %D 2023 %7 2.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Frailty assessment is a major issue in geriatric medicine. The Vulnerable Elders Survey-13 (VES-13) is a simple and practical tool that identifies frailty through a 13-item questionnaire completed by older adults or their family caregivers by self-administration (pencil and paper) or by telephone interview. The VES-13 provides a 10-point score that is also a recognized mortality predictor. Objective: This study aims to design an electronic version of the Echelle de Vulnérabilité des Ainés-13, the French version of the VES-13 (eEVA-13) for use on a digital tablet and validate it. Methods: The scale was implemented as a web App in 3 different screens and used on an Android tablet (14.0× 25.6 cm). Participants were patients attending the outpatient clinic of a French geriatric hospital or hospitalized in a rehabilitation ward and family caregivers of geriatric patients. They completed the scale twice, once by a reference method (self-administered questionnaire or telephone interview) and once by eEVA-13 using the digital tablet. Agreement for diagnosis of frailty was assessed with the κ coefficient, and scores were compared by Bland and Altman plots and interclass correlation coefficients. User experience was assessed by a self-administered questionnaire. Results: In total, 86 participants, including 40 patients and 46 family caregivers, participated in the study. All family caregivers had previously used digital devices, while 13 (32.5%) and 10 (25%) patients had no or infrequent use of them previously. We observed no failure to complete the eEVA-13, and 70% of patients (28/40) and no family caregivers needed support to complete the eEVA-13. The agreement between the eEVA-13 and the reference method for the diagnosis of frailty was excellent (κ=0.92) with agreement in 83 cases and disagreement in 3 cases. The mean difference between the scores provided by the 2 scales was 0.081 (95% CI–1.263 to 1.426). Bland and Altman plots showed a high level of agreement between the eEVA-13 and the reference methods and interclass correlation coefficient value was 0.997 (95% CI 0.994-0.998) for the paper and tablet group and 0.977 (95% CI 0.957-0.988) for the phone and tablet groups. The tablet assessment was found to be easy to use by 77.5% (31/40) of patients and by 96% (44/46) of caregivers. Finally, 85% (39/46) of family caregivers and 50% (20/40) of patients preferred the eEVA-13 to the original version. Conclusions: The eEVA-13 is an appropriate digital tool for diagnosing frailty and can be used by older adults and their family caregivers. The scores obtained with eEVA-13 are highly correlated with those obtained with the original version. The use of health questionnaires on digital tablets is feasible in frail and very old patients, although some patients may need help to use them. %M 37531175 %R 10.2196/42017 %U https://www.jmir.org/2023/1/e42017 %U https://doi.org/10.2196/42017 %U http://www.ncbi.nlm.nih.gov/pubmed/37531175 %0 Journal Article %@ 2817-092X %I JMIR Publications %V 2 %N %P e46021 %T A Semantic Relatedness Model for the Automatic Cluster Analysis of Phonematic and Semantic Verbal Fluency Tasks Performed by People With Parkinson Disease: Prospective Multicenter Study %A Hähnel,Tom %A Feige,Tim %A Kunze,Julia %A Epler,Andrea %A Frank,Anika %A Bendig,Jonas %A Schnalke,Nils %A Wolz,Martin %A Themann,Peter %A Falkenburger,Björn %+ Department of Neurology, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, Dresden, 01307, Germany, 49 351 458 ext 11880, tom.haehnel@uniklinikum-dresden.de %K cognition %K executive function %K language function %K mild cognitive impairment %K Parkinson disease %K Parkinson disease dementia %K semantic clusters %K semantic relatedness %K verbal fluency tasks %D 2023 %7 2.8.2023 %9 Original Paper %J JMIR Neurotech %G English %X Background: Phonematic and semantic verbal fluency tasks (VFTs) are widely used to capture cognitive deficits in people with neurodegenerative diseases. Counting the total number of words produced within a given time frame constitutes the most commonly used analysis for VFTs. The analysis of semantic and phonematic word clusters can provide additional information about frontal and temporal cognitive functions. Traditionally, clusters in the semantic VFT are identified using fixed word lists, which need to be created manually, lack standardization, and are language specific. Furthermore, it is not possible to identify semantic clusters in the phonematic VFT using this technique. Objective: The objective of this study was to develop a method for the automated analysis of semantically related word clusters for semantic and phonematic VFTs. Furthermore, we aimed to explore the cognitive domains captured by this analysis for people with Parkinson disease (PD). Methods: People with PD performed tablet-based semantic (51/85, 60%) and phonematic (69/85, 81%) VFTs. For both tasks, semantic word clusters were determined using a semantic relatedness model based on a neural network trained on the Wikipedia (Wikimedia Foundation) text corpus. The cluster characteristics derived from this model were compared with those derived from traditional evaluation methods of VFTs and a set of neuropsychological parameters. Results: For the semantic VFT, the cluster characteristics obtained through automated analyses showed good correlations with the cluster characteristics obtained through the traditional method. Cluster characteristics from automated analyses of phonematic and semantic VFTs correlated with the overall cognitive function reported by the Montreal Cognitive Assessment, executive function reported by the Frontal Assessment Battery and the Trail Making Test, and language function reported by the Boston Naming Test. Conclusions: Our study demonstrated the feasibility of standardized automated cluster analyses of VFTs using semantic relatedness models. These models do not require manually creating and updating categorized word lists and, therefore, can be easily and objectively implemented in different languages, potentially allowing comparison of results across different languages. Furthermore, this method provides information about semantic clusters in phonematic VFTs, which cannot be obtained from traditional methods. Hence, this method could provide easily accessible digital biomarkers for executive and language functions in people with PD. %R 10.2196/46021 %U https://neuro.jmir.org/2023/1/e46021 %U https://doi.org/10.2196/46021 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 11 %N %P e46477 %T Structure of Health Information With Different Information Models: Evaluation Study With Competency Questions %A Rossander,Anna %A Karlsson,Daniel %+ Department of Applied IT, University of Gothenburg, Department of Applied Information Technology, Division of Informatics, Box 100, Gothenburg, 405 30, Sweden, 46 735989141, anna.rossander@gu.se %K informatics %K health care %K information model %K terminology %K terminologies %K interoperability %K competency question %K interoperable %K competency %K EHR %K electronic health record %K guideline %K standard %K recommendation %K information system %D 2023 %7 31.7.2023 %9 Original Paper %J JMIR Med Inform %G English %X Background: There is a flora of health care information models but no consensus on which to use. This leads to poor information sharing and duplicate modelling work. The amount and type of differences between models has, to our knowledge, not been evaluated. Objective: This work aims to explore how information structured with various information models differ in practice. Our hypothesis is that differences between information models are overestimated. This work will also assess the usability of competency questions as a method for evaluation of information models within health care. Methods: In this study, 4 information standards, 2 standards for secondary use, and 2 electronic health record systems were included as material. Competency questions were developed for a random selection of recommendations from a clinical guideline. The information needed to answer the competency questions was modelled according to each included information model, and the results were analyzed. Differences in structure and terminology were quantified for each combination of standards. Results: In this study, 36 competency questions were developed and answered. In general, similarities between the included information models were larger than the differences. The demarcation between information model and terminology was overall similar; on average, 45% of the included structures were identical between models. Choices of terminology differed within and between models; on average, 11% was usable in interaction with each other. The information models included in this study were able to represent most information required for answering the competency questions. Conclusions: Different but same same; in practice, different information models structure much information in a similar fashion. To increase interoperability within and between systems, it is more important to move toward structuring information with any information model rather than finding or developing a perfect information model. Competency questions are a feasible way of evaluating how information models perform in practice. %M 37523221 %R 10.2196/46477 %U https://medinform.jmir.org/2023/1/e46477 %U https://doi.org/10.2196/46477 %U http://www.ncbi.nlm.nih.gov/pubmed/37523221 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44614 %T A Web-Based Instrument for Infantile Atopic Dermatitis Identification (Electronic Version of the Modified Child Eczema Questionnaire): Development and Implementation %A Fang,Heping %A Chen,Lin %A Li,Juan %A Ren,Luo %A Yin,Yu %A Chen,Danleng %A Yin,Huaying %A Liu,Enmei %A Hu,Yan %A Luo,Xiaoyan %+ Department of Child Health Care, Children’s Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Health and Nutrition, Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China, 86 02363622764, hy420@126.com %K atopic dermatitis %K identification %K infant %K web-based questionnaire %K public health %D 2023 %7 19.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Atopic dermatitis (AD) is a chronic inflammatory cutaneous disease that affects 30.48% of young children; thus, there is a need for epidemiological studies in community settings. Web-based questionnaires (WBQs) are more convenient, time-saving, and efficient than traditional surveys, but the reliability of identifying AD through WBQs and whether AD can be identified without the attendance of doctors, especially in community or similar settings, remains unknown. Objective: This study aimed to develop and validate a web-based instrument for infantile AD identification (electronic version of the modified Child Eczema Questionnaire [eCEQ]) and to clarify the possibility of conducting WBQs to identify infantile AD without the attendance of doctors in a community-representative population. Methods: This study was divided into 2 phases. Phase 1 investigated 205 children younger than 2 years to develop and validate the eCEQ by comparison with the diagnoses of dermatologists. Phase 2 recruited 1375 children younger than 2 years to implement the eCEQ and verify the obtained prevalence by comparison with the previously published prevalence. Results: In phase 1, a total of 195 questionnaires were analyzed from children with a median age of 8.8 (IQR 4.5-15.0) months. The identification values of the eCEQ according to the appropriate rules were acceptable (logic rule: sensitivity 89.2%, specificity 91.5%, positive predictive value 97.1%, and negative predictive value 72.9%; statistic rule: sensitivity 90.5%, specificity 89.4%, positive predictive value 96.4%, and negative predictive value 75%). In phase 2, a total of 837 questionnaires were analyzed from children with a median age of 8.4 (IQR 5.2-14.6) months. The prevalence of infantile AD obtained by the eCEQ (logic rule) was 31.9% (267/837), which was close to the published prevalence (30.48%). Based on the results of phase 2, only 20.2% (54/267) of the participants identified by the eCEQ had previously received a diagnosis from doctors. Additionally, among the participants who were not diagnosed by doctors but were identified by the eCEQ, only 6.1% (13/213) were actually aware of the possible presence of AD. Conclusions: Infantile AD can be identified without the attendance of doctors by using the eCEQ, which can be easily applied to community-based epidemiological studies and provide acceptable identification reliability. In addition, the eCEQ can also be applied to the field of public health to improve the health awareness of the general population. %M 37467020 %R 10.2196/44614 %U https://www.jmir.org/2023/1/e44614 %U https://doi.org/10.2196/44614 %U http://www.ncbi.nlm.nih.gov/pubmed/37467020 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41609 %T The Simplified Chinese Version of the Suitability Assessment of Materials for the Evaluation of Health-Related Information for Adults: Translation and Validation Study %A Shan,Yi %A Ji,Meng %A Xing,Zhaoquan %A Dong,Zhaogang %A Wang,Ding %A Cao,Xiangting %+ School of Languages and Cultures, University of Sydney, A18 - Brennan MacCallum Building, Sydney, NSW 2006, Australia, 61 2 9351 4512, christine.ji@sydney.edu.au %K simplified Chinese version of the SAM %K translation %K validation %K suitability %K health education materials %D 2023 %7 7.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Suitable health education materials can educate people about the potential harms of high-risk factors, leading to expected behavior changes and improved health outcomes. However, most patient education materials were not suitable in terms of content, structure, design, composition, and language, as stated in the literature. There is a pressing need to use well-designed scales to assess the suitability of health education materials. Although such assessment is a common practice in English-speaking communities, few assessment tools are available in mainland China. Objective: This study aimed to translate the Suitability Assessment of Materials (SAM) for the evaluation of health-related information for adults into a simplified Chinese version (S-C-SAM) and validate its reliability for evaluating the suitability of health education materials written in simplified Chinese in mainland China. Methods: The SAM was translated into an S-C-SAM in three steps: (1) translating the SAM into an S-C-SAM, (2) translating the S-C-SAM back into an English version, and (3) testing the translation equivalence between the 2 English versions (original and back-translated) of the SAM linguistically and culturally. Any differences between these 2 English versions were resolved through a panel discussion. The validity of the S-C-SAM was determined by measuring its content validity index. The final version of the S-C-SAM was used by 3 native Chinese-speaking health educators to assess 15 air pollution–related health education materials. The Cohen κ coefficient and Cronbach α were calculated to determine the interrater agreement and internal consistency of the S-C-SAM. Results: We agreed on the final version of the S-C-SAM after settling the discrepancies between the 2 English versions (original and back-translated) and revising 2 items (sentences) rated negatively in content validation. The S-C-SAM was proven valid and reliable: the content validity index was 0.95 both in clarity and in relevance, the Cohen κ coefficient for the interrater agreement was 0.61 (P<.05), and Cronbach α for the internal consistency of the whole scale was .71. Conclusions: The S-C-SAM is the first simplified Chinese version of the SAM. It has been proven valid and reliable for evaluating the suitability of air pollution–related health education materials written in simplified Chinese in mainland China. It has the potential to be used for assessing the suitability of health education materials specifically selected for other health education purposes. %M 37418296 %R 10.2196/41609 %U https://formative.jmir.org/2023/1/e41609 %U https://doi.org/10.2196/41609 %U http://www.ncbi.nlm.nih.gov/pubmed/37418296 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 10 %N %P e43250 %T Role of Oral Intake, Mobility, and Activity Measures in Informing Discharge Recommendations for Hospitalized Inmate and Noninmate Patients With COVID-19: Retrospective Analysis %A Briggs,Matthew S %A Kolbus,Erin Shevawn %A Patterson,Kevin Michael %A Harmon-Matthews,Lindsay Elizabeth %A McGrath,Shana %A Quatman-Yates,Catherine C %A Meirelles,Cristiane %A Salsberry,Marka Jean %+ Rehabilitation Services, The Ohio State University Wexner Medical Center, Jameson Crane Sports Medicine Institute, 2835 Fred Taylor Drive, Columbus, OH, 43202, United States, 1 614 293 2385, matt.briggs@osumc.edu %K incarceration %K Functional Oral Intake %K Activity Measure for Postacute Care %K speech language pathology %K physical therapy %K occupational therapy %K COVID-19 %D 2023 %7 27.6.2023 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Patients who were incarcerated were disproportionately affected by COVID-19 compared with the general public. Furthermore, the impact of multidisciplinary rehabilitation assessments and interventions on the outcomes of patients admitted to the hospital with COVID-19 is limited. Objective: We aimed to compare the functional outcomes of oral intake, mobility, and activity between inmates and noninmates diagnosed with COVID-19 and examine the relationships among these functional measures and discharge destination. Methods: A retrospective analysis was performed on patients admitted to the hospital for COVID-19 at a large academic medical center. Scores on functional measures including the Functional Oral Intake Scale and Activity Measure for Postacute Care (AM-PAC) were collected and compared between inmates and noninmates. Binary logistic regression models were used to evaluate the odds of whether patients were discharged to the same place they were admitted from and whether patients were being discharged with a total oral diet with no restrictions. Independent variables were considered significant if the 95% CIs of the odds ratios (ORs) did not include 1.0. Results: A total of 83 patients (inmates: n=38; noninmates: n=45) were included in the final analysis. There were no differences between inmates and noninmates in the initial (P=.39) and final Functional Oral Intake Scale scores (P=.35) or in the initial (P=.06 and P=.46), final (P=.43 and P=.79), or change scores (P=.97 and P=.45) on the AM-PAC mobility and activity subscales, respectively. When examining separate regression models using AM-PAC mobility or AM-PAC activity scores as independent variables, greater age upon admission decreased the odds (OR 0.922, 95% CI 0.875-0.972 and OR 0.918, 95% CI 0.871-0.968) of patients being discharged with a total oral diet with no restrictions. The following factors increased the odds of patients being discharged to the same place they were admitted from: being an inmate (OR 5.285, 95% CI 1.334-20.931 and OR 6.083, 95% CI 1.548-23.912), “Other” race (OR 7.596, 95% CI 1.203-47.968 and OR 8.515, 95% CI 1.311-55.291), and female sex (OR 4.671, 95% CI 1.086-20.092 and OR 4.977, 95% CI 1.146-21.615). Conclusions: The results of this study provide an opportunity to learn how functional measures may be used to better understand discharge outcomes in both inmate and noninmate patients admitted to the hospital with COVID-19 during the initial period of the pandemic. %M 37224276 %R 10.2196/43250 %U https://rehab.jmir.org/2023/1/e43250 %U https://doi.org/10.2196/43250 %U http://www.ncbi.nlm.nih.gov/pubmed/37224276 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43107 %T Machine Learning Approaches to Classify Self-Reported Rheumatoid Arthritis Health Scores Using Activity Tracker Data: Longitudinal Observational Study %A Rao,Kaushal %A Speier,William %A Meng,Yiwen %A Wang,Jinhan %A Ramesh,Nidhi %A Xie,Fenglong %A Su,Yujie %A Nowell,W Benjamin %A Curtis,Jeffrey R %A Arnold,Corey %+ Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 1825 University Blvd, Shelby 121H, Birmingham, AL, 35233, United States, 1 205 937 0585, jcurtis@uab.edu %K rheumatoid arthritis %K rheumatic %K rheumatism %K Fitbit %K classification %K physical data %K digital health %K activity tracker %K mobile health %K machine learning %K model %K patient reported %K outcome measure %K PROMIS %K nonclinical monitoring %K mHealth %K tracker %K wearable %K arthritis %K mobile phone %D 2023 %7 26.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The increasing use of activity trackers in mobile health studies to passively collect physical data has shown promise in lessening participation burden to provide actively contributed patient-reported outcome (PRO) information. Objective: The aim of this study was to develop machine learning models to classify and predict PRO scores using Fitbit data from a cohort of patients with rheumatoid arthritis. Methods: Two different models were built to classify PRO scores: a random forest classifier model that treated each week of observations independently when making weekly predictions of PRO scores, and a hidden Markov model that additionally took correlations between successive weeks into account. Analyses compared model evaluation metrics for (1) a binary task of distinguishing a normal PRO score from a severe PRO score and (2) a multiclass task of classifying a PRO score state for a given week. Results: For both the binary and multiclass tasks, the hidden Markov model significantly (P<.05) outperformed the random forest model for all PRO scores, and the highest area under the curve, Pearson correlation coefficient, and Cohen κ coefficient were 0.750, 0.479, and 0.471, respectively. Conclusions: While further validation of our results and evaluation in a real-world setting remains, this study demonstrates the ability of physical activity tracker data to classify health status over time in patients with rheumatoid arthritis and enables the possibility of scheduling preventive clinical interventions as needed. If patient outcomes can be monitored in real time, there is potential to improve clinical care for patients with other chronic conditions. %M 37017471 %R 10.2196/43107 %U https://formative.jmir.org/2023/1/e43107 %U https://doi.org/10.2196/43107 %U http://www.ncbi.nlm.nih.gov/pubmed/37017471 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45334 %T Graded Response Model Analysis and Computer Adaptive Test Simulation of the Depression Anxiety Stress Scale 21: Evaluation and Validation Study %A Kraska,Jake %A Bell,Karen %A Costello,Shane %+ School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, 3800, Australia, 61 399052896, jake.kraska@gmail.com %K graded response model %K DASS-21 %K CAT %K computer adaptive testing %K simulation %K psychological distress %K depression %K anxiety %K stress %K simulation %K mental health %K screening tool %K tool %K reliability %K development %K model %D 2023 %7 22.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The Depression Anxiety Stress Scale 21 (DASS-21) is a mental health screening tool with conflicting studies regarding its factor structure. No studies have yet attempted to develop a computer adaptive test (CAT) version of it. Objective: This study calibrated items for, and simulated, a DASS-21 CAT using a nonclinical sample. Methods: An evaluation sample (n=580) was used to evaluate the DASS-21 scales via confirmatory factor analysis, Mokken analysis, and graded response modeling. A CAT was simulated with a validation sample (n=248) and a simulated sample (n=10,000) to confirm the generalizability of the model developed. Results: A bifactor model, also known as the “quadripartite” model (1 general factor with 3 specific factors) in the context of the DASS-21, displayed good fit. All scales displayed acceptable fit with the graded response model. Simulation of 3 unidimensional (depression, anxiety, and stress) CATs resulted in an average 17% to 48% reduction in items administered when a reliability of 0.80 was acceptable. Conclusions: This study clarifies previous conflicting findings regarding the DASS-21 factor structure and suggests that the quadripartite model for the DASS-21 items fits best. Item response theory modeling suggests that the items measure their respective constructs best between 0θ and 3θ (mild to moderate severity). %M 37347530 %R 10.2196/45334 %U https://www.jmir.org/2023/1/e45334 %U https://doi.org/10.2196/45334 %U http://www.ncbi.nlm.nih.gov/pubmed/37347530 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42637 %T Combination of Paper and Electronic Trail Making Tests for Automatic Analysis of Cognitive Impairment: Development and Validation Study %A Zhang,Wei %A Zheng,Xiaoran %A Tang,Zeshen %A Wang,Haoran %A Li,Renren %A Xie,Zengmai %A Yan,Jiaxin %A Zhang,Xiaochen %A Yu,Qing %A Wang,Fei %A Li,Yunxia %+ Department of Neurology, Tongji Hospital, School of Medicine, Tongji University, 389 Xincun Road, Shanghai, 200065, China, 86 13122868963, doctorliyunxia@163.com %K cognition impairment %K Trail Making Test %K vector quantization %K screening %K mixed mode %K paper and electronic devices %D 2023 %7 9.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Computer-aided detection, used in the screening and diagnosing of cognitive impairment, provides an objective, valid, and convenient assessment. Particularly, digital sensor technology is a promising detection method. Objective: This study aimed to develop and validate a novel Trail Making Test (TMT) using a combination of paper and electronic devices. Methods: This study included community-dwelling older adult individuals (n=297), who were classified into (1) cognitively healthy controls (HC; n=100 participants), (2) participants diagnosed with mild cognitive impairment (MCI; n=98 participants), and (3) participants with Alzheimer disease (AD; n=99 participants). An electromagnetic tablet was used to record each participant’s hand-drawn stroke. A sheet of A4 paper was placed on top of the tablet to maintain the traditional interaction style for participants who were not familiar or comfortable with electronic devices (such as touchscreens). In this way, all participants were instructed to perform the TMT-square and circle. Furthermore, we developed an efficient and interpretable cognitive impairment–screening model to automatically analyze cognitive impairment levels that were dependent on demographic characteristics and time-, pressure-, jerk-, and template-related features. Among these features, novel template-based features were based on a vector quantization algorithm. First, the model identified a candidate trajectory as the standard answer (template) from the HC group. The distance between the recorded trajectories and reference was computed as an important evaluation index. To verify the effectiveness of our method, we compared the performance of a well-trained machine learning model using the extracted evaluation index with conventional demographic characteristics and time-related features. The well-trained model was validated using follow-up data (HC group: n=38; MCI group: n=32; and AD group: n=22). Results: We compared 5 candidate machine learning methods and selected random forest as the ideal model with the best performance (accuracy: 0.726 for HC vs MCI, 0.929 for HC vs AD, and 0.815 for AD vs MCI). Meanwhile, the well-trained classifier achieved better performance than the conventional assessment method, with high stability and accuracy of the follow-up data. Conclusions: The study demonstrated that a model combining both paper and electronic TMTs increases the accuracy of evaluating participants’ cognitive impairment compared to conventional paper-based feature assessment. %M 37294606 %R 10.2196/42637 %U https://www.jmir.org/2023/1/e42637 %U https://doi.org/10.2196/42637 %U http://www.ncbi.nlm.nih.gov/pubmed/37294606 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44326 %T Consensus on the Terms and Procedures for Planning and Reporting a Usability Evaluation of Health-Related Digital Solutions: Delphi Study and a Resulting Checklist %A Martins,Ana Isabel %A Santinha,Gonçalo %A Almeida,Ana Margarida %A Ribeiro,Óscar %A Silva,Telmo %A Rocha,Nelson %A Silva,Anabela G %+ Center for Health Technology and Services Research, School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Aveiro, 3810-193, Portugal, 351 234370200, asilva@ua.pt %K usability evaluation %K Delphi study %K user-centered design %K design %K usability %K evaluation %K process %K development %K user %K digital %K efficient %K reporting %K quality %K applicability %D 2023 %7 6.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Usability evaluation both by experts and target users is an integral part of the process of developing and assessing digital solutions. Usability evaluation improves the probability of having digital solutions that are easier, safer, more efficient, and more pleasant to use. However, despite the widespread recognition of the importance of usability evaluation, there is a lack of research and consensus on related concepts and reporting standards. Objective: The aim of the study is to generate consensus on terms and procedures that should be considered when planning and reporting a study on a usability evaluation of health-related digital solutions both by users and experts and provide a checklist that can easily be used by researchers when conducting their usability studies. Methods: A Delphi study with 2 rounds was conducted with a panel of international participants experienced in usability evaluation. In the first round, they were asked to comment on definitions, rate the importance of preidentified methodological procedures using a 9-item Likert scale, and suggest additional procedures. In the second round, experienced participants were asked to reappraise the relevance of each procedure informed by round 1 results. Consensus on the relevance of each item was defined a priori when at least 70% or more experienced participants scored an item 7 to 9 and less than 15% of participants scored the same item 1 to 3. Results: A total of 30 participants (n=20 females) from 11 different countries entered the Delphi study with a mean age of 37.2 (SD 7.7) years. Agreement was achieved on the definitions for all usability evaluation–related terms proposed (usability assessment moderator, participant, usability evaluation method, usability evaluation technique, tasks, usability evaluation environment, usability evaluator, and domain evaluator). A total of 38 procedures related to usability evaluation planning and reporting were identified across rounds (28 were related to usability evaluation involving users and 10 related to usability evaluation involving experts). Consensus on the relevance was achieved for 23 (82%) of the procedures related to usability evaluation involving users and for 7 (70%) of the usability evaluation procedures involving experts. A checklist was proposed that can guide authors when designing and reporting usability studies. Conclusions: This study proposes a set of terms and respective definitions as well as a checklist to guide the planning and reporting of usability evaluation studies, constituting an important step toward a more standardized approach in the field of usability evaluation that may contribute to enhancing the quality of planning and reporting usability studies. Future studies can contribute to further validating this study work by refining the definitions, assessing the practical applicability of the checklist, or assessing whether using this checklist results in higher-quality digital solutions. %M 37279047 %R 10.2196/44326 %U https://www.jmir.org/2023/1/e44326 %U https://doi.org/10.2196/44326 %U http://www.ncbi.nlm.nih.gov/pubmed/37279047 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45028 %T Ecological Momentary Assessment of Cognition in Clinical and Community Samples: Reliability and Validity Study %A Singh,Shifali %A Strong,Roger %A Xu,Irene %A Fonseca,Luciana M %A Hawks,Zoe %A Grinspoon,Elizabeth %A Jung,Lanee %A Li,Frances %A Weinstock,Ruth S %A Sliwinski,Martin J %A Chaytor,Naomi S %A Germine,Laura T %+ McLean Hospital, 1010 Pleasant Street, Belmont, MA, 02478, United States, 1 617 855 2675, ssingh@mclean.harvard.edu %K ecological momentary assessment %K cognition %K digital neuropsychology %K remote assessment %K digital technology %K type 1 diabetes, teleneuropsychology %K reliability %K validity %K cognitive functioning %K psychological %K physiological %K glucose %K community %D 2023 %7 2.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The current methods of evaluating cognitive functioning typically rely on a single time point to assess and characterize an individual’s performance. However, cognitive functioning fluctuates within individuals over time in relation to environmental, psychological, and physiological contexts. This limits the generalizability and diagnostic utility of single time point assessments, particularly among individuals who may exhibit large variations in cognition depending on physiological or psychological context (eg, those with type 1 diabetes [T1D], who may have fluctuating glucose concentrations throughout the day). Objective: We aimed to report the reliability and validity of cognitive ecological momentary assessment (EMA) as a method for understanding between-person differences and capturing within-person variation in cognition over time in a community sample and sample of adults with T1D. Methods: Cognitive performance was measured 3 times a day for 15 days in the sample of adults with T1D (n=198, recruited through endocrinology clinics) and for 10 days in the community sample (n=128, recruited from TestMyBrain, a web-based citizen science platform) using ultrabrief cognitive tests developed for cognitive EMA. Our cognitive EMA platform allowed for remote, automated assessment in participants’ natural environments, enabling the measurement of within-person cognitive variation without the burden of repeated laboratory or clinic visits. This allowed us to evaluate reliability and validity in samples that differed in their expected degree of cognitive variability as well as the method of recruitment. Results: The results demonstrate excellent between-person reliability (ranging from 0.95 to 0.99) and construct validity of cognitive EMA in both the sample of adults with T1D and community sample. Within-person reliability in both samples (ranging from 0.20 to 0.80) was comparable with that observed in previous studies in healthy older adults. As expected, the full-length baseline and EMA versions of TestMyBrain tests correlated highly with one another and loaded together on the expected cognitive domains when using exploratory factor analysis. Interruptions had higher negative impacts on accuracy-based outcomes (β=−.34 to −.26; all P values <.001) than on reaction time–based outcomes (β=−.07 to −.02; P<.001 to P=.40). Conclusions: We demonstrated that ultrabrief mobile assessments are both reliable and valid across 2 very different clinic versus community samples, despite the conditions in which cognitive EMAs are administered, which are often associated with more noise and variability. The psychometric characteristics described here should be leveraged appropriately depending on the goals of the cognitive assessment (eg, diagnostic vs everyday functioning) and the population being studied. %M 37266996 %R 10.2196/45028 %U https://www.jmir.org/2023/1/e45028 %U https://doi.org/10.2196/45028 %U http://www.ncbi.nlm.nih.gov/pubmed/37266996 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e44084 %T Scoring Single-Response Multiple-Choice Items: Scoping Review and Comparison of Different Scoring Methods %A Kanzow,Amelie Friederike %A Schmidt,Dennis %A Kanzow,Philipp %+ Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Robert-Koch-Strasse 40, Göttingen, 37075, Germany, 49 551 3960870, philipp.kanzow@med.uni-goettingen.de %K alternate-choice %K best-answer %K education %K education system %K educational assessment %K educational measurement %K examination %K multiple choice %K results %K scoring %K scoring system %K single choice %K single response %K scoping review %K test %K testing %K true/false %K true-false %K Type A %D 2023 %7 19.5.2023 %9 Review %J JMIR Med Educ %G English %X Background: Single-choice items (eg, best-answer items, alternate-choice items, single true-false items) are 1 type of multiple-choice items and have been used in examinations for over 100 years. At the end of every examination, the examinees’ responses have to be analyzed and scored to derive information about examinees’ true knowledge. Objective: The aim of this paper is to compile scoring methods for individual single-choice items described in the literature. Furthermore, the metric expected chance score and the relation between examinees’ true knowledge and expected scoring results (averaged percentage score) are analyzed. Besides, implications for potential pass marks to be used in examinations to test examinees for a predefined level of true knowledge are derived. Methods: Scoring methods for individual single-choice items were extracted from various databases (ERIC, PsycInfo, Embase via Ovid, MEDLINE via PubMed) in September 2020. Eligible sources reported on scoring methods for individual single-choice items in written examinations including but not limited to medical education. Separately for items with n=2 answer options (eg, alternate-choice items, single true-false items) and best-answer items with n=5 answer options (eg, Type A items) and for each identified scoring method, the metric expected chance score and the expected scoring results as a function of examinees’ true knowledge using fictitious examinations with 100 single-choice items were calculated. Results: A total of 21 different scoring methods were identified from the 258 included sources, with varying consideration of correctly marked, omitted, and incorrectly marked items. Resulting credit varied between –3 and +1 credit points per item. For items with n=2 answer options, expected chance scores from random guessing ranged between –1 and +0.75 credit points. For items with n=5 answer options, expected chance scores ranged between –2.2 and +0.84 credit points. All scoring methods showed a linear relation between examinees’ true knowledge and the expected scoring results. Depending on the scoring method used, examination results differed considerably: Expected scoring results from examinees with 50% true knowledge ranged between 0.0% (95% CI 0% to 0%) and 87.5% (95% CI 81.0% to 94.0%) for items with n=2 and between –60.0% (95% CI –60% to –60%) and 92.0% (95% CI 86.7% to 97.3%) for items with n=5. Conclusions: In examinations with single-choice items, the scoring result is not always equivalent to examinees’ true knowledge. When interpreting examination scores and setting pass marks, the number of answer options per item must usually be taken into account in addition to the scoring method used. %M 37001510 %R 10.2196/44084 %U https://mededu.jmir.org/2023/1/e44084 %U https://doi.org/10.2196/44084 %U http://www.ncbi.nlm.nih.gov/pubmed/37001510 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39808 %T The Chinese Version of the Patient Education Materials Assessment Tool for Printable Materials: Translation, Adaptation, and Validation Study %A Shan,Yi %A Ji,Meng %A Dong,Zhaogang %A Xing,Zhaoquan %A Wang,Ding %A Cao,Xiangting %+ School of Foreign Studies, Nantong University, No. 9, Seyuan Rd., Chongchuan District, Nantong, 226019, China, 86 15558121896, victorsyhz@hotmail.com %K actionability %K adaptation %K Chinese version of the PEMAT-P %K comprehensibility %K health education materials translation %K validation %D 2023 %7 18.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Providing people with understandable and actionable health information can considerably promote healthy behaviors and outcomes. To this end, some valid and reliable scales assessing the patient-friendliness of health education materials, like the PEMAT-P (Patient Education Materials Assessment Tool for printable materials), have been well developed in English-speaking countries. However, the English version of the PEMAT-P has not been translated and adapted into simplified Chinese and validated in mainland China. Objective: This study sought to translate the PEMAT-P tool into a simplified Chinese (Mandarin) version (C-PEMAT-P, a Chinese version of the Patient Education Materials Assessment Tool for printable materials) and verify its validity and reliability for assessing the comprehensibility and actionability of health education resources written in simplified Chinese. As a result, the validated C-PEMAT-P could be used to guide health researchers and educators to design more comprehensible and actionable materials for more tailored and targeted health education and interventions. Methods: We translated the PEMAT-P into simplified Chinese in the following three steps: (1) forward-translating the PEMAT-P into simplified Chinese, (2) back-translating the simplified Chinese version into English, and (3) testing translation equivalence linguistically and culturally by examining the original English version of the PEMAT-P and the back-translated English version of the tool. Any discrepancies between the original English tool and the back-translated English tool were resolved through a panel discussion among the research team of all authors to produce a revised forward-translated Chinese version (C-PEMAT-P). We then evaluated the clarity of construction and wording as well as the content relevance of the C-PEMAT-P using a 4-point ordinal scale to determine its content validity. After that, 2 native Chinese speakers (health educators) used the C-PEMAT-P to rate 15 health education handouts concerning air pollution and health to validate their reliability. We calculated the Cohen coefficient and Cronbach α to determine the interrater agreement and internal consistency of the C-PEMAT-P, respectively. Results: We finalized the translated Chinese tool after discussing the differences between the 2 English versions (original and back-translated) of the PEMAT-P, producing the final Chinese version of the PEMAT-P (C-PEMAT-P). The content validity index of the C-PEMAT-P version was 0.969, the Cohen coefficient for the interrater scoring agreement was 0.928, and the Cronbach α for internal consistency was .897. These values indicated the high validity and reliability of the C-PEMAT-P. Conclusions: The C-PEMAT-P has been proven valid and reliable. It is the first Chinese scale for assessing the comprehensibility and actionability of Chinese health education materials. It can be used as an assessment tool to evaluate health education materials currently available and a guide to help health researchers and educators design more comprehensible and actionable materials for more tailored and targeted health education and interventions. %M 37200085 %R 10.2196/39808 %U https://www.jmir.org/2023/1/e39808 %U https://doi.org/10.2196/39808 %U http://www.ncbi.nlm.nih.gov/pubmed/37200085 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44241 %T Measurement of Humanity Among Health Professionals: Development and Validation of the Medical Humanity Scale Using the Delphi Method %A Ataya,Jawdat %A Jamous,Issam %A Dashash,Mayssoon %+ Medical Education Programme, Syrian Virtual University, Al-Mazzeh Street, Damascus, Syrian Arab Republic, 963 992287487, dr.jawdat.ataya@gmail.com %K medical humanity %K Medical Humanitarian Scale %K scale %K humanity %K humanitarian %K humane %K Hippocratic oath %K Delphi %K development %K patient centered %K compassion %K ethic %K empathy %K empathetic %K validity %K validation %K person centered %K the humanitarian aspect %K students of medical colleges %K Syria %D 2023 %7 2.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the importance of humanism in providing health care, there is a lack of valid and reliable tool for assessing humanity among health professionals. Objective: The aim of this study was to design a new humanism scale and to assess the validity of this scale in measuring humanism among Syrian health professional students. Methods: The Medical Humanity Scale (MHS) was designed. It consists of 27 items categorized into 7 human values including patient-oriented care, respect, empathy, ethics, altruism, and compassion. The scale was tested for internal consistency and reliability using Cronbach α and test-retest methods. The construct validity of the scale was also tested to assess the ability of the scale in differentiating between groups of health professional students with different levels of medical humanity. A 7-point Likert scale was adopted. The study included 300 participants including 97 medical, 78 dental, 82 pharmacy, and 43 preparatory-year students from Syrian universities. The Delphi method was used and factors analysis was performed. Bartlett test of sphericity and the Kaiser-Meyer-Olkin measure of sample adequacy were used. The number of components was extracted using principal component analysis. Results: The mean score of the MHS was 158.7 (SD 11.4). The MHS mean score of female participants was significantly higher than the mean score of male participants (159.59, SD 10.21 vs 155.48, SD 14.35; P=.008). The MHS mean score was significantly lower in dental students (154.12, SD 1.45; P=.005) than the mean scores of medical students (159.77, SD 1.02), pharmacy students (161.40, SD 1.05), and preparatory-year students (159.05, SD 1.94). However, no significant relationship was found between humanism and academic year (P=.32), university type (P=.34), marital status (P=.64), or financial situation (P=.16). The Kaiser-Meyer-Olkin test (0.730) and Bartlett test of sphericity (1201.611, df=351; P=.01) were performed. Factor analysis indicated that the proportion of variables between the first and second factors was greater than 10%, confirming that the scale was a single group. The Cronbach α for the overall scale was 0.735, indicating that the scale had acceptable reliability and validity. Conclusions: The results of this study suggest that the MHS is a reliable and valid tool for measuring humanity among health professional students and the development of patient-centered care. %M 37129940 %R 10.2196/44241 %U https://formative.jmir.org/2023/1/e44241 %U https://doi.org/10.2196/44241 %U http://www.ncbi.nlm.nih.gov/pubmed/37129940 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43348 %T Functional Health Literacy Among Chinese Populations and Associated Factors: Latent Class Analysis %A Dong,Zhaogang %A Ji,Meng %A Shan,Yi %A Xu,Xiaofei %A Xing,Zhaoquan %+ School of Languages and Cultures, The University of Sydney, A18 - Brennan MacCallum Building, Sydney, NSW 2006, Australia, 61 2 9351 4512, christine.ji@sydney.edu.au %K functional health literacy %K associated factors %K Chinese populations %K latent class analysis %D 2023 %7 28.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor functional health literacy has been found to be independently associated with poor self-assessed health, poor understanding of one’s health condition and its management, and higher use of health services. Given the importance of functional health literacy, it is necessary to assess the overall status of functional health literacy in the general public. However, the literature review shows that no studies of functional health literacy have been conducted among the Chinese population in China. Objective: This study aimed to classify Chinese populations into different functional health literacy clusters and ascertain significant factors closely associated with low functional health literacy to provide some implications for health education, medical research, and public health policy making. Methods: We hypothesized that the participants’ functional health literacy levels were associated with various demographic characteristics. Therefore, we designed a four-section questionnaire including the following information: (1) age, gender, and education; (2) self-assessed disease knowledge; (3) 3 validated health literacy assessment tools (ie, the All Aspects of Health Literacy Scale, the eHealth Literacy Scale, and the 6-item General Health Numeracy Test); and (4) health beliefs and self-confidence measured by the Multidimensional Health Locus of Control Scales Form B. Using randomized sampling, we recruited survey participants from Qilu Hospital affiliated to Shandong University, China. The questionnaire was administered via wenjuanxing. A returned questionnaire was valid only when all question items included were answered, according to our predefined validation criterion. All valid data were coded according to the predefined coding schemes of Likert scales with different point (score) ranges. Finally, we used latent class analysis to classify Chinese populations into clusters of different functional health literacy and identify significant factors closely associated with low functional health literacy. Results: All data in the 800 returned questionnaires proved valid according to the predefined validation criterion. Applying latent class analysis, we classified Chinese populations into low (n=292, 36.5%), moderate-to-adequate (n=286, 35.7%), and low-to-moderate (n=222, 27.8%) functional health literacy groups and identified five factors associated with low communicative health literacy: (1) male gender (aged 40-49 years), (2) lower educational attainment (below diploma), (3) age between 38 and 68 years, (4) lower self-efficacy, and (5) belief that staying healthy was a matter of luck. Conclusions: We classified Chinese populations into 3 functional health literacy groups and identified 5 factors associated with low functional health literacy. These associated factors can provide some implications for health education, medical research, and health policy making. %M 37115594 %R 10.2196/43348 %U https://formative.jmir.org/2023/1/e43348 %U https://doi.org/10.2196/43348 %U http://www.ncbi.nlm.nih.gov/pubmed/37115594 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43929 %T Validation of the Attitudes Towards Psychological Online Interventions Questionnaire Among Black Americans: Cross-cultural Confirmatory Factor Analysis %A Ellis,Donovan Michael %A Anderson,Page Lyn %+ Department of Psychology, Georgia State University, Urban Life Bldg, 11th Floor, 140 Decatur Street, Atlanta, GA, 30303, United States, 1 404 413 6258, panderson@gsu.edu %K acceptability %K Black American %K iCBT %K internet-based cognitive behavioral therapy %K digital treatment %K confirmatory factor analysis %K bifactor model %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Acceptability of digital mental health interventions is a significant predictor of treatment-seeking behavior and engagement. However, acceptability has been conceptualized and operationalized in various ways, which decreases measurement precision and leads to heterogeneous conclusions about acceptability. Standardized self-report measures of acceptability have been developed, which have the potential to ameliorate these problems, but none have demonstrated evidence for validation among Black communities, which limits our understanding of attitudes toward these interventions among racially minoritized groups with well-documented barriers to mental health treatment. Objective: This study aims to examine the psychometric validity and reliability of one of the first and most widely used measures of acceptability, the Attitudes Towards Psychological Online Interventions Questionnaire, among a Black American sample. Methods: Participants (N=254) were recruited from a large southeastern university and the surrounding metropolitan area and completed the self-report measure via a web-based survey. A confirmatory factor analysis using mean and variance adjusted weighted least squares estimation was conducted to examine the validity of the underlying hierarchical 4-factor structure proposed by the original authors of the scale. An alternative, hierarchical 2-factor structure model and bifactor model were examined for comparative fit. Results: The findings indicated that the bifactor model demonstrated a superior fit (comparative fit index=0.96, Tucker-Lewis index=0.94, standardized root mean squared residual=0.03, and root mean square error of approximation=0.09) compared with both 2- and 4-factor hierarchical structure models. Conclusions: The findings suggest that, within a Black American sample, there may be greater utility in interpreting the Attitudes Towards Psychological Online Interventions Questionnaire subscales as attitudinal constructs that are distinct from the global acceptability factor. The theoretical and practical implications for culturally responsive measurements were explored. %M 37103983 %R 10.2196/43929 %U https://mental.jmir.org/2023/1/e43929 %U https://doi.org/10.2196/43929 %U http://www.ncbi.nlm.nih.gov/pubmed/37103983 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43002 %T The Chinese Version of the Breast Cancer Literacy Assessment Tool: Translation, Adaptation, and Validation Study %A Shan,Yi %A Ji,Meng %+ School of Languages and Cultures, The University of Sydney, A18 - Brennan MacCallum Building, Sydney, NSW 2006, Australia, 61 2 9351 4512, christine.ji@sydney.edu.au %K breast cancer literacy assessment tool %K translation %K adaptation %K psychometric evaluation %K validity %K reliability %K breast cancer %K cancer %K tool %K women %K prevention %K detection %K intervention %K assessment %K education %K breast cancer literacy %K assessment tool %K cancer awareness %K health literacy %D 2023 %7 19.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Breast cancer is the most common cancer among Chinese women, with an age-standardized prevalence of 21.6 cases per 100,000 women. Limited cancer health literacy reduces females’ ability to engage in cancer prevention and detection. It is necessary to assess Chinese women’s breast cancer literacy to deliver targeted interventions and effective education. However, there is no Breast Cancer Literacy Assessment Tool (B-CLAT) available in China currently. Objective: This study aimed to translate and linguistically and culturally adapt the B-CLAT into a simplified-Chinese version (C-B-CLAT), and then validate its psychometric properties by administering it to Chinese college students. Methods: First, we translated the B-CLAT into a simplified-Chinese version and verified its validity and reliability using rigorous translation and validation guidelines proposed in previous studies. We then evaluated the psychometric properties among 50 female participants with a mean age of 19.62 (SD 1.31) years recruited from Nantong University, China. Results: Items 1, 6, 8, 9, 10, 16, 17, 20, 21, 22, 23, 24, 25, 26, 29, and 30 were deleted to increase the relevant subscale internal consistency. Items 3, 12, 13, 14, 18, 20, 27, and 31 were deleted due to their Cronbach α being lower than .5 in the test-retest analysis. After deletion, the internal consistency of the entire scale was fair with α=.607. The prevention and control subscale had the highest internal consistency with α=.730, followed by the screening and knowledge subscale with α=.509, while the awareness subscale had the lowest internal consistency with α=.224. The intraclass correlation coefficient for the C-B-CLAT (items 2, 4, 5, 7, 11, 15, 28, 32, 33, and 34) was fair to excellent (odds ratio [OR] 0.88, 95% CI 0.503-0.808). The values of Cronbach α for items 2, 4, 5, 7, 11, 15, 28, 32, 33, and 34 ranged from .499 to .806, and the α value for the C-B-CLAT was .607. This indicates fair test-retest reliability. The mean difference in the C-B-CLAT scores between stage 1 and stage 2 was 0.47 (OR 0.67, 95% CI −0.53 to 1.47), which was not significantly different from zero (t48=0.945; P=.35). This result implies that the C-B-CLAT produced the same scores at stage 1 and stage 2 on average, thus showing good agreement in the C-B-CLAT scores between stage 1 and stage 2. The SD of the difference was 3.48. The 95% limits of agreement were −6.34 to 7.28. Conclusions: We developed a simplified-Chinese version of the B-CLAT through translation and adaptation. Psychometric properties testing has proven this version valid and reliable for assessing breast cancer literacy among Chinese college students. %M 37074784 %R 10.2196/43002 %U https://formative.jmir.org/2023/1/e43002 %U https://doi.org/10.2196/43002 %U http://www.ncbi.nlm.nih.gov/pubmed/37074784 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e46305 %T The Relation Between Students’ Theoretical Knowledge and Practical Skills in Endodontics: Retrospective Analysis %A Haupt,Franziska %A Kanzow,Philipp %+ Department of Preventive Dentistry, Periodontology and Cariology, University Medical Center Göttingen, Robert-Koch-Str 40, Göttingen, 37075, Germany, 49 551 3960870, philipp.kanzow@med.uni-goettingen.de %K curricula %K curriculum %K dental %K dental education %K dentist %K dentistry %K endodontics %K endodontology %K educational assessment %K educational measurement %K examination %K knowledge assessment %K practical skills %K skill assessment %K theoretical knowledge %K undergraduate %K undergraduate curriculum %K undergraduate education %D 2023 %7 18.4.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Dental undergraduate students are required to show sufficient practical skills prior to treating patients. Practical skills and the underlying theoretical knowledge are taught in preclinical courses. Usually, the learning outcome is assessed in written multiple-choice examinations (theoretical knowledge) and practical skills tests. However, students’ assessment of practical skills is more time consuming and prone to bias than objective multiple-choice examinations. Objective: This study aims to analyze the relation between students’ theoretical knowledge and practical skills in endodontics. Furthermore, the predictive validity of a theoretical knowledge assessment on students’ practical skills was assessed. Methods: Examination results from all students who participated in the preclinical phantom course in Operative Dentistry (sixth semester of the undergraduate dental curriculum in Germany) between the 2015 summer term and the 2022 summer term were retrospectively evaluated (N=447). The effects of age, sex, previous course participation, and theoretical knowledge on students’ practical skills were assessed, using Pearson correlations, Wilcoxon rank sum tests, and a linear regression analysis. Subsequently, students’ theoretical knowledge and practical skills were compared via a Fisher exact test to identify a suitable pass mark for students’ theoretical knowledge that was associated with sufficient practical skills (≥60%). Results: Students’ theoretical knowledge was significantly associated with practical skills (Padjusted=.02; r=0.13). By using the current pass mark for theoretical knowledge (ie, 60%), a significant differentiation between insufficient practical skills (<60%) and sufficient practical skills (≥60%) was achieved (P=.02). However, for the discrimination between students with sufficient practical skills and students with insufficient practical skills, an adapted pass mark for theoretical knowledge would be more appropriate. The ideal pass mark amounted to 58% (P=.02). Conclusions: Students’ practical skills and theoretical knowledge are significantly correlated. By objectively measuring students’ theoretical knowledge, a rough estimation of students’ practical skills (ie, a differentiation between sufficient and insufficient practical skills) is possible. %M 36994987 %R 10.2196/46305 %U https://www.i-jmr.org/2023/1/e46305 %U https://doi.org/10.2196/46305 %U http://www.ncbi.nlm.nih.gov/pubmed/36994987 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41189 %T Development of the Emoji Faces Pain Scale and Its Validation on Mobile Devices in Adult Surgery Patients: Longitudinal Observational Study %A Li,Lili %A Wu,Sicheng %A Wang,Jian %A Wang,Chunchun %A Zuo,Weixin %A Yu,Liping %A Song,Jiangang %+ Anesthesiology Department, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, 528 Zhangheng Road, Pudong New Area, Shanghai, 20011, China, 86 021 20256301, songjg1993@shutcm.edu.cn %K pain %K mHealth %K scale development %K emoji %K surgery %D 2023 %7 17.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Measuring pain on digital devices using classic unidimensional pain scales such as the visual analog scale (VAS), numerical rating scale (NRS), and faces pain scale (FPS) has been proven to be reliable and valid. Emoji are pictographs designed in colorful form following the Unicode standard. It could be more beneficial to use emoji as faces of FPS on digital devices because emoji can easily fit on most devices and emoji are open-source so no approval would be needed before use. With a concise and user-friendly design, the emoji faces pain scale (Emoji-FPS) might be more generalizable to a wider population and more preferred by digital device users. Objective: This study was designed to develop an Emoji-FPS as well as to evaluate its reliability, validity, and preference on mobile devices in adult patients who underwent surgery. Methods: A modified Delphi technique with 2 rounds of web-based surveys was applied to obtain panelists’ consensus on the sequence of emoji that can best represent 6 levels of pain. The initial candidate sequences of emoji for the Delphi process were constructed referring to 2 well-validated FPSs (Wong-Baker FACES pain rating scale [Wong-Baker FACES] and faces pain scale-revised [FPS-R]). Then, a prospective cohort of patients scheduled to receive perianal surgery was recruited and asked to complete a web-based questionnaire on a mobile device at 5 time points (before surgery [T1], wake up after surgery [T2], 4 hours after surgery [T3], the second day after surgery [T4], and 15 minutes after T4 [T5]). The 4 well-validated pain scales (NRS, VAS, Wong-Baker FACES, and FPS-R) were used as reference scales. Results: After 2 rounds of surveys on 40 Delphi panelists, an Emoji-FPS was finally determined to represent 6 pain levels (0, 2, 4, 6, 8, and 10) from “no hurt” to “hurts worst.” For validation, 300 patients were recruited and 299 were analyzed, the mean age of whom was 38.5 (SD 10.5) years, and 106 (35.5%) were women. For concurrent validity, the Emoji-FPS was highly correlated with 4 reference scales with Spearman correlation coefficient ρ ranging from 0.91 to 0.95. Excellent agreements were observed between 4 versions of Emoji-FPS (iOS, Android, Microsoft, and OpenMoji), with weighted κ coefficients ranging from 0.96 to 0.97. For discriminant validity, patients’ mean preoperative Emoji-FPS score (T1) was significantly higher than their postoperative Emoji-FPS score (T4) with a difference of 1.4 (95% CI 1.3-1.6; P<.001). For test-retest reliability, Emoji-FPS scores measured at T4 and T5 were highly correlated with a ρ of 0.91. The Emoji-FPS was mostly preferred, followed by the Wong-Baker FACES, FPS-R, NRS, and VAS. Conclusions: The Emoji-FPS is reliable and valid compared with traditional pain scales in adult surgery patients. %M 37067854 %R 10.2196/41189 %U https://www.jmir.org/2023/1/e41189 %U https://doi.org/10.2196/41189 %U http://www.ncbi.nlm.nih.gov/pubmed/37067854 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44036 %T A New Questionnaire to Assess Respiratory Symptoms (The Respiratory Symptom Experience Scale): Quantitative Psychometric Assessment and Validation Study %A Shiffman,Saul %A McCaffrey,Stacey A %A Hannon,Michael J %A Goldenson,Nicholas I %A Black,Ryan A %+ PinneyAssociates, Inc, 201 N Craig St, Suite 320, Pittsburgh, PA, 15213, United States, 1 4126875677, shiffman@pinneyassociates.com %K measure development %K respiratory symptoms %K COPD %K e-cigarettes %K electronic nicotine delivery system %K ENDS %K smoking %K respiratory disease %K respiratory health %K health intervention %K questionnaire %K validation %K validate %K development %K respiratory %K pulmonary %K lung %K smoker %K smoking %D 2023 %7 14.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Smokers often experience respiratory symptoms (eg, morning cough), and those who stop smoking, including those who do so by switching completely to electronic nicotine delivery systems (ENDS), may experience reductions in symptoms. Existing respiratory symptom questionnaires may not be suitable for studying these changes, as they are intended for patient populations, such as those with chronic obstructive pulmonary disease (COPD). Objective: This study aimed to develop a respiratory symptom questionnaire appropriate for current smokers and for assessing changes when smokers stop smoking. Methods: The Respiratory Symptom Experience Scale (RSES) was derived from existing instruments and subject matter expert input and refined through cognitive debriefing interviews (n=49). Next, for purposes of the quantitative psychometric evaluation, the RSES was administered to smokers (n=202), former smokers (no tobacco use in >6 months; n=200), and switchers (n=208, smokers who switched to ENDS for >6 months), all of whom had smoked for at least 10 years (mean age 33 years). Participants, who averaged 62 (SD 12) years of age, included 28% (173/610) with respiratory allergy symptoms and 17% (104/610) with COPD. Test-retest reliability was assessed by repeat assessment after 1 week in 128 participants. Results: A generalized partial credit model confirmed that the response options were ordered, and a parallel analysis using principal components confirmed that the scale was unidimensional. With allowance for 2 sets of correlated errors between pairs of items, a 1-factor graded response model fit the data. Discrimination parameters were approximately 1 or greater for all items. Scale reliability was 0.80 or higher across a broad range of severity (standardized scores −0.40 to 3.00). Test-retest reliability (absolute intraclass correlation) was good, at 0.89. RSES convergent validity was supported by substantial differences (Cohen d=0.74) between those with and without a diagnosis of respiratory disease (averaging 0.57 points, indicating that differences of this size or smaller represent meaningful differences). RSES scores also strongly differentiated those with and without COPD (d=1.52). Smokers’ RSES scores were significantly higher than former smokers’ scores (P<.001). Switchers’ RSES scores were significantly lower than smokers’ scores (P<.001) and no different from former smokers’ scores (P=.34). Conclusions: The RSES fills an important gap in the existing toolkit of respiratory symptom questionnaires; it is a reliable and valid tool to assess respiratory symptoms in adult current and former smokers, including those who have switched to noncombusted nicotine products. This suggests that the scale is sensitive to respiratory symptoms that develop in smokers and to their remission when smokers quit or switch to noncombusted nicotine products intended to reduce the harm of smoking. The findings also suggest that switching from cigarettes to ENDS may improve respiratory health. %M 37058347 %R 10.2196/44036 %U https://formative.jmir.org/2023/1/e44036 %U https://doi.org/10.2196/44036 %U http://www.ncbi.nlm.nih.gov/pubmed/37058347 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e37847 %T Sensory Overresponsivity and Symptoms Across the Obsessive-Compulsive Spectrum: Web-Based Longitudinal Observational Study %A Moreno-Amador,Beatriz %A Cervin,Matti %A Martínez-González,Agustin Ernesto %A Piqueras,Jose A %A , %+ Area of Personality, Assessment and Psychological Treatment, Department of Health Psychology, Universidad Miguel Hernández de Elche, Edificio Altamira, Avda. de la Universidad, s/n, Elche, 03202, Spain, 34 966658343, jpiqueras@umh.es %K sensory symptoms %K sensory overresponsivity %K obsessive-compulsive %K hair-pulling %K skin-picking %K hoarding %K body dysmorphic %K adolescents %K adults %D 2023 %7 13.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Sensory overresponsivity (SOR) has emerged as a potential endophenotype in obsessive-compulsive disorder (OCD), but few studies have examined SOR in relation to the major symptom dimensions of OCD and to symptoms across the full obsessive-compulsive (OC) symptom spectrum. Objective: This study had 2 main objectives. First, we examined the psychometric properties of the SOR Scales in a community-based sample of Spanish adolescents and adults. Second, we identified how SOR difficulties are related to symptoms across the full OC spectrum (eg, OC, body dysmorphic, hoarding, skin-picking, and hair-pulling symptoms), including the heterogeneity of OC symptoms. Methods: We translated the SOR Scales into Spanish—a measure that assesses SOR across the 5 sensory modalities—and created a web-based version of the measure. A sample of 1454 adolescents and adults (mean age 23.84, SD 8.46 years) participated in the study, and 388 (26.69%) participants completed the survey twice (approximately 8 months apart). The survey also contained a web-based measure that assesses symptoms across the full OC spectrum: harm and checking, taboo obsessions, contamination or cleaning, symmetry and ordering, body dysmorphic, hoarding, hair-pulling, and skin-picking symptoms. Results: The psychometric properties of the SOR Scales were excellent, and the test-retest reliability was adequate. All types of SOR were related to all major symptom dimensions of OCD and to all OC spectrum symptoms. Conclusions: SOR across the sensory modalities can be validly assessed using a web-based measure. SOR emerged as a pure transdiagnostic phenomenon in relation to symptoms across the OC spectrum, with no specific sensory modality being more strongly related to OC symptoms. SOR can shed much needed light on basic mechanisms that are important for the onset and maintenance of OC spectrum symptoms, and this study shows that large-scale web-based studies can aid in this endeavor. Future studies should examine whether SOR precedes or emerges alongside OC symptoms. %M 37052983 %R 10.2196/37847 %U https://www.jmir.org/2023/1/e37847 %U https://doi.org/10.2196/37847 %U http://www.ncbi.nlm.nih.gov/pubmed/37052983 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43267 %T The Swedish Version of the eHealth Literacy Questionnaire: Translation, Cultural Adaptation, and Validation Study %A Sjöström,Anna E %A Hajdarevic,Senada %A Hörnsten,Åsa %A Kristjánsdóttir,Ólöf %A Castor,Charlotte %A Isaksson,Ulf %+ Department of Nursing, Umeå University, Umeå, 90187, Sweden, 46 907865394, anna.e.sjostrom@umu.se %K cultural adaptation %K digital health %K eHealth %K eHLQ %K eHealth literacy %K health literacy %K validation %D 2023 %7 12.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: With the increasing digitalization in health care, an effective instrument is necessary to assess health care consumers’ digital competencies—their “eHealth literacy.” The 7-scale eHealth Literacy Questionnaire (eHLQ), based on the theoretically robust eHealth Literacy Framework, has shown strong psychometric properties in Denmark and Australia. Objective: The aim of this study was to translate, culturally adapt, and evaluate the psychometric properties of the Swedish version of the eHLQ. Methods: We followed the Translation Integrity Procedure guidelines to translate and culturally adapt the questionnaire to Swedish using forward and backward translations, review by an expert panel, and cognitive interviewing. The psychometric properties of the Swedish eHLQ were investigated by evaluating its internal consistency (Cronbach α) and a priori–defined factor structure (confirmatory factor analysis). Results: A total of 236 primary health care patients and parents of hospitalized children were included in the validation analysis. The mean age was 48.5 years, and 129 (55%) were women. All 7 eHLQ scales showed good internal consistency, with the Cronbach α ranging from .82 to .92. Single-factor and 7-factor confirmatory factor analysis showed satisfactory model-fit values. With one exception, all items demonstrated satisfactory loadings on their respective factors. Conclusions: The Swedish eHLQ demonstrated strong psychometric properties. It has the potential as a useful tool for a variety of purposes, including population surveys, intervention evaluations, and eHealth service implementations. %M 37043268 %R 10.2196/43267 %U https://www.jmir.org/2023/1/e43267 %U https://doi.org/10.2196/43267 %U http://www.ncbi.nlm.nih.gov/pubmed/37043268 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42529 %T Assessment of Energy and Nutrient Intake and the Intestinal Microbiome (ErNst Study): Protocol and Methods of a Cross-sectional Human Observational Study %A Dötsch,Andreas %A Merz,Benedikt %A Louis,Sandrine %A Krems,Carolin %A Herrmann,Maria %A Dörr,Claudia %A Watzl,Bernhard %A Bub,Achim %A Straßburg,Andrea %A Engelbert,Ann Katrin %+ Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut-Federal Research Institute of Nutrition and Food, Haid-und-Neu-Str. 9, Karlsruhe, 76131, Germany, 49 721 6625 ext 443, andreas.doetsch@mri.bund.de %K dietary assessment %K human observational study %K nutrient intake %K human intestinal microbiome %K biomarkers %K 24-hour recall %K validity %K nutrition %K diet %K assessment %K food %K behavior %D 2023 %7 7.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: On the national level, nutritional monitoring requires the assessment of reliable representative dietary intake data. To achieve this, standardized tools need to be developed, validated, and kept up-to-date with recent developments in food products and the nutritional behavior of the population. Recently, the human intestinal microbiome has been identified as an essential mediator between nutrition and host health. Despite growing interest in this connection, only a few associations between the microbiome, nutrition, and health have been clearly established. Available studies paint an inconsistent picture, partly due to a lack of standardization. Objective: First, we aim to verify if food consumption, as well as energy and nutrient intake of the German population, can be recorded validly by means of the dietary recall software GloboDiet, which will be applied in the German National Nutrition Monitoring. Second, we aim to obtain high-quality data using standard methods on the microbiome, combined with dietary intake data and additional fecal sample material, and to also assess the functional activity of the microbiome by measuring microbial metabolites. Methods: Healthy female and male participants aged between 18 and 79 years were recruited. Anthropometric measurements included body height and weight, BMI, and bioelectrical impedance analysis. For validation of the GloboDiet software, current food consumption was assessed with a 24-hour recall. Nitrogen and potassium concentrations were measured from 24-hour urine collections to enable comparison with the intake of protein and potassium estimated by the GloboDiet software. Physical activity was measured over at least 24 hours using a wearable accelerometer to validate the estimated energy intake. Stool samples were collected in duplicate for a single time point and used for DNA isolation and subsequent amplification and sequencing of the 16S rRNA gene to determine microbiome composition. For the identification of associations between nutrition and the microbiome, the habitual diet was determined using a food frequency questionnaire covering 30 days. Results: In total, 117 participants met the inclusion criteria. The study population was equally distributed between the sexes and 3 age groups (18-39, 40-59, and 60-79 years). Stool samples accompanying habitual diet data (30-day food frequency questionnaire) are available for 106 participants. Current diet data and 24-hour urine samples for the validation of GloboDiet are available for 109 participants, of which 82 cases also include physical activity data. Conclusions: We completed the recruitment and sample collection of the ErNst study with a high degree of standardization. Samples and data will be used to validate the GloboDiet software for the German National Nutrition Monitoring and to compare microbiome composition and nutritional patterns. Trial Registration: German Register of Clinical Studies DRKS00015216; https://drks.de/search/de/trial/DRKS00015216 International Registered Report Identifier (IRRID): DERR1-10.2196/42529 %M 37027187 %R 10.2196/42529 %U https://www.researchprotocols.org/2023/1/e42529 %U https://doi.org/10.2196/42529 %U http://www.ncbi.nlm.nih.gov/pubmed/37027187 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40509 %T Digital Intervention Barriers Scale–7 (DIBS-7): Development, Evaluation, and Preliminary Validation %A Ramos,Giovanni %A Montoya,Amanda Kay %A Hammons,Hayley Renee %A Smith,Danielle %A Chavira,Denise April %A Rith-Najarian,Leslie Rose %+ Department of Psychology, University of California, Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, United States, 1 7865642448, gioramos@ucla.edu %K barriers %K development %K digital mental health intervention %K measure %K psychometrics %K scale %K validation %D 2023 %7 6.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The translation of mental health services into digital formats, deemed digital mental health interventions (DMHIs), has the potential to address long-standing obstacles to accessing care. However, DMHIs have barriers of their own that impact enrollment, adherence, and attrition in these programs. Unlike in traditional face-to-face therapy, there is a paucity of standardized and validated measures of barriers in DMHIs. Objective: In this study, we describe the preliminary development and evaluation of such a scale, the Digital Intervention Barriers Scale-7 (DIBS-7). Methods: Following an iterative QUAN → QUAL mixed methods approach, item generation was guided by qualitative analysis of feedback from participants (n=259) who completed a DMHI trial for anxiety and depression and identified barriers related to self-motivation, ease of use, acceptability, and comprehension of tasks. Item refinement was achieved through DMHI expert review. A final item pool was administered to 559 treatment completers (mean age 23.02 years; 438/559, 78.4% female; 374/559, 69.9% racially or ethnically minoritized). Exploratory factor analyses and confirmatory factor analyses were estimated to determine the psychometric properties of the measure. Finally, criterion-related validity was examined by estimating partial correlations between the DIBS-7 mean score and constructs related to treatment engagement in DMHIs. Results: Statistical analyses estimated a 7-item unidimensional scale with high internal consistency (α=.82, ω=0.89). Preliminary criterion-related validity was supported by significant partial correlations between the DIBS-7 mean score and treatment expectations (pr=–0.25), number of modules with activity (pr=–0.55), number of weekly check-ins (pr=–0.28), and treatment satisfaction (pr=–0.71). Conclusions: Overall, these results provide preliminary support for the use of the DIBS-7 as a potentially useful short scale for clinicians and researchers interested in measuring an important variable often associated with treatment adherence and outcomes in DMHIs. %M 37023417 %R 10.2196/40509 %U https://formative.jmir.org/2023/1/e40509 %U https://doi.org/10.2196/40509 %U http://www.ncbi.nlm.nih.gov/pubmed/37023417 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42584 %T Reliability and Validity of the Arabic Version of the Game Experience Questionnaire: Pilot Questionnaire Study %A Rebhi,Mahmoud %A Ben Aissa,Mohamed %A Tannoubi,Amayra %A Saidane,Mouna %A Guelmami,Noomen %A Puce,Luca %A Chen,Wen %A Chalghaf,Nasr %A Azaiez,Fairouz %A Zghibi,Makrem %A Bragazzi,Nicola Luigi %+ Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100 ext 66093, robertobragazzi@gmail.com %K Arab countries %K game experience %K reliability %K scale %K validity %D 2023 %7 20.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Nowadays, digital gaming occupies a central position in the entertainment industry where it has developed into a cherished kind of entertainment in markets all over the world. In addition, it provides other sectors with various social and economic benefits. The Game Experience Questionnaire (GEQ) is a free, quantitative, and comprehensive self-report measure that was developed to assess the player game experience. Despite having been widely used by many research projects in the past, it has not been adapted into Arabic. Furthermore, several components of the scale proved problematic from a psychometric point of view. Therefore, a modified version of the scale is needed to measure the gaming experience of the Arab population. Objective: The aim of this study was to validate and examine the psychometrics of an adapted Arabic version of the GEQ in Tunisia. Methods: A total of 771 volunteer participants completed an online survey, which included an Arabic version of the GEQ, gaming data, and a sociodemographic questionnaire. Subjects were randomized in order to complete two phases of the study: exploratory and confirmatory. The exploratory data were acquired from 360 respondents whose mean age was 23.89 (SD 2.29) years. Out of 360 respondents, 111 (30.8%) were female and 249 (69.2%) were male. Confirmatory data were obtained from the remaining 411 subjects whose mean age was 21.94 (SD 1.80) years. Out of 411 subjects, 169 (41.1%) were female and 242 (58.9%) were male. Results: After the elimination of two items, the exploratory and the confirmatory factor analyses provided an adequate factor structure of the Arabic version of the GEQ. In addition, the internal consistency coefficients suggested the reliability of the instrument. Significant differences were revealed for three subcomponents: flow by age (η2=0.013, P=.002), gender (η2=0.007, P=.02), and game type (η2=0.03, P<.001). For competence (η2=0.01, P=.03) and immersion (η2=0.02, P=.01), significant differences were highlighted by the type of game. The discriminant and convergent validities of the instrument were supported by calculating the average variance extracted (AVE) and comparing the square roots of the AVE values to the correlation coefficients, respectively. Conclusions: The Arabic adapted version of the GEQ is valid and reliable and can be administered to measure the game experience in Arab countries. %M 36482747 %R 10.2196/42584 %U https://formative.jmir.org/2023/1/e42584 %U https://doi.org/10.2196/42584 %U http://www.ncbi.nlm.nih.gov/pubmed/36482747 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41615 %T Development and Internal Validation of the Digital Health Readiness Questionnaire: Prospective Single-Center Survey Study %A Scherrenberg,Martijn %A Falter,Maarten %A Kaihara,Toshiki %A Xu,Linqi %A van Leunen,Mayke %A Kemps,Hareld %A Kindermans,Hanne %A Dendale,Paul %+ Heart Centre Hasselt, Jessa Hospital, Stadsomvaart 11, Hasselt, 3500, Belgium, 32 494 247 479, martijn.scherrenberg@telenet.be %K adherence %K assessment %K digital access %K digital divide %K digital health intervention %K digital health %K digital literacy %K digital skills %K health literacy %K participation %K telemedicine %D 2023 %7 10.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: While questionnaires for assessing digital literacy exist, there is still a need for an easy-to-use and implementable questionnaire for assessing digital readiness in a broader sense. Additionally, learnability should be assessed to identify those patients who need additional training to use digital tools in a health care setting. Objective: The aim of the development of the Digital Health Readiness Questionnaire (DHRQ) was to create a short, usable, and freely accessible questionnaire that was designed from a clinical practice perspective. Methods: It was a prospective single-center survey study conducted in Jessa Hospital Hasselt in Belgium. The questionnaire was developed with a panel of field experts with questions in following 5 categories: digital usage, digital skills, digital literacy, digital health literacy, and digital learnability. All participants who were visiting the cardiology department as patients between February 1, 2022, and June 1, 2022, were eligible for participation. Cronbach α and confirmatory factor analysis were performed. Results: A total number of 315 participants were included in this survey study, of which 118 (37.5%) were female. The mean age of the participants was 62.6 (SD 15.1) years. Cronbach α analysis yielded a score of >.7 in all domains of the DHRQ, which indicates acceptable internal consistency. The fit indices of the confirmatory factor analysis showed a reasonably good fit: standardized root-mean-square residual=0.065, root-mean-square error of approximation=0.098 (95% CI 0.09-0.106), Tucker-Lewis fit index=0.895, and comparative fit index=0.912. Conclusions: The DHRQ was developed as an easy-to-use, short questionnaire to assess the digital readiness of patients in a routine clinical setting. Initial validation demonstrates good internal consistency, and future research will be needed to externally validate the questionnaire. The DHRQ has the potential to be implemented as a useful tool to gain insight into the patients who are treated in a care pathway, tailor digital care pathways to different patient populations, and offer those with low digital readiness but high learnability appropriate education programs in order to let them take part in the digital pathways. %M 36897627 %R 10.2196/41615 %U https://www.jmir.org/2023/1/e41615 %U https://doi.org/10.2196/41615 %U http://www.ncbi.nlm.nih.gov/pubmed/36897627 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42340 %T Psychometric Properties of and Measurement Invariance in the Questionnaire of Stereotypes Toward Older Adulthood in Health Care College Students and Health Professionals of Colombia: Psychometric Study %A Martín-Carbonell,Marta %A Espejo,Begoña %A Castro-Melo,Greys Patricia %A Sequeira-Daza,Doris %A Checa,Irene %+ Universitat de València, Av. Blasco Ibáñez, 21, Valencia, 46010, Spain, 34 963864503, bespejo@uv.es %K psychometric properties %K structural equation modeling %K older adulthood %K geriatric %K gerontology %K health care college students %K health care professionals %K questionnaire %K stereotype %K agism %D 2023 %7 9.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In health professionals, negative stereotypes toward older adulthood have been associated with the difficulty in recognizing pathological processes and the refusal to care for older patients because of assuming that communication with them will be uncomfortable and frustrating. For these reasons, research on stereotypes in these groups has acquired growing importance. The usual strategy to identify and evaluate agist stereotypes is to use scales and questionnaires. Although multiple scales are currently used, in Latin America, the Questionnaire for the Evaluation of Negative Stereotypes Toward Older Adulthood (Cuestionario de Estereotipos Negativos sobre la Vejez [CENVE]), developed in Spain, is widely used but without evidence of construct validity in our context. In addition, although in the original version, a factorial structure of 3 factors was found, in later studies, a unifactorial structure was obtained. Objective: The objective is to study the construct validity of the CENVE in a sample of Colombian health personnel to clarify its factorial structure and concurrent validity. Likewise, the measurement invariance according to gender and age was studied. Methods: A nonprobabilistic sample of 877 Colombian health professionals and intern health students was obtained. The data were collected online using the LimeSurvey tool. To study the factor structure of the CENVE, 2 confirmatory factor analysis (CFA) models were carried out, one to test a single factor and the other to test the 3-related-factor structure. The factor measurement reliability was evaluated with the composite reliability index (CRI) and the average variance extracted (AVE). The measurement invariance was studied according to gender (men and women) and age (emerging adults, 18-29 years old, and adults, 30 years old or older). Using a structural equation model, the relationship between age and the latent CENVE total score was studied to obtain evidence of concurrent validity, since studies indicate that the younger the age, the greater the number of stereotypes. Results: The 1-factor structure was confirmed. The reliability results indicated that both indices show adequate values. Likewise, the existence of a strong invariance in measurement by gender and age group was verified. After contrasting the means of the groups, the results showed that men show more negative stereotypes toward old age than women. Likewise, emerging adults also showed more stereotypes than adults. We also verified that age is inversely related to the latent score of the questionnaire, such that the younger the age, the greater the stereotype. These results are in agreement with those obtained by other authors. Conclusions: The CENVE shows good construct and concurrent validity, as well as good reliability, and it can be used to assess stereotypes toward older adulthood in Colombian health professionals and health sciences college students. This will allow us to better understand the effect of stereotypes on agism. %M 36892936 %R 10.2196/42340 %U https://www.jmir.org/2023/1/e42340 %U https://doi.org/10.2196/42340 %U http://www.ncbi.nlm.nih.gov/pubmed/36892936 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40645 %T Multiple Automated Health Literacy Assessments of Written Health Information: Development of the SHeLL (Sydney Health Literacy Lab) Health Literacy Editor v1 %A Ayre,Julie %A Bonner,Carissa %A Muscat,Danielle M %A Dunn,Adam G %A Harrison,Eliza %A Dalmazzo,Jason %A Mouwad,Dana %A Aslani,Parisa %A Shepherd,Heather L %A McCaffery,Kirsten J %+ Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Rm 128B, Edward Ford Building (A27), Sydney, 2050, Australia, 61 29351 7789, julie.ayre@sydney.edu.au %K health literacy %K comprehension %K health education %K health communication %K medicine information %K readability %D 2023 %7 14.2.2023 %9 Viewpoint %J JMIR Form Res %G English %X Producing health information that people can easily understand is challenging and time-consuming. Existing guidance is often subjective and lacks specificity. With advances in software that reads and analyzes text, there is an opportunity to develop tools that provide objective, specific, and automated guidance on the complexity of health information. This paper outlines the development of the SHeLL (Sydney Health Literacy Lab) Health Literacy Editor, an automated tool to facilitate the implementation of health literacy guidelines for the production of easy-to-read written health information. Target users were any person or organization that develops consumer-facing education materials, with or without prior experience with health literacy concepts. Anticipated users included health professionals, staff, and government and nongovernment agencies. To develop this tool, existing health literacy and relevant writing guidelines were collated. Items amenable to programmable automated assessment were incorporated into the Editor. A set of natural language processing methods were also adapted for use in the SHeLL Editor, though the approach was primarily procedural (rule-based). As a result of this process, the Editor comprises 6 assessments: readability (school grade reading score calculated using the Simple Measure of Gobbledygook (SMOG)), complex language (percentage of the text that contains public health thesaurus entries, words that are uncommon in English, or acronyms), passive voice, text structure (eg, use of long paragraphs), lexical density and diversity, and person-centered language. These are presented as global scores, with additional, more specific feedback flagged in the text itself. Feedback is provided in real-time so that users can iteratively revise and improve the text. The design also includes a “text preparation” mode, which allows users to quickly make adjustments to ensure accurate calculation of readability. A hierarchy of assessments also helps users prioritize the most important feedback. Lastly, the Editor has a function that exports the analysis and revised text. The SHeLL Health Literacy Editor is a new tool that can help improve the quality and safety of written health information. It provides objective, immediate feedback on a range of factors, complementing readability with other less widely used but important objective assessments such as complex and person-centered language. It can be used as a scalable intervention to support the uptake of health literacy guidelines by health services and providers of health information. This early prototype can be further refined by expanding the thesaurus and leveraging new machine learning methods for assessing the complexity of the written text. User-testing with health professionals is needed before evaluating the Editor’s ability to improve the health literacy of written health information and evaluating its implementation into existing Australian health services. %M 36787164 %R 10.2196/40645 %U https://formative.jmir.org/2023/1/e40645 %U https://doi.org/10.2196/40645 %U http://www.ncbi.nlm.nih.gov/pubmed/36787164 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42219 %T A Tablet-Based Aphasia Assessment System “STELA”: Feasibility and Validation Study %A Inamoto,Yoko %A Mukaino,Masahiko %A Imaeda,Sayuri %A Sawada,Manami %A Satoji,Kumi %A Nagai,Ayako %A Hirano,Satoshi %A Okazaki,Hideto %A Saitoh,Eiichi %A Sonoda,Shigeru %A Otaka,Yohei %+ Deparment of Rehabilitation Medicine, Hokkaido University Hospital, Kita 14, Nishi 5, Kita-ku, Sapporo, 060-8648, Japan, 81 11 706 6065, masahikovn@gmail.com %K aphasia %K tablet %K assessment %K validity %K internal consistency %K psychometric %K psychological health %K stress %K digital mental health intervention %K digital health intervention %K heuristic evaluation %K system usability %K auditory comprehension %K reading comprehension %K naming and sentence formation %K repetition %K reading aloud %K Cronbach α %K speech %D 2023 %7 8.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There is an extensive library of language tests, each with excellent psychometric properties; however, many of the tests available take considerable administration time, possibly bearing psychological strain on patients. The Short and Tailored Evaluation of Language Ability (STELA) is a simplified, tablet-based language ability assessment system developed to address this issue, with a reduced number of items and automated testing process. Objective: The aim of this paper is to assess the administration time, internal consistency, and validity of the STELA. Methods: The STELA consists of a tablet app, a microphone, and an input keypad for clinician’s use. The system is designed to assess language ability with 52 questions grouped into 2 comprehension modalities (auditory comprehension and reading comprehension) and 3 expression modalities (naming and sentence formation, repetition, and reading aloud). Performance in each modality was scored as the correct answer rate (0-100), and overall performance expressed as the sum of modality scores (out of 500 points). Results: The time taken to complete the STELA was significantly less than the time for the WAB (mean 16.2, SD 9.4 vs mean 149.3, SD 64.1 minutes; P<.001). The STELA’s total score was strongly correlated with the WAB Aphasia Quotient (r=0.93, P<.001), supporting the former’s concurrent validity concerning the WAB, which is a gold-standard aphasia assessment. Strong correlations were also observed at the subscale level; STELA auditory comprehension versus WAB auditory comprehension (r=0.75, P<.001), STELA repetition versus WAB repetition (r=0.96, P<.001), STELA naming and sentence formation versus WAB naming and word finding (r=0.81, P<.001), and the sum of STELA reading comprehension or reading aloud versus WAB reading (r=0.82, P<.001). Cronbach α obtained for each modality was .862 for auditory comprehension, .872 for reading comprehension, .902 for naming and sentence formation, .787 for repetition, and .892 for reading aloud. Global Cronbach α was .961. The average of the values of item-total correlation to each subscale was 0.61 (SD 0.17). Conclusions: Our study confirmed significant time reduction in the assessment of language ability and provided evidence for good internal consistency and validity of the STELA tablet-based aphasia assessment system. %M 36753308 %R 10.2196/42219 %U https://formative.jmir.org/2023/1/e42219 %U https://doi.org/10.2196/42219 %U http://www.ncbi.nlm.nih.gov/pubmed/36753308 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43175 %T Actual Use Behavior Assessment of a Novel Puff Recording Electronic Nicotine Delivery System: Observation Study %A Gao,Xiang %A Humberstone,Liam %A Liu,Yatao %+ Scientific Horizons Consulting, 5270 California Ave, Suite 300, Irvine, CA, 92617, United States, 1 5106798062, xiang.gao@scientifichorizonsconsulting.com %K e-cigarettes %K electronic nicotine delivery system %K behavior assessment %K nicotine addiction %K PR-ENDS %D 2023 %7 8.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Compared with combustible cigarettes, electronic cigarettes (e-cigarettes) can deliver a sufficient amount of nicotine with a significantly reduced emission of toxicants, which renders them as potential harm reduction candidates for tobacco and smoking replacement. However, the use of e-cigarettes is not harm free and the long-term health effect of using e-cigarettes is yet to be established. Given the high prevalence of e-cigarette use across the globe and its potential health concerns, it is imperative to conduct actual use behavior assessments to better understand how e-cigarettes are being consumed in real-world conditions. However, with the currently available technologies, there is still a lack of noninvasive, noninterventional, and convenient instruments for the real-time and real-world use behavior monitoring of e-cigarette product use. Novel technology-based systems that do not primarily rely on self-report or intrusive measurements to monitor e-cigarette use behaviors are therefore highly desired. Objective: The primary goal of this study is to investigate the e-cigarette actual use behaviors in the real world via a novel puff recording electronic nicotine delivery system (PR-ENDS). Specifically, we aim to analyze and summarize the survey and PR-ENDS use data and to study the relationships and effects of different factors on these variables. Methods: In real-world conditions, 61 enrolled UK e-cigarette users were instructed to use PR-ENDS as the primary source of nicotine with their selected e-liquids for at least 3 weeks (21 days). A baseline survey was conducted to collect information about participants’ demographics and nicotine use history (cigarette and ENDS). The puff data (ie, puff number, puff duration for each puff, device power, e-liquid nicotine concentrations) were directly recorded by PR-ENDS and uploaded to the cloud for further analyses. The nicotine emission and nicotine consumption were estimated based on recorded puff data. Results: Middle-aged adults with a nicotine history represented the major user profile during the PR-ENDS trial. A wide range of device power and e-liquid nicotine concentrations was applied and their combinations during actual use were found to be rather complex. Various puff parameters (ie, puff duration, puff number, nicotine emission) were assessed with contributing factors from device, e-liquid, and user nicotine history in different effect sizes. The real-time observation revealed substantial intra- and interindividual variabilities in PR-ENDS use behaviors. The use pattern of a quick adaptation followed by consistent product use was recognized for at least 3 weeks during actual use. Conclusions: The actual use behavior assessment of PR-ENDS was conducted as a proof-of-concept application. The complex interactions of product attributes and significant intra- and interindividual variabilities in e-cigarette use behaviors provided new insights of compensatory behavior, which can inspire future studies in the field of nicotine addiction and abuse liability behavior assessment. %M 36592426 %R 10.2196/43175 %U https://formative.jmir.org/2023/1/e43175 %U https://doi.org/10.2196/43175 %U http://www.ncbi.nlm.nih.gov/pubmed/36592426 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38298 %T Developing and Evaluating a Measure of the Willingness to Use Pandemic-Related mHealth Tools Using National Probability Samples in the United States: Quantitative Psychometric Analyses and Tests of Sociodemographic Group Differences %A Vincent,Wilson %+ Department of Psychology and Neuroscience, Temple University, Weiss Hall, 1701 N 13th St, Philadelphia, PA, 19122, United States, 1 404 200 4193, wvincent1804@gmail.com %K COVID-19 %K psychometric properties %K mHealth %K digital health %K digital screening %K digital tracking %K pandemic %K national survey %K mobile health %K digital health tool %K vulnerable population %K demographic characteristic %K instrument validation %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There are no psychometrically validated measures of the willingness to engage in public health screening and prevention efforts, particularly mobile health (mHealth)–based tracking, that can be adapted to future crises post–COVID-19. Objective: The psychometric properties of a novel measure of the willingness to participate in pandemic-related screening and tracking, including the willingness to use pandemic-related mHealth tools, were tested. Methods: Data were from a cross-sectional, national probability survey deployed in 3 cross-sectional stages several weeks apart to adult residents of the United States (N=6475; stage 1 n=2190, 33.82%; stage 2 n=2238, 34.56%; and stage 3 n=2047, 31.62%) from the AmeriSpeak probability-based research panel covering approximately 97% of the US household population. Five items asked about the willingness to use mHealth tools for COVID-19–related screening and tracking and provide biological specimens for COVID-19 testing. Results: In the first, exploratory sample, 3 of 5 items loaded onto 1 underlying factor, the willingness to use pandemic-related mHealth tools, based on exploratory factor analysis (EFA). A 2-factor solution, including the 3-item factor, fit the data (root mean square error of approximation [RMSEA]=0.038, comparative fit index [CFI]=1.000, standardized root mean square residual [SRMR]=0.005), and the factor loadings for the 3 items ranged from 0.849 to 0.893. In the second, validation sample, the reliability of the 3-item measure was high (Cronbach α=.90), and 1 underlying factor for the 3 items was confirmed using confirmatory factor analysis (CFA): RMSEA=0, CFI=1.000, SRMR=0 (a saturated model); factor loadings ranged from 1.000 to 0.962. The factor was independently associated with COVID-19–preventive behaviors (eg, “worn a face mask”: r=0.313, SE=0.041, P<.001; “kept a 6-foot distance from those outside my household”: r=0.282, SE=0.050, P<.001) and the willingness to provide biological specimens for COVID-19 testing (ie, swab to cheek or nose: r=0.709, SE=0.017, P<.001; small blood draw: r=0.684, SE=0.019, P<.001). In the third, multiple-group sample, the measure was invariant, or measured the same thing in the same way (ie, difference in CFI [ΔCFI]<0.010 across all grouping categories), across age groups, gender, racial/ethnic groups, education levels, US geographic region, and population density (ie, rural, suburban, urban). When repeated across different samples, factor-analytic findings were essentially the same. Additionally, there were mean differences (ΔM) in the willingness to use mHealth tools across samples, mainly based on race or ethnicity and population density. For example, in SD units, suburban (ΔM=–0.30, SE=0.13, P=.001) and urban (ΔM=–0.42, SE=0.12, P<.001) adults showed less willingness to use mHealth tools than rural adults in the third sample collected on May 30-June 8, 2020, but no differences were detected in the first sample collected on April 20-26, 2020. Conclusions: Findings showed that the screener is psychometrically valid. It can also be adapted to future public health crises. Racial and ethnic minority adults showed a greater willingness to use mHealth tools than White adults. Rural adults showed more mHealth willingness than suburban and urban adults. Findings have implications for public health screening and tracking and understanding digital health inequities, including lack of uptake. %M 36689545 %R 10.2196/38298 %U https://formative.jmir.org/2023/1/e38298 %U https://doi.org/10.2196/38298 %U http://www.ncbi.nlm.nih.gov/pubmed/36689545 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40733 %T Translating and Adapting the DISCERN Instrument Into a Simplified Chinese Version and Validating Its Reliability: Development and Usability Study %A Shan,Yi %A Xing,Zhaoquan %A Dong,Zhaogang %A Ji,Meng %A Wang,Ding %A Cao,Xiangting %+ Department of Urology, Qilu Hospital of Shandong University, 107 Wenhuaxi Road, Jinan, 250012, China, 86 053182166711, sdql2011@126.com %K DISCERN %K translation %K adaptation %K validation %K quality %K patient-targeted health information %K treatment choice %D 2023 %7 2.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a wide variation in the quality of information available to patients on the treatment of the diseases afflicting them. To help patients find clear and accessible information, many scales have been designed to evaluate the quality of health information, including the Patient Education Materials Assessment Tool; the Suitability Assessment of Materials for evaluation of health-related information for adults; and DISCERN, an instrument for judging the quality of written consumer health information on treatment choices. These instruments are primarily in English. Few of them have been translated and adapted into simplified Chinese tools for health information assessment in China. Objective: This study aimed to translate and adapt DISCERN into the first simplified Chinese version and validate the psychometric properties of this newly developed scale for judging the quality of patient-oriented health information on treatment choices. Methods: First, we translated DISCERN into simplified Chinese using rigorous guidelines for translation and validation studies. We tested the translation equivalence and measured the content validity index. We then presented the simplified Chinese instrument to 3 health educators and asked them to use it to assess the quality of 15 lung cancer–related materials. We calculated the Cohen κ coefficient and Cronbach α for all items and for the entire scale to determine the reliability of the new tool. Results: We decided on the simplified Chinese version of the DISCERN instrument (C-DISCERN) after resolving all problems in translation, adaptation, and content validation. The C-DISCERN was valid and reliable: the content validity index was 0.98 (47/48, 98% of the items) for clarity and 0.94 (45/48, 94% of the items) for relevance, the Cronbach α for internal consistency was .93 (95% CI 0.699-1.428) for the whole translated scale, and the Cohen κ coefficient for internal consistency was 0.53 (95% CI 0.417-0.698). Conclusions: C-DISCERN is the first simplified Chinese version of the DISCERN instrument. Its validity and reliability have been attested to assess the quality of patient-targeted information for treatment choices. %M 36729573 %R 10.2196/40733 %U https://www.jmir.org/2023/1/e40733 %U https://doi.org/10.2196/40733 %U http://www.ncbi.nlm.nih.gov/pubmed/36729573 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40858 %T An Effective Test (EOmciSS) for Screening Older Adults With Mild Cognitive Impairment in a Community Setting: Development and Validation Study %A Wu,Jingsong %A Tu,Jingnan %A Liu,Zhizhen %A Cao,Lei %A He,Youze %A Huang,Jia %A Tao,Jing %A Wong,Mabel N K %A Chen,Lidian %A Lee,Tatia M C %A Chan,Chetwyn C H %+ Department of Psychology, The Education University of Hong Kong, Tai Po Luk Ping Road, New Territories Hong Kong, Hong Kong, 999077, Hong Kong, 852 6318 8991, cchchan@eduhk.hk %K mild cognitive impairment %K digital assessment %K digital health %K community dwelling %K screening test %K older adults %K aging %D 2023 %7 30.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Early detection of mild cognitive impairment (MCI) symptoms is an important step to its diagnosis and intervention. We developed a new screening test called “Efficient Online MCI Screening System” (EOmciSS) for use in community-dwelling older adults. It is a self-paced cognitive test to be completed within 10 minutes on tablets or smartphones in homes or care centers for older adults. Objective: This study aims to test the validity of EOmciSS for identifying community-dwelling older adults with MCI risks. Methods: Participants (N=827) completed EOmciSS and other screening tests for MCI. The psychometric properties tested were “subscale item difficulty,” “discriminative index,” “internal consistency,” and “construct validity.” We also tested between-group discrimination using the cross-validation method in an MCI group and a normal cognitive function (NCF) group. Results: A total of 3 accuracy factors and 1 reaction time factor explained the structure of the 20 item factors. The difficulty level of accuracy factors (ie, “trail making,” “clock drawing,” “cube copying,” “delayed recall”) was 0.63-0.99, whereas that of the reaction time factor was 0.77-0.95. The discriminative index of the medium-to-high-difficulty item factors was 0.39-0.97. The internal consistency (Cronbach α) ranged from .41 (for few item factors) to .96. The training data set contained 9 item factors (CC-Acc1, P<.001; CD-Acc1, P=.07; CD-Acc2, P=.06; CD-Acc3, P<.001; TM-Acc4, P=.07; DR-Acc1, P=.03; RS, P=.06; DR-RT1, P=.02; and DR-RT2, P=.05) that were significant predictors for an MCI classification versus NCF classification. Depressive symptoms were identified as significant factors (P<.001) influencing the performance of participants, and were an integral part of our test system. Age (P=.15), number of years of education (P=.18), and proficiency in using an electronic device (P=.39) did not significantly influence the scores nor classification of participants. Application of the MCI/NCF cutoff score (7.90 out of 9.67) to the validation data set yielded an area under the curve of 0.912 (P<.001; 95% CI 0.868-0.955). The sensitivity was 84.9%, specificity was 85.1%, and the Youden index was 0.70. Conclusions: EOmciSS was valid and reliable for identifying older adults with significant risks of MCI. Our results indicate that EOmciSS has higher sensitivity and specificity than those of the Computer-Administered Neuropsychological Screen for Mild Cognitive Impairment and the Computerized Cognitive Screen. The user interface, online operation, and self-paced format allowed the test system to be operated by older adults or their caregivers in different settings (eg, home or care centers for older adults). Depressive symptoms should be an integral part in future MCI screening systems because they influence the test performance and, hence, MCI risk. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000039411; http://www.chictr.org.cn/showprojen.aspx?proj=62903 %M 36716081 %R 10.2196/40858 %U https://www.jmir.org/2023/1/e40858 %U https://doi.org/10.2196/40858 %U http://www.ncbi.nlm.nih.gov/pubmed/36716081 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41845 %T Repeatability, Reproducibility, and Concurrent Validity of a Stethoscope and Health App System for the Quantification of Breath Rate in Healthy Adults: Repeatability and Validity Study %A Becerro de Bengoa Vallejo,Ricardo %A Losa Iglesias,Marta Elena %A Robles Sanchez,Oscar David %+ Departamento de Enfermería y Estomatología, Facultad de CC de la Salud, Universidad Rey Juan Carlos, Av de Atenas S/N, Alcorcón, 28922, Spain, 34 616962413, marta.losa@urjc.es %K breath rate %K stethoscope %K smartphone app %K breathing rate %K vital sign %K respiration %K mobile phone app %K health app %K mobile app %K mHealth %K mobile health %K measurement %K breathing %K assessment %K monitoring %K reliability %K validity %K medical device %K medical instrument %D 2023 %7 12.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Apps for smartphones that can measure the breathing rate easily can be downloaded. Objective: The aim of this study was to demonstrate agreement in measuring breath rates between the stethoscope and Breath Counter health app. Methods: We performed a repeatability study with 56 healthy volunteers. The patient’s demographic data and breathing rates per minute were collected. Breathing rates were measured via two methods: (1) using a stethoscope placed in the upper area of the right lung and (2) a Breath Counter app developed by Vadion on a Samsung Fold smartphone. Results: This study demonstrated high repeatability and validity with respect to the breathing rate parameter of healthy adults using the aforementioned 2 systems. Intrasession repeatability measure using the intraclass correlation coefficient was >0.962, indicating excellent repeatability. Moreover, the intraclass correlation coefficient between methods was 0.793, indicating good repeatability, and coefficients of variation of method errors values were 1.83% with very low values in terms of other repeatability parameters. We found significant correlation coefficients and no systematic differences between the app and stethoscope methods. Conclusions: The app method may be attractive to individuals who require repeatability in a recreational setting. %M 36633892 %R 10.2196/41845 %U https://www.jmir.org/2023/1/e41845 %U https://doi.org/10.2196/41845 %U http://www.ncbi.nlm.nih.gov/pubmed/36633892 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42158 %T Development and Validation of the Epidemiological Tattoo Assessment Tool to Assess Ink Exposure and Related Factors in Tattooed Populations for Medical Research: Cross-sectional Validation Study %A Foerster,Milena %A Dufour,Lucas %A Bäumler,Wolfgang %A Schreiver,Ines %A Goldberg,Marcel %A Zins,Marie %A Ezzedine,Khaled %A Schüz,Joachim %+ Environment and Lifestyle Epidemiology Branch, International Agency for Research on Cancer, World Health Organisation, 150 cours Albert Thomas, Lyon, 69008, France, 33 4 72 73 89 44, foersterm@iarc.who.int %K tattoos %K cancer %K questionnaire development %K exposure assessment %K cohort studies %K epidemiology %K polycyclic aromatic hydrocarbons %K primary aromatic amines %K metals %K digital surface analysis %D 2023 %7 11.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Tattooing, whose popularity is growing worldwide, is an invasive body art that involves the injection of chemical mixtures, the tattoo ink, into the upper layer of the dermis. Although these inks may contain environmental toxins, including known human carcinogens, their long-term health effects are poorly studied. To conduct the urgently required epidemiological studies on tattoos and their long-term health effects, a validated method for assessing the complex tattoo exposure is needed. Objective: We aimed to develop and validate the Epidemiological Tattoo Assessment Tool (EpiTAT), a questionnaire to self-assess tattoo ink exposure in tattooed populations suitable for application in large epidemiological cohort studies. Methods: One of 3 preliminary versions of the EpiTAT using one of the alternative tattoo measurement units hand surface, credit card, or body schemes was randomly filled in by tattooed volunteers in Lyon, France. To identify the most suitable unit of tattoo self-assessment, a validation study was conducted with the selected respondents (N=97) to compare the self-assessments of tattoo surface, color, and coverage with validation measurements made by trained study personnel. Intraclass correlation, the Kendall rank correlation, and 2-tailed t tests were used to statistically compare tattoo size, color area, and tattoo coverage separately for each questionnaire version. Participants’ opinions on the alternative measurement units were also considered in the overall evaluation. For quality control of the validation measures, digital surface analysis of 62 photographs of selected tattoos was performed using Fiji/ImageJ. Results: In general, the results revealed overestimation of self-assessed measures compared with validation measures (eg, mean tattooed body surface 1768, SD 1547, cm2 vs 930, SD 1047, cm2, respectively, for hand surface; P<.001) and validation measures compared with digital image analysis (mean individual tattoo surface 147, SD 303.9, cm2 vs 101, SD 154.7, cm2, respectively; P=.05). Although the measurement unit credit card yielded the most accurate measures for all variables of interest, it had a much lower completion rate (78/129, 60.5%) than hand surface (89/104, 85.6%) and body schemes (90/106, 84.9%). Hand surface measured total tattoo size more accurately than body schemes (absolute agreement intraclass correlation coefficient: 0.71 vs 0.64, respectively). Conclusions: The final version of the EpiTAT contains 21 items and uses hand surface as a visual unit of measurement. Likert scales are used to assess color and coverage as a proportion of the total tattoo area. The overestimation of tattoo size by self-reporting merits further research to identify potential influential factors or predictive patterns that could be considered when calculating exposure. %M 36630184 %R 10.2196/42158 %U https://formative.jmir.org/2023/1/e42158 %U https://doi.org/10.2196/42158 %U http://www.ncbi.nlm.nih.gov/pubmed/36630184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e39220 %T Measuring Digital Vaccine Literacy: Development and Psychometric Assessment of the Digital Vaccine Literacy Scale %A Montagni,Ilaria %A Pouymayou,Aude %A Pereira,Edwige %A Tzourio,Christophe %A Schück,Stéphane %A Texier,Nathalie %A González-Caballero,Juan Luis %A , %+ Bordeaux Population Health UMRS1219, University of Bordeaux, Institut national de la santé et de la recherche médicale, 146 rue Léo Saignat, Bordeaux, 33000, France, 33 0642193363, ilaria.montagni@u-bordeaux.fr %K Internet %K literacy %K measurement %K vaccination %K vaccine %K health information %K health literacy %K online %K content %K validity %K reliability %K digital literacy %D 2022 %7 14.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of the internet to look for information about vaccines has skyrocketed in the last years, especially with the COVID-19 pandemic. Digital vaccine literacy (DVL) refers to understanding, trust, appraisal, and application of vaccine-related information online. Objective: This study aims to develop a tool measuring DVL and assess its psychometric properties. Methods: A 7-item online questionnaire was administered to 848 French adults. Different psychometric analyses were performed, including descriptive statistics, exploratory factor analysis, confirmatory factor analysis, and convergent and discriminant validity. Results: We developed the 7-item DVL scale composed of 3 factors (understanding and trust official information; understanding and trust information in social media; and appraisal of vaccine information online in terms of evaluation of the information and its application for decision making). The mean DVL score of the baseline sample of 848 participants was 19.5 (SD 2.8) with a range of 7-28. The median score was 20. Scores were significantly different by gender (P=.24), age (P=.03), studying or working in the field of health (P=.01), and receiving regular seasonal flu shots (P=.01). Conclusions: The DVL tool showed good psychometric proprieties, resulting in a promising measure of DVL. %M 36515982 %R 10.2196/39220 %U https://www.jmir.org/2022/12/e39220 %U https://doi.org/10.2196/39220 %U http://www.ncbi.nlm.nih.gov/pubmed/36515982 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e39947 %T Theoretical Approach and Scale Construction of Patient Privacy Protection Behavior of Doctors in Public Medical Institutions in China: Pilot Development Study %A Xu,Jie %A Lu,Lu %A Xing,Kaichen %A Shi,Huwei %A Chen,Ruiyao %A Yao,Yujun %A Liu,Sichen %A Xiao,Zhongzhou %A Peng,Xinwei %A Luo,Shuqing %A Zhong,Yun %+ Shanghai Artificial Intelligence Laboratory, West Bank International Artificial Intelligence Center, 701 Yunjin Road, Shanghai, 200030, China, 86 021 23537800, xujie@pjlab.org.cn %K scale %K Chinese public medical institutions %K doctors’ protection behavior of patients’ privacy %D 2022 %7 14.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Considering the high incidence of medical privacy disclosure, it is of vital importance to study doctors’ privacy protection behavior and its influencing factors. Objective: We aim to develop a scale for doctors’ protection of patients’ privacy in Chinese public medical institutions, following construction of a theoretical model framework through grounded theory, and subsequently to validate the scale to measure this protection behavior. Methods: Combined with the theoretical paradigm of protection motivation theory (PMT) and semistructured interview data, the grounded theory research method, followed by the Delphi expert and group discussion methods, a theoretical framework and initial scale for doctors in Chinese public medical institutions to protect patients' privacy was formed. The adjusted scale was collected online using a WeChat electronic survey measured using a 5-point Likert scale. Exploratory and confirmatory factor analysis (EFA and CFA) and tests to analyze reliability and validity were performed on the sample data. SPSS 19.0 and Amos 26.0 statistical analysis software were used for EFA and CFA of the sample data, respectively. Results: According to the internal logic of PMT, we developed a novel theoretical framework of a “storyline,” which was a process from being unaware of patients' privacy to having privacy protection behavior, that affected doctors' cognitive intermediary and changed the development of doctors' awareness, finally affecting actual privacy protection behavior in Chinese public medical institutions. Ultimately, we created a scale to measure 18 variables in the theoretical model, comprising 63 measurement items, with a total of 208 doctors participating in the scaling survey, who were predominantly educated to the master’s degree level (n=151, 72.6%). The department distribution was relatively balanced. Prior to EFA, the Kaiser-Meyer-Olkin (KMO) value was 0.702, indicating that the study was suitable for factor analysis. The minimum value of Cronbach α for each study variable was .754, which met the internal consistency requirements of the scale. The standard factor loading value of each potential measurement item in CFA had scores greater than 0.5, which signified that all the items in the scale could effectively converge to the corresponding potential variables. Conclusions: The theoretical framework and scale to assess doctors' patient protection behavior in public medical institutions in China fills a significant gap in the literature and can be used to further the current knowledge of physicians’ thought processes and adoption decisions. %M 36515996 %R 10.2196/39947 %U https://formative.jmir.org/2022/12/e39947 %U https://doi.org/10.2196/39947 %U http://www.ncbi.nlm.nih.gov/pubmed/36515996 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e42225 %T The Persian Version of the Mobile Application Rating Scale (MARS-Fa): Translation and Validation Study %A Barzegari,Saeed %A Sharifi Kia,Ali %A Bardus,Marco %A Stoyanov,Stoyan R %A GhaziSaeedi,Marjan %A Rafizadeh,Mouna %+ Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston campus, Edgbaston, B15 2TT, United Kingdom, 44 0121 414 3344, m.bardus@bham.ac.uk %K mobile application rating scale %K Farsi %K mobile apps %K validation %K smartphone addiction %K Persian %K Iran %K development %K mobile health %K mHealth %K scale %K validate %K reliability %K measurement tool %K assessment tool %D 2022 %7 5.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 110 million Farsi speakers worldwide have access to a growing mobile app market. Despite restrictions and international sanctions, Iran’s internal mobile health app market is growing, especially for Android-based apps. However, there is a need for guidelines for developing health apps that meet international quality standards. There are also no tools in Farsi that assess health app quality. Developers and researchers who operate in Farsi could benefit from such quality assessment tools to improve their outputs. Objective: This study aims to translate and culturally adapt the Mobile Application Rating Scale in Farsi (MARS-Fa). This study also evaluates the validity and reliability of the newly developed MARS-Fa tool. Methods: We used a well-established method to translate and back translate the MARS-Fa tool with a group of Iranian and international experts in Health Information Technology and Psychology. The final translated version of the tool was tested on a sample of 92 apps addressing smartphone addiction. Two trained reviewers completed an independent assessment of each app in Farsi and English. We reported reliability and construct validity estimates for the objective scales (engagement, functionality, aesthetics, and information quality). Reliability was based on the evaluation of intraclass correlation coefficients, Cronbach α and Spearman-Brown split-half reliability indicators (for internal consistency), as well as Pearson correlations for test-retest reliability. Construct validity included convergent and discriminant validity (through item-total correlations within the objective scales) and concurrent validity using Pearson correlations between the objective and subjective scores. Results: After completing the translation and cultural adaptation, the MARS-Fa tool was used to assess the selected apps for smartphone addiction. The MARS-Fa total scale showed good interrater reliability (intraclass correlation coefficient=0.83, 95% CI 0.74-0.89) and good internal consistency (Cronbach α=.84); Spearman-Brown split-half reliability for both raters was 0.79 to 0.93. The instrument showed excellent test-retest reliability (r=0.94). The correlations among the MARS-Fa subdomains and the total score were all significant and above r=0.40, suggesting good convergent and discriminant validity. The MARS-Fa was positively and significantly correlated with subjective quality (r=0.90, P<.001), and so were the objective subdomains of engagement (r=0.85, P<.001), information quality (r=0.80, P<.001), aesthetics (r=0.79, P<.001), and functionality (r=0.57, P<.001), indicating concurrent validity. Conclusions: The MARS-Fa is a reliable and valid instrument to assess mobile health apps. This instrument could be adopted by Farsi-speaking researchers and developers who want to evaluate the quality of mobile apps. While we tested the tool with a sample of apps addressing smartphone addiction, the MARS-Fa could assess other domains or issues since the Mobile App Rating Scale has been used to rate apps in different contexts and languages. %M 36469402 %R 10.2196/42225 %U https://formative.jmir.org/2022/12/e42225 %U https://doi.org/10.2196/42225 %U http://www.ncbi.nlm.nih.gov/pubmed/36469402 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e40082 %T The Agreement Between Virtual Patient and Unannounced Standardized Patient Assessments in Evaluating Primary Health Care Quality: Multicenter, Cross-sectional Pilot Study in 7 Provinces of China %A Zeng,Minrui %A Cai,Yiyuan %A Cao,Jin %A He,Qianyu %A Wang,Xiaohui %A Lu,Yun %A Liang,Huijuan %A Xu,Dong %A Liao,Jing %+ Department of Medical Statistics & Epidemiology, School of Public Health, Sun Yat-sen University, North Campus, No 74, 2nd Yat-Sen Road, Yuexiu District, Guangzhou, 510080, China, 86 13560339049, liaojing5@sysu.edu.cn %K virtual patient %K unannounced standardized patient %K primary health care %K primary care %K quality assessment %K quality improvement %K scenario %K simulation %K simulate %K medical education %K cross-sectional %K digital health %K eHealth %D 2022 %7 2.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The unannounced standardized patient (USP) is the gold standard for primary health care (PHC) quality assessment but has many restrictions associated with high human and resource costs. Virtual patient (VP) is a valid, low-cost software option for simulating clinical scenarios and is widely used in medical education. It is unclear whether VP can be used to assess the quality of PHC. Objective: This study aimed to examine the agreement between VP and USP assessments of PHC quality and to identify factors influencing the VP-USP agreement. Methods: Eleven matched VP and USP case designs were developed based on clinical guidelines and were implemented in a convenience sample of urban PHC facilities in the capital cities of the 7 study provinces. A total of 720 USP visits were conducted, during which on-duty PHC providers who met the inclusion criteria were randomly selected by the USPs. The same providers underwent a VP assessment using the same case condition at least a week later. The VP-USP agreement was measured by the concordance correlation coefficient (CCC) for continuity scores and the weighted κ for diagnoses. Multiple linear regression was used to identify factors influencing the VP-USP agreement. Results: Only 146 VP scores were matched with the corresponding USP scores. The CCC for medical history was 0.37 (95% CI 0.24-0.49); for physical examination, 0.27 (95% CI 0.12-0.42); for laboratory and imaging tests, –0.03 (95% CI –0.20 to 0.14); and for treatment, 0.22 (95% CI 0.07-0.37). The weighted κ for diagnosis was 0.32 (95% CI 0.13-0.52). The multiple linear regression model indicated that the VP tests were significantly influenced by the different case conditions and the city where the test took place. Conclusions: There was low agreement between VPs and USPs in PHC quality assessment. This may reflect the “know-do” gap. VP test results were also influenced by different case conditions, interactive design, and usability. Modifications to VPs and the reasons for the low VP-USP agreement require further study. %M 36459416 %R 10.2196/40082 %U https://www.jmir.org/2022/12/e40082 %U https://doi.org/10.2196/40082 %U http://www.ncbi.nlm.nih.gov/pubmed/36459416 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e29130 %T Job Disengagement Among Physical Education Teachers: Insights From a Cross-sectional Web-Based Survey With Path Modeling Analysis %A Chalghaf,Nasr %A Chen,Wen %A Tannoubi,Amayra %A Guelmami,Noomen %A Puce,Luca %A Ben Said,Noureddine %A Ben Khalifa,Maher %A Azaiez,Fairouz %A Bragazzi,Nicola Luigi %+ Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100 ext 66093, bragazzi@yorku.ca %K Work Disengagement Scale %K work %K job %K job satisfaction %K family–work conflict %K perceived stress %K physical education %K PLS-SEM %K SmartPLS %K teacher %K engagement %K Arab %K stress %K primary school %K secondary school %K development %K measurement %K scale %K tool %K fitness %K teacher %K educator %K school %K satisfaction %K digital tool %K mental health %K family %K cross-sectional %K survey %K modelling %K psychology %D 2022 %7 1.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical education teachers often experience stress and job disengagement. Objective: This study’s aims were as follows: (1) to adapt in the Arabic language and test the reliability and the validity of the work–family conflict (WFC) and family–work conflict (FWC) scales, (2) to develop and assess the psychometric properties of work disengagement among physical education teachers, and (3) to evaluate an explanatory model by presenting the mediating role of perceived stress as a major influencing factor in work disengagement and job satisfaction. Methods: A total of 303 primary and secondary school physical education teachers, comprising 165 (54.5%) men and 138 (45.5%) women participated voluntarily in our study. The measuring instruments are the Work Disengagement Scale, the Perceived Stress Scale, the WFC scale, the FWC scale, and the 9-item Teacher of Physical Education Job Satisfaction Inventory. Results: The Arabic language versions of the WFC and FWC scales had reasonably adequate psychometric properties, which were justified by confirmatory factor analyses and by the measurement of reliability, convergent, and discriminant validity through the measurement model using SmartPLS software. Similarly, the structural model established with SmartPLS confirmed strong links of the concepts of FWC, WFC, the job satisfaction questionnaire, and perceived stress with work disengagement among teachers of physical education. Conclusions: There is a growing interest in helping teachers cope with the daily pressures of work and family. A positive organizational context is a context with clear values regarding work priorities, which constitutes the basis of a feeling of shared responsibility and professional support. Good conditions can act as protective factors reducing work stress and positively influencing personal well-being, work attitudes, work commitment, and professional efficiency. Additional research on teachers is needed to examine the relationship between perceived work stress and the role of families, along with the extent to which this association can have a significant impact on teachers’ commitment to work. %M 36084318 %R 10.2196/29130 %U https://formative.jmir.org/2022/12/e29130 %U https://doi.org/10.2196/29130 %U http://www.ncbi.nlm.nih.gov/pubmed/36084318 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e38347 %T Measuring the Digital Skills of Catalan Health Care Professionals as a Key Step Toward a Strategic Training Plan: Digital Competence Test Validation Study %A Reixach,Elisenda %A Andrés,Erik %A Sallent Ribes,Josuè %A Gea-Sánchez,Montserrat %A Àvila López,Alícia %A Cruañas,Bea %A González Abad,Anna %A Faura,Ricard %A Guitert,Montse %A Romeu,Teresa %A Hernández-Encuentra,Eulàlia %A Bravo-Ramirez,Sandra %A Saigí-Rubió,Francesc %+ Faculty of Health Sciences, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, Barcelona, 08018, Spain, 34 933 263 622, fsaigi@uoc.edu %K digital health %K eHealth %K digital competences %K digital literacy %K information and communication technology %K ICT %K training %D 2022 %7 30.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite Catalonia being an advanced region in terms of digital health adoption, the “Forum for Professional Dialogue” identified the need to improve information and communication technology (ICT) competences as one of the present and future challenges for health care professionals (HPs). Objective: We aimed to validate the digital competence test developed ad hoc for this study and to measure the digital competence level of Catalan HPs to establish their current level as the baseline for designing a strategic training plan. Methods: An exploratory observational study was conducted based on a voluntary survey where sociodemographic, professional and digital tool knowledge, digital tool use, and training needs data were collected and based on the score obtained from a digital competence test developed ad hoc. The digital competence test consisted of 2 “real-life scenarios” with 7 and 11 questions. Results: In total, 803 HPs, of whom 612 (76.2%) were women, completed the survey between June 28 and July 16, 2021. Most participants self-rated their digital competence level as either intermediate (384/803, 47.8%) or basic (357/803, 44.5%). The mean score in the digital competence test was 22.6 (SD 4.3). Therefore, most participants displayed a basic level of digital competence. The internal consistency of the digital competence test was 0.66, and the discrimination index of all questions was ≥0.2 for all items except for 1 question. Conclusions: This exploratory study highlights the need to improve the digital competence of HPs working in Catalonia, with special effort being made to provide training according to the specific needs of the different HP profiles. The results have informed the Health Plan for Catalonia 2021-2025 and lay the foundations for the development and deployment of a framework program for the digital competences of HPs. The developed digital competence test shows acceptable consistency for the objective pursued, although improvements are needed to fine-tune its accuracy. %M 36449330 %R 10.2196/38347 %U https://www.jmir.org/2022/11/e38347 %U https://doi.org/10.2196/38347 %U http://www.ncbi.nlm.nih.gov/pubmed/36449330 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e38108 %T Psychometric Properties of the Chinese Warwick-Edinburgh Mental Well-being Scale in Medical Staff: Cross-sectional Study %A Dong,Aishu %A Huang,Jing %A Lin,Shudan %A Zhu,Jianing %A Zhou,Haitao %A Jin,Qianqian %A Zhao,Wei %A Zhu,Lianlian %A Guo,Wenjian %+ Oncology Department, Second Affiliated Hospital of Wenzhou Medical University, College West Road 109, 0577, Whenzhou, 325000, China, 86 13957729220, guowenjian@wmu.edu.cn %K psychometric property %K Chinese Warwick-Edinburgh Mental Well-being Scale %K classical test theory %K well-being %K item response theory %K medical staff %K China %D 2022 %7 30.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Worldwide, mental well-being is a critical issue for public health, especially among medical staff; it affects professionalism, efficiency, quality of care delivery, and overall quality of life. Nevertheless, assessing mental well-being is a complex problem. Objective: This study aimed to evaluate the psychometric properties of the Chinese-language version of the 14-item Warwick-Edinburgh Mental Well-being Scale (WEMWBS) in medical staff recruited mainly from 6 hospitals in China and provide a reliable measurement of positive mental well-being. Methods: A cross-sectional online survey was conducted of medical staff from 15 provinces in China from May 15 to July 15, 2020. Confirmatory factor analysis (CFA) was conducted to test the structure of the Chinese WEMWBS. The Spearman correlations of the Chinese WEMWBS with the 5-item World Health Organization Well-Being Index (WHO-5) were used to evaluate convergent validity. The Cronbach α and split-half reliability (λ) represented internal consistency. A graded response model was adopted for an item response theory (IRT) analysis. We report discrimination, difficulty, item characteristic curves (ICCs), and item information curves (IICs). ICCs and IICs were used to estimate reliability and validity based on the IRT analysis. Results: A total of 572 participants from 15 provinces in China finished the Chinese WEMWBS. The CFA showed that the 1D model was satisfactory and internal consistency reliability was excellent, with α=.965 and λ=0.947, while the item-scale correlation coefficients ranged from r=0.727 to r=0.900. The correlation coefficient between the Chinese WEMWBS and the WHO-5 was significant, at r=0.746. The average variance extraction value was 0.656, and the composite reliability value was 0.964, with good aggregation validity. The discrimination of the Chinese WEMWBS items ranged from 2.026 to 5.098. The ICCs illustrated that the orders of the category thresholds for the 14 items were satisfactory. Conclusions: The Chinese WEMWBS showed good psychometric properties and can measure well-being in medical staff. %M 36449336 %R 10.2196/38108 %U https://www.jmir.org/2022/11/e38108 %U https://doi.org/10.2196/38108 %U http://www.ncbi.nlm.nih.gov/pubmed/36449336 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e42341 %T Identifying Risk Factors, Patient-Reported Experience and Outcome Measures, and Data Capture Tools for an Individualized Pain Prediction Tool in Pediatrics: Focus Group Study %A Wood,Michael D %A West,Nicholas C %A Sreepada,Rama S %A Loftsgard,Kent C %A Petersen,Luba %A Robillard,Julie M %A Page,Patricia %A Ridgway,Randa %A Chadha,Neil K %A Portales-Casamar,Elodie %A Görges,Matthias %A , %+ BC Children’s Hospital Research Institute, V3-317, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada, 1 604 875 2000 ext 6920, michael.wood@bcchr.ca %K patient-oriented research %K patient-reported outcome measures %K patient-reported experience measures %K risk prediction %K pain %K individualized risk %K surgery %K anesthesia %K focus groups %K thematic analysis %K perioperative %K participatory medicine %K digital health tool %K postsurgical pain %K children %K opioid use %K virtual focus group %K postoperative %K pediatrics %K risk prediction %K health outcome %D 2022 %7 15.11.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: The perioperative period is a data-rich environment with potential for innovation through digital health tools and predictive analytics to optimize patients’ health with targeted prehabilitation. Although some risk factors for postoperative pain following pediatric surgery are already known, the systematic use of preoperative information to guide personalized interventions is not yet widespread in clinical practice. Objective: Our long-term goal is to reduce the incidence of persistent postsurgical pain (PPSP) and long-term opioid use in children by developing personalized pain risk prediction models that can guide clinicians and families to identify targeted prehabilitation strategies. To develop such a system, our first objective was to identify risk factors, outcomes, and relevant experience measures, as well as data collection tools, for a future data collection and risk modeling study. Methods: This study used a patient-oriented research methodology, leveraging parental/caregiver and clinician expertise. We conducted virtual focus groups with participants recruited at a tertiary pediatric hospital; each session lasted approximately 1 hour and was composed of clinicians or family members (people with lived surgical experience and parents of children who had recently undergone a procedure requiring general anesthesia) or both. Data were analyzed thematically to identify potential risk factors for pain, as well as relevant patient-reported experience and outcome measures (PREMs and PROMs, respectively) that can be used to evaluate the progress of postoperative recovery at home. This guidance was combined with a targeted literature review to select tools to collect risk factor and outcome information for implementation in a future study. Results: In total, 22 participants (n=12, 55%, clinicians and n=10, 45%, family members) attended 10 focus group sessions; participants included 12 (55%) of 22 persons identifying as female, and 12 (55%) were under 50 years of age. Thematic analysis identified 5 key domains: (1) demographic risk factors, including both child and family characteristics; (2) psychosocial risk factors, including anxiety, depression, and medical phobias; (3) clinical risk factors, including length of hospital stay, procedure type, medications, and pre-existing conditions; (4) PREMs, including patient and family satisfaction with care; and (5) PROMs, including nausea and vomiting, functional recovery, and return to normal activities of daily living. Participants further suggested desirable functional requirements, including use of standardized and validated tools, and longitudinal data collection, as well as delivery modes, including electronic, parent proxy, and self-reporting, that can be used to capture these metrics, both in the hospital and following discharge. Established PREM/PROM questionnaires, pain-catastrophizing scales (PCSs), and substance use questionnaires for adolescents were subsequently selected for our proposed data collection platform. Conclusions: This study established 5 key data domains for identifying pain risk factors and evaluating postoperative recovery at home, as well as the functional requirements and delivery modes of selected tools with which to capture these metrics both in the hospital and after discharge. These tools have been implemented to generate data for the development of personalized pain risk prediction models. %M 36378509 %R 10.2196/42341 %U https://periop.jmir.org/2022/1/e42341 %U https://doi.org/10.2196/42341 %U http://www.ncbi.nlm.nih.gov/pubmed/36378509 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e35933 %T A Short Digital Food Frequency Questionnaire (DIGIKOST-FFQ) Assessing Dietary Intake and Other Lifestyle Factors Among Norwegians: Qualitative Evaluation With Focus Group Interviews and Usability Testing %A Henriksen,Hege Berg %A Knudsen,Markus Dines %A Carlsen,Monica Hauger %A Hjartåker,Anette %A Blomhoff,Rune %+ Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Sognsvannsveien 9, Oslo, 0372, Norway, 47 99459673, h.b.henriksen@medisin.uio.no %K digital assessment tool %K assessment tool %K food frequency questionnaire %K food %K diet %K nutrition %K questionnaire %K focus group %K interview %K usability %K physical activity %K lifestyle factor %K dietary intake %K digital health %K chronic disease %K chronic condition %K health promotion %K cancer %K survivor %K usability %K thematic analysis %K research tool %K measurement tool %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In-person dietary counseling and interventions have shown promising results in changing habits toward healthier lifestyles, but they are costly to implement in large populations. Developing digital tools to assess individual dietary intake and lifestyle with integrated personalized feedback systems may help overcome this challenge. We developed a short digital food frequency questionnaire, known as the DIGIKOST-FFQ, to assess diet and other lifestyle factors based on the Norwegian Food-Based Dietary Guidelines. The DIGIKOST-FFQ includes a personalized feedback system, the DIGIKOST report, that benchmarks diet and lifestyle habits. We used qualitative focus group interviews and usability tests to test the feasibility and usability of the DIGIKOST application. Objective: We aimed to explore attitudes, perceptions, and challenges in completing the DIGIKOST-FFQ. We also investigated perceptions and understanding of the personalized feedback in the DIGIKOST report and the technical flow and usability of the DIGIKOST-FFQ and the DIGIKOST report. Methods: Healthy individuals and cancer survivors were invited to participate in the focus group interviews. The transcripts were analyzed using thematic analysis. Another group of healthy individuals completed the usability testing, which was administered individually by a moderator and 2 observers. The results were analyzed based on predefined assignments and discussion with the participants about the interpretation of the DIGIKOST report and technical flow of the DIGIKOST-FFQ. Results: A total of 20 individuals participated in the focus group interviews, divided into 3 groups of healthy individuals and 3 groups of cancer survivors. Each group consisted of 3 to 4 individuals. Five main themes were investigated: (1) completion time (on average 19.1, SD 8.3, minutes, an acceptable duration), (2) layout (participants reported the DIGIKOST-FFQ was easy to navigate and had clear questions but presented challenges in reporting dietary intake, sedentary time, and physical activity in the last year), (3) questions (the introductory questions on habitual intake worked well), (4) pictures (the pictures were very helpful, but some portion sizes were difficult to differentiate and adding weight in grams would have been helpful), and (5) motivation (users were motivated to obtain personalized feedback). Four individuals participated in the usability testing. The results showed that the users could seamlessly log in, give consent, fill in the DIGIKOST-FFQ, and receive, print, and read the DIGIKOST report. However, parts of the report were perceived as difficult to interpret. Conclusions: The DIGIKOST-FFQ was overall well received by participants, who found it feasible to use; however, some adjustments with regard to reporting dietary intake and lifestyle habits were suggested. The DIGIKOST report with personalized feedback was the main motivation to complete the questionnaire. The results from the usability testing revealed a need for adjustments and updates to make the report easier to read. %M 36346647 %R 10.2196/35933 %U https://formative.jmir.org/2022/11/e35933 %U https://doi.org/10.2196/35933 %U http://www.ncbi.nlm.nih.gov/pubmed/36346647 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e39921 %T Relationships and Sex Education Outcomes for Students With Intellectual Disability: Protocol for the Development of a Core Outcome Set %A Paulauskaite,Laura %A Totsika,Vasiliki %A Rivas,Carol %+ Social Research Institute, University College London, 18 Woburn Square, London, WC1H 0NR, United Kingdom, 44 02031086620, laura.paulauskaite.16@ucl.ac.uk %K core outcome set %K relationships and sex education %K intellectual disability %K students %D 2022 %7 7.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: People with intellectual disability are twice as likely to experience sexual abuse, unintended pregnancies, and sexually transmitted diseases as people in the general population. Despite this, very little is known about how to deliver relationships and sex education effectively to this vulnerable population, how to measure the impact of its delivery in schools, and what stakeholders perceive as important outcomes of this education. Objective: To address these urgent issues, this study aims to develop a stakeholder consensus–based core outcome set of relationships and sex education for use in research and educational settings with students with intellectual disability. Methods: The study will use a 2-stage mixed methods design. The first stage will involve a systematic review of relationships and sex education outcomes reported in the literature, followed by qualitative exploration with caregivers, teachers and school staff, policy makers, and researchers to investigate their perspectives of meaningful outcomes of this education. Students with intellectual disability will be enabled to take part to express their views on outcomes of importance to them. The second stage will use findings from stage 1 in a 2-round web-based Delphi study with caregivers, teachers and school staff, policy makers, and researchers to develop consensus on proposed outcomes for the evaluation of relationships and sex education with this population. Results: As of September 2022, we have completed a systematic review and recruited 56 stakeholders (n=53, 95%, adults and n=3, 5%, students with intellectual disability) for the first stage of the study. We are still recruiting students with intellectual disability. Data analysis has not started yet. Recruitment for the second stage will commence in November 2022. We expect to complete the study by October 2023 and publish the results by the end of 2024. Conclusions: The development of a core outcome set of relationships and sex education will provide a significant first step to assist the implementation, delivery, evaluation, and sustainability of relationships and sex education for students with intellectual disability. Key audiences will be teachers, researchers, policy makers, and decision makers. Trial Registration: Core Outcome Measures in Effectiveness Trials 1787; https://www.comet-initiative.org/Studies/Details/1787 International Registered Report Identifier (IRRID): PRR1-10.2196/39921 %M 36342756 %R 10.2196/39921 %U https://www.researchprotocols.org/2022/11/e39921 %U https://doi.org/10.2196/39921 %U http://www.ncbi.nlm.nih.gov/pubmed/36342756 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e40316 %T A Digital Smartphone-Based Self-administered Tool (R+ Dietitian) for Nutritional Risk Screening and Dietary Assessment in Hospitalized Patients With Cancer: Evaluation and Diagnostic Accuracy Study %A Long,Zhiwen %A Huang,Shan %A Zhang,Jie %A Zhang,Deng %A Yin,Jun %A He,Chengyuan %A Zhang,Qinqiu %A Xu,Huilin %A He,Huimin %A Sun,Ho Ching %A Xie,Ke %+ Department of Oncology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Number 32, West 2nd Section, First Ring Road, Qingyang District, Chengdu, 610072, China, 86 18981838382, xieke@med.uestc.edu.cn %K digital tool %K nutritional risk screening %K dietary assessment %K validity %K cancer patients %D 2022 %7 26.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Malnutrition is a common and severe problem in patients with cancer that directly increases the incidence of complications and significantly deteriorates quality of life. Nutritional risk screening and dietary assessment are critical because they are the basis for providing personalized nutritional support. No digital smartphone-based self-administered tool for nutritional risk screening and dietary assessment among hospitalized patients with cancer has been developed and evaluated. Objective: This study aims to develop a digital smartphone-based self-administered mini program for nutritional risk screening and dietary assessment for hospitalized patients with cancer and to evaluate the validity of the mini program. Methods: We have developed the R+ Dietitian mini program, which consists of 3 parts: (1) collection of basic information of patients, (2) nutritional risk screening, and (3) dietary energy and protein assessment. The face-to-face paper-based Nutritional Risk Screening (NRS-2002), the Patient-Generated Subjective Global Assessment Short Form (PG-SGA-SF), and 3 days of 24-hour dietary recall (3d-24HRs) questionnaires were administered according to standard procedure by 2 trained dietitians as the reference methods. Sensitivity, specificity, positive predictive value, negative predictive value, κ value, and correlation coefficients (CCs) of nutritional risk screened in R+ Dietitian against the reference methods, as well as the difference and CCs of estimated dietary energy and protein intakes between R+ Dietitian and 3d-24HRs were calculated to evaluate the validity of R+ Dietitian. Results: A total of 244 hospitalized patients with cancer were recruited to evaluate the validity of R+ Dietitian. The NRS-2002 and PG-SGA-SF tools in R+ Dietitian showed high accuracy, sensitivity, and specificity (77.5%, 81.0%, and 76.7% and 69.3%, 84.5%, and 64.5%, respectively), and fair agreement (κ=0.42 and 0.37, respectively; CC 0.62 and 0.56, respectively) with the NRS-2002 and PG-SGA-SF tools administered by dietitians. The estimated intakes of dietary energy and protein were significantly higher (P<.001 for both) in R+ Dietitian (mean difference of energy intake: 144.2 kcal, SD 454.8; median difference of protein intake: 10.7 g, IQR 9.5-39.8), and showed fair agreement (CC 0.59 and 0.47, respectively), compared with 3d-24HRs performed by dietitians. Conclusions: The identified nutritional risk and assessment of dietary intakes of energy and protein in R+ Dietitian displayed a fair agreement with the screening and assessment conducted by dietitians. R+ Dietitian has the potential to be a tool for nutritional risk screening and dietary intake assessment among hospitalized patients with cancer. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900026324; https://www.chictr.org.cn/showprojen.aspx?proj=41528 %M 36287601 %R 10.2196/40316 %U https://formative.jmir.org/2022/10/e40316 %U https://doi.org/10.2196/40316 %U http://www.ncbi.nlm.nih.gov/pubmed/36287601 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e37385 %T The Development and Evaluation of “Life Age”—a Primary Prevention and Population-Focused Risk Communication Tool: Feasibility Study With a Single-Arm Repeated Measures Design %A Olusan,Adeogo Akinwale %A Barr,Suzanne %A Cobain,Mark %A Whelan,Holly %+ Department of Cardiology, Belfast Health and Social Care (HSC) Trust, 274 Grosvenor Road,, Belfast, BT12 6BA, United Kingdom, 44 7423161441, aakinwale@yahoo.co.uk %K Life Age %K Heart Age %K cardiovascular risk %K lifestyle change %K psychosocial well-being %K population focused risk communication tool %K health promotion %K risk perception %K premature mortality %K risk communication %D 2022 %7 24.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Communicating cardiovascular risk to the general population requires forms of communication that can enhance risk perception and stimulate lifestyle changes associated with reduced cardiovascular risk. Objective: The aim of this study was to evaluate the motivational potential of a novel lifestyle risk assessment (“Life Age”) based on factors predictive of both premature mortality and psychosocial well-being. Methods: A feasibility study with a single-arm repeated measures design was conducted to evaluate the potential efficacy of Life Age on motivating lifestyle changes. Participants were recruited via social media, completed a web-based version of the Life Age questionnaire at baseline and at follow-up (8 weeks), and received 23 e-newsletters based on their Life Age results along with a mobile tracker. Participants’ estimated Life Age scores were analyzed for evidence of lifestyle changes made. Quantitative feedback of participants was also assessed. Results: In total, 18 of 27 participants completed the two Life Age tests. The median baseline Life Age was 1 year older than chronological age, which was reduced to –1.9 years at follow-up, representing an improvement of 2.9 years (P=.02). There were also accompanying improvements in Mediterranean diet score (P=.001), life satisfaction (P=.003), and sleep (P=.05). Quantitative feedback assessment indicated that the Life Age tool was easy to understand, helpful, and motivating. Conclusions: This study demonstrated the potential benefit of a novel Life Age tool in generating a broad set of lifestyle changes known to be associated with clinical risk factors, similar to “Heart Age.” This was achieved without the recourse to expensive biomarker tests. However, the results from this study suggest that the motivated lifestyle changes improved both healthy lifestyle risks and psychosocial well-being, consistent with the approach of Life Age in merging the importance of a healthy lifestyle and psychosocial well-being. Further evaluation using a larger randomized controlled trial is required to fully evaluate the impact of the Life Age tool on lifestyle changes, cardiovascular disease prevention, and overall psychosocial well-being. %M 36279163 %R 10.2196/37385 %U https://formative.jmir.org/2022/10/e37385 %U https://doi.org/10.2196/37385 %U http://www.ncbi.nlm.nih.gov/pubmed/36279163 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e37449 %T Measuring and Enhancing Initial Parent Engagement in Parenting Education: Experiment and Psychometric Analysis %A Mirzadegan,Isaac A %A Blanton,Amelia C %A Meyer,Alexandria %+ Department of Psychology, Florida State University, 1107 W Call Street, Tallahassee, FL, 32306-4301, United States, 1 (850) 644 2040, mirzadegan@gmail.com %K parental engagement %K parenting intervention %K parenting education %K intent to enroll %K measure development %D 2022 %7 30.9.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Prevention efforts focused on parenting can prevent and reduce the rates of child internalizing and externalizing problems, and positive changes in parenting skills have been shown to mediate improvements in child behavioral problems. However, parent skills training programs remain underused, with estimates that under half of eligible parents complete treatment and even lower rates engage in preventive interventions. Moreover, there is no validated measure to assess initial engagement in parent education or skills training, which is an understudied stage of parent engagement. Objective: We aimed to test a novel engagement strategy, exploring whether including information pertaining to the neuroscience of child development and parent skills training enhanced parental intent to enroll. In addition, a novel self-report measure, the 18-item Parenting Resources Acceptability Measure (PRAM), was developed and validated. Methods: In a group of 166 parents of children aged 5 to 12 years, using an engagement strategy based on the Seductive Allure of Neuroscience Explanations, we conducted a web-based experiment to assess whether the inclusion of neuroscience information related to higher levels of engagement via self-report and behavioral measures. The PRAM was subjected to an exploratory factor analysis and examined against relevant validity measures and acceptability measurement criteria. Results: Three PRAM factors emerged (“Acceptability of Parenting Resources,” “Interest in Learning Parenting Strategies,” and “Acceptability of Parenting Websites”), which explained 68.4% of the total variance. Internal consistency among the factors and the total score ranged from good to excellent. The PRAM was correlated with other relevant measures (Parental Locus of Control, Parenting Sense of Competence, Strengths and Difficulties Questionnaire, Parent Engagement in Evidence-Based Services, and behavioral outcomes) and demonstrated good criterion validity and responsiveness. Regarding the engagement manipulation, parents who did not receive the neuroscience explanation self-reported lower interest in learning new parenting skills after watching an informational video compared with parents who did receive a neuroscience explanation. However, there were no significant differences between conditions in behavioral measures of intent to enroll, including the number of mouse clicks, amount of time spent on a page of parenting resources, and requests to receive parenting resources. The effects did not persist at the 1-month follow-up, suggesting that the effects on engagement may be time-limited. Conclusions: The findings provide preliminary evidence for the utility of theory-driven strategies to enhance initial parental engagement in parent skills training, specifically parental interest in learning new parenting skills. In addition, the study findings demonstrate the good initial psychometric properties of the PRAM, a tool to assess parental intent to enroll, which is an early stage of engagement. %M 36178725 %R 10.2196/37449 %U https://pediatrics.jmir.org/2022/3/e37449 %U https://doi.org/10.2196/37449 %U http://www.ncbi.nlm.nih.gov/pubmed/36178725 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 9 %P e39482 %T Transcultural Adaptation of and Theoretical Validation Models for the Spanish Version of the Nurses’ Global Assessment of Suicide Risk Scale: Protocol for a Multicenter Cross-sectional Study %A Garrote-Cámara,Maria Elena %A Juárez-Vela,Raúl %A Sufrate-Sorzano,Teresa %A Durante,Angela %A Ferrara,Paolo %A Terzoni,Stefano %A Pérez,Jesús %A Santolalla-Arnedo,Iván %+ Department of Nursing, Research Group in Care, University of La Rioja, Avenida de la Paz 93-103, Logroño, 26004, Spain, 34 941299000, raul.juarez@unirioja.es %K mental health %K suicide %K psychiatric nursing %K Spanish %K translate %K translation %K scale %K measurement %K assessment %K adapt %K adaptation %K cultural %K transcultural %K suicidal %K nurse %K nursing %K psychiatric %K public health %K prevention %K treatment %K risk %K development %K lethal %K patient %K scientific literature %K variables %K reliability %K validate %K validity %K tool %K Nurse´s Global Assessment of Suicide Risk %K psychometric %D 2022 %7 21.9.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The use of validated instruments means providing health professionals with reliable and valid tools. The Nurses’ Global Assessment of Suicide Risk (NGASR) scale has proven to be valid and reliable in supporting the nursing evaluation of suicide risk in different languages and cultural environments. Objective: The aims of our study are to translate and adapt the NGASR scale for the Spanish population and evaluate its psychometric properties in patients with suicide risk factors. Methods: The translation, adaptation, and modeling of the tool will be performed. The sample will include 165 participants. The psychometric analysis will include reliability and validity tests of the tool’s internal structure. The tool’s reliability will be assessed by exploring internal consistency and calculating the Cronbach α coefficient; significance values of .70 or higher will be accepted as indicators of good internal consistency. The underlying factor structure of the Spanish version of the NGASR scale will be assessed by performing an exploratory factor analysis. The Kaiser-Meyer-Olkin measure of sample adequacy and the Bartlett sphericity statistic will be calculated beforehand. For the latter, if P is <.05 for the null hypothesis of sphericity, the null hypothesis will be rejected. Results: Participants will be recruited between April 2022 and December 2022. Our study is expected to conclude in the first quarter of 2023. Conclusions: We hope to find the same firmness that colleagues have found in other countries in order to consolidate and promote the use of the NGASR tool in the Spanish population. The prevention and treatment of suicidal behavior require holistic, multidisciplinary, and comprehensive management. International Registered Report Identifier (IRRID): PRR1-10.2196/39482 %M 3612975 %R 10.2196/39482 %U https://www.researchprotocols.org/2022/9/e39482 %U https://doi.org/10.2196/39482 %U http://www.ncbi.nlm.nih.gov/pubmed/3612975 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e37337 %T Development of Principles for Health-Related Information on Social Media: Delphi Study %A Denniss,Emily %A Lindberg,Rebecca %A McNaughton,Sarah A %+ Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, 221 Burwood Hwy, Melbourne, 3125, Australia, 61 3 924 68761, e.denniss@deakin.edu.au %K social media %K health information %K information quality %K quality assessment %K research tool %K credibility indicator %K credibility %K credible %K eHealth %K Delphi %K social media %K assessment tool %K measurement tool %K web-based information %K mobile phone %D 2022 %7 8.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Health-related misinformation can be propagated via social media and is a threat to public health. Several quality assessment tools and principles to evaluate health-related information in the public domain exist; however, these were not designed specifically for social media. Objective: This study aims to develop Principles for Health-related Information on Social Media (PRHISM), which can be used to evaluate the quality of health-related social media content. Methods: A modified Delphi approach was used to obtain expert consensus on the principles and functions of PRHISM. Health and social media experts were recruited via Twitter, email, and snowballing. A total of 3 surveys were administered between February 2021 and May 2021. The first survey was informed by a literature review and included open-ended questions and items from existing quality assessment tools. Subsequent surveys were informed by the results of the proceeding survey. Consensus was deemed if ≥80% agreement was reached, and items with consensus were considered relevant to include in PRHISM. After the third survey, principles were finalized, and an instruction manual and scoring tool for PRHISM were developed and circulated to expert participants for final feedback. Results: A total of 34 experts consented to participate, of whom 18 (53%) responded to all 3 Delphi surveys. In total, 13 principles were considered relevant and were included in PRHISM. When the instructions and PRHISM scoring tool were circulated, no objections to the wording of the final principles were received. Conclusions: A total of 13 quality principles were included in the PRHISM tool, along with a scoring system and implementation tool. The principles promote accessibility, transparency, provision of authoritative and evidence-based information and support for consumers’ relationships with health care providers. PRHISM can be used to evaluate the quality of health-related information provided on social media. These principles may also be useful to content creators for developing high-quality health-related social media content and assist consumers in discerning high- and low-quality information. %M 36074544 %R 10.2196/37337 %U https://www.jmir.org/2022/9/e37337 %U https://doi.org/10.2196/37337 %U http://www.ncbi.nlm.nih.gov/pubmed/36074544 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 9 %P e34675 %T Psychometric Properties of the COVID-19 Pandemic Fatigue Scale: Cross-sectional Online Survey Study %A Rodriguez-Blazquez,Carmen %A Romay-Barja,Maria %A Falcon,Maria %A Ayala,Alba %A Forjaz,Maria João %+ School of Medicine, University of Murcia, Campus de Espinardo, Murcia, 31000, Spain, 34 868887583, falcon@um.es %K COVID-19 %K pandemic fatigue %K psychometric properties %K Rasch analysis %K validation %K online survey %K pandemic %K fatigue %K mental health %K information seeking %K health information %D 2022 %7 8.9.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Pandemic fatigue is defined as feelings of demotivation to follow preventive measures against COVID-19, together with decreased trust in government and frequency of information-seeking behaviors. Objective: This study aims to analyze the psychometric properties of the COVID-19–specific pandemic fatigue scale according to classical test theory (CTT) and Rasch model approaches in the general Spanish population. Methods: This was a cross-sectional study in a representative sample of 1018 adults who completed an online survey in November 2020 in the framework of the COVID-19 Snapshot Monitoring (COSMO)-Spain project. The assessments included the 6-item COVID-19 Pandemic Fatigue Scale (CPFS) and other COVID-19–related variables: COVID-19 infection, adherence to preventive behaviors, information-seeking behavior, self-efficacy, worry, and cognitive and affective risk perception. Data quality, acceptability, reliability, and validity were analyzed according to CTT, and the fit to the Rasch model, unidimensionality, appropriateness of the response scale, item local independency, reliability (person-separation index [PSI]), and item-person distribution were also calculated. Results: The mean CPFS score was 17.06 (SD 5.04, range 6-30), with higher scores for women, younger participants, participants who never seek information on COVID-19, those who think they would contract a mild disease in case of infection, those with higher level of worry about coronavirus/COVID-19, and those who felt depressed or felt the coronavirus/COVID-19 is spreading slowly (all P<.01). The Cronbach alpha for the CPFS was 0.74. In the confirmatory factor analysis, one factor was identified (root mean square error of approximation [RMSEA]=.02; comparative fit index [CFI]=.99; χ25=8.06, P=.15). The CPFS showed good fit to the Rasch model (χ 224=42.025, P=.01, PSI=.642), unidimensionality (binomial 95% CI –.005 to .045), and item local independency. Conclusions: Our results suggest that the CPFS has moderate reliability and internal consistency and it is composed of a single dimension. It is a useful tool to ascertain the level of pandemic fatigue in the general population, which may help to guide the communication and information strategies to face the COVID-19 pandemic. %M 35785547 %R 10.2196/34675 %U https://publichealth.jmir.org/2022/9/e34675 %U https://doi.org/10.2196/34675 %U http://www.ncbi.nlm.nih.gov/pubmed/35785547 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e36777 %T Translation and Validation Study of the French Version of the eHealth Literacy Scale: Web-Based Survey on a Student Population %A Chaniaud,Noémie %A Sagnier,Camille %A Loup-Escande,Emilie %+ Centre de Recherche en Psychologie : Cognition, Psychisme, Organisations (UR 7273), Université de Picardie Jules Verne, Chemin du Thil, Amiens, 80 000, France, 33 3 22 82 70 59, noemie.chaniaud@gmail.com %K eHealth Literacy Scale %K eHEALS %K eHealth literacy %K transcultural validation process %K Health Literacy Survey–Europe %K HLS-EU %D 2022 %7 31.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: eHealth literacy is emerging as a crucial concept for promoting patient self-management in an overloaded hospital system. However, to the best of our knowledge, no tool currently exists to measure the level of eHealth literacy among French-speaking people. The eHealth Literacy Scale (eHEALS) is an easy-to-administer 8-item questionnaire (5-point Likert scale, ranging from strongly disagree to strongly agree) that has already been translated into many languages. Currently, it is the most cited questionnaire in the literature. Objective: The aim of this study was to translate eHEALS to French and validate the French version of eHEALS (F-eHEALS). Methods: The validation of the F-eHEALS scale followed the 5 steps of the transcultural validation method: double reverse translation, validation by a committee of experts (n=4), pretest measurement to check the clarity of the items (n=22), administration of the scale in French via a web-based quantitative study combined with two other questionnaires (Health Literacy Survey-Europe–16 and Patient Activation Measure–13; N=328 students), and finally test-retest (n=78) to check the temporal stability of the measurements obtained from the scale. Results: The results obtained for the measurement of factor structure, internal consistency, and temporal stability (intraclass correlation coefficient=0.84; 95% CI 0.76-0.9; F77,77=6.416; P<.001) prove the validity and fidelity of the proposed scale. The internal consistency of F-eHEALS was estimated by Cronbach α of .89. The factor analysis with varimax rotation used to validate the construct showed a 2-factor scale. The effect of the construct was analyzed using 3 hypotheses related to the theory. The F-eHEALS score was correlated with the Health Literacy Survey-Europe–16 score (r=0.34; P<.001) and the Patient Activation Measure–13 score (r=0.31; P<.001). Conclusions: F-eHEALS is consistent with the original version. It presents adequate levels of validity and fidelity. This 2D scale will need to be generalized to other populations in a French-speaking context. Finally, a version taking into account collaborative applications (ie, Health 2.0; eg, Digital Health Literacy Instrument scale) should be considered on the basis of this study. %M 36044264 %R 10.2196/36777 %U https://formative.jmir.org/2022/8/e36777 %U https://doi.org/10.2196/36777 %U http://www.ncbi.nlm.nih.gov/pubmed/36044264 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 8 %P e33402 %T Electronic Data Capture System (REDCap) for Health Care Research and Training in a Resource-Constrained Environment: Technology Adoption Case Study %A Maré,Irma Adele %A Kramer,Beverley %A Hazelhurst,Scott %A Nhlapho,Mapule Dorcus %A Zent,Roy %A Harris,Paul A %A Klipin,Michael %+ Department of Surgery, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, Johannesburg, 2000, South Africa, 27 0117171000, aicm.v2@gmail.com %K electronic data capture %K implementation science %K Research Electronic Data Capture %K REDCap %K biomedical informatics %K South Africa %D 2022 %7 30.8.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Electronic data capture (EDC) in academic health care organizations provides an opportunity for the management, aggregation, and secondary use of research and clinical data. It is especially important in resource-constrained environments such as the South African public health care sector, where paper records are still the main form of clinical record keeping. Objective: The aim of this study was to describe the strategies followed by the University of the Witwatersrand Faculty of Health Sciences (Wits FHS) during the period from 2013 to 2021 to overcome resistance to, and encourage the adoption of, the REDCap (Research Electronic Data Capture; Vanderbilt University) system by academic and clinical staff. REDCap has found wide use in varying domains, including clinical studies and research projects as well as administrative, financial, and human resource applications. Given REDCap’s global footprint in >5000 institutions worldwide and potential for future growth, the strategies followed by the Wits FHS to support users and encourage adoption may be of importance to others using the system, particularly in resource-constrained settings. Methods: The strategies to support users and encourage adoption included top-down organizational support; secure and reliable application, hosting infrastructure, and systems administration; an enabling and accessible REDCap support team; regular hands-on training workshops covering REDCap project setup and data collection instrument design techniques; annual local symposia to promote networking and awareness of all the latest software features and best practices for using them; participation in REDCap Consortium activities; and regular and ongoing mentorship from members of the Vanderbilt University Medical Center. Results: During the period from 2013 to 2021, the use of the REDCap EDC system by individuals at the Wits FHS increased, respectively, from 129 active user accounts to 3447 active user accounts. The number of REDCap projects increased from 149 in 2013 to 12,865 in 2021. REDCap at Wits also supported various publications and research outputs, including journal articles and postgraduate monographs. As of 2020, a total of 233 journal articles and 87 postgraduate monographs acknowledged the use of the Wits REDCap system. Conclusions: By providing reliable infrastructure and accessible support resources, we were able to successfully implement and grow the REDCap EDC system at the Wits FHS and its associated academic medical centers. We believe that the increase in the use of REDCap was driven by offering a dependable, secure service with a strong end-user training and support model. This model may be applied by other academic and health care organizations in resource-constrained environments planning to implement EDC technology. %M 36040763 %R 10.2196/33402 %U https://medinform.jmir.org/2022/8/e33402 %U https://doi.org/10.2196/33402 %U http://www.ncbi.nlm.nih.gov/pubmed/36040763 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 7 %N 2 %P e36618 %T Noncontact Longitudinal Respiratory Rate Measurements in Healthy Adults Using Radar-Based Sleep Monitor (Somnofy): Validation Study %A Toften,Ståle %A Kjellstadli,Jonas T %A Thu,Ole Kristian Forstrønen %A Ellingsen,Ole-Johan %+ Department of Data Science and Research, VitalThings AS, Jarlsøveien 48, Tønsberg, 3124, Norway, 47 47899717, st@vitalthings.com %K noncontact %K monitoring %K radar technology %K respiratory rate %K Somnofy %K validation %D 2022 %7 12.8.2022 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Respiratory rate (RR) is arguably the most important vital sign to detect clinical deterioration. Change in RR can also, for example, be associated with the onset of different diseases, opioid overdoses, intense workouts, or mood. However, unlike for most other vital parameters, an easy and accurate measuring method is lacking. Objective: This study aims to validate the radar-based sleep monitor, Somnofy, for measuring RRs and investigate whether events affecting RR can be detected from personalized baselines calculated from nightly averages. Methods: First, RRs from Somnofy for 37 healthy adults during full nights of sleep were extensively validated against respiratory inductance plethysmography. Then, the night-to-night consistency of a proposed filtered average RR was analyzed for 6 healthy participants in a pilot study in which they used Somnofy at home for 3 months. Results: Somnofy measured RR 84% of the time, with mean absolute error of 0.18 (SD 0.05) respirations per minute, and Bland-Altman 95% limits of agreement adjusted for repeated measurements ranged from –0.99 to 0.85. The accuracy and coverage were substantially higher in deep and light sleep than in rapid eye movement sleep and wake. The results were independent of age, sex, and BMI, but dependent on supine sleeping position for some radar orientations. For nightly filtered averages, the 95% limits of agreement ranged from −0.07 to −0.04 respirations per minute. In the longitudinal part of the study, the nightly average was consistent from night to night, and all substantial deviations coincided with self-reported illnesses. Conclusions: RRs from Somnofy were more accurate than those from any other alternative method suitable for longitudinal measurements. Moreover, the nightly averages were consistent from night to night. Thus, several factors affecting RR should be detectable as anomalies from personalized baselines, enabling a range of applications. More studies are necessary to investigate its potential in children and older adults or in a clinical setting. %M 38875674 %R 10.2196/36618 %U https://biomedeng.jmir.org/2022/2/e36618 %U https://doi.org/10.2196/36618 %U http://www.ncbi.nlm.nih.gov/pubmed/38875674 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e38015 %T Social Media Use for Research Participant Recruitment: Integrative Literature Review %A Darko,Elizabeth Mirekuwaa %A Kleib,Manal %A Olson,Joanne %+ College of Health Sciences, Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada, 1 7807826810, darko@ualberta.ca %K advertisement %K recruitment %K research participants %K social media %K mobile phone %D 2022 %7 4.8.2022 %9 Review %J J Med Internet Res %G English %X Background: Social media tools have provided health researchers with the opportunity to engage with communities and groups in a nonconventional manner to recruit participants for health research. Using social media to advertise research opportunities and recruit participants facilitates accessibility to participants from broad geographical areas and diverse populations. However, little guidance is provided by ethics review boards for researchers to effectively use this recruitment method in their research. Objective: This study sought to explore the literature on the use of social media for participant recruitment for research studies and identify the best practices for recruiting participants using this method. Methods: An integrative review approach was used to synthesize the literature. A total of 5 health sciences databases, namely, EMBASE (Ovid), MEDLINE (Ovid and EBSCOhost), PsycINFO (Ovid), Scopus (Elsevier), and CINAHL Plus with Full Text (EBSCOhost), were searched using predefined keywords and inclusion and exclusion criteria. The initial search was conducted in October 2020 and was updated in February 2022. Descriptive and content analyses were applied to synthesize the results, and the findings are presented in a narrative and tabular format. Results: A total of 96 records were included in this review, 83 (86%) from the initial search and 13 (14%) from the updated search. The publication year ranged between 2011 and 2022, with most publications (63/96, 66%) being from the United States. Regarding recruitment strategy, 45% (43/96) of the studies exclusively used social media, whereas 51% (49/96) used social media in conjunction with other strategies. The remaining 4% (4/96) provided guidelines and recommendations for social media recruitment. Notably, 38% (36/96) of these studies involved hard-to-reach populations. The findings also revealed that the use of social media is a cost-effective and efficient strategy for recruiting research participants. Despite the expanded use across different populations, there is limited participation of older adults in social media recruitment. Conclusions: This review provides important insights into the current use of social media for health research participant recruitment. Ethics boards and research support services in academic institutions are encouraged to explicitly provide researchers with guidelines on the use of social media for health research participant recruitment. A preliminary guideline prepared based on the findings of this review is proposed to spark further development in this area. %M 35925655 %R 10.2196/38015 %U https://www.jmir.org/2022/8/e38015 %U https://doi.org/10.2196/38015 %U http://www.ncbi.nlm.nih.gov/pubmed/35925655 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e36665 %T Initial Psychometric Properties of 7 NeuroUX Remote Ecological Momentary Cognitive Tests Among People With Bipolar Disorder: Validation Study %A Moore,Raeanne C %A Parrish,Emma M %A Van Patten,Ryan %A Paolillo,Emily %A Filip,Tess F %A Bomyea,Jessica %A Lomas,Derek %A Twamley,Elizabeth W %A Eyler,Lisa T %A Depp,Colin A %+ Department of Psychiatry, University of California San Diego, 220 Dickinson St. Ste B (8231), San Diego, CA, 92103-8231, United States, 1 949 933 8063, r6moore@health.ucsd.edu %K neuropsychology %K mobile health %K ambulatory assessment %K ecological momentary assessment %K practice effects %K validity %K testing %K serious mental illness %K mobile phone %D 2022 %7 29.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: As smartphone technology has become nearly ubiquitous, there is a growing body of literature suggesting that ecological momentary cognitive testing (EMCT) offers advantages over traditional pen-and-paper psychological assessment. We introduce a newly developed platform for the self-administration of cognitive tests in ecologically valid ways. Objective: The aim of this study is to develop a Health Insurance Portability and Accountability Act–compliant EMCT smartphone-based platform for the frequent and repeated testing of cognitive abilities in everyday life. This study examines the psychometric properties of 7 mobile cognitive tests covering domains of processing speed, visual working memory, recognition memory, and response inhibition within our platform among persons with and without bipolar disorder (BD). Ultimately, if shown to have adequate psychometric properties, EMCTs may be useful in research on BD and other neurological and psychiatric illnesses. Methods: A total of 45 persons with BD and 21 demographically comparable healthy volunteer participants (aged 18-65 years) completed smartphone-based EMCTs 3 times daily for 14 days. Each EMCT session lasted approximately 1.5 minutes. Only 2 to 3 tests were administered in any given session, no test was administered more than once per day, and alternate test versions were administered in each session. Results: The mean adherence to the EMCT protocol was 69.7% (SD 20.5%), resulting in 3965 valid and complete tests across the full sample. Participants were significantly more likely to miss tests on later versus earlier study days. Adherence did not differ by diagnostic status, suggesting that BD does not interfere with EMCT participation. In most tests, age and education were related to EMCT performance in expected directions. The average performances on most EMCTs were moderately to strongly correlated with the National Institutes of Health Toolbox Cognition Battery. Practice effects were observed in 5 tests, with significant differences in practice effects by BD status in 3 tests. Conclusions: Although additional reliability and validity data are needed, this study provides initial psychometric support for EMCTs in the assessment of cognitive performance in real-world contexts in BD. %M 35904876 %R 10.2196/36665 %U https://www.jmir.org/2022/7/e36665 %U https://doi.org/10.2196/36665 %U http://www.ncbi.nlm.nih.gov/pubmed/35904876 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e31929 %T A Comprehensive Literature Search of Digital Health Technology Use in Neurological Conditions: Review of Digital Tools to Promote Self-management and Support %A Spreadbury,John Henry %A Young,Alex %A Kipps,Christopher Myles %+ Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, SO16 6YD, United Kingdom, 44 02381206132 ext 6132, jhs101@soton.ac.uk %K digital health technology %K digital tools %K neurology %K patients %K self-management %D 2022 %7 28.7.2022 %9 Review %J J Med Internet Res %G English %X Background: The use of digital health technology to promote and deliver postdiagnostic care in neurological conditions is becoming increasingly common. However, the range of digital tools available across different neurological conditions and how they facilitate self-management are unclear. Objective: This review aims to identify digital tools that promote self-management in neurological conditions and to investigate their underlying functionality and salient clinical outcomes. Methods: We conducted a search of 6 databases (ie, CINAHL, EMBASE, MEDLINE, PsycINFO, Web of Science, and the Cochrane Review) using free text and equivalent database-controlled vocabulary terms. Results: We identified 27 published articles reporting 17 self-management digital tools. Multiple sclerosis (MS) had the highest number of digital tools followed by epilepsy, stroke, and headache and migraine with a similar number, and then pain. The majority were aimed at patients with a minority for carers. There were 5 broad categories of functionality promoting self-management: (1) knowledge and understanding; (2) behavior modification; (3) self-management support; (4) facilitating communication; and (5) recording condition characteristics. Salient clinical outcomes included improvements in self-management, self-efficacy, coping, depression, and fatigue. Conclusions: There now exist numerous digital tools to support user self-management, yet relatively few are described in the literature. More research is needed to investigate their use, effectiveness, and sustainability, as well as how this interacts with increasing disability, and their integration within formal neurological care environments. %M 35900822 %R 10.2196/31929 %U https://www.jmir.org/2022/7/e31929 %U https://doi.org/10.2196/31929 %U http://www.ncbi.nlm.nih.gov/pubmed/35900822 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 7 %P e38077 %T Comparison of Accelerometry-Based Measures of Physical Activity: Retrospective Observational Data Analysis Study %A Karas,Marta %A Muschelli,John %A Leroux,Andrew %A Urbanek,Jacek K %A Wanigatunga,Amal A %A Bai,Jiawei %A Crainiceanu,Ciprian M %A Schrack,Jennifer A %+ Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 410 303 1723, jschrac1@jhu.edu %K accelerometry %K actigraphy %K activity counts %K wearable computing %K monitor-independent movement summary %K MIMS %K physical activity %K aging %K older adult population %K wearable device %K health monitoring %K digital health %K wearable technology %K health technology %D 2022 %7 22.7.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Given the evolution of processing and analysis methods for accelerometry data over the past decade, it is important to understand how newer summary measures of physical activity compare with established measures. Objective: We aimed to compare objective measures of physical activity to increase the generalizability and translation of findings of studies that use accelerometry-based data. Methods: High-resolution accelerometry data from the Baltimore Longitudinal Study on Aging were retrospectively analyzed. Data from 655 participants who used a wrist-worn ActiGraph GT9X device continuously for a week were summarized at the minute level as ActiGraph activity count, monitor-independent movement summary, Euclidean norm minus one, mean amplitude deviation, and activity intensity. We calculated these measures using open-source packages in R. Pearson correlations between activity count and each measure were quantified both marginally and conditionally on age, sex, and BMI. Each measures pair was harmonized using nonparametric regression of minute-level data. Results: Data were from a sample (N=655; male: n=298, 45.5%; female: n=357, 54.5%) with a mean age of 69.8 years (SD 14.2) and mean BMI of 27.3 kg/m2 (SD 5.0). The mean marginal participant-specific correlations between activity count and monitor-independent movement summary, Euclidean norm minus one, mean amplitude deviation, and activity were r=0.988 (SE 0.0002324), r=0.867 (SE 0.001841), r=0.913 (SE 0.00132), and r=0.970 (SE 0.0006868), respectively. After harmonization, mean absolute percentage errors of predicting total activity count from monitor-independent movement summary, Euclidean norm minus one, mean amplitude deviation, and activity intensity were 2.5, 14.3, 11.3, and 6.3, respectively. The accuracies for predicting sedentary minutes for an activity count cut-off of 1853 using monitor-independent movement summary, Euclidean norm minus one, mean amplitude deviation, and activity intensity were 0.981, 0.928, 0.904, and 0.960, respectively. An R software package called SummarizedActigraphy, with a unified interface for computation of the measures from raw accelerometry data, was developed and published. Conclusions: The findings from this comparison of accelerometry-based measures of physical activity can be used by researchers and facilitate the extension of knowledge from existing literature by demonstrating the high correlation between activity count and monitor-independent movement summary (and other measures) and by providing harmonization mapping. %M 35867392 %R 10.2196/38077 %U https://mhealth.jmir.org/2022/7/e38077 %U https://doi.org/10.2196/38077 %U http://www.ncbi.nlm.nih.gov/pubmed/35867392 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e32280 %T Inducing and Recording Acute Stress Responses on a Large Scale With the Digital Stress Test (DST): Development and Evaluation Study %A Norden,Matthias %A Hofmann,Amin Gerard %A Meier,Martin %A Balzer,Felix %A Wolf,Oliver T %A Böttinger,Erwin %A Drimalla,Hanna %+ Faculty of Technology, Bielefeld University, Postfach 10 01 31, Bielefeld, 33619, Germany, 49 521 106 12043, drimalla@techfak.uni-bielefeld.de %K stress induction %K smartphone %K stress reactivity %K Trier Social Stress Test %K TSST %K remote %K video recording %K acute stress %K digital health %K mobile health %K mHealth %K mobile phone %D 2022 %7 15.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Valuable insights into the pathophysiology and consequences of acute psychosocial stress have been gained using standardized stress induction experiments. However, most protocols are limited to laboratory settings, are labor-intensive, and cannot be scaled to larger cohorts or transferred to daily life scenarios. Objective: We aimed to provide a scalable digital tool that enables the standardized induction and recording of acute stress responses in outside-the-laboratory settings without any experimenter contact. Methods: On the basis of well-described stress protocols, we developed the Digital Stress Test (DST) and evaluated its feasibility and stress induction potential in a large web-based study. A total of 284 participants completed either the DST (n=103; 52/103, 50.5% women; mean age 31.34, SD 9.48 years) or an adapted control version (n=181; 96/181, 53% women; mean age 31.51, SD 11.18 years) with their smartphones via a web application. We compared their affective responses using the international Positive and Negative Affect Schedule Short Form before and after stress induction. In addition, we assessed the participants’ stress-related feelings indicated in visual analogue scales before, during, and after the procedure, and further analyzed the implemented stress-inducing elements. Finally, we compared the DST participants’ stress reactivity with the results obtained in a classic stress test paradigm using data previously collected in 4 independent Trier Social Stress Test studies including 122 participants overall. Results: Participants in the DST manifested significantly higher perceived stress indexes than the Control-DST participants at all measurements after the baseline (P<.001). Furthermore, the effect size of the increase in DST participants’ negative affect (d=0.427) lay within the range of effect sizes for the increase in negative affect in the previously conducted Trier Social Stress Test experiments (0.281-1.015). Conclusions: We present evidence that a digital stress paradigm administered by smartphone can be used for standardized stress induction and multimodal data collection on a large scale. Further development of the DST prototype and a subsequent validation study including physiological markers are outlined. %M 35838765 %R 10.2196/32280 %U https://www.jmir.org/2022/7/e32280 %U https://doi.org/10.2196/32280 %U http://www.ncbi.nlm.nih.gov/pubmed/35838765 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e38683 %T Development of a Quality Management Model and Self-assessment Questionnaire for Hybrid Health Care: Concept Mapping Study %A Tossaint-Schoenmakers,Rosian %A Kasteleyn,Marise J %A Rauwerdink,Anneloek %A Chavannes,Niels %A Willems,Sofie %A Talboom-Kamp,Esther P W A %+ Saltro Diagnostic Centre, Unilabs Netherlands, Mississippidreef 83, Utrecht, 3565 CE, Netherlands, 31 655895361, rtossaint@saltro.nl %K quality assessment %K hybrid health care %K blended health care %K eHealth %K digital health %K structure %K process %K outcome %K concept mapping %D 2022 %7 7.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Working with eHealth requires health care organizations to make structural changes in the way they work. Organizational structure and process must be adjusted to provide high-quality care. This study is a follow-up study of a systematic literature review on optimally organizing hybrid health care (eHealth and face to face) using the Donabedian Structure-Process-Outcome (SPO) framework to translate the findings into a modus operandi for health care organizations. Objective: This study aimed to develop an SPO-based quality assessment model for organizing hybrid health care using an accompanying self-assessment questionnaire. Health care organizations can use this model and a questionnaire to manage and improve their hybrid health care. Methods: Concept mapping was used to enrich and validate evidence-based knowledge from a literature review using practice-based knowledge from experts. First, brainstorming was conducted. The participants listed all the factors that contributed to the effective organization of hybrid health care and the associated outcomes. Data from the brainstorming phase were combined with data from the literature study, and duplicates were removed. Next, the participants rated the factors on importance and measurability and grouped them into clusters. Finally, using multivariate statistical analysis (multidimensional scaling and hierarchical cluster analysis) and group interpretation, an SPO-based quality management model and an accompanying questionnaire were constructed. Results: All participants (n=39) were familiar with eHealth and were health care professionals, managers, researchers, patients, or eHealth suppliers. The brainstorming and literature review resulted in a list of 314 factors. After removing the duplicates, 78 factors remained. Using multivariate statistical analyses and group interpretations, a quality management model and questionnaire incorporating 8 clusters and 33 factors were developed. The 8 clusters included the following: Vision, strategy, and organization; Quality information technology infrastructure and systems; Quality eHealth application; Providing support to health care professionals; Skills, knowledge, and attitude of health care professionals; Attentiveness to the patient; Patient outcomes; and Learning system. The SPO categories were positioned as overarching themes to emphasize the interrelations between the clusters. Finally, a proposal was made to use the self-assessment questionnaire in practice, allowing measurement of the quality of each factor. Conclusions: The quality of hybrid care is determined by organizational, technological, process, and personal factors. The 33 most important factors were clustered in a quality management model and self-assessment questionnaire called the Hybrid Health Care Quality Assessment. The model visualizes the interrelations between the factors. Using a questionnaire, each factor can be assessed to determine how effectively it is organized and developed over time. Health care organizations can use the Hybrid Health Care Quality Assessment to identify improvement opportunities for solid and sustainable hybrid health care. %M 35797097 %R 10.2196/38683 %U https://formative.jmir.org/2022/7/e38683 %U https://doi.org/10.2196/38683 %U http://www.ncbi.nlm.nih.gov/pubmed/35797097 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37933 %T Chinese Version of the Mobile Health App Usability Questionnaire: Translation, Adaptation, and Validation Study %A Shan,Yi %A Ji,Meng %A Xie,Wenxiu %A Li,Rongying %A Qian,Xiaobo %A Zhang,Xiaomin %A Hao,Tianyong %+ School of Foreign Studies, Nantong University, Number 9, Seyuan Road, Nantong, 226019, China, 86 15558121896, victorsyhz@hotmail.com %K mHealth app %K usability %K Chinese version of MAUQ %K improved translation %K validity %K stability %K reliability %K cross-cultural adaptability %K mobile phone %D 2022 %7 6.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The usability of mobile health (mHealth) apps needs to be effectively evaluated before they are officially approved to be used to deliver health interventions. To this end, the mHealth App Usability Questionnaire (MAUQ) has been designed and proved valid and reliable in assessing the usability of mHealth apps. However, this English questionnaire needs to be translated into other languages, adapted, and validated before being utilized to evaluate the usability of mHealth apps. Objective: This study aims to improve, further adapt, and validate the Chinese version of the MAUQ (C-MAUQ; interactive for patients) on Left-handed Doctor, one of the most popular “reaching out to patients” interactive mHealth apps with chatbot function in China, to test the reliability and cross-cultural adaptability of the questionnaire. Methods: The MAUQ (interactive for patients) has been translated into Chinese and validated for its reliability on Good Doctor, one of the most influential “reaching out to patients” mHealth apps without chatbot function in China. After asking for the researchers’ approval to use this Chinese version, we adjusted and further adapted the C-MAUQ by checking it against the original English version and improving its comprehensibility, readability, idiomaticity, and cross-cultural adaptability. Following a trial survey completed by 50 respondents on wenjuanxing, the most popular online questionnaire platform in China, the improved version of the C-MAUQ (I-C-MAUQ) was finally used to evaluate the usability of Left-handed Doctor through an online questionnaire survey (answered by 322 participants) on wenjuanxing, to test its internal consistency, reliability, and validity. Results: The I-C-MAUQ still retained the 21 items and 3 dimensions of the original MAUQ: 8 items for usability and satisfaction, 6 items for system information arrangement, and 7 items for efficiency. The translation problems in the C-MAUQ, including (1) redundancy, (2) incompleteness, (3) misuse of parts of speech, (4) choice of inappropriate words, (5) incomprehensibility, and (6) cultural difference–induced improper translation, were improved. As shown in the analysis of data obtained through the online survey, the I-C-MAUQ had a better internal consistency (ie, the correlation coefficient between the score of each item and the total score of the questionnaire determined within the range of 0.861-0.938; P<.01), reliability (Cronbach α=.988), and validity (Kaiser–Meyer–Olkin=0.973), compared with the C-MAUQ. It was effectively used to test the usability of Left-handed Doctor, eliciting over 80% of informants’ positive attitudes toward this mHealth app. Conclusions: The I-C-MAUQ is highly reliable and valid for Left-handed Doctor, and suitable for testing the usability of interactive mHealth apps used by patients in China. This finding further confirms the cross-cultural validity, reliability, and adaptability of the MAUQ. We identified certain factors influencing the perceived usability of mHealth apps, including users’ age, gender, education, profession, and possibly previous experience with mHealth apps and the chatbot function of such apps. Most notably, we found a wider acceptance of this new technology among young Chinese female college students who were more engaged in the interaction with health care chatbots. The age-, gender-, and profession-induced preference for new digital health interventions in China aligns with the findings in other similar studies in America and Malaysia. This preference identifies areas for further research on the social, cultural, and gender adaptation of health technologies. %M 35793132 %R 10.2196/37933 %U https://formative.jmir.org/2022/7/e37933 %U https://doi.org/10.2196/37933 %U http://www.ncbi.nlm.nih.gov/pubmed/35793132 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e38837 %T Measures of Daily Activities Associated With Mental Health (Things You Do Questionnaire): Development of a Preliminary Psychometric Study and Replication Study %A Titov,Nickolai %A Dear,Blake F %A Bisby,Madelyne A %A Nielssen,Olav %A Staples,Lauren G %A Kayrouz,Rony %A Cross,Shane %A Karin,Eyal %+ eCentreClinic, School of Psychological Sciences, Macquarie University, 73 Talavera Road, Sydney, 2109, Australia, 61 0488 991 122, nick.titov@mq.edu.au %K anxiety %K depression %K satisfaction with life %K COVID-19 %K behavior %K habits %K cognitions %K survey %K mechanisms %K psychological well-being %D 2022 %7 5.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: A large body of research has identified modifiable cognitions and behaviors (actions) associated with psychological health. However, little is known regarding the actions that are most strongly associated with psychological health or the frequency with which they should be performed. Objective: This paper described 2 studies that used survey methodology to create the Things You Do Questionnaire (TYDQ), which aims to identify and rank actions (items) and domains of actions (factors) most strongly associated with psychological health. Methods: We used digital marketing strategies to recruit Australian adult participants, who were asked to complete 2 web-based surveys comprising versions of the TYDQ; validated measures of depression, anxiety, and satisfaction with life; and demographic questions. In study 1, a total of 3040 participants rated how often they performed each of the 96 items comprising the TYDQ. This design was replicated in study 2, in which a 59-item version of the TYDQ was completed by 3160 participants. In both studies, the factor structure and validity were examined, as were the associations between individual TYDQ items and 3 mental health outcomes: depression, anxiety, and satisfaction with life. Results: In study 1, factor analyses revealed that a 5-factor model comprising 27 items achieved an optimum balance between brevity and variance and accounted for 38.1%, 31.4%, and 33.2% of the variance in scores on measures of depression, anxiety, and satisfaction with life, respectively. The factors were interpreted as realistic thinking, meaningful activities, goals and plans, healthy habits, and social connections. These 5 factors were more strongly associated with psychological health than those such as practicing kindness, exercising gratitude, and practicing spirituality. This pattern of results was replicated across gender, age groups, and depression severity. The 5-factor solution found in study 1 was replicated in study 2. Analyses revealed that a 21-item version accounted for 46.8%, 38.2%, and 38.1% of the variance in scores on measures of depression, anxiety, and satisfaction with life, respectively. Conclusions: These findings indicate that some actions are more strongly associated with psychological health than others and that these activities fall within 5 broad domains, which represent skills often taught in psychological treatments. Subsequent studies are planned to explore the reliability of these items and results in other samples and to examine patterns of change in scores during treatment for anxiety and depression. If replicated, these efforts will assist in the development of new psychological interventions and provide an evidence base for public mental health campaigns designed to promote good mental health and prevent the emergence of common mental disorders. %M 35788101 %R 10.2196/38837 %U https://formative.jmir.org/2022/7/e38837 %U https://doi.org/10.2196/38837 %U http://www.ncbi.nlm.nih.gov/pubmed/35788101 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e32997 %T A Remote Digital Monitoring Platform to Assess Cognitive and Motor Symptoms in Huntington Disease: Cross-sectional Validation Study %A Lipsmeier,Florian %A Simillion,Cedric %A Bamdadian,Atieh %A Tortelli,Rosanna %A Byrne,Lauren M %A Zhang,Yan-Ping %A Wolf,Detlef %A Smith,Anne V %A Czech,Christian %A Gossens,Christian %A Weydt,Patrick %A Schobel,Scott A %A Rodrigues,Filipe B %A Wild,Edward J %A Lindemann,Michael %+ Roche Pharma Research and Early Development, pRED Informatics, Pharmaceutical Sciences, Clinical Pharmacology, and Neuroscience, Ophthalmology, and Rare Diseases Discovery and Translational Area, Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Basel, CH 4070, Switzerland, 41 61 6877909, florian.lipsmeier@roche.com %K Huntington disease %K digital monitoring %K digital biomarkers %K remote monitoring %K smartphone %K smartwatch %K cognition %K motor %K clinical trials %K mobile phone %D 2022 %7 28.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Remote monitoring of Huntington disease (HD) signs and symptoms using digital technologies may enhance early clinical diagnosis and tracking of disease progression, guide treatment decisions, and monitor response to disease-modifying agents. Several recent studies in neurodegenerative diseases have demonstrated the feasibility of digital symptom monitoring. Objective: The aim of this study was to evaluate a novel smartwatch- and smartphone-based digital monitoring platform to remotely monitor signs and symptoms of HD. Methods: This analysis aimed to determine the feasibility and reliability of the Roche HD Digital Monitoring Platform over a 4-week period and cross-sectional validity over a 2-week interval. Key criteria assessed were feasibility, evaluated by adherence and quality control failure rates; test-retest reliability; known-groups validity; and convergent validity of sensor-based measures with existing clinical measures. Data from 3 studies were used: the predrug screening phase of an open-label extension study evaluating tominersen (NCT03342053) and 2 untreated cohorts—the HD Natural History Study (NCT03664804) and the Digital-HD study. Across these studies, controls (n=20) and individuals with premanifest (n=20) or manifest (n=179) HD completed 6 motor and 2 cognitive tests at home and in the clinic. Results: Participants in the open-label extension study, the HD Natural History Study, and the Digital-HD study completed 89.95% (1164/1294), 72.01% (2025/2812), and 68.98% (1454/2108) of the active tests, respectively. All sensor-based features showed good to excellent test-retest reliability (intraclass correlation coefficient 0.89-0.98) and generally low quality control failure rates. Good overall convergent validity of sensor-derived features to Unified HD Rating Scale outcomes and good overall known-groups validity among controls, premanifest, and manifest participants were observed. Among participants with manifest HD, the digital cognitive tests demonstrated the strongest correlations with analogous in-clinic tests (Pearson correlation coefficient 0.79-0.90). Conclusions: These results show the potential of the HD Digital Monitoring Platform to provide reliable, valid, continuous remote monitoring of HD symptoms, facilitating the evaluation of novel treatments and enhanced clinical monitoring and care for individuals with HD. %M 35763342 %R 10.2196/32997 %U https://www.jmir.org/2022/6/e32997 %U https://doi.org/10.2196/32997 %U http://www.ncbi.nlm.nih.gov/pubmed/35763342 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 2 %P e31489 %T Assessing Physician’s Motivational Communication Skills: 5-Step Mixed Methods Development Study of the Motivational Communication Competency Assessment Test %A Gosselin Boucher,Vincent %A Bacon,Simon %A Voisard,Brigitte %A Dragomir,Anda I %A Gemme,Claudia %A Larue,Florent %A Labbé,Sara %A Szczepanik,Geneviève %A Corace,Kimberly %A Campbell,Tavis %A Vallis,Michael %A Garber,Gary %A Rouleau,Codie %A Diodati,Jean G %A Rabi,Doreen %A Sultan,Serge %A Lavoie,Kim %A , %+ Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l’Ile-de-Montréal (CIUSSSNIM), 5400, boul Gouin O,, Montreal, QC, H2G 3G2, Canada, 1 4388808310, vincent.gosselin.boucher@gmail.com %K assessment %K motivational communication %K tool development %K physicians %K health promotion %D 2022 %7 24.6.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: Training physicians to provide effective behavior change counseling using approaches such as motivational communication (MC) is an important aspect of noncommunicable chronic disease prevention and management. However, existing evaluation tools for MC skills are complex, invasive, time consuming, and impractical for use within the medical context. Objective: The objective of this study is to develop and validate a short web-based tool for evaluating health care provider (HCP) skills in MC—the Motivational Communication Competency Assessment Test (MC-CAT). Methods: Between 2016 and 2021, starting with a set of 11 previously identified core MC competencies and using a 5-step, mixed methods, integrated knowledge translation approach, the MC-CAT was created by developing a series of 4 base cases and a scoring scheme, validating the base cases and scoring scheme with international experts, creating 3 alternative versions of the 4 base cases (to create a bank of 16 cases, 4 of each type of base case) and translating the cases into French, integrating the cases into the web-based MC-CAT platform, and conducting initial internal validity assessments with university health students. Results: The MC-CAT assesses MC competency in 20 minutes by presenting HCPs with 4 out of a possible 16 cases (randomly selected and ordered) addressing various behavioral targets (eg, smoking, physical activity, diet, and medication adherence). Individual and global competency scores were calculated automatically for the 11 competency items across the 4 cases, providing automatic scores out of 100. From the factorial analysis of variance for the difference in competency and ranking scores, no significant differences were identified between the different case versions across individual and global competency (P=.26 to P=.97) and ranking scores (P=.24 to P=.89). The initial tests of internal consistency for rank order among the 24 student participants were in the acceptable range (α=.78). Conclusions: The results suggest that MC-CAT is an internally valid tool to facilitate the evaluation of MC competencies among HCPs and is ready to undergo comprehensive psychometric property analyses with a national sample of health care providers. Once psychometric property assessments have been completed, this tool is expected to facilitate the assessment of MC skills among HCPs, skills that will better support patients in adopting healthier lifestyles, which will significantly reduce the personal, social, and economic burdens of noncommunicable chronic diseases. %M 35749167 %R 10.2196/31489 %U https://mededu.jmir.org/2022/2/e31489 %U https://doi.org/10.2196/31489 %U http://www.ncbi.nlm.nih.gov/pubmed/35749167 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e33312 %T A Web-Based, Time-Use App To Assess Children’s Movement Behaviors: Validation Study of My E-Diary for Activities and Lifestyle (MEDAL) %A Tan,Sarah Yi Xuan %A Chia,Airu %A Tai,Bee Choo %A Natarajan,Padmapriya %A Goh,Claire Marie Jie Lin %A Shek,Lynette P %A Saw,Seang Mei %A Chong,Mary Foong-Fong %A Müller-Riemenschneider,Falk %+ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #09-01Q, Singapore, 117549, Singapore, 65 6516 4969, mary_chong@nus.edu.sg %K children %K accelerometer %K MEDAL %K web-based app %K self-report %K validity %K physical activity %K movement behavior %K pediatrics %K sleep %K digital health %K behavior %D 2022 %7 24.6.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Existing modes of collecting self-reported 24-hour movement information from children, including digital assessments, have not been demonstrated to be of acceptable validity when compared to objective measurements. My E-Diary for Activities and Lifestyle (MEDAL) is an interactive web-based diary developed to collect time-use information from children aged 10 years and older. Objective: This study evaluated the validity of MEDAL for assessing children’s movement behaviors by comparing self-reported and accelerometer-measured time spent in movement behavior among children in Singapore aged 10-11 years. Methods: Funding for this study was obtained in October 2017, and data were collected between April and August 2020. Participants recorded their daily activities using MEDAL over 2 specified weekdays and 2 weekend days and wore an Actigraph accelerometer on their nondominant wrist throughout the study to objectively assess movement behaviors. Spearman correlation coefficient and intraclass correlation coefficient (ICC) were used to compare the accelerometer measurements and self-reports for each movement behavior. Bland-Altman plots were generated to investigate trends of bias in the self-reports. Results: Among the participants aged 10-11 years (29/49, 59% boys), we observed that children reported lower light physical activity (LPA) and higher moderate-to-vigorous physical activity (MVPA), inactivity, and night sleep than that measured by the accelerometer. There was a moderate-to-strong correlation between self-reported and accelerometer-measured MVPA (r=0.37; 95% CI 0.20-0.54), inactivity (r=0.36; 95% CI 0.18-0.54), and night sleep (r=0.58; 95% CI 0.43-0.74); the correlation for LPA was poor (r=0.19; 95% CI 0.02-0.36). Agreement was poor for all behaviors (MVPA: ICC=0.24, 95% CI 0.07-0.40; LPA: ICC=0.19, 95% CI 0.01-0.36; inactivity: ICC=0.29, 95% CI 0.11-0.44; night sleep: ICC=0.45, 95% CI 0.29-0.58). There was stronger correlation and agreement on weekdays for inactivity and night sleep; conversely, there was stronger correlation and agreement for MVPA and LPA on weekend days. Finally, based on Bland-Altman plots, we observed that with increasing MVPA, children tended to report higher MVPA than that measured by the accelerometer. There were no clear trends for the other behaviors. Conclusions: MEDAL may be used to assess the movement behaviors of children. Based on self-reports, the children are able to estimate their time spent in MVPA, inactivity, and night sleep although actual time spent in these behaviors may differ from accelerometer-derived estimates; self-reported LPA warrant cautious interpretation. Observable differences in reporting accuracy exist between weekdays and weekend days. %M 35749208 %R 10.2196/33312 %U https://pediatrics.jmir.org/2022/2/e33312 %U https://doi.org/10.2196/33312 %U http://www.ncbi.nlm.nih.gov/pubmed/35749208 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e37356 %T Comparison of the ACASI Mode to Other Survey Modes in Sexual Behavior Surveys in Asia and Sub-Saharan Africa: Systematic Literature Review %A Phoo,Nang Nge Nge %A Lobo,Roanna %A Vujcich,Daniel %A Reid,Alison %+ School of Population Health, Curtin University, Kent Street, Bentley WA, Perth, 6102, Australia, 61 0414954410, nangngenge.phoo@curtin.edu.au %K ACASI %K survey mode %K sexual behaviors %K HIV %K STI %K hepatitis %K blood-borne virus %K Asia %K sub-Saharan Africa %K review %D 2022 %7 31.5.2022 %9 Review %J J Med Internet Res %G English %X Background: Reliable data about sexual behaviors is fundamental in the prevention and control of HIV, hepatitis, and other sexually transmitted infections. Generally, sexual behaviors are regarded as a sociocultural taboo in Africa and Asia, and this results in biased sexual behavior survey data due to social desirability. Various modes of survey delivery, including audio computer-assisted self-interviews (ACASIs), have been investigated to improve data quality. Objective: This study aimed to review studies that compared the ACASI mode to other survey modes in sexual behavior surveys in Asia and sub-Saharan Africa to ascertain the impact of survey mode on responses to sexual behavior questions. Methods: A systematic literature review was conducted according to the Joanna Briggs Institute Manual for Evidence Synthesis. The review protocol was registered at PROSPERO (International Prospective Register of Systematic Reviews). Six databases were searched. Results: A total of 21 papers were included. The face-to-face interview (FTFI) mode was the survey mode most frequently compared to the ACASI mode. Among the most commonly reported outcome variable groups, ACASI participants were more likely to report sexual behaviors, such as “forced sex,” “multiple partners,” “transactional sex,” and “ever had sex,” as compared to FTFI participants. In addition to the survey mode effect, other factors were found to have had an impact on data quality, for example, participant characteristics, social norms, study design, and data collection setting. Conclusions: Use of ACASIs for administering sexual behavior surveys among populations in Asia and sub-Saharan Africa demonstrated higher reports for some sexual behaviors than the use of FTFIs. More studies that compare the ACASI mode to other survey modes would improve our understanding of the usefulness of ACASIs in sexual behavior surveys in these regions. %M 35639465 %R 10.2196/37356 %U https://www.jmir.org/2022/5/e37356 %U https://doi.org/10.2196/37356 %U http://www.ncbi.nlm.nih.gov/pubmed/35639465 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e32922 %T Web-Based Independent Versus Laboratory-Based Stop-Signal Task Performance: Within-Subjects Counterbalanced Comparison Study %A Poulton,Antoinette %A Chen,Li Peng Evelyn %A Dali,Gezelle %A Fox,Michael %A Hester,Robert %+ Melbourne School of Psychological Sciences, University of Melbourne, Redmond Barry Building, Parkville, 3010, Australia, 61 3 8344 6377, antoinette.poulton@unimelb.edu.au %K Stop-Signal Task %K response inhibition %K inhibitory control %K online assessment %K web-based assessment %K cognition %D 2022 %7 30.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Considered a facet of behavioral impulsivity, response inhibition facilitates adaptive and goal-directed behavior. It is often assessed using the Stop-Signal Task (SST), which is presented on stand-alone computers under controlled laboratory conditions. Sample size may consequently be a function of cost or time and sample diversity constrained to those willing or able to attend the laboratory. Statistical power and generalizability of results might, in turn, be impacted. Such limitations may potentially be overcome via the implementation of web-based testing. Objective: The aim of this study was to investigate if there were differences between variables derived from a web-based SST when it was undertaken independently—that is, outside the laboratory, on any computer, and in the absence of researchers—versus when it was performed under laboratory conditions. Methods: We programmed a web-based SST in HTML and JavaScript and employed a counterbalanced design. A total of 166 individuals (mean age 19.72, SD 1.85, range 18-36 years; 146/166, 88% female) were recruited. Of them, 79 undertook the independent task prior to visiting the laboratory and 78 completed the independent task following their laboratory visit. The average time between SST testing was 3.72 (SD 2.86) days. Dependent samples and Bayesian paired samples t tests were used to examine differences between laboratory-based and independent SST variables. Correlational analyses were conducted on stop-signal reaction times (SSRT). Results: After exclusions, 123 participants (mean age 19.73, SD 1.97 years) completed the SST both in the laboratory and independently. While participants were less accurate on go trials and exhibited reduced inhibitory control when undertaking the independent—compared to the laboratory-based—SST, there was a positive association between the SSRT of each condition (r=.48; P<.001; 95% CI 0.33-0.61). Conclusions: Findings suggest a web-based SST, which participants undertake on any computer, at any location, and in the absence of the researcher, is a suitable measure of response inhibition. %M 35635745 %R 10.2196/32922 %U https://www.jmir.org/2022/5/e32922 %U https://doi.org/10.2196/32922 %U http://www.ncbi.nlm.nih.gov/pubmed/35635745 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e35273 %T Momentary Self-regulation: Scale Development and Preliminary Validation %A Scherer,Emily A %A Kim,Sunny Jung %A Metcalf,Stephen A %A Sweeney,Mary Ann %A Wu,Jialing %A Xie,Haiyi %A Mazza,Gina L %A Valente,Matthew J %A MacKinnon,David P %A Marsch,Lisa A %+ Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Suite 315, 46 Centerra Pkwy, Lebanon, NH, 03766, United States, 1 603 646 7000, blood.emily@gmail.com %K self-regulation %K momentary self-regulation %K ecological momentary assessment %K psychometric %K health behavior change %K health risk behaviors %K mobile phone %D 2022 %7 10.5.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Self-regulation refers to a person’s ability to manage their cognitive, emotional, and behavioral processes to achieve long-term goals. Most prior research has examined self-regulation at the individual level; however, individual-level assessments do not allow the examination of dynamic patterns of intraindividual variability in self-regulation and thus cannot aid in understanding potential malleable processes of self-regulation that may occur in response to the daily environment. Objective: This study aims to develop a brief, psychometrically sound momentary self-regulation scale that can be practically administered through participants’ mobile devices at a momentary level. Methods: This study was conducted in 2 phases. In the first phase, in a sample of 522 adults collected as part of a larger self-regulation project, we examined 23 previously validated assessments of self-regulation containing 594 items in total to evaluate the underlying structure of self-regulation via exploratory and confirmatory factor analyses. We then selected 20 trait-level items to be carried forward to the second phase. In the second phase, we converted each item into a momentary question and piloted the momentary items in a sample of 53 adults over 14 days. Using the results from the momentary pilot study, we explored the psychometric properties of the items and assessed their underlying structure. We then proposed a set of subscale and total score calculations. Results: In the first phase, the selected individual-level items appeared to measure 4 factors of self-regulation. The factors identified were perseverance, sensation seeking, emotion regulation, and mindfulness. In the second phase of the ecological momentary assessment pilot, the selected items demonstrated strong construct validity as well as predictive validity for health risk behaviors. Conclusions: Our findings provide preliminary evidence for a 12-item momentary self-regulation scale comprising 4 subscales designed to capture self-regulatory dynamics at the momentary level. %M 35536605 %R 10.2196/35273 %U https://mental.jmir.org/2022/5/e35273 %U https://doi.org/10.2196/35273 %U http://www.ncbi.nlm.nih.gov/pubmed/35536605 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e34347 %T Self-administered Web-Based Tests of Executive Functioning and Perceptual Speed: Measurement Development Study With a Large Probability-Based Survey Panel %A Liu,Ying %A Schneider,Stefan %A Orriens,Bart %A Meijer,Erik %A Darling,Jill E %A Gutsche,Tania %A Gatz,Margaret %+ Center for Economic and Social Research, University of Southern California, 635 Downey Way, Los Angeles, CA, 90089, United States, 1 2138211850, liu.ying@usc.edu %K cognitive tests %K internet %K probability-based %K web-based %K executive function %K response speed %K self-administered test %K mobile phone %D 2022 %7 9.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive testing in large population surveys is frequently used to describe cognitive aging and determine the incidence rates, risk factors, and long-term trajectories of the development of cognitive impairment. As these surveys are increasingly administered on internet-based platforms, web-based and self-administered cognitive testing calls for close investigation. Objective: Web-based, self-administered versions of 2 age-sensitive cognitive tests, the Stop and Go Switching Task for executive functioning and the Figure Identification test for perceptual speed, were developed and administered to adult participants in the Understanding America Study. We examined differences in cognitive test scores across internet device types and the extent to which the scores were associated with self-reported distractions in everyday environments in which the participants took the tests. In addition, national norms were provided for the US population. Methods: Data were collected from a probability-based internet panel representative of the US adult population—the Understanding America Study. Participants with access to both a keyboard- and mouse-based device and a touch screen–based device were asked to complete the cognitive tests twice in a randomized order across device types, whereas participants with access to only 1 type of device were asked to complete the tests twice on the same device. At the end of each test, the participants answered questions about interruptions and potential distractions that occurred during the test. Results: Of the 7410 (Stop and Go) and 7216 (Figure Identification) participants who completed the device ownership survey, 6129 (82.71% for Stop and Go) and 6717 (93.08% for Figure Identification) participants completed the first session and correctly responded to at least 70% of the trials. On average, the standardized differences across device types were small, with the absolute value of Cohen d ranging from 0.05 (for the switch score in Stop and Go and the Figure Identification score) to 0.13 (for the nonswitch score in Stop and Go). Poorer cognitive performance was moderately associated with older age (the absolute value of r ranged from 0.32 to 0.61), and this relationship was comparable across device types (the absolute value of Cohen q ranged from 0.01 to 0.17). Approximately 12.72% (779/6123 for Stop and Go) and 12.32% (828/6721 for Figure Identification) of participants were interrupted during the test. Interruptions predicted poorer cognitive performance (P<.01 for all scores). Specific distractions (eg, watching television and listening to music) were inconsistently related to cognitive performance. National norms, calculated as weighted average scores using sampling weights, suggested poorer cognitive performance as age increased. Conclusions: Cognitive scores assessed by self-administered web-based tests were sensitive to age differences in cognitive performance and were comparable across the keyboard- and touch screen–based internet devices. Distraction in everyday environments, especially when interrupted during the test, may result in a nontrivial bias in cognitive testing. %M 35532966 %R 10.2196/34347 %U https://www.jmir.org/2022/5/e34347 %U https://doi.org/10.2196/34347 %U http://www.ncbi.nlm.nih.gov/pubmed/35532966 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e31739 %T Developing Reporting Guidelines for Social Media Research (RESOME) by Using a Modified Delphi Method: Protocol for Guideline Development %A Kaushal,Aradhna %A Bravo,Caroline %A Duffy,Stephen %A Lewins,Douglas %A Möhler,Ralph %A Raine,Rosalind %A Vlaev,Ivo %A Waller,Jo %A von Wagner,Christian %+ Research Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 02076705723, aradhnakaushal@gmail.com %K social media %K research design %K web-based social networking %K health behavior %K health promotion %K public health %D 2022 %7 9.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social media platforms, such as Facebook, Twitter, and Instagram, are being increasingly used to deliver public health interventions. Despite the high level of research interest, there is no consensus or guidance on how to report on social media interventions. Reporting guidelines that incorporate elements from behavior change theories and social media engagement frameworks could foster more robust evaluations that capture outcomes that have an impact on behavior change and engagement. Objective: The aim of this project is to develop, publish, and promote a list of items for our Reporting Guidelines for Social Media Research (RESOME) checklist. Methods: RESOME will be developed by using a modified Delphi approach wherein 2 rounds of questionnaires will be sent to experts and stakeholders. The questionnaires will ask them to rate their agreement with a series of statements until a level of consensus is reached. This will be followed by a web-based consensus meeting to finalize the reporting guidelines. After the consensus meeting, the reporting guidelines will be published in the form of a paper outlining the need for the new guidelines and how the guidelines were developed, along with the finalized checklist for reporting. Prior to publication, the guidelines will be piloted to check for understanding and simplify the language used, if necessary. Results: The first draft of RESOME has been developed. Round 1 of the Delphi survey took place between July and December 2021. Round 2 is due to take place in February 2022, and the web-based consensus meeting will be scheduled for the spring of 2022. Conclusions: Developing RESOME has the potential to contribute to improved reporting, and such guidelines will make it easier to assess the effectiveness of social media interventions. Future work will be needed to evaluate our guidelines’ usefulness and practicality. International Registered Report Identifier (IRRID): PRR1-10.2196/31739 %M 35532999 %R 10.2196/31739 %U https://www.researchprotocols.org/2022/5/e31739 %U https://doi.org/10.2196/31739 %U http://www.ncbi.nlm.nih.gov/pubmed/35532999 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e36043 %T A 3-Item Measure of Digital Health Care Literacy: Development and Validation Study %A Nelson,Lyndsay A %A Pennings,Jacquelyn S %A Sommer,Evan C %A Popescu,Filoteia %A Barkin,Shari L %+ Department of Medicine, Vanderbilt University Medical Center, 2525 West End Ave, Suite 450, Nashville, TN, 37203, United States, 1 6156009027, lyndsay.a.nelson@vumc.org %K digital literacy %K digital health care %K telehealth %K health equity %K scale development %K mobile phone %D 2022 %7 29.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: With increased reliance on digital health care, including telehealth, efficient and effective ways are needed to assess patients’ comfort and confidence with using these services. Objective: The goal of this study was to develop and validate a brief scale that assesses digital health care literacy. Methods: We first developed an item pool using existing literature and expert review. We then administered the items to participants as part of a larger study. Participants were caregivers of children receiving care at a pediatric clinic who completed a survey either on the web or over the telephone. We randomized participants into development and confirmatory samples, stratifying by language so that exploratory factor analysis and confirmatory factor analysis could be performed with separate samples of participants. We assessed the scale’s validity by examining its associations with participants’ demographics, digital access, and prior digital health care use. Results: Participants (N=508) were, on average, aged 34.7 (SD 7.7) years, and 89.4% (454/508) were women. Of the 508 participants, 280 (55.1%) preferred English as their primary language, 157 (30.9%) preferred Spanish, and 71 (14%) preferred Arabic; 228 (45%) had a high school degree or less; and 230 (45.3%) had an annual household income of 0.99). Furthermore, the aggregate MHQ scores were systematically related to both clinical burden and productivity. At one end of the scale, 89.08% (8986/10,087) of those in the Distressed category mapped to one or more disorders and had an average productivity loss of 15.2 (SD 11.2; SEM [standard error of measurement] 0.5) days per month. In contrast, at the other end of the scale, 0% (1/24,365) of those in the Thriving category mapped to any of the 10 disorders and had an average productivity loss of 1.3 (SD 3.6; SEM 0.1) days per month. Conclusions: The MHQ is a valid and reliable assessment of mental health and well-being when delivered anonymously on the web. %M 35442210 %R 10.2196/34105 %U https://mental.jmir.org/2022/4/e34105 %U https://doi.org/10.2196/34105 %U http://www.ncbi.nlm.nih.gov/pubmed/35442210 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e36825 %T A Computerized Cognitive Test Battery for Detection of Dementia and Mild Cognitive Impairment: Instrument Validation Study %A Ye,Siao %A Sun,Kevin %A Huynh,Duong %A Phi,Huy Q %A Ko,Brian %A Huang,Bin %A Hosseini Ghomi,Reza %+ BrainCheck, Inc, 5616 Kirby Dr. # 690, Houston, TX, 77005, United States, 1 888 416 0004, bin@braincheck.com %K cognitive test %K mild cognitive impairment %K dementia %K cognitive decline %K repeatable battery %K discriminant analysis %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Early detection of dementia is critical for intervention and care planning but remains difficult. Computerized cognitive testing provides an accessible and promising solution to address these current challenges. Objective: The aim of this study was to evaluate a computerized cognitive testing battery (BrainCheck) for its diagnostic accuracy and ability to distinguish the severity of cognitive impairment. Methods: A total of 99 participants diagnosed with dementia, mild cognitive impairment (MCI), or normal cognition (NC) completed the BrainCheck battery. Statistical analyses compared participant performances on BrainCheck based on their diagnostic group. Results: BrainCheck battery performance showed significant differences between the NC, MCI, and dementia groups, achieving 88% or higher sensitivity and specificity (ie, true positive and true negative rates) for separating dementia from NC, and 77% or higher sensitivity and specificity in separating the MCI group from the NC and dementia groups. Three-group classification found true positive rates of 80% or higher for the NC and dementia groups and true positive rates of 64% or higher for the MCI group. Conclusions: BrainCheck was able to distinguish between diagnoses of dementia, MCI, and NC, providing a potentially reliable tool for early detection of cognitive impairment. %M 35436212 %R 10.2196/36825 %U https://aging.jmir.org/2022/2/e36825 %U https://doi.org/10.2196/36825 %U http://www.ncbi.nlm.nih.gov/pubmed/35436212 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e35067 %T Development and Validation of the Adolescent Media Health Literacy Scales: Rasch Measurement Model Approach %A Fleary,Sasha A %+ Department of Community Health and Social Sciences, CUNY Graduate School of Public Health and Health Policy, 55 W 125th St, New York, NY, 10027, United States, 1 646 3640282, sasha.fleary@sph.cuny.edu %K adolescents %K health communications %K health literacy %K measurement %K media health literacy %K Rasch %K mobile phone %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: High media use has been implicated in negative social and health outcomes among adolescents. Therefore, it is critical that adolescents develop skills to healthily engage with media content. Media health literacy (MHL), skills for assessing and responding to health-related media content, and potentially targetable moderators for the relationship between media use and health-related outcomes are understudied in adolescents. The lack of MHL assessment tools may have contributed to this research gap. Objective: This study aimed to develop and validate test-based scales of adolescents’ MHL. Methods: The items developed were vetted iteratively via community reviews and cognitive interviews to establish content and face validity. Adolescents (N=355) completed a questionnaire that included the revised MHL items. The scales (Recognition/Identification, Influence/Critical Analysis, and Action/Reaction) were validated using Rasch measurement models. Convergent validity was assessed by correlating the summed scores of the three scales with existing functional and internet-related health literacy measures. Criterion validity was assessed by modeling logistic regressions for predicting health literacy–related behaviors from each scale after controlling for demographics. Effect sizes were estimated, and a short form was also validated. Results: The final MHL scales (Recognition/Identification, Influence/Critical Analysis, and Action/Reaction) fit their Rasch models. The 9-item Recognition/Identification and 9-item Influence/Critical Analysis scales had good convergent validity with functional and internet-related health literacy measures and were positively related to reading instructions before taking medicines and questioning the truthfulness of health information found online. The 12-item MHL Scales-Short Form also had good convergent and criterion validity. However, convergent and criterion validity were not established for the 3-item Action/Reaction Scale. Conclusions: The Recognition/Identification and Influence/Critical Analysis scales and the MHL Scales-Short Form may be used to determine the impact of MHL on media use and health outcome relationships and ultimately inform the development of interventions and policies to affect these relationships in multiple settings. %M 35436219 %R 10.2196/35067 %U https://pediatrics.jmir.org/2022/2/e35067 %U https://doi.org/10.2196/35067 %U http://www.ncbi.nlm.nih.gov/pubmed/35436219 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 2 %P e34973 %T Readiness to Embrace Artificial Intelligence Among Medical Doctors and Students: Questionnaire-Based Study %A Boillat,Thomas %A Nawaz,Faisal A %A Rivas,Homero %+ Design Lab, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Healthcare City 14, Dubai, United Arab Emirates, 971 43838759, Thomas.boillat@mbru.ac.ae %K artificial intelligence in medicine %K health care %K questionnaire %K medical doctors %K medical students %D 2022 %7 12.4.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: Similar to understanding how blood pressure is measured by a sphygmomanometer, physicians will soon have to understand how an artificial intelligence–based application has come to the conclusion that a patient has hypertension, diabetes, or cancer. Although there are an increasing number of use cases where artificial intelligence is or can be applied to improve medical outcomes, the extent to which medical doctors and students are ready to work and leverage this paradigm is unclear. Objective: This research aims to capture medical students’ and doctors’ level of familiarity toward artificial intelligence in medicine as well as their challenges, barriers, and potential risks linked to the democratization of this new paradigm. Methods: A web-based questionnaire comprising five dimensions—demographics, concepts and definitions, training and education, implementation, and risks—was systematically designed from a literature search. It was completed by 207 participants in total, of which 105 (50.7%) medical doctors and 102 (49.3%) medical students trained in all continents, with most of them in Europe, the Middle East, Asia, and North America. Results: The results revealed no significant difference in the familiarity of artificial intelligence between medical doctors and students (P=.91), except that medical students perceived artificial intelligence in medicine to lead to higher risks for patients and the field of medicine in general (P<.001). We also identified a rather low level of familiarity with artificial intelligence (medical students=2.11/5; medical doctors=2.06/5) as well as a low attendance to education or training. Only 2.9% (3/105) of medical doctors attended a course on artificial intelligence within the previous year, compared with 9.8% (10/102) of medical students. The complexity of the field of medicine was considered one of the biggest challenges (medical doctors=3.5/5; medical students=3.8/5), whereas the reduction of physicians’ skills was the most important risk (medical doctors=3.3; medical students=3.6; P=.03). Conclusions: The question is not whether artificial intelligence will be used in medicine, but when it will become a standard practice for optimizing health care. The low level of familiarity with artificial intelligence identified in this study calls for the implementation of specific education and training in medical schools and hospitals to ensure that medical professionals can leverage this new paradigm and improve health outcomes. %M 35412463 %R 10.2196/34973 %U https://mededu.jmir.org/2022/2/e34973 %U https://doi.org/10.2196/34973 %U http://www.ncbi.nlm.nih.gov/pubmed/35412463 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e36928 %T Adult Vaccine Hesitancy Scale in Arabic and French: Protocol for Translation and Validation in the World Health Organization Eastern Mediterranean Region %A Nour,Radwa %A Powell,Leigh %A Alnakhi,Wafa K %A Mamdouh,Heba %A Zidoun,Youness %A Hussain,Hamid Y %A Al Suwaidi,Hanan %A Zary,Nabil %+ Institute for Excellence in Health Professions Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare City, PO Box 505055, Dubai, United Arab Emirates, 971 585960762, Nabil.Zary@mbru.ac.ae %K scale %K instrument %K vaccine hesitancy %K COVID-19 %K validation %K translation %K Arabic %K French %K EMRO %D 2022 %7 12.4.2022 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The world as we know it changed during the COVID-19 pandemic. Hope has emerged with the development of new vaccines against the disease. However, many factors hinder vaccine uptake and lead to vaccine hesitancy. Understanding the factors affecting vaccine hesitancy and how to assess its prevalence have become imperative amid the COVID-19 pandemic. The vaccine hesitancy scale (VHS), developed by the World Health Organization (WHO) Strategic Advisory Group of Experts on Immunization, has been modified to the adult VHS (aVHS) and validated in English and Chinese. To our knowledge, no available aVHS has been designed or validated in Arabic or French. Objective: The aim of this research is to translate the aVHS from its original English language to Arabic and French and validate the translations in the WHO Eastern Mediterranean region. Methods: The study will follow a cross-sectional design divided into 5 phases. In phase 1, the original aVHS will be forward-translated to Arabic and French, followed by backward translation to English. An expert committee will review and rate all versions of the translations. Expert agreement will then be measured using the Cohen kappa coefficient (k). In phase 2, the translated aVHS will be pilot-tested with 2 samples of participants (n=100): a group that speaks both Arabic and English and another that speaks French and English. Participants’ responses to the English version will also be collected. In phase 3, responses will then be compared. Descriptive statistics and paired t tests or one-way analyses of variance (ANOVA) and Pearson correlation coefficient will be used in the preliminary validation. In phase 4, prefinal versions (Arabic and French) will be tested with larger sample sizes of Arabic speakers (n=1000) and French speakers (n=1000). Sociodemographic information and vaccination status will be collected and used for further analysis. In phase 5, the scale's statistical reliability and internal consistency will be measured using Cronbach alpha. An exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) will be used to examine the model fit resulting from the EFA. ANOVA and regression models will be constructed to control for confounders. All data will be electronically collected. Results: As of January 2022, the scale had been translated to Arabic and French and was undergoing the process of back translation. All data collection tools have been prepared (ie, sociodemographics, vaccination status, and open-ended questions) and are ready to go into their electronic formats. We expect to reach the desired sample size in this phase by June 2022. Conclusions: This study will provide researchers with a validated tool to assess adult vaccine hesitancy within populations that speak Arabic and/or French and provide a road map to scale translation and ensure cross-cultural adaptation. International Registered Report Identifier (IRRID): PRR1-10.2196/36928 %M 35247043 %R 10.2196/36928 %U https://www.researchprotocols.org/2022/4/e36928 %U https://doi.org/10.2196/36928 %U http://www.ncbi.nlm.nih.gov/pubmed/35247043 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 4 %P e31459 %T Problem-Based mHealth Literacy Scale (PB-mHLS): Development and Validation %A Zhang,Lingmin %A Li,Pengxiang %+ School of Media and Communication, Shenzhen University, #L7-910, Houhai AVE, Nanshan District, Shenzhen, 518060, China, 86 0755 86581227, lipx@szu.edu.cn %K mobile health %K mHealth literacy %K instrument development %K problem-based framework %D 2022 %7 8.4.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile devices have greatly facilitated the use of digital health resources, particularly during the COVID-19 pandemic. Mobile health (mHealth) has become a common and important way to monitor and improve health conditions for people from different social classes. The ability to utilize mHealth affects its effectiveness; therefore, the widespread application of mHealth technologies calls for an instrument that can accurately measure health literacy in the era of mobile media. Objective: We aimed to (1) identify the components of mHealth literacy for ordinary users and (2) develop a systematic scale for appropriately measuring individuals’ self-perceived mHealth literacy through a problem-based framework. Methods: We conducted an exploratory study involving in-depth interviews and observations (15 participants) in January 2020 and used exploratory factor analysis and confirmatory factor analysis to identify the components of mHealth literacy and develop an item pool. In February 2020, we conducted a pilot survey with 148 participants to explore the factor structures of items identified during the exploratory study. Subsequently, 2 surveys were administrated using quota sampling. The first survey (conducted in Guangdong, China) collected 552 responses during March 2020; we assessed composite reliability, convergent validity, and discriminant validity. The second survey (conducted in China nationwide) collected 433 responses during October 2021; we assessed criterion-related validity using structural equation modeling. Results: We identified 78 items during the exploratory study. The final scale—the Problem-Based mHealth Literacy Scale—consists of 33 items that reflect 8 domains of mHealth literacy. The first web-based survey suggested that mHealth literacy consists of 8 factors (ie, subscales), namely, mHealth desire, mobile phone operational skills, acquiring mHealth information, acquiring mHealth services, understanding of medical terms, mobile-based patient–doctor communication, evaluating mHealth information, and mHealth decision-making. These factors were found to be reliable (composite reliability >0.7), with good convergent validity (average variance extracted >0.5) and discriminant validity (square root of average variance extracted are greater than the correlation coefficients between factors). The findings also revealed that these 8 factors should be grouped under a second-order factor model (χ2/df=2.701; comparative fit index 0.921; root mean square error of approximation 0.056; target coefficient 0.831). The second survey revealed that mHealth use had a significant impact (β=0.43, P<.001) on mHealth literacy and that mHealth literacy had a significant impact (β=0.23, P<.001) on health prevention behavior. Conclusions: This study revealed the distinctiveness of mHealth literacy by placing mHealth needs, the ability to understand medical terms, and the skills in patient–doctor interactions in the foreground. The Problem-Based mHealth Literacy Scale is a useful instrument for comprehensively measuring individuals’ mHealth literacy and extends the concept of health literacy to the context of mobile communication. %M 35394446 %R 10.2196/31459 %U https://mhealth.jmir.org/2022/4/e31459 %U https://doi.org/10.2196/31459 %U http://www.ncbi.nlm.nih.gov/pubmed/35394446 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e30877 %T Prioritizing Support Offered to Caregivers by Examining the Status Quo and Opportunities for Enhancement When Using Web-Based Self-reported Health Questionnaires: Descriptive Qualitative Study %A Coles,Theresa %A Lucas,Nicole %A Daniell,Erin %A Sullivan,Caitlin %A Wang,Ke %A Olsen,Jennifer M %A Shepherd-Banigan,Megan %+ Department of Population Health Sciences, Duke University, 215 Morris St, Durham, NC, 27701, United States, 1 919 613 7994, theresa.coles@duke.edu %K caregiver %K web-based questionnaires %K self-report questionnaires %K caregiver outcomes %K intervention technology %K patient-reported outcome measures %D 2022 %7 8.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Rosalynn Carter Institute for Caregivers (RCI) offers evidence-based interventions to promote caregivers’ health and well-being. Trained coaches regularly meet with caregivers to offer education and instructions to improve caregiver health, build skill sets, and increase resilience. Two of these interventions, RCI Resources for Enhancing Alzheimer's Caregiver Health (REACH) and Operation Family Caregiver (OFC), use a set of caregiver-reported questionnaires to monitor caregivers’ health status and needs. Objective: This study aims to describe how web-based assessment questionnaires are used to identify and monitor caregiver status in the RCI REACH and OFC programs and outlines perceived enhancements to the web-based system that could support caregiver-coach encounters by directing priorities. Methods: This was a descriptive, qualitative study. Data were collected via semistructured interviews with caregivers and coaches in the RCI REACH and OFC programs from July 2020 to October 2020. During the interviews, participants were asked to describe how the assessment questionnaires were used to inform caregiver-coach encounters, perceived usefulness of enhancements to web-based display, and preference for the structure of score results. The interviews were recorded, transcribed, and coded using structural and interpretive codes from a structured codebook. Qualitative content analysis was used to identify themes and summarize the results. Results: A total of 25 caregivers (RCI REACH: 13/25, 52%; OFC: 12/25, 48%) and 11 coaches (RCI REACH: 5/11, 45%; OFC: 6/11, 55%) were interviewed. Most caregivers indicated that the assessment questions were relevant to their caregiving experience. Some caregivers and coaches indicated that they thought the assessment should be administered multiple times throughout the program to evaluate the caregiver progress. Overall, caregivers did not want their scores to be compared with those of other caregivers, and there was heterogeneity in how caregivers preferred to view their results at the question or topic level. Coaches were uncertain as to which and how much of the results from the self-reported questionnaires should be shared with caregivers. Overall, the results were very similar, regardless of program affiliation (RCI REACH vs OFC). Conclusions: Web-based and procedural enhancements were identified to enrich caregiver-coach encounters. New and enhanced strategies for using web-based assessment questionnaires to direct priorities in the caregiver-coach encounters included integrating figures showing caregiver progress at the individual caregiver level, ability to toggle results through different figures focused on individual versus aggregate results, and support for interpreting scores. The results of this qualitative study will drive the next steps for RCI’s web-based platform and expand on current standards for administering self-reported questionnaires in clinical practice settings. %M 35394436 %R 10.2196/30877 %U https://formative.jmir.org/2022/4/e30877 %U https://doi.org/10.2196/30877 %U http://www.ncbi.nlm.nih.gov/pubmed/35394436 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e26307 %T Differences in Learning and Persistency Characterizing Behavior in Chronic Pain for the Iowa Gambling Task: Web-Based Laboratory-in-the-Field Study %A Zhang,Lili %A Vashisht,Himanshu %A Nethra,Alekhya %A Slattery,Brian %A Ward,Tomas %+ School of Computing, Dublin City University, McNulty Building, Glasnevin Campus, Dublin 9, Ireland, 353 0873747816, lili.zhang27@mail.dcu.ie %K chronic pain %K decision-making %K computational modeling %K Iowa Gambling Task %K lab-in-the-field experiment %D 2022 %7 6.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic pain is a significant worldwide health problem. It has been reported that people with chronic pain experience decision-making impairments, but these findings have been based on conventional laboratory experiments to date. In such experiments, researchers have extensive control of conditions and can more precisely eliminate potential confounds. In contrast, there is much less known regarding how chronic pain affects decision-making captured via laboratory-in-the-field experiments. Although such settings can introduce more experimental uncertainty, collecting data in more ecologically valid contexts can better characterize the real-world impact of chronic pain. Objective: We aim to quantify decision-making differences between individuals with chronic pain and healthy controls in a laboratory-in-the-field environment by taking advantage of internet technologies and social media. Methods: A cross-sectional design with independent groups was used. A convenience sample of 45 participants was recruited through social media: 20 (44%) participants who self-reported living with chronic pain, and 25 (56%) people with no pain or who were living with pain for <6 months acting as controls. All participants completed a self-report questionnaire assessing their pain experiences and a neuropsychological task measuring their decision-making (ie, the Iowa Gambling Task) in their web browser at a time and location of their choice without supervision. Results: Standard behavioral analysis revealed no differences in learning strategies between the 2 groups, although qualitative differences could be observed in the learning curves. However, computational modeling revealed that individuals with chronic pain were quicker to update their behavior than healthy controls, which reflected their increased learning rate (95% highest–posterior-density interval [HDI] 0.66-0.99) when fitted to the Values-Plus-Perseverance model. This result was further validated and extended on the Outcome-Representation Learning model as higher differences (95% HDI 0.16-0.47) between the reward and punishment learning rates were observed when fitted to this model, indicating that individuals with chronic pain were more sensitive to rewards. It was also found that they were less persistent in their choices during the Iowa Gambling Task compared with controls, a fact reflected by their decreased outcome perseverance (95% HDI −4.38 to −0.21) when fitted using the Outcome-Representation Learning model. Moreover, correlation analysis revealed that the estimated parameters had predictive value for the self-reported pain experiences, suggesting that the altered cognitive parameters could be potential candidates for inclusion in chronic pain assessments. Conclusions: We found that individuals with chronic pain were more driven by rewards and less consistent when making decisions in our laboratory-in-the-field experiment. In this case study, it was demonstrated that, compared with standard statistical summaries of behavioral performance, computational approaches offered superior ability to resolve, understand, and explain the differences in decision-making behavior in the context of chronic pain outside the laboratory. %M 35384855 %R 10.2196/26307 %U https://www.jmir.org/2022/4/e26307 %U https://doi.org/10.2196/26307 %U http://www.ncbi.nlm.nih.gov/pubmed/35384855 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e30676 %T Development and Evaluation of Short-Form Measures of the HIV/AIDS Knowledge Assessment Tool Among Sexual and Gender Minorities in Brazil: Cross-sectional Study %A Ferreira,Rayanne C %A Torres,Thiago S %A Ceccato,Maria Das Graças B %A Bezerra,Daniel RB %A Thombs,Brett D %A Luz,Paula M %A Harel,Daphna %+ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av Brasil 4365 Manguinhos, Rio de Janeiro, 21040-900, Brazil, 55 21 3865 9623, luzpaulamendes@gmail.com %K HIV %K knowledge %K sexual and gender minorities %K Brazil %K preexposure prophylaxis %D 2022 %7 29.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In theoretical models of health behavior, knowledge about disease transmission and self-protective behaviors are conceptualized as important drivers of behavior change. Several studies conducted in Brazil point to an unfortunate convergence of sexual and gender minority (SGM) populations with low levels of HIV knowledge and younger age, lower education, engagement in higher-risk sexual behavior, and never having tested for HIV. Measures to assess level of HIV knowledge have been previously published, including the 12-item HIV/AIDS Knowledge Assessment (HIV-KA) tool. However, measure length can be a barrier to assessment. Objective: We started from the 12-item HIV-KA tool and developed candidate short forms using statistical procedures, evaluated their psychometric properties, and tested the equivalency of their associations with other measures of HIV knowledge compared to the 12-item version. Methods: A convenience sample of SGM was recruited during September 2020 to complete an online survey through advertisements on two social networking apps (Grindr and Hornet). The survey instrument included items on sociodemographic information, prior HIV testing and HIV test results, preexposure prophylaxis (PrEP) and antiretroviral treatment use, sexual behavior, and 3 HIV knowledge measures: the HIV-KA, World Health Organization Knowledge About HIV Transmission Prevention Indicator, and the Brief HIV Knowledge Questionnaire. We used exploratory factor analysis and confirmatory factor analysis (CFA) to assess the factor structure of the of the HIV-KA. We used optimal test assembly (OTA) methods to develop candidate short forms of the HIV-KA and evaluated them based on prespecified reliability, concurrent validity, and statistically equivalent convergent validity criteria. Results: Among 2552 SGM individuals from Brazil, mean age was 35.1 years, 98.2% (2507/2552) cisgender men and 1.8% (45/2552) transgender/nonbinary, 56.5% (1441/2552) White, and 31.0% (792/2552) self-reported HIV positive. CFA indicated a 1-factor structure for the 12-item HIV-KA. Concurrent validity correlations were high for all short forms with 6 items, but only versions with 9 items were as reliable as the full-length form and demonstrated equivalency for convergent validity correlations. Suggesting post hoc convergent validity, HIV knowledge scores using the 9- and 10-item short forms were higher for participants who perceived the Undetectable Equals Untransmittable (U=U) slogan as completely accurate versus not accurate. Suggesting post hoc concurrent validity, participants of younger age, of Black, Pardo or indigenous race, and reporting lower education and lower income scored lower on HIV knowledge. Participants who never tested for HIV scored lower than those who tested negative or positive, while those currently using PrEP scored higher than those reporting past or never use. Conclusions: OTA methods were used to shorten the 12-item HIV-KA to 9-item and 10-item versions while maintaining comparable reliability and validity among a large sample of Brazilian SGM. However, these short forms did not shorten sufficiently to justify deviation from the full measure. %M 35348470 %R 10.2196/30676 %U https://publichealth.jmir.org/2022/3/e30676 %U https://doi.org/10.2196/30676 %U http://www.ncbi.nlm.nih.gov/pubmed/35348470 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32537 %T A Novel Experience Sampling Method Tool Integrating Momentary Assessments of Cognitive Biases: Two Compliance, Usability, and Measurement Reactivity Studies %A Boemo,Teresa %A Socastro,Angela %A Blanco,Ivan %A Martin-Garcia,Oscar %A Pacheco-Romero,Ana Mar %A Rodríguez-Carvajal,Raquel %A Sanchez-Lopez,Alvaro %+ Complutense University of Madrid, Campus de Somosaguas, s/n, Madrid, 28223, Spain, 34 674107873, mboemo@ucm.es %K experience sampling method %K compliance %K usability %K measurement reactivity %K emotion %K cognitive biases %D 2022 %7 28.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Experience sampling methods (ESMs) are increasingly being used to study ecological emotion dynamics in daily functioning through repeated assessments taken over several days. However, most of these ESM approaches are only based on self-report assessments, and therefore, studies on the ecological trajectories of their underlying mechanisms are scarce (ie, cognitive biases) and require evaluation through experimental tasks. We developed a novel ESM tool that integrates self-report measures of emotion and emotion regulation with a previously validated app-based cognitive task that allows for the assessment of underlying mechanisms during daily functioning. Objective: The objective of the study is to test this new tool and study its usability and the possible factors related to compliance with it in terms of latency and missing responses. Among the compliance predictors, we considered psychological and time-related variables, as well as usability, measurement reactivity, and participants’ satisfaction with the tool. Methods: We conducted 2 extensive ESM studies—study 1 (N=84; a total of 3 assessments per day for 5 days) and study 2 (N=135; a total of 3 assessments per day for 10 days). Results: In both studies, participants found the tool highly usable (average usability score >81). By using mixed regression models, we found both common and specific results for the compliance predictors. In both study 1 and study 2, latency was significantly predicted by the day (P<.001 and P=.003, respectively). Participants showed slower responses to the notification as the days of the study progressed. In study 2 but not in study 1, latency was further predicted by individual differences in overload with the use of the app, and missing responses were accounted for by individual differences in stress reactivity to notifications (P=.04). Thus, by using a more extensive design, participants who experienced higher overload during the study were characterized by slower responses to notifications (P=.01), whereas those who experienced higher stress reactivity to the notification system were characterized by higher missing responses. Conclusions: The new tool had high levels of usability. Furthermore, the study of compliance is of enormous importance when implementing novel ESM methods, including app-based cognitive tasks. The main predictors of latency and missing responses found across studies, specifically when using extensive ESM protocols (study 2), are methodology-related variables. Future research that integrates cognitive tasks in ESM designs should take these results into consideration by performing accurate estimations of participants’ response rates to facilitate the optimal quality of novel eHealth approaches, as in this study. %M 35343900 %R 10.2196/32537 %U https://formative.jmir.org/2022/3/e32537 %U https://doi.org/10.2196/32537 %U http://www.ncbi.nlm.nih.gov/pubmed/35343900 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e28927 %T Digital Assessment Tools Using Animation Features to Quantify Alcohol Consumption: Systematic App Store and Literature Review %A Wiemker,Veronika %A Neufeld,Maria %A Bunova,Anna %A Danquah,Ina %A Ferreira-Borges,Carina %A Konigorski,Stefan %A Rastogi,Ankit %A Probst,Charlotte %+ Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 6221 56 5040, charlotte.probst@uni-heidelberg.de %K alcohol consumption %K harmful and hazardous drinking %K screening %K assessment methods %K eHealth %K mobile apps %K visualization %K animation features %K AUDIT %K primary health care %D 2022 %7 23.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Accurate and user-friendly assessment tools for quantifying alcohol consumption are a prerequisite for effective interventions to reduce alcohol-related harm. Digital assessment tools (DATs) that allow the description of consumed alcoholic drinks through animation features may facilitate more accurate reporting than conventional approaches. Objective: This review aims to identify and characterize freely available DATs in English or Russian that use animation features to support the quantitative assessment of alcohol consumption (alcohol DATs) and determine the extent to which such tools have been scientifically evaluated in terms of feasibility, acceptability, and validity. Methods: Systematic English and Russian searches were conducted in iOS and Android app stores and via the Google search engine. Information on the background and content of eligible DATs was obtained from app store descriptions, websites, and test completions. A systematic literature review was conducted in Embase, MEDLINE, PsycINFO, and Web of Science to identify English-language studies reporting the feasibility, acceptability, and validity of animation-using alcohol DATs. Where possible, the evaluated DATs were accessed and assessed. Owing to the high heterogeneity of study designs, results were synthesized narratively. Results: We identified 22 eligible alcohol DATs in English, 3 (14%) of which were also available in Russian. More than 95% (21/22) of tools allowed the choice of a beverage type from a visually displayed selection. In addition, 36% (8/22) of tools enabled the choice of a drinking vessel. Only 9% (2/22) of tools allowed the simulated interactive pouring of a drink. For none of the tools published evaluation studies were identified in the literature review. The systematic literature review identified 5 exploratory studies evaluating the feasibility, acceptability, and validity of 4 animation-using alcohol DATs, 1 (25%) of which was available in the searched app stores. The evaluated tools reached moderate to high scores on user rating scales and showed fair to high convergent validity when compared with established assessment methods. Conclusions: Animation-using alcohol DATs are available in app stores and on the web. However, they often use nondynamic features and lack scientific background information. Explorative study data suggest that such tools might enable the user-friendly and valid assessment of alcohol consumption and could thus serve as a building block in the reduction of alcohol-attributable health burden worldwide. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020172825; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172825 %M 35319472 %R 10.2196/28927 %U https://www.jmir.org/2022/3/e28927 %U https://doi.org/10.2196/28927 %U http://www.ncbi.nlm.nih.gov/pubmed/35319472 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e28692 %T Statistical Methods for Item Reduction in a Representative Lifestyle Questionnaire: Pilot Questionnaire Study %A Staffini,Alessio %A Fujita,Kento %A Svensson,Akiko Kishi %A Chung,Ung-Il %A Svensson,Thomas %+ Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan, 81 358414737, kishi@bioeng.t.u-tokyo.ac.jp %K item reduction %K surveys and lifestyle questionnaires %K feedback measures %K questionnaire design %K variance inflation factor %K factor analysis %K mobile phone %D 2022 %7 18.3.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Reducing the number of items in a questionnaire while maintaining relevant information is important as it is associated with advantages such as higher respondent engagement and reduced response error. However, in health care, after the original design, an a posteriori check of the included items in a questionnaire is often overlooked or considered to be of minor importance. When conducted, this is often based on a single selected method. We argue that before finalizing any lifestyle questionnaire, a posteriori validation should always be conducted using multiple approaches to ensure the robustness of the results. Objective: The objectives of this study are to compare the results of two statistical methods for item reduction (variance inflation factor [VIF] and factor analysis [FA]) in a lifestyle questionnaire constructed by combining items from different sources and analyze the different results obtained from the 2 methods and the conclusions that can be made about the original items. Methods: Data were collected from 79 participants (heterogeneous in age and sex) with a high risk of metabolic syndrome working in a financial company based in Tokyo. The lifestyle questionnaire was constructed by combining items (asked with daily, weekly, and monthly frequency) from multiple validated questionnaires and other selected questions. Item reduction was conducted using VIF and exploratory FA. Adequacy tests were used to check the data distribution and sampling adequacy. Results: Among the daily and weekly questions, both VIF and FA identified redundancies in sleep-related items. Among the monthly questions, both approaches identified redundancies in stress-related items. However, the number of items suggested for reduction often differed: VIF suggested larger reductions than FA for daily questions but fewer reductions for weekly questions. Adequacy tests always confirmed that the structural detection was adequate for the considered items. Conclusions: As expected, our analyses showed that VIF and FA produced both similar and different findings, suggesting that questionnaire designers should consider using multiple methods for item reduction. Our findings using both methods indicate that many questions, especially those related to sleep, are redundant, indicating that the considered lifestyle questionnaire can be shortened. %M 35302507 %R 10.2196/28692 %U https://www.i-jmr.org/2022/1/e28692 %U https://doi.org/10.2196/28692 %U http://www.ncbi.nlm.nih.gov/pubmed/35302507 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e23589 %T CoGNIT Automated Tablet Computer Cognitive Testing in Patients With Mild Cognitive Impairment: Feasibility Study %A Behrens,Anders %A Berglund,Johan Sanmartin %A Anderberg,Peter %+ Department of Health, Blekinge Institute of Technology, Valhallavägen 1, Karlskrona, 37141, Sweden, 46 734223736, pan@bth.se %K internet %K cognitive testing %K software %K testing %K impairment %K cognition %K feasibility %K diagnosis %K app %K assessment %K cognitive impairment %D 2022 %7 11.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Early diagnosis of cognitive disorders is becoming increasingly important. Limited resources for specialist assessment and an increasing demographical challenge warrants the need for efficient methods of evaluation. In response, CoGNIT, a tablet app for automatic, standardized, and efficient assessment of cognitive function, was developed. Included tests span the cognitive domains regarded as important for assessment in a general memory clinic (memory, language, psychomotor speed, executive function, attention, visuospatial ability, manual dexterity, and symptoms of depression). Objective: The aim of this study was to assess the feasibility of automatic cognitive testing with CoGNIT in older patients with symptoms of mild cognitive impairment (MCI). Methods: Patients older than 55 years with symptoms of MCI (n=36) were recruited at the research clinic at the Blekinge Institute of Technology (BTH), Karlskrona, Sweden. A research nurse administered the Mini-Mental State Exam (MMSE) and the CoGNIT app on a tablet computer. Technical and testing issues were documented. Results: The test battery was completed by all 36 patients. One test, the four-finger–tapping test, was performed incorrectly by 42% of the patients. Issues regarding clarity of instructions were found in 2 tests (block design test and the one finger-tapping test). Minor software bugs were identified. Conclusions: The overall feasibility of automatic cognitive testing with the CoGNIT app in patients with symptoms of MCI was good. The study highlighted tests that did not function optimally. The four-finger–tapping test will be discarded, and minor improvements to the software will be added before further studies and deployment in the clinic. %M 35275064 %R 10.2196/23589 %U https://formative.jmir.org/2022/3/e23589 %U https://doi.org/10.2196/23589 %U http://www.ncbi.nlm.nih.gov/pubmed/35275064 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e29009 %T Comparing SF-36 Scores Collected Through Web-Based Questionnaire Self-completions and Telephone Interviews: An Ancillary Study of the SENTIPAT Multicenter Randomized Controlled Trial %A Açma,Ayşe %A Carrat,Fabrice %A Hejblum,Gilles %+ Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, 27 Rue Chaligny, Paris, 75012, France, gilles.hejblum@inserm.fr %K Bias, Epidemiologic %K Effect Modifier, Epidemiologic %K Forms as Topic %K Interviews, Telephone %K Internet %K Patient Reported Outcome Measures %K Patient Satisfaction %K Quality of Life %K Surveys and Questionnaires %D 2022 %7 10.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The 36-Item Short Form Health Survey (SF-36) is a popular questionnaire for measuring the self-perception of quality of life in a given population of interest. Processing the answers of a participant comprises the calculation of 10 scores corresponding to 8 scales measuring several aspects of perceived health and 2 summary components (physical and mental). Surprisingly, no study has compared score values issued from a telephone interview versus those from an internet-based questionnaire self-completion. Objective: This study aims to compare the SF-36 score values issued from a telephone interview versus those from an internet-based questionnaire self-completion. Methods: Patients with an internet connection and returning home after hospital discharge were enrolled in the SENTIPAT multicenter randomized trial on the day of discharge. They were randomized to either self-completing a set of questionnaires using a dedicated website (internet group) or providing answers to the same questionnaires administered during a telephone interview (telephone group). This ancillary study of the trial compared SF-36 data related to the posthospitalization period in these 2 groups. To anticipate the potential unbalanced characteristics of the responders in the 2 groups, the impact of the mode of administration of the questionnaire on score differences was investigated using a matched sample of individuals originating from the internet and telephone groups (1:1 ratio), in which the matching procedure was based on a propensity score approach. SF-36 scores observed in the internet and telephone groups were compared using the Wilcoxon-Mann-Whitney test, and the score differences between the 2 groups were also examined according to Cohen effect size. Results: Overall, 29.2% (245/840) and 75% (630/840) of SF-36 questionnaires were completed in the internet and telephone groups, respectively (P<.001). Globally, the score differences between groups before matching were similar to those observed in the matched sample. Mean scores observed in the telephone group were all above the corresponding values observed in the internet group. After matching, score differences in 6 out of the 8 SF-36 scales were statistically significant, with a mean difference greater than 5 for 4 scales and an associated mild effect size ranging from 0.22 to 0.29, and with a mean difference near this threshold for 2 other scales (4.57 and 4.56) and a low corresponding effect size (0.18 and 0.16, respectively). Conclusions: The telephone mode of administration of SF-36 involved an interviewer effect, increasing SF-36 scores. Questionnaire self-completion via the internet should be preferred, and surveys combining various administration methods should be avoided. Trial Registration: ClinicalTrials.gov NCT01769261; https://www.clinicaltrials.gov/ct2/show/record/NCT01769261 %M 35266869 %R 10.2196/29009 %U https://www.jmir.org/2022/3/e29009 %U https://doi.org/10.2196/29009 %U http://www.ncbi.nlm.nih.gov/pubmed/35266869 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e29063 %T A Web-Based Self-assessment Model for Evaluating Multidisciplinary Cancer Teams in Spain: Development and Validation Pilot Study %A Guilabert,Mercedes %A Prades,Joan %A Borras,Josep M %A Maestu,Inmaculada %A Guerra,Juan Antonio %A Fumadó,Lluís %A Mira,José Joaquin %A , %+ Health Psychology Department, Miguel Hernandez University, Avda de la Universidad s/n, Elche, 03202, Spain, 34 96 665 83 17, mguilabert@umh.es %K web-based tool %K multidisciplinary care %K cancer %K evaluation %K quality assurance %D 2022 %7 10.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Tumor boards constitute the main consensus and clinical decision–making body of multidisciplinary teams (MDTs) in cancer care. With the increasing clinical complexity of treatment options (eg, targeted therapies, multimodal treatments) and the progressive incorporation of new areas of intervention (eg, survivorship care), tumor boards are now required to play a central role in all cancer processes. However, although frameworks are in place to evaluate MDT quality, only few web-based tools are available for this purpose; indeed, no web-based MDT evaluation tools have been developed for or adapted to the Spanish National Health System. Objective: The first aim of this study was to develop a web-based self-assessment model (Autoevaluación de Equipos Multidisciplinares de Atención al Cáncer [AEMAC]) for evaluating multidisciplinary cancer teams in Spain and the second aim was to validate this tool by testing its metric properties, acceptability, and usability. Methods: We designed and validated the AEMAC program in 3 stages. In the first stage (research), we reviewed the available scientific evidence and performed a qualitative case study of good practice in multidisciplinary care within the Spanish National Health System (n=4 centers and 28 health care professionals). The results were used to define the thematic areas and quality criteria for the self-evaluation model, which were then discussed and validated by a group of experts. The second stage (development) involved the technological development of a web app that would be accessible from any mobile device. In the third stage (piloting and validation), we conducted 4 pilot tests (n=15 tumor boards, 243 professionals) and used the results to analyze the acceptability and usefulness of the tool. Results: We designed a self-assessment model based on 5 thematic areas encompassing a total of 25 quality components, which users rated on a 3-option development scale. The evaluation process, which was managed entirely from the web app, consisted of individual self-assessment, group prioritization, and creation of an improvement plan. Cronbach alpha (.86), McDonald’s omega (0.88), and various fit indices (comparative fit index between 0.95 and 1 and goodness-of-fit index between 0.97 and 0.99 for all 5 aspects) confirmed internal consistency. The mean rating for overall satisfaction with the tool and for consistency between the content of the tool and the reality of tumor boards was 7.6 out of 10. Conclusions: The results obtained during the period of research and piloting of the AEMAC program showed that it has an appropriate structure and metric properties and could therefore be implemented in a real context and generalized to other hospitals. As a virtual tool, it helps to measure the key aspects of MDT quality, such as effectiveness of collaboration and communication, leadership, and the organizational environment. %M 35266870 %R 10.2196/29063 %U https://www.jmir.org/2022/3/e29063 %U https://doi.org/10.2196/29063 %U http://www.ncbi.nlm.nih.gov/pubmed/35266870 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e32777 %T Validity Evidence of the eHealth Literacy Questionnaire (eHLQ) Part 2: Mixed Methods Approach to Evaluate Test Content, Response Process, and Internal Structure in the Australian Community Health Setting %A Cheng,Christina %A Elsworth,Gerald R %A Osborne,Richard H %+ School of Health Sciences, Centre for Global Health and Equity, Swinburne University of Technology, Room 907, Level 9, AMCD Building, 453/469-477 Burwood Road, Hawthorn, 3122, Australia, 61 392145470, cccheng@swin.edu.au %K eHealth %K health literacy %K health equity %K questionnaire design %K validity evidence %K eHLQ %K mobile phone %D 2022 %7 8.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital technologies have changed how we manage our health, and eHealth literacy is needed to engage with health technologies. Any eHealth strategy would be ineffective if users’ eHealth literacy needs are not addressed. A robust measure of eHealth literacy is essential for understanding these needs. On the basis of the eHealth Literacy Framework, which identified 7 dimensions of eHealth literacy, the eHealth Literacy Questionnaire (eHLQ) was developed. The tool has demonstrated robust psychometric properties in the Danish setting, but validity testing should be an ongoing and accumulative process. Objective: This study aims to evaluate validity evidence based on test content, response process, and internal structure of the eHLQ in the Australian community health setting. Methods: A mixed methods approach was used with cognitive interviewing conducted to examine evidence on test content and response process, whereas a cross-sectional survey was undertaken for evidence on internal structure. Data were collected at 3 diverse community health sites in Victoria, Australia. Psychometric testing included both the classical test theory and item response theory approaches. Methods included Bayesian structural equation modeling for confirmatory factor analysis, internal consistency and test-retest for reliability, and the Bayesian multiple-indicators, multiple-causes model for testing of differential item functioning. Results: Cognitive interviewing identified only 1 confusing term, which was clarified. All items were easy to read and understood as intended. A total of 525 questionnaires were included for psychometric analysis. All scales were homogenous with composite scale reliability ranging from 0.73 to 0.90. The intraclass correlation coefficient for test-retest reliability for the 7 scales ranged from 0.72 to 0.95. A 7-factor Bayesian structural equation modeling using small variance priors for cross-loadings and residual covariances was fitted to the data, and the model of interest produced a satisfactory fit (posterior productive P=.49, 95% CI for the difference between observed and replicated chi-square values −101.40 to 108.83, prior-posterior productive P=.92). All items loaded on the relevant factor, with loadings ranging from 0.36 to 0.94. No significant cross-loading was found. There was no evidence of differential item functioning for administration format, site area, and health setting. However, discriminant validity was not well established for scales 1, 3, 5, 6, and 7. Item response theory analysis found that all items provided precise information at different trait levels, except for 1 item. All items demonstrated different sensitivity to different trait levels and represented a range of difficulty levels. Conclusions: The evidence suggests that the eHLQ is a tool with robust psychometric properties and further investigation of discriminant validity is recommended. It is ready to be used to identify eHealth literacy strengths and challenges and assist the development of digital health interventions to ensure that people with limited digital access and skills are not left behind. %M 35258475 %R 10.2196/32777 %U https://www.jmir.org/2022/3/e32777 %U https://doi.org/10.2196/32777 %U http://www.ncbi.nlm.nih.gov/pubmed/35258475 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e33310 %T Classification of Patients for Whom Benefit of Long-term Opioid Therapy No Longer Outweighs Harm: Protocol for a Delphi Study %A Van Cleve,Raymond %A Edmond,Sara %A Snow,Jennifer %A Black,Anne C %A Pomeranz,Jamie L %A Becker,William %+ Center for Innovation to Implementation, 795 Willow Road (152-MPD), Menlo Park, CA, 94025, United States, 1 (650) 617 2746, vancleve.raymond@gmail.com %K modified Delphi technique %K long-term opioid treatment %K chronic pain %K opioid therapy %K opioids %K pain management %K Delphi study %D 2022 %7 4.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients with chronic pain prescribed long-term opioid therapy may come to a point where the benefits of the therapy are outweighed by the risks and tapering is indicated. At the 2019 Veterans Health Administration State of the Art Conference, there was an acknowledgment of a lack of clinical guidance with regard to treating this subset of patients. Some of the participants believed clinicians and patients would both benefit from a new diagnostic entity describing this situation. Objective: The aim of this study was to determine if a new diagnostic entity was needed and what the criteria of the diagnostic entity would be. Given the ability of the Delphi method to synthesize input from a broad range of experts, we felt this technique was the most appropriate for this study. Methods: We designed a modified Delphi technique involving 3 rounds. The first round is a series of open-ended questions asking about the necessity of this diagnostic entity, how this condition is different from opioid use disorder, and what its possible diagnostic criteria would be. After synthesizing the responses collected, a second round will be conducted to ask participants to rate the different responses offered by their peers. These ratings will be collected and analyzed, and will generate a preliminary definition for this clinical phenomena. In the third round, we will circulate this definition with the aim of achieving consensus. Results: The modified Delphi study was initiated in July of 2020 and analysis is currently underway. Conclusions: This protocol has been approved by the Internal Review Board at the Connecticut Veterans Affairs and the study is in process. This protocol may assist other researchers conducting similar studies. International Registered Report Identifier (IRRID): DERR1-10.2196/33310 %M 35254277 %R 10.2196/33310 %U https://www.researchprotocols.org/2022/3/e33310 %U https://doi.org/10.2196/33310 %U http://www.ncbi.nlm.nih.gov/pubmed/35254277 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31992 %T Psychometric Evaluation of a Fear of COVID-19 Scale in China: Cross-sectional Study %A Choi,Edmond P H %A Duan,Wenjie %A Fong,Daniel Y T %A Lok,Kris Y W %A Ho,Mandy %A Wong,Janet Y H %A Lin,Chia-Chin %+ School of Nursing, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 39176645, dytfong@hku.hk %K Chinese %K COVID-19 %K fear %K psychometric %K validation %K scale %K mental health %K information %K cross-sectional %K validity %K reliability %K support %D 2022 %7 2.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: At the very beginning of the COVID-19 pandemic, information about fear of COVID-19 was very limited in Chinese populations, and there was no standardized and validated scale to measure the fear associated with the pandemic. Objective: This cross-sectional study aimed to adapt and validate a fear scale to determine the levels of fear of COVID-19 among the general population in mainland China and Hong Kong. Methods: A web-based questionnaire platform was developed for data collection; the study instruments were an adapted version of the 8-item Breast Cancer Fear Scale (“Fear Scale”) and the 4-item Patient Health Questionnaire. The internal construct validity, convergent validity, known group validity, and reliability of the adapted Fear Scale were assessed, and descriptive statistics were used to summarize the participants’ fear levels. Results: A total of 2822 study participants aged 18 years or older were included in the analysis. The reliability of the adapted scale was satisfactory, with a Cronbach α coefficient of .93. The item-total correlations corrected for overlap were >0.4, confirming their internal construct validity. Regarding convergent validity, a small-to-moderate correlation between the Fear Scale and the 4-item Patient Health Questionnaire scores was found. Regarding known group validity, we found that the study participants who were recruited from Hong Kong had a higher level of fear than the study participants from mainland China. Older adults had a higher level of fear compared with younger adults. Furthermore, having hypertension, liver disease, heart disease, cancer, anxiety, and insomnia were associated with a higher fear level. The descriptive analysis found that more than 40% of the study participants reported that the thought of COVID-19 scared them. About one-third of the study participants reported that when they thought about COVID-19, they felt nervous, uneasy, and depressed. Conclusions: The psychometric properties of the adapted Fear Scale are acceptable to measure the fear of COVID-19 among Chinese people. Our study stresses the need for more psychosocial support and care to help this population cope with their fears during the pandemic. %M 35072632 %R 10.2196/31992 %U https://formative.jmir.org/2022/3/e31992 %U https://doi.org/10.2196/31992 %U http://www.ncbi.nlm.nih.gov/pubmed/35072632 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e29124 %T Novel Interactive Tool for Breast and Ovarian Cancer Risk Assessment (Bright Pink Assess Your Risk): Development and Usability Study %A Hibler,Elizabeth A %A Fought,Angela J %A Kershaw,Kiarri N %A Molsberry,Rebecca %A Nowakowski,Virginia %A Lindner,Deborah %+ Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, United States, 1 3125031178, elizabeth.hibler@northwestern.edu %K breast cancer %K ovarian cancer %K risk assessment %K genetic testing %D 2022 %7 24.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The lifetime risk of breast and ovarian cancer is significantly higher among women with genetic susceptibility or a strong family history. However, current risk assessment tools and clinical practices may identify only 10% of asymptomatic carriers of susceptibility genes. Bright Pink developed the Assess Your Risk (AYR) tool to estimate breast and ovarian cancer risk through a user-friendly, informative web-based quiz for risk assessment at the population level. Objective: This study aims to present the AYR tool, describe AYR users, and present evidence that AYR works as expected by comparing classification using the AYR tool with gold standard genetic testing guidelines. Methods: The AYR is a recently developed population-level risk assessment tool that includes 26 questions based on the National Comprehensive Cancer Network (NCCN) guidelines and factors from other commonly used risk assessment tools. We included all women who completed the AYR between November 2018 and January 2019, with the exception of self-reported cancer or no knowledge of family history. We compared AYR classifications with those that were independently created using NCCN criteria using measures of validity and the McNemar test. Results: There were 143,657 AYR completions, and most participants were either at increased or average risk for breast cancer or ovarian cancer (137,315/143,657, 95.59%). Using our estimates of increased and average risk as the gold standard, based on the NCCN guidelines, we estimated the sensitivity and specificity for the AYR algorithm–generated risk categories as 100% and 89.9%, respectively (P<.001). The specificity improved when we considered the additional questions asked by the AYR to define increased risk, which were not examined by the NCCN criteria. By race, ethnicity, and age group; we found that the lowest observed specificity was for the Asian race (85.9%) and the 30 to 39 years age group (87.6%) for the AYR-generated categories compared with the NCCN criteria. Conclusions: These results demonstrate that Bright Pink’s AYR is an accurate tool for use by the general population to identify women at increased risk of breast and ovarian cancer. We plan to validate the tool longitudinally in future studies, including the impact of race, ethnicity, and age on breast and ovarian cancer risk assessment. %M 35200148 %R 10.2196/29124 %U https://www.jmir.org/2022/2/e29124 %U https://doi.org/10.2196/29124 %U http://www.ncbi.nlm.nih.gov/pubmed/35200148 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e34237 %T Asynchronous Remote Assessment for Cognitive Impairment: Reliability Verification of the Neurotrack Cognitive Battery %A Myers,Jennifer Rae %A Glenn,Jordan M %A Madero,Erica N %A Anderson,John %A Mak-McCully,Rachel %A Gray,Michelle %A Gills,Joshua L %A Harrison,John E %+ Neurotrack Technologies Inc, 399 Bradford St. #101, Redwood City, CA, 21216, United States, 1 650 549 8566, jennifer@neurotrack.com %K cognition %K screening %K remote testing %K psychometric %K challenge %K validation %K assessment %K impairment %K access %K reliability %K stability %K testing %K utility %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: As evidenced by the further reduction in access to testing during the COVID-19 pandemic, there is an urgent, growing need for remote cognitive assessment for individuals with cognitive impairment. The Neurotrack Cognitive Battery (NCB), our response to this need, was evaluated for its temporal reliability and stability as part of ongoing validation testing. Objective: The aim of this study is to assess the temporal reliability of the NCB tests (5 total) across a 1-week period and to determine the temporal stability of these measures across 3 consecutive administrations in a single day. Methods: For test-retest reliability, a range of 29-66 cognitively healthy participants (ages 18-68 years) completed each cognitive assessment twice, 1 week apart. In a separate study, temporal stability was assessed using data collected from 31 different cognitively healthy participants at 3 consecutive timepoints in a single day. Results: Correlations for the assessments were between 0.72 and 0.83, exceeding the standard acceptable threshold of 0.70 for temporal reliability. Intraclass correlations ranged from 0.60 to 0.84, indicating moderate to good temporal stability. Conclusions: These results highlight the NCB as a brief, easy-to-administer, and reliable assessment for remote cognitive testing. Additional validation research is underway to determine the full magnitude of the clinical utility of the NCB. %M 35179511 %R 10.2196/34237 %U https://formative.jmir.org/2022/2/e34237 %U https://doi.org/10.2196/34237 %U http://www.ncbi.nlm.nih.gov/pubmed/35179511 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e27337 %T Measurement Properties of Smartphone Approaches to Assess Diet, Alcohol Use, and Tobacco Use: Systematic Review %A Thornton,Louise %A Osman,Bridie %A Champion,Katrina %A Green,Olivia %A Wescott,Annie B %A Gardner,Lauren A %A Stewart,Courtney %A Visontay,Rachel %A Whife,Jesse %A Parmenter,Belinda %A Birrell,Louise %A Bryant,Zachary %A Chapman,Cath %A Lubans,David %A Slade,Tim %A Torous,John %A Teesson,Maree %A Van de Ven,Pepijn %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russel Building, Camperdown, Sydney, 2006, Australia, 61 0403744089, louise.thornton@sydney.edu.au %K smartphone %K app %K alcohol %K smoking %K diet %K measurement %K mobile phone %D 2022 %7 17.2.2022 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Poor diet, alcohol use, and tobacco smoking have been identified as strong determinants of chronic diseases, such as cardiovascular disease, diabetes, and cancer. Smartphones have the potential to provide a real-time, pervasive, unobtrusive, and cost-effective way to measure these health behaviors and deliver instant feedback to users. Despite this, the validity of using smartphones to measure these behaviors is largely unknown. Objective: The aim of our review is to identify existing smartphone-based approaches to measure these health behaviors and critically appraise the quality of their measurement properties. Methods: We conducted a systematic search of the Ovid MEDLINE, Embase (Elsevier), Cochrane Library (Wiley), PsycINFO (EBSCOhost), CINAHL (EBSCOHost), Web of Science (Clarivate), SPORTDiscus (EBSCOhost), and IEEE Xplore Digital Library databases in March 2020. Articles that were written in English; reported measuring diet, alcohol use, or tobacco use via a smartphone; and reported on at least one measurement property (eg, validity, reliability, and responsiveness) were eligible. The methodological quality of the included studies was assessed using the Consensus-Based Standards for the Selection of Health Measurement Instruments Risk of Bias checklist. Outcomes were summarized in a narrative synthesis. This systematic review was registered with PROSPERO, identifier CRD42019122242. Results: Of 12,261 records, 72 studies describing the measurement properties of smartphone-based approaches to measure diet (48/72, 67%), alcohol use (16/72, 22%), and tobacco use (8/72, 11%) were identified and included in this review. Across the health behaviors, 18 different measurement techniques were used in smartphones. The measurement properties most commonly examined were construct validity, measurement error, and criterion validity. The results varied by behavior and measurement approach, and the methodological quality of the studies varied widely. Most studies investigating the measurement of diet and alcohol received very good or adequate methodological quality ratings, that is, 73% (35/48) and 69% (11/16), respectively, whereas only 13% (1/8) investigating the measurement of tobacco use received a very good or adequate rating. Conclusions: This review is the first to provide evidence regarding the different types of smartphone-based approaches currently used to measure key behavioral risk factors for chronic diseases (diet, alcohol use, and tobacco use) and the quality of their measurement properties. A total of 19 measurement techniques were identified, most of which assessed dietary behaviors (48/72, 67%). Some evidence exists to support the reliability and validity of using smartphones to assess these behaviors; however, the results varied by behavior and measurement approach. The methodological quality of the included studies also varied. Overall, more high-quality studies validating smartphone-based approaches against criterion measures are needed. Further research investigating the use of smartphones to assess alcohol and tobacco use and objective measurement approaches is also needed. International Registered Report Identifier (IRRID): RR2-10.1186/s13643-020-01375-w %M 35175212 %R 10.2196/27337 %U https://mhealth.jmir.org/2022/2/e27337 %U https://doi.org/10.2196/27337 %U http://www.ncbi.nlm.nih.gov/pubmed/35175212 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30091 %T Usability of Wearable Multiparameter Technology to Continuously Monitor Free-Living Vital Signs in People Living With Chronic Obstructive Pulmonary Disease: Prospective Observational Study %A Hawthorne,Grace %A Greening,Neil %A Esliger,Dale %A Briggs-Price,Samuel %A Richardson,Matthew %A Chaplin,Emma %A Clinch,Lisa %A Steiner,Michael C %A Singh,Sally J %A Orme,Mark W %+ Centre for Exercise and Rehabilitation Science, National Institute for Health Research Leicester Biomedical Research Centre – Respiratory, University Hospitals of Leicester National Health Service Trust, Groby Road, Leicester, LE3 9QP, United Kingdom, 44 116258 ext 3035, grace.france1@nhs.net %K chronic obstructive pulmonary disease %K digital health %K physical activity %K respiratory rate %K wearable technology %K wearable device %K vital signs monitor %D 2022 %7 16.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Vital signs monitoring (VSM) is routine for inpatients, but monitoring during free-living conditions is largely untested in chronic obstructive pulmonary disease (COPD). Objective: This study investigated the usability and acceptability of continuous VSM for people with COPD using wearable multiparameter technology. Methods: In total, 50 people following hospitalization for an acute exacerbation of COPD (AECOPD) and 50 people with stable COPD symptoms were asked to wear an Equivital LifeMonitor during waking hours for 6 weeks (42 days). The device recorded heart rate (HR), respiratory rate (RR), skin temperature, and physical activity. Adherence was defined by the number of days the vest was worn and daily wear time. Signal quality was examined, with thresholds of ≥85% for HR and ≥80% for RR, based on the device’s proprietary confidence algorithm. Data quality was calculated as the percentage of wear time with acceptable signal quality. Participant feedback was assessed during follow-up phone calls. Results: In total, 84% of participants provided data, with average daily wear time of 11.8 (SD 2.2) hours for 32 (SD 11) days (average of study duration 76%, SD 26%). There was greater adherence in the stable group than in the post-AECOPD group (≥5 weeks wear: 71.4% vs 45.7%; P=.02). For all 84 participants, the median HR signal quality was 90% (IQR 80%-94%) and the median RR signal quality was 93% (IQR 92%-95%). The median HR data quality was 81% (IQR 58%-91%), and the median RR data quality was 85% (IQR 77%-91%). Stable group BMI was associated with HR signal quality (rs=0.45, P=.008) and HR data quality (rs=0.44, P=.008). For the AECOPD group, RR data quality was associated with waist circumference and BMI (rs=–0.49, P=.009; rs=–0.44, P=.02). In total, 36 (74%) participants in the Stable group and 21 (60%) participants in the AECOPD group accepted the technology, but 10 participants (12%) expressed concerns with wearing a device around their chest. Conclusions: This wearable multiparametric technology showed good user acceptance and was able to measure vital signs in a COPD population. Data quality was generally high but was influenced by body composition. Overall, it was feasible to continuously measure vital signs during free-living conditions in people with COPD symptoms but with additional challenges in the post-AECOPD context. %M 35171101 %R 10.2196/30091 %U https://humanfactors.jmir.org/2022/1/e30091 %U https://doi.org/10.2196/30091 %U http://www.ncbi.nlm.nih.gov/pubmed/35171101 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e31830 %T Identification of Social Engagement Indicators Associated With Autism Spectrum Disorder Using a Game-Based Mobile App: Comparative Study of Gaze Fixation and Visual Scanning Methods %A Varma,Maya %A Washington,Peter %A Chrisman,Brianna %A Kline,Aaron %A Leblanc,Emilie %A Paskov,Kelley %A Stockham,Nate %A Jung,Jae-Yoon %A Sun,Min Woo %A Wall,Dennis P %+ Department of Pediatrics and Biomedical Data Science, Stanford University, 1265 Welch Road, Stanford, CA, 94304, United States, 1 650 497 9214, dpwall@stanford.edu %K mobile health %K autism spectrum disorder %K social phenotyping %K computer vision %K gaze %K mobile diagnostics %K pattern recognition %K autism %K diagnostic %K pattern %K engagement %K gaming %K app %K insight %K vision %K video %D 2022 %7 15.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Autism spectrum disorder (ASD) is a widespread neurodevelopmental condition with a range of potential causes and symptoms. Standard diagnostic mechanisms for ASD, which involve lengthy parent questionnaires and clinical observation, often result in long waiting times for results. Recent advances in computer vision and mobile technology hold potential for speeding up the diagnostic process by enabling computational analysis of behavioral and social impairments from home videos. Such techniques can improve objectivity and contribute quantitatively to the diagnostic process. Objective: In this work, we evaluate whether home videos collected from a game-based mobile app can be used to provide diagnostic insights into ASD. To the best of our knowledge, this is the first study attempting to identify potential social indicators of ASD from mobile phone videos without the use of eye-tracking hardware, manual annotations, and structured scenarios or clinical environments. Methods: Here, we used a mobile health app to collect over 11 hours of video footage depicting 95 children engaged in gameplay in a natural home environment. We used automated data set annotations to analyze two social indicators that have previously been shown to differ between children with ASD and their neurotypical (NT) peers: (1) gaze fixation patterns, which represent regions of an individual’s visual focus and (2) visual scanning methods, which refer to the ways in which individuals scan their surrounding environment. We compared the gaze fixation and visual scanning methods used by children during a 90-second gameplay video to identify statistically significant differences between the 2 cohorts; we then trained a long short-term memory (LSTM) neural network to determine if gaze indicators could be predictive of ASD. Results: Our results show that gaze fixation patterns differ between the 2 cohorts; specifically, we could identify 1 statistically significant region of fixation (P<.001). In addition, we also demonstrate that there are unique visual scanning patterns that exist for individuals with ASD when compared to NT children (P<.001). A deep learning model trained on coarse gaze fixation annotations demonstrates mild predictive power in identifying ASD. Conclusions: Ultimately, our study demonstrates that heterogeneous video data sets collected from mobile devices hold potential for quantifying visual patterns and providing insights into ASD. We show the importance of automated labeling techniques in generating large-scale data sets while simultaneously preserving the privacy of participants, and we demonstrate that specific social engagement indicators associated with ASD can be identified and characterized using such data. %M 35166683 %R 10.2196/31830 %U https://www.jmir.org/2022/2/e31830 %U https://doi.org/10.2196/31830 %U http://www.ncbi.nlm.nih.gov/pubmed/35166683 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e28233 %T Web-Based Cognitive Testing in Psychiatric Research: Validation and Usability Study %A Lynham,Amy Joanne %A Jones,Ian R %A Walters,James T R %+ Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychiatry and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, CF24 4HQ, United Kingdom, 44 29206 88434, waltersjt@cardiff.ac.uk %K cognition %K mental health %K online %K digital %K assessment %K validation %K memory %K attention %K mobile phone %D 2022 %7 10.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive impairments are features of many psychiatric disorders and affect functioning. A barrier to cognitive research on psychiatric disorders is the lack of large cross-disorder data sets. However, the collection of cognitive data can be logistically challenging and expensive. Web-based collection may be an alternative; however, little is known about who does and does not complete web-based cognitive assessments for psychiatric research. Objective: The aims of this study are to develop a web-based cognitive battery for use in psychiatric research, validate the battery against the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery, and compare the characteristics of the participants who chose to take part with those of the individuals who did not participate. Methods: Tasks were developed by The Many Brains Project and selected to measure the domains specified by the MATRICS initiative. We undertook a cross-validation study of 65 participants with schizophrenia, bipolar disorder, depression, or no history of psychiatric disorders to compare the web-based tasks with the MATRICS Consensus Cognitive Battery. Following validation, we invited participants from 2 large ongoing genetic studies, which recruited participants with psychiatric disorders to complete the battery and evaluated the demographic and clinical characteristics of those who took part. Results: Correlations between web-based and MATRICS tasks ranged between 0.26 and 0.73. Of the 961 participants, 887 (92.3%) completed at least one web-based task, and 644 (67%) completed all tasks, indicating adequate completion rates. Predictors of web-based participation included being female (odds ratio [OR] 1.3, 95% CI 1.07-1.58), ethnicity other than White European (OR 0.66, 95% CI 0.46-0.96), higher levels of education (OR 1.19, 95% CI 1.11-1.29), diagnosis of an eating disorder (OR 2.17, 95% CI 1.17-4) or depression and anxiety (OR 5.12, 95% CI 3.38-7.83), and absence of a diagnosis of schizophrenia (OR 0.59, 95% CI 0.35-0.94). Lower performance on the battery was associated with poorer functioning (B=−1.76, SE 0.26; P<.001). Conclusions: Our findings offer valuable insights into the advantages and disadvantages of testing cognitive function remotely for mental health research. %M 35142640 %R 10.2196/28233 %U https://www.jmir.org/2022/2/e28233 %U https://doi.org/10.2196/28233 %U http://www.ncbi.nlm.nih.gov/pubmed/35142640 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e31146 %T An Ethics Checklist for Digital Health Research in Psychiatry: Viewpoint %A Shen,Francis X %A Silverman,Benjamin C %A Monette,Patrick %A Kimble,Sara %A Rauch,Scott L %A Baker,Justin T %+ Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, United States, 1 617 462 3845, fshen1@mgh.harvard.edu %K digital phenotyping %K computataional psychiatry %K ethics %K law %K privacy %K informed consent %D 2022 %7 9.2.2022 %9 Viewpoint %J J Med Internet Res %G English %X Background: Psychiatry has long needed a better and more scalable way to capture the dynamics of behavior and its disturbances, quantitatively across multiple data channels, at high temporal resolution in real time. By combining 24/7 data—on location, movement, email and text communications, and social media—with brain scans, genetics, genomics, neuropsychological batteries, and clinical interviews, researchers will have an unprecedented amount of objective, individual-level data. Analyzing these data with ever-evolving artificial intelligence could one day include bringing interventions to patients where they are in the real world in a convenient, efficient, effective, and timely way. Yet, the road to this innovative future is fraught with ethical dilemmas as well as ethical, legal, and social implications (ELSI). Objective: The goal of the Ethics Checklist is to promote careful design and execution of research. It is not meant to mandate particular research designs; indeed, at this early stage and without consensus guidance, there are a range of reasonable choices researchers may make. However, the checklist is meant to make those ethical choices explicit, and to require researchers to give reasons for their decisions related to ELSI issues. The Ethics Checklist is primarily focused on procedural safeguards, such as consulting with experts outside the research group and documenting standard operating procedures for clearly actionable data (eg, expressed suicidality) within written research protocols. Methods: We explored the ELSI of digital health research in psychiatry, with a particular focus on what we label “deep phenotyping” psychiatric research, which combines the potential for virtually boundless data collection and increasingly sophisticated techniques to analyze those data. We convened an interdisciplinary expert stakeholder workshop in May 2020, and this checklist emerges out of that dialogue. Results: Consistent with recent ELSI analyses, we find that existing ethical guidance and legal regulations are not sufficient for deep phenotyping research in psychiatry. At present, there are regulatory gaps, inconsistencies across research teams in ethics protocols, and a lack of consensus among institutional review boards on when and how deep phenotyping research should proceed. We thus developed a new instrument, an Ethics Checklist for Digital Health Research in Psychiatry (“the Ethics Checklist”). The Ethics Checklist is composed of 20 key questions, subdivided into 6 interrelated domains: (1) informed consent; (2) equity, diversity, and access; (3) privacy and partnerships; (4) regulation and law; (5) return of results; and (6) duty to warn and duty to report. Conclusions: Deep phenotyping research offers a vision for vastly more effective care for people with, or at risk for, psychiatric disease. The potential perils en route to realizing this vision are significant; however, and researchers must be willing to address the questions in the Ethics Checklist before embarking on each leg of the journey. %M 35138261 %R 10.2196/31146 %U https://www.jmir.org/2022/2/e31146 %U https://doi.org/10.2196/31146 %U http://www.ncbi.nlm.nih.gov/pubmed/35138261 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e28252 %T Measuring Electronic Health Literacy: Development, Validation, and Test of Measurement Invariance of a Revised German Version of the eHealth Literacy Scale %A Marsall,Matthias %A Engelmann,Gerrit %A Skoda,Eva-Maria %A Teufel,Martin %A Bäuerle,Alexander %+ Clinic for Psychosomatic Medicine and Psychotherapy, LVR–University Hospital Essen, University of Duisburg-Essen, Virchowstr. 174, Essen, 45147, Germany, 49 17678909441, matthias.marsall@stud.uni-due.de %K eHealth %K eHeals %K health literacy %K factor analysis %K validation %K measurement invariance %K internet %K health information %D 2022 %7 2.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The World Wide Web has become an essential source of health information. Nevertheless, the amount and quality of information provided may lead to information overload. Therefore, people need certain skills to search for, identify, and evaluate information from the internet. In the context of health information, these competencies are summarized as the construct of eHealth literacy. Previous research has highlighted the relevance of eHealth literacy in terms of health-related outcomes. However, the existing instrument assessing eHealth literacy in the German language reveals methodological limitations regarding test development and validation. The development and validation of a revised scale for this important construct is highly relevant. Objective: The objective of this study was the development and validation of a revised German eHealth literacy scale. In particular, this study aimed to focus on high methodological and psychometric standards to provide a valid and reliable instrument for measuring eHealth literacy in the German language. Methods: Two internationally validated instruments were merged to cover a wide scope of the construct of eHealth literacy and create a revised eHealth literacy scale. Translation into the German language followed scientific guidelines and recommendations to ensure content validity. Data from German-speaking people (n=470) were collected in a convenience sample from October to November 2020. Validation was performed by factor analyses. Further, correlations were performed to examine convergent, discriminant, and criterion validity. Additionally, analyses of measurement invariance of gender, age, and educational level were conducted. Results: Analyses revealed a 2-factorial model of eHealth literacy. By item-reduction, the 2 factors information seeking and information appraisal were measured with 8 items reaching acceptable-to-good model fits (comparative fit index [CFI]: 0.942, Tucker Lewis index [TLI]: 0.915, root mean square error of approximation [RMSEA]: 0.127, and standardized root mean square residual [SRMR]: 0.055). Convergent validity was comprehensively confirmed by significant correlations of information seeking and information appraisal with health literacy, internet confidence, and internet anxiety. Discriminant and criterion validity were examined by correlation analyses with various scales and could partly be confirmed. Scalar level of measurement invariance for gender (CFI: 0.932, TLI: 0.923, RMSEA: 0.122, and SRMR: 0.068) and educational level (CFI: 0.937, TLI: 0.934, RMSEA: 0.112, and SRMR: 0.063) were confirmed. Measurement invariance of age was rejected. Conclusions: Following scientific guidelines for translation and test validation, we developed a revised German eHealth Literacy Scale (GR-eHEALS). Our factor analyses confirmed an acceptable-to-good model fit. Construct validation in terms of convergent, discriminant, and criterion validity could mainly be confirmed. Our findings provide evidence for measurement invariance of the instrument regarding gender and educational level. The newly revised GR-eHEALS questionnaire represents a valid instrument to measure the important health-related construct eHealth literacy. %M 35107437 %R 10.2196/28252 %U https://www.jmir.org/2022/2/e28252 %U https://doi.org/10.2196/28252 %U http://www.ncbi.nlm.nih.gov/pubmed/35107437 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e25752 %T Development of a Quality Assurance Score for the Nigeria AIDS Indicator and Impact Survey (NAIIS) Database: Validation Study %A Salihu,Hamisu M %A Yusuf,Zenab %A Dongarwar,Deepa %A Aliyu,Sani H %A Yusuf,Rafeek A %A Aliyu,Muktar H %A Aliyu,Gambo %+ Center of Excellence in Health Equity, Training and Research, Baylor College of Medicine, 3701, Kirby Drive, Houston, TX, 77030, United States, 1 8327908353, deepa.dongarwar@bcm.edu %K database quality assurance %K Delphi method %K quality assurance tool %K Nigeria AIDS Indicator and Impact Survey %D 2022 %7 28.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In 2018, Nigeria implemented the world’s largest HIV survey, the Nigeria AIDS Indicator and Impact Survey (NAIIS), with the overarching goal of obtaining more reliable metrics regarding the national scope of HIV epidemic control in Nigeria. Objective: This study aimed to (1) describe the processes involved in the development of a new database evaluation tool (Database Quality Assurance Score [dQAS]) and (2) assess the application of the dQAS in the evaluation and validation of the NAIIS database. Methods: The dQAS tool was created using an online, electronic Delphi (e-Delphi) methodology with the assistance of expert review panelists. Thematic categories were developed to form superordinate categories that grouped themes together. Subordinate categories were then created that decomposed themes for more specificity. A validation score using dQAS was employed to assess the technical performance of the NAIIS database. Results: The finalized dQAS tool was composed of 34 items, with a total score of 81. The tool had 2 sections: validation item section, which contains 5 subsections, and quality assessment score section, with a score of “1” for “Yes” to indicate that the performance measure item was present and “0” for “No” to indicate that the measure was absent. There were also additional scaling scores ranging from “0” to a maximum of “4” depending on the measure. The NAIIS database achieved 78 out of the maximum total score of 81, yielding an overall technical performance score of 96.3%, which placed it in the highest category denoted as “Exceptional.” Conclusions: This study showed the feasibility of remote internet-based collaboration for the development of dQAS—a tool to assess the validity of a locally created database infrastructure for a resource-limited setting. Using dQAS, the NAIIS database was found to be valid, reliable, and a valuable source of data for future population-based, HIV-related studies. %M 35089143 %R 10.2196/25752 %U https://formative.jmir.org/2022/1/e25752 %U https://doi.org/10.2196/25752 %U http://www.ncbi.nlm.nih.gov/pubmed/35089143 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e29718 %T Health-Related Quality of Life Among Pregnant Women With Pre-pregnancy Smoking and Smoking Cessation During Pregnancy in China: National Cross-sectional Study %A Hu,Kadi %A Zou,Shiqian %A Zhang,Casper JP %A Wu,Huailiang %A Akinwunmi,Babatunde %A Wang,Zilian %A Ming,Wai-Kit %+ Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, To Yuen Building, 31 To Yuen Street, Hong Kong, China, 852 34426956, wkming2@cityu.edu.hk %K health-related quality of life %K pregnant women %K smoking status %K pre-pregnancy smoking %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Previous studies have hardly explored the influence of pre-pregnancy smoking and smoking cessation during pregnancy on the health-related quality of life (HRQoL) of pregnant women, which is a topic that need to be addressed. In addition, pregnant women in China constitute a big population in the largest developing country of the world and cannot be neglected. Objective: This study aims to evaluate the HRQoL of pregnant women in China with different smoking statuses and further estimate the association between pre-pregnancy smoking, smoking cessation, and the HRQoL. Methods: A nationwide cross-sectional study was conducted to determine the association between different smoking statuses (smoking currently, quit smoking, never smoking) and the HRQoL in pregnant women across mainland China. A web-based questionnaire was delivered through the Banmi Online Maternity School platform, including questions about demographics, smoking status, and the HRQoL. EuroQoL Group’s 5-dimension 5-level (EQ-5D-5L) scale with EuroQoL Group’s visual analog scale (EQ-VAS) was used for measuring the HRQoL. Ethical approval was granted by the institutional review board of the First Affiliated Hospital of Sun Yat-sen University (ICE-2017-296). Results: From August to September 2019, a total of 16,483 participants from 31 provinces were included, of which 93 (0.56%) were smokers, 731 (4.43%) were ex-smokers, and 15,659 (95%) were nonsmokers. Nonsmokers had the highest EQ-VAS score (mean 84.49, SD 14.84), smokers had the lowest EQ-VAS score (mean 77.38, SD 21.99), and the EQ-VAS score for ex-smokers was in between (mean 81.04, SD 17.68). A significant difference in EQ-VAS scores was detected between nonsmokers and ex-smokers (P<.001), which indicated that pre-pregnancy smoking does have a negative impact on the HRQoL (EQ-VAS) of pregnant women. Compared with nonsmokers, ex-smokers suffered from more anxiety/depression problems (P=.001, odds ratio [OR] 1.29, 95% CI 1.12-1.50). Among ex-smokers, the increased cigarette consumption was associated with a lower EQ-5D index (P=.007) and EQ-VAS score (P=.01) of pregnant women. Compared to smokers, no significant difference was found in the ex-smokers’ EQ-5D index and EQ-VAS score (P=.33). Conclusions: Smoking history is associated with a lower HRQoL in pregnant Chinese women. Pre-pregnancy smoking is related to a lower HRQoL (EQ-VAS) and a higher incidence of depression/anxiety problems. Smoking cessation during pregnancy does not significantly improve the HRQoL of pregnant Chinese women. Among ex-smokers, the more cigarettes they smoke, the lower HRQoL they have during pregnancy. We suggest that the Chinese government should strengthen the education on quitting smoking and avoiding second-hand smoke for women who have pregnancy plans and their family members. %M 35072649 %R 10.2196/29718 %U https://publichealth.jmir.org/2022/1/e29718 %U https://doi.org/10.2196/29718 %U http://www.ncbi.nlm.nih.gov/pubmed/35072649 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 1 %P e28621 %T Validity and Reliability of the Korean Version of the Health Information Technology Usability Evaluation Scale: Psychometric Evaluation %A Lee,Jisan %A Schnall,Rebecca %+ School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, United States, 1 2123426886, rb897@columbia.edu %K mobile application %K menstruation %K survey %K questionnaire %K translations %K medical informatics %K app %K validity %K reliability %K usability %K assessment %K mHealth %K evaluation %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Rigorous development of mobile technologies requires the use of validated instruments to evaluate the usability of these tools, which has become more relevant with the expansion of these technologies. Although various usability evaluation tools have been developed, there are relatively few simple evaluation instruments that have been validated across diseases and languages in mobile health (mHealth) information technology for use in multiple diseases. Objective: The purpose of this study is to validate the Korean version of the Health Information Technology Usability Evaluation Scale (Korean Health-ITUES) and assess its applicability for different health conditions. Methods: To develop the Korean Health-ITUES, we used a validation process involving the following 3 steps: (1) customization of the Health-ITUES for menstrual symptoms, (2) translation of the Health-ITUES from English into Korean, and (3) examination of the reliability and validity of the instrument. The translation process adhered to the World Health Organization (WHO) guidelines for translation and back-translation, expert review, and reconciliation. Results: The Korean Health-ITUES showed reliable internal consistency with Cronbach α=.951; meanwhile, factor loadings of the 20 items in the 4 subscales ranged from 0.416 to 0.892. Conclusions: The Health-ITUES demonstrated reliability and validity for its use in assessing mHealth apps’ usability in young Korean women with menstrual discomfort. Given the strong psychometric properties of this tool in Korean and English and across 2 different health conditions, the Health-ITUES is a valid and reliable instrument for assessing the usability of mHealth apps. The Health-ITUES is also a valid instrument for evaluating mHealth technologies, which are widely used by patients to self-manage their health and by providers to improve health care delivery. %M 35072630 %R 10.2196/28621 %U https://medinform.jmir.org/2022/1/e28621 %U https://doi.org/10.2196/28621 %U http://www.ncbi.nlm.nih.gov/pubmed/35072630 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e32855 %T Validity Testing and Cultural Adaptation of the eHealth Literacy Questionnaire (eHLQ) Among People With Chronic Diseases in Taiwan: Mixed Methods Study %A Chen,Yu-Chi %A Cheng,Christina %A Osborne,Richard H %A Kayser,Lars %A Liu,Chieh-Yu %A Chang,Li-Chun %+ Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, No.155, Section 2, Li-Nong Street, Beitou District, Taipei, 112, Taiwan, 886 228267093, ycchen2@nycu.edu.tw %K chronic illness %K eHealth literacy questionnaire %K eHLQ %K validation %K cultural adaptation %K eHealth %D 2022 %7 19.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Advancements in digital technologies seek to promote health and access to services. However, people lacking abilities and confidence to use technology are likely to be left behind, leading to health disparities. In providing digital health services, health care providers need to be aware of users’ diverse electronic health (eHealth) literacy to address their particular needs and ensure equitable uptake and use of digital services. To understand such needs, an instrument that captures users’ knowledge, skills, trust, motivation, and experiences in relation to technology is required. The eHealth Literacy Questionnaire (eHLQ) is a multidimensional tool with 7 scales covering diverse dimensions of eHealth literacy. The tool was simultaneously developed in English and Danish using a grounded and validity-driven approach and has been shown to have strong psychometric properties. Objective: This study aims to translate and culturally adapt the eHLQ for application among Mandarin-speaking people with chronic diseases in Taiwan and then undertake a rigorous set of validity-testing procedures. Methods: The cross-cultural adaptation of the eHLQ included translation and evaluation of the translations. The measurement properties were assessed using classical test theory and item response theory (IRT) approaches. Content validity, known-group validity, and internal consistency were explored, as well as item characteristic curves (ICCs), item discrimination, and item location/difficulty. Results: The adapted version was reviewed, and a recommended forward translation was confirmed through consensus. The tool exhibited good content validity. A total of 420 people with 1 or more chronic diseases participated in a validity-testing survey. The eHLQ showed good internal consistency (Cronbach α=.75-.95). For known-group validity, all 7 eHLQ scales showed strong associations with education. Unidimensionality and local independence assumptions were met except for scale 2. IRT analysis showed that all items demonstrated good discrimination (range 0.27-12.15) and a good range of difficulty (range 0.59-1.67) except for 2 items in scale 7. Conclusions: Using a rigorous process, the eHLQ was translated from English into a culturally appropriate tool for use in the Mandarin language. Validity testing provided evidence of satisfactory-to-strong psychometric properties of the eHLQ. The 7 scales are likely to be useful research tools for evaluating digital health interventions and for informing the development of health technology products and interventions that equitably suit diverse users’ needs. %M 35044310 %R 10.2196/32855 %U https://www.jmir.org/2022/1/e32855 %U https://doi.org/10.2196/32855 %U http://www.ncbi.nlm.nih.gov/pubmed/35044310 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e34103 %T A New Digital Assessment of Mental Health and Well-being in the Workplace: Development and Validation of the Unmind Index %A Sierk,Anika %A Travers,Eoin %A Economides,Marcos %A Loe,Bao Sheng %A Sun,Luning %A Bolton,Heather %+ Unmind Ltd, 180 Borough High Street, London, SE1 1LB, United Kingdom, eoin.travers@unmind.com %K mental health %K well-being %K mHealth %K measurement %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Unmind is a workplace, digital, mental health platform with tools to help users track, maintain, and improve their mental health and well-being (MHWB). Psychological measurement plays a key role on this platform, providing users with insights on their current MHWB, the ability to track it over time, and personalized recommendations, while providing employers with aggregate information about the MHWB of their workforce. Objective: Due to the limitations of existing measures for this purpose, we aimed to develop and validate a novel well-being index for digital use, to capture symptoms of common mental health problems and key aspects of positive well-being. Methods: In Study 1A, questionnaire items were generated by clinicians and screened for face validity. In Study 1B, these items were presented to a large sample (n=1104) of UK adults, and exploratory factor analysis was used to reduce the item pool and identify coherent subscales. In Study 2, the final measure was presented to a new nationally representative UK sample (n=976), along with a battery of existing measures, with 238 participants retaking the Umind Index after 1 week. The factor structure and measurement invariance of the Unmind Index was evaluated using confirmatory factor analysis, convergent and discriminant validity by estimating correlations with existing measures, and reliability by examining internal consistency and test-retest intraclass correlations. Results: Studies 1A and 1B yielded a 26-item measure with 7 subscales: Calmness, Connection, Coping, Happiness, Health, Fulfilment, and Sleep. Study 2 showed that the Unmind Index is fitted well by a second-order factor structure, where the 7 subscales all load onto an overall MHWB factor, and established measurement invariance by age and gender. Subscale and total scores correlate well with existing mental health measures and generally diverge from personality measures. Reliability was good or excellent across all subscales. Conclusions: The Unmind Index is a robust measure of MHWB that can help to identify target areas for intervention in nonclinical users of a mental health app. We argue that there is value in measuring mental ill health and mental well-being together, rather than treating them as separate constructs. %M 35037895 %R 10.2196/34103 %U https://mental.jmir.org/2022/1/e34103 %U https://doi.org/10.2196/34103 %U http://www.ncbi.nlm.nih.gov/pubmed/35037895 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e31759 %T Using Facebook Advertisements for Women’s Health Research: Methodology and Outcomes of an Observational Study %A Farr,Deeonna E %A Battle,Darian A %A Hall,Marla B %+ Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 2307 Carol G Belk Building, Mail Stop 529, Greenville, NC, 27858, United States, 1 2527375392, farrd17@ecu.edu %K social media %K surveys %K questionnaires %K advertising %K patient selection %K methodology %K ethnic groups %K health research %K healthcare %K health care %K women’s health %D 2022 %7 12.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Recruitment of diverse populations for health research studies remains a challenge. The COVID-19 pandemic has exacerbated these challenges by limiting in-person recruitment efforts and placing additional demands on potential participants. Social media, through the use of Facebook advertisements, has the potential to address recruitment challenges. However, existing reports are inconsistent with regard to the success of this strategy. Additionally, limited information is available about processes that can be used to increase the diversity of study participants. Objective: A Qualtrics survey was fielded to ascertain women’s knowledge of and health care experiences related to breast density. This paper describes the process of using Facebook advertisements for recruitment and the effectiveness of various advertisement strategies. Methods: Facebook advertisements were placed in 2 rounds between June and July 2020. During round 1, multiple combinations of headlines and interest terms were tested to determine the most cost-effective advertisement. The best performing advertisement was used in round 2 in combination with various strategies to enhance the diversity of the survey sample. Advertisement performance, cost, and survey respondent data were collected and examined. Results: In round 1, a total of 45 advertisements with 5 different headlines were placed, and the average cost per link click for each headline ranged from US $0.12 to US $0.79. Of the 164 women recruited in round 1, in total 91.62% were eligible to complete the survey. Advertisements used during recruitment in round 2 resulted in an average cost per link click of US $0.11. During the second round, 478 women attempted the survey, and 87.44% were eligible to participate. The majority of survey respondents were White (80.41%), over the age of 55 years (63.94%), and highly educated (63.71%). Conclusions: Facebook advertisements can be used to recruit respondents for health research quickly, but this strategy may yield participants who are less racially diverse, more educated, and older than the general population. Researchers should consider recruiting participants through other methods in addition to creating Facebook advertisements targeting underrepresented populations. %M 35019843 %R 10.2196/31759 %U https://formative.jmir.org/2022/1/e31759 %U https://doi.org/10.2196/31759 %U http://www.ncbi.nlm.nih.gov/pubmed/35019843 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e26299 %T Unit Response and Costs in Web Versus Face-To-Face Data Collection: Comparison of Two Cross-sectional Health Surveys %A Braekman,Elise %A Demarest,Stefaan %A Charafeddine,Rana %A Drieskens,Sabine %A Berete,Finaba %A Gisle,Lydia %A Van der Heyden,Johan %A Van Hal,Guido %+ Lifestyle and chronic diseases, Epidemiology and public health, Sciensano, Juliette Wytsmanstraat 14, Brussels, Belgium, 32 2 642 57 06, elise.braekman@sciensano.be %K health interview surveys %K data collection mode %K face-to-face %K web %K unit response %K response rate %K nonresponse %K data collection costs %K web data %K health surveys %K internet penetration %K web survey %K costs %D 2022 %7 7.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Potential is seen in web data collection for population health surveys due to its combined cost-effectiveness, implementation ease, and increased internet penetration. Nonetheless, web modes may lead to lower and more selective unit response than traditional modes, and this may increase bias in the measured indicators. Objective: This research assesses the unit response and costs of a web study versus face-to-face (F2F) study. Methods: Alongside the Belgian Health Interview Survey by F2F edition 2018 (BHISF2F; net sample used: 3316), a web survey (Belgian Health Interview Survey by Web [BHISWEB]; net sample used: 1010) was organized. Sociodemographic data on invited individuals was obtained from the national register and census linkages. Unit response rates considering the different sampling probabilities of both surveys were calculated. Logistic regression analyses examined the association between mode system and sociodemographic characteristics for unit nonresponse. The costs per completed web questionnaire were compared with the costs for a completed F2F questionnaire. Results: The unit response rate is lower in BHISWEB (18.0%) versus BHISF2F (43.1%). A lower response rate was observed for the web survey among all sociodemographic groups, but the difference was higher among people aged 65 years and older (15.4% vs 45.1%), lower educated people (10.9% vs 38.0%), people with a non-Belgian European nationality (11.4% vs 40.7%), people with a non-European nationality (7.2% vs 38.0%), people living alone (12.6% vs 40.5%), and people living in the Brussels-Capital (12.2% vs 41.8%) region. The sociodemographic characteristics associated with nonresponse are not the same in the 2 studies. Having another European (OR 1.60, 95% CI 1.20-2.13) or non-European nationality (OR 2.57, 95% CI 1.79-3.70) compared to a Belgian nationality and living in the Brussels-Capital (OR 1.72, 95% CI 1.41-2.10) or Walloon (OR 1.47, 95% CI 1.15-1.87) regions compared to the Flemish region are associated with a higher nonresponse only in the BHISWEB study. In BHISF2F, younger people (OR 1.31, 95% CI 1.11-1.54) are more likely to be nonrespondents than older people, and this was not the case in BHISWEB. In both studies, lower educated people have a higher probability of being nonrespondent, but this effect is more pronounced in BHISWEB (low vs high education level: Web, OR 2.71, 95% CI 2.21-3.39 and F2F OR 1.70, 95% CI 1.48-1.95). The BHISWEB study had a considerable advantage; the cost per completed questionnaire was almost 3 times lower (€41 [US $48]) compared with F2F data collection (€111 [US $131]). Conclusions: The F2F unit response rate was generally higher, yet for certain groups the difference between web and F2F was more limited. Web data collection has a considerable cost advantage. It is therefore worth experimenting with adaptive mixed-mode designs to optimize financial resources without increasing selection bias (eg, only inviting sociodemographic groups who are keener to participate online for web surveys while continuing to focus on increasing F2F response rates for other groups). %M 34994701 %R 10.2196/26299 %U https://www.jmir.org/2022/1/e26299 %U https://doi.org/10.2196/26299 %U http://www.ncbi.nlm.nih.gov/pubmed/34994701 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e28368 %T A New Remote Guided Method for Supervised Web-Based Cognitive Testing to Ensure High-Quality Data: Development and Usability Study %A Leong,Victoria %A Raheel,Kausar %A Sim,Jia Yi %A Kacker,Kriti %A Karlaftis,Vasilis M %A Vassiliu,Chrysoula %A Kalaivanan,Kastoori %A Chen,S H Annabel %A Robbins,Trevor W %A Sahakian,Barbara J %A Kourtzi,Zoe %+ Psychology, School of Social Sciences, Nanyang Technological University, 48 Nanyang Avenue, Singapore, 639818, Singapore, 65 6514 1052, victorialeong@ntu.edu.sg %K web-based testing %K neurocognitive assessment %K COVID-19 %K executive functions %K learning %D 2022 %7 6.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The global COVID-19 pandemic has triggered a fundamental reexamination of how human psychological research can be conducted safely and robustly in a new era of digital working and physical distancing. Online web-based testing has risen to the forefront as a promising solution for the rapid mass collection of cognitive data without requiring human contact. However, a long-standing debate exists over the data quality and validity of web-based studies. This study examines the opportunities and challenges afforded by the societal shift toward web-based testing and highlights an urgent need to establish a standard data quality assurance framework for online studies. Objective: This study aims to develop and validate a new supervised online testing methodology, remote guided testing (RGT). Methods: A total of 85 healthy young adults were tested on 10 cognitive tasks assessing executive functioning (flexibility, memory, and inhibition) and learning. Tasks were administered either face-to-face in the laboratory (n=41) or online using remote guided testing (n=44) and delivered using identical web-based platforms (Cambridge Neuropsychological Test Automated Battery, Inquisit, and i-ABC). Data quality was assessed using detailed trial-level measures (missed trials, outlying and excluded responses, and response times) and overall task performance measures. Results: The results indicated that, across all data quality and performance measures, RGT data was statistically-equivalent to in-person data collected in the lab (P>.40 for all comparisons). Moreover, RGT participants out-performed the lab group on measured verbal intelligence (P<.001), which could reflect test environment differences, including possible effects of mask-wearing on communication. Conclusions: These data suggest that the RGT methodology could help ameliorate concerns regarding online data quality—particularly for studies involving high-risk or rare cohorts—and offer an alternative for collecting high-quality human cognitive data without requiring in-person physical attendance. %M 34989691 %R 10.2196/28368 %U https://www.jmir.org/2022/1/e28368 %U https://doi.org/10.2196/28368 %U http://www.ncbi.nlm.nih.gov/pubmed/34989691 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 1 %P e31679 %T Continuous User Experience Monitoring of a Patient-Completed Preoperative Assessment System in the United Kingdom: Cross-sectional Study %A Maramba,Inocencio Daniel %A Chatterjee,Arunangsu %+ Centre for Health Technology, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, United Kingdom, 44 1752 587484, inocencio.maramba@plymouth.ac.uk %K preoperative assessment %K self-completed patient questionnaires %K digital health %K usability %K user experience %K web-based %D 2022 %7 6.1.2022 %9 Original Paper %J JMIRx Med %G English %X Background: Anesthetic preoperative assessment (POA) is now a common part of the surgical care pathway, and guidelines support its routine use. MyPreOp (Ultramed Ltd) is a web-based POA system that enables remote assessments. Usability is a key factor in the success of digital health solutions. Objective: This study aims to assess the usability of the MyPreOp system through patient feedback, investigate the amount of time it took for patients to complete the POA questionnaire and the factors that influenced completion time, and explore the effect on completion times of implementing a validated eHealth usability scale, as compared to using a simple but unvalidated usability evaluation scale, and to test the feasibility of administering a more detailed usability evaluation scale in a staggered manner so as not to unduly increase completion times. Methods: In this cross-sectional study, anonymized data sets were extracted from the MyPreOp system. The participants were adults (aged ≥18 years), scheduled for nonurgent surgical procedures performed in hospitals in the United Kingdom, who gave consent for their anonymized data to be analyzed. Data collected included age, gender, American Society of Anesthesiology (ASA) physical classification status, and completion time. Two user experience evaluations were used: in Phase 1, 2 questions asking about overall experience and ease of use, and in Phase 2, a previously validated usability questionnaire, with its 20 questions equally distributed among 5 succeeding patient cohorts. There were 2593 respondents in total (Phase 1: n=1193; Phase 2: n=1400). The median age of the participants was 46 years, and 1520 (58.62%) of the 2593 respondents were female. End points measured were the median completion times in Phase I and Phase II. The data were collected by extracting a subset of records from the database and exported to a spreadsheet for analysis (Excel, Microsoft Corporation). The data were analyzed for differences in completion times between Phase I and Phase II, as well as for differences between age groups, genders, and ASA classifications. Results: MyPreOp scored well in usability in both phases. In Phase 1, 81.64% (974/1193) of respondents had a good or better experience, and 93.8% (1119/1193) found it easy to use. The usability rating in Phase 2 was 4.13 out of a maximum of 5, indicating high usability. The median completion time was 40.4 minutes. The implementation of the longer usability evaluation scale in Phase 2 did not negatively impact the completion times. Age and ASA physical status were found to be moderately associated with increased completion times. Conclusions: MyPreOp rates high in both user experience and usability. The method of dividing the questionnaire into 5 blocks is valid and does not negatively affect completion times. Further research into the factors affecting completion time is recommended. %M 37725545 %R 10.2196/31679 %U https://med.jmirx.org/2022/1/e31679 %U https://doi.org/10.2196/31679 %U http://www.ncbi.nlm.nih.gov/pubmed/37725545 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e25748 %T Assessing Cognitive Function in Multiple Sclerosis With Digital Tools: Observational Study %A Hsu,Wan-Yu %A Rowles,William %A Anguera,Joaquin A %A Anderson,Annika %A Younger,Jessica W %A Friedman,Samuel %A Gazzaley,Adam %A Bove,Riley %+ Department of Neurology, Weill Institute for Neurosciences, University of California, 675 Nelson Rising Lane, San Francisco, CA, 94158, United States, 1 415 595 2795, Riley.Bove@ucsf.edu %K cognition %K digital health %K mHealth %K multiple sclerosis %K cognitive assessment %D 2021 %7 30.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive impairment (CI) is one of the most prevalent symptoms of multiple sclerosis (MS). However, it is difficult to include cognitive assessment as part of MS standard care since the comprehensive neuropsychological examinations are usually time-consuming and extensive. Objective: To improve access to CI assessment, we evaluated the feasibility and potential assessment sensitivity of a tablet-based cognitive battery in patients with MS. Methods: In total, 53 participants with MS (24 [45%] with CI and 29 [55%] without CI) and 24 non-MS participants were assessed with a tablet-based cognitive battery (Adaptive Cognitive Evaluation [ACE]) and standard cognitive measures, including the Symbol Digit Modalities Test (SDMT) and the Paced Auditory Serial Addition Test (PASAT). Associations between performance in ACE and the SDMT/PASAT were explored, with group comparisons to evaluate whether ACE modules can capture group-level differences. Results: Correlations between performance in ACE and the SDMT (R=–0.57, P<.001), as well as PASAT (R=–0.39, P=.01), were observed. Compared to non-MS and non-CI MS groups, the CI MS group showed a slower reaction time (CI MS vs non-MS: P<.001; CI MS vs non-CI MS: P=.004) and a higher attention cost (CI MS vs non-MS: P=.02; CI MS vs non-CI MS: P<.001). Conclusions: These results provide preliminary evidence that ACE, a tablet-based cognitive assessment battery, provides modules that could potentially serve as a digital cognitive assessment for people with MS. Trial Registration: ClinicalTrials.gov NCT03569618; https://clinicaltrials.gov/ct2/show/NCT03569618 %M 34967751 %R 10.2196/25748 %U https://www.jmir.org/2021/12/e25748 %U https://doi.org/10.2196/25748 %U http://www.ncbi.nlm.nih.gov/pubmed/34967751 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e26763 %T Assessing Physicians’ Recall Bias of Work Hours With a Mobile App: Interview and App-Recorded Data Comparison %A Wang,Hsiao-Han %A Lin,Yu-Hsuan %+ Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan Township, Miaoli County, 35053, Taiwan, 886 37 206 166 ext 36383, yuhsuanlin@nhri.edu.tw %K smartphone %K mobile app %K work hours %K recall bias %K time perception %K physicians %K labor policy %D 2021 %7 24.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous studies have shown inconsistencies in the accuracy of self-reported work hours. However, accurate documentation of work hours is fundamental for the formation of labor policies. Strict work-hour policies decrease medical errors, improve patient safety, and promote physicians’ well-being. Objective: The aim of this study was to estimate physicians’ recall bias of work hours with a mobile app, and to examine the association between the recall bias and physicians’ work hours. Methods: We quantified recall bias by calculating the differences between the app-recorded and self-reported work hours of the previous week and the penultimate week. We recruited 18 physicians to install the “Staff Hours” app, which automatically recorded GPS-defined work hours for 2 months, contributing 1068 person-days. We examined the association between work hours and two recall bias indicators: (1) the difference between self-reported and app-recorded work hours and (2) the percentage of days for which work hours were not precisely recalled during interviews. Results: App-recorded work hours highly correlated with self-reported counterparts (r=0.86-0.88, P<.001). Self-reported work hours were consistently significantly lower than app-recorded hours by –8.97 (SD 8.60) hours and –6.48 (SD 8.29) hours for the previous week and the penultimate week, respectively (both P<.001). The difference for the previous week was significantly correlated with work hours in the previous week (r=–0.410, P=.01), whereas the correlation of the difference with the hours in the penultimate week was not significant (r=–0.119, P=.48). The percentage of hours not recalled (38.6%) was significantly higher for the penultimate week (38.6%) than for the first week (16.0%), and the former was significantly correlated with work hours of the penultimate week (r=0.489, P=.002) Conclusions: Our study identified the existence of recall bias of work hours, the extent to which the recall was biased, and the influence of work hours on recall bias. %M 34951600 %R 10.2196/26763 %U https://www.jmir.org/2021/12/e26763 %U https://doi.org/10.2196/26763 %U http://www.ncbi.nlm.nih.gov/pubmed/34951600 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e25414 %T Lessons Learned: Beta-Testing the Digital Health Checklist for Researchers Prompts a Call to Action by Behavioral Scientists %A Bartlett Ellis,Rebecca %A Wright,Julie %A Miller,Lisa Soederberg %A Jake-Schoffman,Danielle %A Hekler,Eric B %A Goldstein,Carly M %A Arigo,Danielle %A Nebeker,Camille %+ Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093-0811, United States, 1 858 534 7786, nebeker@eng.ucsd.edu %K digital health %K mHealth %K research ethics %K institutional review board %K IRB %K behavioral medicine %K wearable sensors %K social media %K bioethics %K data management %K usability %K privacy %K access %K risks and benefits %K mobile phone %D 2021 %7 22.12.2021 %9 Viewpoint %J J Med Internet Res %G English %X Digital technologies offer unique opportunities for health research. For example, Twitter posts can support public health surveillance to identify outbreaks (eg, influenza and COVID-19), and a wearable fitness tracker can provide real-time data collection to assess the effectiveness of a behavior change intervention. With these opportunities, it is necessary to consider the potential risks and benefits to research participants when using digital tools or strategies. Researchers need to be involved in the risk assessment process, as many tools in the marketplace (eg, wellness apps, fitness sensors) are underregulated. However, there is little guidance to assist researchers and institutional review boards in their evaluation of digital tools for research purposes. To address this gap, the Digital Health Checklist for Researchers (DHC-R) was developed as a decision support tool. A participatory research approach involving a group of behavioral scientists was used to inform DHC-R development. Scientists beta-tested the checklist by retrospectively evaluating the technologies they had chosen for use in their research. This paper describes the lessons learned because of their involvement in the beta-testing process and concludes with recommendations for how the DHC-R could be useful for a variety of digital health stakeholders. Recommendations focus on future research and policy development to support research ethics, including the development of best practices to advance safe and responsible digital health research. %M 34941548 %R 10.2196/25414 %U https://www.jmir.org/2021/12/e25414 %U https://doi.org/10.2196/25414 %U http://www.ncbi.nlm.nih.gov/pubmed/34941548 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30368 %T The Successful Synchronized Orchestration of an Investigator-Initiated Multicenter Trial Using a Clinical Trial Management System and Team Approach: Design and Utility Study %A Mudaranthakam,Dinesh Pal %A Brown,Alexandra %A Kerling,Elizabeth %A Carlson,Susan E %A Valentine,Christina J %A Gajewski,Byron %+ University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, United States, 1 9139456922, dmudaranthakam@kumc.edu %K data management %K data quality %K metrics %K trial execution %K clinical trials %K cost %K accrual %K accrual inequality %K rare diseases %K healthcare %K health care %K health operations %D 2021 %7 22.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As the cost of clinical trials continues to rise, novel approaches are required to ensure ethical allocation of resources. Multisite trials have been increasingly utilized in phase 1 trials for rare diseases and in phase 2 and 3 trials to meet accrual needs. The benefits of multisite trials include easier patient recruitment, expanded generalizability, and more robust statistical analyses. However, there are several problems more likely to arise in multisite trials, including accrual inequality, protocol nonadherence, data entry mistakes, and data integration difficulties. Objective: The Biostatistics & Data Science department at the University of Kansas Medical Center developed a clinical trial management system (comprehensive research information system [CRIS]) specifically designed to streamline multisite clinical trial management. Methods: A National Institute of Child Health and Human Development–funded phase 3 trial, the ADORE (assessment of docosahexaenoic acid [DHA] on reducing early preterm birth) trial fully utilized CRIS to provide automated accrual reports, centralize data capture, automate trial completion reports, and streamline data harmonization. Results: Using the ADORE trial as an example, we describe the utility of CRIS in database design, regulatory compliance, training standardization, study management, and automated reporting. Our goal is to continue to build a CRIS through use in subsequent multisite trials. Reports generated to suit the needs of future studies will be available as templates. Conclusions: The implementation of similar tools and systems could provide significant cost-saving and operational benefit to multisite trials. Trial Registration: ClinicalTrials.gov NCT02626299; https://tinyurl.com/j6erphcj %M 34941552 %R 10.2196/30368 %U https://formative.jmir.org/2021/12/e30368 %U https://doi.org/10.2196/30368 %U http://www.ncbi.nlm.nih.gov/pubmed/34941552 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e25899 %T Use of the McIsaac Score to Predict Group A Streptococcal Pharyngitis in Outpatient Nurse Phone Triage and Electronic Visits Compared With In-Person Visits: Retrospective Observational Study %A Pecina,Jennifer L %A Nigon,Leah M %A Penza,Kristine S %A Murray,Martha A %A Kronebusch,Beckie J %A Miller,Nathaniel E %A Jensen,Teresa B %+ Department of Family Medicine, Mayo Clinic, 200 1st street SW, Rochester, MN, United States, 1 507 284 2511, pecina.jennifer@mayo.edu %K strep pharygitis %K e-visit %K electronic visit %K telemedicine %K telecare %K virtual visit %K McIssac score %K nurse phone triage %K scoring system %K sore throat %K group A streptococcus %K telehealth %K nurse %K phone %K triage %D 2021 %7 20.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The McIsaac criteria are a validated scoring system used to determine the likelihood of an acute sore throat being caused by group A streptococcus (GAS) to stratify patients who need strep testing. Objective: We aim to compare McIsaac criteria obtained during face-to-face (f2f) and non-f2f encounters. Methods: This retrospective study compared the percentage of positive GAS tests by McIsaac score for scores calculated during nurse protocol phone encounters, e-visits (electronic visits), and in person f2f clinic visits. Results: There was no difference in percentages of positive strep tests between encounter types for any of the McIsaac scores. There were significantly more phone and e-visit encounters with any missing score components compared with f2f visits. For individual score components, there were significantly fewer e-visits missing fever and cough information compared with phone encounters and f2f encounters. F2f encounters were significantly less likely to be missing descriptions of tonsils and lymphadenopathy compared with phone and e-visit encounters. McIsaac scores of 4 had positive GAS rates of 55% to 68% across encounter types. There were 4 encounters not missing any score components with a McIsaac score of 0. None of these 4 encounters had a positive GAS test. Conclusions: McIsaac scores of 4 collected during non-f2f care could be used to consider empiric treatment for GAS without testing if significant barriers to testing exist such as the COVID-19 pandemic or geographic barriers. Future studies should evaluate further whether non-f2f encounters with McIsaac scores of 0 can be safely excluded from GAS testing. %M 34932016 %R 10.2196/25899 %U https://www.jmir.org/2021/12/e25899 %U https://doi.org/10.2196/25899 %U http://www.ncbi.nlm.nih.gov/pubmed/34932016 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 2 %P e30620 %T The Contact Dermatitis Quality of Life Index (CDQL): Survey Development and Content Validity Assessment %A Hill,Mary K %A Laughter,Melissa R %A Harmange,Cecile I %A Dellavalle,Robert P %A Rundle,Chandler W %A Dunnick,Cory A %+ School of Medicine, University of Colorado, 1665 Aurora Court, MS 703, Aurora, CO, 80045, United States, 1 7208480500, cecile.harmange@cuanschutz.edu %K contact dermatitis %K allergic contact dermatitis %K irritant contact dermatitis %K quality of life %K outcomes instruments %K health outcomes %D 2021 %7 16.12.2021 %9 Original Paper %J JMIR Dermatol %G English %X Background: There is limited measurement and reporting of quality of life (QoL) outcomes for patients with contact dermatitis (CD). Objective: The purpose of this study is to develop a standardized Contact Dermatitis Quality of Life index (CDQL) for adult patients. Methods: A list of 81 topics was compiled from a review of QoL measures used previously in CD research. A total of 2 rounds of web-based Delphi surveys were sent to physicians who registered to attend the 2018 American Contact Dermatitis Society meeting, asking that they rank the relevance of topics for measuring QoL in CD using a 4-point scale. Items met consensus for inclusion if at least 78% of respondents ranked them as relevant or very relevant, and their median score was ≥3.25. Results: Of the 210 physicians contacted, 34 physicians completed the initial survey and 17 completed the follow-up survey. A total of 22 topics met consensus for inclusion in the CDQL, addressing symptoms, emotions, functions of daily living, social and physical functions, work/school functions, and treatment. Conclusions: This study was limited by the following factors: few open-ended questions in the initial survey, a lack of direct patient feedback, and long survey length, which likely contributed to lower survey participation. The CDQL is a comprehensive, CD-specific QoL measure developed on the basis of expert consensus via a modified Delphi process to be used by physicians and other health care professionals who care for adult patients with contact dermatitis. %M 37632827 %R 10.2196/30620 %U https://derma.jmir.org/2021/2/e30620 %U https://doi.org/10.2196/30620 %U http://www.ncbi.nlm.nih.gov/pubmed/37632827 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e32891 %T Accuracy and Cost-effectiveness of Technology-Assisted Dietary Assessment Comparing the Automated Self-administered Dietary Assessment Tool, Intake24, and an Image-Assisted Mobile Food Record 24-Hour Recall Relative to Observed Intake: Protocol for a Randomized Crossover Feeding Study %A Whitton,Clare %A Healy,Janelle D %A Collins,Clare E %A Mullan,Barbara %A Rollo,Megan E %A Dhaliwal,Satvinder S %A Norman,Richard %A Boushey,Carol J %A Delp,Edward J %A Zhu,Fengqing %A McCaffrey,Tracy A %A Kirkpatrick,Sharon I %A Atyeo,Paul %A Mukhtar,Syed Aqif %A Wright,Janine L %A Ramos-García,César %A Pollard,Christina M %A Kerr,Deborah A %+ School of Population Health, Faculty of Health Sciences, Curtin University, Kent Street, Perth, 6102, Australia, 61 892664122, D.Kerr@curtin.edu.au %K 24-hour recall %K Automated Self-Administered Dietary Assessment Tool %K Intake24 %K mobile food record %K image-assisted dietary assessment %K validation %K controlled feeding %K accuracy %K dietary measurement error %K self-report %K energy intake %K adult %K cost-effectiveness %K acceptability %K mobile technology %K diet surveys %K mobile phone %D 2021 %7 16.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The assessment of dietary intake underpins population nutrition surveillance and nutritional epidemiology and is essential to inform effective public health policies and programs. Technological advances in dietary assessment that use images and automated methods have the potential to improve accuracy, respondent burden, and cost; however, they need to be evaluated to inform large-scale use. Objective: The aim of this study is to compare the accuracy, acceptability, and cost-effectiveness of 3 technology-assisted 24-hour dietary recall (24HR) methods relative to observed intake across 3 meals. Methods: Using a controlled feeding study design, 24HR data collected using 3 methods will be obtained for comparison with observed intake. A total of 150 healthy adults, aged 18 to 70 years, will be recruited and will complete web-based demographic and psychosocial questionnaires and cognitive tests. Participants will attend a university study center on 3 separate days to consume breakfast, lunch, and dinner, with unobtrusive documentation of the foods and beverages consumed and their amounts. Following each feeding day, participants will complete a 24HR process using 1 of 3 methods: the Automated Self-Administered Dietary Assessment Tool, Intake24, or the Image-Assisted mobile Food Record 24-Hour Recall. The sequence of the 3 methods will be randomized, with each participant exposed to each method approximately 1 week apart. Acceptability and the preferred 24HR method will be assessed using a questionnaire. Estimates of energy, nutrient, and food group intake and portion sizes from each 24HR method will be compared with the observed intake for each day. Linear mixed models will be used, with 24HR method and method order as fixed effects, to assess differences in the 24HR methods. Reporting bias will be assessed by examining the ratios of reported 24HR intake to observed intake. Food and beverage omission and intrusion rates will be calculated, and differences by 24HR method will be assessed using chi-square tests. Psychosocial, demographic, and cognitive factors associated with energy misestimation will be evaluated using chi-square tests and multivariable logistic regression. The financial costs, time costs, and cost-effectiveness of each 24HR method will be assessed and compared using repeated measures analysis of variance tests. Results: Participant recruitment commenced in March 2021 and is planned to be completed by the end of 2021. Conclusions: This protocol outlines the methodology of a study that will evaluate the accuracy, acceptability, and cost-effectiveness of 3 technology-enabled dietary assessment methods. This will inform the selection of dietary assessment methods in future studies on nutrition surveillance and epidemiology. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000209897; https://tinyurl.com/2p9fpf2s International Registered Report Identifier (IRRID): DERR1-10.2196/32891 %M 34924357 %R 10.2196/32891 %U https://www.researchprotocols.org/2021/12/e32891 %U https://doi.org/10.2196/32891 %U http://www.ncbi.nlm.nih.gov/pubmed/34924357 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e32294 %T Examining the Impact of Question Construction on Reporting of Sexual Identity: Survey Experiment Among Young Adults %A Young,William J %A Bover Manderski,Michelle T %A Ganz,Ollie %A Delnevo,Cristine D %A Hrywna,Mary %+ Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, 303 George Street, Suite 500, New Brunswick, NJ, 08901, United States, 1 848 932 8054, william.j.young@rutgers.edu %K survey measurement %K sexual identity %K survey wording experiment %D 2021 %7 13.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Compared with heterosexuals, sexual minorities in the United States experience a higher incidence of negative physical and mental health outcomes. However, a variety of measurement challenges limit researchers’ ability to conduct meaningful survey research to understand these disparities. Despite the prevalence of additional identities, many national health surveys only offer respondents 3 substantive options for reporting their sexual identities (straight/heterosexual, gay or lesbian, and bisexual), which could lead to measurement error via misreporting and item nonresponse. Objective: This study compared the traditional 3-option approach to measuring sexual identity with an expanded approach that offered respondents 5 additional options. Methods: An online survey experiment conducted among New Jersey residents between March and June 2021 randomly assigned 1254 young adults (ages 18-21) to answer either the 3-response measure of sexual identity or the expanded item. Response distributions for each measure were compared as were the odds of item nonresponse. Results: The expanded version of the question appeared to result in more accurate reporting among some subgroups and induced less item nonresponse; 12% (77/642) of respondents in the expanded version selected a response that was not available in the shorter version. Females answering the expanded item were less likely to identify as gay or lesbian (2.1% [10/467] vs. 6.6% [30/457]). Females and Non-Hispanic Whites were slightly more likely to skip the shorter version than the longer version (1.1% [5/457 for females and 3/264 for Non-Hispanic Whites] vs. 0% [0/467 for females and 0/277 for Non-Hispanic Whites]). About 5% (32/642) of respondents answering the longer item were unsure of their sexual identity (a similar option was not available in the shorter version). Compared with respondents answering the longer version of the question, those answering the shorter version had substantially greater odds of skipping the question altogether (odds ratio 9.57, 95% CI 1.21-75.74; P=.03). Conclusions: Results favor the use of a longer, more detailed approach to measuring sexual identity in epidemiological research. Such a measure will likely allow researchers to produce more accurate estimates of health behaviors and outcomes among sexual minorities. %M 34898444 %R 10.2196/32294 %U https://publichealth.jmir.org/2021/12/e32294 %U https://doi.org/10.2196/32294 %U http://www.ncbi.nlm.nih.gov/pubmed/34898444 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e31860 %T Increasing Participation Rates in Germany’s Skin Cancer Screening Program (HELIOS): Protocol for a Mixed Methods Study %A Steeb,Theresa %A Heppt,Markus V %A Erdmann,Michael %A Wessely,Anja %A Klug,Stefanie J %A Berking,Carola %+ Department of Dermatology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, Ulmenweg 18, Erlangen, 91054, Germany, 49 1318545852, theresa.steeb@uk-erlangen.de %K skin cancer %K melanoma %K squamous cell carcinoma %K basal cell carcinoma %K screening %K early detection %K focus group %K mixed methods %K cross-sectional study %K prevention %D 2021 %7 13.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In 2008, a nationwide skin cancer screening (SCS) program was implemented in Germany. However, participation rates remain low. Objective: The overall objective of the HELIOS study is to identify subgroup-specific invitation and communication strategies to increase informed SCS participation in Germany. Methods: Focus group discussions will be performed in Erlangen, Germany, to explore potential invitation and communication strategies as well as possible barriers and motivating factors to participate in SCS. Male and female patients of different age groups who have already been diagnosed with skin cancer, as well as participants without a prior diagnosis of skin cancer, will be invited. Based on these results, an online questionnaire will be developed to identify subgroup-specific invitation strategies. A random sample of 2500 persons from the general population aged >35 years from the Munich area will be contacted to complete the questionnaire. Besides descriptive analysis, multinomial logistic regression will be performed. Additionally, a cluster analysis will be conducted to discover patterns or similarities among the participants. Results: Recruitment for the focus group studies started in February 2021 and is ongoing. As of August 2021, we have enrolled 39 participants. We expect to end enrollment in the qualitative study in September 2021 and to finish the analysis in December 2021. The second part of the study will then start in January 2022. Conclusions: The results of this project will enable us to derive improved and more efficient invitation and communication strategies for SCS. These may be implemented in the future to facilitate increased SCS uptake and early skin cancer detection. International Registered Report Identifier (IRRID): DERR1-10.2196/31860 %M 34898465 %R 10.2196/31860 %U https://www.researchprotocols.org/2021/12/e31860 %U https://doi.org/10.2196/31860 %U http://www.ncbi.nlm.nih.gov/pubmed/34898465 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e28021 %T Recruitment of Patients With Amyotrophic Lateral Sclerosis for Clinical Trials and Epidemiological Studies: Descriptive Study of the National ALS Registry’s Research Notification Mechanism %A Mehta,Paul %A Raymond,Jaime %A Han,Moon Kwon %A Larson,Theodore %A Berry,James D %A Paganoni,Sabrina %A Mitsumoto,Hiroshi %A Bedlack,Richard Stanley %A Horton,D Kevin %+ Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA, 30341, United States, 1 770 488 0556, pum4@cdc.gov %K amyotrophic lateral sclerosis %K Lou Gehrig disease %K motor neuron disease %K clinical trials %K patient recruitment %K National ALS Registry %K research notification mechanism %D 2021 %7 7.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Researchers face challenges in patient recruitment, especially for rare, fatal diseases such as amyotrophic lateral sclerosis (ALS). These challenges include obtaining sufficient statistical power as well as meeting eligibility requirements such as age, sex, and study proximity. Similarly, persons with ALS (PALS) face difficulty finding and enrolling in research studies for which they are eligible. Objective: The aim of this study was to describe how the federal Agency for Toxic Substances and Disease Registry’s (ATSDR) National ALS Registry is linking PALS to scientists who are conducting research, clinical trials, and epidemiological studies. Methods: Through the Registry’s online research notification mechanism (RNM), PALS can elect to be notified about new research opportunities. This mechanism allows researchers to upload a standardized application outlining their study design and objectives, and proof of Institutional Review Board approval. If the application is approved, ATSDR queries the Registry for PALS meeting the study’s specific eligibility criteria, and then distributes the researcher’s study material and contact information to PALS via email. PALS then need to contact the researcher directly to take part in any research. Such an approach allows ATSDR to protect the confidentiality of Registry enrollees. Results: From 2013 to 2019, a total of 46 institutions around the United States and abroad have leveraged this tool and over 600,000 emails have been sent, resulting in over 2000 patients conservatively recruited for clinical trials and epidemiological studies. Patients between the ages of 60 and 69 had the highest level of participation, whereas those between the ages of 18 and 39 and aged over 80 had the lowest. More males participated (4170/7030, 59.32%) than females (2860/7030, 40.68%). Conclusions: The National ALS Registry’s RNM benefits PALS by connecting them to appropriate ALS research. Simultaneously, the system benefits researchers by expediting recruitment, increasing sample size, and efficiently identifying PALS meeting specific eligibility requirements. As more researchers learn about and use this mechanism, both PALS and researchers can hasten research and expand trial options for PALS. %M 34878988 %R 10.2196/28021 %U https://www.jmir.org/2021/12/e28021 %U https://doi.org/10.2196/28021 %U http://www.ncbi.nlm.nih.gov/pubmed/34878988 %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 %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e11055 %T Reliability and Confirmatory Factor Analysis (CFA) of a Paper- Versus App-Administered Resilience Scale in Scottish Youths: Comparative Study %A Mcgeough,Julienne %A Gallagher-Mitchell,Thomas %A Clark,Dan Philip Andrew %A Harrison,Neil %+ Department of Psychology, Liverpool Hope University, Hope Park, Liverpool, L16 9JD, United Kingdom, 44 1512913073, mcgeouj@hope.ac.uk %K resilience %K psychometrics %K app administration %K cyberpsychology %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adequately measuring resilience is important to support young people and children who may need to access resources through social work or educational settings. A widely accepted measure of youth resilience has been developed previously and has been shown to be suitable for vulnerable youth. While the measure is completed by the young person on paper, it has been designed to be worked through with a teacher or social worker in case further clarification is required. However, this method is time consuming and, when faced with large groups of pupils who need assessment, can be overwhelming for schools and practitioners. This study assesses app software with a built-in avatar that can guide young persons through the assessment and its interpretation. Objective: Our primary objective is to compare the reliability and psychometric properties of a mobile software app to a paper version of the Child and Youth Resilience measure (CYRM-28). Second, this study assesses the use of the CYRM-28 in a Scottish youth population (aged 11-18 years). Methods: Following focus groups and discussion with teachers, social workers, and young people, an avatar was developed by a software company and integrated into an android smartphone app designed to ask questions via the device’s inbuilt text-to-voice engine. In total, 714 students from 2 schools in North East Scotland completed either a paper version or app version of the CYRM-28. A cross-sectional design was used, and students completed their allocated version twice, with a 2-week period in between each testing. All participants could request clarification either from a guidance teacher (paper version) or from the in-built software glossary (app version). Results: Test and retest correlations showed that the app version performed better than the paper version of the questionnaire (paper version: r303=0.81; P<.001; 95% CI 0.77-0.85; app version: r413=0.84; P<.001; 95% CI 0.79-0.89). Fisher r to z transformation revealed a significant difference in the correlations (Z=–2.97, P<.01). Similarly, Cronbach α in both conditions was very high (app version: α=.92; paper version: α=.87), suggesting item redundancy. Ordinarily, this would lead to a possible removal of highly correlated items; however, our primary objective was to compare app delivery methods over a pen-and-paper mode and was hence beyond the scope of the study. Fisher r to z transformation revealed a significant difference in the correlations (Z=–3.69, P<.01). A confirmatory factor analysis supported the 3-factor solution (individual, relational, and contextual) and reported a good model fit (χ215=27.6 [n=541], P=.24). Conclusions: ALEX, an avatar with an integrated voice guide, had higher reliability when measuring resilience than a paper version with teacher assistance. The CFA reports similar structure using the avatar when compared against the original validation. %M 34878995 %R 10.2196/11055 %U https://mhealth.jmir.org/2021/12/e11055 %U https://doi.org/10.2196/11055 %U http://www.ncbi.nlm.nih.gov/pubmed/34878995 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28782 %T Patient-Reported Outcome Measure for Real-time Symptom Assessment in Women With Endometriosis: Focus Group Study %A van Barneveld,Esther %A Lim,Arianne %A van Hanegem,Nehalennia %A Vork,Lisa %A Herrewegh,Alexandra %A van Poll,Mikal %A Manders,Jessica %A van Osch,Frits %A Spaans,Wilbert %A van Koeveringe,Gommert %A Vrijens,Desiree %A Kruimel,Joanna %A Bongers,Marlies %A Leue,Carsten %+ Department of Gynaecology and Obstetrics, Maastricht University Medical Centre+, P. Debyelaan 25, Maastricht, 6229 HX, Netherlands, 31 433876543, esthervb@gmail.com %K endometriosis %K pelvic pain %K positive affect %K negative affect %K patient-reported outcome measure %K focus groups %K experience sampling method %K momentary symptom assessment %K mobile phone %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Symptoms related to endometriosis have a significant impact on the quality of life, and symptoms often recur. The experience sampling method (ESM), a digital questioning method characterized by randomly repeated momentary assessments, has several advantages over traditionally used measurements, including the ability to assess the temporal relationship between variables such as physical, mental, and social factors. Objective: The aim of this study is to develop an ESM tool for patients with endometriosis to accurately measure symptoms and their course over time, allowing for personalized treatment and adequate monitoring of treatment efficacy in individual patients. Methods: On the basis of international guidelines, items from validated questionnaires were selected through a literature review and during focus groups and multidisciplinary expert meetings. Data analysis was conducted using ATLAS.ti (ATLAS.ti Scientific Software Development GmbH). The feasibility and usability of the newly developed momentary assessment tool were tested for 28 consecutive days in 5 patients with endometriosis-related pain symptoms. Results: Momentary assessment items contained questions concerning endometriosis symptoms, general somatic symptoms, psychological symptoms, contextual information, and the use of food and medication. A morning questionnaire on sleep and sexuality was included. In a pilot study, the patients considered the tool easy to use but time consuming. The average compliance rate of momentary assessments was 37.8% (106/280), with the highest completion rate during the first week (39/70, 56%). Therefore, it is advisable to use the ESM for a maximum of 7 days. Conclusions: A new digital tool for endometriosis symptom assessment was developed using the ESM, which may help overcome the limitations of current retrospective questionnaires. After validation and testing, future studies will be planned to evaluate the use of this tool in a clinical setting in order to propose a personalized treatment plan for women with endometriosis. %M 34870608 %R 10.2196/28782 %U https://formative.jmir.org/2021/12/e28782 %U https://doi.org/10.2196/28782 %U http://www.ncbi.nlm.nih.gov/pubmed/34870608 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e27533 %T Selecting and Evaluating Mobile Health Apps for the Healthy Life Trajectories Initiative: Development of the eHealth Resource Checklist %A Vanderloo,Leigh M %A Carsley,Sarah %A Agarwal,Payal %A Marini,Flavia %A Dennis,Cindy-Lee %A Birken,Catherine %+ Child Health Evaluative Sciences, The Hospital for Sick Children, 686 Bay St, Toronto, ON, M5G 0A4, Canada, 1 5194956306, lvande32@uwo.ca %K eHealth resources %K applications %K quality assessment %K preconception health %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The ubiquity of smartphones and mobile devices in the general population presents an unprecedented opportunity for preventative health. Not surprisingly, the use of electronic health (eHealth) resources accessed through mobile devices in clinical trials is becoming more prevalent; the selection, screening, and collation of quality eHealth resources is necessary to clinical trials using these technologies. However, the constant creation and turnover of new eHealth resources can make this task difficult. Although syntheses of eHealth resources are becoming more common, their methodological and reporting quality require improvement so as to be more accessible to nonexperts. Further, there continues to be significant variation in quality criteria employed for assessment, with no clear method for developing the included criteria. There is currently no single existing framework that addresses all six dimensions of mobile health app quality identified in Agarwal et al’s recent scoping review (ie, basic descriptions of the design and usage of the resource; technical features and accessibility; health information quality; usability; evidence of impact; and user engagement and behavior change). In instances where highly systematic tactics are not possible (due to time constraints, cost, or lack of expertise), there may be value in adopting practical and pragmatic approaches to helping researchers and clinicians identify and disseminate e-resources. Objective: The study aimed to create a set of guidelines (ie, a checklist) to aid the members of the Healthy Life Trajectories Initiative (HeLTI) Canada trial—a preconception randomized controlled clinical trial to prevent child obesity—to assist their efforts in searching, identifying, screening, and including selected eHealth resources for participant use in the study intervention. Methods: A framework for searching, screening, and selecting eHealth resources was adapted from the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) checklist for systematic and scoping reviews to optimize the rigor, clarity, and transparency of the process. Details regarding searching, selecting, extracting, and assessing quality of eHealth resources are described. Results: This study resulted in the systematic development of a checklist consisting of 12 guiding principles, organized in a chronological versus priority sequence to aid researchers in searching, screening, and assessing the quality of various eHealth resources. Conclusions: The eHealth Resource Checklist will assist researchers in navigating the eHealth resource space by providing a mechanism to detail their process of developing inclusion criteria, identifying search location, selecting and reviewing evidence, extracting information, evaluating the quality of the evidence, and synthesizing the extracted evidence. The overarching goal of this checklist is to provide researchers or generalists new to the eHealth field with a tool that balances pragmatism with rigor and that helps standardize the process of searching and critiquing digital material—a particularly important aspect given the recent explosion of and reliance on eHealth resources. Moreover, this checklist may be useful to other researchers and practitioners developing similar health interventions. %M 34860681 %R 10.2196/27533 %U https://mhealth.jmir.org/2021/12/e27533 %U https://doi.org/10.2196/27533 %U http://www.ncbi.nlm.nih.gov/pubmed/34860681 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e24840 %T Development of a Web-Based School Support System Within the AVATAR Project for Psychosocial Well-being in Adolescents: Pilot Feasibility Study %A Mastorci,Francesca %A Piaggi,Paolo %A Trivellini,Gabriele %A Doveri,Cristina %A Casu,Anselmo %A Bastiani,Luca %A Marinaro,Irene %A Vassalle,Cristina %A Pingitore,Alessandro %+ Clinical Physiology Institute, Consiglio Nazionale delle Ricerche Area della Ricerca di Pisa (CNR), Via Moruzzi 1, Pisa, 56124, Italy, 39 050312605, pingi@ifc.cnr.it %K adolescent %K well-being management %K schools %K web tool %K health promotion %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Health and well-being promotions are key points of educational programs for adolescents within schools. There are several health education programs mainly based on lifestyle habit changes; however, social and emotional dimensions should be considered within these educational strategies. Objective: This study aimed to (1) develop a new web-based school support system to assess and analyze individual, classroom, and scholastic institute data on lifestyle habits, social context, emotional status, and scholastic performance; (2) create a web tool for managing the well-being of adolescents through a dynamic and personalized interface that provides immediate feedback that allows the school to monitor progress; and (3) evaluate, in a pilot study, the feasibility of this web-based school support system in order to build health programs that are specific to the needs of the studied population. Methods: The AVATAR (a new purpose for the promotion and evaluation of health and well-being among healthy teenagers) method consists of integrating the information coming from different questionnaires. In particular, to allow planning didactic and educational actions based on the results obtained, the AVATAR approach allows subdivision of the results of the different observed variables and the 4 components into the following 3 percentile categories: modify, improve, and maintain. The AVATAR web platform was designed to collect data on lifestyle, emotional status, and social context from junior high schools in terms of the fundamental aspects of adolescent daily life, with free use by the scholastic community (scholars, teachers, and parents). In this pilot/feasibility study, data from 331 students were acquired between 2018 and 2019 at the beginning of the scholastic year (pre) and at the end following the school-based program (post). Results: Preliminary results showed that after school planning and specific program implementation, defined after AVATAR feedback, students reported better well-being perception characterized by higher perception in psychological well-being (P=.001), mood (P=.001), self-perception (P=.006), and autonomy (P=.001), and an increase in the perception of financial resources (P=.001), which helped in developing healthy lifestyle habits (P=.007). In the social context assessment, students reported stronger relationships with family (P=.02) and peers (P=.001), and a lower perception of bullying (P=.001). Conclusions: The AVATAR web-based platform is a feasible and flexible tool for the health and well-being management of adolescents from epidemiological, preventive, and educational points of view. In particular, it can be used to (1) promote information campaigns aimed at modifying risk behaviors in the student population, (2) sensitize students and put them at the center of their growth path, (3) inform institutions about the health and well-being of the school population, (4) ensure health programs are acceptable and feasible to users before launching on a large scale, and (5) improve the relationship of users (school) and educational agencies with research groups. %M 34860668 %R 10.2196/24840 %U https://formative.jmir.org/2021/12/e24840 %U https://doi.org/10.2196/24840 %U http://www.ncbi.nlm.nih.gov/pubmed/34860668 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31127 %T Short Form of the Pediatric Symptom Checklist-Youth Self-Report (PSC-17-Y): Spanish Validation Study %A Piqueras,Jose A %A Vidal-Arenas,Verónica %A Falcó,Raquel %A Moreno-Amador,Beatriz %A Marzo,Juan C %A Holcomb,Juliana M %A Murphy,Michael %+ Area of Personality, Assessment and Psychological Treatment, Department of Health Psychology, Universidad Miguel Hernandez de Elche, Edificio Altamira, Avenida de la Universidad, s/n, Elche, 03202, Spain, 34 966658343, jpiqueras@umh.es %K PSC-17-Y %K psychometric properties %K screening %K mental problems %K adolescents %K adolescent health %K adolescent medicine %K psychiatry %K psychology %K psychosocial issues %D 2021 %7 1.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The short form, 17-item version of the Pediatric Symptom Checklist-Youth Self-Report (PSC-17-Y) is a validated measure that assesses psychosocial problems overall (OVR) and in 3 major psychopathological domains (internalizing, externalizing, and attention-deficit/hyperactivity disorder), taking 5-10 min to complete. Prior research has established sound psychometric properties of the PSC-17-Y for English speakers. Objective: This study extends psychometric evidence for the acceptability of the PSC-17-Y in a large sample of Spanish adolescents, providing proof of its reliability and structure, convergent and discriminant validity, and longitudinal and gender invariance. Methods: Data were collected on 5430 adolescents, aged 12-18 years, who filled out the PSC-17-Y twice during 2018-2019 (7-month interval). We calculated the Cronbach alpha and the McDonald omega coefficients to test reliability, the Pearson correlation for convergent (distress) and criterion validity (well-being, quality of life, and socioemotional skills), confirmatory factor analysis (CFA) for structure validity, and multigroup and longitudinal measurement invariance analysis for longitudinal and gender stability. Results: Within structural analysis for the PSC-17-Y, CFA supported a correlated 3-factor solution, which was also invariant longitudinally and across gender. All 3 subscales showed evidence of reliability, with coefficients near or above .70. Moreover, scores of PSC-17-Y subscales were positively related with convergent measures and negatively related with criterion measures. Normative data for the PSC-17-Y are presented in the form of percentiles (75th and 90th). Conclusions: This work provides the first evidence of the reliability and validity of the Spanish version of the PSC-17-Y administered over the internet to assess mental health problems among adolescents, maintaining the same domains as the long version. %M 34855614 %R 10.2196/31127 %U https://www.jmir.org/2021/12/e31127 %U https://doi.org/10.2196/31127 %U http://www.ncbi.nlm.nih.gov/pubmed/34855614 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e29243 %T Evaluation of an Online System for Routine Outcome Monitoring: Cross-sectional Survey Study %A Wiebe,Deanna E %A Remers,Shannon %A Nippak,Pria %A Meyer,Julien %+ Department of Health Services Management, Ryerson University, 55 Dundas Street West, 8th floor, TRS 2-042, Toronto, ON, M5G 2C3, Canada, 1 416 979 5000 ext 6409, dwiebe@ryerson.ca %K routine outcome monitoring %K progress monitoring and feedback %K outcome measures %K web-based outcome monitoring %K routine outcome monitoring software %K outcome measurement questionnaire %K measurement-based care %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The use of routine outcome monitoring (ROM) in the treatment of mental health has emerged as a method of improving psychotherapy treatment outcomes. Despite this, very few clinicians regularly use ROM in clinical practice. Online ROM has been suggested as a solution to increase adoption. Objective: The aim of this study is to identify the influence of moving ROM online on client completion rates of self-reported outcome measures and to identify implementation and utilization barriers to online ROM by assessing clinicians’ views on their experience using the online system over previous paper-based methods. Methods: Client completion rates of self-reported outcome measures were compared pre- and postimplementation of an online system of ROM. In addition, a survey questionnaire was administered to 324 mental health service providers regarding their perception of the benefits with an online system of ROM. Results: Client completion rates of self-reported measures increased from 15.62% (427/2734) to 53.98% (1267/2347) after they were moved online. Furthermore, 57% (56/98) of service providers found the new system less time-consuming than the previous paper-based ROM, and 64% (63/98) found that it helped monitor clients. However, the perceived value of the system remains in doubt as only 23% (23/98) found it helped them identify clients at risk for treatment failure, and only 18% (18/98) found it strengthened the therapeutic alliance. Conclusions: Although the current study suggests mixed results regarding service providers’ views on their experience using an online system for ROM, it has identified barriers and challenges that are actionable for improvement. %M 34855615 %R 10.2196/29243 %U https://mental.jmir.org/2021/12/e29243 %U https://doi.org/10.2196/29243 %U http://www.ncbi.nlm.nih.gov/pubmed/34855615 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e24332 %T Implementation Outcome Scales for Digital Mental Health (iOSDMH): Scale Development and Cross-sectional Study %A Sasaki,Natsu %A Obikane,Erika %A Vedanthan,Rajesh %A Imamura,Kotaro %A Cuijpers,Pim %A Shimazu,Taichi %A Kamada,Masamitsu %A Kawakami,Norito %A Nishi,Daisuke %+ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan, 81 3 5841 3521, d-nishi@m.u-tokyo.ac.jp %K implementation outcomes %K acceptability %K appropriateness %K feasibility %K harm %D 2021 %7 23.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health interventions are being used more than ever for the prevention and treatment of psychological problems. Optimizing the implementation aspects of digital mental health is essential to deliver the program to populations in need, but there is a lack of validated implementation outcome measures for digital mental health interventions. Objective: The primary aim of this study is to develop implementation outcome scales of digital mental health for different levels of stakeholders involved in the implementation process: users, providers, and managers or policy makers. The secondary aim is to validate the developed scale for users. Methods: We developed English and Japanese versions of the implementation outcome scales for digital mental health (iOSDMH) based on the literature review and panel discussions with experts in implementation research and web-based psychotherapy. The study developed acceptability, appropriateness, feasibility, satisfaction, and harm as the outcome measures for users, providers, and managers or policy makers. We conducted evidence-based interventions via the internet using UTSMeD, a website for mental health information (N=200). Exploratory factor analysis (EFA) was conducted to assess the structural validity of the iOSDMH for users. Satisfaction, which consisted of a single item, was not included in the EFA. Results: The iOSDMH was developed for users, providers, and managers or policy makers. The iOSDMH contains 19 items for users, 11 items for providers, and 14 items for managers or policy makers. Cronbach α coefficients indicated intermediate internal consistency for acceptability (α=.665) but high consistency for appropriateness (α=.776), feasibility (α=.832), and harm (α=.777) of the iOSDMH for users. EFA revealed 3-factor structures, indicating acceptability and appropriateness as close concepts. Despite the similarity between these 2 concepts, we inferred that acceptability and appropriateness should be used as different factors, following previous studies. Conclusions: We developed iOSDMH for users, providers, and managers. Psychometric assessment of the scales for users demonstrated acceptable reliability and validity. Evaluating the components of digital mental health implementation is a major step forward in implementation science. %M 34817391 %R 10.2196/24332 %U https://formative.jmir.org/2021/11/e24332 %U https://doi.org/10.2196/24332 %U http://www.ncbi.nlm.nih.gov/pubmed/34817391 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e28393 %T Cross-Cultural Modification Strategies for Instruments Measuring Health Beliefs About Cancer Screening: Systematic Review %A Lei,Fang %A Lee,Eunice %+ University of California, Los Angeles, Factor Bldg, 700 Tiverton Dr, Los Angeles, CA, 90095, United States, 1 3107330963, alicelf@ucla.edu %K cancer screening %K health beliefs %K instrument modification %K strategy %K systematic review %D 2021 %7 18.11.2021 %9 Review %J JMIR Cancer %G English %X Background: Modification is an important process by which to adapt an instrument to be used for another culture. However, it is not fully understood how best to modify an instrument to be used appropriately in another culture. Objective: This study aims to synthesize the modification strategies used in the cross-cultural adaptation process for instruments measuring health beliefs about cancer screening. Methods: A systematic review design was used for conducting this study. Keywords including constructs about instrument modification, health belief, and cancer screening were searched in the PubMed, Google Scholar, CINAHL, and PsycINFO databases. Bowling’s checklist was used to evaluate methodological rigor of the included articles. Results were reported using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) approach with a narrative method. Results: A total of 1312 articles were initially identified in the databases. After removing duplications and assessing titles, abstracts, and texts of the articles, 18 studies met the inclusion criteria for the study. Based on Flaherty’s cultural equivalence model, strategies used in the modification process included rephrasing items and response options to achieve semantic equivalence; changing subjects of items, changing wording of items, adding items, and deleting items to achieve content equivalence; adding subscales and items and deleting subscales and items to achieve criterion equivalence. Solutions used to resolve disagreements in the modification process included consultation with experts or literature search, following the majority, and consultation with the author who developed the scales. Conclusions: This study provides guidance for researchers who want to modify an instrument to be used in another culture. It can potentially give cross-cultural researchers insight into modification strategies and a better understanding of the modification process in cross-cultural instrument adaptation. More research could be done to help researchers better modify cross-cultural instruments to achieve cultural equivalence. %M 34792474 %R 10.2196/28393 %U https://cancer.jmir.org/2021/4/e28393 %U https://doi.org/10.2196/28393 %U http://www.ncbi.nlm.nih.gov/pubmed/34792474 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e30042 %T Use of Patient-Reported Outcome Measures and Patient-Reported Experience Measures Within Evaluation Studies of Telemedicine Applications: Systematic Review %A Knapp,Andreas %A Harst,Lorenz %A Hager,Stefan %A Schmitt,Jochen %A Scheibe,Madlen %+ Center for Evidence-Based Healthcare, University Hospital Carl Gustav Carus, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Fetscherstrasse 74, Dresden, 01307, Germany, 49 3514585665, andreas.knapp@uniklinikum-dresden.de %K telemedicine %K telehealth %K evaluation %K outcome %K patient-reported outcome measures %K patient-reported outcome %K patient-reported experience measures %K patient-reported experience %K measurement instrument %K questionnaire %D 2021 %7 17.11.2021 %9 Review %J J Med Internet Res %G English %X Background: With the rise of digital health technologies and telemedicine, the need for evidence-based evaluation is growing. Patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) are recommended as an essential part of the evaluation of telemedicine. For the first time, a systematic review has been conducted to investigate the use of PROMs and PREMs in the evaluation studies of telemedicine covering all application types and medical purposes. Objective: This study investigates the following research questions: in which scenarios are PROMs and PREMs collected for evaluation purposes, which PROM and PREM outcome domains have been covered and how often, which outcome measurement instruments have been used and how often, does the selection and quantity of PROMs and PREMs differ between study types and application types, and has the use of PROMs and PREMs changed over time. Methods: We conducted a systematic literature search of the MEDLINE and Embase databases and included studies published from inception until April 2, 2020. We included studies evaluating telemedicine with patients as the main users; these studies reported PROMs and PREMs within randomized controlled trials, controlled trials, noncontrolled trials, and feasibility trials in English and German. Results: Of the identified 2671 studies, 303 (11.34%) were included; of the 303 studies, 67 (22.1%) were feasibility studies, 70 (23.1%) were noncontrolled trials, 20 (6.6%) were controlled trials, and 146 (48.2%) were randomized controlled trials. Health-related quality of life (n=310; mean 1.02, SD 1.05), emotional function (n=244; mean 0.81, SD 1.18), and adherence (n=103; mean 0.34, SD 0.53) were the most frequently assessed outcome domains. Self-developed PROMs were used in 21.4% (65/303) of the studies, and self-developed PREMs were used in 22.3% (68/303). PROMs (n=884) were assessed more frequently than PREMs (n=234). As the evidence level of the studies increased, the number of PROMs also increased (τ=−0.45), and the number of PREMs decreased (τ=0.35). Since 2000, not only has the number of studies using PROMs and PREMs increased, but the level of evidence and the number of outcome measurement instruments used have also increased, with the number of PREMs permanently remaining at a lower level. Conclusions: There have been increasingly more studies, particularly high-evidence studies, which use PROMs and PREMs to evaluate telemedicine. PROMs have been used more frequently than PREMs. With the increasing maturity stage of telemedicine applications and higher evidence level, the use of PROMs increased in line with the recommendations of evaluation guidelines. Health-related quality of life and emotional function were measured in almost all the studies. Simultaneously, health literacy as a precondition for using the application adequately, alongside proper training and guidance, has rarely been reported. Further efforts should be pursued to standardize PROM and PREM collection in evaluation studies of telemedicine. %M 34523604 %R 10.2196/30042 %U https://www.jmir.org/2021/11/e30042 %U https://doi.org/10.2196/30042 %U http://www.ncbi.nlm.nih.gov/pubmed/34523604 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e30644 %T eHealth Literacy Instruments: Systematic Review of Measurement Properties %A Lee,Jiyeon %A Lee,Eun-Hyun %A Chae,Duckhee %+ Graduate School of Public Health, Ajou University, 164, Worldcup-ro, Yeongtong-gu, Suwon, 16499, Republic of Korea, 82 31 219 5296, ehlee@ajou.ac.kr %K eHealth literacy %K systematic review %K meta-analysis %K psychometrics %K reliability %K validity %K scale %K instrument %D 2021 %7 15.11.2021 %9 Review %J J Med Internet Res %G English %X Background: The internet is now a major source of health information. With the growth of internet users, eHealth literacy has emerged as a new concept for digital health care. Therefore, health professionals need to consider the eHealth literacy of consumers when providing care utilizing digital health technologies. Objective: This study aimed to identify currently available eHealth literacy instruments and evaluate their measurement properties to provide robust evidence to researchers and clinicians who are selecting an eHealth literacy instrument. Methods: We conducted a systematic review and meta-analysis of self-reported eHealth literacy instruments by applying the updated COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) methodology. Results: This study included 7 instruments from 41 articles describing 57 psychometric studies, as identified in 4 databases (PubMed, CINAHL, Embase, and PsycInfo). No eHealth literacy instrument provided evidence for all measurement properties. The eHealth literacy scale (eHEALS) was originally developed with a single-factor structure under the definition of eHealth literacy before the rise of social media and the mobile web. That instrument was evaluated in 18 different languages and 26 countries, involving diverse populations. However, various other factor structures were exhibited: 7 types of two-factor structures, 3 types of three-factor structures, and 1 bifactor structure. The transactional eHealth literacy instrument (TeHLI) was developed to reflect the broader concept of eHealth literacy and was demonstrated to have a sufficient low-quality and very low-quality evidence for content validity (relevance, comprehensiveness, and comprehensibility) and sufficient high-quality evidence for structural validity and internal consistency; however, that instrument has rarely been evaluated. Conclusions: The eHealth literacy scale was the most frequently investigated instrument. However, it is strongly recommended that the instrument's content be updated to reflect recent advancements in digital health technologies. In addition, the transactional eHealth literacy instrument needs improvements in content validity and further psychometric studies to increase the credibility of its synthesized evidence. %M 34779781 %R 10.2196/30644 %U https://www.jmir.org/2021/11/e30644 %U https://doi.org/10.2196/30644 %U http://www.ncbi.nlm.nih.gov/pubmed/34779781 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 4 %P e24950 %T Investigating the Use of Virtual Reality Headsets for Postural Control Assessment: Instrument Validation Study %A Sylcott,Brian %A Lin,Chia-Cheng %A Williams,Keith %A Hinderaker,Mark %+ Department of Engineering, East Carolina University, 1000 East 5th Street, Greenville, NC, 27858, United States, 1 2527374652, sylcottb15@ecu.edu %K postural sway %K virtual reality %K force plate %K center of pressure %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Accurately measuring postural sway is an important part of balance assessment and rehabilitation. Although force plates give accurate measurements, their costs and space requirements make their use impractical in many situations. Objective: The work presented in this paper aimed to address this issue by validating a virtual reality (VR) headset as a relatively low-cost alternative to force plates for postural sway measurement. The HTC Vive (HTC Corporation) VR headset has built-in sensors that allow for position and orientation tracking, making it a potentially effective tool for balance assessments. Methods: Participants in this study were asked to stand upright on a force plate (NeuroCom; Natus Medical Incorporated) while wearing the HTC Vive. Position data were collected from the headset and force plate simultaneously as participants experienced a custom-built VR environment that covered their entire field of view. The intraclass correlation coefficient (ICC) was used to examine the test-retest reliability of the postural control variables, which included the normalized path length, root mean square (RMS), and peak-to-peak (P2P) value. These were computed from the VR position output data and the center of pressure (COP) data from the force plate. Linear regression was used to investigate the correlations between the VR and force plate measurements. Results: Our results showed that the test-retest reliability of the RMS and P2P value of VR headset outputs (ICC: range 0.285-0.636) was similar to that of the RMS and P2P value of COP outputs (ICC: range 0.228-0.759). The linear regression between VR and COP measures showed significant correlations in RMSs and P2P values. Conclusions: Based on our results, the VR headset has the potential to be used for postural control measurements. However, the further development of software and testing protocols for balance assessments is needed. %M 34779789 %R 10.2196/24950 %U https://rehab.jmir.org/2021/4/e24950 %U https://doi.org/10.2196/24950 %U http://www.ncbi.nlm.nih.gov/pubmed/34779789 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e21462 %T The Online Patient Satisfaction Index for Patients With Low Back Pain: Development, Reliability, and Validation Study %A Afzali,Tamana %A Lauridsen,Henrik Hein %A Thomsen,Janus Laust %A Hartvigsen,Jan %A Jensen,Martin Bach %A Riis,Allan %+ Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Fyrkildevej 7, Aalborg, 9220, Denmark, 45 20823660, ariis@dcm.aau.dk %K data accuracy %K patient satisfaction %K rehabilitation %K low back pain %K internet-based intervention %K mobile phone %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Low back pain is highly prevalent, and most often, a specific causative factor cannot be identified. Therefore, for most patients, their low back pain is labeled as nonspecific. Patient education and information are recommended for all these patients. The internet is an accessible source of medical information on low back pain. Approximately 50% of patients with low back pain search the internet for health and medical advice. Patient satisfaction with education and information is important in relation to patients’ levels of inclination to use web-based information and their trust in the information they find. Although patients who are satisfied with the information they retrieve use the internet as a supplementary source of information, dissatisfied patients tend to avoid using the internet. Consumers’ loyalty to a product is often applied to evaluate their satisfaction. Consumers have been shown to be good ambassadors for a service when they are willing to recommend the service to a friend or colleague. When consumers are willing to recommend a service to a friend or colleague, they are also likely to be future users of the service. To the best of our knowledge, no multi-item instrument exists to specifically evaluate satisfaction with information delivered on the web for people with low back pain. Objective: This study aims to report on the development, reliability testing, and construct validity testing of the Online Patient Satisfaction Index to measure patients’ satisfaction with web-based information for low back pain. Methods: This is a cross-sectional validation study of the Online Patient Satisfaction Index. The index was developed with experts and assessed for face validity. It was subsequently administered to 150 adults with nonspecific low back pain. Of these, 46% (70/150) were randomly assigned to participate in a reliability test using an intraclass correlation coefficient of agreement. Construct validity was evaluated by hypothesis testing based on a web app (MyBack) and Wikipedia on low back pain. Results: The index includes 8 items. The median score (range 0-24) based on the MyBack website was 20 (IQR 18-22), and the median score for Wikipedia was 12 (IQR 8-15). The entire score range was used. Overall, 53 participants completed a retest, of which 39 (74%) were stable in their satisfaction with the home page and were included in the analysis for reliability. Intraclass correlation coefficient of agreement was estimated to be 0.82 (95% CI 0.68-0.90). Two hypothesized correlations for construct validity were confirmed through an analysis using complete data. Conclusions: The index had good face validity, excellent reliability, and good construct validity and can be used to measure satisfaction with the provision of web-based information regarding nonspecific low back pain among people willing to access the internet to obtain health information. Trial Registration: ClinicalTrials.gov NCT03449004; https://clinicaltrials.gov/ct2/show/NCT03449004 %M 34779785 %R 10.2196/21462 %U https://formative.jmir.org/2021/11/e21462 %U https://doi.org/10.2196/21462 %U http://www.ncbi.nlm.nih.gov/pubmed/34779785 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30313 %T Development of a Severity Score and Comparison With Validated Measures for Depression and Anxiety: Validation Study %A Lynch,William %A Platt,Michael L %A Pardes,Adam %+ NeuroFlow, Inc, 111 S Independence Mall E, Suite 701, Philadelphia, PA, United States, 1 267 671 7316, adam@neuroflow.com %K PHQ-9 %K GAD-7 %K depression assessment %K anxiety assessment %K measurement-based care %K integrated behavioral health %D 2021 %7 10.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Less than 10% of the individuals seeking behavioral health care receive measurement-based care (MBC). Technology has the potential to implement MBC in a secure and efficient manner. To test this idea, a mobile health (mHealth) platform was developed with the goal of making MBC easier to deliver by clinicians and more accessible to patients within integrated behavioral health care. Data from over 3000 users of the mHealth platform were used to develop an output severity score, a robust screening measure for depression and anxiety. Objective: The aim of this study is to compare severity scores with scores from validated assessments for depression and anxiety and scores from clinician review to evaluate the potential added value of this new measure. Methods: The severity score uses patient-reported and passively collected data related to behavioral health on an mHealth platform. An artificial intelligence–derived algorithm was developed that condenses behavioral health data into a single, quantifiable measure for longitudinal tracking of an individual’s depression and anxiety symptoms. Linear regression and Bland-Altman analyses were used to evaluate the relationships and differences between severity scores and Personal Health Questionnaire-9 (PHQ-9) or Generalized Anxiety Disorder-7 (GAD-7) scores from over 35,000 mHealth platform users. The severity score was also compared with a review by a panel of expert clinicians for a subset of 250 individuals. Results: Linear regression results showed a strong correlation between the severity score and PHQ-9 (r=0.74; P<.001) and GAD-7 (r=0.80; P<.001) changes. A strong positive correlation was also found between the severity score and expert panel clinical review (r=0.80-0.84; P<.001). However, Bland-Altman analysis and the evaluation of outliers on regression analysis showed that the severity score was significantly different from the PHQ-9. Conclusions: Clinicians can reliably use the mHealth severity score as a proxy measure for screening and monitoring behavioral health symptoms longitudinally. The severity score may identify at-risk individuals who are not identified by the PHQ-9. Further research is warranted to evaluate the sensitivity and specificity of the severity score. %M 34757319 %R 10.2196/30313 %U https://formative.jmir.org/2021/11/e30313 %U https://doi.org/10.2196/30313 %U http://www.ncbi.nlm.nih.gov/pubmed/34757319 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e28915 %T Data Quality of Longitudinally Collected Patient-Reported Outcomes After Thoracic Surgery: Comparison of Paper- and Web-Based Assessments %A Yu,Hongfan %A Yu,Qingsong %A Nie,Yuxian %A Xu,Wei %A Pu,Yang %A Dai,Wei %A Wei,Xing %A Shi,Qiuling %+ School of Public Health and Management, Chongqing Medical University, No 1, Medical College Road, Yuzhong District, Chonqqing, 400016, China, 86 18290585397, qshi@cqmu.edu.cn %K patient-reported outcome (PRO) %K data quality %K MDASI-LC %K postoperative care %K symptoms %D 2021 %7 9.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: High-frequency patient-reported outcome (PRO) assessments are used to measure patients' symptoms after surgery for surgical research; however, the quality of those longitudinal PRO data has seldom been discussed. Objective: The aim of this study was to determine data quality-influencing factors and to profile error trajectories of data longitudinally collected via paper-and-pencil (P&P) or web-based assessment (electronic PRO [ePRO]) after thoracic surgery. Methods: We extracted longitudinal PRO data with 678 patients scheduled for lung surgery from an observational study (n=512) and a randomized clinical trial (n=166) on the evaluation of different perioperative care strategies. PROs were assessed by the MD Anderson Symptom Inventory Lung Cancer Module and single-item Quality of Life Scale before surgery and then daily after surgery until discharge or up to 14 days of hospitalization. Patient compliance and data error were identified and compared between P&P and ePRO. Generalized estimating equations model and 2-piecewise model were used to describe trajectories of error incidence over time and to identify the risk factors. Results: Among 678 patients, 629 with at least 2 PRO assessments, 440 completed 3347 P&P assessments and 189 completed 1291 ePRO assessments. In total, 49.4% of patients had at least one error, including (1) missing items (64.69%, 1070/1654), (2) modifications without signatures (27.99%, 463/1654), (3) selection of multiple options (3.02%, 50/1654), (4) missing patient signatures (2.54%, 42/1654), (5) missing researcher signatures (1.45%, 24/1654), and (6) missing completion dates (0.30%, 5/1654). Patients who completed ePRO had fewer errors than those who completed P&P assessments (ePRO: 30.2% [57/189] vs. P&P: 57.7% [254/440]; P<.001). Compared with ePRO patients, those using P&P were older, less educated, and sicker. Common risk factors of having errors were a lower education level (P&P: odds ratio [OR] 1.39, 95% CI 1.20-1.62; P<.001; ePRO: OR 1.82, 95% CI 1.22-2.72; P=.003), treated in a provincial hospital (P&P: OR 3.34, 95% CI 2.10-5.33; P<.001; ePRO: OR 4.73, 95% CI 2.18-10.25; P<.001), and with severe disease (P&P: OR 1.63, 95% CI 1.33-1.99; P<.001; ePRO: OR 2.70, 95% CI 1.53-4.75; P<.001). Errors peaked on postoperative day (POD) 1 for P&P, and on POD 2 for ePRO. Conclusions: It is possible to improve data quality of longitudinally collected PRO through ePRO, compared with P&P. However, ePRO-related sampling bias needs to be considered when designing clinical research using longitudinal PROs as major outcomes. %M 34751657 %R 10.2196/28915 %U https://www.jmir.org/2021/11/e28915 %U https://doi.org/10.2196/28915 %U http://www.ncbi.nlm.nih.gov/pubmed/34751657 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e17670 %T Evidence of Construct Validity of Computer-Based Tests for Clinical Reasoning: Instrument Validation Study %A Zuo,Tianming %A Sun,Baozhi %A Guan,Xu %A Zheng,Bin %A Qu,Bo %+ Institute for International Health Professions Education and Research, China Medical University, No. 77 Puhe Road, Shenyang, 110122, China, 86 189 0091 0198, qubo6666@163.com %K medical education %K assessment %K computer-based test %K clinical reasoning %K validity %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Clinical reasoning (CR) is a fundamental skill for all medical students. In our medical education system, however, there are shortcomings in the conventional methods of teaching CR. New technology is needed to enhance our CR teaching, especially as we are facing an influx of new health trainees. China Medical University (CMU), in response to this need, has developed a computer-based CR training system (CMU-CBCRT). Objective: We aimed to find evidence of construct validity of the CMU-CBCRT. Methods: We recruited 385 students from fifth year undergraduates to postgraduate year (PGY) 3 to complete the test on CMU-CBCRT. The known-groups technique was used to evaluate the construct validity of the CBCRT by comparing the test scores among 4 training levels (fifth year MD, PGY-1, PGY-2, and PGY-3). Results: We found that test scores increased with years of training. Significant differences were found in the test scores on information collection, diagnosis, and treatment and total scores among different training years of participants. However, significant results were not found for treatment errors. Conclusions: We provided evidence of construct validity of the CMU-CBCRT, which could determine the CR skills of medical students at varying early stage in their careers. %M 34751658 %R 10.2196/17670 %U https://games.jmir.org/2021/4/e17670 %U https://doi.org/10.2196/17670 %U http://www.ncbi.nlm.nih.gov/pubmed/34751658 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e30093 %T A Decision Support Tool for Allogeneic Hematopoietic Stem Cell Transplantation for Children With Sickle Cell Disease: Acceptability and Usability Study %A Veludhandi,Anirudh %A Ross,Diana %A Sinha,Cynthia B %A McCracken,Courtney %A Bakshi,Nitya %A Krishnamurti,Lakshmanan %+ School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA, 30322, United States, 1 404 727 5671, lkrishn@emory.edu %K decision support tool %K sickle cell disease %K mobile application %K mHealth %K pediatrics %K transplant %K mobile phone %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals living with sickle cell disease (SCD) may benefit from a variety of disease-modifying therapies, including hydroxyurea, voxelotor, crizanlizumab, L-glutamine, and chronic blood transfusions. However, allogeneic hematopoietic stem cell transplantation (HCT) remains the only nonexperimental treatment with curative intent. As HCT outcomes can be influenced by the complex interaction of several risk factors, HCT can be a difficult decision for health care providers to make for their patients with SCD. Objective: The aim of this study is to determine the acceptability and usability of a prototype decision support tool for health care providers in decision-making about HCT for SCD, together with patients and their families. Methods: On the basis of published transplant registry data, we developed the Sickle Options Decision Support Tool for Children, which provides health care providers with personalized transplant survival and risk estimates for their patients to help them make informed decisions regarding their patients’ management of SCD. To evaluate the tool for its acceptability and usability, we conducted beta tests of the tool and surveys with physicians using the Ottawa Decision Support Framework and mobile health app usability questionnaire, respectively. Results: According to the mobile health app usability questionnaire survey findings, the overall usability of the tool was high (mean 6.15, SD 0.79; range 4.2-7). According to the Ottawa Decision Support Framework survey findings, acceptability of the presentation of information on the decision support tool was also high (mean 2.94, SD 0.63; range 2-4), but the acceptability regarding the amount of information was mixed (mean 2.59, SD 0.5; range 2-3). Most participants expressed that they would use the tool in their own patient consults (13/15, 87%) and suggested that the tool would ease the decision-making process regarding HCT (8/9, 89%). The 4 major emergent themes from the qualitative analysis of participant beta tests include user interface, data content, usefulness during a patient consult, and potential for a patient-focused decision aid. Most participants supported the idea of a patient-focused decision aid but recommended that it should include more background on HCT and a simplification of medical terminology. Conclusions: We report the development, acceptability, and usability of a prototype decision support tool app to provide individualized risk and survival estimates to patients interested in HCT in a patient consultation setting. We propose to finalize the tool by validating predictive analytics using a large data set of patients with SCD who have undergone HCT. Such a tool may be useful in promoting physician-patient collaboration in making shared decisions regarding HCT for SCD. Further incorporation of patient-specific measures, including the HCT comorbidity index and the quality of life after transplant, may improve the applicability of the decision support tool in a health care setting. %M 34709190 %R 10.2196/30093 %U https://formative.jmir.org/2021/10/e30093 %U https://doi.org/10.2196/30093 %U http://www.ncbi.nlm.nih.gov/pubmed/34709190 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e26821 %T Psychometric Properties of the Internet Gaming Disorder Scale–Short-Form (IGDS9-SF): Systematic Review %A Poon,Lok Y J %A Tsang,Hector W H %A Chan,Tsan Y J %A Man,Sze W T %A Ng,Lok Y %A Wong,Yi L E %A Lin,Chung-Ying %A Chien,Chi-Wen %A Griffiths,Mark D %A Pontes,Halley M %A Pakpour,Amir H %+ Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 701, Taiwan, 886 6 2353535 ext 5106, cylin36933@gmail.com %K psychometrics %K IGDS9-SF %K gaming addiction %K gaming disorder %K problematic gaming %K internet %K gaming %K internet gaming %D 2021 %7 18.10.2021 %9 Review %J J Med Internet Res %G English %X Background: The Internet Gaming Disorder Scale–Short-Form (IGDS9-SF) is among the best with regard to its psychometric properties. Therefore, clinical psychologists are likely guided to use the IGDS9-SF if they want to assess or screen the disordered gaming in their practice. However, the information, especially psychometric evidence, concerning the IGDS9-SF has not been fully examined and summarized. Objective: This systematic review evaluated the psychometric properties of different language versions of the IGDS9-SF and assessed its methodological quality in order to improve the clinicians’ understanding of the IGDS9-SF and facilitate its use. Methods: Systematic literature searches were carried out using Embase, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science. The review included English-language studies of any research design that have reported at least one psychometric property of the IGDS9-SF, as defined by the COnsensus-based Standards for the selection of health status Measurement INstrument (COSMIN), and have aimed at testing the psychometric properties of the IGDS9-SF. Results: In total, 21 studies comprising 15 language versions of the IGDS9-SF were included. Overall, the IGDS9-SF showed adequate internal consistency (although some items did not have satisfactory item-total correlation [IT]), excellent criterion validity, and the ability to distinguish different subgroups with measurement invariance being supported across gender and age. In terms of factor structure, the IGDS9-SF was shown to have a unidimensional factor structure across all 21 studies. Conclusions: Although there is insufficient evidence regarding the responsiveness and properties of the IGDS9-SF using item response theory, the existing evidence supports its use in assessing disordered gaming among individuals. %M 34661543 %R 10.2196/26821 %U https://www.jmir.org/2021/10/e26821 %U https://doi.org/10.2196/26821 %U http://www.ncbi.nlm.nih.gov/pubmed/34661543 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e29615 %T Validity and Reliability of the Self-administered Psycho-TherApy-SystemS (SELFPASS) Item Pool for the Daily Mood Tracking of Depressive Symptoms: Cross-sectional Web-Based Survey %A Mayer,Gwendolyn %A Hummel,Svenja %A Gronewold,Nadine %A Oetjen,Neele %A Hilbel,Thomas %A Schultz,Jobst-Hendrik %+ Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 130 3, Heidelberg, 69120, Germany, 49 6221 56 35685, gwendolyn.mayer@med.uni-heidelberg.de %K self-management %K mood tracking %K validity %K reliability %K item pool %K questionnaire %K depression %K anxiety %K mood assessment %D 2021 %7 18.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: e-Mental health apps targeting depression have gained increased attention in mental health care. Daily self-assessment is an essential part of e-mental health apps. The Self-administered Psycho-TherApy-SystemS (SELFPASS) app is a self-management app to manage depressive and comorbid anxiety symptoms of patients with a depression diagnosis. A self-developed item pool with 40 depression items and 12 anxiety items is included to provide symptom-specific suggestions for interventions. However, the psychometric properties of the item pool have not yet been evaluated. Objective: The aim of this study is to investigate the validity and reliability of the SELFPASS item pool. Methods: A weblink with the SELFPASS item pool and validated mood assessment scales was distributed to healthy subjects and patients who had received a diagnosis of a depressive disorder within the last year. Two scores were derived from the SELFPASS item pool: SELFPASS depression (SP-D) and SELFPASS anxiety (SP-A). Reliability was examined using Cronbach α. Construct validity was assessed through Pearson correlations with the Patient Health Questionnaire-9 (PHQ-9), the General Anxiety Disorder Scale-7 (GAD-7), and the WHO-5-Wellbeing-Scale (WHO-5). Logistic regression analysis was performed as an indicator for concurrent criterion validity of SP-D and SP-A. Factor analysis was performed to provide information about the underlying factor structure of the item pool. Item-scale correlations were calculated in order to determine item quality. Results: A total of 284 participants were included, with 192 (67.6%) healthy subjects and 92 (32.4%) patients. Cronbach α was set to .94 for SP-D and α=.88 for SP-A. We found significant positive correlations between SP-D and PHQ-9 scores (r=0.87; P<.001) and between SP-A and GAD-7 scores (r=0.80; P<.001), and negative correlations between SP-D and WHO-5 scores (r=–0.80; P<.001) and between SP-A and WHO-5 scores (r=–0.69; P<.001). Increasing scores of SP-D and SP-A led to increased odds of belonging to the patient group (SP-D: odds ratio 1.03, 95% CI 1.01-1.05; P<.001; SP-A: 1.05, 1.05-1.01; P=.01). The item pool yielded 2 factors: one that consisted of mood-related items and another with somatic-related items. Conclusions: The SELFPASS item pool showed good psychometric properties in terms of reliability, construct, and criterion validity. The item pool is an appropriate source for daily mood tracking in future e-mental health apps among patients with depression. Our study provides general recommendations for future developments as well as recommendations within the item pool. %M 34661547 %R 10.2196/29615 %U https://mental.jmir.org/2021/10/e29615 %U https://doi.org/10.2196/29615 %U http://www.ncbi.nlm.nih.gov/pubmed/34661547 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e30243 %T Validity Evidence Based on Relations to Other Variables of the eHealth Literacy Questionnaire (eHLQ): Bayesian Approach to Test for Known-Groups Validity %A Cheng,Christina %A Elsworth,Gerald %A Osborne,Richard H %+ Centre for Global Health and Equity, School of Health Sciences, Swinburne University of Technology, Room 907, Level 9, AMDC Building, 453/469-477 Burwood Road, Hawthorn, Victoria 3122, Australia, 61 392145470, cccheng@swin.edu.au %K eHealth %K digital health %K health literacy %K health equity %K questionnaire design %K health literacy questionnaire %K validity evidence %K mediation effect %K mobile phone %D 2021 %7 14.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: As health resources and services are increasingly delivered through digital platforms, eHealth literacy is becoming a set of essential capabilities to improve consumer health in the digital era. To understand eHealth literacy needs, a meaningful measure is required. Strong initial evidence for the reliability and construct validity of inferences drawn from the eHealth Literacy Questionnaire (eHLQ) was obtained during its development in Denmark, but validity testing for varying purposes is an ongoing and cumulative process. Objective: This study aims to examine validity evidence based on relations to other variables—using data collected with the known-groups approach—to further explore if the eHLQ is a robust tool to understand eHealth literacy needs in different contexts. A priori hypotheses are set for the expected score differences among age, sex, education, and information and communication technology (ICT) use for each of the 7 eHealth literacy constructs represented by the 7 eHLQ scales. Methods: A Bayesian mediated multiple indicators multiple causes model approach was used to simultaneously identify group differences and test measurement invariance through differential item functioning across the groups, with ICT use as a mediator. A sample size of 500 participants was estimated. Data were collected at 3 diverse health sites in Australia. Results: Responses from 525 participants were included for analysis. Being older was significantly related to lower scores in 4 eHLQ scales, with 3. Ability to actively engage with digital services having the strongest effect (total effect –0.37; P<.001), followed by 1. Using technology to process health information (total effect –0.32; P<.001), 5. Motivated to engage with digital services (total effect –0.21; P=.01), and 7. Digital services that suit individual needs (total effect –0.21; P=.02). However, the effects were only partially mediated by ICT use. Higher education was associated with higher scores in 1. Using technology to process health information (total effect 0.22; P=.01) and 3. Ability to actively engage with digital services (total effect 0.25; P<.001), with the effects mostly mediated by ICT use. Higher ICT use was related to higher scores in all scales except 2. Understanding health concepts and language and 4. Feel safe and in control. Either no or ignorable cases of differential item functioning were found across the 4 groups. Conclusions: By using a Bayesian mediated multiple indicators multiple causes model, this study provides supportive validity evidence for the eHLQ based on relations to other variables as well as established evidence regarding internal structure related to measurement invariance across the groups for the 7 scales in the Australian community health context. This study also demonstrates that the eHLQ can be used to gain valuable insights into people’s eHealth literacy needs to help optimize access and use of digital health and promote health equity. %M 34647897 %R 10.2196/30243 %U https://www.jmir.org/2021/10/e30243 %U https://doi.org/10.2196/30243 %U http://www.ncbi.nlm.nih.gov/pubmed/34647897 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 4 %P e26675 %T Interpretation of a 12-Lead Electrocardiogram by Medical Students: Quantitative Eye-Tracking Approach %A Tahri Sqalli,Mohammed %A Al-Thani,Dena %A Elshazly,Mohamed B %A Al-Hijji,‪Mohammed %+ Information and Computing Technology Division, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, 34110, Qatar, 974 50588170, mtahrisqalli@hbku.edu.qa %K eye tracking %K electrocardiogram %K ECG interpretation %K medical education %K human-computer interaction %K medical student %K eye %K tracking %K interpretation %K ECG %D 2021 %7 14.10.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: Accurate interpretation of a 12-lead electrocardiogram (ECG) demands high levels of skill and expertise. Early training in medical school plays an important role in building the ECG interpretation skill. Thus, understanding how medical students perform the task of interpretation is important for improving this skill. Objective: We aimed to use eye tracking as a tool to research how eye fixation can be used to gain a deeper understanding of how medical students interpret ECGs. Methods: In total, 16 medical students were recruited to interpret 10 different ECGs each. Their eye movements were recorded using an eye tracker. Fixation heatmaps of where the students looked were generated from the collected data set. Statistical analysis was conducted on the fixation count and duration using the Mann-Whitney U test and the Kruskal-Wallis test. Results: The average percentage of correct interpretations was 55.63%, with an SD of 4.63%. After analyzing the average fixation duration, we found that medical students study the three lower leads (rhythm strips) the most using a top-down approach: lead II (mean=2727 ms, SD=456), followed by leads V1 (mean=1476 ms, SD=320) and V5 (mean=1301 ms, SD=236). We also found that medical students develop a personal system of interpretation that adapts to the nature and complexity of the diagnosis. In addition, we found that medical students consider some leads as their guiding point toward finding a hint leading to the correct interpretation. Conclusions: The use of eye tracking successfully provides a quantitative explanation of how medical students learn to interpret a 12-lead ECG. %M 34647899 %R 10.2196/26675 %U https://mededu.jmir.org/2021/4/e26675 %U https://doi.org/10.2196/26675 %U http://www.ncbi.nlm.nih.gov/pubmed/34647899 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e25776 %T Measuring the Time to Deterioration for Health-Related Quality of Life in Patients With Metastatic Breast Cancer Using a Web-Based Monitoring Application: Longitudinal Cohort Study %A Brusniak,Katharina %A Feisst,Manuel %A Sebesteny,Linda %A Hartkopf,Andreas %A Graf,Joachim %A Engler,Tobias %A Schneeweiss,Andreas %A Wallwiener,Markus %A Deutsch,Thomas Maximilian %+ Department of Gynecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, Heidelberg, Germany, 49 6221 56 36956, Markus.Wallwiener@med.uni-heidelberg.de %K eHealth %K breast cancer %K health-related quality of life %K quality of life %K time to deterioration %K EQ-VAS %K EQ-5D-5L %K EORTC QLQ-C30 %D 2021 %7 12.10.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Health-related quality of life (HRQoL) is used to evaluate the treatment of metastatic breast cancer. In a long-term therapy setting, HRQoL can be used as an important benchmark for treatment success. With the help of digital apps, HRQoL monitoring can be extended to more remote areas and be administered on a more frequent basis. Objective: This study aims to evaluate 3 common HRQoL questionnaires in metastasized breast cancer in terms of TTD in a digital, web-based setting. We further aim to examine the development of the HRQoL in different systemic treatment groups in each of these evaluation instruments. Methods: A total of 192 patients with metastatic breast cancer were analyzed in this bicentric prospective online cohort study at two German university hospitals. Patients completed questionnaires on HRQoL (EuroQol Visual Analog Scale [EQ-VAS], EuroQol 5 Dimension 5 Level [EQ-5D-5L], European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Core 30 item [EORTC QLQ-C30]) via an online platform over a 6-month period. Treatment schedules and medical history were retrieved from medical records. Unadjusted Cox regression analysis on treatment-related factors was performed. We conducted subgroup analyses in regard to TTD events between different treatments. Results: The EQ-VAS showed a higher rate of deterioration after 8 weeks (84/179, 46.9%) than the EQ-5D-5L (47/163, 28.8%) and EORTC QLQ-C30 (65/176, 36.9%). Unadjusted Cox regression revealed significant connections between known metastases in the liver (P=.03, HR 1.64, 95% CI 1.06-2.52) and pleura (P=.04, HR 0.42, 95% CI 0.18-0.96) in the EQ-VAS. Significant relations between EQ-VAS events and single EQ-5D-5L items and the EQ-5D-5L summary score were demonstrated. All treatment groups significantly differed from the CDK4/6 inhibition subgroup in the EQ-VAS. Conclusions: Compared to the EQ-5D-5L and QLQ-C30, the EQ-VAS showed a higher rate of deterioration after 8 weeks. Significant connections to certain metastatic locations were only detected in the EQ-VAS. The EQ-VAS is capable of reflecting the distinctive HRQoL profiles of different systemic treatments as well as the different aspects of HRQoL presented in the EQ-5D-5L. TTD with the EQ-VAS is an adequate mean of examining longitudinal development of HRQoL among breast cancer patients. %M 34636732 %R 10.2196/25776 %U https://cancer.jmir.org/2021/4/e25776 %U https://doi.org/10.2196/25776 %U http://www.ncbi.nlm.nih.gov/pubmed/34636732 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e32365 %T Understanding Uptake of Digital Health Products: Methodology Tutorial for a Discrete Choice Experiment Using the Bayesian Efficient Design %A Szinay,Dorothy %A Cameron,Rory %A Naughton,Felix %A Whitty,Jennifer A %A Brown,Jamie %A Jones,Andy %+ Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich Research Park Earlham Road, Norwich, NR4 7TJ, United Kingdom, 44 1603593064, d.szinay@uea.ac.uk %K discrete choice experiment %K stated preference methods %K mHealth %K digital health %K quantitative methodology %K uptake %K engagement %K methodology %K preference %K Bayesian %K design %K tutorial %K qualitative %K user preference %D 2021 %7 11.10.2021 %9 Tutorial %J J Med Internet Res %G English %X Understanding the preferences of potential users of digital health products is beneficial for digital health policy and planning. Stated preference methods could help elicit individuals’ preferences in the absence of observational data. A discrete choice experiment (DCE) is a commonly used stated preference method—a quantitative methodology that argues that individuals make trade-offs when engaging in a decision by choosing an alternative of a product or a service that offers the greatest utility, or benefit. This methodology is widely used in health economics in situations in which revealed preferences are difficult to collect but is much less used in the field of digital health. This paper outlines the stages involved in developing a DCE. As a case study, it uses the application of a DCE to reveal preferences in targeting the uptake of smoking cessation apps. It describes the establishment of attributes, the construction of choice tasks of 2 or more alternatives, and the development of the experimental design. This tutorial offers a guide for researchers with no prior knowledge of this research technique. %M 34633290 %R 10.2196/32365 %U https://www.jmir.org/2021/10/e32365 %U https://doi.org/10.2196/32365 %U http://www.ncbi.nlm.nih.gov/pubmed/34633290 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e30701 %T Improvement and Evaluation of the TOPCOP Taxonomy of Patient Portals: Taxonomy-Evaluation-Delphi (TED) Approach %A Glöggler,Michael %A Ammenwerth,Elske %+ Institute of Medical Informatics, UMIT – Private University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnöfer-Zentrum 1, Hall in Tirol, 6060, Austria, 43 50 8648 ext 3809, michael.gloeggler@edu.umit-tirol.at %K taxonomy %K classification system %K patient portal %K EHR portal %K online EHR access %K evaluation %K Delphi study %K electronic health records %K digital health %K health information %K information management %K user perspectives %D 2021 %7 5.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient portals have been introduced in many countries over the last 10 years, but many health information managers still feel they have too little knowledge of patient portals. A taxonomy can help them to better compare and select portals. This has led us to develop the TOPCOP taxonomy for classifying and comparing patient portals. However, the taxonomy has not been evaluated by users. Objective: This study aimed to evaluate the taxonomy’s usefulness to support health information managers in comparing, classifying, defining a requirement profile for, and selecting patient portals and to improve the taxonomy where needed. Methods: We used a modified Delphi approach. We sampled a heterogeneous panel of 13 health information managers from 3 countries using the criterion sampling strategy. We conducted 4 anonymous survey rounds with qualitative and quantitative questions. In round 1, the panelists assessed the appropriateness of each dimension, and we collected new ideas to improve the dimensions. In rounds 2 and 3, the panelists iteratively evaluated the taxonomy that was revised based on round 1. In round 4, the panelists assessed the need for a taxonomy and the appropriateness of patient engagement as a distinguishing concept. Then, they compared 2 real portals with the final taxonomy and evaluated its usefulness for comparing portals, creating an initial requirement profile, and selecting patient portals. To determine group consensus, we applied the RAND/UCLA Appropriateness Method. Results: The final taxonomy consists of 25 dimensions with 65 characteristics. Five new dimensions were added to the original taxonomy, with 8 characteristics added to already existing dimensions. Group consensus was achieved on the need for such a taxonomy to compare portals, on patient engagement as an appropriate distinguishing concept, and on the comprehensibility of the taxonomy’s form. Further, consensus was achieved on the taxonomy’s usefulness for classifying and comparing portals, assisting users in better understanding portals, creating a requirement profile, and selecting portals. This allowed us to test the usefulness of the final taxonomy with the intended users. Conclusions: The TOPCOP taxonomy aims to support health information managers in comparing and selecting patient portals. By providing a standardized terminology to describe various aspects of patient portals independent of clinical setting or country, the taxonomy will also be useful for advancing research and evaluation of patient portals. %M 34403354 %R 10.2196/30701 %U https://www.jmir.org/2021/10/e30701 %U https://doi.org/10.2196/30701 %U http://www.ncbi.nlm.nih.gov/pubmed/34403354 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e27174 %T A Tool to Assess the Trustworthiness of Evidence-Based Point-of-Care Information for Health Care Professionals (CAPOCI): Design and Validation Study %A Lenaerts,Gerlinde %A Bekkering,Geertruida E %A Goossens,Martine %A De Coninck,Leen %A Delvaux,Nicolas %A Cordyn,Sam %A Adriaenssens,Jef %A Aertgeerts,Bert %A Vankrunkelsven,Patrik %+ Belgian Centre for Evidence-Based Medicine, Kapucijnenvoer 7, Leuven, 3000, Belgium, 32 16 37 72 73, gerlinde.lenaerts@cebam.be %K evidence-based medicine %K evidence-based practice %K point-of-care systems %K health care quality %K information science %K practice guidelines as a topic %D 2021 %7 5.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: User-friendly information at the point of care for health care professionals should be well structured, rapidly accessible, comprehensive, and trustworthy. The reliability of information and the associated methodological process must be clear. There is no standard tool to evaluate the trustworthiness of such point-of-care (POC) information. Objective: We aim to develop and validate a new tool for assessment of trustworthiness of evidence-based POC resources to enhance the quality of POC resources and facilitate evidence-based practice. Methods: We designed the Critical Appraisal of Point-of-Care Information (CAPOCI) tool based on the criteria important for assessment of trustworthiness of POC information, reported in a previously published review. A group of health care professionals and methodologists (the authors of this paper) defined criteria for the CAPOCI tool in an iterative process of discussion and pilot testing until consensus was reached. In the next step, all criteria were subject to content validation with a Delphi study. We invited an international panel of 10 experts to rate their agreement with the relevance and wording of the criteria and to give feedback. Consensus was reached when 70% of the experts agreed. When no consensus was reached, we reformulated the criteria based on the experts’ comments for a next round of the Delphi study. This process was repeated until consensus was reached for each criterion. In a last step, the interrater reliability of the CAPOCI tool was calculated with a 2-tailed Kendall tau correlation coefficient to quantify the agreement between 2 users who piloted the CAPOCI tool on 5 POC resources. Two scoring systems were tested: a 3-point ordinal scale and a 7-point Likert scale. Results: After validation, the CAPOCI tool was designed with 11 criteria that focused on methodological quality and author-related information. The criteria assess authorship, literature search, use of preappraised evidence, critical appraisal of evidence, expert opinions, peer review, timeliness and updating, conflict of interest, and commercial support. Interrater agreement showed substantial agreement between 2 users for scoring with the 3-point ordinal scale (τ=.621, P<.01) and scoring with the 7-point Likert scale (τ=.677, P<.01). Conclusions: The CAPOCI tool may support validation teams in the assessment of trustworthiness of POC resources. It may also provide guidance for producers of POC resources. %M 34609314 %R 10.2196/27174 %U https://www.jmir.org/2021/10/e27174 %U https://doi.org/10.2196/27174 %U http://www.ncbi.nlm.nih.gov/pubmed/34609314 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e26980 %T Knowledge, Attitudes, and Practices Regarding COVID-19 Among Health Care Workers in Public Health Facilities in Eastern Ethiopia: Cross-sectional Survey Study %A Farah,Alinoor Mohamed %A Nour,Tahir Yousuf %A Obsiye,Muse %A Aden,Mowlid Akil %A Ali,Omar Moeline %A Hussein,Muktar Arab %A Budul,Abdullahi Bedel %A Omer,Muktar %A Getnet,Fentabil %+ Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Sciences, Jigjiga University, CoMHS Building, 2nd Floor, Jigjiga, 1020, Ethiopia, 251 911053913, alinuriana@yahoo.com %K COVID-19 %K knowledge %K attitude %K practice %K health care workers %K Eastern Ethiopia %D 2021 %7 1.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: On March 13, 2020, Ethiopia reported the first confirmed case of COVID-19 in Addis Ababa. COVID-19 is likely to overwhelm an already-fragile health care delivery system and reduce the availability of essential health services. This analysis of data from the Somali Region of Eastern Ethiopia on health care workers’ (HCWs) knowledge, attitudes, and practices regarding the prevention and control of COVID-19 may be used in planning health education programs about the emerging viral disease. Objective: This study aimed to investigate the knowledge, attitudes, and practices of HCWs regarding COVID-19 infection. Methods: This cross-sectional study was conducted among HCWs in three public health facilities in the Somali Region, Eastern Ethiopia. A self-administered questionnaire was shared with all HCWs working at the public health facilities. A total of 15 knowledge questions were scored as 1 or 0 for correct or incorrect responses, respectively. A total of 14 practice questions were scored on a 3-point scale from 1 (“always”) to 3 (“never”). A total of six attitude questions were rated on a 5-point Likert scale, in a negative dimension, as follows: 1 (“strongly agree”), 2 (“agree”), 3 (“neutral”), 4 (“disagree”), and 5 (“strongly disagree”). Mean scores were calculated and used as a cut point to dichotomize the outcome variables (>13.7 indicated good knowledge, <18.8 indicated good practices, and ≤10.5 indicated favorable attitudes). We used t tests and analyses of variance (ie, F tests) to analyze the mean score differences of knowledge, attitudes, and practices between the independent variables. Spearman correlation was used to assess the relationship between mean knowledge and attitude scores. Results: Of the 686 HCWs approached, a total of 434 HCWs responded (63.3% response rate). The mean age of the participants was 27.6 (SD 5.3) years, and the majority of the participants were male (293/434, 67.5%). The mean knowledge score was 13.7 (SD 2.6), and 73.3% (318/434) of participants had sufficient knowledge. The mean attitude score was 10.5 (SD 4.1), and 54.8% (238/434) of the participants had a good attitude toward COVID-19. The mean practice score was 18.8 (SD 5.8), and 61.5% (267/434) of the participants practiced precautionary measures to prevent COVID-19. There was a negative correlation between knowledge and attitude scores (r=–0.295, P<.001) and between knowledge and practice scores (r=–0.298, P<.001). Conclusions: The overall levels of knowledge and practice were relatively better than the attitude level. This highlights the need to implement strategies that enhance the positive attitudes and safe practices of the HCWs for better containment of the pandemic and supporting of essential health care services. %M 34477559 %R 10.2196/26980 %U https://formative.jmir.org/2021/10/e26980 %U https://doi.org/10.2196/26980 %U http://www.ncbi.nlm.nih.gov/pubmed/34477559 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 2 %P e27869 %T Trends in Hidradenitis Suppurativa Disease Severity and Quality of Life Outcome Measures: Scoping Review %A Maghfour,Jalal %A Sivesind,Torunn Elise %A Dellavalle,Robert Paul %A Dunnick,Cory %+ Department of Dermatology, University of Colorado School of Medicine, 1665 Aurora Ct, Aurora, CO, 80045, United States, 1 7208480500, cory.dunnick@cuanschutz.edu %K hidradenitis suppurativa %K severity of illness index %K patient-reported outcome measures %K quality of life %K treatment outcome %K illness index %K patient outcomes %K disease severity %K Sartorius %K dermatology %K treatment interventions %D 2021 %7 1.10.2021 %9 Review %J JMIR Dermatol %G English %X Background: Although there has been an increase in the number of randomized controlled trials evaluating treatment efficacy for hidradenitis suppurativa (HS), instrument measurements of disease severity and quality of life (QoL) are varied, making the compilation of data and comparisons between studies a challenge for clinicians. Objective: We aimed to perform a systematic literature search to examine the recent trends in the use of disease severity and QoL outcome instruments in randomized controlled trials that have been conducted on patients with HS. Methods: A scoping review was conducted in February 2021. The PubMed, Embase, Web of Science, and Cochrane databases were used to identify all articles published from January 1964 to February 2021. In total, 41 articles were included in this systematic review. Results: The HS Clinical Response (HiSCR) score (18/41, 44%) was the most commonly used instrument for disease severity, followed by the Sartorius and Modified Sartorius scales (combined: 16/41, 39%). The Dermatology Life Quality Index (18/41, 44%) and visual analogue pain scales (12/41, 29%) were the most commonly used QoL outcome instruments in HS research. Conclusions: Randomized controlled trials conducted from 2013 onward commonly used the validated HiSCR score, while older studies were more heterogeneous and less likely to use a validated scale. A few (6/18, 33%) QoL measures were validated instruments but were not specific to HS; therefore, they may not be representative of all factors that impact patients with HS. Trial Registration: National Institute of Health Research PROSPERO CRD42020209582; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020209582 %M 37632807 %R 10.2196/27869 %U https://derma.jmir.org/2021/2/e27869 %U https://doi.org/10.2196/27869 %U http://www.ncbi.nlm.nih.gov/pubmed/37632807 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e31627 %T Measuring a Broad Spectrum of eHealth Skills in the Web 3.0 Context Using an eHealth Literacy Scale: Development and Validation Study %A Liu,Hua-Xuan %A Chow,Bik-Chu %A Liang,Wei %A Hassel,Holger %A Huang,YaJun Wendy %+ Department of Sport, Physical Education and Health, Hong Kong Baptist University, Room 926, 9/F, Academic and Administration Building, Kowloon, Hong Kong, China (Hong Kong), 852 1 305 157 5809, xuan0402@life.hkbu.edu.hk %K eHealth literacy %K scale development %K validation %K college students %D 2021 %7 23.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth literacy (EHL) refers to a variety of capabilities that enable individuals to obtain health information from electronic resources and apply it to solve health problems. With the digitization of health care and the wide availability of health apps, a more diverse range of eHealth skills is required to properly use such health facilities. Existing EHL measurements focus mainly on the skill of obtaining health information (Web 1.0), whereas skills for web-based interactions (Web 2.0) and self-managing health data and applying information (Web 3.0) have not been well measured. Objective: This study aims to develop an EHL scale (eHLS) termed eHLS-Web3.0 comprising a comprehensive spectrum of Web 1.0, 2.0, and 3.0 skills to measure EHL, and evaluate its validity and reliability along with the measurement invariance among college students. Methods: In study 1, 421 Chinese college students (mean age 20.5, SD 1.4 years; 51.8% female) and 8 health experts (mean age 38.3, SD 5.9 years; 87.5% female) were involved to develop the eHLS-Web3.0. The scale development included three steps: item pool generation, content validation, and exploratory factor analysis. In study 2, 741 college students (mean age 21.3, SD 1.4 years; 52.2% female) were recruited from 4 Chinese cities to validate the newly developed eHLS-Web3.0. The construct validity, convergent validity, concurrent validity, internal consistency reliability, test-retest reliability, and measurement invariance across genders, majors, and regions were examined by a series of statistical analyses, including confirmatory factor analysis (CFA) and multigroup CFAs using SPSS and Mplus software packages. Results: Based on the item pool of 374 statements collected during the conceptual development, 24 items (4-10 items per subscale) were generated and adjusted after cognitive testing and content validity examination. Through exploratory factor analysis, a 3-factor eHLS-Web3.0 was finally developed, and it included acquisition (8 items), verification (6 items), and application (10 items). In study 2, CFAs supported the construct validity of the 24-item 3D eHLS-Web3.0 (χ2244=903.076, χ2244=3.701, comparative fit index=0.924, Tucker-Lewis index=0.914, root mean square error of approximation [RMSEA]=0.06, and standardized root mean residual [SRMR]=0.051). The average variance extracted (AVE) value of 0.58 and high correlation between eHLS-Web3.0 subscales and the eHealth Literacy Scale (r=0.725-0.880, P<.001) indicated the convergent validity and concurrent validity of the eHLS-Web3.0. The results also indicated satisfactory internal consistency reliability (α=.976, ρ=0.934-0.956) and test-retest reliability (r=0.858, P<.001) of the scale. Multigroup CFA demonstrated the 24-item eHLS-Web3.0 to be invariant at all configural, metric, strength, and structural levels across genders (female and male), majors (sport-related, medical, and general), and regions (Yinchuan, Kunming, Xiamen, and Beijing). Conclusions: The 24-item 3D eHLS-Web3.0 proved to be a reliable and valid measurement tool for EHL in the Web 3.0 context among Chinese college students. %M 34554098 %R 10.2196/31627 %U https://www.jmir.org/2021/9/e31627 %U https://doi.org/10.2196/31627 %U http://www.ncbi.nlm.nih.gov/pubmed/34554098 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 8 %N 3 %P e22818 %T Testing of a Self-administered 6-Minute Walk Test Using Technology: Usability, Reliability and Validity Study %A Smith-Turchyn,Jenna %A Adams,Scott C %A Sabiston,Catherine M %+ School of Rehabilitation Science, McMaster University, 1400 Main Street W., Hamilton, ON, L8S 1C7, Canada, 1 9055259140, smithjf@mcmaster.ca %K exercise %K physical activity %K usability testing %K applications %K mobile phone %D 2021 %7 23.9.2021 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: The need to attend a medically supervised hospital- or clinic-based appointment is a well-recognized barrier to exercise participation. The development of reliable and accurate home-based functional tests has the potential to decrease the burden on the health care system while enabling support, information, and assessment. Objective: This study aims to explore the usability (ie, acceptability, satisfaction, accuracy, and practicality) of the EasyMeasure app to self-administer the 6-minute walk test (6MWT) in young, healthy adults and determine parallel form reliability and construct validity of conducting a self-administered 6MWT using technology. Methods: We used a usability study design. English-speaking, undergraduate university students who had access to an iPhone or iPad device running iOS 10 or later and self-reported ability to walk for 6 minutes were recruited for this study. Consenting participants were randomized to either a standard 6MWT group (ie, supervised without the use of the app) or a technology 6MWT group (ie, unsupervised with the app to mimic independent implementation of the test). All participants performed a maximal treadmill test. Participants in the 6MWT group completed the Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire and a satisfaction questionnaire after completing the assessment. Parallel form reliability of the 6MWT using technology was analyzed by comparing participant self-administered scores and assessor scores using Pearson correlation coefficients across and between trials. Construct validity was assessed by comparing participant 6MWT scores (both standard and using technology) with maximum treadmill test variables (peak oxygen uptake and ventilatory threshold [VT]). Results: In total, 20 university students consented to participate in the study. All but 2 participants (8/10, 80%) in the technology 6MWT group had deviations that prevented them from accurately conducting the 6MWT using the app, and none of the participants were able to successfully score the 6MWT. However, a significantly strong correlation was found (r=.834; P=.003) when comparing participants’ scores for the 6MWT using technology with the assessors’ scores. No significant correlations were found between maximal treadmill test peak oxygen uptake scores and 6MWT prediction equations using standard 6MWT scores (equation 1: r=0.119; P=.78; equation 2: r=0.095; P=.82; equation 3: r=0.119; P=.78); however, standard 6MWT scores were significantly correlated with VT values (r=0.810; P=.02). The calculated submaximal treadmill scores and assessor 6MWT scores using technology also demonstrated a significant correlation (r=0.661; P=.04). Conclusions: This study demonstrated significant usability concerns regarding the accuracy of a self-administered 6MWT using the EasyMeasure app. However, the strong and significant correlation between the 6MWT and VT values demonstrates the potential of the 6MWT to measure functional capacity for community-based exercise screening and patient monitoring. %M 34554105 %R 10.2196/22818 %U https://rehab.jmir.org/2021/3/e22818 %U https://doi.org/10.2196/22818 %U http://www.ncbi.nlm.nih.gov/pubmed/34554105 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28518 %T Assessing Professionals’ Adoption Readiness for eMental Health: Development and Validation of the eMental Health Adoption Readiness Scale %A Feijt,Milou A %A de Kort,Yvonne A W %A Westerink,Joyce H D M %A Bierbooms,Joyce J P A %A Bongers,Inge M B %A IJsselsteijn,Wijnand A %+ Human-Technology Interaction Group, Department of Industrial Engineering & Innovation Sciences, Eindhoven University of Technology, De Rondom 70, Eindhoven, 5612 AP, Netherlands, 31 40 247 2889, m.a.feijt@tue.nl %K eMental health %K adoption of innovation %K mental health care %K scale development %D 2021 %7 17.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The last few decades have witnessed significant advances in the development of digital tools and applications for mental health care. Despite growing evidence for their effectiveness, acceptance and use of these tools in clinical practice remain low. Hence, a validated and easy-to-use instrument for assessing professionals’ readiness to adopt eMental health (EMH) is necessary to gain further insights into the process of EMH adoption and facilitate future research on this topic. Objective: The aim of this study is to develop and validate an instrument for assessing mental health care professionals’ readiness to adopt EMH. Methods: Item generation was guided by literature and inputs from mental health care professionals and experts in survey development. Exploratory factor analyses were conducted on an initial set of 29 items completed by a sample of mental health care professionals (N=432); thereafter, the scale was reduced to 15 items in an iterative process. The factor structure thus obtained was subsequently tested using a confirmatory factor analysis with a second sample of mental health care professionals (N=363). The internal consistency, convergent validity, and predictive validity of the eMental Health Adoption Readiness (eMHAR) Scale were assessed. Results: Exploratory factor analysis resulted in a 3-factor solution with 15 items. The factors were analyzed and labeled as perceived benefits and applicability of EMH, EMH proactive innovation, and EMH self-efficacy. These factors were confirmed through a confirmatory factor analysis. The total scale and subscales showed a good internal consistency (Cronbach α=.73-.88) along with acceptable convergent and predictive relationships with related constructs. Conclusions: The constructed eMHAR Scale showed a conceptually interpretable 3-factor structure having satisfactory characteristics and relationships with relevant concepts. Its ease of use allows for quick acquisition of data that can contribute to understanding and facilitating the process of adoption of EMH by clinical professionals. %M 34533469 %R 10.2196/28518 %U https://www.jmir.org/2021/9/e28518 %U https://doi.org/10.2196/28518 %U http://www.ncbi.nlm.nih.gov/pubmed/34533469 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26608 %T Exploring Test-Retest Reliability and Longitudinal Stability of Digital Biomarkers for Parkinson Disease in the m-Power Data Set: Cohort Study %A Sahandi Far,Mehran %A Eickhoff,Simon B %A Goni,Maria %A Dukart,Juergen %+ Institute of Neuroscience and Medicine, Brain & Behaviour (INM-7), Research Centre Jülich, Wilhelm-Johnen-Strasse, Jülich, 52425, Germany, 49 1632874330, juergen.dukart@gmail.com %K health sciences %K medical research %K biomarkers %K diagnostic markers %K neurological disorders %K Parkinson disease %K mobile phone %D 2021 %7 13.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital biomarkers (DB), as captured using sensors embedded in modern smart devices, are a promising technology for home-based sign and symptom monitoring in Parkinson disease (PD). Objective: Despite extensive application in recent studies, test-retest reliability and longitudinal stability of DB have not been well addressed in this context. We utilized the large-scale m-Power data set to establish the test-retest reliability and longitudinal stability of gait, balance, voice, and tapping tasks in an unsupervised and self-administered daily life setting in patients with PD and healthy controls (HC). Methods: Intraclass correlation coefficients were computed to estimate the test-retest reliability of features that also differentiate between patients with PD and healthy volunteers. In addition, we tested for longitudinal stability of DB measures in PD and HC, as well as for their sensitivity to PD medication effects. Results: Among the features differing between PD and HC, only a few tapping and voice features had good to excellent test-retest reliabilities and medium to large effect sizes. All other features performed poorly in this respect. Only a few features were sensitive to medication effects. The longitudinal analyses revealed significant alterations over time across a variety of features and in particular for the tapping task. Conclusions: These results indicate the need for further development of more standardized, sensitive, and reliable DB for application in self-administered remote studies in patients with PD. Motivational, learning, and other confounders may cause variations in performance that need to be considered in DB longitudinal applications. %M 34515645 %R 10.2196/26608 %U https://www.jmir.org/2021/9/e26608 %U https://doi.org/10.2196/26608 %U http://www.ncbi.nlm.nih.gov/pubmed/34515645 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e25660 %T Tablet-Based Cognitive Impairment Screening for Adults With HIV Seeking Clinical Care: Observational Study %A Rubin,Leah H %A Severson,Joan %A Marcotte,Thomas D %A Savin,Micah J %A Best,Allen %A Johnson,Shane %A Cosman,Joshua %A Merickel,Michael %A Buchholz,Alison %A Del Bene,Victor A %A Eldred,Lois %A Sacktor,Ned C %A Fuchs,Joelle-Beverlie %A Althoff,Keri N %A Moore,Richard D %+ Johns Hopkins University, 600 N Wolfe St, Meyer 6-113a, Baltimore, MD, 21287-7613, United States, 1 3128024802, lrubin@jhu.edu %K cognitive complications %K people with HIV %K digital assessment %K HIV %K tablet %K screening %D 2021 %7 9.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Neurological complications including cognitive impairment persist among people with HIV on antiretrovirals; however, cognitive screening is not routinely conducted in HIV clinics. Objective: Our objective for this study was 3-fold: (1) to determine the feasibility of implementing an iPad-based cognitive impairment screener among adults seeking HIV care, (2) to examine the psychometric properties of the tool, and (3) to examine predictors of cognitive impairment using the tool. Methods: A convenience sample of participants completed Brain Baseline Assessment of Cognition and Everyday Functioning (BRACE), which included (1) Trail Making Test Part A, measuring psychomotor speed; (2) Trail Making Test Part B, measuring set-shifting; (3) Stroop Color, measuring processing speed; and (4) the Visual–Spatial Learning Test. Global neuropsychological function was estimated as mean T score performance on the 4 outcomes. Impairment on each test or for the global mean was defined as a T score ≤40. Subgroups of participants repeated the tests 4 weeks or >6 months after completing the first test to evaluate intraperson test–retest reliability and practice effects (improvements in performance due to repeated test exposure). An additional subgroup completed a lengthier cognitive battery concurrently to assess validity. Relevant factors were abstracted from electronic medical records to examine predictors of global neuropsychological function. Results: The study population consisted of 404 people with HIV (age: mean 53.6 years; race: 332/404, 82% Black; 34/404, 8% White, 10/404, 2% American Indian/Alaskan Native; 28/404, 7% other and 230/404, 58% male; 174/404, 42% female) of whom 99% (402/404) were on antiretroviral therapy. Participants completed BRACE in a mean of 12 minutes (SD 3.2), and impairment was demonstrated by 34% (136/404) on Trail Making Test A, 44% (177/404) on Trail Making Test B, 40% (161/404) on Stroop Color, and 17% (67/404) on Visual-Spatial Learning Test. Global impairment was demonstrated by 103 out of 404 (25%). Test–retest reliability for the subset of participants (n=26) repeating the measure at 4 weeks was 0.81 and for the subset of participants (n=67) repeating the measure almost 1 year later (days: median 294, IQR 50) was 0.63. There were no significant practice effects at either time point (P=.20 and P=.68, respectively). With respect for validity, the correlation between global impairment on the lengthier cognitive battery and BRACE was 0.63 (n=61; P<.001), with 84% sensitivity and 94% specificity to impairment on the lengthier cognitive battery. Conclusions: We were able to successfully implement BRACE and estimate cognitive impairment burden in the context of routine clinic care. BRACE was also shown to have good psychometric properties. This easy-to-use tool in clinical settings may facilitate the care needs of people with HIV as cognitive impairment continues to remain a concern in people with HIV. %M 34499048 %R 10.2196/25660 %U https://mental.jmir.org/2021/9/e25660 %U https://doi.org/10.2196/25660 %U http://www.ncbi.nlm.nih.gov/pubmed/34499048 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e30237 %T Using the Think-Aloud Method to Assess the Feasibility and Acceptability of Network Canvas Among Black Men Who Have Sex With Men and Transgender Persons: Qualitative Analysis %A Crawford,Natalie D %A Josma,Dorie %A Harrington,Kristin R V %A Morris,Joseph %A Quamina,Alvan %A Birkett,Michelle %A Phillips II,Gregory %+ Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Grace Crum Rollins Building, 1518 Clifton Rd, Atlanta, GA, 30322, United States, 1 404 712 9445, ndcrawford@emory.edu %K think-aloud %K egocentric networks %K sociogram %K social networks %K MSM %K transgender %K network canvas %K black MSM %K infectious disease transmission %K stigma %D 2021 %7 9.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Characteristics of an individual’s social network have been important factors in understanding infectious disease transmission patterns. Social network data collection is generally time and resource intensive, yet it is crucial to our understanding of the complex epidemiologic landscape of human behaviors among stigmatized social groups. Objective: We sought to evaluate the feasibility and acceptability of a self-administered social network data collection tool, Network Canvas, among Black men who have sex with men (BMSM) and transgender persons using the think-aloud method, which is a robust and flexible research technique used to perform usability testing. Methods: We piloted a self-administered network interview within the Network Canvas Software Suite. Participants aged 18 years and older were recruited through a community-based organization in Atlanta, GA, and were included based upon their willingness to share information on sexual behaviors and drug use for themselves and their social networks. A semistructured interview guide was used to document cognitive decision-making processes while using the tool. Recorded interviews were transcribed verbatim, and thematic analyses were performed. Results: Among 7 BMSM and transgender participants, three main themes were identified from cognitive processes: (1) the utility, (2) navigation, and (3) intuitive design of Network Canvas. Overall, Network Canvas was described as “easy to use,” with suggestions mainly directed toward improving navigation tools and implementing an initial tutorial on the program prior to use. Participants were willing to use Network Canvas to document their social networks and characteristics. In general, observed verbal responses from participants matched their behavior, although there were some discrepancies between verbal affirmations of use and understanding versus external observation. Conclusions: We found Network Canvas to be a useful new tool to capture social network data. Self-administration allowed participants the opportunity to provide sensitive information about themselves and their social networks. Furthermore, automated name generation and visualization of an individuals’ social network in the app has the potential to reduce cognitive burden during data collection. More efficient methods of social network data collection have the potential to provide epidemiologic information to guide prevention efforts for populations with stigmatized health conditions or behaviors. %M 34499040 %R 10.2196/30237 %U https://formative.jmir.org/2021/9/e30237 %U https://doi.org/10.2196/30237 %U http://www.ncbi.nlm.nih.gov/pubmed/34499040 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27098 %T Machine Learning Analysis of Time-Dependent Features for Predicting Adverse Events During Hemodialysis Therapy: Model Development and Validation Study %A Liu,Yi-Shiuan %A Yang,Chih-Yu %A Chiu,Ping-Fang %A Lin,Hui-Chu %A Lo,Chung-Chuan %A Lai,Alan Szu-Han %A Chang,Chia-Chu %A Lee,Oscar Kuang-Sheng %+ Institute of Clinical Medicine, National Yang Ming Chiao Tung University School of Medicine, 2F, Shou-Ren Bldg, 155, Sec 2, Li-Nong St, Beitou Dist, Taipei, 11221, Taiwan, 886 228712121 ext 7391, oscarlee9203@gmail.com %K hemodialysis %K intradialytic adverse events %K prediction algorithm %K machine learning %D 2021 %7 7.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Hemodialysis (HD) therapy is an indispensable tool used in critical care management. Patients undergoing HD are at risk for intradialytic adverse events, ranging from muscle cramps to cardiac arrest. So far, there is no effective HD device–integrated algorithm to assist medical staff in response to these adverse events a step earlier during HD. Objective: We aimed to develop machine learning algorithms to predict intradialytic adverse events in an unbiased manner. Methods: Three-month dialysis and physiological time-series data were collected from all patients who underwent maintenance HD therapy at a tertiary care referral center. Dialysis data were collected automatically by HD devices, and physiological data were recorded by medical staff. Intradialytic adverse events were documented by medical staff according to patient complaints. Features extracted from the time series data sets by linear and differential analyses were used for machine learning to predict adverse events during HD. Results: Time series dialysis data were collected during the 4-hour HD session in 108 patients who underwent maintenance HD therapy. There were a total of 4221 HD sessions, 406 of which involved at least one intradialytic adverse event. Models were built by classification algorithms and evaluated by four-fold cross-validation. The developed algorithm predicted overall intradialytic adverse events, with an area under the curve (AUC) of 0.83, sensitivity of 0.53, and specificity of 0.96. The algorithm also predicted muscle cramps, with an AUC of 0.85, and blood pressure elevation, with an AUC of 0.93. In addition, the model built based on ultrafiltration-unrelated features predicted all types of adverse events, with an AUC of 0.81, indicating that ultrafiltration-unrelated factors also contribute to the onset of adverse events. Conclusions: Our results demonstrated that algorithms combining linear and differential analyses with two-class classification machine learning can predict intradialytic adverse events in quasi-real time with high AUCs. Such a methodology implemented with local cloud computation and real-time optimization by personalized HD data could warn clinicians to take timely actions in advance. %M 34491204 %R 10.2196/27098 %U https://www.jmir.org/2021/9/e27098 %U https://doi.org/10.2196/27098 %U http://www.ncbi.nlm.nih.gov/pubmed/34491204 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e28391 %T Perceived Benefits, Barriers, and Facilitators of a Digital Patient-Reported Outcomes Tool for Routine Diabetes Care: Protocol for a National, Multicenter, Mixed Methods Implementation Study %A Skovlund,Søren Eik %A Nicolucci,Antonio %A Balk-Møller,Nina %A Berthelsen,Dorthe B %A Glümer,Charlotte %A Perrild,Hans %A Kjær,Pernille %A Nørgaard,Lise Mellergaard %A Troelsen,Lise Havbæk %A Pietraszek,Anna %A Hessler,Danielle %A Kaplan,Sherrie %A Ejskjær,Niels %+ Department of Clinical Medicine, Aalborg University, Soendre Skovvej 15, Aalborg, Denmark, 45 40228835, soren@sorenskovlund.com %K diabetes %K type 1 diabetes %K type 2 diabetes %K multisector care %K digital health %K patient-reported outcomes %K patient-centered care %K internet-administered %K feasibility %K mixed-method research %K mobile phone %D 2021 %7 3.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is growing evidence that digital patient-reported outcome (PRO) questionnaires and PRO-based decision support tools may help improve the active engagement of people with diabetes in self-care, thereby improving the quality of care. However, many barriers still exist for the real-world effectiveness and implementation of such PRO tools in routine care. Furthermore, limited research has evaluated the acceptability, feasibility, and benefits of such tools across different health care settings. Objective: This study aims to evaluate the acceptability, feasibility, and perceived benefits of the Danish digital PRO diabetes tool in different health care settings in Denmark and to determine the factors affecting its implementation. Furthermore, the study evaluates the psychometric characteristics of the Danish PRO Diabetes Questionnaire and the validity of the scoring algorithms for dialogue support. The objective of this study is to guide the ongoing optimization of the PRO diabetes tool, its implementation, and the design of future randomized controlled effectiveness studies. Methods: We designed a multicenter, mixed methods, single-arm acceptability-feasibility implementation study protocol to contribute to the real-world pilot test of a new digital PRO diabetes tool in routine diabetes care. The use of the tool involves two main steps. First, the people with diabetes will complete a digital PRO Diabetes Questionnaire in the days before a routine diabetes visit. Second, the health care professional (HCP) will use a digital PRO tool to review the PRO results together with the people with diabetes during the visit. The PRO diabetes tool is designed to encourage and support people to take an active role for the people with diabetes in their own care and to expedite the delivery of person-centered, collaborative, and coordinated care. Results: A multicenter pilot study protocol and psychometrically designed digital data collection tools for evaluation were developed and deployed as part of a national evaluation of a new digital PRO diabetes intervention. A total of 598 people with diabetes and 34 HCPs completed the study protocol by April 1, 2021. Conclusions: A large-scale, mixed methods, multicenter study for evaluating the use of the nationally developed PRO Diabetes Questionnaire in routine care across all health care sectors in Denmark by using the RE-AIM (Reach, Efficacy, Adoption, Implementation and Maintenance) model as a framework has been designed and is ongoing. This study is expected to provide new important and detailed information about the real-world acceptability, perceived relevance, and benefits of the PRO diabetes tool among a large heterogeneous population of people with diabetes in Denmark and HCPs in different care settings. The results will be used to further improve the PRO tool, design implementation facilitation support strategies, and design future controlled effectiveness studies. International Registered Report Identifier (IRRID): DERR1-10.2196/28391 %M 34477563 %R 10.2196/28391 %U https://www.researchprotocols.org/2021/9/e28391 %U https://doi.org/10.2196/28391 %U http://www.ncbi.nlm.nih.gov/pubmed/34477563 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e30861 %T Comparison of the Differences Between Web-Based and Traditional Questionnaire Surveys in Pediatrics: Comparative Survey Study %A Fang,Heping %A Xian,Ruoling %A Ma,Zhuoying %A Lu,Mingyue %A Hu,Yan %+ Department of Child Health Care, Children’s Hospital of Chongqing Medical University, No.136, 2nd Zhongshan Road, Yuzhong District, Chongqing, , China, 86 023 63622764, hy420@126.com %K pediatrics %K survey %K questionnaire %K web survey %K comparative study %D 2021 %7 26.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: A web-based survey is a novel method for data capture. Some studies have applied web-based surveys in pediatrics, but few of them have reported data on the differences between web-based and traditional questionnaire surveys. Objective: The objective of our study was to evaluate the internal consistency of a web-based survey and compare it with a traditional questionnaire survey in pediatrics. Methods: A convenience sample of caregivers was invited to participate in the survey on feeding patterns and their children’s eating behaviors if their children were aged 2 to 7 years. A web-based survey and a traditional questionnaire survey were carried out between October 2018 and July 2019. A total of 1085 caregivers were involved in this study, and they were divided into the following three groups based on methods and sources: (1) web-based survey from a web source, (2) web-based survey from a hospital source, and (3) traditional questionnaire survey from a hospital source. The data were then compared and analyzed. Results: A total of 735 caregivers participated in the web-based survey and 350 caregivers participated in the traditional questionnaire survey, and 816 cases were then included in the analyses after data processing. The effective rate of the web-based survey was 70.1% (515/735), and the completeness rate of the traditional questionnaire survey was 86.0% (301/350). There were no significant differences between web-based surveys from different sources. However, demographic characteristics were significantly different between the web-based and traditional questionnaire surveys, mainly in terms of age and caregivers (χ²4=16.509, P=.002 and χ²4=111.464, P<.001, respectively). Caregivers of children aged 2 to 3 years and grandparents were more likely to respond to the web-based survey. Age-specific stratified analysis showed that the score of “monitoring” and the reporting rate of “poor appetite” in children aged 2 to 3 years were significantly higher in the web-based survey compared to the traditional questionnaire survey after adjusting for demographic characteristics. Conclusions: A web-based survey could be a feasible tool in pediatric studies. However, differences in demographic characteristics and their possible impacts on the results should be considered in the analyses. %M 34319240 %R 10.2196/30861 %U https://www.jmir.org/2021/8/e30861 %U https://doi.org/10.2196/30861 %U http://www.ncbi.nlm.nih.gov/pubmed/34319240 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e26348 %T Validity of the Aktibipo Self-rating Questionnaire for the Digital Self-assessment of Mood and Relapse Detection in Patients With Bipolar Disorder: Instrument Validation Study %A Anýž,Jiří %A Bakštein,Eduard %A Dally,Andrea %A Kolenič,Marián %A Hlinka,Jaroslav %A Hartmannová,Tereza %A Urbanová,Kateřina %A Correll,Christoph U %A Novák,Daniel %A Španiel,Filip %+ National Insitute of Mental Health, Topolová 748, Klecany, 250 67, Czech Republic, 420 283 088 409, jiri.anyz@nudz.cz %K bipolar disorder %K symptom monitoring %K ecological mood assessment %K relapse detection %K mobile application %K mobile phone %D 2021 %7 9.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Self-reported mood is a valuable clinical data source regarding disease state and course in patients with mood disorders. However, validated, quick, and scalable digital self-report measures that can also detect relapse are still not available for clinical care. Objective: In this study, we aim to validate the newly developed ASERT (Aktibipo Self-rating) questionnaire—a 10-item, mobile app–based, self-report mood questionnaire consisting of 4 depression, 4 mania, and 2 nonspecific symptom items, each with 5 possible answers. The validation data set is a subset of the ongoing observational longitudinal AKTIBIPO400 study for the long-term monitoring of mood and activity (via actigraphy) in patients with bipolar disorder (BD). Patients with confirmed BD are included and monitored with weekly ASERT questionnaires and monthly clinical scales (Montgomery-Åsberg Depression Rating Scale [MADRS] and Young Mania Rating Scale [YMRS]). Methods: The content validity of the ASERT questionnaire was assessed using principal component analysis, and the Cronbach α was used to assess the internal consistency of each factor. The convergent validity of the depressive or manic items of the ASERT questionnaire with the MADRS and YMRS, respectively, was assessed using a linear mixed-effects model and linear correlation analyses. In addition, we investigated the capability of the ASERT questionnaire to distinguish relapse (YMRS≥15 and MADRS≥15) from a nonrelapse (interepisode) state (YMRS<15 and MADRS<15) using a logistic mixed-effects model. Results: A total of 99 patients with BD were included in this study (follow-up: mean 754 days, SD 266) and completed an average of 78.1% (SD 18.3%) of the requested ASERT assessments (completion time for the 10 ASERT questions: median 24.0 seconds) across all patients in this study. The ASERT depression items were highly associated with MADRS total scores (P<.001; bootstrap). Similarly, ASERT mania items were highly associated with YMRS total scores (P<.001; bootstrap). Furthermore, the logistic mixed-effects regression model for scale-based relapse detection showed high detection accuracy in a repeated holdout validation for both depression (accuracy=85%; sensitivity=69.9%; specificity=88.4%; area under the receiver operating characteristic curve=0.880) and mania (accuracy=87.5%; sensitivity=64.9%; specificity=89.9%; area under the receiver operating characteristic curve=0.844). Conclusions: The ASERT questionnaire is a quick and acceptable mood monitoring tool that is administered via a smartphone app. The questionnaire has a good capability to detect the worsening of clinical symptoms in a long-term monitoring scenario. %M 34383689 %R 10.2196/26348 %U https://mental.jmir.org/2021/8/e26348 %U https://doi.org/10.2196/26348 %U http://www.ncbi.nlm.nih.gov/pubmed/34383689 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e29271 %T The Effect of Collaborative Reviews of Electronic Patient-Reported Outcomes on the Congruence of Patient- and Clinician-Reported Toxicity in Cancer Patients Receiving Systemic Therapy: Prospective, Multicenter, Observational Clinical Trial %A Trojan,Andreas %A Leuthold,Nicolas %A Thomssen,Christoph %A Rody,Achim %A Winder,Thomas %A Jakob,Andreas %A Egger,Claudine %A Held,Ulrike %A Jackisch,Christian %+ OnkoZentrum Zürich, Seestrasse 259, Zurich, 8038, Switzerland, 41 43 344 33 33, trojan@1st.ch %K cancer %K consilium %K app %K eHealth %K ePRO %K CTCAE %K congruency %K patient-reported %K symptoms %D 2021 %7 5.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic patient-reported outcomes (ePRO) are a relatively novel form of data and have the potential to improve clinical practice for cancer patients. In this prospective, multicenter, observational clinical trial, efforts were made to demonstrate the reliability of patient-reported symptoms. Objective: The primary objective of this study was to assess the level of agreement κ between symptom ratings by physicians and patients via a shared review process in order to determine the future reliability and utility of self-reported electronic symptom monitoring. Methods: Patients receiving systemic therapy in a (neo-)adjuvant or noncurative intention setting captured ePRO for 52 symptoms over an observational period of 90 days. At 3-week intervals, randomly selected symptoms were reviewed between the patient and physician for congruency on severity of the grading of adverse events according to the Common Terminology Criteria of Adverse Events (CTCAE). The patient-physician agreement for the symptom review was assessed via Cohen kappa (κ), through which the interrater reliability was calculated. Chi-square tests were used to determine whether the patient-reported outcome was different among symptoms, types of cancer, demographics, and physicians’ experience. Results: Among the 181 patients (158 women and 23 men; median age 54.4 years), there was a fair scoring agreement (κ=0.24; 95% CI 0.16-0.33) for symptoms that were entered 2 to 4 weeks before the intended review (first rating) and a moderate agreement (κ=0.41; 95% CI 0.34-0.48) for symptoms that were entered within 1 week of the intended review (second rating). However, the level of agreement increased from moderate (first rating, κ=0.43) to substantial (second rating, κ=0.68) for common symptoms of pain, fever, diarrhea, obstipation, nausea, vomiting, and stomatitis. Similar congruency levels of ratings were found for the most frequently entered symptoms (first rating: κ=0.42; second rating: κ=0.65). The symptom with the lowest agreement was hair loss (κ=–0.05). With regard to the latency of symptom entry into the review, hardly any difference was demonstrated between symptoms that were entered from days 1 to 3 and from days 4 to 7 before the intended review (κ=0.40 vs κ=0.39, respectively). In contrast, for symptoms that were entered 15 to 21 days before the intended review, no congruency was demonstrated (κ=–0.15). Congruency levels seemed to be unrelated to the type of cancer, demographics, and physicians’ review experience. Conclusions: The shared monitoring and review of symptoms between patients and clinicians has the potential to improve the understanding of patient self-reporting. Our data indicate that the integration of ePRO into oncological clinical research and continuous clinical practice provides reliable information for self-empowerment and the timely intervention of symptoms. Trial Registration: ClinicalTrials.gov NCT03578731; https://clinicaltrials.gov/ct2/show/NCT03578731 %M 34383675 %R 10.2196/29271 %U https://www.jmir.org/2021/8/e29271 %U https://doi.org/10.2196/29271 %U http://www.ncbi.nlm.nih.gov/pubmed/34383675 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 3 %P e29021 %T Ecological Momentary Assessment of Depression in People With Advanced Dementia: Longitudinal Pilot Study %A Niculescu,Iulia %A Quirt,Hannah %A Arora,Twinkle %A Borsook,Terry %A Green,Robin %A Ford,Brett %A Iaboni,Andrea %+ KITE, Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada, 1 (416) 597 3422 ext 3027, andrea.iaboni@uhn.ca %K dementia %K depression %K ecological momentary assessment %K tool performance %D 2021 %7 4.8.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Barriers to assessing depression in advanced dementia include the presence of informant and patient recall biases. Ecological momentary assessment provides an improved approach for mood assessment by collecting observations in intervals throughout the day, decreasing recall bias, and increasing ecological validity. Objective: This study aims to evaluate the feasibility, reliability, and validity of the modified 4-item Cornell Scale for Depression in Dementia for Momentary Assessment (mCSDD4-MA) tool to assess depression in patients with advanced dementia. Methods: A intensive longitudinal pilot study design was used. A total of 12 participants with advanced dementia were enrolled from an inpatient psychogeriatric unit. Participants were assessed using clinical depression assessments at admission and discharge. Research staff recorded observations four times a day for 6 weeks on phones with access to the mCSDD4-MA tool. Descriptive data related to feasibility were reported (ie, completion rates). Statistical models were used to examine the interrater reliability and construct and predictive validity of the data. Results: Overall, 1923 observations were completed, representing 55.06% (1923/3496) of all rating opportunities with 2 raters and 66.01% (1923/2913) with at least one rater. Moderate interrater reliability was demonstrated for all items, except for lack of interest. Moderate correlations were observed between observers and patient-reported outcomes, where observers reported fewer symptoms relative to participants’ self-reports. Several items were associated with and able to predict depression. Conclusions: The mCSDD4-MA tool was feasible to use, and most items in the tool showed moderate reliability and validity for assessing depression in dementia. Repeated and real-time depression assessment in advanced dementia holds promise for the identification of clinical depression and depressive symptoms. %M 34346884 %R 10.2196/29021 %U https://aging.jmir.org/2021/3/e29021 %U https://doi.org/10.2196/29021 %U http://www.ncbi.nlm.nih.gov/pubmed/34346884 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e26412 %T Recursive Partitioning vs Computerized Adaptive Testing to Reduce the Burden of Health Assessments in Cleft Lip and/or Palate: Comparative Simulation Study %A Harrison,Conrad J %A Sidey-Gibbons,Chris J %A Klassen,Anne F %A Wong Riff,Karen W Y %A Furniss,Dominic %A Swan,Marc C %A Rodrigues,Jeremy N %+ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, The Botnar Research Centre, Old Road, Oxford, OX3 7LD, United Kingdom, 44 1865 227 374, conrad.harrison@medsci.ox.ac.uk %K cleft Lip %K cleft palate %K patient-reported outcome measures %K outcome assessment %K CLEFT-Q %K computerized adaptive test %K machine learning %K decision tree %K regression tree %D 2021 %7 30.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Computerized adaptive testing (CAT) has been shown to deliver short, accurate, and personalized versions of the CLEFT-Q patient-reported outcome measure for children and young adults born with a cleft lip and/or palate. Decision trees may integrate clinician-reported data (eg, age, gender, cleft type, and planned treatments) to make these assessments even shorter and more accurate. Objective: We aimed to create decision tree models incorporating clinician-reported data into adaptive CLEFT-Q assessments and compare their accuracy to traditional CAT models. Methods: We used relevant clinician-reported data and patient-reported item responses from the CLEFT-Q field test to train and test decision tree models using recursive partitioning. We compared the prediction accuracy of decision trees to CAT assessments of similar length. Participant scores from the full-length questionnaire were used as ground truth. Accuracy was assessed through Pearson’s correlation coefficient of predicted and ground truth scores, mean absolute error, root mean squared error, and a two-tailed Wilcoxon signed-rank test comparing squared error. Results: Decision trees demonstrated poorer accuracy than CAT comparators and generally made data splits based on item responses rather than clinician-reported data. Conclusions: When predicting CLEFT-Q scores, individual item responses are generally more informative than clinician-reported data. Decision trees that make binary splits are at risk of underfitting polytomous patient-reported outcome measure data and demonstrated poorer performance than CATs in this study. %M 34328443 %R 10.2196/26412 %U https://www.jmir.org/2021/7/e26412 %U https://doi.org/10.2196/26412 %U http://www.ncbi.nlm.nih.gov/pubmed/34328443 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e24436 %T A Health Information Quality Assessment Tool for Korean Online Newspaper Articles: Development Study %A Lee,Naae %A Oh,Seung-Won %A Cho,Belong %A Myung,Seung-Kwon %A Hwang,Seung-Sik %A Yoon,Goo Hyeon %+ Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, 38-40FL Gangnam Finance Center 152, Teheran-ro, Gangnam-gu, Seoul, 06236, Republic of Korea, 82 2 2112 5500, sw.oh@snu.ac.kr %K assessment tools %K information seeking %K newspaper articles %K online health information %K quality assessment %D 2021 %7 29.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Concern regarding the reliability and accuracy of the health-related information provided by online newspaper articles has increased. Numerous criteria and items have been proposed and published regarding the quality assessment of online information, but there is no standard quality assessment tool available for online newspapers. Objective: This study aimed to develop the Health Information Quality Assessment Tool (HIQUAL) for online newspaper articles. Methods: We reviewed previous health information quality assessment tools and related studies and accordingly developed and customized new criteria. The interrater agreement for the new assessment tool was assessed for 3 newspaper articles on different subjects (colorectal cancer, obesity genetic testing, and hypertension diagnostic criteria) using the Fleiss κ and Gwet agreement coefficient. To compare the quality scores generated by each pair of tools, convergent validity was measured using the Kendall τ ranked correlation. Results: Overall, the HIQUAL for newspaper articles comprised 10 items across 5 domains: reliability, usefulness, understandability, sufficiency, and transparency. The interrater agreement for the article on colorectal cancer was in the moderate to substantial range (Fleiss κ=0.48, SE 0.11; Gwet agreement coefficient=0.74, SE 0.13), while for the article introducing obesity genetic testing it was in the substantial range, with values of 0.63 (SE 0.28) and 0.86 (SE 0.10) for the two measures, respectively. There was relatively low agreement for the article on hypertension diagnostic criteria at 0.20 (SE 0.10) and 0.75 (SE 0.13), respectively. Validity of the correlation assessed with the Kendall τ showed good correlation between tools (HIQUAL vs DISCERN=0.72, HIQUAL vs QUEST [Quality Evaluation Scoring Tool]=0.69). Conclusions: We developed a new assessment tool to evaluate the quality of health information in online newspaper articles, to help consumers discern accurate sources of health information. The HIQUAL can help increase the accuracy and quality of online health information in Korea. %M 34326038 %R 10.2196/24436 %U https://www.jmir.org/2021/7/e24436 %U https://doi.org/10.2196/24436 %U http://www.ncbi.nlm.nih.gov/pubmed/34326038 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e25177 %T Digital Health Interventions in Physiotherapy: Development of Client and Health Care Provider Survey Instruments %A Merolli,Mark %A Hinman,Rana S %A Lawford,Belinda J %A Choo,Dawn %A Gray,Kathleen %+ Centre for Digital Transformation of Health, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Level 7, 161 Barry St, Carlton, Melbourne, Victoria, 3053, Australia, 61 383443689, merollim@unimelb.edu.au %K digital health interventions %K surveys and questionnaires %K World Health Organization %K physiotherapy %K physical therapy %K musculoskeletal %K mobile phone %D 2021 %7 28.7.2021 %9 Early Report %J JMIR Res Protoc %G English %X Background: The advancement of digital health has widened the scope of technology use across multiple frontiers of health care services, including personalized therapeutics, mobile health, eHealth record management, and telehealth consultations. The World Health Organization (WHO) responded to this in 2018 by publishing an inaugural broad classification framework of digital health interventions (DHIs) used to address contemporary health system needs. Objective: This study aims to describe the systematic development of dual survey instruments (clinician and patient) to support data collection, administered in a physiotherapy setting, about perceptions toward DHIs. This is achieved by adapting the WHO framework classification for DHIs for application in real-world research. Methods: Using a qualitative item review approach, WHO DHI descriptors were adapted and refined systematically to be used in a survey form. This approach was designed to align with the processes of delivering and receiving care in clinical practice, using musculoskeletal physiotherapy as a practical case scenario. Results: Complementary survey instruments (for health care providers and clients) were developed by adapting descriptor items. These instruments will be used in a larger study exploring the willingness of physiotherapists and patients to use digital technologies in the management of musculoskeletal conditions. Conclusions: This study builds on the WHO-standardized DHI framework. We developed dual novel survey instruments by adapting and refining the functions of DHIs. These may be deployed to explore the perceived usefulness and application of DHIs for different clinical care functions. Researchers may wish to use these survey instruments to examine digital health use systematically in a variety of clinical fields or technology scenarios in a way that is standardized and generalizable. %M 34319242 %R 10.2196/25177 %U https://www.researchprotocols.org/2021/7/e25177 %U https://doi.org/10.2196/25177 %U http://www.ncbi.nlm.nih.gov/pubmed/34319242 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e27633 %T Web-Based Survival Analysis Tool Tailored for Medical Research (KMplot): Development and Implementation %A Lánczky,András %A Győrffy,Balázs %+ Department of Bioinformatics, Semmelweis University, Tűzoltó utca 7-9, Budapest, 1094, Hungary, 36 305142822, gyorffy.balazs@med.semmelweis-univ.hu %K Kaplan-Meier plot %K internet %K Cox regression %K follow-up %K multivariate analysis %K survival %D 2021 %7 26.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Survival analysis is a cornerstone of medical research, enabling the assessment of clinical outcomes for disease progression and treatment efficiency. Despite its central importance, no commonly used spreadsheet software can handle survival analysis and there is no web server available for its computation. Objective: Here, we introduce a web-based tool capable of performing univariate and multivariate Cox proportional hazards survival analysis using data generated by genomic, transcriptomic, proteomic, or metabolomic studies. Methods: We implemented different methods to establish cut-off values for the trichotomization or dichotomization of continuous data. The false discovery rate is computed to correct for multiple hypothesis testing. A multivariate analysis option enables comparing omics data with clinical variables. Results: We established a registration-free web-based survival analysis tool capable of performing univariate and multivariate survival analysis using any custom-generated data. Conclusions: This tool fills a gap and will be an invaluable contribution to basic medical and clinical research. %M 34309564 %R 10.2196/27633 %U https://www.jmir.org/2021/7/e27633 %U https://doi.org/10.2196/27633 %U http://www.ncbi.nlm.nih.gov/pubmed/34309564 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e17660 %T Assessing Apps for Health Care Workers Using the ISYScore-Pro Scale: Development and Validation Study %A Grau-Corral,Inmaculada %A Pantoja,Percy Efrain %A Grajales III,Francisco J %A Kostov,Belchin %A Aragunde,Valentín %A Puig-Soler,Marta %A Roca,Daria %A Couto,Elvira %A Sisó-Almirall,Antoni %+ Fundacion iSYS (internet, Salud y Sociedad), c/ Mallorca 140 2-4, Barcelona, 08036, Spain, 34 692241233, Imma.grau.corral@gmail.com %K assessment %K mobile app %K mobile application %K mHealth %K health care professionals %K mobile application rating scale %K scale development %D 2021 %7 21.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The presence of mobile phone and smart devices has allowed for the use of mobile apps to support patient care. However, there is a paucity in our knowledge regarding recommendations for mobile apps specific to health care professionals. Objective: The aim of this study is to establish a validated instrument to assess mobile apps for health care providers and health systems. Our objective is to create and validate a tool that evaluates mobile health apps aimed at health care professionals based on a trust, utility, and interest scale. Methods: A five-step methodology framework guided our approach. The first step consisted of building a scale to evaluate apps for health care professionals based on a literature review. This was followed with expert panel validation through a Delphi method of (rated) web-based questionnaires to empirically evaluate the inclusion and weight of the indicators identified through the literature review. Repeated iterations were followed until a consensus greater than 75% was reached. The scale was then tested using a pilot to assess reliability. Interrater agreement of the pilot was measured using a weighted Cohen kappa. Results: Using a literature review, a first draft of the scale was developed. This was followed with two Delphi rounds between the local research group and an external panel of experts. After consensus was reached, the resulting ISYScore-Pro 17-item scale was tested. A total of 280 apps were originally identified for potential testing (140 iOS apps and 140 Android apps). These were categorized using International Statistical Classification of Diseases, Tenth Revision. Once duplicates were removed and they were downloaded to confirm their specificity to the target audience (ie, health care professionals), 66 remained. Of these, only 18 met the final criteria for inclusion in validating the ISYScore-Pro scale (interrator reliabilty 92.2%; kappa 0.840, 95% CI 0.834-0.847; P<.001). Conclusions: We have developed a reproducible methodology to objectively evaluate mobile health apps targeted to health care professionals and providers, the ISYScore-Pro scale. Future research will be needed to adapt the scale to other languages and across other domains (eg, legal compliance or security). %M 34287216 %R 10.2196/17660 %U https://mhealth.jmir.org/2021/7/e17660 %U https://doi.org/10.2196/17660 %U http://www.ncbi.nlm.nih.gov/pubmed/34287216 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e19245 %T European Portuguese Version of the User Satisfaction Evaluation Questionnaire (USEQ): Transcultural Adaptation and Validation Study %A Domingos,Célia %A Costa,Patrício Soares %A Santos,Nadine Correia %A Pêgo,José Miguel %+ Life and Health Sciences Research Institute, School of Medicine, University of Minho, Campus de Gualtar, Braga, 4710-057, Portugal, 351 253604932, jmpego@med.uminho.pt %K satisfaction %K usability %K reliability %K validity %K seniors %K elderly %K technology %K wearables %D 2021 %7 29.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable activity trackers have the potential to encourage users to adopt healthier lifestyles by tracking daily health information. However, usability is a critical factor in technology adoption. Older adults may be more resistant to accepting novel technologies. Understanding the difficulties that older adults face when using activity trackers may be useful for implementing strategies to promote their use. Objective: The purpose of this study was to conduct a transcultural adaptation of the User Satisfaction Evaluation Questionnaire (USEQ) into European Portuguese and validate the adapted questionnaire. Additionally, we aimed to provide information about older adults’ satisfaction regarding the use of an activity tracker (Xiaomi Mi Band 2). Methods: The USEQ was translated following internationally accepted guidelines. The psychometric evaluation of the final version of the translated USEQ was assessed based on structural validity using exploratory and confirmatory factor analyses. Construct validity was examined using divergent and discriminant validity analysis, and internal consistency was evaluated using Cronbach α and McDonald ω coefficients. Results: A total of 110 older adults completed the questionnaire. Confirmatory factor analysis supported the conceptual unidimensionality of the USEQ (χ24=7.313, P=.12, comparative fit index=0.973, Tucker-Lewis index=0.931, goodness of fit index=0.977, root mean square error of approximation=0.087, standardized root mean square residual=0.038). The internal consistency showed acceptable reliability (Cronbach α=.677, McDonald ω=0.722). Overall, 90% of the participants reported excellent satisfaction with the Xiaomi Mi Band 2. Conclusions: The findings support the use of this translated USEQ as a valid and reliable tool for measuring user satisfaction with wearable activity trackers in older adults, with psychometric properties consistent with the original version. %M 34185018 %R 10.2196/19245 %U https://mhealth.jmir.org/2021/6/e19245 %U https://doi.org/10.2196/19245 %U http://www.ncbi.nlm.nih.gov/pubmed/34185018 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e25310 %T Development of an Android-Based Self-Report Assessment for Elderly Driving Risk (SAFE-DR) App: Mixed Methods Study %A Hwang,Ho Sung %A Choi,Seong-Youl %+ Department of Occupational Therapy, Gwangju Women’s University, 201, Yeodae-gil, Gwangsan-gu, Gwangju, , Republic of Korea, 82 10 3209 ext 9146, ckshrj6@hanmail.net %K Android driving app %K driving safety %K reliability %K self-assessment %K validity %K mHealth %K driving %D 2021 %7 17.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Self-report assessments for elderly drivers are used in various countries for accessible, widespread self-monitoring of driving ability in the elderly population. Likewise, in South Korea, a paper-based Self-Report Assessment for Elderly Driving Risk (SAFE-DR) has been developed. Here, we implemented the SAFE-DR through an Android app, which provides the advantages of accessibility, convenience, and provision of diverse information, and verified its reliability and validity. Objective: This study tested the validity and reliability of a mobile app-based version of a self-report assessment for elderly persons contextualized to the South Korean culture and compared it with a paper-based test. Methods: In this mixed methods study, we recruited and interviewed 567 elderly drivers (aged 65 years and older) between August 2018 and May 2019. For participants who provided consent, the app-based test was repeated after 2 weeks and an additional paper-based test (Driver 65 Plus test) was administered. Using the collected data, we analyzed the reliability and validity of the app-based SAFE-DR. The internal consistency of provisional items in each subdomain of the SAFE-DR and the test-retest stability were analyzed to examine reliability. Exploratory factor analysis was performed to examine the validity of the subdomain configuration. To verify the appropriateness of using an app-based test for older drivers possibly unfamiliar with mobile technology, the correlation between the results of the SAFE-DR app and the paper-based offline test was also analyzed. Results: In the reliability analysis, Cronbach α for all items was 0.975 and the correlation of each item with the overall score ranged from r=0.520 to r=0.823; 4 items with low correlations were removed from each of the subdomains. In the retest after 2 weeks, the mean correlation coefficient across all items was r=0.951, showing very high reliability. Exploratory factor analysis on 40 of the 44 items established 5 subdomains: on-road (8 items), coping (16 items), cognitive functions (5 items), general conditions (8 items), and medical health (3 items). A very strong negative correlation of –0.864 was observed between the total score for the app-based SAFE-DR and the paper-based Driver 65 Plus with decorrelation scales. The app-based test was found to be reliable. Conclusions: In this study, we developed an app-based self-report assessment tool for elderly drivers and tested its reliability and validity. This app can help elderly individuals easily assess their own driving skills. Therefore, this assessment can be used to educate drivers and for preventive screening for elderly drivers who want to renew their driver’s licenses in South Korea. In addition, the app can contribute to safe driving among elderly drivers. %M 33934068 %R 10.2196/25310 %U https://mhealth.jmir.org/2021/6/e25310 %U https://doi.org/10.2196/25310 %U http://www.ncbi.nlm.nih.gov/pubmed/33934068 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e29122 %T The Development of a Digital Patient-Reported Outcome Measurement for Adults With Chronic Disease (The Parsley Symptom Index): Prospective Cohort Study %A Williams,Hants %A Steinberg,Sarah %A Berzin,Robin %+ School of Health Technology and Management, Stony Brook University, 101 Nicolls Rd, Stony Brook, NY, 11794, United States, 1 6502183789, hantsawilliams@gmail.com %K patient-reported outcomes %K PROMs %K chronic diseases %K symptom management %K Parsley Symptom Index %K Review of Symptoms %D 2021 %7 11.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The monitoring and management of chronic illness has always been a challenge. Patient-reported outcome measures (PROMs) can be powerful tools for monitoring symptoms and guiding treatment of chronic diseases, but the available PROM tools are either too broad or too disease specific for the needs of a primary care practice focused on longitudinal care. Objective: In this study we describe the development and preliminary validation of the Parsley Symptom Index (PSI). Methods: This prospective cohort study took place from January 5, 2018, to June 05, 2020, among a sample of 4621 adult patients at Parsley Health. After a review of literature, followed by binning and winnowing of potential items, a 45-item PROM that also served as a review of systems (ROS) was developed. The PSI was deployed and completed by patients via an online portal. Construct and face validity was performed by clinicians, tested on patients, and feasibility was measured by response rate, completion rate, and percentage of missing data. Results: The response rate for 12,175 collected PSIs was 93.72% (4331/4621) with a 100% item completion rate. A confirmatory factor analysis confirmed the model structure was satisfactory by a Comparative Fit Index of 0.943, Tucker–Lewis index of 0.938, and root mean square error of approximation of 0.028. Conclusions: A 45-item ROS-style PROM designed to capture chronic disease symptoms was developed, and preliminary validation suggests that the PSI can be deployed, completed, and helpful to both patients and clinicians. %M 33999007 %R 10.2196/29122 %U https://formative.jmir.org/2021/6/e29122 %U https://doi.org/10.2196/29122 %U http://www.ncbi.nlm.nih.gov/pubmed/33999007 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e25794 %T A Web-Based Time-Use Application to Assess Diet and Movement Behavior in Asian Schoolchildren: Development and Usability Study of My E-Diary for Activities and Lifestyle (MEDAL) %A Chia,Airu %A Chew,Muhammad Naeem Jia Sheng %A Tan,Sarah Yi Xuan %A Chan,Mei Jun %A T Colega,Marjorelee %A Toh,Jia Ying %A Natarajan,Padmapriya %A Lança,Carla %A Shek,Lynette P %A Saw,Seang-Mei %A Müller-Riemenschneider,Falk %A Chong,Mary Foong-Fong %+ Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, Singapore, 117549, Singapore, 65 6516 4969, mary_chong@nus.edu.sg %K time use %K web-based %K diet %K movement behaviors %K usability %K schoolchildren %D 2021 %7 9.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based time-use diaries for schoolchildren are limited, and existing studies focus mostly on capturing physical activities and sedentary behaviors but less comprehensively on dietary behaviors. Objective: This study aims to describe the development of My E-Diary for Activities and Lifestyle (MEDAL)—a self-administered, web-based time-use application to assess diet and movement behavior—and to evaluate its usability in schoolchildren in Singapore. Methods: MEDAL was developed through formative research and an iterative user-centric design approach involving small groups of schoolchildren (ranging from n=5 to n=15, aged 7-13 years). To test the usability, children aged 10-11 years were recruited from 2 primary schools in Singapore to complete MEDAL for 2 weekdays and 2 weekend days and complete a 10-item usability questionnaire. Results: The development process revealed that younger children (aged <9 years) were less able to complete MEDAL independently. Of the 204 participants (118/204, 57.8% boys, and 31/201, 15.4% overweight) in the usability study, 57.8% (118/204) completed 3 to 4 days of recording, whereas the rest recorded for 2 days or less. The median time taken to complete MEDAL was 14.2 minutes per day. The majority of participants agreed that instructions were clear (193/203, 95.1%), that MEDAL was easy to use (173/203, 85.2%), that they liked the application (172/202, 85.1%), and that they preferred recording their activities on the web than on paper (167/202, 82.7%). Among all the factors evaluated, recording for 4 days was the least satisfactory component reported. Compared with boys, girls reported better recall ability and agreed that the time spent on completing 1-day entry was appropriate. Conclusions: MEDAL appears to be a feasible application to capture diet and movement behaviors in children aged 10-12 years, particularly in the Asian context. Some gender differences in usability performance were observed, but the majority of the participants had a positive experience using MEDAL. The validation of the data collected through the application is in progress. %M 34106084 %R 10.2196/25794 %U https://www.jmir.org/2021/6/e25794 %U https://doi.org/10.2196/25794 %U http://www.ncbi.nlm.nih.gov/pubmed/34106084 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27407 %T Association Between the Digital Clock Drawing Test and Neuropsychological Test Performance: Large Community-Based Prospective Cohort (Framingham Heart Study) %A Yuan,Jing %A Libon,David J %A Karjadi,Cody %A Ang,Alvin F A %A Devine,Sherral %A Auerbach,Sanford H %A Au,Rhoda %A Lin,Honghuang %+ Computational Biomedicine, School of Medicine, Boston University, 72 E. Concord Street, E-632, Boston, MA, 02118, United States, 1 617 358 0091, hhlin@bu.edu %K clock drawing test %K neuropsychological test %K cognition %K technology %K digital assessment %K mild cognitive impairment %K association %K neurology %K Framingham Heart Study %D 2021 %7 8.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The Clock Drawing Test (CDT) has been widely used in clinic for cognitive assessment. Recently, a digital Clock Drawing Text (dCDT) that is able to capture the entire sequence of clock drawing behaviors was introduced. While a variety of domain-specific features can be derived from the dCDT, it has not yet been evaluated in a large community-based population whether the features derived from the dCDT correlate with cognitive function. Objective: We aimed to investigate the association between dCDT features and cognitive performance across multiple domains. Methods: Participants from the Framingham Heart Study, a large community-based cohort with longitudinal cognitive surveillance, who did not have dementia were included. Participants were administered both the dCDT and a standard protocol of neuropsychological tests that measured a wide range of cognitive functions. A total of 105 features were derived from the dCDT, and their associations with 18 neuropsychological tests were assessed with linear regression models adjusted for age and sex. Associations between a composite score from dCDT features were also assessed for associations with each neuropsychological test and cognitive status (clinically diagnosed mild cognitive impairment compared to normal cognition). Results: The study included 2062 participants (age: mean 62, SD 13 years, 51.6% women), among whom 36 were diagnosed with mild cognitive impairment. Each neuropsychological test was associated with an average of 50 dCDT features. The composite scores derived from dCDT features were significantly associated with both neuropsychological tests and mild cognitive impairment. Conclusions: The dCDT can potentially be used as a tool for cognitive assessment in large community-based populations. %M 34100766 %R 10.2196/27407 %U https://www.jmir.org/2021/6/e27407 %U https://doi.org/10.2196/27407 %U http://www.ncbi.nlm.nih.gov/pubmed/34100766 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e29365 %T Meaning in Life Among Patients With Chronic Pain and Suicidal Ideation: Mixed Methods Study %A Costanza,Alessandra %A Chytas,Vasileios %A Piguet,Valérie %A Luthy,Christophe %A Mazzola,Viridiana %A Bondolfi,Guido %A Cedraschi,Christine %+ Department of Psychiatry, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, Geneva, 1211, Switzerland, 41 223795900, alessandra.costanza@unige.ch %K suicide %K suicidal behavior %K suicidal ideation %K suicide attempt %K chronic pain %K meaning in life %K protective factors %K risk factors %K mental health %D 2021 %7 4.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with chronic pain have elevated risk of suicidal ideation and behavior, including suicide attempts and completed suicides. In most studies, associations between chronic pain and suicidal ideation/suicidal behavior are robust even after adjusting for the effect of sociodemographics and psychiatric comorbidity. However, to refine the risk profile of these patients, further exploration of other possible risk and protective factors is necessary. Objective: There is a common clinical observation that experiencing chronic pain often requires a revision of life goals and expectations, and hence, it impacts the existential domain including one’s perception of the meaning in life (MiL). This study aimed to characterize the main domains that constitute the personal MiL, including the “presence of” and “search for” constructs, in a group of patients with chronic pain and suicidal ideation. Methods: Seventy participants were enlisted by ongoing recruitment through a larger project anchored in daily clinical practice at the Multidisciplinary Pain Center of the Geneva University Hospitals. It was an observational mixed method study. Data were recorded through both validated quantitative questionnaires and qualitative open-ended questions. Results: The total sample consisted of 70 patients. Responses to questionnaires showed a depressive episode in 68 (97%) patients and anxious disorders in 25 (36%) patients. With a score threshold for positive MiL of 24, the mean score for the “presence of” construct was 20.13 (SD 8.23), and 63% (44/70) of respondents had a score <24. The mean score for the “search for” construct was lower at 18.14 (SD 8.64), and 70% (49/70) of respondents had a score <24. The “presence of” and “search for” constructs were significantly positively correlated (R=0.402; P=.001). An open question addressed the “presence of” construct by inviting the respondents to cite domains they consider as providing meaning in their life at the present time. All patients responded to this question, citing one or more domains. The three main dimensions that emerged from content analysis of this qualitative section were as follows: the domain of relationships, the domain of personal activities, and pain and its consequences on MiL. Conclusions: The study results provide insights into patients with chronic pain and suicidal ideation, including the domains that provide them with meaning in their lives and the impact of pain on these domains with regard to suicidal ideation. The main clinical implications concern both prevention and supportive/psychotherapeutic interventions. They are based on a narrative approach aiming to explore with the patients the content of their suffering and the MiL domains that they could identify to mitigate it, in order to restructure/reinforce these domains and thus possibly reduce suicidal ideation. Specifically, a focus on maintaining the domains of interpersonal relationships and personal activities can allow patients to ultimately escape the biopsychosocial vicious cycle of chronic pain–induced deep moral suffering. %M 34003136 %R 10.2196/29365 %U https://formative.jmir.org/2021/6/e29365 %U https://doi.org/10.2196/29365 %U http://www.ncbi.nlm.nih.gov/pubmed/34003136 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 2 %P e25876 %T Gender Differences in State Anxiety Related to Daily Function Among Older Adults During the COVID-19 Pandemic: Questionnaire Study %A Rosenblum,Sara %A Cohen Elimelech,Ortal %+ The Laboratory of Complex Human Activity and Participation, Department of Occupational Therapy, University of Haifa, Mount Carmel, Haifa, 31905, Israel, 972 4 8240474, rosens@research.haifa.ac.il %K COVID-19 %K coronavirus %K anxiety %K cognition %K aging %K eHealth %K online data %D 2021 %7 3.6.2021 %9 Original Paper %J JMIR Aging %G English %X Background: The COVID-19 pandemic poses a challenge to people’s day-to-day functioning and emotional and physical health, especially among older adults. Objective: The aim of this study is to analyze gender differences in state anxiety, daily functional self-actualization, and functional cognition as well as the relationships among those factors in older adults during the COVID-19 pandemic lockdown. Methods: We collected data on the web from a sample of 204 people (102 men and 102 women) aged 60 years and older. In addition to a demographic questionnaire, we used the State-Trait Personality Inventory to assess state anxiety, the Daily Functional Actualization questionnaire to evaluate daily functional self-actualization, and the Daily Living Questionnaire to measure functional cognition. Results: Significant gender differences were found for state anxiety (t202=−2.36, P=.02); daily functional self-actualization (t202=2.15, P=.03); and the functional cognition components: complex tasks (Z=−3.07, P=.002); cognitive symptoms that might be interfering (Z=−2.15, P=.028); executive functions (Z=−2.21, P=.024); and executive function monitoring (Z=−2.21, P=.027). Significant medium correlations were found between both state anxiety level and daily functional self-actualization (r=−0.62, P<.001) and functional cognition (r=0.37-0.40, P<.001). Gender predicted 3% of the variance in state anxiety level, while daily functional self-actualization predicted 41% and complex activities (Daily Living Questionnaire) predicted an additional 3% (F3,200=58.01, P<.001). Conclusions: In older adults, anxiety is associated with cognitive decline, which may harm daily functional abilities and lead to social isolation, loneliness, and decreased well-being. Self-awareness and knowledge of gender differences and relationships between common available resources of daily functional self-actualization and functional cognition with anxiety may be strengthening factors in crisis periods such as the COVID-19 pandemic. %M 33939623 %R 10.2196/25876 %U https://aging.jmir.org/2021/2/e25876 %U https://doi.org/10.2196/25876 %U http://www.ncbi.nlm.nih.gov/pubmed/33939623 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e24901 %T Assessing Health-Related Quality of Life, Morbidity, and Survival Status for Individuals With Down Syndrome in Pakistan (DS-Pak): Protocol for a Web-Based Collaborative Registry %A Siddiqui,Ayat %A Ladak,Laila Akbar %A Kazi,Abdul Momin %A Kaleem,Sidra %A Akbar,Fizza %A Kirmani,Salman %+ Department of Pediatrics, Aga Khan University Hospital, National Stadium Rd, Karachi, 74800, Pakistan, 92 34930051, laila.ladak@aku.edu %K Down syndrome %K registry %K web-based registry %K health-related quality of life %K lower-middle income country %K mobile health %K patient-reported outcome %D 2021 %7 3.6.2021 %9 Proposal %J JMIR Res Protoc %G English %X Background: Down syndrome is the most common chromosomal disorder, with a global incidence of 1 in 700 live births. However, the true prevalence, associated morbidities, and health-related quality of life (HRQOL) of these individuals and their families are not well documented, especially in low- and middle-income countries such as Pakistan. Disease-specific documentation in the form of a collaborative registry is required to better understand this condition and the associated health outcomes. This protocol paper describes the aims and processes for developing the first comprehensive, web-based collaborative registry for Down syndrome in a Pakistani cohort. Objective: This study aims to assess the HRQOL, long-term survival, and morbidity of individuals with Down syndrome by using a web-based collaborative registry. Methods: The registry data collection will be conducted at the Aga Khan University Hospital and at the Karachi Down Syndrome Program. Data will be collected by in-person interviews or virtually via telephone or video interviews. Participants of any age and sex with Down syndrome (trisomy 21) will be recruited. After receiving informed consent and assent, a series of tablet-based questionnaires will be administered. The questionnaires aim to assess the sociodemographic background, clinical status, and HRQOL of the participants and their families. Data will be uploaded to a secure cloud server to allow for real-time access to participant responses by the clinicians to plan prompt interventions. Patient safety and confidentiality will be maintained by using multilayer encryption and unique coded patient identifiers. The collected data will be analyzed using IBM SPSS Statistics for Windows, Version 22.0 (IBM Corporation), with the mean and SD of continuous variables being reported. Categorical variables will be analyzed with their percentages being reported and with a P value cutoff of .05. Multivariate regression analysis will be conducted to identify predictors related to the HRQOL in patients with Down syndrome. Survival analysis will be reported using the Kaplan-Meier survival curves. Results: The web-based questionnaire is currently being finalized before the commencement of pilot testing. This project has not received funding at the moment (ethical review committee approval reference ID: 2020-3582-11145). Conclusions: This registry will allow for a comprehensive understanding of Down syndrome in low- and middle-income countries. This can provide the opportunity for data-informed interventions, which are tailored to the specific needs of this patient population and their families. Although this web-based registry is a proof of concept, it has the potential to be expanded to national, regional, and international levels. International Registered Report Identifier (IRRID): PRR1-10.2196/24901 %M 34081014 %R 10.2196/24901 %U https://www.researchprotocols.org/2021/6/e24901 %U https://doi.org/10.2196/24901 %U http://www.ncbi.nlm.nih.gov/pubmed/34081014 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e27668 %T STAR Duodecim eHealth Tool to Recognize Chronic Disease Risk Factors and Change Unhealthy Lifestyle Choices Among the Long-Term Unemployed: Protocol for a Mixed Methods Validation Study %A Kuhlberg,Henna %A Kujala,Sari %A Hörhammer,Iiris %A Koskela,Tuomas %+ Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, Tampere, 33520, Finland, 358 504488439, henna.kuhlberg@gmail.com %K eHealth %K risk assessment %K long-term unemployed %K expected age of death %K online intervention %K risk factors %K chronic illnesses %K primary prevention %K online health check %K long-term %K multimorbidity %K health care services %K examination %K evaluation %K lifestyle %D 2021 %7 1.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Lifestyle choices and socioeconomic status have a significant impact on the expected onset of diseases, age of death, and risk factors concerning long-term illnesses and morbidity. STAR is an online health examination tool, which gives users a report that includes an evaluation of their life expectancy and an estimated risk for developing common long-term illnesses based on questions about health, characteristics, lifestyle, and quality of life. Objective: The goals of this study are to (1) review the capacity of STAR to recognize morbidity risks in comparison to a traditional nurse-led health examination and patient-reported health challenges; (2) evaluate the user experience and usability of STAR; and (3) assess the potential impact of STAR on the health confidence and motivation of patients to make healthier lifestyle choices. Methods: This mixed methods validation study will consist of a quantitative part (questionnaires) and a qualitative part (phone interviews and open-ended questions from the questionnaires). The participants will include 100 long-term unemployed individuals attending a health check for the unemployed. The participants will be recruited from three Finnish public health centers in Espoo, Hämeenlinna, and Tampere. At the health centers, the participants will use STAR and attend a nurse’s health check. Surveys with multiple-choice and open-ended questions will be collected from the participants, the nurse, and a study assistant. The questionnaires include questions about the participant’s background and health challenges from the patient and nurse points of view, as well as questions about how well the health challenges matched the STAR report. The questionnaires also gather data about user experience, health confidence, and usability of STAR. A study assistant will fill out an observer’s form containing questions about use time and possible problems encountered while using STAR. A sample of the unemployed participants will be interviewed by telephone subsequently. For the quantitative data, descriptive statistics and a reliability analysis will be performed, and mean sum scores will be computed for the study variables. Thematic analysis of the qualitative data will be performed. Results: This study was approved by the Ethics Committee of the Expert Responsibility Area of Tampere University Hospital in June 2020 (ETL Code R20067). Data collection will begin in June 2021 and will take approximately 3-6 months. Conclusions: Online health examinations can improve the effectiveness of primary prevention in health care by supporting efficient evidence-based morbidity risk estimation and motivating patients to change unhealthy behaviors. A multimethod approach is used to allow for assessment of the tool’s usefulness from the points of view of both professionals and patients. This study will further provide a rich understanding of how the tool can be used as part of routine health checks, and how and why the tool may or may not motivate users for making healthier lifestyle choices. International Registered Report Identifier (IRRID): PRR1-10.2196/27668 %M 34061041 %R 10.2196/27668 %U https://www.researchprotocols.org/2021/6/e27668 %U https://doi.org/10.2196/27668 %U http://www.ncbi.nlm.nih.gov/pubmed/34061041 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 5 %P e24567 %T Using Digital Tools to Engage Patients With Psychosis and Their Families in Research: Survey Recruitment and Completion in an Early Psychosis Intervention Program %A Polillo,Alexia %A Voineskos,Aristotle N %A Foussias,George %A Kidd,Sean A %A Sav,Andreea %A Hawley,Steve %A Soklaridis,Sophie %A Stergiopoulos,Vicky %A Kozloff,Nicole %+ Centre for Addiction and Mental Health, 1025 Queen Street West, B1-4345, Toronto, ON, M6J 1H1, Canada, 1 416 535 8501, n.kozloff@mail.utoronto.ca %K digital %K online %K psychosis %K schizophrenia %K early psychosis intervention %K surveys %D 2021 %7 31.5.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Barriers to recruiting and retaining people with psychosis and their families in research are well-established, potentially biasing clinical research samples. Digital research tools, such as online platforms, mobile apps, and text messaging, have the potential to address barriers to research by facilitating remote participation. However, there has been limited research on leveraging these technologies to engage people with psychosis and their families in research. Objective: The objective of this study was to assess the uptake of digital tools to engage patients with provisional psychosis and their families in research and their preferences for different research administration methods. Methods: This study used Research Electronic Data Capture (REDCap)—a secure web-based platform with built-in tools for data collection and storage—to send web-based consent forms and surveys on service engagement via text message or email to patients and families referred to early psychosis intervention services; potential participants were also approached or reminded about the study in person. We calculated completion rates and timing using remote and in-person methods and compensation preferences. Results: A total of 447 patients with provisional psychosis and 187 of their family members agreed to receive the web-based consent form, and approximately half of the patients (216/447, 48.3%) and family members (109/187, 58.3%) consented to participate in the survey. Most patients (182/229, 79.5%) and family members (75/116, 64.7%) who completed the consent form did so remotely, with more family members (41/116, 35.3%) than patients (47/229, 20.5%) completing it in person. Of those who consented, 77.3% (167/216) of patients and 72.5% (79/109) of family members completed the survey, and most did the survey remotely. Almost all patients (418/462, 90.5%) and family members (174/190, 91.6%) requested to receive the consent form and survey by email, and only 4.1% (19/462) and 3.2% (6/190), respectively, preferred text message. Just over half of the patients (91/167, 54.5%) and family members (42/79, 53.2%) preferred to receive electronic gift cards from a coffee shop as study compensation. Most surveys were completed on weekdays between 12 PM and 6 PM. Conclusions: When offered the choice, most participants with psychosis and their families chose remote administration methods, suggesting that digital tools may enhance research recruitment and participation in this population, particularly in the context of the COVID-19 global pandemic. %M 34057421 %R 10.2196/24567 %U https://mental.jmir.org/2021/5/e24567 %U https://doi.org/10.2196/24567 %U http://www.ncbi.nlm.nih.gov/pubmed/34057421 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e24100 %T Allostatic Stress and Inflammatory Biomarkers in Transgender and Gender Expansive Youth: Protocol for a Pilot Cohort Study %A Cohen,Mara %A Karrington,Baer %A Trachtman,Howard %A Salas-Humara,Caroline %+ Department of Pediatrics, New York University Langone, 145 E 32nd St, 14th Floor, New York, NY, 10016, United States, 1 6469297970, mara.cohen2@nyulangone.org %K transgender %K gender diverse %K adolescence %K allostatic load %K stress biomarkers %K participatory action research %K stress %K biomarkers %K participatory %K gender %D 2021 %7 19.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: A growing number of adolescents are coming out as transgender and gender expansive (TGE). These teenagers have been shown to have significantly worse health outcomes than their cisgender peers. Hypotheses to explain this discrepancy are based on increased stress levels surrounding the societal acceptance of gender identity. In this context, elevated allostatic load (AL), which describes the wear and tear sustained by the body in response to repeated exposure to stress, has been associated with adverse long-term health outcomes. Objective: This protocol aims to measure AL among TGE adolescents compared with their cisgender peers and assess how AL varies depending on psychological stress and perceived societal acceptance. Methods: This is an observational proof-of-concept pilot study in which AL will be measured by assaying an array of inflammatory cytokines and cortisol in urine, saliva, and hair samples of TGE youth, and these parameters will be compared with those of age-matched control participants. A questionnaire will assess 4 aspects of psychosocial well-being: presence and management of depression and anxiety, gender identity support by family members, gender minority stress, and degree of perceived safety in the surrounding community. Samples and surveys will be collected at 3 visits (baseline, 6 months, and 12 months). This study will incorporate TGE coinvestigators to inform all aspects of design, data collection, and analysis and ensure that practices are carried out in a respectful and sensitive manner. Results: As of May 2021, the start of data collection for this project has continued to be postponed as a result of the COVID-19 pandemic, which has both impacted the functioning of the clinic and funding requests. We hope to begin participant recruitment and interviews with coinvestigators soon. Conclusions: We hypothesize that AL will be primarily influenced by psychological well-being and perceived support and that it will be similar in TGE adolescents and in age-matched cisgender control participants when acceptance and perceived support are high. The results of this study have the potential to increase our understanding of the health challenges faced by TGE individuals during adolescence as well as to show that low levels of acceptance may have detrimental health outcomes secondary to elevated ALs; this may lead to the development of a biomarker profile to assess allostatic stress in TGE patients that can be used to guide management. International Registered Report Identifier (IRRID): PRR1-10.2196/24100 %M 34009131 %R 10.2196/24100 %U https://www.researchprotocols.org/2021/5/e24100 %U https://doi.org/10.2196/24100 %U http://www.ncbi.nlm.nih.gov/pubmed/34009131 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 2 %P e23591 %T An Instrument for Measuring Social Participation to Examine Older Adults' Use of the Internet as a Social Platform: Development and Validation Study %A Anderberg,Peter %A Abrahamsson,Linda %A Berglund,Johan Sanmartin %+ Department of Health, Blekinge Institute of Technology, Blekinge Tekniska Högskola (BTH), Karlskrona, 37179, Sweden, 46 46 73 422 3736, pan@bth.se %K internet %K older people %K social participation %K aging %K instrument %K elderly %K social platform %K perception %K connectedness %D 2021 %7 17.5.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Older people’s use of the internet is increasingly coming into focus with the demographic changes of a growing older population. Research reports several benefits of older people’s internet use and highlights problems such as various forms of inequality in use within the group. There is a need for consistent measurements to follow the development and use of the internet in this group and to be able to compare groups both within and between countries, as well as follow the changes over time. Objective: The aim of this study was to create an instrument to measure an older person’s perception of the benefits of their online social participation, unconnected to specific applications and services. The instrument to measure internet social participation proposed in this paper builds on social participation factors and is a multidimensional construct incorporating both social relations and societal connectedness. Methods: A short instrument for measuring social participation over the internet was created. An exploratory factor analysis (EFA) was conducted in a random selection of persons aged 65 years or older (n=193) on 10 initial items. Further validation was made by confirmatory factor analysis (CFA) in the remaining group (n=193). Results: A 1-factor solution for the social internet score was decided upon after exploratory factor analysis (EFA; based on a random sample of half the data set). None of the questionnaire items were excluded based on the EFA, as they all had high loadings, the lowest being 0.61. The Cronbach α coefficient was .92. The 1-factor solution explained 55% of the variance. CFA was performed and included all 10 questionnaire items in a 1-factor solution. Indices of goodness of fit of the model showed room for improvement. Removal of 4 questions in a stepwise procedure resulted in a 6-item model (χ26=13.985; χ2/degrees of freedom=1.554; comparative fit index=0.992; root mean square error of approximation=0.054; standardized root mean square residual=0.025). Conclusions: The proposed instrument can be used to measure digital social participation and coherence with society. The factor analysis is based on a sufficient sample of the general population of older adults in Sweden, and overall the instrument performed as expected. %M 33999004 %R 10.2196/23591 %U https://aging.jmir.org/2021/2/e23591 %U https://doi.org/10.2196/23591 %U http://www.ncbi.nlm.nih.gov/pubmed/33999004 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e25316 %T User-Centered Development of a Mobile App for Biopsychosocial Pain Assessment in Adults: Usability, Reliability, and Validity Study %A Lopes,Filipa %A Rodrigues,Mário %A Silva,Anabela G %+ Center for Health Technology and Services Research (CINTESIS.UA), School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Aveiro, 3810-193, Portugal, 351 234247119 ext 27120, asilva@ua.pt %K pain assessment %K mobile app %K validity %K reliability %K usability %K mHealth %K pain %K user-centered design %D 2021 %7 14.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pain-related mobile apps targeting pain assessment commonly limit pain assessment to pain behaviors and physiological aspects. However, current guidelines state that pain assessment should follow the biopsychosocial model, clearly addressing biological, psychological, and social aspects of the pain experience. Existing reviews also highlight that pain specialists and end users are not commonly involved in the development process of mobile apps for pain assessment, negatively affecting the quality of the available apps. Objective: This study aimed to develop a mobile app for pain assessment (AvaliaDor) and assess its usability, validity, reliability, and measurement error in a sample of real patients with chronic pain recruited from a physiotherapy clinic. Methods: This study was divided into 2 phases: phase 1—development of the AvaliaDor app; and phase 2—assessment of the apps’ usability, reliability, measurement error, and validity. AvaliaDor was developed (phase 1) based on the literature and the recommendations of physiotherapists and patients with pain in cycles of evaluation, inclusion of recommendations, and reevaluation until no further changes were required. The final version of the app was then tested in patients with musculoskeletal pain attending a private physiotherapy practice (phase 2) who were asked to use the app twice on 2 consecutive days for reliability purposes. In addition, participants had to complete a set of paper-based scales (Brief Pain Inventory, painDETECT, Pain Catastrophizing Scale, and Tampa Scale for Kinesiophobia), which were used to assess the validity (criterion validity and hypothesis testing) of the app, and the Post-Study System Usability Questionnaire was used to assess its usability. Results: The development process (phase 1) included 5 physiotherapists external to the research team and 5 patients with musculoskeletal pain, and it resulted in the creation of an app named AvaliaDor, which includes an assessment of pain intensity, location, and phenotype; associated disability; and the issues of pain catastrophizing and fear of movement. A total of 52 patients with pain (mean age 50.12 years, SD 11.71 years; 39 females) participated in phase 2 and used the app twice. The Pearson correlation coefficient between the scores on the paper-based scales and the app ranged between 0.81 and 0.93 for criterion validity and between 0.41 and 0.59 for hypothesis testing. Test-retest reliability was moderate to good (intraclass correlation coefficient between 0.67 and 0.90) and the score for usability was 1.16 (SD 0.27), indicating good usability. Conclusions: A mobile app named AvaliaDor was developed to assess the intensity, location, and phenotype of pain; associated disability; and the issues of pain catastrophizing and fear of movement in a user-centered design process. The app was shown to be usable, valid, and reliable for assessing pain from a biopsychosocial perspective in a heterogeneous group of patients with pain. Future work can explore the long-term use of AvaliaDor in clinical contexts and its advantages for the assessment and management of patients with pain. %M 33988515 %R 10.2196/25316 %U https://mhealth.jmir.org/2021/5/e25316 %U https://doi.org/10.2196/25316 %U http://www.ncbi.nlm.nih.gov/pubmed/33988515 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e25218 %T Automatic Classification of Screen Gaze and Dialogue in Doctor-Patient-Computer Interactions: Computational Ethnography Algorithm Development and Validation %A Helou,Samar %A Abou-Khalil,Victoria %A Iacobucci,Riccardo %A El Helou,Elie %A Kiyono,Ken %+ Global Center for Medical Engineering and Informatics, Osaka University, Osaka Prefecture, Suita, Yamadaoka 2-2, Osaka, 565-0871, Japan, 81 8056856848, helou.samar@gmail.com %K computational ethnography %K patient-physician communication %K doctor-patient-computer interaction %K electronic medical records %K pose estimation %K gaze %K voice activity %K dialogue %K clinic layout %D 2021 %7 10.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The study of doctor-patient-computer interactions is a key research area for examining doctor-patient relationships; however, studying these interactions is costly and obtrusive as researchers usually set up complex mechanisms or intrude on consultations to collect, then manually analyze the data. Objective: We aimed to facilitate human-computer and human-human interaction research in clinics by providing a computational ethnography tool: an unobtrusive automatic classifier of screen gaze and dialogue combinations in doctor-patient-computer interactions. Methods: The classifier’s input is video taken by doctors using their computers' internal camera and microphone. By estimating the key points of the doctor's face and the presence of voice activity, we estimate the type of interaction that is taking place. The classification output of each video segment is 1 of 4 interaction classes: (1) screen gaze and dialogue, wherein the doctor is gazing at the computer screen while conversing with the patient; (2) dialogue, wherein the doctor is gazing away from the computer screen while conversing with the patient; (3) screen gaze, wherein the doctor is gazing at the computer screen without conversing with the patient; and (4) other, wherein no screen gaze or dialogue are detected. We evaluated the classifier using 30 minutes of video provided by 5 doctors simulating consultations in their clinics both in semi- and fully inclusive layouts. Results: The classifier achieved an overall accuracy of 0.83, a performance similar to that of a human coder. Similar to the human coder, the classifier was more accurate in fully inclusive layouts than in semi-inclusive layouts. Conclusions: The proposed classifier can be used by researchers, care providers, designers, medical educators, and others who are interested in exploring and answering questions related to screen gaze and dialogue in doctor-patient-computer interactions. %M 33970117 %R 10.2196/25218 %U https://www.jmir.org/2021/5/e25218 %U https://doi.org/10.2196/25218 %U http://www.ncbi.nlm.nih.gov/pubmed/33970117 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e25082 %T Testing a Novel Web-Based Neurocognitive Battery in the General Community: Validation and Usability Study %A Capizzi,Riley %A Fisher,Melissa %A Biagianti,Bruno %A Ghiasi,Neelufaer %A Currie,Ariel %A Fitzpatrick,Karrie %A Albertini,Nicholas %A Vinogradov,Sophia %+ Department of Psychology, Temple University, 1701 N 13th St, Philadelphia, PA, 19122, United States, 1 (847) 997 4148, capizzi@temple.edu %K cognition %K normative %K remote %K digital %K online %K web-based %K BrainHQ %K Posit Science Corporation %D 2021 %7 6.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, there has been increased interest in the development of remote psychological assessments. These platforms increase accessibility and allow clinicians to monitor important health metrics, thereby informing patient-centered treatment. Objective: In this study, we report the properties and usability of a new web-based neurocognitive assessment battery and present a normative data set for future use. Methods: A total of 781 participants completed a portion of 8 tasks that captured performance in auditory processing, visual-spatial working memory, visual-spatial learning, cognitive flexibility, and emotional processing. A subset of individuals (n=195) completed a 5-question survey measuring the acceptability of the tasks. Results: Between 252 and 426 participants completed each task. Younger individuals outperformed their older counterparts in 6 of the 8 tasks. Therefore, central tendency data metrics were presented using 7 different age bins. The broad majority of participants found the tasks interesting and enjoyable and endorsed some interest in playing them at home. Only 1 of 195 individuals endorsed not at all for the statement, “I understood the instructions.” Older individuals were less likely to understand the instructions; however, 72% (49/68) of individuals over the age of 60 years still felt that they mostly or very much understood the instructions. Conclusions: Overall, the tasks were found to be widely acceptable to the participants. The use of web-based neurocognitive tasks such as these may increase the ability to deploy precise data-informed interventions to a wider population. %M 33955839 %R 10.2196/25082 %U https://www.jmir.org/2021/5/e25082 %U https://doi.org/10.2196/25082 %U http://www.ncbi.nlm.nih.gov/pubmed/33955839 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e25244 %T Assessment of Outcomes of Immediately Loaded Dental Implants in Orofacial Cleft Patients: Protocol for a Single-Arm Clinical Trial %A Mallick,Rizwana %A Pisulkar,Sweta Kale %A Reddy,Srinivas Gosla %+ Department of Prosthodontics and Crown & Bridge, Faculty of Dentistry, Jamia Millia Islamia, Maulana Mohammad Ali Jauhar Marg, New Delhi, 110025, India, 91 9717499339, rmallick@jmi.ac.in %K clinical trial protocols %K dental implants %K dentistry %K immediate dental implant loading %K implant-supported dental prosthesis %K mouth rehabilitation %K oral health %K orofacial cleft %K quality of life %K rehabilitation research %K treatment outcome %D 2021 %7 5.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Orofacial cleft, one of the most common congenital deformities, presents with a plethora of defects, subjecting the patient to a multitude of treatments from a young age. Among the oral hard tissue problems, absence of a maxillary permanent tooth in the cleft region either due to congenital absence or extraction due to compromised prognosis is a common finding. Conventionally, the missing tooth is replaced using a removable or fixed partial denture; however, the treatment modality does not satisfactorily meet patient expectations. The most recent decade has seen increasing use of dental implants in the cleft region; however, the outcome of an immediately loaded dental implant is still elusive for orofacial cleft patients. Objective: This protocol is for a single-arm clinical trial aimed at determining the treatment outcome of immediately loaded dental implants in patients with a nonsyndromic orofacial cleft. Methods: Patients meeting the set criteria will be sequentially enrolled until a sample size of 30 dental implants is met and will undergo the proposed treatment according to the predecided protocol. All patients will be followed up at the designated time intervals to record various clinical and radiographic parameters. Implant success will be defined based on the criteria elucidated by Misch et al in the Pisa, Italy Consensus. A quality-of-life assessment questionnaire will also be recorded at the end of patient’s follow-up to determine their acceptance of the treatment. Results: A total of 30 dental implants will be placed in patients with a nonsyndromic orofacial cleft. Obtained results will be statistically analyzed to determine the treatment outcomes and success. Conclusions: This study will help determine the feasibility of immediately loaded dental implants in compromised bone sites such as those presented in cleft patients and will help in generating findings that can be used to fill the lacunae currently present in the holistic treatment of cleft patients. Trial Registration: Clinical Trial Registry of India CTRI/2020/09/027997; http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=47659&EncHid=&userName=dental%20implants International Registered Report Identifier (IRRID): PRR1-10.2196/25244 %M 33949960 %R 10.2196/25244 %U https://www.researchprotocols.org/2021/5/e25244 %U https://doi.org/10.2196/25244 %U http://www.ncbi.nlm.nih.gov/pubmed/33949960 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26232 %T Attitudes of Health Care Professionals Toward Older Adults’ Abilities to Use Digital Technology: Questionnaire Study %A Mannheim,Ittay %A Wouters,Eveline J M %A van Boekel,Leonieke C %A van Zaalen,Yvonne %+ School for Allied Health Professions, Fontys University of Applied Science, 2 Dominee Theodor Fliednerstraat, Eindhoven, 5631 BN, Netherlands, 31 62 8754948, ittay.mannheim@gmail.com %K ageism %K attitudes %K stereotype activation %K digital technology %D 2021 %7 21.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital technologies (DTs) for older adults focus mainly on health care and are considered to have the potential to improve the well-being of older adults. However, adoption rates of these DTs are considered low. Although previous research has investigated possible reasons for adoption and acceptance of DT, age-based stereotypes (eg, those held by health care professionals) toward the abilities of older adults to use DTs have yet to be considered as possible barriers to adoption. Objective: The aim of this study was to investigate the influencing role of ageism in the context of health care professionals attitudes toward older adults’ abilities to use health care DT. A further goal was to examine if social comparison and stereotype activation affect and moderate this association. Methods: A new measurement to assess health care professionals’ attitudes toward older adults using technology (ATOAUT-10) was developed and used in 2 studies. Study 1 involved the development of the ATOAUT-10 scale using a principal component analysis and further examined health care professionals’ attitudes toward the use of health care DTs and correlations with ageism. Study 2 further explored the correlation between ageism and ATOAUT in an experimental design with health care professionals. Results: In study 1, physiotherapists (N=97) rated older adults as young as 50 years as less able to use health care DT compared to younger adults (P<.001). A multiple regression analysis revealed that higher levels of ageism, beyond other predictors, were predictive of more negative ATOAUT, (β=.36; t=3.73; P<.001). In study 2, the salience of age was manipulated. Health care professionals (N=93) were randomly assigned to rate the abilities of a young or old person to use health care DT. Old age salience moderated the correlation between ageism and ATOAUT (R2=0.19; F6,85=3.35; P=.005), such that higher levels of ageism correlated with more negative ATOAUT in the old age salient condition, but not the young condition. Stereotype activation accounted for health care professionals’ attitudes more than did the experience of working with older patients or the professionals’ age. Conclusions: Negative and ageist attitudes of health care professionals can potentially affect how older adults are viewed in relation to DT and consequently might influence actual use and adoption of technology-based treatment. Future studies should broaden the validation of the ATOAUT-10 scale on more diverse samples and focus on the discriminatory aspect of ageism and self-ageism of older adults. This study calls for a focus on ageism as a determinant of adoption of DT. %M 33881408 %R 10.2196/26232 %U https://www.jmir.org/2021/4/e26232 %U https://doi.org/10.2196/26232 %U http://www.ncbi.nlm.nih.gov/pubmed/33881408 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e26471 %T Assessing the Quality of Mobile Health-Related Apps: Interrater Reliability Study of Two Guides %A Miró,Jordi %A Llorens-Vernet,Pere %+ Universitat Rovira i Virgili; Department of Psychology, Centre de Recerca en Avaluació i Mesura de la Conducta, Institut d'Investigació Sanitària Pere Virgili, Dept de Psicologia, Carretera de Valls, s/n, Tarragona, 43007, Spain, 34 977558179, jordi.miro@urv.cat %K mHealth %K mobile health %K mobile apps %K evaluation studies, rating %K interrater reliability %K MARS %K MAG %D 2021 %7 19.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a huge number of health-related apps available, and the numbers are growing fast. However, many of them have been developed without any kind of quality control. In an attempt to contribute to the development of high-quality apps and enable existing apps to be assessed, several guides have been developed. Objective: The main aim of this study was to study the interrater reliability of a new guide — the Mobile App Development and Assessment Guide (MAG) — and compare it with one of the most used guides in the field, the Mobile App Rating Scale (MARS). Moreover, we also focused on whether the interrater reliability of the measures is consistent across multiple types of apps and stakeholders. Methods: In order to study the interrater reliability of the MAG and MARS, we evaluated the 4 most downloaded health apps for chronic health conditions in the medical category of IOS and Android devices (ie, App Store and Google Play). A group of 8 reviewers, representative of individuals that would be most knowledgeable and interested in the use and development of health-related apps and including different types of stakeholders such as clinical researchers, engineers, health care professionals, and end users as potential patients, independently evaluated the quality of the apps using the MAG and MARS. We calculated the Krippendorff alpha for every category in the 2 guides, for each type of reviewer and every app, separately and combined, to study the interrater reliability. Results: Only a few categories of the MAG and MARS demonstrated a high interrater reliability. Although the MAG was found to be superior, there was considerable variation in the scores between the different types of reviewers. The categories with the highest interrater reliability in MAG were “Security” (α=0.78) and “Privacy” (α=0.73). In addition, 2 other categories, “Usability” and “Safety,” were very close to compliance (health care professionals: α=0.62 and 0.61, respectively). The total interrater reliability of the MAG (ie, for all categories) was 0.45, whereas the total interrater reliability of the MARS was 0.29. Conclusions: This study shows that some categories of MAG have significant interrater reliability. Importantly, the data show that the MAG scores are better than the ones provided by the MARS, which is the most commonly used guide in the area. However, there is great variability in the responses, which seems to be associated with subjective interpretation by the reviewers. %M 33871376 %R 10.2196/26471 %U https://mhealth.jmir.org/2021/4/e26471 %U https://doi.org/10.2196/26471 %U http://www.ncbi.nlm.nih.gov/pubmed/33871376 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 4 %P e25050 %T Measuring and Quantifying Collateral Information in Psychiatry: Development and Preliminary Validation of the McLean Collateral Information and Clinical Actionability Scale %A Owoyemi,Praise %A Salcone,Sarah %A King,Christopher %A Kim,Heejung Julie %A Ressler,Kerry James %A Vahia,Ipsit Vihang %+ Division of Geriatric Psychiatry, McLean Hospital, 115 Mill St., Mail stop 234, Belmont, MA, 02478, United States, 1 617 855 3291, ivahia@mclean.harvard.edu %K electronic media %K psychotherapy %K text message %K electronic mail %K collateral information %K telecommunication %K communications media %K digital %D 2021 %7 14.4.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The review of collateral information is an essential component of patient care. Although this is standard practice, minimal research has been done to quantify collateral information collection and to understand how collateral information translates to clinical decision making. To address this, we developed and piloted a novel measure (the McLean Collateral Information and Clinical Actionability Scale [M-CICAS]) to evaluate the types and number of collateral sources viewed and the resulting actions made in a psychiatric setting. Objective: This study aims to test the feasibility of the M-CICAS, validate this measure against clinician notes via medical records, and evaluate whether reviewing a higher volume of collateral sources is associated with more clinical actions taken. Methods: For the M-CICAS, we developed a three-part instrument, focusing on measuring collateral sources reviewed, clinical actions taken, and shared decision making between the clinician and patient. To determine feasibility and preliminary validity, we piloted this measure among clinicians providing psychotherapy at McLean Hospital. These clinicians (n=7) completed the M-CICAS after individual clinical sessions with 89 distinct patient encounters. Scales were completed by clinicians only once for each patient during routine follow-up visits. After clinicians completed these scales, researchers conducted chart reviews by completing the M-CICAS using only the clinician’s corresponding note from that session. For the analyses, we generated summary scores for the number of collateral sources and clinical actions for each encounter. We examined Pearson correlation coefficients to assess interrater reliability between clinicians and chart reviewers, and simple univariate regression modeling followed by multilevel mixed effects regression modeling to test the relationship between collateral information accessed and clinical actions taken. Results: The study staff had high interrater reliability on the M-CICAS for the sources reviewed (r=0.98; P<.001) and actions taken (r=0.97; P<.001). Clinician and study staff ratings were moderately correlated and statistically significant on the M-CICAS summary scores for the sources viewed (r=0.24, P=.02 and r=0.25, P=.02, respectively). Univariate regression modeling with a two-tailed test demonstrated a significant association between collateral sources and clinical actions taken when clinicians completed the M-CICAS (β=.27; t87=2.47; P=.02). The multilevel fixed slopes random intercepts model confirmed a significant association even when accounting for clinician differences (β=.23; t57=2.13; P=.04). Conclusions: This pilot study established the feasibility and preliminary validity of the M-CICAS in assessing collateral sources and clinical decision making in psychiatry. This study also indicated that reviewing more collateral sources may lead to an increased number of clinical actions following a session. %M 33851928 %R 10.2196/25050 %U https://mental.jmir.org/2021/4/e25050 %U https://doi.org/10.2196/25050 %U http://www.ncbi.nlm.nih.gov/pubmed/33851928 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e26214 %T Structure and Functioning of Acute Inpatient Psychiatric Units in Spain: Qualitative Study %A Rodriguez-Jimenez,Roberto %A Corripio,Iluminada %A Campos,Ricardo %A Páramo,Mario %A Franco-Martin,Manuel %A Segura,Estefanía %A González,Sergio %A Martínez-Raga,José %+ Department of Psychiatry, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Av de Córdoba km 5,400, Madrid, 28041, Spain, 34 91 390 85 36, roberto.rodriguez.jimenez@gmail.com %K acute inpatient psychiatric units %K organization %K resources %K scorecard %K Spain %D 2021 %7 7.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: As a consequence of the decentralization of health care provision to the different Regions (called Autonomous Communities) in Spain, different health care models and resources have been developed for psychiatric patients. It would be very useful to obtain comprehensive and comparative data on health care models, resources, and activity of acute inpatient psychiatric units (AIPUs) as a key part of mental health systems. Objective: The aim of this study was to determine the current state of AIPUs in Spain through a national scorecard that allows the current situation to be visualized in terms of resources, processes, and outputs. Methods: A 104-item online questionnaire was sent to all the AIPUs of the different Regions in Spain. It was divided into 11 sections, including data on the resources, processes, and outputs of the AIPUs plus general data, an indicator dashboard, and good practices. Results: The questionnaire was completed by 60.0% (117/195) of the AIPUs invited to participate. The information collected has allowed us to obtain a detailed snapshot of the current situation of AIPUs in Spain at the levels of infrastructure and material resources, staffing, organization and activity of the units, coordination with other units, guidelines, processes and protocols used, participation and communication with patients and their families, teaching activity, and research linked to the units. Conclusions: This project aimed to help understand the general situation of AIPUs in Spain and its different Regions, contribute to enhancing the benchmarking and harmonization among Spanish Regions, and provide data for future comparisons with other countries. International Registered Report Identifier (IRRID): RR1-10.2196/26214 %M 33729167 %R 10.2196/26214 %U https://www.researchprotocols.org/2021/4/e26214 %U https://doi.org/10.2196/26214 %U http://www.ncbi.nlm.nih.gov/pubmed/33729167 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e22603 %T Online Tool for the Assessment of the Burden of COVID-19 in Patients: Development Study %A van Noort,Esther M J %A Claessens,Danny %A Moor,Catharina C %A Berg,Carlijn A L Van Den %A Kasteleyn,Marise J %A in 't Veen,Johannes C C M %A Van Schayck,Onno C P %A Chavannes,Niels H %+ Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands, 31 162520571, e.m.j.van_noort@lumc.nl %K COVID-19 %K patient-reported outcomes %K ABCoV tool %K monitoring %K patient outcome %K long-term impact %K tool %K assessment %K online patient platform %D 2021 %7 31.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The impact of COVID-19 has been felt worldwide, yet we are still unsure about its full impact. One of the gaps in our current knowledge relates to the long-term mental and physical impact of the infection on affected individuals. The COVID-19 pandemic hit the Netherlands at the end of February 2020, resulting in over 900,000 people testing positive for the virus, over 24,000 hospitalizations, and over 13,000 deaths by the end of January 2021. Although many patients recover from the acute phase of the disease, experience with other virus outbreaks has raised concerns regarding possible late sequelae of the infection. Objective: This study aims to develop an online tool to assess the long-term burden of COVID-19 in patients. Methods: In this paper, we describe the process of development, assessment, programming, implementation, and use of this new tool: the assessment of burden of COVID-19 (ABCoV) tool. This new tool is based on the well-validated assessment of burden of chronic obstructive pulmonary disease tool. Results: As of January 2021, the new ABCoV tool has been used in an online patient platform by more than 2100 self-registered patients and another 400 patients in a hospital setting, resulting in over 2500 patients. These patients have submitted the ABCoV questionnaire 3926 times. Among the self-registered patients who agreed to have their data analyzed (n=1898), the number of females was high (n=1153, 60.7%), many were medically diagnosed with COVID-19 (n=892, 47.0%), and many were relatively young with only 7.4% (n=141) being older than 60 years. Of all patients that actually used the tool (n=1517), almost one-quarter (n=356, 23.5%) used the tool twice, and only a small group (n=76, 5.0%) used the tool 6 times. Conclusions: This new ABCoV tool has been broadly and repeatedly used, and may provide insight into the perceived burden of disease, provide direction for personalized aftercare for people post COVID-19, and help us to be prepared for possible future recurrences. %M 33729982 %R 10.2196/22603 %U https://formative.jmir.org/2021/3/e22603 %U https://doi.org/10.2196/22603 %U http://www.ncbi.nlm.nih.gov/pubmed/33729982 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 3 %P e26265 %T Users’ Willingness to Share Health Information in a Social Question-and-Answer Community: Cross-sectional Survey in China %A Li,PengFei %A Xu,Lin %A Tang,TingTing %A Wu,Xiaoqian %A Huang,Cheng %+ College of Medical Informatics, Chongqing Medical University, No.1 Yixueyuan Road, Yuzhong District, Chongqing, , China, 86 023 6848 0060, huangcheng@cqmu.edu.cn %K health information %K willingness to share information %K %K structural equation model %K Zhihu %D 2021 %7 30.3.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Social question-and-answer communities play an increasingly important role in the dissemination of health information. It is important to identify influencing factors of user willingness to share health information to improve public health literacy. Objective: This study explored influencing factors of social question-and-answer community users who share health information to provide reference for the construction of a high-quality health information sharing community. Methods: A cross-sectional study was conducted through snowball sampling of 185 participants who are Zhihu users in China. A structural equation analysis was used to verify the interaction and influence of the strength between variables in the model. Hierarchical regression was also used to test the mediating effect in the model. Results: Altruism (β=.264, P<.001), intrinsic reward (β=.260, P=.03), self-efficacy (β=.468, P<.001), and community influence (β=.277, P=.003) had a positive effect on users’ willingness to share health information (WSHI). By contrast, extrinsic reward (β=−0.351, P<.001) had a negative effect. Self-efficacy also had a mediating effect (β=.147, 29.15%, 0.147/0.505) between community influence and WSHI. Conclusions: The findings suggest that users’ WSHI is influenced by many factors including altruism, self-efficacy, community influence, and intrinsic reward. Improving the social atmosphere of the platform is an effective method of encouraging users to share health information. %M 33783364 %R 10.2196/26265 %U https://medinform.jmir.org/2021/3/e26265 %U https://doi.org/10.2196/26265 %U http://www.ncbi.nlm.nih.gov/pubmed/33783364 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e25085 %T Association Between a Low Carbohydrate Diet, Quality of Life, and Glycemic Control in Australian Adults Living With Type 1 Diabetes: Protocol for a Mixed Methods Pilot Study %A Paul,Janine %A Jani,Rati %A Davoren,Peter %A Knight-Agarwal,Catherine %+ Diabetes and Endocrinology, Gold Coast University Hospital and Health Service, 1 Hospital Boulevard, Southport, 4215, Australia, 61 7 5687 4779 ext 74779, u3189207@uni.canberra.edu.au %K type 1 diabetes %K diet %K low carbohydrate %K HbA1c %K adults %K quality of life %D 2021 %7 26.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, the prevalence of type 1 diabetes mellitus (T1DM) is rising. In 2020, a total of 124,652 Australians had T1DM. Maintaining optimal glycemic control (hemoglobin A1c ≤7.0%, ≤53 mmol/mol) on a standard carbohydrate diet can be a challenge for people living with T1DM. The Diabetes Complications and Control Trial established that macrovascular and microvascular complications could be reduced by improving glycemic control. Recent studies have found that a very low or low carbohydrate diet can improve glycemic control. However, the overall evidence relating to an association between a very low or low carbohydrate diet and glycemic control in people living with T1DM is both limited and mixed. In addition, research has suggested that a reduced quality of life due to anxiety and depression adversely influences glycemic control. Despite a potential link between a very low or low carbohydrate diet and optimal glycemic control, to our knowledge, no research has examined an association between a low carbohydrate diet, quality of life, and glycemic control, making this study unique in its approach. Objective: The study aims to develop a validated diabetes-specific quality of life questionnaire for use in Australian adults with T1DM and to determine if an association exists between a low carbohydrate diet, quality of life, and glycemic control in Australian adults living with T1DM. Methods: This cross-sectional study will be conducted in a tertiary hospital outpatient setting and will consist of 3 phases: phase 1, online Australian diabetes-specific quality of life questionnaire development and piloting (25-30 adults with T1DM); phase 2, questionnaire validation (364 adults with T1DM); and phase 3, a 12-week dietary intervention to determine if an association exists between a low carbohydrate diet, quality of life, and glycemic control in adults with T1DM (16-23 adults with T1DM). The validation of the study-developed Australian diabetes-specific quality of life questionnaire, and changes in hemoglobin A1c and quality of life in adults with T1DM while undertaking a low carbohydrate diet over 12 weeks will be the primary outcomes of this study. Results: Phase 1 of the study is currently open for recruitment and has recruited 12 participants to date. It is anticipated that the first results will be submitted for publication in November 2021. Presently, no results are available. Conclusions: This study is the first of its kind in that it will be the first to generate a new validated instrument, which could be used in evidence-based practice and research to understand the quality of life of Australian adults with T1DM. Second, the low carbohydrate dietary intervention outcomes could be used to inform clinicians about an alternative approach to assist T1DM adults in improving their quality of life and glycemic control. Finally, this study could warrant the development of an evidence-based low carbohydrate dietary guideline for adults living with T1DM with the potential to have a profound impact on this population. Trial Registration: ClinicalTrials.gov NCT04213300; https://clinicaltrials.gov/ct2/show/NCT04213300 International Registered Report Identifier (IRRID): PRR1-10.2196/25085 %M 33769300 %R 10.2196/25085 %U https://www.researchprotocols.org/2021/3/e25085 %U https://doi.org/10.2196/25085 %U http://www.ncbi.nlm.nih.gov/pubmed/33769300 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24466 %T Arabic Version of the Electronic Health Literacy Scale in Arabic-Speaking Individuals in Sweden: Prospective Psychometric Evaluation Study %A Wångdahl,Josefin %A Dahlberg,Karuna %A Jaensson,Maria %A Nilsson,Ulrica %+ Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, 751 22, Sweden, 46 702034045, josefin.wangdahl@pubcare.uu.se %K eHealth %K digital health literacy %K eHEALS %K health literacy %K internet %K psychometrics %K evaluation, migrants, refugees, Arabic %D 2021 %7 22.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Health information is often communicated through the internet. It is vital for the end user to have a range of digital skills as well as understand the information to promote their health. There is a valid and reliable 8-item instrument, the Electronic Health Literacy Scale (eHEALS), that evaluates these skills. The number of Arabic-speaking people migrating to Sweden and to other parts of the world is increasing due to unstable military and political situations in their countries of origin. Poor health and limited health literacy have been described in this population in Sweden. Still, to our knowledge, an Arabic version of eHEALS has not been tested for validity or reliability. Thus, Arabic-speaking populations in Sweden cannot be included in studies measuring eHealth literacy, which does not support equal treatment in health care. Objective: The aim of this study was to translate and adapt the original English eHEALS version into Arabic and to evaluate its psychometric properties. Methods: The eHEALS was rigorously translated, adapted, and evaluated for content validity. We conducted prospective psychometric evaluation with natively Arabic-speaking participants living in Sweden. Construct validity, factor structure, internal consistency, and test-retest reliability were evaluated using Spearman correlation, principal component analysis, Cronbach α, and weighted quadratic Cohen κ, respectively. Results: The study population consisted of Arabic-speaking participants (n=298; age: mean 41.8 years, SD 10.5). Construct validity was supported with weak and moderate correlations. Principal component factor analysis revealed a one-factor structure. Internal consistency was high (Cronbach α=0.92); test-retest reliability was acceptable (weighted quadratic Cohen κ=0.76). Evaluation indicated that eHealth literacy threshold values should be dichotomized (limited and sufficient) rather than trichotomized (inadequate, problematic, and sufficient). Conclusions: The Arabic version of eHEALS, a unidimensional scale that is valid and reliable for measuring eHealth literacy among natively Arabic-speaking people in Sweden, was found to be acceptable and feasible in a general population. %M 33749614 %R 10.2196/24466 %U https://www.jmir.org/2021/3/e24466 %U https://doi.org/10.2196/24466 %U http://www.ncbi.nlm.nih.gov/pubmed/33749614 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e15032 %T An 11-Item Measure of User- and Human-Centered Design for Personal Health Tools (UCD-11): Development and Validation %A Witteman,Holly O %A Vaisson,Gratianne %A Provencher,Thierry %A Chipenda Dansokho,Selma %A Colquhoun,Heather %A Dugas,Michele %A Fagerlin,Angela %A Giguere,Anik MC %A Haslett,Lynne %A Hoffman,Aubri %A Ivers,Noah M %A Légaré,France %A Trottier,Marie-Eve %A Stacey,Dawn %A Volk,Robert J %A Renaud,Jean-Sébastien %+ Université Laval, 1050, avenue de la Médecine, Quebec City, QC, Canada, 1 418 656 2131, holly.witteman@fmed.ulaval.ca %K patient-centered care %K patient participation %K health services research %K validation studies as topic %K surveys and questionnaires %K humans %K user-centred design, human-centred design %K user-centered design %K human-centered design %K co-design %K instrument %K scale %K index %K patient and public involvement %D 2021 %7 16.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Researchers developing personal health tools employ a range of approaches to involve prospective users in design and development. Objective: The aim of this paper was to develop a validated measure of the human- or user-centeredness of design and development processes for personal health tools. Methods: We conducted a psychometric analysis of data from a previous systematic review of the design and development processes of 348 personal health tools. Using a conceptual framework of user-centered design, our team of patients, caregivers, health professionals, tool developers, and researchers analyzed how specific practices in tool design and development might be combined and used as a measure. We prioritized variables according to their importance within the conceptual framework and validated the resultant measure using principal component analysis with Varimax rotation, classical item analysis, and confirmatory factor analysis. Results: We retained 11 items in a 3-factor structure explaining 68% of the variance in the data. The Cronbach alpha was .72. Confirmatory factor analysis supported our hypothesis of a latent construct of user-centeredness. Items were whether or not: (1) patient, family, caregiver, or surrogate users were involved in the steps that help tool developers understand users or (2) develop a prototype, (3) asked their opinions, (4) observed using the tool or (5) involved in steps intended to evaluate the tool, (6) the process had 3 or more iterative cycles, (7) changes between cycles were explicitly reported, (8) health professionals were asked their opinion and (9) consulted before the first prototype was developed or (10) between initial and final prototypes, and (11) a panel of other experts was involved. Conclusions: The User-Centered Design 11-item measure (UCD-11) may be used to quantitatively document the user/human-centeredness of design and development processes of patient-centered tools. By building an evidence base about such processes, we can help ensure that tools are adapted to people who will use them, rather than requiring people to adapt to tools. %M 33724194 %R 10.2196/15032 %U https://www.jmir.org/2021/3/e15032 %U https://doi.org/10.2196/15032 %U http://www.ncbi.nlm.nih.gov/pubmed/33724194 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e17856 %T Testing the Digital Health Literacy Instrument for Adolescents: Cognitive Interviews %A Park,Eunhee %A Kwon,Misol %+ School of Nursing, University at Buffalo, 201 E Wende Hall, 3435 Main St, Buffalo, NY, 14214-3079, United States, 1 716 829 3701, eunheepa@buffalo.edu %K adolescent %K digital health literacy %K ehealth literacy %K cognitive interview %D 2021 %7 15.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the increasing number of youth seeking health information on the internet, few studies have been conducted to measure digital health literacy in this population. The digital health literacy instrument (DHLI) is defined as a scale that measures the ability to operate digital devices and read and write in web-based modes, and it assesses seven subconstructs: operational skills, navigation skills, information searching, evaluating reliability, determining relevance, adding self-generated content to a web-based app, and protecting privacy. Currently, there is no validation process of this instrument among adolescents. Objective: This study aims to explore the usability and content validity of DHLI. Methods: Upon the approval of institutional review board protocol, cognitive interviews were conducted. A total of 34 adolescents aged 10-18 years (n=17, 50% female) participated in individual cognitive interviews. Two rounds of concurrent cognitive interviews were conducted to assess the content validity of DHLI using the thinking aloud method and probing questions. Results: Clarity related to unclear wording, undefined technical terms, vague terms, and difficult vocabularies was a major issue identified. Problems related to potentially inappropriate assumptions were also identified. In addition, concerns related to recall bias and socially sensitive phenomena were raised. No issues regarding response options or instrument instructions were noted. Conclusions: The initial round of interviews provided a potential resolution to the problems identified with comprehension and communication, whereas the second round prompted improvement in content validity. Dual rounds of cognitive interviews provided substantial insights into survey interpretation when introduced to US adolescents. This study examined the validity of the DHLI and suggests revision points for assessing adolescent digital health literacy. %M 33720031 %R 10.2196/17856 %U https://www.jmir.org/2021/3/e17856 %U https://doi.org/10.2196/17856 %U http://www.ncbi.nlm.nih.gov/pubmed/33720031 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 3 %P e18269 %T Comparative Analysis of Paper-Based and Web-Based Versions of the National Comprehensive Cancer Network-Functional Assessment of Cancer Therapy-Breast Cancer Symptom Index (NFBSI-16) Questionnaire in Breast Cancer Patients: Randomized Crossover Study %A Ma,Jinfei %A Zou,Zihao %A Pazo,Emmanuel Eric %A Moutari,Salissou %A Liu,Ye %A Jin,Feng %+ Department of Breast Surgery, The First Affiliated Hospital of China Medical University, No 155 Nanjing Road, Heping District, Shenyang, 110001, China, 86 18040031101, jinfeng@cmu.edu.cn %K breast cancer %K NFBSI-16 %K patient-reported outcome %K reproducibility %K test-retest reliability %K web-based questionnaire %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Breast cancer remains the most common neoplasm diagnosed among women in China and globally. Health-related questionnaire assessments in research and clinical oncology settings have gained prominence. The National Comprehensive Cancer Network–Functional Assessment of Cancer Therapy–Breast Cancer Symptom Index (NFBSI-16) is a rapid and powerful tool to help evaluate disease- or treatment-related symptoms, both physical and emotional, in patients with breast cancer for clinical and research purposes. Prevalence of individual smartphones provides a potential web-based approach to administrating the questionnaire; however, the reliability of the NFBSI-16 in electronic format has not been assessed. Objective: This study aimed to assess the reliability of a web-based NFBSI-16 questionnaire in breast cancer patients undergoing systematic treatment with a prospective open-label randomized crossover study design. Methods: We recruited random patients with breast cancer under systematic treatment from the central hospital registry to complete both paper- and web-based versions of the questionnaires. Both versions of the questionnaires were self-assessed. Patients were randomly assigned to group A (paper-based first and web-based second) or group B (web-based first and paper-based second). A total of 354 patients were included in the analysis (group A: n=177, group B: n=177). Descriptive sociodemographic characteristics, reliability and agreement rates for single items, subscales, and total score were analyzed using the Wilcoxon test. The Lin concordance correlation coefficient (CCC) and Spearman and Kendall τ rank correlations were used to assess test-retest reliability. Results: Test-retest reliability measured with CCCs was 0.94 for the total NFBSI-16 score. Significant correlations (Spearman ρ) were documented for all 4 subscales—Disease-Related Symptoms Subscale–Physical (ρ=0.93), Disease-Related Symptoms Subscale–Emotional (ρ=0.85), Treatment Side Effects Subscale (ρ=0.95), and Function and Well-Being Subscale (ρ=0.91)—and total NFBSI-16 score (ρ=0.94). Mean differences of the test and retest were all close to zero (≤0.06). The parallel test-retest reliability of subscales with the Wilcoxon test comparing individual items found GP3 (item 5) to be significantly different (P=.02). A majority of the participants in this study (255/354, 72.0%) preferred the web-based over the paper-based version. Conclusions: The web-based version of the NFBSI-16 questionnaire is an excellent tool for monitoring individual breast cancer patients under treatment, with the majority of participants preferring it over the paper-based version. %M 33650978 %R 10.2196/18269 %U https://medinform.jmir.org/2021/3/e18269 %U https://doi.org/10.2196/18269 %U http://www.ncbi.nlm.nih.gov/pubmed/33650978 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e13591 %T Web-Based Dietary Intake Estimation to Assess the Reproducibility and Relative Validity of the EatWellQ8 Food Frequency Questionnaire: Validation Study %A Alawadhi,Balqees %A Fallaize,Rosalind %A Franco,Rodrigo Zenun %A Hwang,Faustina %A Lovegrove,Julie %+ Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, RG6 6AP, United Kingdom, 44 0118 378 6418, j.a.lovegrove@reading.ac.uk %K web-based %K Kuwait %K weighed food record %K app %K food frequency questionnaire %K validation %K dietary assessment %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The web-based EatWellQ8 food frequency questionnaire (FFQ) was developed as a dietary assessment tool for healthy adults in Kuwait. Validation against reliable instruments and assessment of its reproducibility are required to ensure the accuracy of the EatWellQ8 FFQ in computing nutrient intake. Objective: This study aims to assess the reproducibility and relative validity of the EatWellQ8 146-item FFQ, which included images of food portion sizes based on The Composition of Foods by McCance and Widdowson and food composition tables from Kuwait and the Kingdom of Bahrain, against a paper-based FFQ (PFFQ) and a 4-day weighed food record (WFR). Methods: Reproducibility of the EatWellQ8 FFQ was assessed using a test-retest methodology. Participants were required to complete the FFQ at 2 time points, 4 weeks apart. To assess the relative validity of the EatWellQ8 FFQ, a subset of the participants were asked to complete a PFFQ or a 4-day WFR 1 week after the administration of the EatWellQ8 FFQ. The level of agreement between nutrient and food group intakes was estimated by repeated EatWellQ8 FFQ administration. The EatWellQ8 FFQ, PFFQ, and 4-day WFR were also evaluated using the Bland-Altman methodology and classified into quartiles of daily intake. Crude unadjusted correlation coefficients were also calculated for nutrients and food groups. Results: A total of 99 Kuwaiti participants (64/99, 65% female and 35/99, 35% male) completed the study—53 participated in the reproducibility study and the 4-day WFR validity study (mean age 37.1 years, SD 9.9) and 46 participated in the PFFQ validity study (mean age 36.2 years, SD 8.3). Crude unadjusted correlations for repeated EatWellQ8 FFQs ranged from 0.37 to 0.93 (mean r=0.67, SD 0.14; 95% CI 0.11-0.95) for nutrients and food groups (P=.01). Mean cross-classification into exact agreement plus adjacent was 88% for nutrient intakes and 86% for food groups, and Bland-Altman plots showed good agreement for energy-adjusted macronutrient intakes. The association between the EatWellQ8 FFQ and PFFQ varied, with crude unadjusted correlations ranging from 0.42 to 0.73 (mean r=0.46, SD 0.12; 95% CI −0.02 to 0.84; P=.046). Mean cross-classification into exact agreement plus adjacent was 84% for nutrient intake and 74% for food groups. Bland-Altman plots showed moderate agreement for both energy and energy-controlled nutrient intakes. Crude unadjusted correlations for the EatWellQ8 FFQ and the 4-day WFR ranged from 0.40 to 0.88 (mean r=0.58, SD 0.13; 95% CI 0.01-0.58; P=.01). Mean cross-classification into exact agreement plus adjacent was 85% for nutrient intake and 83% for food groups. Bland-Altman plots showed moderate agreement for energy-adjusted macronutrient intakes. Conclusions: The results indicate that the web-based EatWellQ8 FFQ is reproducible for assessing nutrient and food group intake and has moderate agreement compared with a PFFQ and a 4-day WFR for measuring energy and nutrient intakes. %M 33650974 %R 10.2196/13591 %U https://formative.jmir.org/2021/3/e13591 %U https://doi.org/10.2196/13591 %U http://www.ncbi.nlm.nih.gov/pubmed/33650974 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 1 %P e25991 %T Accuracy and Monitoring of Pediatric Early Warning Score (PEWS) Scores Prior to Emergent Pediatric Intensive Care Unit (ICU) Transfer: Retrospective Analysis %A Kowalski,Rebecca L %A Lee,Laura %A Spaeder,Michael C %A Moorman,J Randall %A Keim-Malpass,Jessica %+ School of Nursing, University of Virginia, PO Box 800782, Charlottesville, VA, 22908, United States, 1 2433961, jesskeim@gmail.com %K pediatric intensive care unit %K cardiorespiratory monitoring %K hospital transfer %K clinical deterioration %K monitoring %K ICU %K intensive care unit %K pediatric %K retrospective %K detection %K deterioration %K child %K accuracy %K cohort %D 2021 %7 22.2.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Current approaches to early detection of clinical deterioration in children have relied on intermittent track-and-trigger warning scores such as the Pediatric Early Warning Score (PEWS) that rely on periodic assessment and vital sign entry. There are limited data on the utility of these scores prior to events of decompensation leading to pediatric intensive care unit (PICU) transfer. Objective: The purpose of our study was to determine the accuracy of recorded PEWS scores, assess clinical reasons for transfer, and describe the monitoring practices prior to PICU transfer involving acute decompensation. Methods: We conducted a retrospective cohort study of patients ≤21 years of age transferred emergently from the acute care pediatric floor to the PICU due to clinical deterioration over an 8-year period. Clinical charts were abstracted to (1) determine the clinical reason for transfer, (2) quantify the frequency of physiological monitoring prior to transfer, and (3) assess the timing and accuracy of the PEWS scores 24 hours prior to transfer. Results: During the 8-year period, 72 children and adolescents had an emergent PICU transfer due to clinical deterioration, most often due to acute respiratory distress. Only 35% (25/72) of the sample was on continuous telemetry or pulse oximetry monitoring prior to the transfer event, and 47% (34/72) had at least one incorrectly documented PEWS score in the 24 hours prior to the event, with a score underreporting the actual severity of illness. Conclusions: This analysis provides support for the routine assessment of clinical deterioration and advocates for more research focused on the use and utility of continuous cardiorespiratory monitoring for patients at risk for emergent transfer. %M 33547772 %R 10.2196/25991 %U https://pediatrics.jmir.org/2021/1/e25991 %U https://doi.org/10.2196/25991 %U http://www.ncbi.nlm.nih.gov/pubmed/33547772 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e18750 %T Using the Patient Portal Sexual Health Instrument in Surveys and Patient Questionnaires Among Sexual Minority Men in the United States: Cross-sectional Psychometric Validation Study %A Jackman,Kevon-Mark P %A Kane,Jeremy %A Kharrazi,Hadi %A Johnson,Renee M %A Latkin,Carl %+ Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Hampton House 8th Floor, Baltimore, MD, 21205, United States, 1 410 955 3910, kjackma2@jhmi.edu %K health information technology %K sexual behavior %K HIV %K STI %K patient portals %D 2021 %7 10.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient portal modules, including electronic personal health records, health education, and prescription refill ordering, may be leveraged to address the sexually transmitted infection (STI) burden, including HIV, among gay, bisexual, and other sexual minority men (SMM). Theoretical frameworks in the implementation sciences highlight examining constructs of innovation attributes and performance expectations as key determinants of behavioral intentions and the use of new web-based health technologies. However, behavioral intentions to use patient portals for HIV and other STI prevention and care among SMM is understudied. Objective: The aim of this study is to develop a brief instrument for measuring attitudes focused on using patient portals for STI prevention and care among a nationwide sample of SMM. Methods: A total of 12 items of the American Men’s Internet Survey-Patient Portal Sexual Health Instrument (AMIS-PPSHI) were adapted from a previous study. Psychometric analyses of the AMIS-PPSHI items were conducted among a randomized subset of 2018 AMIS participants reporting web-based access to their health records (N=1375). Parallel analysis and inspection of eigenvalues in a principal component analysis (PCA) informed factor retention in exploratory factor analysis (EFA). After EFA, Cronbach α was used to examine the internal consistency of the scale and its subscales. Confirmatory factor analysis (CFA) was used to assess the goodness of fit of the final factor structure. We calculated the total AMIS-PPSHI scale scores for comparisons within group categories, including age, STI diagnosis history, recency of testing, serious mental illness, and anticipated health care stigma. Results: The AMIS-PPSHI scale resulting from EFA consisted of 12 items and had good internal consistency (α=.84). The EFA suggested 3 subscales: sexual health engagement and awareness (α=.87), enhancing dyadic communication (α=.87), and managing sexual health care (α=.79). CFA demonstrated good fit in the 3-factor PPSHI structure: root mean square error of approximation=0.061, comparative fit index=0.964, Tucker-Lewis index=0.953, and standardized root mean square residual=0.041. The most notable differences were lower scores on the enhanced dyadic communication subscale among people living with HIV. Conclusions: PPSHI is a brief instrument with strong psychometric properties that may be adapted for use in large surveys and patient questionnaires in other settings. Scores demonstrate that patient portals are favorable web-based solutions to deliver health services focused on STI prevention and care among SMM in the United States. More attention is needed to address the privacy implications of interpersonal use of patient portals outside of traditional health settings among persons with HIV. %M 33565987 %R 10.2196/18750 %U http://www.jmir.org/2021/2/e18750/ %U https://doi.org/10.2196/18750 %U http://www.ncbi.nlm.nih.gov/pubmed/33565987 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e24457 %T Malay Version of the mHealth App Usability Questionnaire (M-MAUQ): Translation, Adaptation, and Validation Study %A Mustafa,Norashikin %A Safii,Nik Shanita %A Jaffar,Aida %A Sani,Nor Samsiah %A Mohamad,Mohd Izham %A Abd Rahman,Abdul Hadi %A Mohd Sidik,Sherina %+ Dietetics Program and Center for Community Health Study, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Jalan Raja Muda Ab Aziz, Kuala Lumpur, 50300, Malaysia, 60 039289 7662, nikshanita@ukm.edu.my %K mHealth app %K questionnaire validation %K questionnaire translation %K Malay MAUQ %K usability %K mHealth %K education %K usability %K Malay language %K Malay %K questionnaire %K mobile phone %D 2021 %7 4.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps play an important role in delivering education, providing advice on treatment, and monitoring patients’ health. Good usability of mHealth apps is essential to achieve the objectives of mHealth apps efficiently. To date, there are questionnaires available to assess the general system usability but not explicitly tailored to precisely assess the usability of mHealth apps. Hence, the mHealth App Usability Questionnaire (MAUQ) was developed with 4 versions according to the type of app (interactive or standalone) and according to the target user (patient or provider). Standalone MAUQ for patients comprises 3 subscales, which are ease of use, interface and satisfaction, and usefulness. Objective: This study aimed to translate and validate the English version of MAUQ (standalone for patients) into a Malay version of MAUQ (M-MAUQ) for mHealth app research and usage in future in Malaysia. Methods: Forward and backward translation and harmonization of M-MAUQ were conducted by Malay native speakers who also spoke English as their second language. The process began with a forward translation by 2 independent translators followed by harmonization to produce an initial translated version of M-MAUQ. Next, the forward translation was continued by another 2 translators who had never seen the original MAUQ. Lastly, harmonization was conducted among the committee members to resolve any ambiguity and inconsistency in the words and sentences of the items derived with the prefinal adapted questionnaire. Subsequently, content and face validations were performed with 10 experts and 10 target users, respectively. Modified kappa statistic was used to determine the interrater agreement among the raters. The reliability of the M-MAUQ was assessed by 51 healthy young adult mobile phone users. Participants needed to install the MyFitnessPal app and use it for 2 days for familiarization before completing the designated task and answer the M-MAUQ. The MyFitnessPal app was selected because it is one among the most popular installed mHealth apps globally available for iPhone and Android users and represents a standalone mHealth app. Results: The content validity index for the relevancy and clarity of M-MAUQ were determined to be 0.983 and 0.944, respectively, which indicated good relevancy and clarity. The face validity index for understandability was 0.961, which indicated that users understood the M-MAUQ. The kappa statistic for every item in M-MAUQ indicated excellent agreement between the raters (κ ranging from 0.76 to 1.09). The Cronbach α for 18 items was .946, which also indicated good reliability in assessing the usability of the mHealth app. Conclusions: The M-MAUQ fulfilled the validation criteria as it revealed good reliability and validity similar to the original version. M-MAUQ can be used to assess the usability of mHealth apps in Malay in the future. %M 33538704 %R 10.2196/24457 %U http://mhealth.jmir.org/2021/2/e24457/ %U https://doi.org/10.2196/24457 %U http://www.ncbi.nlm.nih.gov/pubmed/33538704 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 1 %P e20172 %T Interformat Reliability of Web-Based Parent-Rated Questionnaires for Assessing Neurodevelopmental Disorders Among Preschoolers: Cross-sectional Community Study %A Tanaka,Masanori %A Saito,Manabu %A Takahashi,Michio %A Adachi,Masaki %A Nakamura,Kazuhiko %+ Faculty of Business Administration, Hokkai-Gakuen University, 4-1-40, Asahi-machi, Toyohira, Sapporo, Hokkaido, 062-8605, Japan, 81 11 841 1161 ext 2302, m-tnk@hgu.jp %K neurodevelopmental disorders %K web-based questionnaire %K preschoolers %K parents %K interformat reliability %D 2021 %7 4.2.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Early detection and intervention for neurodevelopmental disorders are effective. Several types of paper questionnaires have been developed to assess these conditions in early childhood; however, the psychometric equivalence between the web-based and the paper versions of these questionnaires is unknown. Objective: This study examined the interformat reliability of the web-based parent-rated version of the Autism Spectrum Screening Questionnaire (ASSQ), Attention-Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS), Developmental Coordination Disorder Questionnaire 2007 (DCDQ), and Strengths and Difficulties Questionnaire (SDQ) among Japanese preschoolers in a community developmental health check-up setting. Methods: A set of paper-based questionnaires were distributed for voluntary completion to parents of children aged 5 years. The package of the paper format questionnaires included the ASSQ, ADHD-RS, DCDQ, parent-reported SDQ (P-SDQ), and several additional demographic questions. Responses were received from 508 parents of children who agreed to participate in the study. After 3 months, 300 parents, who were among the initial responders, were randomly selected and asked to complete the web-based versions of these questionnaires. A total of 140 parents replied to the web-based format and were included as a final sample in this study. Results: We obtained the McDonald ω coefficients for both the web-based and paper formats of the ASSQ (web-based: ω=.90; paper: ω=.86), ADHD-RS total and subscales (web-based: ω=.88-.94; paper: ω=.87-.93), DCDQ total and subscales (web-based: ω=.82-.94; paper: ω=.74-.92), and P-SDQ total and subscales (web-based: ω=.55-.81; paper: ω=.52-.80). The intraclass correlation coefficients between the web-based and paper formats were all significant at the 99.9% confidence level: ASSQ (r=0.66, P<.001); ADHD-RS total and subscales (r=0.66-0.74, P<.001); DCDQ total and subscales (r=0.66-0.71, P<.001); P-SDQ Total Difficulties and subscales (r=0.55-0.73, P<.001). There were no significant differences between the web-based and paper formats for total mean score of the ASSQ (P=.76), total (P=.12) and subscale (P=.11-.47) mean scores of DCDQ, and the P-SDQ Total Difficulties mean score (P=.20) and mean subscale scores (P=.28-.79). Although significant differences were found between the web-based and paper formats for mean ADHD-RS scores (total: t132=2.83, P=.005; Inattention subscale: t133=2.15, P=.03; Hyperactivity/Impulsivity subscale: t133=3.21, P=.002), the effect sizes were small (Cohen d=0.18-0.22). Conclusions: These results suggest that the web-based versions of the ASSQ, ADHD-RS, DCDQ, and P-SDQ were equivalent, with the same level of internal consistency and intrarater reliability as the paper versions, indicating the applicability of the web-based versions of these questionnaires for assessing neurodevelopmental disorders. %M 33455899 %R 10.2196/20172 %U https://pediatrics.jmir.org/2021/1/e20172 %U https://doi.org/10.2196/20172 %U http://www.ncbi.nlm.nih.gov/pubmed/33455899 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e21220 %T COVID-19–Related Knowledge and Practices Among Health Care Workers in Saudi Arabia: Cross-sectional Questionnaire Study %A Shaikhain,Talal Ahmad %A Al-Husayni,Faisal Abdulmohsen %A Alhejaili,Essam Awadh %A Al-Harbi,Maha Nawaf %A Bogari,Anas Abdullah %A Baghlaf,Bayan Abdulaziz %A Alzahrani,Mohammed Saeed %+ Department of Infectious Disease, National Guard Hospital, Old Makkah Road, Jeddah, 22384, Saudi Arabia, 966 556655712, mzahrani@gmail.com %K COVID-19 %K health care workers %K infection control %K attitude %K knowledge %K Saudi Arabia %D 2021 %7 25.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Health care workers are at the front line against COVID-19. The risk of transmission decreases with adequate knowledge of infection prevention methods. However, health care workers reportedly lack a proper attitude and knowledge of different viral outbreaks. Objective: This study aimed to assess the knowledge and attitude of health care workers in Saudi Arabia toward COVID-19. Assessment of these parameters may help researchers focus on areas that require improvement. Methods: A cross-sectional questionnaire study was conducted among 563 participants recruited from multiple cities in Saudi Arabia. An online questionnaire was shared via social media applications, which contained questions to health care workers about general information regarding COVID-19 and standard practices. Results: The mean age of the study population was 30.7 (SD 8) years. Approximately 8.3% (47/563) of the health care workers were isolated as suspected cases of COVID-19, and 0.9% (n=5) were found positive. The majority agreed that social distancing, face masks, and hand washing are effective methods for preventing disease transmission. However, only 63.7% (n=359) knew the correct duration of hand washing. Almost 70% (n=394) strictly adhered to hand hygiene practices, but less than half complied with the practice of wearing a face mask. Significant differences in health care workers' attitudes were observed on the basis of their city of residence, their adherence to COVID-19 practices, and their compliance with the use of a face mask. Among the health care workers, 27.2% (n=153) declared that they will isolate themselves at home and take influenza medication if they experience COVID-19 symptoms. Conclusions: The majority of health care workers in Saudi Arabia presented acceptable levels of general knowledge on COVID-19, but they lack awareness in some crucial details that may prevent disease spread. Intense courses and competency assessments are highly recommended. Prevention of disease progression is the only option for the time being. %M 33460390 %R 10.2196/21220 %U http://formative.jmir.org/2021/1/e21220/ %U https://doi.org/10.2196/21220 %U http://www.ncbi.nlm.nih.gov/pubmed/33460390 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e25018 %T The Digital Marshmallow Test (DMT) Diagnostic and Monitoring Mobile Health App for Impulsive Behavior: Development and Validation Study %A Sobolev,Michael %A Vitale,Rachel %A Wen,Hongyi %A Kizer,James %A Leeman,Robert %A Pollak,J P %A Baumel,Amit %A Vadhan,Nehal P %A Estrin,Deborah %A Muench,Frederick %+ The Partnership to End Addiction, 485 Lexington Avenue, 3rd Floor, New York, NY, 10017, United States, 1 9175320623, fmuench@toendaddiction.org %K impulse control %K impulsivity %K self-regulation %K self-control %K mobile health %K mHealth %K ecological momentary assessment %K active task %K ResearchKit %D 2021 %7 22.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The classic Marshmallow Test, where children were offered a choice between one small but immediate reward (eg, one marshmallow) or a larger reward (eg, two marshmallows) if they waited for a period of time, instigated a wealth of research on the relationships among impulsive responding, self-regulation, and clinical and life outcomes. Impulsivity is a hallmark feature of self-regulation failures that lead to poor health decisions and outcomes, making understanding and treating impulsivity one of the most important constructs to tackle in building a culture of health. Despite a large literature base, impulsivity measurement remains difficult due to the multidimensional nature of the construct and limited methods of assessment in daily life. Mobile devices and the rise of mobile health (mHealth) have changed our ability to assess and intervene with individuals remotely, providing an avenue for ambulatory diagnostic testing and interventions. Longitudinal studies with mobile devices can further help to understand impulsive behaviors and variation in state impulsivity in daily life. Objective: The aim of this study was to develop and validate an impulsivity mHealth diagnostics and monitoring app called Digital Marshmallow Test (DMT) using both the Apple and Android platforms for widespread dissemination to researchers, clinicians, and the general public. Methods: The DMT app was developed using Apple’s ResearchKit (iOS) and Android’s ResearchStack open source frameworks for developing health research study apps. The DMT app consists of three main modules: self-report, ecological momentary assessment, and active behavioral and cognitive tasks. We conducted a study with a 21-day assessment period (N=116 participants) to validate the novel measures of the DMT app. Results: We used a semantic differential scale to develop self-report trait and momentary state measures of impulsivity as part of the DMT app. We identified three state factors (inefficient, thrill seeking, and intentional) that correlated highly with established measures of impulsivity. We further leveraged momentary semantic differential questions to examine intraindividual variability, the effect of daily life, and the contextual effect of mood on state impulsivity and daily impulsive behaviors. Our results indicated validation of the self-report sematic differential and related results, and of the mobile behavioral tasks, including the Balloon Analogue Risk Task and Go-No-Go task, with relatively low validity of the mobile Delay Discounting task. We discuss the design implications of these results to mHealth research. Conclusions: This study demonstrates the potential for assessing different facets of trait and state impulsivity during everyday life and in clinical settings using the DMT mobile app. The DMT app can be further used to enhance our understanding of the individual facets that underlie impulsive behaviors, as well as providing a promising avenue for digital interventions. Trial Registration: ClinicalTrials.gov NCT03006653; https://www.clinicaltrials.gov/ct2/show/NCT03006653 %M 33480854 %R 10.2196/25018 %U http://mhealth.jmir.org/2021/1/e25018/ %U https://doi.org/10.2196/25018 %U http://www.ncbi.nlm.nih.gov/pubmed/33480854 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e18214 %T The Acceptability and Efficacy of Electronic Data Collection in a Hospital Neurodevelopmental Clinic: Pilot Questionnaire Study %A Patel,Shrujna %A Boulton,Kelsie Ann %A Redoblado-Hodge,Marie Antoinette %A Papanicolaou,Angela %A Barnett,Diana %A Bennett,Beverley %A Drevensek,Suzi %A Cramsie,Jane %A Ganesalingam,Kalaichelvi %A Ong,Natalie %A Rozsa,Magdalen %A Sutherland,Rebecca %A Williamsz,Marcia %A Pokorski,Izabella %A Song,Yun Ju Christine %A Silove,Natalie %A Guastella,Adam John %+ Autism Clinic for Translational Research, Brain and Mind Centre, Children’s Hospital Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, 100 Mallett Street, Camperdown, 2050, Australia, 61 2 9351 0539, adam.guastella@sydney.edu.au %K electronic data collection %K family-centered care %K hospital-based data collection %D 2021 %7 19.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a growing need for cost-efficient and patient-centered approaches to support families in hospital- and community-based neurodevelopmental services. For such purposes, electronic data collection (EDC) may hold advantages over paper-based data collection. Such EDC approaches enable automated data collection for scoring and interpretation, saving time for clinicians and services and promoting more efficient service delivery. Objective: This pilot study evaluated the efficacy of EDC for the Child Development Unit, a hospital-based diagnostic assessment clinic in the Sydney Children’s Hospital Network. Caregiver response rates and preference for EDC or paper-based methods were evaluated as well as the moderating role of demographic characteristics such as age, level of education, and ethnic background. Methods: Families were sent either a paper-based questionnaire via post or an electronic mail link for completion before attending their first on-site clinic appointment for assessment. A total of 62 families were provided a paper version of the questionnaire, while 184 families were provided the online version of the same questionnaire. Results: Completion rates of the questionnaire before the first appointment were significantly higher for EDC (164/184, 89.1%) in comparison to paper-based methods (24/62, 39%; P<.001). Within the EDC group, a vast majority of respondents indicated a preference for completing the questionnaire online (151/173, 87.3%), compared to paper completion (22/173, 12.7%; P<.001). Of the caregiver demographic characteristics, only the respondent’s level of education was associated with modality preference, such that those with a higher level of education reported a greater preference for EDC (P=.04). Conclusions: These results show that EDC is feasible in hospital-based clinics and has the potential to offer substantial benefits in terms of centralized data collation, time and cost savings, efficiency of service, and resource allocation. The results of this study therefore support the continued use of electronic methods to improve family-centered care in clinical practices. %M 33464217 %R 10.2196/18214 %U http://formative.jmir.org/2021/1/e18214/ %U https://doi.org/10.2196/18214 %U http://www.ncbi.nlm.nih.gov/pubmed/33464217 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 1 %P e23090 %T Swedish Web Version of the Quality of Recovery Scale Adapted for Patients Undergoing Local Anesthesia and Peripheral Nerve Blockade (SwQoR-LA): Prospective Psychometric Evaluation Study %A Nilsson,Ulrica %A Dahlberg,Karuna %A Jaensson,Maria %+ Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, 14183, Sweden, 46 70 420 34 95, ulrica.nilsson@ki.se %K day surgery %K local anesthesia %K peripheral nerve blockade %K postoperative recovery %K psychometric evaluation %D 2021 %7 15.1.2021 %9 Original Paper %J JMIR Perioper Med %G English %X Background: The frequency and timing of assessing patient symptoms and discomfort during postoperative recovery are goals. Therefore, real-time recovery evaluation has been suggested to identify specific deficits in patient recovery. Objective: This study aimed to psychometrically evaluate the Swedish Web Version of the Quality of Recovery (SwQoR) Scale adapted for patients undergoing local and peripheral nerve block (SwQoR-LA). Methods: This was a secondary analysis of a psychometric evaluation of 107 patients aged ≥18 years undergoing day surgery under local or peripheral nerve block anesthesia at 4 different day surgery departments in Sweden. The SwQoR-LA, available through a mobile app called Recovery Assessment by Phone Points (RAPP), was completed daily on postoperative days 1-7. Results: Some evidence of construct validity was supported, and discriminant validity was found in 7 of 8 items related to general anesthesia. The internal consistency was acceptable (.87-.89), and the split-half reliability was 0.80-0.86. Cohen d effect size was 0.98, and the percentage of change from baseline was 43.4%. No floor nor ceiling effects were found. Conclusions: The SwQoR-LA is valid, reliable, responsive, and clinically feasible for digital real-time recovery assessment of patient recovery to identify specific deficits in patient recovery and detect those patients who might benefit from a timely intervention. Trial Registration: ClinicalTrials.gov NCT02492191; https://clinicaltrials.gov/ct2/show/NCT02492191 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2015-009901 %M 33448932 %R 10.2196/23090 %U http://periop.jmir.org/2021/1/e23090/ %U https://doi.org/10.2196/23090 %U http://www.ncbi.nlm.nih.gov/pubmed/33448932 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e25382 %T The Current State and Diagnostic Accuracy of Digital Mental Health Assessment Tools for Psychiatric Disorders: Protocol for a Systematic Review and Meta-analysis %A Martin-Key,Nayra A %A Schei,Thea S %A Barker,Eleanor J %A Spadaro,Benedetta %A Funnell,Erin %A Benacek,Jiri %A Tomasik,Jakub %A Bahn,Sabine %+ Department of Chemical Engineering and Biotechnology, Cambridge Centre for Neuropsychiatric Research, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223 334151, sb209@cam.ac.uk %K diagnostic accuracy %K digital mental health %K digital questionnaire %K meta-analysis %K psychiatry %K systematic review %D 2021 %7 8.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite the rapidly growing number of digital assessment tools for screening and diagnosing mental health disorders, little is known about their diagnostic accuracy. Objective: The purpose of this systematic review and meta-analysis is to establish the diagnostic accuracy of question- and answer-based digital assessment tools for diagnosing a range of highly prevalent psychiatric conditions in the adult population. Methods: The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) will be used. The focus of the systematic review is guided by the population, intervention, comparator, and outcome framework (PICO). We will conduct a comprehensive systematic literature search of MEDLINE, PsychINFO, Embase, Web of Science Core Collection, Cochrane Library, Applied Social Sciences Index and Abstracts (ASSIA), and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for appropriate articles published from January 1, 2005. Two authors will independently screen the titles and abstracts of identified references and select studies according to the eligibility criteria. Any inconsistencies will be discussed and resolved. The two authors will then extract data into a standardized form. Risk of bias will be assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool, and a descriptive analysis and meta-analysis will summarize the diagnostic accuracy of the identified digital assessment tools. Results: The systematic review and meta-analysis commenced in November 2020, with findings expected by May 2021. Conclusions: This systematic review and meta-analysis will summarize the diagnostic accuracy of question- and answer-based digital assessment tools. It will identify implications for clinical practice, areas for improvement, and directions for future research. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020214724; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020214724. International Registered Report Identifier (IRRID): DERR1-10.2196/25382 %M 33416508 %R 10.2196/25382 %U http://www.researchprotocols.org/2021/1/e25382/ %U https://doi.org/10.2196/25382 %U http://www.ncbi.nlm.nih.gov/pubmed/33416508 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e21895 %T The Digital Therapeutic Alliance and Human-Computer Interaction %A D'Alfonso,Simon %A Lederman,Reeva %A Bucci,Sandra %A Berry,Katherine %+ School of Computing and Information Systems, University of Melbourne, Doug McDonell Building, Parkville, 3010, Australia, 61 3 9035 5511, dalfonso@unimelb.edu.au %K therapeutic alliance %K digital mental health %K affective computing %K persuasive computing %K positive computing %K mobile phone %K mHealth %D 2020 %7 29.12.2020 %9 Viewpoint %J JMIR Ment Health %G English %X The therapeutic alliance (TA), the relationship that develops between a therapist and a client/patient, is a critical factor in the outcome of psychological therapy. As mental health care is increasingly adopting digital technologies and offering therapeutic interventions that may not involve human therapists, the notion of a TA in digital mental health care requires exploration. To date, there has been some incipient work on developing measures to assess the conceptualization of a digital TA for mental health apps. However, the few measures that have been proposed have more or less been derivatives of measures from psychology used to assess the TA in traditional face-to-face therapy. This conceptual paper explores one such instrument that has been proposed in the literature, the Mobile Agnew Relationship Measure, and examines it through a human-computer interaction (HCI) lens. Through this process, we show how theories from HCI can play a role in shaping or generating a more suitable, purpose-built measure of the digital therapeutic alliance (DTA), and we contribute suggestions on how HCI methods and knowledge can be used to foster the DTA in mental health apps. %M 33372897 %R 10.2196/21895 %U http://mental.jmir.org/2020/12/e21895/ %U https://doi.org/10.2196/21895 %U http://www.ncbi.nlm.nih.gov/pubmed/33372897 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e17332 %T Electronic Cognitive Screen Technology for Screening Older Adults With Dementia and Mild Cognitive Impairment in a Community Setting: Development and Validation Study %A Chan,Joyce Y C %A Wong,Adrian %A Yiu,Brian %A Mok,Hazel %A Lam,Patti %A Kwan,Pauline %A Chan,Amany %A Mok,Vincent C T %A Tsoi,Kelvin K F %A Kwok,Timothy C Y %+ Department of Medicine and Therapeutics, The Chinese University of Hong Kong, 9/F., Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, 30-32 Ngan Shing St, Shatin, N.T., Hong Kong, 852, Hong Kong, 852 3505 3145, tkwok@cuhk.edu.hk %K EC-Screen %K cognitive screening %K dementia %K mild cognitive impairment %D 2020 %7 18.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: A digital cognitive test can be a useful and quick tool for the screening of cognitive impairment. Previous studies have shown that the diagnostic performance of digital cognitive tests is comparable with that of conventional paper-and-pencil tests. However, the use of commercially available digital cognitive tests is not common in Hong Kong, which may be due to the high cost of the tests and the language barrier. Thus, we developed a brief and user-friendly digital cognitive test called the Electronic Cognitive Screen (EC-Screen) for the detection of mild cognitive impairment (MCI) and dementia of older adults. Objective: The aim of this study was to evaluate the performance of the EC-Screen for the detection of MCI and dementia in older adults. Methods: The EC-Screen is a brief digital cognitive test that has been adapted from the Rapid Cognitive Screen test. The EC-Screen uses a cloud-based platform and runs on a tablet. Participants with MCI, dementia, and cognitively healthy controls were recruited from research clinics and the community. The outcomes were the performance of the EC-Screen in distinguishing participants with MCI and dementia from controls, and in distinguishing participants with dementia from those with MCI and controls. The cohort was randomly split into derivation and validation cohorts based on the participants’ disease group. In the derivation cohort, the regression-derived score of the EC-Screen was calculated using binomial logistic regression. Two predictive models were produced. The first model was used to distinguish participants with MCI and dementia from controls, and the second model was used to distinguish participants with dementia from those with MCI and controls. Receiver operating characteristic curves were constructed and the areas under the curves (AUCs) were calculated. The performances of the two predictive models were tested using the validation cohorts. The relationship between the EC-Screen and paper-and-pencil Montreal Cognitive Assessment-Hong Kong version (HK-MoCA) was evaluated by the Pearson correlation coefficient. Results: A total of 126 controls, 54 participants with MCI, and 63 participants with dementia were included in the study. In differentiating participants with MCI and dementia from controls, the AUC of the EC-Screen in the derivation and validation cohorts was 0.87 and 0.84, respectively. The optimal sensitivity and specificity in the derivation cohorts were 0.81 and 0.80, respectively. In differentiating participants with dementia from those with MCI and controls, the AUC of the derivation and validation cohorts was 0.90 and 0.88, respectively. The optimal sensitivity and specificity in the derivation cohort were 0.83 and 0.83, respectively. There was a significant correlation between the EC-Screen and HK-MoCA (r=–0.67, P<.001). Conclusions: The EC-Screen is suggested to be a promising tool for the detection of MCI and dementia. This test can be self-administered or assisted by a nonprofessional staff or family member. Therefore, the EC-Screen can be a useful tool for case finding in primary health care and community settings. %M 33337341 %R 10.2196/17332 %U http://www.jmir.org/2020/12/e17332/ %U https://doi.org/10.2196/17332 %U http://www.ncbi.nlm.nih.gov/pubmed/33337341 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e19888 %T Evaluation of a Mobile App to Enhance Relational Awareness and Change During Cognitive Analytic Therapy: Mixed Methods Case Series %A Kellett,Stephen %A Easton,Katherine %A Cooper,Martin %A Millings,Abigail %A Simmonds-Buckley,Melanie %A Parry,Glenys %+ Sheffield Health & Social Care NHS Foundation Trust, University of Sheffield, 1 Vicar Lane, Sheffield, S1 2LT, United Kingdom, 44 114 222 6537, s.kellett@sheffield.ac.uk %K cognitive analytic therapy %K case series %K effectiveness %K outcome %K eHealth %K app %K awareness %K mHealth %K innovation %K therapy %D 2020 %7 18.12.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: There has been a lack of technological innovation regarding improving the delivery of integrative psychotherapies. This project sought to evaluate an app designed to replace previous paper-based methods supporting relational awareness and change during cognitive analytic therapy (CAT). Objective: We aimed to assess patients’ and therapists’ experience of using the technology (ie, the “CAT-App”) and to evaluate the relationship between app usage and clinical outcome. Methods: The design was a mixed methods case series. Patients completed the Clinical Outcomes in Routine Evaluation-Outcome Measure pre- and post-CAT. Mood data plus the frequency and effectiveness of relational awareness and change were collected via the app. Therapists and patients were interviewed about their experiences using the app. Results: Ten patients (treated by 3 therapists) were enrolled; seven completed treatment and 4 had a reliable improvement in their mental health. App usage and mood change did not differ according to clinical outcome, but there was a statistically significant difference in app usage between completers and dropouts. The qualitative themes described by the therapists were (1) the challenge of incorporating the technology into their clinical practice and (2) the barriers and benefits of the technology. Clients’ themes were (1) data protection, (2) motivation and engagement, and (3) restrictions versus flexibility. Conclusions: The CAT-App is capable of supporting relational awareness and change and is an upgrade on older, paper-based formats. Further clinical evaluation is required. %M 33337342 %R 10.2196/19888 %U http://mental.jmir.org/2020/12/e19888/ %U https://doi.org/10.2196/19888 %U http://www.ncbi.nlm.nih.gov/pubmed/33337342 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 4 %P e21161 %T Spanish Version of the System Usability Scale for the Assessment of Electronic Tools: Development and Validation %A Sevilla-Gonzalez,Magdalena Del Rocio %A Moreno Loaeza,Lizbeth %A Lazaro-Carrera,Laura Sofia %A Bourguet Ramirez,Brigette %A Vázquez Rodríguez,Anabel %A Peralta-Pedrero,María Luisa %A Almeda-Valdes,Paloma %+ Unidad de Investigación en Enfermedades Metabólicas, Instituto Nacional de Nutrición Salvador Zubirán and Instituto Tecnológico y de Estudios Superiores de Monterrey Tec Salud, Vasco de Quiroga #15, Tlalpan, Ciudad de México, 14080, Mexico, 52 54870900 ext 6322, palomaalmeda@yahoo.com %K mHealth %K usability %K validation %K System Usability Scale %K Spanish %D 2020 %7 16.12.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The System Usability Scale (SUS) is a common metric used to assess the usability of a system, and it was initially developed in English. The implementation of electronic systems for clinical counseling (eHealth and mobile health) is increasing worldwide. Therefore, tools are needed to evaluate these applications in the languages and regional contexts in which the electronic tools are developed. Objective: This study aims to translate, culturally adapt, and validate the original English version of the SUS into a Spanish version. Methods: The translation process included forward and backward translation. Forward translations were made by 2 native Spanish speakers who spoke English as their second language, and a backward translation was made by a native English speaker. The Spanish SUS questionnaire was validated by 10 experts in mobile app development. The face validity of the questionnaire was tested with 10 mobile phone users, and the reliability testing was conducted among 88 electronic application users. Results: The content validity index of the new Spanish SUS was good, as indicated by a rating of 0.92 for the relevance of the items. The questionnaire was easy to understand, based on a face validity index of 0.94. The Cronbach α was .812 (95% CI 0.748-0.866; P<.001). Conclusions: The new Spanish SUS questionnaire is a valid and reliable tool to assess the usability of electronic tools among Spanish-speaking users. %M 33325828 %R 10.2196/21161 %U http://humanfactors.jmir.org/2020/4/e21161/ %U https://doi.org/10.2196/21161 %U http://www.ncbi.nlm.nih.gov/pubmed/33325828 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e18613 %T Psychometric Validation and Cultural Adaptation of the Simplified Chinese eHealth Literacy Scale: Cross-Sectional Study %A Xu,Richard Huan %A Zhou,Lingming %A Lu,Sabrina Yujun %A Wong,Eliza Laiyi %A Chang,Jinghui %A Wang,Dong %+ School of Health management, Southern Medical University, No. 1023 Shatai nan Road, Guangzhou, China, 86 61648573, dongw96@smu.edu.cn %K electronic health literacy %K eHEALS %K psychometric property %K classical test theory %K item response theory %K China %D 2020 %7 7.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The rapid proliferation of web-based information on health and health care has profoundly changed individuals’ health-seeking behaviors, with individuals choosing the internet as their first source of information on their health conditions before seeking professional advice. However, barriers to the evaluation of people’s eHealth literacy present some difficulties for decision makers with respect to encouraging and empowering patients to use web-based resources. Objective: This study aims to examine the psychometric properties of a simplified Chinese version of the eHealth Literacy Scale (SC-eHEALS). Methods: Data used for analysis were obtained from a cross-sectional multicenter survey. Confirmatory factor analysis (CFA) was used to examine the structure of the SC-eHEALS. Correlations between the SC-eHEALS and ICEpop capability measure for adults (ICECAP-A) items and overall health status were estimated to assess the convergent validity. Internal consistency reliability was confirmed using Cronbach alpha (α), McDonald omega (ω), and split-half reliability (λ). A general partial credit model was used to perform the item response theory (IRT) analysis. Item difficulty, discrimination, and fit were reported. Item-category characteristic curves (ICCs) and item and test information curves were used to graphically assess the validity and reliability based on the IRT analysis. Differential item functioning (DIF) was used to check for possible item bias on gender and age. Results: A total of 574 respondents from 5 cities in China completed the SC-eHEALS. CFA confirmed that the one-factor model was acceptable. The internal consistency reliability was good, with α=0.96, ω=0.92, and λ=0.96. The item-total correlation coefficients ranged between 0.86 and 0.91. Items 8 and 4 showed the lowest and highest mean scores, respectively. The correlation coefficients between the SC-eHEALS and ICECAP-A items and overall health status were significant, but the strength was mild. The discrimination of SC-eHEALS items ranged between 2.63 and 5.42. ICCs indicated that the order of categories’ thresholds for all items was as expected. In total, 70% of the information provided by SC-eHEALS was below the average level of the latent trait. DIF was found for item 6 on age. Conclusions: The SC-eHEALS has been demonstrated to have good psychometric properties and can therefore be used to evaluate people’s eHealth literacy in China. %M 33284123 %R 10.2196/18613 %U http://www.jmir.org/2020/12/e18613/ %U https://doi.org/10.2196/18613 %U http://www.ncbi.nlm.nih.gov/pubmed/33284123 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e23819 %T Development and Validation of a Scale to Measure Intimate Partner Violence Among Transgender and Gender Diverse Populations: Protocol for a Linear Three-Phase Study (Project Empower) %A Stephenson,Rob %A Todd,Kieran %A Gamarel,Kristi E %A Bonar,Erin E %A Peitzmeier,Sarah %+ Center for Sexuality and Health Disparities and The School of Nursing, University of Michigan, 400 North Ingalls, Ann Arbor, MI, 48109, United States, 1 7346150149, rbsteph@umich.edu %K intimate partner violence %K transgender %K scale %D 2020 %7 26.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Intimate partner violence (IPV) is approximately twice as prevalent among transgender and gender diverse individuals (those whose current gender identity does not match their sex assigned at birth) than among cisgender individuals (those whose gender aligns with their sex assigned at birth). However, most existing scales measuring IPV are not validated among transgender and gender diverse populations and do not consider the unique forms of IPV experienced by transgender and gender diverse individuals. Objective: This paper describes the protocol for Project Empower, a study that seeks to develop and validate a new scale to measure IPV as experienced by transgender and gender diverse adults. A new scale is necessary to improve the accuracy of IPV measurement among transgender and gender diverse populations and may inform the current tools used to screen and link to services for transgender and gender diverse people who experience or perpetrate IPV. Methods: The proposed new scale will be developed by a linear three-phase process. In Phase I, we will recruit a maximum of 110 transgender and gender diverse participants to participate in in-depth interviews and focus groups. Phase I will collect qualitative data on the experiences of IPV among transgender and gender individuals. After generating scale items from the qualitative data in Phase I, Phase II will conduct up to 10 cognitive interviews to examine understanding of scale items and refine wording. Phase III will then conduct a survey with an online recruited sample of 700 transgender and gender diverse individuals to validate the scale using factor analysis and examine the prevalence, antecedents, and linked health outcomes of IPV. This study will generate the first comprehensive IPV scale including trans-specific IPV tactics that has undergone robust mixed-methods validation for use in transgender and gender diverse populations, regardless of sex assigned at birth. Results: Project Empower launched in August 2019, with Phases I and II expected to be complete by late 2020. Phase III (survey of 700 transgender individuals) is expected to be launched in January 2021. Conclusions: A scale that more accurately captures the forms of IPV experienced by transgender and gender diverse people not only has the potential to lead to more accurate measurements of prevalence but also can identify unique forms of violence that may form the basis of IPV prevention interventions. Additionally, identifying the forms of IPV experienced by transgender and gender diverse people has the potential to lead to the refinement of clinical screening tools used to identify and refer those who experience and perpetrate violence in clinical settings. International Registered Report Identifier (IRRID): DERR1-10.2196/23819 %M 33242022 %R 10.2196/23819 %U http://www.researchprotocols.org/2020/11/e23819/ %U https://doi.org/10.2196/23819 %U http://www.ncbi.nlm.nih.gov/pubmed/33242022 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 11 %P e24245 %T Shaping Blended Care: Adapting an Instrument to Support Therapists in Using eMental Health %A Kip,Hanneke %A Wentzel,Jobke %A Kelders,Saskia M %+ Centre for eHealth and Wellbeing Research, Department of Psychology, Health & Technology, University of Twente, Drienerlolaan 5, Enschede, 7500 AE, Netherlands, 31 53 489 9180, h.kip@utwente.nl %K eHealth %K blended care %K implementation science %K participatory development %K forensic psychiatry %K mobile phone %D 2020 %7 13.11.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Although eMental health interventions, especially when delivered in a blended way, have great potential to improve the quality and efficiency of mental health care, their use in practice lags behind expectations. The Fit for Blended Care (FfBC) instrument was developed to support therapists and clients in shaping blended care in a way that optimally fits their needs. However, this existing version cannot be directly applied to specific branches of mental health care as it is too broad and generic. Objective: The goal of this study is to adapt the existing FfBC instrument to fit a specific, complex setting—forensic mental health care—by means of participatory development with therapists. Methods: The participatory process was divided into 4 phases and was executed by a project team consisting of 1 manager, 3-5 therapists, and 1 researcher. In phase 1, general requirements for the adaptation of the existing instrument were discussed in 2 focus groups with the project team. In phase 2, patient-related factors that influence the use of an existing web-based intervention were elicited through semistructured interviews with all 18 therapists working at an outpatient clinic. In phase 3, multiple focus groups with the project teams were held to create the first version of the adapted FfBC instrument. In phase 4, a digital prototype of the instrument was used with 8 patients, and the experiences of the 4 therapists were discussed in a focus group. Results: In phase 1, it became clear that the therapists’ main requirement was to develop a much shorter instrument with a few items, in which the content was specifically tailored to the characteristics of forensic psychiatric outpatients. The interviews showed a broad range of patient-related factors, of which 5 were used in the instrument: motivation for blended treatment; writing about thoughts, feelings, and behavior; conscientiousness; psychosocial problems; and social support. In addition, a part of the instrument was focused on the practical necessary preconditions that patients should fill by themselves before the treatment was developed. The use of the web-based prototype of the instrument in treatment resulted in overall positive experiences with the content; however, therapists indicated that the items should be formulated in a more patient-centered way to encourage their involvement in discussing the factors. Conclusions: The participatory, iterative process of this study resulted in an adapted version of the FfBC instrument that fits the specific forensic context and supports shared decision making. In general, the adaptiveness of the instrument is important: its content and implementation should fit the type of care, the organization, and eHealth intervention. To adapt the instrument to other contexts, the guidelines described in this paper can be followed. %M 33185559 %R 10.2196/24245 %U http://mental.jmir.org/2020/11/e24245/ %U https://doi.org/10.2196/24245 %U http://www.ncbi.nlm.nih.gov/pubmed/33185559 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 4 %P e19723 %T Use of a Low-Cost Portable 3D Virtual Reality Simulator for Psychomotor Skill Training in Minimally Invasive Surgery: Task Metrics and Score Validity %A Alvarez-Lopez,Fernando %A Maina,Marcelo Fabián %A Arango,Fernando %A Saigí-Rubió,Francesc %+ Faculty of Health Sciences, Universitat Oberta de Catalunya, Avinguda Tibidabo, 39-43, Barcelona, 08035, Spain, 34 933 263 622, fsaigi@uoc.edu %K simulation training %K minimally invasive surgical procedures %K medical education %K user-computer interface %K computer-assisted surgery %K Leap Motion Controller %D 2020 %7 27.10.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: The high cost and low availability of virtual reality simulators in surgical specialty training programs in low- and middle-income countries make it necessary to develop and obtain sources of validity for new models of low-cost portable simulators that enable ubiquitous learning of psychomotor skills in minimally invasive surgery. Objective: The aim of this study was to obtain validity evidence for relationships to other variables, internal structure, and consequences of testing for the task scores of a new low-cost portable simulator mediated by gestures for learning basic psychomotor skills in minimally invasive surgery. This new simulator is called SIMISGEST-VR (Simulator of Minimally Invasive Surgery mediated by Gestures - Virtual Reality). Methods: In this prospective observational validity study, the authors looked for multiple sources of evidence (known group construct validity, prior videogaming experience, internal structure, test-retest reliability, and consequences of testing) for the proposed SIMISGEST-VR tasks. Undergraduate students (n=100, reference group), surgical residents (n=20), and experts in minimally invasive surgery (n=28) took part in the study. After answering a demographic questionnaire and watching a video of the tasks to be performed, they individually repeated each task 10 times with each hand. The simulator provided concurrent, immediate, and terminal feedback and obtained the task metrics (time and score). From the reference group, 29 undergraduate students were randomly selected to perform the tasks 6 months later in order to determine test-retest reliability. Results: Evidence from multiple sources, including strong intrarater reliability and internal consistency, considerable evidence for the hypothesized consequences of testing, and partial confirmation for relations to other variables, supports the validity of the scores and the metrics used to train and teach basic psychomotor skills for minimally invasive surgery via a new low-cost portable simulator that utilizes interaction technology mediated by gestures. Conclusions: The results obtained provided multiple sources of evidence to validate SIMISGEST-VR tasks aimed at training novices with no prior experience and enabling them to learn basic psychomotor skills for minimally invasive surgery. %M 33107833 %R 10.2196/19723 %U http://games.jmir.org/2020/4/e19723/ %U https://doi.org/10.2196/19723 %U http://www.ncbi.nlm.nih.gov/pubmed/33107833 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e17213 %T Screening for Hearing Impairment in Older Adults by Smartphone-Based Audiometry, Self-Perception, HHIE Screening Questionnaire, and Free-Field Voice Test: Comparative Evaluation of the Screening Accuracy With Standard Pure-Tone Audiometry %A Li,Lok Yee Joyce %A Wang,Shin-Yi %A Wu,Cheng-Jung %A Tsai,Cheng-Yu %A Wu,Te-Fang %A Lin,Yaoh-Shiang %+ Department of Otolaryngology, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd, Zhonghe District, New Taipei City, 23561, Taiwan, 886 22490088, b101090126@tmu.edu.tw %K hearing impairment %K self-perception %K HHIE-S questionnaire %K free-field voice test %K mobile phone %K audiometry %K mobile health %D 2020 %7 27.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hearing impairment is the most frequent sensory deficit in humans, affecting more than 360 million people worldwide. In fact, hearing impairment is not merely a health problem, but it also has a great impact on the educational performance, economic income, and quality of life. Hearing impairment is therefore an important social concern. Objective: We aimed to evaluate and compare the accuracy of self-perception, Hearing Handicap Inventory for the Elderly-Screening (HHIE-S) questionnaire, free-field voice test, and smartphone-based audiometry as tests for screening moderate hearing impairment in older adults in China. Methods: In this study, 41 patients were recruited through a single otology practice. All patients were older than 65 years. Patients with otorrhea and cognitive impairment were excluded. Moderate hearing impairment was defined as mean hearing thresholds at 500, 1000, 2000, and 4000 Hz >40 dB hearing loss (pure-tone average > 40 dB hearing loss). All patients completed 5 hearing tests, namely, the self-perception test, HHIE-S questionnaire test, free-field voice test, smartphone-based audiometry test, and standard pure-tone audiometry by the same audiologist. We compared the results of these tests to the standard audiogram in the better-hearing ear. Results: The sensitivity and the specificity of the self-perception test were 0.58 (95% CI 0.29-0.84) and 0.34 (95% CI 0.19-0.54), respectively. The sensitivity and the specificity of the HHIE-S questionnaire test were 0.67 (95% CI 0.35-0.89) and 0.31 (95% CI 0.316-0.51), respectively. The sensitivity and the specificity of the free-field voice test were 0.83 (95% CI 0.51-0.97) and 0.41 (95% CI 0.24-0.61), respectively. The sensitivity and the specificity of the smartphone-based audiometry test were 0.92 (95% CI 0.60-0.99) and 0.76 (95% CI 0.56-0.89), respectively. Smartphone-based audiometry correctly diagnosed the presence of hearing loss with high sensitivity and high specificity. Conclusions: Smartphone-based audiometry may be a dependable screening test to rule out moderate hearing impairment in the older population. %M 33107828 %R 10.2196/17213 %U http://mhealth.jmir.org/2020/10/e17213/ %U https://doi.org/10.2196/17213 %U http://www.ncbi.nlm.nih.gov/pubmed/33107828 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e20404 %T Evaluation of the Perceived Persuasiveness Questionnaire: User-Centered Card-Sort Study %A Beerlage-de Jong,Nienke %A Kip,Hanneke %A Kelders,Saskia Marion %+ Department of Psychology, Health and Technology, Center for eHealth and Wellbeing Research, University of Twente, P O Box 217, 7500AE, Enschede , Netherlands, 31 534893517, n.beerlage-dejong@utwente.nl %K eHealth %K behavior change support systems %K card sort %K perceived persuasiveness %K persuasive systems design %K mental model %K questionnaire evaluation %D 2020 %7 23.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth technologies aim to change users’ health-related behavior. Persuasive design and system features can make an eHealth technology more motivating, engaging, or supportive to its users. The Persuasive Systems Design (PSD) model incorporates software features that have the possibility to increase the persuasiveness of technologies. However, the effects of specific PSD software features on the effectiveness of an intervention are still largely unknown. The Perceived Persuasiveness Questionnaire (PPQ) was developed to gain insight into the working mechanisms of persuasive technologies. Although the PPQ seems to be a suitable method for measuring subjective persuasiveness, it needs to be further evaluated to determine how suitable it is for measuring perceived persuasiveness among the public. Objective: This study aims to evaluate the face and construct validity of the PPQ, identify points of improvement, and provide suggestions for further development of the PPQ. Methods: A web-based closed-ended card-sort study was performed wherein participants grouped existing PPQ items under existing PPQ constructs. Participants were invited via a Massive Open Online Course on eHealth. A total of 398 people (average age 44.15 years, SD 15.17; 251/398, 63.1% women) completed the card sort. Face validity was evaluated by determining the item-level agreement of the original PPQ constructs. Construct validity was evaluated by determining the construct in which each item was placed most often, regardless of the original placement and how often 2 items were (regardless of the constructs) paired together and what interitem correlations were according to a cluster analysis. Results: Four PPQ constructs obtained relatively high face validity scores: perceived social support, use continuance, perceived credibility, and perceived effort. Item-level agreement on the other constructs was relatively low. Item-level agreement for almost all constructs, except perceived effort and perceived effectiveness, would increase if items would be grouped differently. Finally, a cluster analysis of the PPQ indicated that the strengths of the newly identified 9 clusters varied strongly. Unchanged strong clusters were only found for perceived credibility support, perceived social support, and use continuance. The placement of the other items was much more spread out over the other constructs, suggesting an overlap between them. Conclusions: The findings of this study provide a solid starting point toward a redesigned PPQ that is a true asset to the field of persuasiveness research. To achieve this, we advocate that the redesigned PPQ should adhere more closely to what persuasiveness is according to the PSD model and to the mental models of potential end users of technology. The revised PPQ should, for example, enquire if the user thinks anything is done to provide task support but not how this is done exactly. %M 33095173 %R 10.2196/20404 %U http://www.jmir.org/2020/10/e20404/ %U https://doi.org/10.2196/20404 %U http://www.ncbi.nlm.nih.gov/pubmed/33095173 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 4 %P e20126 %T A Tablet App for Handwriting Skill Screening at the Preliteracy Stage: Instrument Validation Study %A Dui,Linda Greta %A Lunardini,Francesca %A Termine,Cristiano %A Matteucci,Matteo %A Stucchi,Natale Adolfo %A Borghese,Nunzio Alberto %A Ferrante,Simona %+ Department of Electronics, Information and Bioengineering, Politecnico di Milano, Via Colombo 40, Milan, 20133, Italy, 39 0223999690, lindagreta.dui@polimi.it %K serious game %K tablet %K isochrony %K homothety %K speed-accuracy tradeoff %K steering law %K writing %K prevention %D 2020 %7 22.10.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Difficulties in handwriting, such as dysgraphia, impact several aspects of a child’s everyday life. Current methodologies for the detection of such difficulties in children have the following three main weaknesses: (1) they are prone to subjective evaluation; (2) they can be administered only when handwriting is mastered, thus delaying the diagnosis and the possible adoption of countermeasures; and (3) they are not always easily accessible to the entire community. Objective: This work aims at developing a solution able to: (1) quantitatively measure handwriting features whose alteration is typically seen in children with dysgraphia; (2) enable their study in a preliteracy population; and (3) leverage a standard consumer technology to increase the accessibility of both early screening and longitudinal monitoring of handwriting difficulties. Methods: We designed and developed a novel tablet-based app Play Draw Write to assess potential markers of dysgraphia through the quantification of the following three key handwriting laws: isochrony, homothety, and speed-accuracy tradeoff. To extend such an approach to a preliteracy age, the app includes the study of the laws in terms of both word writing and symbol drawing. The app was tested among healthy children with mastered handwriting (third graders) and those at a preliterate age (kindergartners). Results: App testing in 15 primary school children confirmed that the three laws hold on the tablet surface when both writing words and drawing symbols. We found significant speed modulation according to size (P<.001), no relevant changes to fraction time for 67 out of 70 comparisons, and significant regression between movement time and index of difficulty for 44 out of 45 comparisons (P<.05, R2>0.28, 12 degrees of freedom). Importantly, the three laws were verified on symbols among 19 kindergartners. Results from the speed-accuracy exercise showed a significant evolution with age of the global movement time (circle: P=.003, square: P<.001, word: P=.001), the goodness of fit of the regression between movement time and accuracy constraints (square: P<.001, circle: P=.02), and the index of performance (square: P<.001). Our findings show that homothety, isochrony, and speed-accuracy tradeoff principles are present in children even before handwriting acquisition; however, some handwriting-related skills are partially refined with age. Conclusions: The designed app represents a promising solution for the screening of handwriting difficulties, since it allows (1) anticipation of the detection of alteration of handwriting principles at a preliteracy age and (2) provision of broader access to the monitoring of handwriting principles. Such a solution potentially enables the selective strengthening of lacking abilities before they exacerbate and affect the child’s whole life. %M 33090110 %R 10.2196/20126 %U http://games.jmir.org/2020/4/e20126/ %U https://doi.org/10.2196/20126 %U http://www.ncbi.nlm.nih.gov/pubmed/33090110 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e19179 %T Measurement Properties of Existing Patient-Reported Outcome Measures on Medication Adherence: Systematic Review %A Kwan,Yu Heng %A Weng,Si Dun %A Loh,Dionne Hui Fang %A Phang,Jie Kie %A Oo,Livia Jia Yi %A Blalock,Dan V %A Chew,Eng Hui %A Yap,Kai Zhen %A Tan,Corrinne Yong Koon %A Yoon,Sungwon %A Fong,Warren %A Østbye,Truls %A Low,Lian Leng %A Bosworth,Hayden Barry %A Thumboo,Julian %+ Program in Health Services and Systems Research,, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore, 65 63778465, yuheng_02071988@hotmail.com %K systematic review %K reliability and validity %K medication adherence %K patient reported outcome measures %D 2020 %7 9.10.2020 %9 Review %J J Med Internet Res %G English %X Background: Medication adherence is essential for improving the health outcomes of patients. Various patient-reported outcome measures (PROMs) have been developed to measure medication adherence in patients. However, no study has summarized the psychometric properties of these PROMs to guide selection for use in clinical practice or research. Objective: This study aims to evaluate the quality of the PROMs used to measure medication adherence. Methods: This study was guided by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Relevant articles were retrieved from the EMBASE, PubMed, Cochrane Library, Web of Science, and CINAHL (Cumulative Index to Nursing and Allied Health Literature) databases. The PROMs were then evaluated based on the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) guidelines. Results: A total of 121 unique medication adherence PROMs from 214 studies were identified. Hypotheses testing for construct validity and internal consistency were the most frequently assessed measurement properties. PROMs with at least a moderate level of evidence for ≥5 measurement properties include the Adherence Starts with Knowledge 20, Compliance Questionnaire-Rheumatology, General Medication Adherence Scale, Hill-Bone Scale, Immunosuppressant Therapy Barrier Scale, Medication Adherence Reasons Scale (MAR-Scale) revised, 5-item Medication Adherence Rating Scale (MARS-5), 9-item MARS (MARS-9), 4-item Morisky Medication Adherence Scale (MMAS-4), 8-item MMAS (MMAS-8), Self-efficacy for Appropriate Medication Adherence Scale, Satisfaction with Iron Chelation Therapy, Test of Adherence to Inhalers, and questionnaire by Voils. The MAR-Scale revised, MMAS-4, and MMAS-8 have been administered electronically. Conclusions: This study identified 121 PROMs for medication adherence and provided synthesized evidence for the measurement properties of these PROMs. The findings from this study may assist clinicians and researchers in selecting suitable PROMs to assess medication adherence. %M 33034566 %R 10.2196/19179 %U https://www.jmir.org/2020/10/e19179 %U https://doi.org/10.2196/19179 %U http://www.ncbi.nlm.nih.gov/pubmed/33034566 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e19089 %T Development of an Item Bank to Measure Medication Adherence: Systematic Review %A Kwan,Yu Heng %A Oo,Livia Jia Yi %A Loh,Dionne Hui Fang %A Phang,Jie Kie %A Weng,Si Dun %A Blalock,Dan V %A Chew,Eng Hui %A Yap,Kai Zhen %A Tan,Corrinne Yong Koon %A Yoon,Sungwon %A Fong,Warren %A Østbye,Truls %A Low,Lian Leng %A Bosworth,Hayden Barry %A Thumboo,Julian %+ Program in Health Services and Systems Research, Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore, 65 63778465, yuheng@u.duke.nus.edu %K systematic review %K patient-reported outcome measures %K item bank %K adherence %D 2020 %7 8.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Medication adherence is important in managing the progression of chronic diseases. A promising approach to reduce cognitive burden when measuring medication adherence lies in the use of computer‐adaptive tests (CATs) or in the development of shorter patient-reported outcome measures (PROMs). However, the lack of an item bank currently hampers this progress. Objective: We aim to develop an item bank to measure general medication adherence. Methods: Using the preferred reporting items for systematic review and meta-analysis (PRISMA), articles published before October 2019 were retrieved from PubMed, Embase, CINAHL, the Cochrane Library, and Web of Science. Items from existing PROMs were classified and selected (“binned” and “winnowed”) according to standards published by the Patient-Reported Outcomes Measurement Information System (PROMIS) Cooperative Group. Results: A total of 126 unique PROMs were identified from 213 studies in 48 countries. Items from the literature review (47 PROMs with 579 items for which permission has been obtained) underwent binning and winnowing. This resulted in 421 candidate items (77 extent of adherence and 344 reasons for adherence). Conclusions: We developed an item bank for measuring general medication adherence using items from validated PROMs. This will allow researchers to create new PROMs from selected items and provide the foundation to develop CATs. %M 33030441 %R 10.2196/19089 %U https://www.jmir.org/2020/10/e19089 %U https://doi.org/10.2196/19089 %U http://www.ncbi.nlm.nih.gov/pubmed/33030441 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e17757 %T Psychometric Evaluation of the TWente Engagement with Ehealth Technologies Scale (TWEETS): Evaluation Study %A Kelders,Saskia Marion %A Kip,Hanneke %A Greeff,Japie %+ Center for eHealth and Wellbeing Research, Department of Psychology, Health, and Technology, University of Twente, PO Box 217, Enschede, 7500AE, Netherlands, 31 534896055, s.m.kelders@utwente.nl %K engagement %K attrition %K eHealth %K adoption %K adherence %K questionnaire %K scale validation %K digital health interventions %D 2020 %7 9.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Engagement emerges as a predictor for the effectiveness of digital health interventions. However, a shared understanding of engagement is missing. Therefore, a new scale has been developed that proposes a clear definition and creates a tool to measure it. The TWente Engagement with Ehealth Technologies Scale (TWEETS) is based on a systematic review and interviews with engaged health app users. It defines engagement as a combination of behavior, cognition, and affect. Objective: This paper aims to evaluate the psychometric properties of the TWEETS. In addition, a comparison is made with the experiential part of the Digital Behavior Change Intervention Engagement Scale (DBCI-ES-Ex), a scale that showed some issues in previous psychometric analyses. Methods: In this study, 288 participants were asked to use any step counter app on their smartphones for 2 weeks. They completed online questionnaires at 4 time points: T0=baseline, T1=after 1 day, T2=1 week, and T3=2 weeks. At T0, demographics and personality (conscientiousness and intellect/imagination) were assessed; at T1-T3, engagement, involvement, enjoyment, subjective usage, and perceived behavior change were included as measures that are theoretically related to our definition of engagement. Analyses focused on internal consistency, reliability, and the convergent, divergent, and predictive validity of both engagement scales. Convergent validity was assessed by correlating the engagement scales with involvement, enjoyment, and subjective usage; divergent validity was assessed by correlating the engagement scales with personality; and predictive validity was assessed by regression analyses using engagement to predict perceived behavior change at later time points. Results: The Cronbach alpha values of the TWEETS were .86, .86, and .87 on T1, T2, and T3, respectively. Exploratory factor analyses indicated that a 1-factor structure best fits the data. The TWEETS is moderately to strongly correlated with involvement and enjoyment (theoretically related to cognitive and affective engagement, respectively; P<.001). Correlations between the TWEETS and frequency of use were nonsignificant or small, and differences between adherers and nonadherers on the TWEETS were significant (P<.001). Correlations between personality and the TWEETS were nonsignificant. The TWEETS at T1 was predictive of perceived behavior change at T3, with an explained variance of 16%. The psychometric properties of the TWEETS and the DBCI-ES-Ex seemed comparable in some aspects (eg, internal consistency), and in other aspects, the TWEETS seemed somewhat superior (divergent and predictive validity). Conclusions: The TWEETS performs quite well as an engagement measure with high internal consistency, reasonable test-retest reliability and convergent validity, good divergent validity, and reasonable predictive validity. As the psychometric quality of a scale is a reflection of how closely a scale matches the conceptualization of a concept, this paper is also an attempt to conceptualize and define engagement as a unique concept, providing a first step toward an acceptable standard of defining and measuring engagement. %M 33021487 %R 10.2196/17757 %U https://www.jmir.org/2020/10/e17757 %U https://doi.org/10.2196/17757 %U http://www.ncbi.nlm.nih.gov/pubmed/33021487 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19716 %T Mobile Insight in Risk, Resilience, and Online Referral (MIRROR): Psychometric Evaluation of an Online Self-Help Test %A van Herpen,Merel Marjolein %A Boeschoten,Manon A %A te Brake,Hans %A van der Aa,Niels %A Olff,Miranda %+ ARQ Centre of Expertise for the Impact of Disasters and Crises, Nienoord 5, Diemen, , Netherlands, 31 610082023, m.van.herpen@impact.arq.org %K potentially traumatic events %K mobile mental health %K self-help %K online %K resilience %K posttraumatic stress disorder %D 2020 %7 25.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Most people who experience a potentially traumatic event (PTE) recover on their own. A small group of individuals develops psychological complaints, but this is often not detected in time or guidance to care is suboptimal. To identify these individuals and encourage them to seek help, a web-based self-help test called Mobile Insight in Risk, Resilience, and Online Referral (MIRROR) was developed. MIRROR takes an innovative approach since it integrates both negative and positive outcomes of PTEs and time since the event and provides direct feedback to the user. Objective: The goal of this study was to assess MIRROR’s use, examine its psychometric properties (factor structure, internal consistency, and convergent and divergent validity), and evaluate how well it classifies respondents into different outcome categories compared with reference measures. Methods: MIRROR was embedded in the website of Victim Support Netherlands so visitors could use it. We compared MIRROR’s outcomes to reference measures of PTSD symptoms (PTSD Checklist for DSM-5), depression, anxiety, stress (Depression Anxiety Stress Scale–21), psychological resilience (Resilience Evaluation Scale), and positive mental health (Mental Health Continuum Short Form). Results: In 6 months, 1112 respondents completed MIRROR, of whom 663 also completed the reference measures. Results showed good internal consistency (interitem correlations range .24 to .55, corrected item-total correlations range .30 to .54, and Cronbach alpha coefficient range .62 to .68), and convergent and divergent validity (Pearson correlations range –.259 to .665). Exploratory and confirmatory factor analyses (EFA+CFA) yielded a 2-factor model with good model fit (CFA model fit indices: χ219=107.8, P<.001, CFI=.965, TLI=.948, RMSEA=.065), conceptual meaning, and parsimony. MIRROR correctly classified respondents into different outcome categories compared with the reference measures. Conclusions: MIRROR is a valid and reliable self-help test to identify negative (PTSD complaints) and positive outcomes (psychosocial functioning and resilience) of PTEs. MIRROR is an easily accessible online tool that can help people who have experienced a PTE to timely identify psychological complaints and find appropriate support, a tool that might be highly needed in times like the coronavirus pandemic. %M 32975521 %R 10.2196/19716 %U http://www.jmir.org/2020/9/e19716/ %U https://doi.org/10.2196/19716 %U http://www.ncbi.nlm.nih.gov/pubmed/32975521 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e18234 %T A Rapid Electronic Cognitive Assessment Measure for Multiple Sclerosis: Validation of Cognitive Reaction, an Electronic Version of the Symbol Digit Modalities Test %A Middleton,Rod M %A Pearson,Owen R %A Ingram,Gillian %A Craig,Elaine M %A Rodgers,William J %A Downing-Wood,Hannah %A Hill,Joseph %A Tuite-Dalton,Katherine %A Roberts,Christopher %A Watson,Lynne %A Ford,David V %A Nicholas,Richard %A , %+ Population Data Science, Swansea University Medical School, Swansea University, Data Science Building, Singleton Park, Swansea, SA2 8PP, United Kingdom, 44 1792606760, r.m.middleton@swansea.ac.uk %K cognition %K multiple sclerosis %K eHealth %K electronic assessment %K patient reported outcomes %K neurology %D 2020 %7 23.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Incorporating cognitive testing into routine clinical practice is a challenge in multiple sclerosis (MS), given the wide spectrum of both cognitive and physical impairments people can have and the time that testing requires. Shortened paper and verbal assessments predominate but still are not used routinely. Computer-based tests are becoming more widespread; however, changes in how a paper test is implemented can impact what exactly is being assessed in an individual. The Symbol Digit Modalities Test (SDMT) is one validated test that forms part of the cognitive batteries used in MS and has some computer-based versions. We developed a tablet-based SDMT variant that has the potential to be ultimately deployed to patients’ own devices. Objective: This paper aims to develop, validate, and deploy a computer-based SDMT variant, the Cognition Reaction (CoRe) test, that can reliably replicate the characteristics of the paper-based SDMT. Methods: We carried out analysis using Pearson and intraclass correlations, as well as a Bland-Altman comparison, to examine consistency between the SDMT and CoRe tests and for test-retest reliability. The SDMT and CoRe tests were evaluated for sensitivity to disability levels and age. A novel metric in CoRe was found: question answering velocity could be calculated. This was evaluated in relation to disability levels and age for people with MS and compared with a group of healthy control volunteers. Results: SDMT and CoRe test scores were highly correlated and consistent with 1-month retest values. Lower scores were seen in patients with higher age and some effect was seen with increasing disability. There was no learning effect evident. Question answering velocity demonstrated a small increase in speed over the 90-second duration of the test in people with MS and healthy controls. Conclusions: This study validates a computer-based alternative to the SDMT that can be used in clinics and beyond. It enables accurate recording of elements of cognition relevant in MS but offers additional metrics that may offer further value to clinicians and people with MS. %M 32965240 %R 10.2196/18234 %U http://www.jmir.org/2020/9/e18234/ %U https://doi.org/10.2196/18234 %U http://www.ncbi.nlm.nih.gov/pubmed/32965240 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e20641 %T Automatic Grading of Stroke Symptoms for Rapid Assessment Using Optimized Machine Learning and 4-Limb Kinematics: Clinical Validation Study %A Park,Eunjeong %A Lee,Kijeong %A Han,Taehwa %A Nam,Hyo Suk %+ Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemoon-gu, Seoul, 03722, Republic of Korea, 82 222280245, hsnam@yuhs.ac %K machine learning %K artificial intelligence %K sensors %K kinematics %K stroke %K telemedicine %D 2020 %7 16.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Subtle abnormal motor signs are indications of serious neurological diseases. Although neurological deficits require fast initiation of treatment in a restricted time, it is difficult for nonspecialists to detect and objectively assess the symptoms. In the clinical environment, diagnoses and decisions are based on clinical grading methods, including the National Institutes of Health Stroke Scale (NIHSS) score or the Medical Research Council (MRC) score, which have been used to measure motor weakness. Objective grading in various environments is necessitated for consistent agreement among patients, caregivers, paramedics, and medical staff to facilitate rapid diagnoses and dispatches to appropriate medical centers. Objective: In this study, we aimed to develop an autonomous grading system for stroke patients. We investigated the feasibility of our new system to assess motor weakness and grade NIHSS and MRC scores of 4 limbs, similar to the clinical examinations performed by medical staff. Methods: We implemented an automatic grading system composed of a measuring unit with wearable sensors and a grading unit with optimized machine learning. Inertial sensors were attached to measure subtle weaknesses caused by paralysis of upper and lower limbs. We collected 60 instances of data with kinematic features of motor disorders from neurological examination and demographic information of stroke patients with NIHSS 0 or 1 and MRC 7, 8, or 9 grades in a stroke unit. Training data with 240 instances were generated using a synthetic minority oversampling technique to complement the imbalanced number of data between classes and low number of training data. We trained 2 representative machine learning algorithms, an ensemble and a support vector machine (SVM), to implement auto-NIHSS and auto-MRC grading. The optimized algorithms performed a 5-fold cross-validation and were searched by Bayes optimization in 30 trials. The trained model was tested with the 60 original hold-out instances for performance evaluation in accuracy, sensitivity, specificity, and area under the receiver operating characteristics curve (AUC). Results: The proposed system can grade NIHSS scores with an accuracy of 83.3% and an AUC of 0.912 using an optimized ensemble algorithm, and it can grade with an accuracy of 80.0% and an AUC of 0.860 using an optimized SVM algorithm. The auto-MRC grading achieved an accuracy of 76.7% and a mean AUC of 0.870 in SVM classification and an accuracy of 78.3% and a mean AUC of 0.877 in ensemble classification. Conclusions: The automatic grading system quantifies proximal weakness in real time and assesses symptoms through automatic grading. The pilot outcomes demonstrated the feasibility of remote monitoring of motor weakness caused by stroke. The system can facilitate consistent grading with instant assessment and expedite dispatches to appropriate hospitals and treatment initiation by sharing auto-MRC and auto-NIHSS scores between prehospital and hospital responses as an objective observation. %M 32936079 %R 10.2196/20641 %U http://www.jmir.org/2020/9/e20641/ %U https://doi.org/10.2196/20641 %U http://www.ncbi.nlm.nih.gov/pubmed/32936079 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21195 %T Health Technology Readiness Profiles Among Danish Individuals With Type 2 Diabetes: Cross-Sectional Study %A Thorsen,Ida Kær %A Rossen,Sine %A Glümer,Charlotte %A Midtgaard,Julie %A Ried-Larsen,Mathias %A Kayser,Lars %+ The Centre for Physical Activity Research, University of Copenhagen, Rigshospitalet 7641, Blegdamsvej 9, Copenhagen, DK-2100, Denmark, 45 35 45 76 41, ida.kaer.thorsen@regionh.dk %K readiness for health technology %K telemedicine %K diabetes mellitus, type 2 %K socioeconomic factors %K mental health %K psychological distress %K healthcare disparities %K delivery of healthcare %K exercise %D 2020 %7 15.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Information technologies (IT) are increasingly implemented in type 2 diabetes (T2D) treatment as a resource for remotely supported health care. However, possible pitfalls of introducing IT in health care are generally overlooked. Specifically, the effectiveness of IT to improve health care may depend on the user’s readiness for health technology. Objective: We aim to investigate readiness for health technology in relation to mental well-being, sociodemographic, and disease-related characteristics among individuals with T2D. Methods: Individuals with T2D (aged ≥18 years) who had been referred to self-management education, exercise, diet counseling, smoking cessation, or alcohol counseling completed a questionnaire survey covering (1) background information, (2) the 5-item World Health Organization Well-Being Index (WHO-5), (3) receptiveness to IT use in physical activity, and (4) the Readiness and Enablement Index for Health Technology (READHY), constituted by dimensions related to self-management, social support, and eHealth literacy. Individuals were divided into profiles using cluster analysis based on their READHY scores. Outcomes included differences across profiles in mental well-being, sociodemographic, and disease-related characteristics. Results: Participants in the study were 155 individuals with T2D with a mean age of 60.2 (SD 10.7) years, 55.5% (86/155) of which were men and 44.5% (69/155) of which were women. Participants were stratified into 5 health technology readiness profiles based on the cluster analysis: Profile 1, high health technology readiness; Profile 2, medium health technology readiness; Profile 3, medium health technology readiness and high level of emotional distress; Profile 4, medium health technology readiness and low-to-medium eHealth literacy; Profile 5, low health technology readiness. No differences in sociodemographic and disease-related characteristics were observed across profiles; however, we identified 3 vulnerable subgroups of individuals: Profile 3 (21/155, 13.5%), younger individuals (mean age of 53.4 years, SD 8.9 years) with low mental well-being (mean 42.7, SD 14.7) and emotional distress (mean 1.69, SD 0.38); Profile 4 (20/155, 12.9%), older individuals (mean age 66.3 years, SD 9.0 years) with less IT use (50.0% used IT for communication) and low-to-medium eHealth literacy; and Profile 5 (36/155, 23.2%) with low mental well-being (mean 43.4, SD 20.1) and low readiness for health technology. Conclusions: Implementation of IT in health care of individuals with T2D should be based on comprehensive consideration of mental well-being, emotional distress, and readiness for health technology rather than sociodemographic and disease-related characteristics to identify the individuals in need of social support, self-management education, and extensive IT support. A one-size-fits-all approach to IT implementation in health care will potentially increase the risk of treatment failure among the most vulnerable individuals. %M 32930669 %R 10.2196/21195 %U http://www.jmir.org/2020/9/e21195/ %U https://doi.org/10.2196/21195 %U http://www.ncbi.nlm.nih.gov/pubmed/32930669 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19472 %T Validation of the Raw National Aeronautics and Space Administration Task Load Index (NASA-TLX) Questionnaire to Assess Perceived Workload in Patient Monitoring Tasks: Pooled Analysis Study Using Mixed Models %A Said,Sadiq %A Gozdzik,Malgorzata %A Roche,Tadzio Raoul %A Braun,Julia %A Rössler,Julian %A Kaserer,Alexander %A Spahn,Donat R %A Nöthiger,Christoph B %A Tscholl,David Werner %+ Department of Anesthesiology, University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland, 41 786718911, sadiq.said@usz.ch %K workload %K questionnaires %K National Aeronautics and Space Administration Task Load Index %K awareness %K situation awareness %K patient monitoring %K thromboelastometry %D 2020 %7 7.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient monitoring is indispensable in any operating room to follow the patient’s current health state based on measured physiological parameters. Reducing workload helps to free cognitive resources and thus influences human performance, which ultimately improves the quality of care. Among the many methods available to assess perceived workload, the National Aeronautics and Space Administration Task Load Index (NASA-TLX) provides the most widely accepted tool. However, only few studies have investigated the validity of the NASA-TLX in the health care sector. Objective: This study aimed to validate a modified version of the raw NASA-TLX in patient monitoring tasks by investigating its correspondence with expected lower and higher workload situations and its robustness against nonworkload-related covariates. This defines criterion validity. Methods: In this pooled analysis, we evaluated raw NASA-TLX scores collected after performing patient monitoring tasks in four different investigator-initiated, computer-based, prospective, multicenter studies. All of them were conducted in three hospitals with a high standard of care in central Europe. In these already published studies, we compared conventional patient monitoring with two newly developed situation awareness–oriented monitoring technologies called Visual Patient and Visual Clot. The participants were resident and staff anesthesia and intensive care physicians, and nurse anesthetists with completed specialization qualification. We analyzed the raw NASA-TLX scores by fitting mixed linear regression models and univariate models with different covariates. Results: We assessed a total of 1160 raw NASA-TLX questionnaires after performing specific patient monitoring tasks. Good test performance and higher self-rated diagnostic confidence correlated significantly with lower raw NASA-TLX scores and the subscores (all P<.001). Staff physicians rated significantly lower workload scores than residents (P=.001), whereas nurse anesthetists did not show any difference in the same comparison (P=.83). Standardized distraction resulted in higher rated total raw NASA-TLX scores (P<.001) and subscores. There was no gender difference regarding perceived workload (P=.26). The new visualization technologies Visual Patient and Visual Clot resulted in significantly lower total raw NASA-TLX scores and all subscores, including high self-rated performance, when compared with conventional monitoring (all P<.001). Conclusions: This study validated a modified raw NASA-TLX questionnaire for patient monitoring tasks. The scores obtained correctly represented the assumed influences of the examined covariates on the perceived workload. We reported high criterion validity. The NASA-TLX questionnaire appears to be a reliable tool for measuring subjective workload. Further research should focus on its applicability in a clinical setting. %M 32780712 %R 10.2196/19472 %U http://www.jmir.org/2020/9/e19472/ %U https://doi.org/10.2196/19472 %U http://www.ncbi.nlm.nih.gov/pubmed/32780712 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e18570 %T DenTiUS Plaque, a Web-Based Application for the Quantification of Bacterial Plaque: Development and Usability Study %A Vila-Blanco,Nicolás %A Freire,Vicente %A Balsa-Castro,Carlos %A Tomás,Inmaculada %A Carreira,María J %+ Centro Singular de Investigación en Tecnoloxías Intelixentes, Universidade de Santiago de Compostela, C/Jenaro de la Fuente, s/n, Santiago de Compostela, E15782, Spain, 34 881816430, mariajose.carreira@usc.es %K computer-aided diagnoses %K computer-based biomedical applications %K dental health %K dental plaque quantification %K web-based tools %K medical informatics %D 2020 %7 3.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In the dentistry field, the analysis of dental plaque is vital because it is the main etiological factor in the 2 most prevalent oral diseases: caries and periodontitis. In most of the papers published in the dental literature, the quantification of dental plaque is carried out using traditional, non-automated, and time-consuming indices. Therefore, the development of an automated plaque quantification tool would be of great value to clinicians and researchers. Objective: This study aimed to develop a web-based tool called DenTiUS and various clinical indices to evaluate dental plaque levels using image analysis techniques. Methods: The tool was executed as a web-based application to facilitate its use by researchers. Expert users are free to define experiments, including images from either a single patient (to observe an individual plaque growth pattern) or several patients (to perform a group characterization) at a particular moment or over time. A novel approach for detecting visible plaque has been developed as well as a new concept known as nonvisible plaque. This new term implies the classification of the remaining dental area into 3 subregions according to the risk of accumulating plaque in the near future. New metrics have also been created to describe visible and nonvisible plaque levels. Results: The system generates results tables of the quantitative analysis with absolute averages obtained in each image (indices about visible plaque) and relative measurements (indices about visible and nonvisible plaque) relating to the reference moment. The clinical indices that can be calculated are the following: plaque index of an area per intensity (API index, a value between 0 and 100), area growth index (growth rate of plaque per unit of time in hours; percentage area/hour), and area time index (the time in days needed to achieve a plaque area of 100% concerning the initial area at the same moment). Images and graphics can be obtained for a moment from a patient in addition to a full report presenting all the processing data. Dentistry experts evaluated the DenTiUS Plaque software through a usability test, with the best-scoring questions those related to the workflow efficiency, value of the online help, attractiveness of the user interface, and overall satisfaction. Conclusions: The DenTiUS Plaque software allows automatic, reliable, and repeatable quantification of dental plaque levels, providing information about area, intensity, and growth pattern. Dentistry experts recognized that this software is suitable for quantification of dental plaque levels. Consequently, its application in the analysis of plaque evolution patterns associated with different oral conditions, as well as to evaluate the effectiveness of various oral hygiene measures, can represent an improvement in the clinical setting and the methodological quality of research studies. %M 32663148 %R 10.2196/18570 %U https://www.jmir.org/2020/9/e18570 %U https://doi.org/10.2196/18570 %U http://www.ncbi.nlm.nih.gov/pubmed/32663148 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e16792 %T Comparing Web-Based and Lab-Based Cognitive Assessment Using the Cambridge Neuropsychological Test Automated Battery: A Within-Subjects Counterbalanced Study %A Backx,Rosa %A Skirrow,Caroline %A Dente,Pasquale %A Barnett,Jennifer H %A Cormack,Francesca K %+ Cambridge Cognition Ltd, Tunbridge Court, Tunbridge Ln, Bottisham, Cambridge, CB25 9TU, United Kingdom, 44 (0)1223 810 700, caroline.skirrow@camcog.com %K reliability %K mobile health %K neuropsychological tests %K CANTAB %K cognition %D 2020 %7 4.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Computerized assessments are already used to derive accurate and reliable measures of cognitive function. Web-based cognitive assessment could improve the accessibility and flexibility of research and clinical assessment, widen participation, and promote research recruitment while simultaneously reducing costs. However, differences in context may influence task performance. Objective: This study aims to determine the comparability of an unsupervised, web-based administration of the Cambridge Neuropsychological Test Automated Battery (CANTAB) against a typical in-person lab-based assessment, using a within-subjects counterbalanced design. The study aims to test (1) reliability, quantifying the relationship between measurements across settings using correlational approaches; (2) equivalence, the extent to which test results in different settings produce similar overall results; and (3) agreement, by quantifying acceptable limits to bias and differences between measurement environments. Methods: A total of 51 healthy adults (32 women and 19 men; mean age 36.8, SD 15.6 years) completed 2 testing sessions, which were completed on average 1 week apart (SD 4.5 days). Assessments included equivalent tests of emotion recognition (emotion recognition task [ERT]), visual recognition (pattern recognition memory [PRM]), episodic memory (paired associate learning [PAL]), working memory and spatial planning (spatial working memory [SWM] and one touch stockings of Cambridge), and sustained attention (rapid visual information processing [RVP]). Participants were randomly allocated to one of the two groups, either assessed in-person in the laboratory first (n=33) or with unsupervised web-based assessments on their personal computing systems first (n=18). Performance indices (errors, correct trials, and response sensitivity) and median reaction times were extracted. Intraclass and bivariate correlations examined intersetting reliability, linear mixed models and Bayesian paired sample t tests tested for equivalence, and Bland-Altman plots examined agreement. Results: Intraclass correlation (ICC) coefficients ranged from ρ=0.23-0.67, with high correlations in 3 performance indices (from PAL, SWM, and RVP tasks; ρ≥0.60). High ICC values were also seen for reaction time measures from 2 tasks (PRM and ERT tasks; ρ≥0.60). However, reaction times were slower during web-based assessments, which undermined both equivalence and agreement for reaction time measures. Performance indices did not differ between assessment settings and generally showed satisfactory agreement. Conclusions: Our findings support the comparability of CANTAB performance indices (errors, correct trials, and response sensitivity) in unsupervised, web-based assessments with in-person and laboratory tests. Reaction times are not as easily translatable from in-person to web-based testing, likely due to variations in computer hardware. The results underline the importance of examining more than one index to ascertain comparability, as high correlations can present in the context of systematic differences, which are a product of differences between measurement environments. Further work is now needed to examine web-based assessments in clinical populations and in larger samples to improve sensitivity for detecting subtler differences between test settings. %M 32749999 %R 10.2196/16792 %U https://www.jmir.org/2020/8/e16792 %U https://doi.org/10.2196/16792 %U http://www.ncbi.nlm.nih.gov/pubmed/32749999 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e18015 %T A Tool for Rating the Value of Health Education Mobile Apps to Enhance Student Learning (MARuL): Development and Usability Study %A Gladman,Tehmina %A Tylee,Grace %A Gallagher,Steve %A Mair,Jonathan %A Rennie,Sarah C %A Grainger,Rebecca %+ Education Unit, University of Otago Wellington, PO Box 7343, Newtown, Wellington, 6242, New Zealand, 64 04 918 6749, tehmina.gladman@otago.ac.nz %K questionnaire design %K medical education %K health occupations students %K just-in-time learning %K self-directed learning %K mobile phone %K rubric %K mobile learning %K mobile apps %K mhealth %K digital learning %D 2020 %7 31.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To realize the potential for mobile learning in clinical skills acquisition, medical students and their teachers should be able to evaluate the value of an app to support student learning of clinical skills. To our knowledge, there is currently no rubric for evaluation of quality or value that is specific for apps to support medical student learning. Such a rubric might assist students to be more confident in using apps to support their learning. Objective: The objective of this study was to develop an instrument that can be used by health professional educators to rate the value of a mobile app to support health professional student learning. Methods: Using the literature, we developed a list of potential criteria for the evaluation of educational app value, which were then refined with a student group using a modified nominal group technique. The refined list was organized into themes, and the initial rubric, Mobile App Rubric for Learning (MARuL, version 1), was developed. iOS and Android app stores were searched for clinical skills apps that met our inclusion criteria. After the 2 reviewers were trained and the item descriptions were refined (version 2), a random sample of 10 included apps, 5 for each mobile operating system, was reviewed. Interitem and interrater analyses and discussions with the reviewers resulted in refinement of MARuL to version 3. The reviewers completed a review of 41 clinical skills mobile apps, and a second round of interitem and interrater reliability testing was performed, leading to version 4 of the MARuL. Results: Students identified 28 items (from an initial set of 144 possible items) during the nominal group phase, and these were then grouped into 4 themes: teaching and learning, user centered, professional, and usability. Testing and refinement with reviewers reduced the list to 26 items. Internal consistency for MARuL was excellent (α=.96), and the interrater reliability as measured by the intraclass correlation coefficient (ICC) was good (ICC=0.66). Conclusions: MARuL offers a fast and user-friendly method for teachers to select valuable apps to enhance student learning. %M 32735228 %R 10.2196/18015 %U https://mhealth.jmir.org/2020/7/e18015 %U https://doi.org/10.2196/18015 %U http://www.ncbi.nlm.nih.gov/pubmed/32735228 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17760 %T The Mobile App Development and Assessment Guide (MAG): Delphi-Based Validity Study %A Llorens-Vernet,Pere %A Miró,Jordi %+ Unit for the Study and Treatment of Pain-ALGOS, Research Center for Behavior Assessment, Universitat Rovira i Virgili, Carretera de Valls, s/n, Tarragona, 43007, Spain, 34 +34649298921, jordi.miro@urv.cat %K assessment %K Delphi method %K MAG %K mobile apps %K mobile health %K validity %K guide %D 2020 %7 31.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In recent years, there has been an exponential growth of mobile health (mHealth)–related apps. This has occurred in a somewhat unsupervised manner. Therefore, having a set of criteria that could be used by all stakeholders to guide the development process and the assessment of the quality of the apps is of most importance. Objective: The aim of this paper is to study the validity of the Mobile App Development and Assessment Guide (MAG), a guide recently created to help stakeholders develop and assess mobile health apps. Methods: To conduct a validation process of the MAG, we used the Delphi method to reach a consensus among participating stakeholders. We identified 158 potential participants: 45 patients as potential end users, 41 health care professionals, and 72 developers. We sent participants an online survey and asked them to rate how important they considered each item in the guide to be on a scale from 0 to 10. Two rounds were enough to reach consensus. Results: In the first round, almost one-third (n=42) of those invited participated, and half of those (n=24) also participated in the second round. Most items in the guide were found to be important to a quality mHealth-related app; a total of 48 criteria were established as important. “Privacy,” “security,” and “usability” were the categories that included most of the important criteria. Conclusions: The data supports the validity of the MAG. In addition, the findings identified the criteria that stakeholders consider to be most important. The MAG will help advance the field by providing developers, health care professionals, and end users with a valid guide so that they can develop and identify mHealth-related apps that are of quality. %M 32735226 %R 10.2196/17760 %U http://mhealth.jmir.org/2020/7/e17760/ %U https://doi.org/10.2196/17760 %U http://www.ncbi.nlm.nih.gov/pubmed/32735226 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e17854 %T Development of a Short Instrument for Measuring Health-Related Quality of Life in Oncological Patients for Clinical Use: Protocol for an Observational Study %A Schrage,Theresa %A Görlach,Mirja %A Betz,Christian Stephan %A Bokemeyer,Carsten %A Kröger,Nicolaus %A Mueller,Volkmar %A Petersen,Cordula %A Krüll,Andreas %A Schulz,Holger %A Bleich,Christiane %+ Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, Germany, 49 40741053807, t.schrage@uke.de %K patient-reported outcomes %K health-related quality of life %K oncology %K psychometric validation %K mixed methods study %D 2020 %7 29.7.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer patients often suffer from the physical and psychological burden of their disease and its treatment. This is frequently insufficiently identified and addressed in clinical practice. In the context of improving patient-centered care in oncological patients, patient-reported outcomes (PROs) represent an important addition to current routine care. So far, available PRO questionnaires for cancer patients are unsuitable for routine procedures due to their length and complexity. Objective: This study aimed to develop and psychometrically test a short questionnaire to measure health-related quality of life (HrQoL) in cancer patients for use in routine care. Methods: This observational study consists of two parts: (1) a qualitative study to develop a short questionnaire measuring HrQoL and (2) a quantitative study to psychometrically test this questionnaire in five oncological departments of a comprehensive cancer center. In part 1 of the study, semistructured interviews with 28 cancer patients, as well as five focus groups with 22 clinicians and nurses, were conducted to identify clinically relevant dimensions of HrQoL. The identified dimensions were complemented with related dimensions from empirical studies and reviewed via expert discussion. Based on this, a short instrument was developed. In part 2 of the study, the developed questionnaire was tested in cancer in- and outpatients at five participating oncological clinics using additional standardized questionnaires assessing HrQoL and other important PROs. The questionnaire was presented to more than 770 patients twice during treatment. Results: The project started in May 2017 with recruitment for study phase I beginning in December 2017. Recruitment for study phases I and II ended in April 2018 and February 2019, respectively. After study phase II and psychometrical analyses, the newly developed questionnaire measuring the HrQoL of all cancer entities in routine care was finalized. Conclusions: With five to six dimensions and one item per dimension, the developed questionnaire is short enough to not disrupt routine procedures during treatment and is profound enough to inform clinicians about the patient’s HrQoL impairments and status. Trial Registration: Open Science Framework Registries 10.17605/OSF.IO/Y7XCE; https://osf.io/y7xce/ International Registered Report Identifier (IRRID): RR1-10.2196/17854 %M 32726289 %R 10.2196/17854 %U https://www.researchprotocols.org/2020/7/e17854 %U https://doi.org/10.2196/17854 %U http://www.ncbi.nlm.nih.gov/pubmed/32726289 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17967 %T The Assessment of Supportive Accountability in Adults Seeking Obesity Treatment: Psychometric Validation Study %A Chhabria,Karishma %A Ross,Kathryn M %A Sacco,Shane J %A Leahey,Tricia M %+ The Center for Health Care Data, Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, 1200 Pressler St, Houston, TX, 77030, United States, 1 713 500 9428, karishma.s.chhabria@uth.tmc.edu %K supportive accountability %K social support %K SALLIS %K factor analysis %K obesity %K weight loss %K technology %K mobile phone %D 2020 %7 28.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Technology-mediated obesity treatments are commonly affected by poor long-term adherence. Supportive Accountability Theory suggests that the provision of social support and oversight toward goals may help to maintain adherence in technology-mediated treatments. However, no tool exists to measure the construct of supportive accountability. Objective: This study aimed to develop and psychometrically validate a supportive accountability measure (SAM) by examining its performance in technology-mediated obesity treatment. Methods: Secondary data analyses were conducted in 2 obesity treatment studies to validate the SAM (20 items). Study 1 examined reliability, criterion validity, and construct validity using an exploratory factor analysis in individuals seeking obesity treatment. Study 2 examined the construct validity of SAM in technology-mediated interventions involving different self-monitoring tools and varying amounts of phone-based interventionist support. Participants received traditional self-monitoring tools (standard, in-home self-monitoring scale [SC group]), newer, technology-based self-monitoring tools (TECH group), or these newer technology tools plus additional phone-based support (TECH+PHONE group). Given that the TECH+PHONE group involves more interventionist support, we hypothesized that this group would have greater supportive accountability than the other 2 arms. Results: In Study 1 (n=353), the SAM showed strong reliability (Cronbach α=.92). A factor analysis revealed a 3-factor solution (representing Support for Healthy Eating Habits, Support for Exercise Habits, and Perceptions of Accountability) that explained 69% of the variance. Convergent validity was established using items from the motivation for weight loss scale, specifically the social regulation subscale (r=0.33; P<.001) and social pressure for weight loss subscale (r=0.23; P<.001). In Study 2 (n=80), the TECH+PHONE group reported significantly higher SAM scores at 6 months compared with the SC and TECH groups (r2=0.45; P<.001). Higher SAM scores were associated with higher adherence to weight management behaviors, including higher scores on subscales representing healthy dietary choices, the use of self-monitoring strategies, and positive psychological coping with weight management challenges. The association between total SAM scores and percent weight change was in the expected direction but not statistically significant (r=−0.26; P=.06). Conclusions: The SAM has strong reliability and validity across the 2 studies. Future studies may consider using the SAM in technology-mediated weight loss treatment to better understand whether support and accountability are adequately represented and how supportive accountability impacts treatment adherence and outcomes. Trial Registration: ClinicalTrials.gov NCT01999244; https://clinicaltrials.gov/ct2/show/NCT01999244 %M 32720911 %R 10.2196/17967 %U https://www.jmir.org/2020/7/e17967 %U https://doi.org/10.2196/17967 %U http://www.ncbi.nlm.nih.gov/pubmed/32720911 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17312 %T Psychometric Properties of the Norwegian Version of the Electronic Health Literacy Scale (eHEALS) Among Patients After Percutaneous Coronary Intervention: Cross-Sectional Validation Study %A Brørs,Gunhild %A Wentzel-Larsen,Tore %A Dalen,Håvard %A Hansen,Tina B %A Norman,Cameron D %A Wahl,Astrid %A Norekvål,Tone M %A , %+ Department of Heart Disease, Haukeland University Hospital, Postbox 1400, Bergen, 5020, Norway, 47 99044635, tone.merete.norekval@helse-bergen.no %K eHealth literacy %K eHEALS %K health literacy %K percutaneous coronary intervention %K psychometric properties %K validation %D 2020 %7 28.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based technology has recently become an important source for sharing health information with patients after an acute cardiac event. Therefore, consideration of patients’ perceived electronic health (eHealth) literacy skills is crucial for improving the delivery of patient-centered health information. Objective: The aim of this study was to translate and adapt the eHealth Literacy Scale (eHEALS) to conditions in Norway, and to determine its psychometric properties. More specifically, we set out to determine the reliability (internal consistency, test-retest) and construct validity (structural validity, hypotheses testing, and cross-cultural validity) of the eHEALS in self-report format administered to patients after percutaneous coronary intervention. Methods: The original English version of the eHEALS was translated into Norwegian following a widely used cross-cultural adaptation process. Internal consistency was calculated using Cronbach α. The intraclass correlation coefficient (ICC) was used to assess the test-retest reliability. Confirmatory factor analysis (CFA) was performed for a priori-specified 1-, 2-, and 3-factor models. Demographic, health-related internet use, health literacy, and health status information was collected to examine correlations with eHEALS scores. Results: A total of 1695 patients after percutaneous coronary intervention were included in the validation analysis. The mean age was 66 years, and the majority of patients were men (1313, 77.46%). Cronbach α for the eHEALS was >.99. The corresponding Cronbach α for the 2-week retest was .94. The test-retest ICC for eHEALS was 0.605 (95% CI 0.419-0.743, P<.001). The CFA showed a modest model fit for the 1- and 2-factor models (root mean square error of approximation>0.06). After modifications in the 3-factor model, all of the goodness-of-fit indices indicated a good fit. There was a weak correlation with age (r=–0.206). Between-groups analysis of variance showed a difference according to educational groups and the eHEALS score, with a mean difference ranging from 2.24 (P=.002) to 4.61 (P<.001), and a higher eHEALS score was found for patients who were employed compared to those who were retired (mean difference 2.31, P<.001). The eHEALS score was also higher among patients who reported using the internet to find health information (95% CI –21.40 to –17.21, P<.001), and there was a moderate correlation with the patients’ perceived usefulness (r=0.587) and importance (r=0.574) of using the internet for health information. There were also moderate correlations identified between the eHEALS score and the health literacy domains appraisal of health information (r=0.380) and ability to find good health information (r=0.561). Weak correlations with the mental health composite score (r=0.116) and physical health composite score (r=0.116) were identified. Conclusions: This study provides new information on the psychometric properties of the eHEALS for patients after percutaneous coronary intervention, suggesting a multidimensional rather than unidimensional construct. However, the study also indicated a redundancy of items, indicating the need for further validation studies. Trial Registration: ClinicalTrials.gov NCT03810612; https://clinicaltrials.gov/ct2/show/NCT03810612 %M 32720900 %R 10.2196/17312 %U https://www.jmir.org/2020/7/e17312 %U https://doi.org/10.2196/17312 %U http://www.ncbi.nlm.nih.gov/pubmed/32720900 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17134 %T Assessment of the Fairness of Privacy Policies of Mobile Health Apps: Scale Development and Evaluation in Cancer Apps %A Benjumea,Jaime %A Ropero,Jorge %A Rivera-Romero,Octavio %A Dorronzoro-Zubiete,Enrique %A Carrasco,Alejandro %+ Department of Electronic Technology, Universidad de Sevilla, Escuela Técnica Superior de Ingeniería Informática, Avda Reina Mercedes s/n, Sevilla, Spain, 34 6306 29719, jaimebm@us.es %K privacy %K mhealth apps %K fairness assessment scale %K cancer apps %K GDPR %D 2020 %7 28.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cancer patients are increasingly using mobile health (mHealth) apps to take control of their health. Many studies have explored their efficiency, content, usability, and adherence; however, these apps have created a new set of privacy challenges, as they store personal and sensitive data. Objective: The purpose of this study was to refine and evaluate a scale based on the General Data Protection Regulation and assess the fairness of privacy policies of mHealth apps. Methods: Based on the experience gained from our previous work, we redefined some of the items and scores of our privacy scale. Using the new version of our scale, we conducted a case study in which we analyzed the privacy policies of cancer Android apps. A systematic search of cancer mobile apps was performed in the Spanish version of the Google Play website. Results: The redefinition of certain items reduced discrepancies between reviewers. Thus, use of the scale was made easier, not only for the reviewers but also for any other potential users of our scale. Assessment of the privacy policies revealed that 29% (9/31) of the apps included in the study did not have a privacy policy, 32% (10/31) had a score over 50 out of a maximum of 100 points, and 39% (12/31) scored fewer than 50 points. Conclusions: In this paper, we present a scale for the assessment of mHealth apps that is an improved version of our previous scale with adjusted scores. The results showed a lack of fairness in the mHealth app privacy policies that we examined, and the scale provides developers with a tool to evaluate their privacy policies. %M 32720913 %R 10.2196/17134 %U http://mhealth.jmir.org/2020/7/e17134/ %U https://doi.org/10.2196/17134 %U http://www.ncbi.nlm.nih.gov/pubmed/32720913 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 7 %P e16850 %T Predicting the Development of Type 2 Diabetes in a Large Australian Cohort Using Machine-Learning Techniques: Longitudinal Survey Study %A Zhang,Lei %A Shang,Xianwen %A Sreedharan,Subhashaan %A Yan,Xixi %A Liu,Jianbin %A Keel,Stuart %A Wu,Jinrong %A Peng,Wei %A He,Mingguang %+ China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi’an Jiaotong University Health Science Center, 76 Yanta West Road, Yanta District, Xi'an, Shaanxi, 710061, China, 86 15910593477, Lei.Zhang1@monash.edu %K diabetes %K machine learning %K risk prediction %K cohort study %D 2020 %7 28.7.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Previous conventional models for the prediction of diabetes could be updated by incorporating the increasing amount of health data available and new risk prediction methodology. Objective: We aimed to develop a substantially improved diabetes risk prediction model using sophisticated machine-learning algorithms based on a large retrospective population cohort of over 230,000 people who were enrolled in the study during 2006-2017. Methods: We collected demographic, medical, behavioral, and incidence data for type 2 diabetes mellitus (T2DM) in over 236,684 diabetes-free participants recruited from the 45 and Up Study. We predicted and compared the risk of diabetes onset in these participants at 3, 5, 7, and 10 years based on three machine-learning approaches and the conventional regression model. Results: Overall, 6.05% (14,313/236,684) of the participants developed T2DM during an average 8.8-year follow-up period. The 10-year diabetes incidence in men was 8.30% (8.08%-8.49%), which was significantly higher (odds ratio 1.37, 95% CI 1.32-1.41) than that in women at 6.20% (6.00%-6.40%). The incidence of T2DM was doubled in individuals with obesity (men: 17.78% [17.05%-18.43%]; women: 14.59% [13.99%-15.17%]) compared with that of nonobese individuals. The gradient boosting machine model showed the best performance among the four models (area under the curve of 79% in 3-year prediction and 75% in 10-year prediction). All machine-learning models predicted BMI as the most significant factor contributing to diabetes onset, which explained 12%-50% of the variance in the prediction of diabetes. The model predicted that if BMI in obese and overweight participants could be hypothetically reduced to a healthy range, the 10-year probability of diabetes onset would be significantly reduced from 8.3% to 2.8% (P<.001). Conclusions: A one-time self-reported survey can accurately predict the risk of diabetes using a machine-learning approach. Achieving a healthy BMI can significantly reduce the risk of developing T2DM. %M 32720912 %R 10.2196/16850 %U https://medinform.jmir.org/2020/7/e16850 %U https://doi.org/10.2196/16850 %U http://www.ncbi.nlm.nih.gov/pubmed/32720912 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17926 %T Psychometric Properties of the Korean Version of the PsyMate Scale Using a Smartphone App: Ecological Momentary Assessment Study %A Yang,Yong Sook %A Ryu,Gi Wook %A Delespaul,Philippe A E G %A Choi,Mona %+ Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 3341, monachoi@yuhs.ac %K psychometrics %K reliability %K validity %K PsyMate scale %K ecological momentary assessment %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Ecological momentary assessment (EMA) is a method for capturing the changes in the variables in daily life with increased accuracy and decreased recall bias. The PsyMate scale assesses momentary moods in daily life and can be used in various settings. Objective: The aim of this study was to develop a Korean version of the PsyMate (K-PsyMate) scale and evaluate its psychometric properties by using the EMA method in patients with moyamoya disease (MMD) in South Korea. Methods: Patients with MMD aged over 18 years were recruited from July 2018 to January 2019 at the inpatient and outpatient departments of a university hospital in South Korea. The K-PsyMate scale comprising 13 items was developed following a translation/back translation approach of the English version and loaded onto a mobile app. Participants were instructed to enter their moods 4 times a day for 7 consecutive days. Content validity index, factor analysis, and Pearson’s correlation were performed for validity analysis. For reliability, intraclass correlation coefficients between the first and last measurements were estimated by mean rating, absolute agreement, and a 2-way mixed-effects model. Usability was analyzed through a descriptive analysis, 2-tailed t test, and analysis of variance, and the results were confirmed by Mann-Whitney U test and the Kruskal-Wallis test, as the dependent variable was not normally distributed. Results: In total, 1929 assessments from 93 patients were analyzed. The mean age of the participants was 40.59 (SD 10.06) years, and 66 (71%) of the 93 participants were women. Content validity was excellent as content validity index was 0.99, and 2 factors, negative affect and positive affect, were derived by an exploratory factor analysis. The correlations between the subdomains of the K-PsyMate scale and Hospital Anxiety and Depression Scale were significant (P<.001). The agreement between the first and last measurements was poor to moderate according to the obtained intraclass correlation coefficient values. Usability was evaluated by 67 (72%) out of the 93 participants. The participants rated the accuracy of assessing their momentary moods on the app at 4.13 (SD 0.97), easiness in understanding questions, operating, and inputting answers at 4.12 (SD 0.88), and interruption by the survey alarms at 2.48 (SD 1.02) out of 5. Conclusions: The K-PsyMate scale has good validity but poor to moderate agreement, which reflects the characteristics of the EMA data collected in real and natural living environments without control. The findings of our study show that the K-PsyMate scale uploaded in a mobile app can be a valid and reliable tool for evaluating the momentary mood of patients with MMD because using a mobile app is convenient and patients are familiar with their own smartphones, which they use in their daily lives. %M 32706707 %R 10.2196/17926 %U http://mhealth.jmir.org/2020/7/e17926/ %U https://doi.org/10.2196/17926 %U http://www.ncbi.nlm.nih.gov/pubmed/32706707 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 3 %P e19713 %T Patients’ Utilization and Perception of an Artificial Intelligence–Based Symptom Assessment and Advice Technology in a British Primary Care Waiting Room: Exploratory Pilot Study %A Miller,Stephen %A Gilbert,Stephen %A Virani,Vishaal %A Wicks,Paul %+ Ada Health GmbH, Adalbertstraße 20, Berlin, , Germany, 49 3060031987, science@ada.com %K human-centered design %K innovative %K health care apps %K eHealth %K symptom checker %K primary care %K general practice %K app %K usability %K acceptability %K utility %D 2020 %7 10.7.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: When someone needs to know whether and when to seek medical attention, there are a range of options to consider. Each will have consequences for the individual (primarily considering trust, convenience, usefulness, and opportunity costs) and for the wider health system (affecting clinical throughput, cost, and system efficiency). Digital symptom assessment technologies that leverage artificial intelligence may help patients navigate to the right type of care with the correct degree of urgency. However, a recent review highlighted a gap in the literature on the real-world usability of these technologies. Objective: We sought to explore the usability, acceptability, and utility of one such symptom assessment technology, Ada, in a primary care setting. Methods: Patients with a new complaint attending a primary care clinic in South London were invited to use a custom version of the Ada symptom assessment mobile app. This exploratory pilot study was conducted between November 2017 and January 2018 in a practice with 20,000 registered patients. Participants were asked to complete an Ada self-assessment about their presenting complaint on a study smartphone, with assistance provided if required. Perceptions on the app and its utility were collected through a self-completed study questionnaire following completion of the Ada self-assessment. Results: Over a 3-month period, 523 patients participated. Most were female (n=325, 62.1%), mean age 39.79 years (SD 17.7 years), with a larger proportion (413/506, 81.6%) of working-age individuals (aged 15-64) than the general population (66.0%). Participants rated Ada’s ease of use highly, with most (511/522, 97.8%) reporting it was very or quite easy. Most would use Ada again (443/503, 88.1%) and agreed they would recommend it to a friend or relative (444/520, 85.3%). We identified a number of age-related trends among respondents, with a directional trend for more young respondents to report Ada had provided helpful advice (50/54, 93%, 18-24-year olds reported helpful) than older respondents (19/32, 59%, adults aged 70+ reported helpful). We found no sex differences on any of the usability questions fielded. While most respondents reported that using the symptom checker would not have made a difference in their care-seeking behavior (425/494, 86.0%), a sizable minority (63/494, 12.8%) reported they would have used lower-intensity care such as self-care, pharmacy, or delaying their appointment. The proportion was higher for patients aged 18-24 (11/50, 22%) than aged 70+ (0/28, 0%). Conclusions: In this exploratory pilot study, the digital symptom checker was rated as highly usable and acceptable by patients in a primary care setting. Further research is needed to confirm whether the app might appropriately direct patients to timely care, and understand how this might save resources for the health system. More work is also needed to ensure the benefits accrue equally to older age groups. %M 32540836 %R 10.2196/19713 %U https://humanfactors.jmir.org/2020/3/e19713 %U https://doi.org/10.2196/19713 %U http://www.ncbi.nlm.nih.gov/pubmed/32540836 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 5 %N 3 %P e18208 %T Web-Based and mHealth Technologies to Support Self-Management in People Living With Type 2 Diabetes: Validation of the Diabetes Self-Management and Technology Questionnaire (DSMT-Q) %A Kelly,Laura %A Jenkinson,Crispin %A Morley,David %+ Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, United Kingdom, 44 (0)1865 289425, laura.kelly@ndph.ox.ac.uk %K mHealth %K self-care %K type 2 diabetes %K self-monitoring %K questionnaire %D 2020 %7 9.7.2020 %9 Original Paper %J JMIR Diabetes %G English %X Background: A growing number of web-based and mobile health (mHealth) technologies have been developed to support type 2 diabetes self-management. Little is known about individuals’ experiences with these technologies and how they support self-management. Appropriate tools are needed to understand how web-based and mHealth interventions may impact self-management. Objective: This study aimed to develop an instrument, the Diabetes Self-Management and Technology Questionnaire (DSMT-Q), to assess self-management among people living with type 2 diabetes who use web-based and mHealth technologies. Methods: A total of 36 candidate questionnaire items, drafted previously, were refined using cognitive debriefing interviews (n=8), expert consultation, and public patient involvement feedback. Item reduction steps were performed on survey data (n=250), and tests of validity and reliability were subsequently performed. Results: Following amendments, patients and experts found 21 items relevant and acceptable for inclusion in the instrument. Survey participants included 104 (41.6%) women and 146 (58.4%) men. Two subscales with high construct validity, internal consistency, and test-retest reliability were identified: “Understanding individual health and making informed decisions” and “Confidence to reach and sustain goals.” Conclusions: Analyses confirmed good psychometric properties in the DSMT-Q scales. This tool will facilitate the measurement of self-management in people living with type 2 diabetes who use web-based or mHealth technologies. %M 32673214 %R 10.2196/18208 %U https://diabetes.jmir.org/2020/3/e18208 %U https://doi.org/10.2196/18208 %U http://www.ncbi.nlm.nih.gov/pubmed/32673214 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e15770 %T Evaluating the Impact of the Grading and Assessment of Predictive Tools Framework on Clinicians and Health Care Professionals’ Decisions in Selecting Clinical Predictive Tools: Randomized Controlled Trial %A Khalifa,Mohamed %A Magrabi,Farah %A Gallego Luxan,Blanca %+ Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine and Health Sciences, Macquarie University, 75 Talavera Rd, North Ryde, NSW 2113, Sydney, 2113, Australia, 61 438632060, mohamed.khalifa@mq.edu.au %K clinical prediction rule %K clinical decision rules %K evidence-based medicine %K evaluation study %D 2020 %7 9.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: While selecting predictive tools for implementation in clinical practice or for recommendation in clinical guidelines, clinicians and health care professionals are challenged with an overwhelming number of tools. Many of these tools have never been implemented or evaluated for comparative effectiveness. To overcome this challenge, the authors developed and validated an evidence-based framework for grading and assessment of predictive tools (the GRASP framework). This framework was based on the critical appraisal of the published evidence on such tools. Objective: The aim of the study was to examine the impact of using the GRASP framework on clinicians’ and health care professionals’ decisions in selecting clinical predictive tools. Methods: A controlled experiment was conducted through a web-based survey. Participants were randomized to either review the derivation publications, such as studies describing the development of the predictive tools, on common traumatic brain injury predictive tools (control group) or to review an evidence-based summary, where each tool had been graded and assessed using the GRASP framework (intervention group). Participants in both groups were asked to select the best tool based on the greatest validation or implementation. A wide group of international clinicians and health care professionals were invited to participate in the survey. Task completion time, rate of correct decisions, rate of objective versus subjective decisions, and level of decisional conflict were measured. Results: We received a total of 194 valid responses. In comparison with not using GRASP, using the framework significantly increased correct decisions by 64%, from 53.7% to 88.1% (88.1/53.7=1.64; t193=8.53; P<.001); increased objective decision making by 32%, from 62% (3.11/5) to 82% (4.10/5; t189=9.24; P<.001); decreased subjective decision making based on guessing by 20%, from 49% (2.48/5) to 39% (1.98/5; t188=−5.47; P<.001); and decreased prior knowledge or experience by 8%, from 71% (3.55/5) to 65% (3.27/5; t187=−2.99; P=.003). Using GRASP significantly decreased decisional conflict and increased the confidence and satisfaction of participants with their decisions by 11%, from 71% (3.55/5) to 79% (3.96/5; t188=4.27; P<.001), and by 13%, from 70% (3.54/5) to 79% (3.99/5; t188=4.89; P<.001), respectively. Using GRASP decreased the task completion time, on the 90th percentile, by 52%, from 12.4 to 6.4 min (t193=−0.87; P=.38). The average System Usability Scale of the GRASP framework was very good: 72.5% and 88% (108/122) of the participants found the GRASP useful. Conclusions: Using GRASP has positively supported and significantly improved evidence-based decision making. It has increased the accuracy and efficiency of selecting predictive tools. GRASP is not meant to be prescriptive; it represents a high-level approach and an effective, evidence-based, and comprehensive yet simple and feasible method to evaluate, compare, and select clinical predictive tools. %M 32673228 %R 10.2196/15770 %U https://www.jmir.org/2020/7/e15770 %U https://doi.org/10.2196/15770 %U http://www.ncbi.nlm.nih.gov/pubmed/32673228 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 2 %P e16261 %T Development and Validation of the Reasons to Exergame (RTEX) Scale in Young Adults: Exploratory Factors Analysis %A O'Loughlin,Erin %A Sabiston,Catherine M %A Kakinami,Lisa %A McGrath,Jennifer J %A Consalvo,Mia %A O'Loughlin,Jennifer L %A Barnett,Tracie A %+ Centre de Recherche du CHUM, Concordia University, 850 rue Saint-Denis, Bureau S02-370, Montreal, QC, H2X 0A9, Canada, 1 514 890 8000 ext 15853, erin_oloughlin@hotmail.com %K exergaming %K youth %K young adults %K motivation %K scale %D 2020 %7 15.6.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Exergaming is associated with positive health benefits; however, little is known about what motivates young people to exergame. Objective: This study aimed to develop a new Reasons to Exergame (RTEX) scale and describe its psychometric properties (Study 1) including test-retest reliability (Study 2). We also examined the test-retest reliability of self-report exergaming behavior measures (Study 2). Methods: We identified scale items in consultation with experts. In Study 1, we conducted an Exploratory Factor Analysis of RTEX and examined how the factors identified relate to exergaming frequency and intensity in a population-based sample of 272 young adults. In Study 2, we examined the test-retest reliability of RTEX factors and self-report measures of past-week exergaming frequency and intensity among 147 college students. Results: We identified four factors in RTEX: exergaming for fitness, exergaming for enjoyment, preferring exergaming over other gaming options, and choosing exergaming over competing interests (eg, sports). Test-retest reliability of RTEX factors (ICC 0.7-0.8) and self-report exergaming frequency (ICC 0.4-0.9) was adequate. Exergaming for fitness and enjoyment were positively associated with the frequency of exergaming with friends and family, and with exergaming intensity. Preferring exergaming over other gaming options and choosing exergaming over competing interests (eg, sports) were not related to exergaming behavior. Conclusions: RTEX is a psychometrically sound scale with four factors that measure reasons to exergame. Replication of these findings is needed in larger, more diverse samples. %M 32538792 %R 10.2196/16261 %U http://games.jmir.org/2020/2/e16261/ %U https://doi.org/10.2196/16261 %U http://www.ncbi.nlm.nih.gov/pubmed/32538792 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e16213 %T Comparisons Between Hypothesis- and Data-Driven Approaches for Multimorbidity Frailty Index: A Machine Learning Approach %A Peng,Li-Ning %A Hsiao,Fei-Yuan %A Lee,Wei-Ju %A Huang,Shih-Tsung %A Chen,Liang-Kung %+ Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei, 11217, Taiwan, 886 2 28757830, lkchen2@vghtpe.gov.tw %K multimorbidity frailty index %K machine learning %K random forest %K unplanned hospitalizations %K intensive care unit admissions %K mortality %D 2020 %7 11.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Using big data and the theory of cumulative deficits to develop the multimorbidity frailty index (mFI) has become a widely accepted approach in public health and health care services. However, constructing the mFI using the most critical determinants and stratifying different risk groups with dose-response relationships remain major challenges in clinical practice. Objective: This study aimed to develop the mFI by using machine learning methods that select variables based on the optimal fitness of the model. In addition, we aimed to further establish 4 entities of risk using a machine learning approach that would achieve the best distinction between groups and demonstrate the dose-response relationship. Methods: In this study, we used Taiwan’s National Health Insurance Research Database to develop a machine learning multimorbidity frailty index (ML-mFI) using the theory of cumulative diseases/deficits of an individual older person. Compared to the conventional mFI, in which the selection of diseases/deficits is based on expert opinion, we adopted the random forest method to select the most influential diseases/deficits that predict adverse outcomes for older people. To ensure that the survival curves showed a dose-response relationship with overlap during the follow-up, we developed the distance index and coverage index, which can be used at any time point to classify the ML-mFI of all subjects into the categories of fit, mild frailty, moderate frailty, and severe frailty. Survival analysis was conducted to evaluate the ability of the ML-mFI to predict adverse outcomes, such as unplanned hospitalizations, intensive care unit (ICU) admissions, and mortality. Results: The final ML-mFI model contained 38 diseases/deficits. Compared with conventional mFI, both indices had similar distribution patterns by age and sex; however, among people aged 65 to 69 years, the mean mFI and ML-mFI were 0.037 (SD 0.048) and 0.0070 (SD 0.0254), respectively. The difference may result from discrepancies in the diseases/deficits selected in the mFI and the ML-mFI. A total of 86,133 subjects aged 65 to 100 years were included in this study and were categorized into 4 groups according to the ML-mFI. Both the Kaplan-Meier survival curves and Cox models showed that the ML-mFI significantly predicted all outcomes of interest, including all-cause mortality, unplanned hospitalizations, and all-cause ICU admissions at 1, 5, and 8 years of follow-up (P<.01). In particular, a dose-response relationship was revealed between the 4 ML-mFI groups and adverse outcomes. Conclusions: The ML-mFI consists of 38 diseases/deficits that can successfully stratify risk groups associated with all-cause mortality, unplanned hospitalizations, and all-cause ICU admissions in older people, which indicates that precise, patient-centered medical care can be a reality in an aging society. %M 32525481 %R 10.2196/16213 %U http://www.jmir.org/2020/6/e16213/ %U https://doi.org/10.2196/16213 %U http://www.ncbi.nlm.nih.gov/pubmed/32525481 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e15815 %T Reliability, Feasibility, and Patient Acceptance of an Electronic Version of a Multidimensional Health Assessment Questionnaire for Routine Rheumatology Care: Validation and Patient Preference Study %A Pincus,Theodore %A Castrejon,Isabel %A Riad,Mariam %A Obreja,Elena %A Lewis,Candice %A Krogh,Niels Steen %+ Rush University Medical Center, 1611 West Harrison, Suite 510, Chicago, IL, United States, 1 3129428268, tedpincus@gmail.com %K patient reported outcomes %K health status measures %K electronic version %K rapid3 %K mdhaq %D 2020 %7 27.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: A multidimensional health assessment questionnaire (MDHAQ) that was developed primarily for routine rheumatology care has advanced clinical research concerning disease burden, disability, and mortality in rheumatic diseases. Routine Assessment of Patient Index Data 3 (RAPID3), an index within the MDHAQ, is the most widely used index to assess rheumatoid arthritis (RA) in clinical care in the United States, and it recognizes clinical status changes in all studied rheumatic diseases. MDHAQ physical function scores are far more significant in the prognosis of premature RA mortality than laboratory or imaging data. However, electronic medical records (EMRs) generally do not include patient questionnaires. An electronic MDHAQ (eMDHAQ), linked by fast healthcare interoperability resources (FIHR) to an EMR, can facilitate clinical and research advances. Objective: This study analyzed the reliability, feasibility, and patient acceptance of an eMDHAQ. Methods: Since 2006, all Rush University Medical Center rheumatology patients with all diagnoses have been asked to complete a paper MDHAQ at each routine care encounter. In April 2019, patients were invited to complete an eMDHAQ at the conclusion of the encounter. Analyses were conducted to determine the reliability of eMDHAQ versus paper MDHAQ scores, arithmetically and by intraclass correlation coefficient (ICC). The feasibility of the eMDHAQ was analyzed based on the time for patient completion. The patient preference for the electronic or paper version was analyzed through a patient paper questionnaire. Results: The 98 study patients were a typical routine rheumatology patient group. Seven paper versus eMDHAQ scores were within 2%, differences neither clinically nor statistically significant. ICCs of 0.86-0.98 also indicated good to excellent reliability. Mean eMDHAQ completion time was a feasible 8.2 minutes. The eMDHAQ was preferred by 72% of patients; preferences were similar according to age and educational level. Conclusions: The results on a paper MDHAQ versus eMDHAQ were similar. Most patients preferred an eMDHAQ. %M 32459182 %R 10.2196/15815 %U http://formative.jmir.org/2020/5/e15815/ %U https://doi.org/10.2196/15815 %U http://www.ncbi.nlm.nih.gov/pubmed/32459182 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15909 %T A Questionnaire for Assessing User Satisfaction With Mobile Health Apps: Development Using Rasch Measurement Theory %A Melin,Jeanette %A Bonn,Stephanie Erika %A Pendrill,Leslie %A Trolle Lagerros,Ylva %+ Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Eugeniahemmet T2, Stockholm, 171 76, Sweden, 46 46 851779183, ylva.trolle@ki.se %K cell phone %K healthy lifestyle %K methods %K mobile applications %K psychometrics %K smartphone %K telemedicine %K mobile phone %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps offer great opportunities to deliver large-scale, cost-efficient digital solutions for implementing lifestyle changes. Furthermore, many mHealth apps act as medical devices. Yet, there is little research on how to assess user satisfaction with an mHealth solution. Objective: This study presents the development of the mHealth Satisfaction Questionnaire and evaluates its measurement properties. Methods: Respondents who took part in the Health Integrator Study and were randomized to use the Health Integrator smartphone app for lifestyle changes (n=112), with and without additional telephone coaching, rated their satisfaction with the app using the new 14-item mHealth Satisfaction Questionnaire. The ratings were given on a 5-point Likert scale and measurement properties were evaluated using Rasch measurement theory (RMT). Results: Optimal scoring was reached when response options 2, 3, and 4 were collapsed, giving three response categories. After omitting two items that did not fit into the scale, fit residuals were within, or close to, the recommended range of ±2.5. There was no differential item functioning between intervention group, age group, or sex. The Person Separation Index was 0.79, indicating that the scale’s ability to discriminate correctly between person leniency was acceptable for group comparisons but not for individual evaluations. The scale did not meet the criterion of unidimensionality; 16.1% (18/112) of the respondents were outside the desired range of −1.96 to 1.96. In addition, several items showed local dependency and three underlying dimensions emerged: negative experiences, positive experiences, and lifestyle consequences of using the mHealth solution. Conclusions: In times where mHealth apps and digital solutions are given more attention, the mHealth Satisfaction Questionnaire provides a new possibility to measure user satisfaction to ensure usability and improve development of new apps. Our study is one of only a few cases where RMT has been used to evaluate the usability of such an instrument. There is, though, a need for further development of the mHealth Satisfaction Questionnaire, including the addition of more items and consideration of further response options. The mHealth Satisfaction Questionnaire should also be evaluated in a larger sample and with other mHealth apps and in other contexts. Trial Registration: ClinicalTrials.gov NCT03579342; http://clinicaltrials.gov/ct2/show/NCT03579342. %M 32452817 %R 10.2196/15909 %U http://mhealth.jmir.org/2020/5/e15909/ %U https://doi.org/10.2196/15909 %U http://www.ncbi.nlm.nih.gov/pubmed/32452817 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16669 %T Autoencoder as a New Method for Maintaining Data Privacy While Analyzing Videos of Patients With Motor Dysfunction: Proof-of-Concept Study %A D'Souza,Marcus %A Van Munster,Caspar E P %A Dorn,Jonas F %A Dorier,Alexis %A Kamm,Christian P %A Steinheimer,Saskia %A Dahlke,Frank %A Uitdehaag,Bernard M J %A Kappos,Ludwig %A Johnson,Matthew %+ Neurologic Clinic and Policlinic, Departments of Medicine, Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Petersgraben 4, Basel, 4031, Switzerland, 41 61 265 4151, marcus.dsouza@usb.ch %K autoencoder %K video-rating %K machine learning algorithms %K deep neuronal network %K Neurostatus-EDSS %D 2020 %7 8.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In chronic neurological diseases, especially in multiple sclerosis (MS), clinical assessment of motor dysfunction is crucial to monitor the disease in patients. Traditional scales are not sensitive enough to detect slight changes. Video recordings of patient performance are more accurate and increase the reliability of severity ratings. When these recordings are automated, quantitative disability assessments by machine learning algorithms can be created. Creation of these algorithms involves non–health care professionals, which is a challenge for maintaining data privacy. However, autoencoders can address this issue. Objective: The aim of this proof-of-concept study was to test whether coded frame vectors of autoencoders contain relevant information for analyzing videos of the motor performance of patients with MS. Methods: In this study, 20 pre-rated videos of patients performing the finger-to-nose test were recorded. An autoencoder created encoded frame vectors from the original videos and decoded the videos again. The original and decoded videos were shown to 10 neurologists at an academic MS center in Basel, Switzerland. The neurologists tested whether the 200 videos were human-readable after decoding and rated the severity grade of each original and decoded video according to the Neurostatus-Expanded Disability Status Scale definitions of limb ataxia. Furthermore, the neurologists tested whether ratings were equivalent between the original and decoded videos. Results: In total, 172 of 200 (86.0%) videos were of sufficient quality to be ratable. The intrarater agreement between the original and decoded videos was 0.317 (Cohen weighted kappa). The average difference in the ratings between the original and decoded videos was 0.26, in which the original videos were rated as more severe. The interrater agreement between the original videos was 0.459 and that between the decoded videos was 0.302. The agreement was higher when no deficits or very severe deficits were present. Conclusions: The vast majority of videos (172/200, 86.0%) decoded by the autoencoder contained clinically relevant information and had fair intrarater agreement with the original videos. Autoencoders are a potential method for enabling the use of patient videos while preserving data privacy, especially when non–health-care professionals are involved. %M 32191621 %R 10.2196/16669 %U https://www.jmir.org/2020/5/e16669 %U https://doi.org/10.2196/16669 %U http://www.ncbi.nlm.nih.gov/pubmed/32191621 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e15668 %T The Korean Version of the Academic Cyberincivility Assessment Questionnaire for Nursing Students in South Korea: Validity and Reliability Study %A Hong,Minjoo %A De Gagne,Jennie C %A Shin,Hyewon %A Kwon,Suhye %A Choi,Gum-Hee %+ School of Nursing, Clemson University, 605 Grove Road, Greenville, SC, 29605, United States, 1 864 720 2060, shin@clemson.edu %K cybercivility %K health professions education %K nursing students %K social media %K web-based learning %D 2020 %7 5.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Cybercivility, the practice of what to say and how to say it in online environments, encourages individuals to treat each other with respect. However, the anonymity of online communities may lead some individuals to behave in ways that violate social and cultural norms. These individuals treat others with a lack of regard and even bully others in faceless online confrontations. This practice of cyberincivility can be found across the internet, on commercial sites, and in schools offering online courses. Research on cybercivility and cyberincivility has increased in the United States, where instruments have been developed to measure the impact of cyberincivility in health profession education. However, there is no available instrument that measures nursing students’ online behaviors in South Korea. Objective: The aim of this study was to develop and evaluate a Korean version of the Academic Cyberincivility Assessment Questionnaire developed in the United States. Methods: Data were collected from 213 nursing students in three South Korean colleges. The Academic Cyberincivility Assessment Questionnaire developed by De Gagne and colleagues was adapted to measure students’ knowledge of cybercivility, and their experiences with and acceptability of cyberincivility. Content validity was tested using the content validity index (CVI). Criterion validity was tested using the digital citizenship scale. Reliability was evaluated using Cronbach alpha. The goodness-of-fit of construct validity was determined through exploratory and confirmatory factor analyses. Results: The CVI was 0.8 or higher for all items. Kuder–Richardson Formula 20, measuring reliability of the knowledge scale, was 0.22 and Cronbach alpha, measuring reliability of the experience scale, was .96. The goodness-of-fit of the model was Chi square=5568.63 (P<.001), the comparative fit index (CFI) was 0.92, and the root mean square error of approximation (RMSEA) was 0.08, which satisfied the criteria. The reliability of the acceptability scale was .96, and the goodness-of-fit indices satisfied the criteria (minimum Chi square/df=2.34, Tucker-Lewis Index =0.92, incremental fit index=0.93, root mean square residual=0.05, CFI=0.93, and RMSEA=0.08). Conclusions: This study extended and reevaluated the US version of cybercivility scales in a culturally distinct context. The three dimensions of cybercivility include knowledge, experience, and acceptability. Acceptability is well-validated as a dimension, whereas the knowledge dimension requires reexamination for application to Koreans. A revision of the instrument is needed that considers the cultural differences between South Korea and the United States. This paper calls for more attention to be paid to contextualized cybercivility scales among health professions in countries outside the United States. %M 32369027 %R 10.2196/15668 %U https://www.jmir.org/2020/5/e15668 %U https://doi.org/10.2196/15668 %U http://www.ncbi.nlm.nih.gov/pubmed/32369027 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e15075 %T Development and Validation of a Comprehensive Well-Being Scale for People in the University Environment (Pitt Wellness Scale) Using a Crowdsourcing Approach: Cross-Sectional Study %A Zhou,Leming %A Parmanto,Bambang %+ Department of Health Information Management, University of Pittsburgh, 6021 Forbes Tower, 3600 Forbes Ave at Meyran Ave, Pittsburgh, PA, 15260, United States, 1 412 383 6653, Leming.Zhou@pitt.edu %K crowdsourcing %K questionnaire design %K university %D 2020 %7 29.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Well-being has multiple domains, and these domains are unique to the population being examined. Therefore, to precisely assess the well-being of a population, a scale specifically designed for that population is needed. Objective: The goal of this study was to design and validate a comprehensive well-being scale for people in a university environment, including students, faculty, and staff. Methods: A crowdsourcing approach was used to determine relevant domains for the comprehensive well-being scale in this population and identify specific questions to include in each domain. A web-based questionnaire (Q1) was used to collect opinions from a group of university students, faculty, and staff about the domains and subdomains of the scale. A draft of a new well-being scale (Q2) was created in response to the information collected via Q1, and a second group of study participants was invited to evaluate the relevance and clarity of each statement. A newly created well-being scale (Q3) was then used by a third group of university students, faculty, and staff. A psychometric analysis was performed on the data collected via Q3 to determine the validity and reliability of the well-being scale. Results: In the first step, a group of 518 university community members (students, faculty, and staff) indicated the domains and subdomains that they desired to have in a comprehensive well-being scale. In the second step, a second group of 167 students, faculty, and staff evaluated the relevance and clarity of the proposed statements in each domain. In the third step, a third group of 546 students, faculty, and staff provided their responses to the new well-being scale (Pitt Wellness Scale). The psychometric analysis indicated that the reliability of the well-being scale was high. Conclusions: Using a crowdsourcing approach, we successfully created a comprehensive and highly reliable well-being scale for people in the university environment. Our new Pitt Wellness Scale may be used to measure the well-being of people in the university environment. %M 32347801 %R 10.2196/15075 %U http://www.jmir.org/2020/4/e15075/ %U https://doi.org/10.2196/15075 %U http://www.ncbi.nlm.nih.gov/pubmed/32347801 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 4 %P e17497 %T A Web-Based Adaptation of the Quality of Life in Bipolar Disorder Questionnaire: Psychometric Evaluation Study %A Morton,Emma %A Hou,Sharon HJ %A Fogarty,Oonagh %A Murray,Greg %A Barnes,Steven %A Depp,Colin %A , %A Michalak,Erin %+ Department of Psychiatry, University of British Columbia, 420-5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada, 1 604 827 3393, emma.morton@ubc.ca %K bipolar disorder %K survey methodology %K patient reported outcomes %K psychometrics %K questionnaire design %K quality of life %K validation studies %D 2020 %7 27.4.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Quality of life (QoL) is considered a key treatment outcome in bipolar disorder (BD) across research, clinical, and self-management contexts. Web-based assessment of patient-reported outcomes offer numerous pragmatic benefits but require validation to ensure measurement equivalency. A web-based version of the Quality of Life in Bipolar Disorder (QoL.BD) questionnaire was developed (QoL Tool). Objective: This study aimed to evaluate the psychometric properties of a web-based QoL self-report questionnaire for BD (QoL Tool). Key aims were to (1) characterize the QoL of the sample using the QoL Tool, (2) evaluate the internal consistency of the web-based measure, and (3) determine whether the factor structure of the original version of the QoL.BD instrument was replicated in the web-based instrument. Methods: Community-based participatory research methods were used to inform the development of a web-based adaptation of the QoL.BD instrument. Individuals with BD who registered for an account with the QoL Tool were able to opt in to sharing their data for research purposes. The distribution of scores and internal consistency estimates, as indicated by Cronbach alpha, were inspected. An exploratory factor analysis using maximum likelihood and oblique rotation was conducted. Inspection of the scree plot, eigenvalues, and minimum average partial correlation were used to determine the optimal factor structure to extract. Results: A total of 498 people with BD (349/498, 70.1% female; mean age 39.64, SD 12.54 years; 181/498, 36.3% BD type I; 195/498, 39.2% BD type II) consented to sharing their QoL Tool data for the present study. Mean scores across the 14 QoL Tool domains were, in general, significantly lower than that of the original QoL.BD validation sample. Reliability estimates for QoL Tool domains were comparable with that observed for the QoL.BD instrument (Cronbach alpha=.70-.93). Exploratory factor analysis supported the extraction of an 11-factor model, with item loadings consistent with the factor structure suggested by the original study. Findings for the sleep and physical domains differed from the original study, with this analysis suggesting one shared latent construct. Conclusions: The psychometric properties of the web-based QoL Tool are largely concordant with the original pen-and-paper QoL.BD, although some minor differences in the structure of the sleep and physical domains were observed. Despite this small variation from the factor structure identified in the QoL.BD instrument, the latent factor structure of the QoL Tool largely reproduced the original findings and theoretical structure of QoL areas relevant to people with BD. These findings underscore the research and clinical utility of this instrument, but further comparison of the psychometric properties of the QoL Tool relative to the QoL.BD instrument is warranted. Future adaptations of the QoL Tool, including the production of an app-based version of the QoL Tool, are also discussed. %M 32338620 %R 10.2196/17497 %U http://mental.jmir.org/2020/4/e17497/ %U https://doi.org/10.2196/17497 %U http://www.ncbi.nlm.nih.gov/pubmed/32338620 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e15376 %T Exploring the Hierarchical Influence of Cognitive Functions for Alzheimer Disease: The Framingham Heart Study %A Ding,Huitong %A An,Ning %A Au,Rhoda %A Devine,Sherral %A Auerbach,Sanford H %A Massaro,Joseph %A Joshi,Prajakta %A Liu,Xue %A Liu,Yulin %A Mahon,Elizabeth %A Ang,Ting FA %A Lin,Honghuang %+ Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, 72 E Concord St, E632, Boston, MA, 02118, United States, 1 6173580091, hhlin@bu.edu %K Alzheimer disease %K neuropsychological test %K stratification %K Bayesian network %K clustering %D 2020 %7 23.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Although some neuropsychological (NP) tests are considered more central for the diagnosis of Alzheimer disease (AD), there is a lack of understanding about the interaction between different cognitive tests. Objective: This study aimed to demonstrate a global view of hierarchical probabilistic dependencies between NP tests and the likelihood of cognitive impairment to assist physicians in recognizing AD precursors. Methods: Our study included 2091 participants from the Framingham Heart Study. These participants had undergone a variety of NP tests, including Wechsler Memory Scale, Wechsler Adult Intelligence Scale, and Boston Naming Test. Heterogeneous cognitive Bayesian networks were developed to understand the relationship between NP tests and the cognitive status. The performance of probabilistic inference was evaluated by the 10-fold cross validation. Results: A total of 4512 NP tests were used to build the Bayesian network for the dementia diagnosis. The network demonstrated conditional dependency between different cognitive functions that precede the development of dementia. The prediction model reached an accuracy of 82.24%, with sensitivity of 63.98% and specificity of 92.74%. This probabilistic diagnostic system can also be applied to participants that exhibit more heterogeneous profiles or with missing responses for some NP tests. Conclusions: We developed a probabilistic dependency network for AD diagnosis from 11 NP tests. Our study revealed important psychological functional segregations and precursor evidence of AD development and heterogeneity. %M 32324139 %R 10.2196/15376 %U http://www.jmir.org/2020/4/e15376/ %U https://doi.org/10.2196/15376 %U http://www.ncbi.nlm.nih.gov/pubmed/32324139 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16520 %T The French eHealth Acceptability Scale Using the Unified Theory of Acceptance and Use of Technology 2 Model: Instrument Validation Study %A Hayotte,Meggy %A Thérouanne,Pierre %A Gray,Laura %A Corrion,Karine %A d'Arripe-Longueville,Fabienne %+ Laboratoire Motricité Humaine Expertise Sport Santé, Université Côte d'Azur, 261 Boulevard du Mercantour, Nice, 06200, France, 33 4 89 15 39 52, meggy.hayotte@etu.univ-cotedazur.fr %K telemedicine %K validation study %K factor analysis, statistical %K surveys and questionnaires %K acceptability %D 2020 %7 15.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Technology-based physical activity suggests new opportunities for public health initiatives. Yet only 45% of technology interventions are theoretically based, and the acceptability mechanisms have been insufficiently studied. Acceptability and acceptance theories have provided interesting insights, particularly the unified theory of acceptance and use of technology 2 (UTAUT2). In several studies, the psychometric qualities of acceptability scales have not been well demonstrated. Objective: The aim of this study was to adapt the UTAUT2 to the electronic health (eHealth) context and provide a preliminary validation of the eHealth acceptability scale in a French sample. Methods: In line with the reference validation methodologies, we carried out the following stages of validating the scale with a total of 576 volunteers: translation and adaptation, dimensionality tests, reliability tests, and construct validity tests. We used confirmatory factor analysis to validate a 22-item instrument with 7 subscales: Performance Expectancy, Effort Expectancy, Social Influence, Facilitating Conditions, Hedonic Motivation, Price Value, and Habit. Results: The dimensionality tests showed that the bifactor confirmatory model presented the best fit indexes: χ2173=434.86 (P<.001), χ2/df=2.51, comparative fit index=.97, Tucker-Lewis index=.95, and root mean square error of approximation=.053 (90% CI .047-.059). The invariance tests of the eHealth acceptability factor structure by sex demonstrated no significant differences between models, except for the strict model. The partial strict model demonstrated no difference from the strong model. Cronbach alphas ranged from .77 to .95 for the 7 factors. We measured the internal reliability with a 4-week interval. The intraclass correlation coefficients for each subscale ranged from .62 to .88, and there were no significant differences in the t tests from time 1 to time 2. Assessments for convergent validity demonstrated that the eHealth acceptability constructs were significantly and positively related to behavioral intention, usage, and constructs from the technology acceptance model and the theory of planned behavior. Conclusions: The 22-item French-language eHealth acceptability scale, divided into 7 subscales, showed good psychometric qualities. This scale is thus a valid and reliable tool to assess the acceptability of eHealth technology in French-speaking samples and offers promising avenues in research, clinical practice, and marketing. %M 32293569 %R 10.2196/16520 %U https://www.jmir.org/2020/4/e16520 %U https://doi.org/10.2196/16520 %U http://www.ncbi.nlm.nih.gov/pubmed/32293569 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16148 %T Development of an Instrument to Assess Parents’ Excessive Web-Based Searches for Information Pertaining to Their Children’s Health: The “Children’s Health Internet Research, Parental Inventory” (CHIRPI) %A Barke,Antonia %A Doering,Bettina K %+ Clinical and Biological Psychology, Catholic University Eichstaett-Ingolstadt, Ostenstrasse 25, Eichstaett, 85072, Germany, 49 842193 ext 21842, abarke@gwdg.de %K hypochondriasis %K internet %K health behavior %K health knowledge, attitudes, practice %K questionnaire %K children %K parents %D 2020 %7 15.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: People often search the internet to obtain health-related information not only for themselves but also for family members and, in particular, their children. However, for a minority of parents, such searches may become excessive and distressing. Little is known about excessive web-based searching by parents for information regarding their children’s health. Objective: This study aimed to develop and validate an instrument designed to assess parents' web-based health information searching behavior, the Children’s Health Internet Research, Parental Inventory (CHIRPI). Methods: A pilot survey was used to establish the instrument (21 items). CHIRPI was validated online in a second sample (372/384, 96.9% mothers; mean age 32.7 years, SD 5.8). Item analyses, an exploratory factor analysis (EFA), and correlations with parents’ perception of their children’s health-related vulnerability (Child Vulnerability Scale, CVS), parental health anxiety (modified short Health Anxiety Inventory, mSHAI), and parental cyberchondria (Cyberchondria Severity Scale, CSS-15) were calculated. A subset of participants (n=73) provided retest data after 4 weeks. CHIRPI scores (total scores and subscale scores) of parents with a chronically ill child and parents who perceived their child to be vulnerable (CVS+; CVS>10) were compared with 2×2 analyses of variances (ANOVAs) with the factors Child’s Health Status (chronically ill vs healthy) and perceived vulnerability (CVS+ vs CVS−). Results: CHIRPI’s internal consistency was standardized alpha=.89. The EFA identified three subscales: Symptom Focus (standardized alpha=.87), Implementing Advice (standardized alpha=.74) and Distress (standardized alpha=.89). The retest reliability of CHIRPI was measured as rtt=0.78. CHIRPI correlated strongly with CSS-15 (r=0.66) and mSHAI (r=0.39). The ANOVAs comparing the CHIRPI total score and the subscale scores for parents having a chronically ill child and parents perceiving their child as vulnerable revealed the main effects for perceiving one’s child as vulnerable but not for having a chronically ill child. No interactions were found. This pattern was observed for the CHIRPI total score (η2=0.053) and each subscale (Symptom Focus η2=0.012; Distress η2=0.113; and Implementing Advice η2=0.018). Conclusions: The psychometric properties of CHIRPI are excellent. Correlations with mSHAI and CSS-15 indicate its validity. CHIRPI appears to be differentially sensitive to excessive searches owing to parents perceiving their child’s health to be vulnerable rather than to higher informational needs of parents with chronically ill children. Therefore, it may help to identify parents who search excessively for web-based health information. CHIRPI (and, in particular, the Distress subscale) seems to capture a pattern of factors related to anxious health-related cognitions, emotions, and behaviors of parents, which is also applied to their children. %M 32293571 %R 10.2196/16148 %U https://www.jmir.org/2020/4/e16148 %U https://doi.org/10.2196/16148 %U http://www.ncbi.nlm.nih.gov/pubmed/32293571 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 3 %P e16509 %T Innovative Approaches to Obtain Minors’ Consent for Biomedical HIV Prevention Trials: Multi-Site Quasi-Experimental Study of Adolescent and Parent Perspectives %A Knopf,Amelia %A Ott,Mary A %A Draucker,Claire Burke %A Fortenberry,J Dennis %A Reirden,Daniel H %A Arrington-Sanders,Renata %A Schneider,John %A Straub,Diane %A Baker,Rebecca %A Bakoyannis,Giorgos %A Zimet,Gregory D %+ Department of Community & Health Services, School of Nursing, Indiana University, 600 Barnhill Drive, Indianapolis, IN, 46202, United States, 1 2063569430, asknopf@iu.edu %K HIV %K biomedical ethics %K adolescence %K parental consent %D 2020 %7 30.3.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite the high burden of new HIV infections in minor adolescents, they are often excluded from biomedical HIV prevention trials, largely owing to the ethical complexities of obtaining consent for enrollment. Researchers and ethics regulators have a duty to protect adolescents—as a special category of human subjects, they must have protection that extends beyond those afforded to all human subjects. Typically, additional protection includes parental consent for enrollment. However, parental consent can present a risk of harm for minor adolescents. Research involving minor adolescents indicate that they are unwilling to join biomedical trials for stigmatized health problems, such as HIV, when parental consent is required. This presents a significant barrier to progress in adolescent HIV prevention by creating delays in research and the translation of new scientific evidence generated in biomedical trials in adult populations. Objective: This protocol aims to examine how parental involvement in the consent process affects the acceptability of hypothetical participation in biomedical HIV prevention trials from the perspectives of minor adolescents and parents of minor adolescents. Methods: In this protocol, we use a quasi-experimental design that involves a simulated consent process for 2 different HIV prevention trials. The first trial is modeled after an open-label study of the use of tenofovir disoproxil fumarate and emtricitabine as preexposure prophylaxis for HIV. The second trial is modeled after a phase IIa trial of an injectable HIV integrase inhibitor. There are 2 groups in the study—minor adolescents aged 14 to 17 years, inclusive, and parents of minor adolescents in the same age range. The adolescent participants are randomized to 1 of 3 consent conditions with varying degrees of parental involvement. After undergoing a simulated consent process, they rate their willingness to participate (WTP) in each of the 2 trials if offered the opportunity. The primary outcome is WTP, given the consent condition. Parents undergo a similar process but are asked to rate the acceptability of each of the 3 consent conditions. The primary outcome is acceptability of the consent method for enrollment. The secondary outcomes include the following: capacity to consent among both participant groups, the prevalence of medical mistrust, and the effects of the study phase (eg, phase IIa vs the open-label study) and drug administration route (eg, oral vs injection) on WTP (adolescents) and acceptability (parents) of the consent method. Results: Enrollment began in April 2018 and ended mid-September 2019. Data are being analyzed and dissemination is expected in April 2020. Conclusions: The study will provide the needed empirical data about minor adolescents’ and parents’ perspectives on consent methods for minors. The evidence generated can be used to guide investigators and ethics regulators in the design of consent processes for biomedical HIV prevention trials. International Registered Report Identifier (IRRID): DERR1-10.2196/16509 %M 32224493 %R 10.2196/16509 %U http://www.researchprotocols.org/2020/3/e16509/ %U https://doi.org/10.2196/16509 %U http://www.ncbi.nlm.nih.gov/pubmed/32224493 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e14479 %T The German Version of the Mobile App Rating Scale (MARS-G): Development and Validation Study %A Messner,Eva-Maria %A Terhorst,Yannik %A Barke,Antonia %A Baumeister,Harald %A Stoyanov,Stoyan %A Hides,Leanne %A Kavanagh,David %A Pryss,Rüdiger %A Sander,Lasse %A Probst,Thomas %+ Clinical Psychology and Psychotherapy, Ulm University, Albert-Einstein-Allee 47, Ulm, Germany, 49 07315032802, eva-maria.messner@uni-ulm.de %K mHealth %K Mobile App Rating Scale %K mobile app %K assessment %K rating %K scale development %D 2020 %7 27.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The number of mobile health apps (MHAs), which are developed to promote healthy behaviors, prevent disease onset, manage and cure diseases, or assist with rehabilitation measures, has exploded. App store star ratings and descriptions usually provide insufficient or even false information about app quality, although they are popular among end users. A rigorous systematic approach to establish and evaluate the quality of MHAs is urgently needed. The Mobile App Rating Scale (MARS) is an assessment tool that facilitates the objective and systematic evaluation of the quality of MHAs. However, a German MARS is currently not available. Objective: The aim of this study was to translate and validate a German version of the MARS (MARS-G). Methods: The original 19-item MARS was forward and backward translated twice, and the MARS-G was created. App description items were extended, and 104 MHAs were rated twice by eight independent bilingual researchers, using the MARS-G and MARS. The internal consistency, validity, and reliability of both scales were assessed. Mokken scale analysis was used to investigate the scalability of the overall scores. Results: The retranslated scale showed excellent alignment with the original MARS. Additionally, the properties of the MARS-G were comparable to those of the original MARS. The internal consistency was good for all subscales (ie, omega ranged from 0.72 to 0.91). The correlation coefficients (r) between the dimensions of the MARS-G and MARS ranged from 0.93 to 0.98. The scalability of the MARS (H=0.50) and MARS-G (H=0.48) were good. Conclusions: The MARS-G is a reliable and valid tool for experts and stakeholders to assess the quality of health apps in German-speaking populations. The overall score is a reliable quality indicator. However, further studies are needed to assess the factorial structure of the MARS and MARS-G. %M 32217504 %R 10.2196/14479 %U http://mhealth.jmir.org/2020/3/e14479/ %U https://doi.org/10.2196/14479 %U http://www.ncbi.nlm.nih.gov/pubmed/32217504 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e17921 %T The Multiple Sclerosis Health Resource Utilization Survey (MS-HRS): Development and Validation Study %A Ness,Nils-Henning %A Haase,Rocco %A Kern,Raimar %A Schriefer,Dirk %A Ettle,Benjamin %A Cornelissen,Christian %A Akguen,Katja %A Ziemssen,Tjalf %+ University Hospital Carl Gustav Carus, Fetscherstr. 74, Dresden, 01307, Germany, 49 3514584465, tjalf.ziemssen@uniklinikum-dresden.de %K multiple sclerosis %K patient-reported outcome measures %K resource utilization %K validation %K questionnaire development %D 2020 %7 17.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Survey-based studies are frequently used to describe the economic impact of multiple sclerosis (MS). However, there is no validated health resource survey available, preventing comparison of study results and meaningful conclusions regarding the efficiency of long-term treatments. Objective: The aim of this study was to develop and validate a tablet- and paper-based MS health resource utilization survey. Methods: We developed and validated the Multiple Sclerosis Health Resource Utilization Survey (MS-HRS), consisting of 24 cost items for paper and tablet users. Data for validation came from two large German observational studies. Survey practicability was assessed according to the response rate. Reliability was described using test-retest reliability as well as Guttman lambda. Construct validity was assessed as convergent and discriminant validity via correlations with associated patient-reported outcomes and known-group analyses. Results: In total, 2207 out of 2388 (response rate: 92.4%) patients completed the survey and were included to determine psychometric properties. The test-retest reliability had an intraclass correlation coefficient of 0.828 over a course of 3 months. Convergent validity analyses showed that total costs correlated positively with increased disability (r=0.411, P<.001). For discriminant validity, correlations of total costs with the Treatment Satisfaction Questionnaire for Medication ranged from −0.006 (convenience) to −0.216 (effectiveness). The mean annual cost was €28,203 (SD €14,808) (US $39,203; SD US $20,583) with disease-modifying therapies. Conclusions: The MS-HRS is a multilingual, reliable, valid, electronically available, and easy-to-administer questionnaire providing a holistic cross-sectional and longitudinal assessment of resource utilization in patients with MS. %M 32181745 %R 10.2196/17921 %U http://www.jmir.org/2020/3/e17921/ %U https://doi.org/10.2196/17921 %U http://www.ncbi.nlm.nih.gov/pubmed/32181745 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e13561 %T Translation of the Chinese Version of the Nomophobia Questionnaire and Its Validation Among College Students: Factor Analysis %A Gao,Ye %A Dai,Hongliang %A Jia,Guizhi %A Liang,Chunguang %A Tong,Tong %A Zhang,Zhiyu %A Song,Ruobing %A Wang,Qing %A Zhu,Yue %+ School of Nursing, Jinzhou Medical University, No 40, Section 3, Songpo Road, Jinzhou, 121001, China, 86 15941628736, 63398880@qq.com %K nomophobia %K reliability %K validity %K mobile phone %D 2020 %7 13.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nomophobia or phobia of no mobile phone is the fear of being without a mobile phone or being unable to contact others via a mobile phone. It is a newly emerging psychiatric disorder among mobile phone users. Objective: There are no psychometric scales available in China for examining nomophobia, although China has become the largest mobile phone handset consumer market in the world. Therefore, this study aimed to translate the original English version of a psychometric scale into Chinese and further examine its reliability and validity among Chinese college students. Methods: The original version of the Nomophobia Questionnaire (NMP-Q) was first translated into Chinese using the backward and forward translation procedure. An exploratory factor analysis (a principal component analysis plus varimax rotation) and a confirmatory factor analysis (CFA) were performed to examine the underlying factor structure of the translated questionnaire. The internal consistency reliability of the scale was determined by computing the Cronbach alpha coefficient, the test-retest reliability, and the corrected item-total correlation. A multivariate regression analysis was used for examining associations between nomophobia and independent variables among the college students. Results: A total of 2000 participants were included in the study. Their ages ranged from 16 to 25 years, with 51.95% (1039/2000) being male participants. The Chinese version of NMP-Q retained 18 items. The eigenvalues, total variance explained, and scree plot jointly support a 4-factor structure of the translated questionnaire. The CFA reached the adaptive standard, and the discriminant validity of the scale was good. The Cronbach alpha coefficient of this scale was .925, and the Cronbach alpha coefficients of the subscales were .882, .843, .895, and .818. The test-retest reliability was 0.947. Corrected item-total correlation ranged from 0.539 to 0.663. The significant predictors for each of the dimensions of nomophobia and total score of the questionnaire were the average number of hours spent on a mobile phone daily and gender. Conclusions: The Chinese version of the NMP-Q exhibited satisfactory psychometric properties. %M 32167480 %R 10.2196/13561 %U http://mhealth.jmir.org/2020/3/e13561/ %U https://doi.org/10.2196/13561 %U http://www.ncbi.nlm.nih.gov/pubmed/32167480 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 2 %P e14566 %T Assessment of Microstressors in Adults: Questionnaire Development and Ecological Validation of the Mainz Inventory of Microstressors %A Chmitorz,Andrea %A Kurth,Karolina %A Mey,Lara K %A Wenzel,Mario %A Lieb,Klaus %A Tüscher,Oliver %A Kubiak,Thomas %A Kalisch,Raffael %+ Faculty of Social Work, Health Care and Nursing Sciences, Esslingen University of Applied Sciences, Flandernstraße 101, Esslingen, Germany, 49 7113974732, andrea.chmitorz@hs-esslingen.de %K microstressor %K daily hassles %K validation %K ecological momentary assessment %D 2020 %7 24.2.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Many existing scales for microstressor assessment do not differentiate between objective (ie, observable) stressor events and stressful cognitions or concerns. They often mix items assessing objective stressor events with items measuring other aspects of stress, such as perceived stressor severity, the evoked stress reaction, or further consequences on health, which may result in spurious associations in studies that include other questionnaires that measure such constructs. Most scales were developed several decades ago; therefore, modern life stressors may not be represented. Ecological momentary assessment (EMA) allows for sampling of current behaviors and experiences in real time and in the natural habitat, thereby maximizing the generalization of the findings to real-life situations (ie, ecological validity) and minimizing recall bias. However, it has not been used for the validation of microstressor questionnaires so far. Objective: The aim is to develop a questionnaire that (1) allows for retrospective assessment of microstressors over one week, (2) focuses on objective (ie, observable) microstressors, (3) includes stressors of modern life, and (4) separates stressor occurrence from perceived stressor severity. Methods: Cross-sectional (N=108) and longitudinal studies (N=10 and N=70) were conducted to evaluate the Mainz Inventory of Microstressors (MIMIS). In the longitudinal studies, EMA was used to compare stressor data, which was collected five times per day for 7 or 30 days with retrospective reports (end-of-day, end-of-week). Pearson correlations and multilevel modeling were used in the analyses. Results: High correlations were found between end-of-week, end-of-day, and EMA data for microstressor occurrence (counts) (r≥.69 for comparisons per week, r≥.83 for cumulated data) and for mean perceived microstressor severity (r≥.74 for comparisons per week, r≥.85 for cumulated data). The end-of-week questionnaire predicted the EMA assessments sufficiently (counts: beta=.03, 95% CI .02-.03, P<.001; severity: beta=.73, 95% CI .59-.88, P<.001) and the association did not change significantly over four subsequent weeks. Conclusions: Our results provide evidence for the ecological validity of the MIMIS questionnaire. %M 32130154 %R 10.2196/14566 %U http://mental.jmir.org/2020/2/e14566/ %U https://doi.org/10.2196/14566 %U http://www.ncbi.nlm.nih.gov/pubmed/32130154 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e16316 %T The Swedish Version of the Electronic Health Literacy Scale: Prospective Psychometric Evaluation Study Including Thresholds Levels %A Wångdahl,Josefin %A Jaensson,Maria %A Dahlberg,Karuna %A Nilsson,Ulrica %+ Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Alfred Nobels Allé 23, Huddinge, Sweden, 46 8 524 838 22, ulrica.nilsson@ki.se %K eHealth %K literacy %K internet %K psychometrics %D 2020 %7 24.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To enhance the efficacy of information and communication, health care has increasingly turned to digitalization. Electronic health (eHealth) is an important factor that influences the use and receipt of benefits from Web-based health resources. Consequently, the concept of eHealth literacy has emerged, and in 2006 Norman and Skinner developed an 8-item self-report instrument to measure these skills: the eHealth Literacy Scale (eHEALS). However, the eHEALS has not been tested for reliability and validity in the general Swedish population and no threshold values have been established. Objective: The aim of this study was to translate and adapt eHEALS into a Swedish version; evaluate convergent validity and psychometric properties; and determine threshold levels for inadequate, problematic, and sufficient eHealth literacy. Methods: Prospective psychometric evaluation study included 323 participants equally distributed between sexes with a mean age of 49 years recruited from 12 different arenas. Results: There were some difficulties translating the English concept health resources. This resulted in this concept being translated as health information (ie, Hälsoinformation in Swedish). The eHEALS total score was 29.3 (SD 6.2), Cronbach alpha .94, Spearman-Brown coefficient .96, and response rate 94.6%. All a priori hypotheses were confirmed, supporting convergent validity. The test-retest reliability indicated an almost perfect agreement, .86 (P<.001). An exploratory factor analysis found one component explaining 64% of the total variance. No floor or ceiling effect was noted. Thresholds levels were set at 8 to 20 = inadequate, 21 to 26 = problematic, and 27 to 40 = sufficient, and there were no significant differences in distribution of the three levels between the Swedish version of eHEALS and the HLS-EU-Q16. Conclusions: The Swedish version of eHEALS was assessed as being unidimensional with high internal consistency of the instrument, making the reliability adequate. Adapted threshold levels for inadequate, problematic, and sufficient levels of eHealth literacy seem to be relevant. However, there are some linguistic issues relating to the concept of health resources. %M 32130168 %R 10.2196/16316 %U https://mhealth.jmir.org/2020/2/e16316 %U https://doi.org/10.2196/16316 %U http://www.ncbi.nlm.nih.gov/pubmed/32130168 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 1 %P e16131 %T Descriptive Evaluation and Accuracy of a Mobile App to Assess Fall Risk in Seniors: Retrospective Case-Control Study %A Rabe,Sophie %A Azhand,Arash %A Pommer,Wolfgang %A Müller,Swantje %A Steinert,Anika %+ Lindera GmbH, Kottbusser Damm 79, Berlin, 10967, Germany, 49 030 12085471, sophie.rabe@lindera.de %K falls %K seniors %K fall risk assessment %K app %K mHealth %K retrospective cohort study %K discriminative ability %D 2020 %7 14.2.2020 %9 Original Paper %J JMIR Aging %G English %X Background: Fall-risk assessment is complex. Based on current scientific evidence, a multifactorial approach, including the analysis of physical performance, gait parameters, and both extrinsic and intrinsic risk factors, is highly recommended. A smartphone-based app was designed to assess the individual risk of falling with a score that combines multiple fall-risk factors into one comprehensive metric using the previously listed determinants. Objective: This study provides a descriptive evaluation of the designed fall-risk score as well as an analysis of the app’s discriminative ability based on real-world data. Methods: Anonymous data from 242 seniors was analyzed retrospectively. Data was collected between June 2018 and May 2019 using the fall-risk assessment app. First, we provided a descriptive statistical analysis of the underlying dataset. Subsequently, multiple learning models (Logistic Regression, Gaussian Naive Bayes, Gradient Boosting, Support Vector Classification, and Random Forest Regression) were trained on the dataset to obtain optimal decision boundaries. The receiver operating curve with its corresponding area under the curve (AUC) and sensitivity were the primary performance metrics utilized to assess the fall-risk score's ability to discriminate fallers from nonfallers. For the sake of completeness, specificity, precision, and overall accuracy were also provided for each model. Results: Out of 242 participants with a mean age of 84.6 years old (SD 6.7), 139 (57.4%) reported no previous falls (nonfaller), while 103 (42.5%) reported a previous fall (faller). The average fall risk was 29.5 points (SD 12.4). The performance metrics for the Logistic Regression Model were AUC=0.9, sensitivity=100%, specificity=52%, and accuracy=73%. The performance metrics for the Gaussian Naive Bayes Model were AUC=0.9, sensitivity=100%, specificity=52%, and accuracy=73%. The performance metrics for the Gradient Boosting Model were AUC=0.85, sensitivity=88%, specificity=62%, and accuracy=73%. The performance metrics for the Support Vector Classification Model were AUC=0.84, sensitivity=88%, specificity=67%, and accuracy=76%. The performance metrics for the Random Forest Model were AUC=0.84, sensitivity=88%, specificity=57%, and accuracy=70%. Conclusions: Descriptive statistics for the dataset were provided as comparison and reference values. The fall-risk score exhibited a high discriminative ability to distinguish fallers from nonfallers, irrespective of the learning model evaluated. The models had an average AUC of 0.86, an average sensitivity of 93%, and an average specificity of 58%. Average overall accuracy was 73%. Thus, the fall-risk app has the potential to support caretakers in easily conducting a valid fall-risk assessment. The fall-risk score’s prospective accuracy will be further validated in a prospective trial. %M 32130111 %R 10.2196/16131 %U http://aging.jmir.org/2020/1/e16131/ %U https://doi.org/10.2196/16131 %U http://www.ncbi.nlm.nih.gov/pubmed/32130111 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e16932 %T A Physician-Completed Digital Tool for Evaluating Disease Progression (Multiple Sclerosis Progression Discussion Tool): Validation Study %A Ziemssen,Tjalf %A Piani-Meier,Daniela %A Bennett,Bryan %A Johnson,Chloe %A Tinsley,Katie %A Trigg,Andrew %A Hach,Thomas %A Dahlke,Frank %A Tomic,Davorka %A Tolley,Chloe %A Freedman,Mark S %+ Center of Clinical Neuroscience, Neurological University Clinic Carl Gustav Carus, TU Dresden, Fetscherstraße 74, Dresden, Germany, 49 351 458 4465, ziemssen@web.de %K multiple sclerosis %K relapsing-remitting multiple sclerosis %K secondary progressive multiple sclerosis %K transition %K progression %K digital %K validation %D 2020 %7 12.2.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Defining the transition from relapsing-remitting multiple sclerosis (RRMS) to secondary progressive multiple sclerosis (SPMS) can be challenging and delayed. A digital tool (MSProDiscuss) was developed to facilitate physician-patient discussion in evaluating early, subtle signs of multiple sclerosis (MS) disease progression representing this transition. Objective: This study aimed to determine cut-off values and corresponding sensitivity and specificity for predefined scoring algorithms, with or without including Expanded Disability Status Scale (EDSS) scores, to differentiate between RRMS and SPMS patients and to evaluate psychometric properties. Methods: Experienced neurologists completed the tool for patients with confirmed RRMS or SPMS and those suspected to be transitioning to SPMS. In addition to age and EDSS score, each patient’s current disease status (disease activity, symptoms, and its impacts on daily life) was collected while completing the draft tool. Receiver operating characteristic (ROC) curves determined optimal cut-off values (sensitivity and specificity) for the classification of RRMS and SPMS. Results: Twenty neurologists completed the draft tool for 198 patients. Mean scores for patients with RRMS (n=89), transitioning to SPMS (n=47), and SPMS (n=62) were 38.1 (SD 12.5), 55.2 (SD 11.1), and 69.6 (SD 12.0), respectively (P<.001, each between-groups comparison). Area under the ROC curve (AUC) including and excluding EDSS were for RRMS (including) AUC 0.91, 95% CI 0.87-0.95, RRMS (excluding) AUC 0.88, 95% CI 0.84-0.93, SPMS (including) AUC 0.91, 95% CI 0.86-0.95, and SPMS (excluding) AUC 0.86, 95% CI 0.81-0.91. In the algorithm with EDSS, the optimal cut-off values were ≤51.6 for RRMS patients (sensitivity=0.83; specificity=0.82) and ≥58.9 for SPMS patients (sensitivity=0.82; specificity=0.84). The optimal cut-offs without EDSS were ≤46.3 and ≥57.8 and resulted in similar high sensitivity and specificity (0.76-0.86). The draft tool showed excellent interrater reliability (intraclass correlation coefficient=.95). Conclusions: The MSProDiscuss tool differentiated RRMS patients from SPMS patients with high sensitivity and specificity. In clinical practice, it may be a useful tool to evaluate early, subtle signs of MS disease progression indicating the evolution of RRMS to SPMS. MSProDiscuss will help assess the current level of progression in an individual patient and facilitate a more informed physician-patient discussion. %M 32049062 %R 10.2196/16932 %U https://www.jmir.org/2020/2/e16932 %U https://doi.org/10.2196/16932 %U http://www.ncbi.nlm.nih.gov/pubmed/32049062 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e16736 %T Measuring Interests Not Minutes: Development and Validation of the Adolescents’ Digital Technology Interactions and Importance Scale (ADTI) %A Moreno,Megan A %A Binger,Kole %A Zhao,Qianqian %A Eickhoff,Jens %+ Department of Pediatrics, University of Wisconsin-Madison, 2870 University Ave, Suite 200, Madison, WI, 53705, United States, 1 6082632846, mamoreno@pediatrics.wisc.edu %K technology %K adolescents %K methodology, survey %K social media %K screen time %K instrument development %D 2020 %7 12.2.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Interactive digital technology use is integral to adolescents’ lives and has been associated with both health benefits and risks. Previous studies have largely focused on measuring the quantity of technology use or understanding the use of specific platforms. To better understand adolescents’ interactive digital technology use, we need new approaches that consider technology interactions and their importance. Objective: This study aimed to develop an assessment tool to evaluate adolescents’ digital technology interactions and their perceived importance. Methods: We used a validated scale development approach comprising 2 initial steps to create an item pool: item pool development and item pool refinement. These steps relied upon empirical literature review and an expert convening. We then evaluated the item pool using a Web-based survey. Data were collected via Qualtrics panel recruitment from a national sample of 12- to 18-year-olds. Participant data were randomly split into a development subsample for exploratory factor analysis (EFA) and a test subsample for confirmatory factor analysis (CFA). We assessed Cronbach alpha as well as model fit characteristics including root mean square error of approximation (RMSEA) and comparative fit index (CFI). Results: Our initial item pool had 71 items and the refined item pool contained 40. A total of 761 adolescents assessed the item pool via Web-based survey. Participants had a mean age of 14.8 (SD 1.7) years and were 52.8% (402/761) female and 77.5% (590/761) white. The EFA analysis included 500 participants and an 18-item draft scale was created. The CFA included 261 participants to test the draft scale. Adequate model fit for the scale was indicated by an RMSEA of 0.063 and a CFI of 0.95. The final scale included 18 items in a 3-factor model, with Cronbach alpha for the 3 factors of .87 (factor 1), .90 (factor 2) and .82 (factor 3). The 3 factors were named (1) technology to bridge online and offline experiences, (2) technology to go outside one’s identity or offline environment, and (3) technology for social connection. Conclusions: The resulting Adolescents’ Digital Technology Interactions and Importance (ADTI) scale is a promising and psychometrically validated tool for identifying the importance of distinct technology interactions. The scale is informed by relevant theory and expert input. The 3 subscales have utility for future studies to understand whether certain subscale score ranges are associated with health or well-being outcomes. %M 32049068 %R 10.2196/16736 %U https://www.jmir.org/2020/2/e16736 %U https://doi.org/10.2196/16736 %U http://www.ncbi.nlm.nih.gov/pubmed/32049068 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e13468 %T Validation of an Electronic Visual Analog Scale mHealth Tool for Acute Pain Assessment: Prospective Cross-Sectional Study %A Escalona-Marfil,Carles %A Coda,Andrea %A Ruiz-Moreno,Jorge %A Riu-Gispert,Lluís Miquel %A Gironès,Xavier %+ Facultat de Ciències de la Salut de Manresa, Universitat de Vic–Universitat Central de Catalunya, Av Universitària, 4-6, Manresa, Spain, 34 938 77 41 79 ext 234, carlesescalona@gmail.com %K pain %K visual analog pain scale %K pain measurement %K mobile phone %K mHealth %K validation %K tablet %D 2020 %7 12.2.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Accurate measurement of pain is required to improve its management and in research. The visual analog scale (VAS) on paper format has been shown to be an accurate, valid, reliable, and reproducible way to measure pain intensity. However, some limitations should be considered, some of which can be implemented with the introduction of an electronic VAS version, suitable to be used both in a tablet and a smartphone. Objective: This study aimed to validate a new method of recording pain level by comparing the traditional paper VAS with the pain level module on the newly designed Interactive Clinics app. Methods: A prospective observational cross-sectional study was designed. The sample consisted of 102 participants aged 18 to 65 years. A Force Dial FDK 20 algometer (Wagner Instruments) was employed to induce mild pressure symptoms on the participants’ thumbs. Pain was measured using a paper VAS (10 cm line) and the app. Results: Intermethod reliability estimated by ICC(3,1) was 0.86 with a 95% confidence interval of 0.81 to 0.90, indicating good reliability. Intramethod reliability estimated by ICCa(3,1) was 0.86 with a 95% confidence interval of 0.81 to 0.90, also indicating good reliability. Bland-Altman analysis showed a difference of 0.175 (0.49), and limits of agreement ranged from –0.79 to 1.14. Conclusions: The pain level module on the app is highly reliable and interchangeable with the paper VAS version. This tool could potentially help clinicians and researchers precisely assess pain in a simple, economic way with the use of a ubiquitous technology. %M 32049063 %R 10.2196/13468 %U http://www.jmir.org/2020/2/e13468/ %U https://doi.org/10.2196/13468 %U http://www.ncbi.nlm.nih.gov/pubmed/32049063 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e13244 %T Applicability of the User Engagement Scale to Mobile Health: A Survey-Based Quantitative Study %A Holdener,Marianne %A Gut,Alain %A Angerer,Alfred %+ Winterthur Institute of Health Economics, School of Management and Law, Zurich University of Applied Sciences, Gertrudstrasse 15, Winterthur, 8401, Switzerland, 41 798145158, marianneholdener@bluemail.ch %K mobile health %K mhealth %K mobile apps %K user engagement %K measurement %K user engagement scale %K chatbot %D 2020 %7 3.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There has recently been exponential growth in the development and use of health apps on mobile phones. As with most mobile apps, however, the majority of users abandon them quickly and after minimal use. One of the most critical factors for the success of a health app is how to support users’ commitment to their health. Despite increased interest from researchers in mobile health, few studies have examined the measurement of user engagement with health apps. Objective: User engagement is a multidimensional, complex phenomenon. The aim of this study was to understand the concept of user engagement and, in particular, to demonstrate the applicability of a user engagement scale (UES) to mobile health apps. Methods: To determine the measurability of user engagement in a mobile health context, a UES was employed, which is a psychometric tool to measure user engagement with a digital system. This was adapted to Ada, developed by Ada Health, an artificial intelligence–powered personalized health guide that helps people understand their health. A principal component analysis (PCA) with varimax rotation was conducted on 30 items. In addition, sum scores as means of each subscale were calculated. Results: Survey data from 73 Ada users were analyzed. PCA was determined to be suitable, as verified by the sampling adequacy of Kaiser-Meyer-Olkin=0.858, a significant Bartlett test of sphericity (χ2300=1127.1; P<.001), and communalities mostly within the 0.7 range. Although 5 items had to be removed because of low factor loadings, the results of the remaining 25 items revealed 4 attributes: perceived usability, aesthetic appeal, reward, and focused attention. Ada users showed the highest engagement level with perceived usability, with a value of 294, followed by aesthetic appeal, reward, and focused attention. Conclusions: Although the UES was deployed in German and adapted to another digital domain, PCA yielded consistent subscales and a 4-factor structure. This indicates that user engagement with health apps can be assessed with the German version of the UES. These results can benefit related mobile health app engagement research and may be of importance to marketers and app developers. %M 31899454 %R 10.2196/13244 %U https://mhealth.jmir.org/2020/1/e13244 %U https://doi.org/10.2196/13244 %U http://www.ncbi.nlm.nih.gov/pubmed/31899454 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e14985 %T Understanding Drivers of Resistance Toward Implementation of Web-Based Self-Management Tools in Routine Cancer Care Among Oncology Nurses: Cross-Sectional Survey Study %A de Wit,Matthijs %A Kleijnen,Mirella %A Lissenberg-Witte,Birgit %A van Uden-Kraan,Cornelia %A Millet,Kobe %A Frambach,Ruud %A Verdonck-de Leeuw,Irma %+ Vrije Universiteit Amsterdam, Department of Clinical, Neuro- and Developmental Psychology, Van der Boechorstraat 7, Amsterdam, 1081 BT, Netherlands, 31 204440988, im.verdonck@vumc.nl %K psycho-oncology %K health-related quality of life %K self-management %K eHealth %K implementation science %K resistance to innovations %D 2019 %7 17.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Supporting patients to engage in (Web-based) self-management tools is increasingly gaining importance, but the engagement of health care professionals is lagging behind. This can partly be explained by resistance among health care professionals. Objective: The aim of this study was to investigate drivers of resistance among oncology nurses toward Web-based self-management tools in cancer care. Methods: Drawing from previous research, combining clinical and marketing perspectives, and several variables and instruments, we developed the Resistance to Innovation model (RTI-model). The RTI-model distinguishes between passive and active resistance, which can be enhanced or reduced by functional drivers (incompatibility, complexity, lack of value, and risk) and psychological drivers (role ambiguity, social pressure from the institute, peers, and patients). Both types of drivers can be moderated by staff-, organization-, patient-, and environment-related factors. We executed a survey covering all components of the RTI-model on a cross-sectional sample of nurses working in oncology in the Netherlands. Structural equation modeling was used to test the full model, using a hierarchical approach. In total, 2500 nurses were approached, out of which 285 (11.40%) nurses responded. Results: The goodness of fit statistic of the uncorrected base model of the RTI-model (n=239) was acceptable (χ21=9.2; Comparative Fit Index=0.95; Tucker Lewis index=0.21; Root Mean Square Error of Approximation=0.19; Standardized Root Mean Square=0.016). In line with the RTI-model, we found that both passive and active resistance among oncology nurses toward (Web-based) self-management tools were driven by both functional and psychological drivers. Passive resistance toward Web-based self-management tools was enhanced by complexity, lack of value, and role ambiguity, and it was reduced by institutional social pressure. Active resistance was enhanced by complexity, lack of value, and social pressure from peers, and it was reduced by social pressure from the institute and patients. In contrast to what we expected, incompatibility with current routines was not a significant driver of either passive or active resistance. This study further showed that these drivers of resistance were moderated by expertise (P=.03), managerial support (P=.004), and influence from external stakeholders (government; P=.04). Conclusions: Both passive and active resistance in oncology nurses toward Web-based self-management tools for patients with cancer are driven by functional and psychological drivers, which may be more or less strong, depending on expertise, managerial support, and governmental influence. %M 31845900 %R 10.2196/14985 %U http://www.jmir.org/2019/12/e14985/ %U https://doi.org/10.2196/14985 %U http://www.ncbi.nlm.nih.gov/pubmed/31845900 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e15191 %T Continuous Digital Monitoring of Walking Speed in Frail Elderly Patients: Noninterventional Validation Study and Longitudinal Clinical Trial %A Mueller,Arne %A Hoefling,Holger Alfons %A Muaremi,Amir %A Praestgaard,Jens %A Walsh,Lorcan C %A Bunte,Ola %A Huber,Roland Martin %A Fürmetz,Julian %A Keppler,Alexander Martin %A Schieker,Matthias %A Böcker,Wolfgang %A Roubenoff,Ronenn %A Brachat,Sophie %A Rooks,Daniel S %A Clay,Ieuan %+ Novartis Institutes for BioMedical Research, Campus St Johan, Basel, Switzerland, 41 61 324 1111, ieuan.clay@novartis.com %K gait %K walking speed %K mobility limitation %K accelerometry %K clinical trials %K frailty %K wearable electronic devices %K algorithms %K open source data %K data collection %K dataset %D 2019 %7 27.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital technologies and advanced analytics have drastically improved our ability to capture and interpret health-relevant data from patients. However, only limited data and results have been published that demonstrate accuracy in target indications, real-world feasibility, or the validity and value of these novel approaches. Objective: This study aimed to establish accuracy, feasibility, and validity of continuous digital monitoring of walking speed in frail, elderly patients with sarcopenia and to create an open source repository of raw, derived, and reference data as a resource for the community. Methods: Data described here were collected as a part of 2 clinical studies: an independent, noninterventional validation study and a phase 2b interventional clinical trial in older adults with sarcopenia. In both studies, participants were monitored by using a waist-worn inertial sensor. The cross-sectional, independent validation study collected data at a single site from 26 naturally slow-walking elderly subjects during a parcours course through the clinic, designed to simulate a real-world environment. In the phase 2b interventional clinical trial, 217 patients with sarcopenia were recruited across 32 sites globally, where patients were monitored over 25 weeks, both during and between visits. Results: We have demonstrated that our approach can capture in-clinic gait speed in frail slow-walking adults with a residual standard error of 0.08 m per second in the independent validation study and 0.08, 0.09, and 0.07 m per second for the 4 m walk test (4mWT), 6-min walk test (6MWT), and 400 m walk test (400mWT) standard gait speed assessments, respectively, in the interventional clinical trial. We demonstrated the feasibility of our approach by capturing 9668 patient-days of real-world data from 192 patients and 32 sites, as part of the interventional clinical trial. We derived inferred contextual information describing the length of a given walking bout and uncovered positive associations between the short 4mWT gait speed assessment and gait speed in bouts between 5 and 20 steps (correlation of 0.23) and longer 6MWT and 400mWT assessments with bouts of 80 to 640 steps (correlations of 0.48 and 0.59, respectively). Conclusions: This study showed, for the first time, accurate capture of real-world gait speed in slow-walking older adults with sarcopenia. We demonstrated the feasibility of long-term digital monitoring of mobility in geriatric populations, establishing that sufficient data can be collected to allow robust monitoring of gait behaviors outside the clinic, even in the absence of feedback or incentives. Using inferred context, we demonstrated the ecological validity of in-clinic gait assessments, describing positive associations between in-clinic performance and real-world walking behavior. We make all data available as an open source resource for the community, providing a basis for further study of the relationship between standardized physical performance assessment and real-world behavior and independence. %M 31774406 %R 10.2196/15191 %U http://mhealth.jmir.org/2019/11/e15191/ %U https://doi.org/10.2196/15191 %U http://www.ncbi.nlm.nih.gov/pubmed/31774406 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e16197 %T Assessing the Psychometric Properties of the Digital Behavior Change Intervention Engagement Scale in Users of an App for Reducing Alcohol Consumption: Evaluation Study %A Perski,Olga %A Lumsden,Jim %A Garnett,Claire %A Blandford,Ann %A West,Robert %A Michie,Susan %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 20 7679 1258, olga.perski@ucl.ac.uk %K engagement %K digital behaviour change interventions %K mHealth %K psychometrics %K self-report scale %K smartphone apps %K excessive alcohol consumption %D 2019 %7 20.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The level and type of engagement with digital behavior change interventions (DBCIs) are likely to influence their effectiveness, but validated self-report measures of engagement are lacking. The DBCI Engagement Scale was designed to assess behavioral (ie, amount, depth of use) and experiential (ie, attention, interest, enjoyment) dimensions of engagement. Objective: We aimed to assess the psychometric properties of the DBCI Engagement Scale in users of a smartphone app for reducing alcohol consumption. Methods: Participants (N=147) were UK-based, adult, excessive drinkers recruited via an online research platform. Participants downloaded the Drink Less app and completed the scale immediately after their first login in exchange for a financial reward. Criterion variables included the objectively recorded amount of use, depth of use, and subsequent login. Five types of validity (ie, construct, criterion, predictive, incremental, divergent) were examined in exploratory factor, correlational, and regression analyses. The Cronbach alpha was calculated to assess the scale’s internal reliability. Covariates included motivation to reduce alcohol consumption. Results: Responses on the DBCI Engagement Scale could be characterized in terms of two largely independent subscales related to experience and behavior. The experiential and behavioral subscales showed high (α=.78) and moderate (α=.45) internal reliability, respectively. Total scale scores predicted future behavioral engagement (ie, subsequent login) with and without adjusting for users’ motivation to reduce alcohol consumption (adjusted odds ratio [ORadj]=1.14; 95% CI 1.03-1.27; P=.01), which was driven by the experiential (ORadj=1.19; 95% CI 1.05-1.34; P=.006) but not the behavioral subscale. Conclusions: The DBCI Engagement Scale assesses behavioral and experiential aspects of engagement. The behavioral subscale may not be a valid indicator of behavioral engagement. The experiential subscale can predict subsequent behavioral engagement with an app for reducing alcohol consumption. Further refinements and validation of the scale in larger samples and across different DBCIs are needed. %M 31746771 %R 10.2196/16197 %U http://www.jmir.org/2019/11/e16197/ %U https://doi.org/10.2196/16197 %U http://www.ncbi.nlm.nih.gov/pubmed/31746771 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e14392 %T Collective Empowerment in Online Health Communities: Scale Development and Empirical Validation %A Atanasova,Sara %A Petric,Gregor %+ Centre for Methodology and Informatics, Faculty of Social Sciences, University of Ljubljana, Kardeljeva pl 5, Ljubljana, 1000, Slovenia, 386 31 837 696, sara.atanasova@fdv.uni-lj.si %K patient empowerment %K collective empowerment %K online health community %K psychometrics %K reliability %K validity %K weights and measures %D 2019 %7 20.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The role of online health communities (OHCs) in patient empowerment is growing and has been increasingly studied in recent years. Research has focused primarily on individualistic conception of patients’ empowerment, with much less attention paid to the role of OHCs in the development of patients’ collective empowerment. Although OHCs have immense potential for empowerment that goes beyond the individual, the concept and scale of collective empowerment in OHCs have not yet been developed or validated. Objective: This study aimed to develop an instrument for measuring collective empowerment in online health communities (CE-OHC) and to test its quality by investigating its factorial structure, reliability, construct validity, and predictive validity. Methods: The CE-OHC scale was developed according to a strict methodology for developing valid and reliable scales. An initial set of 20 items was first tested in the pilot study conducted in 2016 using a sample of 280 registered users of Slovenia’s largest OHC. A refined version with 11 items was tested in the main study conducted in 2018 on a random sample of 30,000 registered users of the same OHC. The final sample comprised 784 users. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to investigate the factorial structure, discriminant validity, and convergent validity of the scale. Cronbach alpha coefficient was used to determine the CE-OHC scale’s internal consistency. To establish the predictive validity, ordinary least squares regression was performed to test the role of CE-OHC in users’ civic participation. Results: The EFA resulted in a two-factor solution, and the two factors—knowledge of resources and resource mobilization for collective action—together explain 63.8% of the variance. The second-order CFA demonstrated a good fit to the data (root mean square error of approximation=0.07) and the scale had a good internal consistency (alpha=.86). Although evidence of the scale’s convergent validity was partially provided, discriminant validity of the scale remained unconfirmed. Overall, CE-OHC was confirmed to be a predictor of users’ civic participation, but the influence was somewhat weak and inconsistent across two subscales. Conclusions: The proposed CE-OHC scale is a reliable and relatively valid instrument and serves as a good baseline to advance the measurement of collective empowerment in OHC contexts. This is the first scale developed for this purpose, and future research should focus on the development of a clear nomological network of the collective empowerment construct in relation to the OHC settings. %M 31746772 %R 10.2196/14392 %U http://www.jmir.org/2019/11/e14392/ %U https://doi.org/10.2196/14392 %U http://www.ncbi.nlm.nih.gov/pubmed/31746772 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e14829 %T A Scale to Assess the Methodological Quality of Studies Assessing Usability of Electronic Health Products and Services: Delphi Study Followed by Validity and Reliability Testing %A Silva,Anabela G %A Simões,Patrícia %A Santos,Rita %A Queirós,Alexandra %A Rocha,Nelson P %A Rodrigues,Mário %+ School of Health Sciences, University of Aveiro, Agras do Crasto, Campus Universitário de Santiago, Aveiro, , Portugal, 351 234247119 ext 27120, asilva@ua.pt %K quality of health care %K eHealth %K mHealth %K efficiency %D 2019 %7 15.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The usability of electronic health (eHealth) and mobile health apps is of paramount importance as it impacts the quality of care. Methodological quality assessment is a common practice in the field of health for different designs and types of studies. However, we were unable to find a scale to assess the methodological quality of studies on the usability of eHealth products or services. Objective: This study aimed to develop a scale to assess the methodological quality of studies assessing usability of mobile apps and to perform a preliminary analysis of of the scale’s feasibility, reliability, and construct validity on studies assessing usability of mobile apps, measuring aspects of physical activity. Methods: A 3-round Delphi panel was used to generate a pool of items considered important when assessing the quality of studies on the usability of mobile apps. These items were used to write the scale and the guide to assist its use. The scale was then used to assess the quality of studies on usability of mobile apps for physical activity, and it assessed in terms of feasibility, interrater reliability, and construct validity. Results: A total of 25 experts participated in the Delphi panel, and a 15-item scale was developed. This scale was shown to be feasible (time of application mean 13.10 [SD 2.59] min), reliable (intraclass correlation coefficient=0.81; 95% CI 0.55-0.93), and able to discriminate between low- and high-quality studies (high quality: mean 9.22 [SD 0.36]; low quality: mean 6.86 [SD 0.80]; P=.01). Conclusions: The scale that was developed can be used both to assess the methodological quality of usability studies and to inform its planning. %M 31730036 %R 10.2196/14829 %U http://www.jmir.org/2019/11/e14829/ %U https://doi.org/10.2196/14829 %U http://www.ncbi.nlm.nih.gov/pubmed/31730036 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e14947 %T Measurement Properties of the Online EuroQol-5D-Youth Instrument in Children and Adolescents With Type 1 Diabetes Mellitus: Questionnaire Study %A Mayoral,Karina %A Rajmil,Luis %A Murillo,Marta %A Garin,Olatz %A Pont,Angels %A Alonso,Jordi %A Bel,Joan %A Perez,Jacobo %A Corripio,Raquel %A Carreras,Gemma %A Herrero,Javier %A Mengibar,Jose-Maria %A Rodriguez-Arjona,Dolors %A Ravens-Sieberer,Ulrike %A Raat,Hein %A Serra-Sutton,Vicky %A Ferrer,Montse %+ Health Services Research Group, Hospital del Mar Medical Research Institute, Doctor Aiguader, 88, Office 144, Barcelona, 08003, Spain, 34 933160763, mferrer@imim.es %K health-related quality of life %K type 1 diabetes %K EQ-5D-Y %K EuroQol %K validity %D 2019 %7 12.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The lack of continuity between health-related quality of life (HRQoL) instruments designed for children and adults hinders change analysis with a life course approach. To resolve this gap, EuroQol (EQ) developed the EQ-5D-Youth (EQ-5D-Y), derived from the EQ-5D for adults. Few studies have assessed the metric properties of EQ-5D-Y in children with specific chronic conditions, and none have done so for children with type I diabetes mellitus (T1DM). Objective: This study aimed to evaluate the acceptability, validity, reliability, and responsiveness of the EQ-5D-Y in children and adolescents with T1DM, when administered online. Methods: Participants with T1DM were consecutively recruited from July to December 2014, from a list of potential candidates aged 8-19 years, who attended outpatient pediatric endocrinology units. Before every quarterly routine visit, participants received an email/telephone reminder to complete the online version of two generic HRQoL questionnaires: EQ-5D-Y and KIDSCREEN-27. The EQ-5D-Y measures five dimensions, from which an equally weighted summary score was constructed (range: 0-100). Completion rate and distribution statistics were calculated. Construct validity was evaluated through known group comparisons based on general health, acute diabetic decompensations, mental health, family function, and a multitrait, multimethod matrix between EQ-5D-Y and KIDSCREEN by using Spearman correlations. Construct validity hypotheses were stated a priori. Reliability was assessed with the intraclass correlation coefficient and responsiveness by testing changes over time and calculating the effect size. Reliability and responsiveness were tested among the stable and improved subsamples defined by a KIDSCREEN-10 index change of <4.5 points or ≥4.5 points, respectively, from the first to the fourth visit. Results: Of the 136 participants, 119 (87.5%) responded to the EQ-5D-Y at the last visit. The dimensions that showed higher percentages of participants with problems were “having pain/discomfort” (34.6%) and “worried/sad/unhappy” (28.7%). The mean (SD) of the EQ-5D-Y summary score was 8.5 (10.9), with ceiling and floor effects of 50.7% and 0%, respectively. Statistically significant HRQoL differences between groups defined by their general health (excellent/very good and good/regular/bad) and mental health (Strengths and Difficulties Questionnaire score ≤15 and >16, respectively) were found in three EQ-5D-Y dimensions (“doing usual activities,” “having pain/discomfort,” and “feeling worried/sad/unhappy”), summary score (effect size for general health and mental health groups=0.7 and 1.5, respectively), and KIDSCREEN-10 index (effect size for general health and mental health groups=0.6 and 0.9, respectively). Significant differences in the EQ-5D-Y dimensions were also found according to acute diabetic decompensations in “looking after myself” (P=.005) and according to family function in “having pain/discomfort” (P=.03). Results of the multitrait, multimethod matrix confirmed three of the four relationships hypothesized as substantial (0.21, 0.58, 0.50, and 0.46). The EQ-5D-Y summary score presented an intraclass correlation coefficient of 0.83. Statistically significant change between visits was observed in the improved subsample, with an effect size of 0.7 (P<.001). Conclusions: These results support the use of the EQ-5D-Y administered online as an acceptable, valid, reliable, and responsive instrument for evaluating HRQoL in children and adolescents with T1DM. %M 31714252 %R 10.2196/14947 %U http://www.jmir.org/2019/11/e14947/ %U https://doi.org/10.2196/14947 %U http://www.ncbi.nlm.nih.gov/pubmed/31714252 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e13757 %T Associations Between Heart Rate Variability Measured With a Wrist-Worn Sensor and Older Adults’ Physical Function: Observational Study %A Graham,Sarah Anne %A Jeste,Dilip V %A Lee,Ellen E %A Wu,Tsung-Chin %A Tu,Xin %A Kim,Ho-Cheol %A Depp,Colin A %+ Sam and Rose Stein Institute for Research on Aging, University of California San Diego, 9500 Gilman Drive, #0664, La Jolla, CA, 92093-0664, United States, 1 858 534 5433, sagraham@ucsd.edu %K wearable technology %K aging %K electrocardiogram %K geriatric assessment %D 2019 %7 23.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Heart rate variability (HRV), or variation in beat-to-beat intervals of the heart, is a quantitative measure of autonomic regulation of the cardiovascular system. Low HRV derived from electrocardiogram (ECG) recordings is reported to be related to physical frailty in older adults. Recent advances in wearable technology offer opportunities to more easily integrate monitoring of HRV into regular clinical geriatric health assessments. However, signals obtained from ECG versus wearable photoplethysmography (PPG) devices are different, and a critical first step preceding their widespread use is to determine whether HRV metrics derived from PPG devices also relate to older adults’ physical function. Objective: This study aimed to investigate associations between HRV measured with a wrist-worn PPG device, the Empatica E4 sensor, and validated clinical measures of both objective and self-reported physical function in a cohort of older adults living independently within a continuing care senior housing community. Our primary hypothesis was that lower HRV would be associated with lower physical function. In addition, we expected that HRV would explain a significant proportion of variance in measures of physical health status. Methods: We evaluated 77 participants from an ongoing study of older adults aged between 65 and 95 years. The assessments encompassed a thorough examination of domains typically included in a geriatric health evaluation. We collected HRV data with the Empatica E4 device and examined bivariate correlations between HRV quantified with the triangular index (HRV TI) and 3 widely used and validated measures of physical functioning—the Short Physical Performance Battery (SPPB), Timed Up and Go (TUG), and Medical Outcomes Study Short Form 36 (SF-36) physical composite scores. We further investigated the additional predictive power of HRV TI on physical health status, as characterized by SF-36 physical composite scores and Cumulative Illness Rating Scale for Geriatrics (CIRS-G) scores, using generalized estimating equation regression analyses with backward elimination. Results: We observed significant associations of HRV TI with SPPB (n=52; Spearman ρ=0.41; P=.003), TUG (n=51; ρ=−0.40; P=.004), SF-36 physical composite scores (n=49; ρ=0.37; P=.009), and CIRS-G scores (n=52, ρ=−0.43; P=.001). In addition, the HRV TI explained a significant proportion of variance in SF-36 physical composite scores (R2=0.28 vs 0.11 without HRV) and CIRS-G scores (R2=0.33 vs 0.17 without HRV). Conclusions: The HRV TI measured with a relatively novel wrist-worn PPG device was related to both objective (SPPB and TUG) and self-reported (SF-36 physical composite) measures of physical function. In addition, the HRV TI explained additional variance in self-reported physical function and cumulative illness severity beyond traditionally measured aspects of physical health. Future steps include longitudinal tracking of changes in both HRV and physical function, which will add important insights regarding the predictive value of HRV as a biomarker of physical health in older adults. %M 31647469 %R 10.2196/13757 %U http://mhealth.jmir.org/2019/10/e13757/ %U https://doi.org/10.2196/13757 %U http://www.ncbi.nlm.nih.gov/pubmed/31647469 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 10 %P e14397 %T Development of a Patient-Reported Outcome Instrument for Patients With Severe Lower Extremity Trauma (LIMB-Q): Protocol for a Multiphase Mixed Methods Study %A Mundy,Lily R %A Klassen,Anne %A Grier,Jordan %A Carty,Matthew J %A Pusic,Andrea L %A Hollenbeck,Scott T %A Gage,Mark J %+ Section of Orthopaedic Trauma, Department of Orthopaedic Surgery, Duke University, 2301 Erwin Rd, Durham, NC, 27710, United States, 1 9196848111, gage78@gmail.com %K amputation %K limb salvage %K lower extremity %K trauma %K survey %K questionnaire %K patient reported outcome measures %K quality of life %K patient satisfaction %D 2019 %7 17.10.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: A current limitation in the care of patients with severe lower extremity traumatic injuries is the lack of a rigorously developed patient-reported outcome (PRO) instrument specific to lower extremity trauma patients. Objective: This mixed methods protocol aims to describe phases I and II of the development of a PRO instrument for lower extremity trauma patients, following international PRO development guidelines. Methods: The phase I study follows an interpretive description approach. Development of the PRO instrument begins with identifying the concepts that are important to patients, after which a preliminary conceptual framework is devised from a systematic literature review and used to generate an interview guide. Patients aged 18 years or above with limb-threatening lower extremity traumatic injuries resulting in reconstruction, amputation, or amputation after failed reconstruction will be recruited. The subjects will participate in semistructured, in-depth qualitative interviews to identify all important concepts of interest. The qualitative interview data will be coded with top-level domains, themes, and subthemes. The codes will then be utilized to refine the conceptual framework and generate preliminary items and a set of scales. The preliminary scales will be further refined via a process of conducting cognitive debriefing interviews with lower extremity trauma patients and soliciting expert opinions. Phase III will include a large-scale field test, using Rasch measurement theory to analyze the psychometric properties of the instrument; shortening and finalizing the scales; and determining the reliability, validity, and responsiveness of the instrument. Results: Phases I and II of this study have been funded. Phase I of this study has been completed, and phase II began in January 2019 and is expected to be completed in November 2019. Phase III will begin following the completion of phase II. Conclusions: This protocol describes the initial phases of development of a novel PRO instrument for use in lower extremity trauma patients. International Registered Report Identifier (IRRID): DERR1-10.2196/14397 %M 31625944 %R 10.2196/14397 %U http://www.researchprotocols.org/2019/10/e14397/ %U https://doi.org/10.2196/14397 %U http://www.ncbi.nlm.nih.gov/pubmed/31625944 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e13602 %T The Internet Intervention Patient Adherence Scale for Guided Internet-Delivered Behavioral Interventions: Development and Psychometric Evaluation %A Lenhard,Fabian %A Mitsell,Kajsa %A Jolstedt,Maral %A Vigerland,Sarah %A Wahlund,Tove %A Nord,Martina %A Bjureberg,Johan %A Sahlin,Hanna %A Andrén,Per %A Aspvall,Kristina %A Melin,Karin %A Mataix-Cols,David %A Serlachius,Eva %A Högström,Jens %+ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, CAP Research Centre, Gävlegatan 22, SE-113 30, Stockholm,, Sweden, 46 8 514 522 12, fabian.lenhard@ki.se %K patient compliance %K eHealth %K measure %K internet %K cognitive behavioral therapy %D 2019 %7 1.10.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient adherence is defined as the extent to which a patient complies with medical or health advice. At present, there is a lack of reliable and valid measures specifically designed to measure adherence to internet-delivered behavioral interventions. Objective: The objective of this study was to develop and psychometrically evaluate a novel measure of adherence to guided internet-delivered behavioral interventions. Methods: In collaboration with experienced clinicians and researchers in the field, a 5-item, clinician-rated internet intervention Patient Adherence Scale (iiPAS) was developed. The initial scale was tested in a sample of children and adolescents (N=50) participating in internet-delivered cognitive behavioral therapy (ICBT) studies. A revised version of the iiPAS was then administered to a larger sample of children and adolescents (N=148) with various behavioral problems participating in ICBT trials. The scale was evaluated according to a classical test theory framework. Results: The iiPAS demonstrated excellent internal consistency. Factor analyses revealed one underlying factor, explaining about 80% of the variance, suggesting that the scale captures a homogeneous adherence construct. The iiPAS was strongly associated with objective measures of patient activity in ICBT (number of logins, number of written characters, and completed modules). Furthermore, mid- and posttreatment ratings of the iiPAS were significantly correlated with treatment outcomes. By contrast, objective measures of patient activity in the Web-based platform did not correlate with treatment outcomes. Conclusions: The iiPAS could be a useful tool to measure adherence in a broad range of internet-delivered behavioral interventions. %M 31573901 %R 10.2196/13602 %U https://www.jmir.org/2019/10/e13602 %U https://doi.org/10.2196/13602 %U http://www.ncbi.nlm.nih.gov/pubmed/31573901 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 2 %P e14429 %T Virtual Reality Support for Joint Attention Using the Floreo Joint Attention Module: Usability and Feasibility Pilot Study %A Ravindran,Vijay %A Osgood,Monica %A Sazawal,Vibha %A Solorzano,Rita %A Turnacioglu,Sinan %+ Floreo Inc, 1875 Connecticut Ave NW, Washington, DC, 20009-6046, United States, 1 2402449473, sinan@floreotech.com %K autism spectrum disorder %K interpersonal skills %K virtual reality, instructional %D 2019 %7 30.9.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Advances in virtual reality (VR) technology offer new opportunities to design supports for the core behaviors associated with autism spectrum disorder (ASD) that promote progress toward optimal outcomes. Floreo has developed a novel mobile VR platform that pairs a user receiving instruction on target skills with an adult monitor. Objective: The primary objective of this pilot study was to explore the feasibility of using Floreo’s Joint Attention Module in school-aged children with autism in a special education setting. A secondary objective was to explore a novel joint attention measure designed for use with school-aged children and to observe whether there was a suggestion of change in joint attention skills from preintervention to postintervention. Methods: A total of 12 participants (age range: 9 to 16 years) received training with the Joint Attention Module for 14 sessions over 5 weeks. Results: No serious side effects were reported, and no participants dropped out of the study because of undesirable side effects. On the basis of monitor data, 95.4% (126/132) of the time participants tolerated the headset, 95.4% (126/132) of the time participants seemed to enjoy using Floreo’s platform, and 95.5% (128/134) of the time the VR experience was reported as valuable. In addition, scoring of the joint attention measure suggested a positive change in participant skills related to the total number of interactions, use of eye contact, and initiation of interactions. Conclusions: The study results suggest that Floreo’s Joint Attention Module is safe and well tolerated by students with ASD, and preliminary data also suggest that its use is related to improvements in fundamental joint attention skills. %M 31573921 %R 10.2196/14429 %U http://pediatrics.jmir.org/2019/2/e14429/ %U https://doi.org/10.2196/14429 %U http://www.ncbi.nlm.nih.gov/pubmed/31573921 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 9 %P e12532 %T Accuracy of Parent-Reported Child Height and Weight and Calculated Body Mass Index Compared With Objectively Measured Anthropometrics: Secondary Analysis of a Randomized Controlled Trial %A Chai,Li Kheng %A Collins,Clare E %A May,Chris %A Holder,Carl %A Burrows,Tracy L %+ School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, University Drive, Callaghan,, Australia, 61 249215514, tracy.burrows@newcastle.edu.au %K telemedicine %K parents %K child %K body height %K body weight %K body mass index %K self report %K dimensional measurement accuracy %D 2019 %7 16.09.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic health (eHealth) interventions for children often rely on parent-reported child anthropometric measures. However, limited studies have assessed parental accuracy in reporting child height and weight via Web-based approaches. Objective: The objective of this study was to determine the accuracy of parent-reported child height and weight, as well as body mass index and weight category that we calculated from these data. We also aimed to explore whether parent report was influenced by age, sex, weight status, or exposure to participation in a 12-week brief Web-based family lifestyle intervention. Methods: This study was a secondary analysis of data from a 12-week childhood obesity pilot randomized controlled trial in families with children aged 4 to 11 years in Australia. We asked parents to report demographic information, including child height and weight, using an online survey before their child’s height and weight were objectively measured by a trained research assistant at baseline and week 12. We analyzed data using the Lin concordance correlation coefficient (ρc, ranging from 0 [poor] to ±1 [perfect] concordance), Cohen kappa coefficient, and multivariable linear regression models. Results: There were 42 families at baseline and 35 families (83%) at week 12. Overall, the accuracy of parent-reported child height was moderate (ρc=.94), accuracy of weight was substantial (ρc=.96), and accuracy of calculated body mass index was poor (ρc=.63). Parents underreported child height and weight, respectively, by 0.9 cm and 0.5 kg at baseline and by 0.2 cm and 1.6 kg after participating in a 12-week brief Web-based family lifestyle intervention. The overall interrater agreement of child body mass index category was moderate at baseline (κ=.59) and week 12 (κ=.54). The weight category calculated from 74% (n=31) and 70% (n=23) of parent-reported child height and weight was accurate at baseline and week 12, respectively. Parental age was significantly (95% CI –0.52 to –0.06; P=.01) associated with accuracy of reporting child height. Child age was significantly (95% CI –2.34 to –0.06; P=.04) associated with reporting of child weight. Conclusions: Most Australian parents were reasonably accurate in reporting child height and weight among a group of children aged 4 to 11 years. The weight category of most of the children when calculated from parent-reported data was in agreement with the objectively measured data despite the body mass index calculated from parent-reported data having poor concordance at both time points. Online parent-reported child height and weight may be a valid method of collecting child anthropometric data ahead of participation in a Web-based program. Future studies with larger sample sizes and repeated measures over time in the context of eHealth research are warranted. Future studies should consider modeling the impact of calibration equations applied to parent-reported anthropometric data on study outcomes. %M 31538954 %R 10.2196/12532 %U https://www.jmir.org/2019/9/e12532/ %U https://doi.org/10.2196/12532 %U http://www.ncbi.nlm.nih.gov/pubmed/31538954 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e14657 %T Response Time as an Implicit Self-Schema Indicator for Depression Among Undergraduate Students: Preliminary Findings From a Mobile App–Based Depression Assessment %A Chung,Kyungmi %A Park,Jin Young %A Joung,DaYoung %A Jhung,Kyungun %+ Department of Psychiatry, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Simgokro 100gil 25 Seo-gu, Incheon, 22711, Republic of Korea, 82 32 290 3878, kyungun12@gmail.com %K depressive symptoms %K response time %K self-concept %K mobile phone %K mobile apps %K diagnostic screening programs %K self-assessment %K treatment adherence %K compliance %D 2019 %7 13.09.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Response times to depressive symptom items in a mobile-based depression screening instrument has potential as an implicit self-schema indicator for depression but has yet to be determined; the instrument was designed to readily record depressive symptoms experienced on a daily basis. In this study, the well-validated Korean version of the Center for Epidemiologic Studies Depression Scale-Revised (K-CESD-R) was adopted. Objective: The purpose of this study was to investigate the relationship between depression severity (ie, explicit measure: total K-CESD-R Mobile scores) and the latent trait of interest in schematic self-referent processing of depressive symptom items (ie, implicit measure: response times to items in the K-CESD-R Mobile scale). The purpose was to investigate this relationship among undergraduate students who had never been diagnosed with, but were at risk for, major depressive disorder (MDD) or comorbid MDD with other neurological or psychiatric disorders. Methods: A total of 70 participants—36 males (51%) and 34 females (49%)—aged 19-29 years (mean 22.66, SD 2.11), were asked to complete both mobile and standard K-CESD-R assessments via their own mobile phones. The mobile K-CESD-R sessions (binary scale: yes or no) were administered on a daily basis for 2 weeks. The standard K-CESD-R assessment (5-point scale) was administered on the final day of the 2-week study period; the assessment was delivered via text message, including a link to the survey, directly to participants’ mobile phones. Results: A total of 5 participants were excluded from data analysis. The result of polynomial regression analysis showed that the relationship between total K-CESD-R Mobile scores and the reaction times to the depressive symptom items was better explained by a quadratic trend—F (2, 62)=21.16, P<.001, R2=.41—than by a linear trend—F (1, 63)=25.43, P<.001, R2=.29. It was further revealed that the K-CESD-R Mobile app had excellent internal consistency (Cronbach alpha=.94); at least moderate concurrent validity with other depression scales, such as the Korean version of the Quick Inventory for Depressive Symptomatology-Self Report (ρ=.38, P=.002) and the Patient Health Questionnaire-9 (ρ=.48, P<.001); a high adherence rate for all participants (65/70, 93%); and a high follow-up rate for 10 participants whose mobile or standard K-CESD-R score was 13 or greater (8/10, 80%). Conclusions: As hypothesized, based on a self-schema model for depression that represented both item and person characteristics, the inverted U-shaped relationship between the explicit and implicit self-schema measures for depression showed the potential of an organizational breakdown; this also showed the potential for a subsequent return to efficient processing of schema-consistent information along a continuum, ranging from nondepression through mild depression to severe depression. Further, it is expected that the updated K-CESD-R Mobile app can play an important role in encouraging people at risk for depression to seek professional follow-up for mental health care. %M 31586362 %R 10.2196/14657 %U https://mhealth.jmir.org/2019/9/e14657/ %U https://doi.org/10.2196/14657 %U http://www.ncbi.nlm.nih.gov/pubmed/31586362 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e13408 %T Translation of the eHealth Impact Questionnaire for a Population of Dutch Electronic Health Users: Validation Study %A Neijenhuijs,Koen Ilja %A van der Hout,Anja %A Veldhuijzen,Evalien %A Scholten-Peeters,Gwendolijne G M %A van Uden-Kraan,Cornelia F %A Cuijpers,Pim %A Verdonck-de Leeuw,Irma M %+ Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van Der Boechorststaat 7, Amsterdam, 1081 BT, Netherlands, 31 20 444 0931, im.verdonck@amsterdamumc.nl %K eHealth %K evaluation %K e-Health Impact Questionnaire %K psychometrics %D 2019 %7 26.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The eHealth Impact Questionnaire (eHIQ) provides a standardized method to measure attitudes of electronic health (eHealth) users toward eHealth. It has previously been validated in a population of eHealth users in the United Kingdom and consists of 2 parts and 5 subscales. Part 1 measures attitudes toward eHealth in general and consists of the subscales attitudes towards online health information (5 items) and attitudes towards sharing health experiences online (6 items). Part 2 measures the attitude toward a particular eHealth application and consists of the subscales confidence and identification (9 items), information and presentation (8 items), and understand and motivation (9 items). Objective: This study aimed to translate and validate the eHIQ in a Dutch population of eHealth users. Methods: The eHIQ was translated and validated in accordance with the COnsensus-based Standards for the selection of health status Measurement INstruments criteria. The validation comprised 3 study samples, with a total of 1287 participants. Structural validity was assessed using confirmatory factor analyses and exploratory factor analyses (EFAs; all 3 samples). Internal consistency was assessed using hierarchical omega (all 3 samples). Test-retest reliability was assessed after 2 weeks, using 2-way intraclass correlation coefficients (sample 1). Measurement error was assessed by calculating the smallest detectable change (sample 1). Convergent and divergent validity were assessed using correlations with the remaining measures (all 3 samples). A graded response model was fit, and item information curves were plotted to describe the information provided by items across item trait levels (all 3 samples). Results: The original factor structure showed a bad fit in all 3 study samples. EFAs showed a good fit for a modified factor structure in the first study sample. This factor structure was subsequently tested in samples 2 and 3 and showed acceptable to good fits. Internal consistency, test-retest reliability, convergent validity, and divergent validity were acceptable to good for both the original as the modified factor structure, except for test-retest reliability of one of the original subscales and the 2 derivative subscales in the modified factor structure. The graded response model showed that some items underperformed in both the original and modified factor structure. Conclusions: The Dutch version of the eHIQ (eHIQ-NL) shows a different factor structure compared with the original English version. Part 1 of the eHIQ-NL consists of 3 subscales: attitudes towards online health information (5 items), comfort with sharing health experiences online (3 items), and usefulness of sharing health experiences online (3 items). Part 2 of the eHIQ-NL consists of 3 subscales: motivation and confidence to act (10 items), information and presentation (13 items), and identification (3 items). %M 31452516 %R 10.2196/13408 %U http://www.jmir.org/2019/8/e13408/ %U https://doi.org/10.2196/13408 %U http://www.ncbi.nlm.nih.gov/pubmed/31452516 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e12771 %T Is Wearable Technology Becoming Part of Us? Developing and Validating a Measurement Scale for Wearable Technology Embodiment %A Nelson,Elizabeth C %A Verhagen,Tibert %A Vollenbroek-Hutten,Miriam %A Noordzij,Matthijs L %+ Biomedical Signals and Systems, University of Twente, PO Box 217, Enschede,, Netherlands, 31 642683161, e.c.nelson@utwente.nl %K embodiment %K wearable technology %K measurement development %K human technology interaction %K eHealth %K mHealth %K wearable electronic devices %K self-help devices %K health information technology %K medical informatics %D 2019 %7 09.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To experience external objects in such a way that they are perceived as an integral part of one’s own body is called embodiment. Wearable technology is a category of objects, which, due to its intrinsic properties (eg, close to the body, inviting frequent interaction, and access to personal information), is likely to be embodied. This phenomenon, which is referred to in this paper as wearable technology embodiment, has led to extensive conceptual considerations in various research fields. These considerations and further possibilities with regard to quantifying wearable technology embodiment are of particular value to the mobile health (mHealth) field. For example, the ability to predict the effectiveness of mHealth interventions and knowing the extent to which people embody the technology might be crucial for improving mHealth adherence. To facilitate examining wearable technology embodiment, we developed a measurement scale for this construct. Objective: This study aimed to conceptualize wearable technology embodiment, create an instrument to measure it, and test the predictive validity of the scale using well-known constructs related to technology adoption. The introduced instrument has 3 dimensions and includes 9 measurement items. The items are distributed evenly between the 3 dimensions, which include body extension, cognitive extension, and self-extension. Methods: Data were collected through a vignette-based survey (n=182). Each respondent was given 3 different vignettes, describing a hypothetical situation using a different type of wearable technology (a smart phone, a smart wristband, or a smart watch) with the purpose of tracking daily activities. Scale dimensions and item reliability were tested for their validity and Goodness of Fit Index (GFI). Results: Convergent validity of the 3 dimensions and their reliability were established as confirmatory factor analysis factor loadings (>0.70), average variance extracted values (>0.50), and minimum item to total correlations (>0.40) exceeded established threshold values. The reliability of the dimensions was also confirmed as Cronbach alpha and composite reliability exceeded 0.70. GFI testing confirmed that the 3 dimensions function as intercorrelated first-order factors. Predictive validity testing showed that these dimensions significantly add to multiple constructs associated with predicting the adoption of new technologies (ie, trust, perceived usefulness, involvement, attitude, and continuous intention). Conclusions: The wearable technology embodiment measurement instrument has shown promise as a tool to measure the extension of an individual’s body, cognition, and self, as well as predict certain aspects of technology adoption. This 3-dimensional instrument can be applied to mixed method research and used by wearable technology developers to improve future versions through such things as fit, improved accuracy of biofeedback data, and customizable features or fashion to connect to the users’ personal identity. Further research is recommended to apply this measurement instrument to multiple scenarios and technologies, and more diverse user groups. %M 31400106 %R 10.2196/12771 %U https://mhealth.jmir.org/2019/8/e12771/ %U https://doi.org/10.2196/12771 %U http://www.ncbi.nlm.nih.gov/pubmed/31400106 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 8 %P e12836 %T Assessing the Content Validity of a New Patient-Reported Measure of Barriers to Antiretroviral Therapy Adherence for Electronic Administration in Routine HIV Care: Proposal for a Web-Based Delphi Study %A Engler,Kim %A Ahmed,Sara %A Lessard,David %A Vicente,Serge %A Lebouché,Bertrand %+ Center for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve Blvd, Montreal, QC, H4A 3S5, Canada, 1 514 934 1934 ext 32126, kimcengler@gmail.com %K HIV %K antiretroviral therapy, highly active %K patient-reported outcome measure %K medication adherence %K Delphi technique %K stakeholder participation %K Canada %K France %D 2019 %7 02.08.2019 %9 Proposal %J JMIR Res Protoc %G English %X Background: Adherence to lifesaving antiretroviral therapy (ART) for HIV infection remains a challenge for many patients. Routine screening for barriers to ART adherence could help make HIV care more patient-centered and prevent virologic rebound or failure. Our team is currently developing a new HIV-specific patient-reported outcome measure (PROM) of these barriers for use in Canada and France along with a digital app for its electronic administration. In our previous work, we developed the PROM’s multidimensional conceptual framework and generated 100 English items, which have been translated to French. Objective: This study aims to use a Web-based Delphi to help validate and select the content of this new HIV-specific PROM, based on the perspective of anglophone and francophone patients and providers in Canada and France. Here, we present the proposal for this Delphi. Methods: This modified Delphi will involve a diverse panel of patients (n=32) and providers (n=52) recruited especially from the 9 sites of the PROM development study (site locations in Canada: Montreal, Toronto, Vancouver; in France: Paris, Nantes, Clermont-Ferrand, Saint-Martin, Cayenne). Overall, 2 rounds of Web-based questionnaires will be conducted. The threshold for consensus is set at 60% and will determine which items are carried forward to the second round. Per item, 3 aspects will be rated: importance as a barrier to ART adherence, relevance for HIV care, and clarity. In both rounds, space will be available for free text comments. Overall comprehensiveness will be assessed in the second round. Results: This study has undergone a methodological review by experts in patient-oriented research. It has received approval from a research ethics board of the McGill University Health Centre. It is financially supported, in part, by the Canadian Institutes of Health Research’s Strategy for Patient-Oriented Research-Quebec Support Unit (M006). As of May 21, 2019, 15 people living with HIV and 25 providers completed the first round of the Delphi (24 from Canada and 16 from France). Conclusions: To our knowledge, this is the first Delphi to seek consensus on the most relevant and clinically actionable barriers to ART adherence, collecting opinions on an extensive list of barriers. Drawing on a relatively large and diverse panel of HIV patients and providers, it essentially engages key stakeholders in decision making about the PROM’s final content, helping to ensure its utility and adoption. International Registered Report Identifier (IRRID): PRR1-10.2196/12836 %M 31376275 %R 10.2196/12836 %U https://www.researchprotocols.org/2019/8/e12836/ %U https://doi.org/10.2196/12836 %U http://www.ncbi.nlm.nih.gov/pubmed/31376275 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 3 %P e12788 %T A Brief Measure of Interpersonal Interaction for 2-Player Serious Games: Questionnaire Validation %A Gorsic,Maja %A Clapp,Joshua D %A Darzi,Ali %A Novak,Domen %+ Department of Electrical and Computer Engineering, University of Wyoming, 1000 E University Ave, Laramie, WY, 82071, United States, 1 307 766 5599, dnovak1@uwyo.edu %K attitude to computers %K competitive behavior %K exercise %K motivation %K questionnaire design %K virtual reality %D 2019 %7 23.07.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: Competitive and cooperative serious games have become increasingly popular in areas such as rehabilitation and education and have several potential advantages over single-player games. However, they are not suitable for everyone, and the user experience in competitive and cooperative serious games depends on many factors. One important factor is the verbal interaction between players, but the effect of this factor has not been extensively studied because of the lack of a validated measurement tool. Objective: This paper aimed to validate a brief questionnaire that measures the verbal interaction between 2 players of a serious game. The questionnaire consists of 8 questions pertaining to the amount of conversation, its valence (positive or negative emotion), and its game relatedness. Methods: The questionnaire was validated with 30 pairs of participants who played a competitive serious game for 10 min while being recorded with cameras. The questionnaire was filled out by both participants, an in-person observer, and 2 members of our research group who watched the videos. Results from these raters were used to develop questionnaire instructions, and the finalized questionnaire was given to 2 additional raters who were trained on 5 videos and then rated the other 25 videos independently. Results: The questionnaire’s interrater reliability is excellent for the amount of conversation and its game relatedness (intraclass correlation coefficients [ICCs] above 0.9). Interrater reliability is fair to good for conversation valence (ICCs between 0.4 and 0.7). We believe that the lower interrater reliability for valence is primarily because of a limited spread of valence values in our sample. Furthermore, questionnaire ratings were significantly correlated with players’ personality characteristics (eg, amount of conversation was correlated with extraversion) and pressure/tension experienced in the competitive game. Conclusions: The validated questionnaire has the potential to be a useful tool for studying user experience in competitive and cooperative serious games. Furthermore, it could be adapted for other applications such as entertainment games. However, it has only been validated with unimpaired university students in a 2-player competitive serious game and should next be validated with different target populations (eg, stroke survivors) and different game designs (eg, cooperative games). %M 31339107 %R 10.2196/12788 %U https://games.jmir.org/2019/3/e12788/ %U https://doi.org/10.2196/12788 %U http://www.ncbi.nlm.nih.gov/pubmed/31339107 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e12212 %T Computerized Quality of Life Assessment: A Randomized Experiment to Determine the Impact of Individualized Feedback on Assessment Experience %A Geerards,Daan %A Pusic,Andrea %A Hoogbergen,Maarten %A van der Hulst,René %A Sidey-Gibbons,Chris %+ Patient-Reported Outcomes, Value & Experience Center, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, United States, 1 6177328124, drcgibbons@gmail.com %K quality of life %K outcome assessment %K patient-reported outcome measures %K computer-adaptive testing %K WHOQOL %K psychometrics %K feedback %D 2019 %7 11.07.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Quality of life (QoL) assessments, or patient-reported outcome measures (PROMs), are becoming increasingly important in health care and have been associated with improved decision making, higher satisfaction, and better outcomes of care. Some physicians and patients may find questionnaires too burdensome; however, this issue could be addressed by making use of computerized adaptive testing (CAT). In addition, making the questionnaire more interesting, for example by providing graphical and contextualized feedback, may further improve the experience of the users. However, little is known about how shorter assessments and feedback impact user experience. Objective: We conducted a controlled experiment to assess the impact of tailored multimodal feedback and CAT on user experience in QoL assessment using validated PROMs. Methods: We recruited a representative sample from the general population in the United Kingdom using the Oxford Prolific academic Web panel. Participants completed either a CAT version of the World Health Organization Quality of Life assessment (WHOQOL-CAT) or the fixed-length WHOQOL-BREF, an abbreviated version of the WHOQOL-100. We randomly assigned participants to conditions in which they would receive no feedback, graphical feedback only, or graphical and adaptive text-based feedback. Participants rated the assessment in terms of perceived acceptability, engagement, clarity, and accuracy. Results: We included 1386 participants in our analysis. Assessment experience was improved when graphical and tailored text-based feedback was provided along with PROMs (Δ=0.22, P<.001). Providing graphical feedback alone was weakly associated with improvement in overall experience (Δ=0.10, P=.006). Graphical and text-based feedback made the questionnaire more interesting, and users were more likely to report they would share the results with a physician or family member (Δ=0.17, P<.001, and Δ=0.17, P<.001, respectively). No difference was found in perceived accuracy of the graphical feedback scores of the WHOQOL-CAT and WHOQOL-BREF (Δ=0.06, P=.05). CAT (stopping rule [SE<0.45]) resulted in the administration of 25% fewer items than the fixed-length assessment, but it did not result in an improved user experience (P=.21). Conclusions: Using tailored text-based feedback to contextualize numeric scores maximized the acceptability of electronic QoL assessment. Improving user experience may increase response rates and reduce attrition in research and clinical use of PROMs. In this study, CAT administration was associated with a modest decrease in assessment length but did not improve user experience. Patient-perceived accuracy of feedback was equivalent when comparing CAT with fixed-length assessment. Fixed-length forms are already generally acceptable to respondents; however, CAT might have an advantage over longer questionnaires that would be considered burdensome. Further research is warranted to explore the relationship between assessment length, feedback, and response burden in diverse populations. %M 31298217 %R 10.2196/12212 %U http://www.jmir.org/2019/7/e12212/ %U https://doi.org/10.2196/12212 %U http://www.ncbi.nlm.nih.gov/pubmed/31298217 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e13490 %T Validation of the Electronic Version of the International Index of Erectile Function (IIEF-5 and IIEF-15): A Crossover Study %A van Kollenburg,Rob A A %A de Bruin,Daniel Martijn %A Wijkstra,Hessel %+ Department of Urology, Amsterdam University Medical Centers, Location Amsterdam Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 205666465, r.a.vankollenburg@amsterdamumc.nl %K ePROM %K smartphone %K surveys and questionnaires %D 2019 %7 02.07.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient-reported outcome measures (PROMs) are increasingly used to measure patient’s perspective of functional well-being, disease burden, treatment effectiveness, and clinical decision making. Electronic versions are increasingly feasible because of smartphone and tablet usage. However, validation of these electronic PROMs (ePROMs) is warranted for justified implementation. The International Index of Erectile Function (IIEF) 5 and 15 are widely used PROMs in urology to measure erectile dysfunction. Measurement reliability and validity testing of the IIEF ePROMs are essential before clinical application. Objective: The aim of this study was to assess reliability and validity of an ePROM version of both IIEF-5 and 15. Methods: This study included 179 patients from our urology outpatient clinic. It also had a randomized crossover design—participants completed either a paper and electronic IIEF-5 or 15 or twice completed an electronic version—with a 5-day delay. Internal consistency was assessed using Cronbach alpha and Spearman-Brown coefficient, test-retest reliability using the intraclass correlation coefficient (ICC), and convergent validity using the Pearson and Spearman correlation coefficient. Results: A total of 122 participants completed the study. Internal consistency was excellent for the electronic IIEF-5 (ICC 0.902) and good to excellent for the domains of the IIEF-15 (ICC 0.962-0.834). Test-retest reliability was excellent for the IIEF-5 (ICC 0.924) and good to excellent for the domains of the IIEF-15 (ICC 0.950-0.778). Convergent validity was excellent for the IIEF-5 and IIEF-15, with a correlation of r=0.923 and r=0.951, respectively. Conclusions: We successfully introduced patient-acceptable ePROM versions of the IIEF-5 and IIEF-15. This study’s results demonstrate that the ePROM versions of the IIEF-5 and IIEF-15 can be reliably implemented, as outcomes are reliable and in accordance with findings of the paper version. Trial Registration: ClinicalTrials.gov NCT03222388; https://clinicaltrials.gov/ct2/show/NCT03222388 %M 31267983 %R 10.2196/13490 %U https://www.jmir.org/2019/7/e13490/ %U https://doi.org/10.2196/13490 %U http://www.ncbi.nlm.nih.gov/pubmed/31267983 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e12952 %T “Seeing Pain Differently”: A Qualitative Investigation Into the Differences and Similarities of Pain and Rheumatology Specialists’ Interpretation of Multidimensional Mobile Health Pain Data From Children and Young People With Juvenile Idiopathic Arthritis %A Lee,Rebecca Rachael %A Rashid,Amir %A Ghio,Daniela %A Thomson,Wendy %A Cordingley,Lis %+ NIHR Manchester Musculoskeletal Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Room 2.908, Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom, 44 1612757757, rebecca.lee-4@manchester.ac.uk %K mHeath %K pain assessment %K juvenile idiopathic arthritis %K focus group %K qualitative research %D 2019 %7 02.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In contrast to the use of traditional unidimensional paper-based scales, a mobile health (mHealth) assessment of pain in children and young people (CYP) with juvenile idiopathic arthritis (JIA) enables comprehensive and complex multidimensional pain data to be captured remotely by individuals. However, how professionals use multidimensional pain data to interpret and synthesize pain reports gathered using mHealth tools is not yet known. Objective: The aim of this study was to explore the salience and prioritization of different mHealth pain features as interpreted by key stakeholders involved in research and management of pain in CYP with JIA. Methods: Pain and rheumatology specialists were purposively recruited via professional organizations. Face-to-face focus groups were conducted for each specialist group. Participants were asked to rank order 9 static vignette scenarios created from real patient mHealth multidimensional pain data. These data had been collected by a researcher in a separate study using My Pain Tracker, a valid and acceptable mHealth iPad pain communication tool that collects information about intensity, severity, location, emotion, and pictorial pain qualities. In the focus groups, specialists discussed their decision-making processes behind each rank order in the focus groups. The total group rank ordering of vignette scenarios was calculated. Qualitative data from discussions were analyzed using latent thematic analysis. Results: A total of 9 pain specialists took part in 1 focus group and 10 rheumatology specialists in another. In pain specialists, the consensus for the highest pain experience (44%) was poorer than their ranking of the lowest pain experiences (55%). Conversely, in rheumatology specialists, the consensus for the highest pain experience (70%) was stronger than their ranking of the lowest pain experience (50%). Pain intensity was a high priority for pain specialists, but rheumatology specialists gave high priority to intensity and severity taken together. Pain spread was highly prioritized, with the number of pain locations (particular areas or joints) being a high priority for both groups; radiating pain was a high priority for pain specialists only. Pain emotion was challenging for both groups and was only perceived to be a high priority when specialists had additional confirmatory evidence (such as information about pain interference or clinical observations) to validate the pain emotion report. Pain qualities such as particular word descriptors, use of the color red, and fire symbols were seen to be high priority by both groups in interpretation of CYP pain reports. Conclusions: Pain interpretation is complex. Findings from this study of specialists’ decision-making processes indicate which aspects of pain are prioritized and weighted more heavily than others by those interpreting mHealth data. Findings are useful for developing electronic graphical summaries which assist specialists in interpreting patient-reported mHealth pain data more efficiently in clinical and research settings. %M 31267979 %R 10.2196/12952 %U https://mhealth.jmir.org/2019/7/e12952/ %U https://doi.org/10.2196/12952 %U http://www.ncbi.nlm.nih.gov/pubmed/31267979 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e13475 %T Development and Validation of a Personalized Social Media Platform–Based HIV Incidence Risk Assessment Tool for Men Who Have Sex With Men in China %A Yun,Ke %A Xu,Junjie %A Leuba,Sequoia %A Zhu,Yunyu %A Zhang,Jing %A Chu,Zhenxing %A Geng,Wenqing %A Jiang,Yongjun %A Shang,Hong %+ Key Laboratory of AIDS Immunology of National Health Commission of the People's Republic of China, Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, No 155, Nanjing North Street, Heping District, Shenyang,, China, 86 8328 2634, hongshang100@hotmail.com %K HIV %K risk prediction %K social media %K men who have sex with men %K China %D 2019 %7 18.06.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Personalized risk assessments can help medical providers determine targeted populations for counseling and risk reduction interventions. Objective: The objective of this study was to develop a social media platform–based HIV risk prediction tool for men who have sex with men (MSM) in China based on an independent MSM cohort to help medical providers determine target populations for counseling and risk reduction treatments. Methods: A prospective cohort of MSM from Shenyang, China, followed from 2009 to 2016, was used to develop and validate the prediction model. The eligible MSM were randomly assigned to the training and validation dataset, and Cox proportional hazards regression modeling was conducted using predictors for HIV seroconversion selected by the training dataset. Discrimination and calibration were performed, and the related nomogram and social media platform–based HIV risk assessment tool were constructed. Results: The characteristics of the sample between the training dataset and the validation dataset were similar. The risk prediction model identified the following predictors for HIV seroconversion: the main venue used to find male sexual partners, had condomless receptive or insertive anal intercourse, and used rush poppers. The model was well calibrated. The bootstrap C-index was 0.75 (95% CI 0.65-0.85) in the training dataset, and 0.60 (95% CI 0.45-0.74) in the validation dataset. The calibration plots showed good agreement between predicted risk and the actual proportion of no HIV infection in both the training and validation datasets. Nomogram and WeChat-based HIV incidence risk assessment tools for MSM were developed. Conclusions: This social media platform–based HIV infection risk prediction tool can be distributed easily, improve awareness of personal HIV infection risk, and stratify the MSM population based on HIV risk, thus informing targeted interventions for MSM at greatest risk for HIV infection. %M 31215509 %R 10.2196/13475 %U https://www.jmir.org/2019/6/e13475/ %U https://doi.org/10.2196/13475 %U http://www.ncbi.nlm.nih.gov/pubmed/31215509 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e13951 %T A Novel Instrument for Measuring Older People’s Attitudes Toward Technology (TechPH): Development and Validation %A Anderberg,Peter %A Eivazzadeh,Shahryar %A Berglund,Johan Sanmartin %+ Department of Health, Blekinge Institute of Technology, Valhallavägen 1, Karlskrona, 37139, Sweden, 46 734223736, peter.anderberg@bth.se %K technophilia %K aging %K internet %K health technology %K eHealth %D 2019 %7 23.05.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of health technology by older people is coming increasingly in focus with the demographic changes. Health information technology is generally perceived as an important factor in enabling increased quality of life and reducing the cost of care for this group. Age-appropriate design and facilitation of technology adoption are important to ensure functionality and removal of various barriers to usage. Development of assessment tools and instruments for evaluating older persons’ technology adoption and usage as well as measuring the effects of the interventions are of high priority. Both usability and acceptance of a specific technology or service are important factors in evaluating the impact of a health information technology intervention. Psychometric measures are seldom included in evaluations of health technology. However, basic attitudes and sentiments toward technology (eg, technophilia) could be argued to influence both the level of satisfaction with the technology itself as well as the perception of the health intervention outcome. Objective: The purpose of this study is to develop a reduced and refined instrument for measuring older people's attitudes and enthusiasm for technology based on relevant existing instruments for measuring technophilia. A requirement of the new instrument is that it should be short and simple to make it usable for evaluation of health technology for older people. Methods: Initial items for the TechPH questionnaire were drawn from a content analysis of relevant existing technophilia measure instruments. An exploratory factor analysis was conducted in a random selection of persons aged 65 years or older (N=374) on eight initial items. The scale was reduced to six items, and the internal consistency and reliability of the scale were examined. Further validation was made by a confirmatory factor analysis (CFA). Results: The exploratory factor analysis resulted in two factors. These factors were analyzed and labeled techEnthusiasm and techAnxiety. They demonstrated relatively good internal consistency (Cronbach alpha=.72 and .68, respectively). The factors were confirmed in the CFA and showed good model fit (χ28=21.2, χ2/df=2.65, comparative fit index=0.97, adjusted goodness-of-fit index=0.95, root mean square error of approximation=0.067, standardized root mean square residual=0.036). Conclusions: The construed TechPH score showed expected relations to external real-world criteria, and the two factors showed interesting internal relations. Different technophilia personality traits distinguish clusters with different behaviors of adaptation as well as usage of new technology. Whether there is an independent association with the TechPH score against outcomes in health technology projects needs to be shown in further studies. The instrument must also be validated in different contexts, such as other countries. %M 31124467 %R 10.2196/13951 %U http://www.jmir.org/2019/5/e13951/ %U https://doi.org/10.2196/13951 %U http://www.ncbi.nlm.nih.gov/pubmed/31124467 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e12875 %T Developing the National Usability-Focused Health Information System Scale for Physicians: Validation Study %A Hyppönen,Hannele %A Kaipio,Johanna %A Heponiemi,Tarja %A Lääveri,Tinja %A Aalto,Anna-Mari %A Vänskä,Jukka %A Elovainio,Marko %+ National Institute for Health and Welfare, PO Box 30, Helsinki, 00271, Finland, 358 295247434, tarja.heponiemi@thl.fi %K physicians %K health information systems %K questionnaire %K validation studies %D 2019 %7 16.05.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Problems in the usability of health information systems (HISs) are well acknowledged, but research still lacks a validated questionnaire for measuring and monitoring different dimensions of usability of HISs. Such questionnaires are needed not only for research but also for developing usability of HISs from the viewpoint of end-user experiences. Objective: This study aimed to develop and test the validity of the questionnaire measuring the National Usability-Focused HIS-Scale (NuHISS) among a nationally representative sample of Finnish physicians. Methods: We utilized 2 cross-sectional data collected from a random sample of Finnish physicians in 2014 (N=3781; of which 2340 [61.9%] were women) and 2017 (N=4018; of which 2604 [64.8%] were women). Exploratory and confirmatory factor analyses (structural equation modeling [SEM]) were applied to test the structural validity of the NuHISS. As the concurrent validity measure, we used the self-reported overall quality of the electronic health record system (school grade) provided by the participants using marginal structural models. Results: The exploratory factor analyses with Varimax rotation suggested that the 7-factor solution did offer a good fit to the data in both samples (C2=2136.14 in 2014 and C2=2109.83 in 2017, both P<.001). Moreover, structural equation modelling analyses, using comparative fit index (CFI), Tucker-Lewis Index (TLI), Normed Fit Index (NFI), root mean squared error of approximation (RMSEA), and Standardized Root Mean square Residual (SRMR), showed that the 7-factor solution provided an acceptable fit in both samples (CFI=0.92/0.91, TLI=0.92/0.91, NFI=0.92/0.91, RMSEA=0.048/0.049, and SRMR=0.040/0.039). In addition, concurrent validity of this solution was shown to be acceptable. Ease of use, but also all other dimensions, was especially associated with overall quality reports independent of measured confounders. The 7-factor solution included dimensions of technical quality, information quality, feedback, ease of use, benefits, internal collaboration, and cross-organizational collaboration. Conclusions: NuHISS provides a useful tool for measuring usability of HISs among physicians and offers a valid measure for monitoring the long-term development of HISs on a large scale. The relative importance of items needs to be assessed against national electronic health policy goals and complemented with items that have remained outside the NuHISS from the questionnaire when appropriate. %M 31099336 %R 10.2196/12875 %U https://www.jmir.org/2019/5/e12875/ %U https://doi.org/10.2196/12875 %U http://www.ncbi.nlm.nih.gov/pubmed/31099336 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e11561 %T Advancing Optimal Development in Children: Examining the Construct Validity of a Parent Reflective Functioning Questionnaire %A De Roo,Monica %A Wong,Gina %A Rempel,Gwen R %A Fraser,Shawn N %+ Centre for Nursing and Health Studies, Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, AB, T9S 3A3, Canada, 1 7804300590, shawnf@athabascau.ca %K mentalization %K parent reflective functioning %K questionnaire design %K parenting %D 2019 %7 09.05.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parental reflective functioning (PRF) is the capacity parents have to understand their own mental states and those of their children, as well as the influence of those mental states on behavior. Parents with greater capacity for PRF are more likely to foster secure attachment with their children. The Parental Development Interview is a gold standard measure of PRF but is hampered by cost, training, and length of administration. The 18-item Parent Reflective Functioning Questionnaire (PRFQ-18) is a simpler option developed to capture 3 types of PRF: (1) prementalizing, (2) parent’s certainty, and (3) interest and curiosity surrounding a child’s mental state. Objective: The aim of this study was to examine the factor structure and select psychometric properties of the PRFQ in a sample of Canadian parents. Methods: We examined the factor structure and discriminant and construct validity of the PRFQ-18 among 306 parents (males=120 and females=186) across Canada; the age range of children was 0 to 12 years. Parents also completed Web-based measures of perceived stress, parental coping, parenting competence, and social support. Results: A confirmatory factor analysis confirmed the hypothesized 3-factor structure of the PRFQ-18 providing evidence that the PRFQ-18 may be a useful and practical measure of PRF in Canadian adults and showed minor revisions may improve the suitability of the PRFQ-18 for assessing PRF. Conclusions: These results add support for the construct validity of the PRFQ-18. %M 31518301 %R 10.2196/11561 %U http://pediatrics.jmir.org/2019/1/e11561/ %U https://doi.org/10.2196/11561 %U http://www.ncbi.nlm.nih.gov/pubmed/31518301 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e12525 %T QuikLitE, a Framework for Quick Literacy Evaluation in Medicine: Development and Validation %A Zheng,Jiaping %A Yu,Hong %+ Department of Computer Science, University of Massachusetts Lowell, One University Avenue, Lowell, MA, 01854, United States, 1 978 934 3620, yu_hong@uml.edu %K health literacy %K psychometrics %K crowdsourcing %D 2019 %7 22.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: A plethora of health literacy instruments was developed over the decades. They usually start with experts curating passages of text or word lists, followed by psychometric validation and revision based on test results obtained from a sample population. This process is costly and it is difficult to customize for new usage scenarios. Objective: This study aimed to develop and evaluate a framework for dynamically creating test instruments that can provide a focused assessment of patients’ health literacy. Methods: A health literacy framework and scoring method were extended from the vocabulary knowledge test to accommodate a wide range of item difficulties and various degrees of uncertainty in the participant’s answer. Web-based tests from Amazon Mechanical Turk users were used to assess reliability and validity. Results: Parallel forms of our tests showed high reliability (correlation=.78; 95% CI 0.69-0.85). Validity measured as correlation with an electronic health record comprehension instrument was higher (.47-.61 among 3 groups) than 2 existing tools (Short Assessment of Health Literacy-English, .38-.43; Short Test of Functional Health Literacy in Adults, .34-.46). Our framework is able to distinguish higher literacy levels that are often not measured by other instruments. It is also flexible, allowing customizations to the test the designer’s focus on a particular interest in a subject matter or domain. The framework is among the fastest health literacy instrument to administer. Conclusions: We proposed a valid and highly reliable framework to dynamically create health literacy instruments, alleviating the need to repeat a time-consuming process when a new use scenario arises. This framework can be customized to a specific need on demand and can measure skills beyond the basic level. %M 30794206 %R 10.2196/12525 %U http://www.jmir.org/2019/2/e12525/ %U https://doi.org/10.2196/12525 %U http://www.ncbi.nlm.nih.gov/pubmed/30794206 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e12376 %T Toward an Objective Assessment of Implementation Processes for Innovations in Health Care: Psychometric Evaluation of the Normalization Measure Development (NoMAD) Questionnaire Among Mental Health Care Professionals %A Vis,Christiaan %A Ruwaard,Jeroen %A Finch,Tracy %A Rapley,Tim %A de Beurs,Derek %A van Stel,Henk %A van Lettow,Britt %A Mol,Mayke %A Kleiboer,Annet %A Riper,Heleen %A Smit,Jan %+ Department of Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, Netherlands, 31 646098094, p.d.c.vis@vu.nl %K implementation science %K eHealth %K psychometrics %K eMental health %K normalization process theory %K implementation assessment %D 2019 %7 20.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Successfully implementing eMental health (eMH) interventions in routine mental health care constitutes a major challenge. Reliable instruments to assess implementation progress are essential. The Normalization MeAsure Development (NoMAD) study developed a brief self-report questionnaire that could be helpful in measuring implementation progress. Based on the Normalization Process Theory, this instrument focuses on 4 generative mechanisms involved in implementation processes: coherence, cognitive participation, collective action, and reflexive monitoring. Objective: The aim of this study was to translate the NoMAD questionnaire to Dutch and to confirm the factor structure in Dutch mental health care settings. Methods: Dutch mental health care professionals involved in eMH implementation were invited to complete the translated NoMAD questionnaire. Confirmatory factor analysis (CFA) was conducted to verify interpretability of scale scores for 3 models: (1) the theoretical 4-factor structure, (2) a unidimensional model, and (3) a hierarchical model. Potential improvements were explored, and correlated scale scores with 3 control questions were used to assess convergent validity. Results: A total of 262 professionals from mental health care settings in the Netherlands completed the questionnaire (female: 81.7%; mean age: 45 [SD=11]). The internal consistency of the 20-item questionnaire was acceptable (.62≤alpha≤.85). The theorized 4-factor model fitted the data slightly better in the CFA than the hierarchical model (Comparative Fit Index=0.90, Tucker Lewis Index=0.88, Root Mean Square Error of Approximation=0.10, Standardized Root Mean Square Residual=0.12, χ22=22.5, P≤.05). However, the difference is small and possibly not outweighing the practical relevance of a total score and subscale scores combined in one hierarchical model. One item was identified as weak (λCA.2=0.10). A moderate-to-strong convergent validity with 3 control questions was found for the Collective Participation scale (.47≤r≤.54, P≤.05). Conclusions: NoMAD’s theoretical factor structure was confirmed in Dutch mental health settings to acceptable standards but with room for improvement. The hierarchical model might prove useful in increasing the practical utility of the NoMAD questionnaire by combining a total score with information on the 4 generative mechanisms. Future research should assess the predictive value and responsiveness over time and elucidate the conceptual interpretability of NoMAD in eMH implementation practices. %M 30785402 %R 10.2196/12376 %U http://www.jmir.org/2019/2/e12376/ %U https://doi.org/10.2196/12376 %U http://www.ncbi.nlm.nih.gov/pubmed/30785402 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e10377 %T Development of the Multidimensional Readiness and Enablement Index for Health Technology (READHY) Tool to Measure Individuals’ Health Technology Readiness: Initial Testing in a Cancer Rehabilitation Setting %A Kayser,Lars %A Rossen,Sine %A Karnoe,Astrid %A Elsworth,Gerald %A Vibe-Petersen,Jette %A Christensen,Jesper Frank %A Ried-Larsen,Mathias %A Osborne,Richard H %+ Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, DK-1014, Denmark, 45 28757291, lk@sund.ku.dk %K health technology readiness %K questionnaire %K eHealth literacy, enablement %D 2019 %7 12.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The increasing digitization of health care services with enhanced access to fast internet connections, along with wide use of smartphones, offers the opportunity to get health advice or treatment remotely. For service providers, it is important to consider how consumers can take full advantage of available services and how this can create an enabling environment. However, it is important to consider the digital context and the attributes of current and future users, such as their readiness (ie, knowledge, skills, and attitudes, including trust and motivation). Objective: The objective of this study was to evaluate how the eHealth Literacy Questionnaire (eHLQ) combined with selected dimensions from the Health Education Impact Questionnaire (heiQ) and the Health Literacy Questionnaire (HLQ) can be used together as an instrument to characterize an individual’s level of health technology readiness and explore how the generated data can be used to create health technology readiness profiles of potential users of health technologies and digital health services. Methods: We administered the instrument and sociodemographic questions to a population of 305 patients with a recent cancer diagnosis referred to rehabilitation in a setting that plans to introduce various technologies to assist the individuals. We evaluated properties of the Readiness and Enablement Index for Health Technology (READHY) instrument using confirmatory factor analysis, convergent and discriminant validity analysis, and exploratory factor analysis. To identify different health technology readiness profiles in the population, we further analyzed the data using hierarchical and k-means cluster analysis. Results: The confirmatory factor analysis found a suitable fit for the 13 factors with only 1 cross-loading of 1 item between 2 dimensions. The convergent and discriminant validity analysis revealed many factor correlations, suggesting that, in this population, a more parsimonious model might be achieved. Exploratory factor analysis pointed to 5 to 6 constructs based on aggregates of the existing dimensions. The results were not satisfactory, so we performed an 8-factor confirmatory factor analysis, resulting in a good fit with only 1 item cross-loading between 2 dimensions. Cluster analysis showed that data from the READHY instrument can be clustered to create meaningful health technology readiness profiles of users. Conclusions: The 13 dimensions from heiQ, HLQ, and eHLQ can be used in combination to describe a user’s health technology readiness level and degree of enablement. Further studies in other populations are needed to understand whether the associations between dimensions are consistent and the number of dimensions can be reduced. %M 30747717 %R 10.2196/10377 %U http://www.jmir.org/2019/2/e10377/ %U https://doi.org/10.2196/10377 %U http://www.ncbi.nlm.nih.gov/pubmed/30747717 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11099 %T Assessing the Validity of the MyJump2 App for Measuring Different Jumps in Professional Cerebral Palsy Football Players: An Experimental Study %A Coswig,Victor %A Silva,Anselmo De Athayde Costa E %A Barbalho,Matheus %A Faria,Fernando Rosch De %A Nogueira,Claudio D %A Borges,Mariane %A Buratti,Jéssica R %A Vieira,Ivaldo B %A Román,Francisco Javier López %A Gorla,José I %+ Faculty of Physical Education, Federal University of Pará, Campus Castanhal, Rua Major Wilson 3094, Casa 180 qd 8, Castanhal, 68742-89, Brazil, 55 91984273036, vcoswig@gmail.com %K cerebral palsy football %K jump performance %K mobile apps %K mobile phone %K paralympic sports %D 2019 %7 30.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Vertical jumps can be used to assess neuromuscular status in sports performance. This is particularly important in Cerebral Palsy Football (CP Football) because players are exposed to high injury risk, but it may be complicated because the gold standard for assessing jump performance is scarce in field evaluation. Thus, field techniques, such as mobile apps, have been proposed as an alternative method for solving this problem. Objective: This study aims to evaluate the reliability of the measures of the MyJump2 app to assess vertical jump performance in professional CP Football. Methods: We assessed 40 male CP Football athletes (age 28.1 [SD 1.4] years, weight 72.5 [SD 6.2] kg, and height 176 [SD 4.2] cm) through the countermovement jump (CMJ) and squat jump (SJ) using a contact mat. At the same time, we assessed the athletes using the MyJump2 app. Results: There were no significant differences between the instruments in SJ height (P=.12) and flight time (P=.15). Additionally, there were no significant differences between the instruments for CMJ in jump height (P=.16) and flight time (P=.13). In addition, it was observed that there were significant and strong intraclass correlations in all SJ variables varying from 0.86 to 0.89 (both P<.001), which was classified as “almost perfect.” Similar results were observed in all variables from the CMJ, varying from 0.92 to 0.96 (both P ≤.001). Conclusions: We conclude that the MyJump2 app presents high validity and reliability for measuring jump height and flight time of the SJ and CMJ in CP Football athletes. %M 30698529 %R 10.2196/11099 %U http://mhealth.jmir.org/2019/1/e11099/ %U https://doi.org/10.2196/11099 %U http://www.ncbi.nlm.nih.gov/pubmed/30698529 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e12075 %T A Modular Health-Related Quality of Life Instrument for Electronic Assessment and Treatment Monitoring: Web-Based Development and Psychometric Validation of Core Thrive Items %A Wicks,Paul %A McCaffrey,Stacey %A Goodwin,Kim %A Black,Ryan %A Hoole,Michael %A Heywood,James %+ PatientsLikeMe, 160 2nd Street, Cambridge, MA, 02142, United States, 1 6174994003, pwicks@patientslikeme.com %K personal health records %K health-related quality of life %K patient reported outcome measures %D 2019 %7 25.01.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient-reported outcome (PRO) measures describe natural history, manage disease, and measure the effects of interventions in trials. Patients themselves increasingly use Web-based PRO tools to track their progress, share their data, and even self-experiment. However, existing PROs have limitations such as being: designed for paper (not screens), long and burdensome, negatively framed, under onerous licensing restrictions, either too generic or too specific. Objective: This study aimed to develop and validate the core items of a modular, patient-centric, PRO system (Thrive) that could measure health status across a range of chronic conditions with minimal burden. Methods: Thrive was developed in 4 phases, largely consistent with Food and Drug Administration guidance regarding PRO development. First, preliminary core items (common across multiple conditions: core Thrive items) were developed through literature review, analysis of approximately 20 existing PROs on PatientsLikeMe, and feedback from psychometric and content experts. Second, 2 rounds of cognitive interviews were iteratively conducted with patients (N=14) to obtain feedback on the preliminary items. Third, core Thrive items were administered electronically along with comparator measures, including 20-item Short-Form General Health Survey (SF)-20 and Patient Health Questionnaire (PHQ)-9, to a large sample (N=2002) of adults with chronic diseases through the PatientsLikeMe platform. On the basis of theoretical and empirical rationale, items were revised or removed. Fourth, the revised core Thrive items were administered to another sample of patients (N=704) with generic and condition-specific comparator measures. A psychometric evaluation, which included both modern and classical test theory approaches, was conducted on these items, and several more items were removed. Results: Cognitive interviews helped to remove confusing or redundant items. Empirical testing of subscales revealed good internal consistency (Cronbach alpha=.712-.879), test-retest reliability (absolute intraclass correlations=.749-.912), and convergent validity with legacy PRO scales (eg, Pearson r=.5-.75 between Thrive subscales and PHQ-9 total). The finalized instrument consists of a 19-item core including 5 multi-item subscales: Core symptoms, Abilities, Mobility, Sleep, and Thriving. Results provide evidence of construct (content, convergent) validity, high levels of test-retest and internal consistency reliability, and the ability to detect change over time. The items did not exhibit bias based on gender or age, and the items generally functioned similarly across conditions. These results support the use of Thrive Core items across diverse chronic patient populations. Conclusions: Thrive appears to be a useful approach for capturing important domains for patients with chronic conditions. This core set serves as a foundation to begin developing modular condition-specific versions in the near future. Cross-walking against traditional PROs from the PatientsLikeMe platform is underway, in addition to clinical validation and comparison with biomarkers. Thrive is licensed under Creative Commons Attribution ShareAlike 4.0. %M 30681962 %R 10.2196/12075 %U http://www.jmir.org/2019/1/e12075/ %U https://doi.org/10.2196/12075 %U http://www.ncbi.nlm.nih.gov/pubmed/30681962 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11130 %T The App Behavior Change Scale: Creation of a Scale to Assess the Potential of Apps to Promote Behavior Change %A McKay,Fiona H %A Slykerman,Sarah %A Dunn,Matthew %+ School of Health and Social Development, Deakin University, Burwood Hwy, Burwood, 3125, Australia, 61 392517183, fiona.mckay@deakin.edu.au %K apps %K smartphone %K mobile phone %K mobile app %K scale development %K rating %D 2019 %7 25.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Using mobile phone apps to promote behavior change is becoming increasingly common. However, there is no clear way to rate apps against their behavior change potential. Objective: This study aimed to develop a reliable, theory-based scale that can be used to assess the behavior change potential of smartphone apps. Methods: A systematic review of all studies purporting to investigate app’s behavior change potential was conducted. All scales and measures from the identified studies were collected to create an item pool. From this item pool, 3 health promotion exerts created the App Behavior Change Scale (ABACUS). To test the scale, 70 physical activity apps were rated to provide information on reliability. Results: The systematic review returned 593 papers, the abstracts and titles of all were reviewed, with the full text of 77 papers reviewed; 50 papers met the inclusion criteria. From these 50 papers, 1333 questions were identified. Removing duplicates and unnecessary questions left 130 individual questions, which were then refined into the 21-item scale. The ABACUS demonstrates high percentage agreement among reviewers (over 80%), with 3 questions scoring a Krippendorff alpha that would indicate agreement and a further 7 came close with alphas >.5. The scale overall reported high interrater reliability (2-way mixed interclass coefficient=.92, 95% CI 0.81-0.97) and high internal consistency (Cronbach alpha=.93). Conclusions: The ABACUS is a reliable tool that can be used to determine the behavior change potential of apps. This instrument fills a gap by allowing the evaluation of a large number of apps to be standardized across a range of health categories. %M 30681967 %R 10.2196/11130 %U http://mhealth.jmir.org/2019/1/e11130/ %U https://doi.org/10.2196/11130 %U http://www.ncbi.nlm.nih.gov/pubmed/30681967 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e10178 %T EuroQol (EQ-5D-5L) Validity in Assessing the Quality of Life in Adults With Asthma: Cross-Sectional Study %A Hernandez,Gimena %A Garin,Olatz %A Dima,Alexandra L %A Pont,Angels %A Martí Pastor,Marc %A Alonso,Jordi %A Van Ganse,Eric %A Laforest,Laurent %A de Bruin,Marijn %A Mayoral,Karina %A Serra-Sutton,Vicky %A Ferrer,Montse %A , %+ Health Services Research Group, Hospital del Mar Medical Research Institute, Dr Aiguader 88, Barcelona, 08003, Spain, 34 933160763, mferrer@imim.es %K asthma %K EQ-5D-5L %K EuroQol %K health-related quality of life %K Web-based survey %K validity %K patient-reported outcome measures %D 2019 %7 23.01.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The EuroQol-5 Dimension (EQ-5D), developed in 1990, is a most widely used generic tool to measure the health-related quality of life (HRQoL) and considered suitable for patients with asthma. In 2009, the EuroQol Group developed a new EQ-5D version to overcome limitations related to its consistently reported high ceiling effect. To enhance the sensitivity for assessing the HRQoL in further patient populations, the number of responses of EQ-5D was increased from 3 to 5 levels (EQ-5D-5L). Moreover, the availability of well-defined requirements for its Web-based administration allows EQ-5D-5L use to monitor the HRQoL in electronic health (eHealth) programs. No study has evaluated the metric properties of the new EQ-5D-5L in patients with asthma yet. Objective: This study aims to examine the distribution, construct validity, and reliability of the new EQ-5D-5L questionnaire administered online to adults with asthma. Methods: We evaluated patients with asthma (age: 18-40 years) from a primary care setting in France and England, who self-completed the EQ-5D-5L questionnaire online. The inclusion criteria were persistent asthma defined as >6 months of prescribed inhaled corticosteroids and long-acting beta-agonists or inhaled corticosteroids alone during the 12 months prior to inclusion. The EQ-5D index was obtained by applying the English preference value set for the new EQ-5D-5L and the French 3L-5L crosswalk value set. Both value sets produced single preference-based indices ranging from 1 (best health state) to negative values (health states valued as worse than death), where 0=death, allowing the calculation of quality-adjusted life years. Responses to dimensions and index distribution, including ceiling and floor effects, were examined. The construct validity was assessed by comparing the means of known groups by analyses of variance and calculation of effect sizes. Results: Of 312 patients answering the baseline Web-based survey, 290 completed the EQ-5D-5L (93%). The floor effect was null, and the ceiling effect was 26.5% (74/279). The mean EQ-5D-5L index was 0.88 (SD 0.14) with the English value set and 0.83 (SD 0.19) with the French 3L-5L crosswalk value set. In both indices, large effect sizes were observed for known groups defined by the Asthma Control Questionnaire (1.06 and 1.04, P<.001). Differences between extreme groups defined by chronic conditions (P=.002 and P=.003 for the English value set and French 3L-5L crosswalk value set, respectively), short-acting beta-agonists (SABAs) canisters in the last 12 months (P=.02 and P=.03), or SABA use during the previous 4 weeks (P=.03 and P=.01) were of moderate magnitude with effect sizes around 0.5. Conclusions: The new EQ-5D-5L questionnaire has an acceptable ceiling effect, a good construct validity based on the discriminant ability for distinguishing among health-related known groups, and high reliability, supporting its adequacy for assessing the HRQoL in patients with asthma. EQ-5D-5L completion by most Web-based respondents supports the feasibility of this administration form. %M 30672744 %R 10.2196/10178 %U http://www.jmir.org/2019/1/e10178/ %U https://doi.org/10.2196/10178 %U http://www.ncbi.nlm.nih.gov/pubmed/30672744 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e10004 %T An Electronic Patient-Reported Outcome Tool for the FACT-B (Functional Assessment of Cancer Therapy-Breast) Questionnaire for Measuring the Health-Related Quality of Life in Patients With Breast Cancer: Reliability Study %A Matthies,Lina Maria %A Taran,Florin-Andrei %A Keilmann,Lucia %A Schneeweiss,Andreas %A Simoes,Elisabeth %A Hartkopf,Andreas D %A Sokolov,Alexander N %A Walter,Christina B %A Sickenberger,Nina %A Wallwiener,Stephanie %A Feisst,Manuel %A Gass,Paul %A Lux,Michael P %A Schuetz,Florian %A Fasching,Peter A %A Sohn,Christof %A Brucker,Sara Y %A Graf,Joachim %A Wallwiener,Markus %+ Hospital for General Obstetrics and Gynecology, Gynecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 440, Heidelberg, 69120, Germany, 49 (0)6221 5636956, markus.wallwiener@gmail.com %K breast cancer %K ePRO measurement %K FACT-B %K HRQoL %K patient-reported outcomes %K reliability of ePRO %D 2019 %7 22.01.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The most frequent malignant disease in women is breast cancer. In the metastatic setting, quality of life is the primary therapeutic goal, and systematic treatment has only a limited effect on survival rates; therefore, the concept of the health-related quality of life (HRQoL) and measurement of patient-reported outcomes (PROs) are gaining more and more importance in the therapy setting of diseases such as breast cancer. One of the frequently used questionnaires for measuring the HRQoL in patients with breast cancer is the Functional Assessment of Cancer Therapy-Breast (FACT-B). Currently, paper-based surveys still predominate, as only a few reliable and validated electronic-based questionnaires are available. ePRO tools for the FACT-B questionnaire with proven reliability are missing so far. Objective: The aim of this study was to analyze the reliability of tablet-based measurement of FACT-B in the German language in adjuvant (curative) and metastatic breast cancer patients. Methods: Paper- and tablet-based questionnaires were completed by a total of 106 female adjuvant and metastatic breast cancer patients. All patients were required to complete the electronically based (ePRO) and paper-based version of the FACT-B. A frequency analysis was performed to determine descriptive sociodemographic characteristics. Both dimensions of reliability (parallel forms reliability using Wilcoxon test and test of internal consistency using Spearman ρ) and agreement rates for single items, Kendall tau for each subscale, and total score were analyzed. Results: High correlations were shown for both dimensions of reliability (parallel forms reliability and internal consistency) in the patients’ response behavior between paper-based and electronically based questionnaires. Regarding the reliability test of parallel forms, no significant differences were found in 35 of 37 single items, while significant correlations in the test for consistency were found in all 37 single items, in all 5 sum individual item subscale scores, as well as in total FACT-B score. Conclusions: The ePRO version of the FACT-B questionnaire is reliable for patients with breast cancer in both adjuvant and metastatic settings, showing highly significant correlations with the paper-based version in almost all questions all subscales and the total score. %M 30668517 %R 10.2196/10004 %U http://www.jmir.org/2019/1/e10004/ %U https://doi.org/10.2196/10004 %U http://www.ncbi.nlm.nih.gov/pubmed/30668517 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 6 %N 1 %P e11127 %T Global Consensus From Clinicians Regarding Low Back Pain Outcome Indicators for Older Adults: Pairwise Wiki Survey Using Crowdsourcing %A Wong,Arnold YL %A Lauridsen,Henrik H %A Samartzis,Dino %A Macedo,Luciana %A Ferreira,Paulo H %A Ferreira,Manuela L %+ Department of Rehabilitation Sciences, Hong Kong Polytechnic University, Room ST512, 5/F, Ng Wing Hong Building, 11 Yuk Choi Road, Hong Kong,, China (Hong Kong), 852 2766 6741, arnold.wong@polyu.edu.hk %K crowdsourcing %K wiki survey %K low back pain %K older people %K outcome indicators %D 2019 %7 15.01.2019 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Low back pain (LBP) is one of the most debilitating conditions among older adults. Unfortunately, existing LBP outcome questionnaires are not adapted for specific circumstances related to old age, which may make these measures less than ideal for evaluating LBP in older adults. Objective: To explore the necessity of developing age-specific outcome measures, crowdsourcing was conducted to solicit opinions from clinicians globally. Methods: Clinicians around the world voted and/or prioritized various LBP outcome indicators for older adults on a pairwise wiki survey website. Seven seed outcome indicators were posted for voting while respondents were encouraged to suggest new indicators for others to vote/prioritize. The website was promoted on the social media of various health care professional organizations. An established algorithm calculated the mean scores of all ideas. A score >50 points means that the idea has >50% probability of beating another randomly presented indicator. Results: Within 42 days, 128 respondents from 6 continents cast 2466 votes and proposed 14 ideas. Indicators pertinent to improvements of physical functioning and age-related social functioning scored >50 while self-perceived reduction of LBP scored 32. Conclusions: This is the first crowdsourcing study to address LBP outcome indicators for older adults. The study noted that age-specific outcome indicators should be integrated into future LBP outcome measures for older adults. Future research should solicit opinions from older patients with LBP to develop age-specific back pain outcome measures that suit clinicians and patients alike. %M 30664493 %R 10.2196/11127 %U http://rehab.jmir.org/2019/1/e11127/ %U https://doi.org/10.2196/11127 %U http://www.ncbi.nlm.nih.gov/pubmed/30664493 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 1 %P e10675 %T Web-Based Measure of Life Events Using Computerized Life Events and Assessment Record (CLEAR): Preliminary Cross-Sectional Study of Reliability, Validity, and Association With Depression %A Bifulco,Antonia %A Spence,Ruth %A Nunn,Stephen %A Kagan,Lisa %A Bailey-Rodriguez,Deborah %A Hosang,Georgina M %A Taylor,Matthew %A Fisher,Helen L %+ Centre for Abuse and Trauma Studies, Department of Psychology, Middlesex University, The Burroughs, London, NW4 4BT, United Kingdom, 44 02084113705, a.bifulco@mdx.ac.uk %K depression %K life change events %K life stress %K health technology %K internet %K psychometrics %K psychological tests %D 2019 %7 08.01.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Given the criticisms of life event checklists and the costs associated with interviews, life event research requires a sophisticated but easy-to-use measure for research and clinical practice. Therefore, the Computerized Life Events and Assessment Record (CLEAR), based on the Life Events and Difficulties Schedule (LEDS), was developed. Objective: The objective of our study was to test CLEAR’s reliability, validity, and association with depression. Methods: CLEAR, the General Health Questionnaire, and the List of Threatening Experiences Questionnaire (LTE-Q) were completed by 328 participants (126 students; 202 matched midlife sample: 127 unaffected controls, 75 recurrent depression cases). Test-retest reliability over 3-4 weeks was examined and validity determined by comparing CLEAR with LEDS and LTE-Q. Both CLEAR and LTE-Q were examined in relation to depression. Results: CLEAR demonstrated good test-retest reliability for the overall number of life events (0.89) and severe life events (.60). Long-term problems showed similar findings. In terms of validity, CLEAR severe life events had moderate sensitivity (59.1%) and specificity (65.4%) when compared with LEDS. CLEAR demonstrated moderate sensitivity (43.1%) and specificity (78.6%) when compared with LTE-Q. CLEAR severe life events and long-term problems were significantly associated with depression (odds ratio, OR 3.50, 95% CI 2.10 to 5.85, P<.001; OR 3.38, 95% CI 2.02 to 5.67, P<.001, respectively), whereas LTE-Q events were not (OR 1.06, 95% CI 0.43 to 2.60, P=.90). Conclusions: CLEAR has acceptable reliability and validity and predicts depression. It, therefore, has great potential for effective use in research and clinical practice identifying stress-related factors for the onset and maintenance of depression and related disorders. %M 30622088 %R 10.2196/10675 %U https://mental.jmir.org/2019/1/e10675/ %U https://doi.org/10.2196/10675 %U http://www.ncbi.nlm.nih.gov/pubmed/30622088 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e11302 %T Measurement of Quality of Life in Patients with Mycosis Fungoides/Sézary Syndrome Cutaneous T-Cell Lymphoma: Development of an Electronic Instrument %A McCaffrey,Stacey %A Black,Ryan A %A Nagao,Mitchell %A Sepassi,Marjan %A Sharma,Gaurav %A Thornton,Susan %A Kim,Youn H %A Braverman,Julia %+ PatientsLikeMe, Inc, 160 Second Street, Cambridge, MA, 02142, United States, 1 6174994003, research@patientslikeme.com %K quality of life %K Rasch %K patient-reported outcome %K cutaneous T-cell lymphoma %K mycosis fungoides %K Sézary syndrome %D 2019 %7 07.01.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Although the quality of life (QoL) plays an important role in treatment decision making and clinical management of mycosis fungoides (MF) or Sézary syndrome (SS) subtypes of cutaneous T-cell lymphomas (MF/SS-CTCLs), an MF- or SS-specific measure of QoL does not exist. Objective: The objective of this research was to develop and validate the first QoL instrument for MF/SS-CTCL using a patient-centered approach. Methods: A conceptual framework for the MF/SS-CTCL QoL was developed through a literature review and interviews with key opinion leaders. Concept elicitation with patients was utilized to refine the conceptual model and generate preliminary items. The items were then revised based on qualitative and quantitative feedback obtained through cognitive debriefing surveys and interviews with patients. Next, participants (N=126) completed the preliminary MF/SS-CTCL QoL and a comparator measure of health-related QoL (Skindex-29) through the PatientsLikeMe Open Research Exchange. The MF/SS-CTCL QoL was completed again 5 days later by 66 participants for the purposes of evaluating test-retest reliability. The MF/SS-CTCL QoL was finalized based on results from an empirical evaluation, which included both classical and modern test theory approaches. Specifically, this included evaluation of (1) the optimal item response theory measurement model; (2) item fit; (3) unidimensionality; (4) rating scale performance; (5) reliability; (6) test information (precision); (7) person-to-item map; (8) convergent and discriminant validity; and (9) presence of bias via differential item function. Results: Results from the comprehensive psychometric evaluation utilizing a Rasch-Grouped Rating Scale model yielded a final 12-item instrument. The rating scale functioned as expected, and the instrument exhibited adequate person reliability (.87), good to excellent test-retest reliability (r=.89, P<.001), high levels of measurement precision, and good person-to-item targeting. The correlation between the MF/SS-CTCL QoL and the Skindex-29 (r=.852, P<.001) was significantly greater than the correlation between the MF/SS-CTCL QoL and syndrome stage (r=.260, P<.001), providing support for convergent and discriminant validity. Items did not show significant bias based on gender, age, or race. Rasch scores were converted to scaled scores with qualitative descriptive categories for ease of interpretation. Conclusions: Empirical evaluation demonstrated strong evidence of excellent psychometric properties. Utilizing a patient-centered measure development approach ensures that this QoL instrument captures the information that is most meaningful and clinically relevant to patients. %M 30617041 %R 10.2196/11302 %U https://www.jmir.org/2019/1/e11302/ %U https://doi.org/10.2196/11302 %U http://www.ncbi.nlm.nih.gov/pubmed/30617041 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 4 %P e10255 %T The Service User Technology Acceptability Questionnaire: Psychometric Evaluation of the Norwegian Version %A Torbjørnsen,Astrid %A Småstuen,Milada C %A Jenum,Anne Karen %A Årsand,Eirik %A Ribu,Lis %+ Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet – Oslo Metropolitan University, Postboks 4 St. Olavs plass, Oslo, 0130, Norway, 47 92633075, astridto@oslomet.no %K acceptability %K factor analysis %K health care %K mHealth %K telemedicine %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: When developing a mobile health app, users’ perception of the technology should preferably be evaluated. However, few standardized and validated questionnaires measuring acceptability are available. Objective: The aim of this study was to assess the validity of the Norwegian version of the Service User Technology Acceptability Questionnaire (SUTAQ). Methods: Persons with type 2 diabetes randomized to the intervention groups of the RENEWING HEALTH study used a diabetes diary app. At the one-year follow-up, participants in the intervention groups (n=75) completed the self-reported instrument SUTAQ to measure the acceptability of the equipment. We conducted confirmatory factor analysis for evaluating the fit of the original five-factor structure of the SUTAQ. Results: We confirmed only 2 of the original 5 factors of the SUTAQ, perceived benefit and care personnel concerns. Conclusions: The original five-factor structure of the SUTAQ was not confirmed in the Norwegian study, indicating that more research is needed to tailor the questionnaire to better reflect the Norwegian setting. However, a small sample size prevented us from drawing firm conclusions about the translated questionnaire. %M 30578191 %R 10.2196/10255 %U http://humanfactors.jmir.org/2018/4/e10255/ %U https://doi.org/10.2196/10255 %U http://www.ncbi.nlm.nih.gov/pubmed/30578191 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e12202 %T Corrigendum and Editorial Warning Regarding Use of the MMAS-8 Scale (The Health Buddies App as a Novel Tool to Improve Adherence and Knowledge in Atrial Fibrillation Patients: A Pilot Study) %A Desteghe,Lien %A Kluts,Kiki %A Vijgen,Johan %A Koopman,Pieter %A Dilling-Boer,Dagmara %A Schurmans,Joris %A Dendale,Paul %A Heidbuchel,Hein %+ Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, Hasselt, 3500, Belgium, 32 11 30 82 26, lien.desteghe@uhasselt.be %D 2018 %7 30.11.2018 %9 Corrigenda and Addenda %J JMIR Mhealth Uhealth %G English %X %M 30578241 %R 10.2196/12202 %U https://mhealth.jmir.org/2018/11/e12202/ %U https://doi.org/10.2196/12202 %U http://www.ncbi.nlm.nih.gov/pubmed/30578241 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e272 %T Responsiveness, Reliability, and Minimally Important and Minimal Detectable Changes of 3 Electronic Patient-Reported Outcome Measures for Low Back Pain: Validation Study %A Froud,Robert %A Fawkes,Carol %A Foss,Jonathan %A Underwood,Martin %A Carnes,Dawn %+ Clinical Trials Unit, Warwick Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, United Kingdom, 44 024 7657 4221, r.froud@warwick.ac.uk %K electronic patient-reported outcome measures %K validation %K responsiveness %K reliability %K minimally important change %K minimal detectable change %K Roland Morris Disability Questionnaire %K visual analog scale %K numerical rating scale %D 2018 %7 24.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The Roland Morris Disability Questionnaire (RMDQ), visual analog scale (VAS) of pain intensity, and numerical rating scale (NRS) are among the most commonly used outcome measures in trials of interventions for low back pain. Their use in paper form is well established. Few data are available on the metric properties of electronic counterparts. Objective: The goal of our research was to establish responsiveness, minimally important change (MIC) thresholds, reliability, and minimal detectable change at a 95% level (MDC95) for electronic versions of the RMDQ, VAS, and NRS as delivered via iOS and Android apps and Web browser. Methods: We recruited adults with low back pain who visited osteopaths. We invited participants to complete the eRMDQ, eVAS, and eNRS at baseline, 1 week, and 6 weeks along with a health transition question at 1 and 6 weeks. Data from participants reporting recovery were used in MIC and responsiveness analyses using receiver operator characteristic (ROC) curves and areas under the ROC curves (AUCs). Data from participants reporting stability were used for analyses of reliability (intraclass correlation coefficient [ICC] agreement) and MDC95. Results: We included 442 participants. At 1 and 6 weeks, ROC AUCs were 0.69 (95% CI 0.59 to 0.80) and 0.67 (95% CI 0.46 to 0.87) for the eRMDQ, 0.69 (95% CI 0.58 to 0.80) and 0.74 (95% CI 0.53 to 0.95) for the eVAS, and 0.73 (95% CI 0.66 to 0.80) and 0.81 (95% CI 0.69 to 0.92) for the eNRS, respectively. Associated MIC thresholds were estimated as 1 (0 to 2) and 2 (–1 to 5), 13 (9 to 17) and 7 (–12 to 26), and 2 (1 to 3) and 1 (0 to 2) points, respectively. Over a 1-week period in participants categorized as “stable” and “about the same” using the transition question, ICCs were 0.87 (95% CI 0.66 to 0.95) and 0.84 (95% CI 0.73 to 0.91) for the eRMDQ with MDC95 of 4 and 5, 0.31 (95% CI –0.25 to 0.71) and 0.61 (95% CI 0.36 to 0.77) for the eVAS with MDC95 of 39 and 34, and 0.52 (95% CI 0.14 to 0.77) to 0.67 (95% CI 0.51 to 0.78) with MDC95 of 4 and 3 for the eNRS. Conclusions: The eRMDQ was reliable with borderline adequate responsiveness. The eNRS was responsive with borderline reliability. While the eVAS had adequate responsiveness, it did not have an attractive reliability profile. Thus, the eNRS might be preferred over the eVAS for measuring pain intensity. The observed electronic outcome measures’ metric properties are within the ranges of values reported in the literature for their paper counterparts and are adequate for measuring changes in a low back pain population. %M 30355556 %R 10.2196/jmir.9828 %U http://www.jmir.org/2018/10/e272/ %U https://doi.org/10.2196/jmir.9828 %U http://www.ncbi.nlm.nih.gov/pubmed/30355556 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 8 %P e10056 %T Abstract Animations for the Communication and Assessment of Pain in Adults: Cross-Sectional Feasibility Study %A Jonassaint,Charles R %A Rao,Nema %A Sciuto,Alex %A Switzer,Galen E %A De Castro,Laura %A Kato,Gregory J %A Jonassaint,Jude C %A Hammal,Zakia %A Shah,Nirmish %A Wasan,Ajay %+ Center for Behavioral Health and Smart Technology, Department of Medicine, University of Pittsburgh, Suite 600, 230 McKee Place, Pittsburgh, PA, 15213, United States, 1 412 586 9850, jonassaintcr@upmc.edu %K pain %K pain measurement %K chronic pain %K medical informatics %K mobile apps %D 2018 %7 03.08.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Pain is the most common physical symptom requiring medical care, yet the current methods for assessing pain are sorely inadequate. Pain assessment tools can be either too simplistic or take too long to complete to be useful for point-of-care diagnosis and treatment. Objective: The aim was to develop and test Painimation, a novel tool that uses graphic visualizations and animations instead of words or numeric scales to assess pain quality, intensity, and course. This study examines the utility of abstract animations as a measure of pain. Methods: Painimation was evaluated in a chronic pain medicine clinic. Eligible patients were receiving treatment for pain and reported pain more days than not for at least 3 months. Using a tablet computer, participating patients completed the Painimation instrument, the McGill Pain Questionnaire (MPQ), and the PainDETECT questionnaire for neuropathic symptoms. Results: Participants (N=170) completed Painimation and indicated it was useful for describing their pain (mean 4.1, SE 0.1 out of 5 on a usefulness scale), and 130 of 162 participants (80.2%) agreed or strongly agreed that they would use Painimation to communicate with their providers. Animations selected corresponded with pain adjectives endorsed on the MPQ. Further, selection of the electrifying animation was associated with self-reported neuropathic pain (r=.16, P=.03), similar to the association between neuropathic pain and PainDETECT (r=.17, P=.03). Painimation was associated with PainDETECT (r=.35, P<.001). Conclusions: Using animations may be a faster and more patient-centered method for assessing pain and is not limited by age, literacy level, or language; however, more data are needed to assess the validity of this approach. To establish the validity of using abstract animations (“painimations”) for communicating and assessing pain, apps and other digital tools using painimations will need to be tested longitudinally across a larger pain population and also within specific, more homogenous pain conditions. %M 30076127 %R 10.2196/10056 %U http://www.jmir.org/2018/8/e10056/ %U https://doi.org/10.2196/10056 %U http://www.ncbi.nlm.nih.gov/pubmed/30076127 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 1 %N 2 %P e3 %T A Digital Patient-Led Hospital Checklist for Enhancing Safety in Cataract Surgery: Qualitative Study %A Stolk-Vos,Aline C %A van der Steen,Jolet JE %A Drossaert,Constance HC %A Braakman-Jansen,Annemarie %A Zijlmans,Bart LM %A Kranenburg,Leonieke W %A de Korne,Dirk F %+ Rotterdam Ophthalmic Institute, Ooghuis, 4th Floor, Schiedamse Vest 160, Rotterdam, 3011BH, Netherlands, 31 0104023448, a.stolk@eyehospital.nl %K patient participation %K checklist %K cataract %K surgery %K patient safety %K handheld computers %K health information management %K health communication %K information technology %D 2018 %7 16.07.2018 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Surgery holds high risk for iatrogenic patient harm. Correct and sufficient communication and information during the surgical process is a root solution for preventing patient harm. Information technology may substantially contribute to engaging patients in this process. Objective: To explore the feasibility of a digital patient-led checklist for cataract surgery, we evaluated the experiences of patients and nurses who have used this novel tool with a focus on use, appreciation, and impact. Methods: A multidisciplinary team, including cataract surgeons, nurses, pharmacists and administrative representatives developed a 19-item digital patient-led checklist for cataract patients who underwent surgery in an ambulatory setting. This “EYEpad” checklist was distributed to patients and their companions during their hospital visit via an application on a tablet. It contained necessary information the patient should have received before or during the surgical preparation (8 items), before anesthesia (2 items), and before discharge (9 items). Patients and their companions were invited to actively indicate the information they received, or information discussed with them, by ticking on the EYEpad. Our qualitative research design included semi-structured individual interviews with 17 patients and a focus group involving 6 nurses. The transcripts were analyzed by 2 independent coders using both deductive and inductive coding. Results: All but one of the 17 patients used the EYEpad, occasionally assisted by his or her companion (usually the partner). In several cases, the checklist was completed by the companion. Most patients felt positively about the usability of the EYEpad. Yet, for most of the patients, it was not clear why they received the checklist. Only 4 of them indicated that they understood that the EYEpad was used to determine if there were sufficient and correct information discussed or checked by the nurses. Although most nurses agreed the EYEpad was easy to use and could be a useful tool for improving patient engagement for improving safety, they felt that not all elderly patients were willing or capable of using it and it interfered with the existing surgical process. They also anticipated the need to spend more time explaining the purpose and use of the EYEpad. Conclusions: Our results showed that a digital patient-led checklist is a potentially valid way to increase patient participation in safety improvement efforts, even among elderly patients. It also illustrates the crucial role nurses play in the implementation and diffusion of technological innovations. Increased patient participation will only improve safety when both healthcare workers and patients feel empowered to share responsibility and balance their power. %M 33401370 %R 10.2196/periop.9463 %U http://periop.jmir.org/2018/2/e3/ %U https://doi.org/10.2196/periop.9463 %U http://www.ncbi.nlm.nih.gov/pubmed/33401370 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 7 %P e227 %T Relative Validity and Reproducibility of a New 44-Item Diet and Food Frequency Questionnaire Among Adults: Online Assessment %A Affret,Aurélie %A El Fatouhi,Douae %A Dow,Courtney %A Correia,Emmanuelle %A Boutron-Ruault,Marie-Christine %A Fagherazzi,Guy %+ Inserm U1018, Center for Research in Epidemiology and Population Health, 114 Rue Edouard Vaillant, Villejuif, 94805, France, 33 33 142116466, marie-christine.boutron@gustaveroussy.fr %K Short Food Frequency e-Questionnaire %K Web-based %K validity %K reproducibility %K online dietary assessment tool %D 2018 %7 05.07.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Dietary questionnaires currently available which can assess the habitual diet are timely, costly, or not adapted well to the modern diet; thus, there is a need for a shorter food frequency e-Questionnaire (FFeQ) adapted to Western diets, in order to properly estimate energy and macronutrient intakes or rank individuals according to food and nutrient intakes. Objective: The aim of this study was to evaluate the relative validity and reproducibility of a 30-minute and 44-item FFeQ in a sample of adults obtained from the general population. Methods: A sample of French adults was recruited through social media and an advertising campaign. A total of 223 volunteers completed the FFeQ twice at one-year intervals and were included in the reproducibility study. During that interval, 92 participants completed three-to-six 24-hour recalls and were included in the validity study. Nutrient and dietary intakes were computed for all validity and reproducibility participants. The level of agreement between the two methods was evaluated for nutrient and food group intakes using classification into quintiles of daily intake, correlation coefficients and Bland-Altman plots. Results: For relative validity, correlation coefficients ranged from 0.09 to 0.88 (unadjusted correlation coefficients, median: 0.48) and 0.02 to 0.68 (deattenuated and energy adjusted correlation coefficients, median: 0.50) for food group and nutrient intakes, respectively. The median proportion of subjects classified into the same or adjacent quintile was 73% and 66% for food and nutrient intakes, respectively. Bland-Altman plots showed good agreement across the range of intakes. Regarding reproducibility, intraclass correlation coefficients ranged from 0.33 to 0.72 (median: 0.60) and 0.55 to 0.73 (median: 0.64), for food and nutrient intakes, respectively. Conclusions: The FFeQ showed acceptable validity and reproducibility in a sample of adults based on their food and nutrient intakes. The FFeQ is a promising and low-cost tool that can be used in large-scale online epidemiological studies or clinical routines and could be integrated into evidence-based smartphone apps for assessing diet components. %M 29980502 %R 10.2196/jmir.9113 %U http://www.jmir.org/2018/7/e227/ %U https://doi.org/10.2196/jmir.9113 %U http://www.ncbi.nlm.nih.gov/pubmed/29980502 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e192 %T Online Self-Administered Cognitive Testing Using the Amsterdam Cognition Scan: Establishing Psychometric Properties and Normative Data %A Feenstra,Heleen EM %A Vermeulen,Ivar E %A Murre,Jaap MJ %A Schagen,Sanne B %+ Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX, Netherlands, 31 205129077, h.feenstra@nki.nl %K cognition %K neuropsychological tests %K self-assessment %K internet %K reproducibility of results %K reference standards %D 2018 %7 30.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Online tests enable efficient self-administered assessments and consequently facilitate large-scale data collection for many fields of research. The Amsterdam Cognition Scan is a new online neuropsychological test battery that measures a broad variety of cognitive functions. Objective: The aims of this study were to evaluate the psychometric properties of the Amsterdam Cognition Scan and to establish regression-based normative data. Methods: The Amsterdam Cognition Scan was self-administrated twice from home—with an interval of 6 weeks—by 248 healthy Dutch-speaking adults aged 18 to 81 years. Results: Test-retest reliability was moderate to high and comparable with that of equivalent traditional tests (intraclass correlation coefficients: .45 to .80; .83 for the Amsterdam Cognition Scan total score). Multiple regression analyses indicated that (1) participants’ age negatively influenced all (12) cognitive measures, (2) gender was associated with performance on six measures, and (3) education level was positively associated with performance on four measures. In addition, we observed influences of tested computer skills and of self-reported amount of computer use on cognitive performance. Demographic characteristics that proved to influence Amsterdam Cognition Scan test performance were included in regression-based predictive formulas to establish demographically adjusted normative data. Conclusions: Initial results from a healthy adult sample indicate that the Amsterdam Cognition Scan has high usability and can give reliable measures of various generic cognitive ability areas. For future use, the influence of computer skills and experience should be further studied, and for repeated measurements, computer configuration should be consistent. The reported normative data allow for initial interpretation of Amsterdam Cognition Scan performances. %R 10.2196/jmir.9298 %U http://www.jmir.org/2018/5/e192/ %U https://doi.org/10.2196/jmir.9298 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e56 %T Accurately Inferring Compliance to Five Major Food Guidelines Through Simplified Surveys: Applying Data Mining to the UK National Diet and Nutrition Survey %A Rosso,Nicholas %A Giabbanelli,Philippe %+ Data Analytics for Complex Human Behaviors Laboratory, Department of Computer Science, Furman University, 3300 Poinsett Hwy, Greenville, SC, 29613, United States, 1 864 294 2097, giabbanelli@gmail.com %K diet, food, and nutrition %K public health informatics %K supervised machine learning %D 2018 %7 30.05.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: National surveys in public health nutrition commonly record the weight of every food consumed by an individual. However, if the goal is to identify whether individuals are in compliance with the 5 main national nutritional guidelines (sodium, saturated fats, sugars, fruit and vegetables, and fats), much less information may be needed. A previous study showed that tracking only 2.89% of all foods (113/3911) was sufficient to accurately identify compliance. Further reducing the data needs could lower participation burden, thus decreasing the costs for monitoring national compliance with key guidelines. Objective: This study aimed to assess whether national public health nutrition surveys can be further simplified by only recording whether a food was consumed, rather than having to weigh it. Methods: Our dataset came from a generalized sample of inhabitants in the United Kingdom, more specifically from the National Diet and Nutrition Survey 2008-2012. After simplifying food consumptions to a binary value (1 if an individual consumed a food and 0 otherwise), we built and optimized decision trees to find whether the foods could accurately predict compliance with the major 5 nutritional guidelines. Results: When using decision trees of a similar size to previous studies (ie, involving as many foods), we were able to correctly infer compliance for the 5 guidelines with an average accuracy of 80.1%. This is an average increase of 2.5 percentage points over a previous study, showing that further simplifying the surveys can actually yield more robust estimates. When we allowed the new decision trees to use slightly more foods than in previous studies, we were able to optimize the performance with an average increase of 3.1 percentage points. Conclusions: Although one may expect a further simplification of surveys to decrease accuracy, our study found that public health dietary surveys can be simplified (from accurately weighing items to simply checking whether they were consumed) while improving accuracy. One possibility is that the simplification reduced noise and made it easier for patterns to emerge. Using simplified surveys will allow to monitor public health nutrition in a more cost-effective manner and possibly decrease the number of errors as participation burden is reduced. %R 10.2196/publichealth.9536 %U http://publichealth.jmir.org/2018/2/e56/ %U https://doi.org/10.2196/publichealth.9536 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e194 %T Computer-Based Driving in Dementia Decision Tool With Mail Support: Cluster Randomized Controlled Trial %A Rapoport,Mark J %A Zucchero Sarracini,Carla %A Kiss,Alex %A Lee,Linda %A Byszewski,Anna %A Seitz,Dallas P %A Vrkljan,Brenda %A Molnar,Frank %A Herrmann,Nathan %A Tang-Wai,David F %A Frank,Christopher %A Henry,Blair %A Pimlott,Nicholas %A Masellis,Mario %A Naglie,Gary %+ Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada, 1 416 480 4085, mark.rapoport@sunnybrook.ca %K dementia %K mild cognitive impairment %K automobile driving %K decision support systems, clinical %D 2018 %7 25.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Physicians often find significant challenges in assessing automobile driving in persons with mild cognitive impairment and mild dementia and deciding when to report to transportation administrators. Care must be taken to balance the safety of patients and other road users with potential negative effects of issuing such reports. Objective: The aim of this study was to assess whether a computer-based Driving in Dementia Decision Tool (DD-DT) increased appropriate reporting of patients with mild dementia or mild cognitive impairment to transportation administrators. Methods: The study used a parallel-group cluster nonblinded randomized controlled trial design to test a multifaceted knowledge translation intervention. The intervention included a computer-based decision support system activated by the physician-user, which provides a recommendation about whether to report patients with mild dementia or mild cognitive impairment to transportation administrators, based on an algorithm derived from earlier work. The intervention also included a mailed educational package and Web-based specialized reporting forms. Specialists and family physicians with expertise in dementia or care of the elderly were stratified by sex and randomized to either use the DD-DT or a control version of the tool that required identical data input as the intervention group, but instead generated a generic reminder about the reporting legislation in Ontario, Canada. The trial ran from September 9, 2014 to January 29, 2016, and the primary outcome was the number of reports made to the transportation administrators concordant with the algorithm. Results: A total of 69 participating physicians were randomized, and 36 of these used the DD-DT; 20 of the 35 randomized to the intervention group used DD-DT with 114 patients, and 16 of the 34 randomized to the control group used it with 103 patients. The proportion of all assessed patients reported to the transportation administrators concordant with recommendation did not differ between the intervention and the control groups (50% vs 49%; Z=−0.19, P=.85). Two variables predicted algorithm-based reporting—caregiver concern (odds ratio [OR]=5.8, 95% CI 2.5-13.6, P<.001) and abnormal clock drawing (OR 6.1, 95% CI 3.1-11.8, P<.001). Conclusions: On the basis of this quantitative analysis, in-office abnormal clock drawing and expressions of concern about driving from caregivers substantially influenced physicians to report patients with mild dementia or mild cognitive impairment to transportation administrators, but the DD-DT tool itself did not increase such reports among these expert physicians. Trial Registration: ClinicalTrials.gov NCT02036099; https://clinicaltrials.gov/ct2/show/NCT02036099 (Archived by WebCite at http://www.webcitation.org/6zGMF1ky8) %M 29802093 %R 10.2196/jmir.9126 %U http://www.jmir.org/2018/5/e194/ %U https://doi.org/10.2196/jmir.9126 %U http://www.ncbi.nlm.nih.gov/pubmed/29802093 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e10662 %T A Mobile App for Identifying Individuals With Undiagnosed Diabetes and Prediabetes and for Promoting Behavior Change: 2-Year Prospective Study %A Leung,Angela YM %A Xu,Xin Yi %A Chau,Pui Hing %A Yu,Yee Tak Esther %A Cheung,Mike KT %A Wong,Carlos KH %A Fong,Daniel YT %A Wong,Janet YH %A Lam,Cindy LK %+ Centre for Gerontological Nursing, School of Nursing, The Hong Kong Polytechnic University, GH528, 5th Floor, Core G, School of Nursing, Hung Hom, Kowloon, Hong Kong SAR,, China (Hong Kong), 852 27665587, angela.ym.leung@polyu.edu.hk %K diabetes mellitus %K prediabetes %K prediabetic state %K mobile apps %K lifestyle %D 2018 %7 24.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To decrease the burden of diabetes in society, early screening of undiagnosed diabetes and prediabetes is needed. Integrating a diabetes risk score into a mobile app would provide a useful platform to enable people to self-assess their risk of diabetes with ease. Objective: The objectives of this study were to (1) assess the profile of Diabetes Risk Score mobile app users, (2) determine the optimal cutoff value of the Finnish Diabetes Risk Score to identify undiagnosed diabetes and prediabetes in the Chinese population, (3) estimate users’ chance of developing diabetes within 2 years of using the app, and (4) investigate high-risk app users’ lifestyle behavior changes after ascertaining their risk level from the app. Methods: We conducted this 2-phase study among adults via mobile app and online survey from August 2014 to December 2016. Phase 1 adopted a cross-sectional design, with a descriptive analysis of the app users’ profile. We used a Cohen kappa score to show the agreement between the risk level (as shown in the app) and glycated hemoglobin test results. We used sensitivity, specificity, and area under the curve to determine the optimal cutoff value of the diabetes risk score in this population. Phase 2 was a prospective cohort study. We used a logistic regression model to estimate the chance of developing diabetes after using the app. Paired t tests compared high-risk app users’ lifestyle changes. Results: A total of 13,289 people used the app in phase 1a. After data cleaning, we considered 4549 of these as valid data. Most users were male, and 1811 (39.81%) had tertiary education or above. Among them, 188 (10.4%) users agreed to attend the health assessment in phase 1b. We recommend the optimal value of the diabetes risk score for identifying persons with undiagnosed diabetes and prediabetes to be 9, with an area under the receiver operating characteristic curve of 0.67 (95% CI 0.60-0.74), sensitivity of 0.70 (95% CI 0.58-0.80), and specificity of 0.57 (95% CI 0.47-0.66). At the 2-year follow-up, people in the high-risk group had a higher chance of developing diabetes (odds ratio 4.59, P=.048) than the low-risk group. The high-risk app users improved their daily intake of vegetables (baseline: mean 0.76, SD 0.43; follow-up: mean 0.93, SD 0.26; t81=–3.77, P<.001) and daily exercise (baseline: mean 0.40, SD 0.49; follow-up: mean 0.54, SD 0.50; t81=–2.08, P=.04). Conclusions: The Diabetes Risk Score app has been shown to be a feasible and reliable tool to identify persons with undiagnosed diabetes and prediabetes and to predict diabetes incidence in 2 years. The app can also encourage high-risk people to modify dietary habits and reduce sedentary lifestyle. %M 29793901 %R 10.2196/10662 %U http://mhealth.jmir.org/2018/5/e10662/ %U https://doi.org/10.2196/10662 %U http://www.ncbi.nlm.nih.gov/pubmed/29793901 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 2 %P e10308 %T Translation, Cross-Cultural Adaptation, and Validation of the Malay Version of the System Usability Scale Questionnaire for the Assessment of Mobile Apps %A Mohamad Marzuki,Muhamad Fadhil %A Yaacob,Nor Azwany %A Yaacob,Najib Majdi %+ Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia, 60 97676621, fadhilmarzuki@gmail.com %K usability %K System Usability Scale %K Malay %K questionnaire translation %K questionnaire validation %K mobile app %D 2018 %7 14.05.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: A mobile app is a programmed system designed to be used by a target user on a mobile device. The usability of such a system refers not only to the extent to which product can be used to achieve the task that it was designed for, but also its effectiveness and efficiency, as well as user satisfaction. The System Usability Scale is one of the most commonly used questionnaires used to assess the usability of a system. The original 10-item version of System Usability Scale was developed in English and thus needs to be adapted into local languages to assess the usability of a mobile apps developed in other languages. Objective: The aim of this study is to translate and validate (with cross-cultural adaptation) the English System Usability Scale questionnaire into Malay, the main language spoken in Malaysia. The development of a translated version will allow the usability of mobile apps to be assessed in Malay. Methods: Forward and backward translation of the questionnaire was conducted by groups of Malay native speakers who spoke English as their second language. The final version was obtained after reconciliation and cross-cultural adaptation. The content of the Malay System Usability Scale questionnaire for mobile apps was validated by 10 experts in mobile app development. The efficacy of the questionnaire was further probed by testing the face validity on 10 mobile phone users, followed by reliability testing involving 54 mobile phone users. Results: The content validity index was determined to be 0.91, indicating good relevancy of the 10 items used to assess the usability of a mobile app. Calculation of the face validity index resulted in a value of 0.94, therefore indicating that the questionnaire was easily understood by the users. Reliability testing showed a Cronbach alpha value of .85 (95% CI 0.79-0.91) indicating that the translated System Usability Scale questionnaire is a reliable tool for the assessment of usability of a mobile app. Conclusions: The Malay System Usability Scale questionnaire is a valid and reliable tool to assess the usability of mobile app in Malaysia. %M 29759955 %R 10.2196/10308 %U http://humanfactors.jmir.org/2018/2/e10308/ %U https://doi.org/10.2196/10308 %U http://www.ncbi.nlm.nih.gov/pubmed/29759955 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e31 %T Cognitive Assessment of Patients With Alzheimer's Disease by Telemedicine: Pilot Study %A Carotenuto,Anna %A Rea,Raffaele %A Traini,Enea %A Ricci,Giovanna %A Fasanaro,Angiola Maria %A Amenta,Francesco %+ Clinical Research, Telemedicine and Telepharmacy Centre, School of Pharmacy, University of Camerino, Via Madonna delle Carceri no 9, Camerino, 62032, Italy, 39 0737401725, enea.traini@unicam.it %K dementia %K telemedicine %K videoconference %K telepsychology %K MMSE by videoconference %K ADAS-cog by videoconference %D 2018 %7 11.05.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Approximately 46.8 million people are living with dementia worldwide and their number will grow in the next years. Any potential treatment should be administered as early as possible because it is important to provide an early cognitive assessment and to regularly monitor the mental function of patients. Information and communication technologies can be helpful to reach and follow patients without displacing them, but there may be doubts about the reliability of cognitive tests performed by telemedicine. Objective: The purpose of this study was to evaluate the reliability of the Mini Mental State Examination (MMSE) and the Alzheimer’s Disease Assessment Scale cognitive subscale (ADAS-cog) tests administered in hospital by videoconference to patients with mild to moderate Alzheimer's disease. Methods: The tests were administered to 28 Alzheimer's disease outpatients (8 male, mean age 73.88, SD 7.45 years; 20 female mean age 76.00, SD 5.40 years) recruited and followed in the Alzheimer’s Unit of the A Cardarelli National Hospital (Naples, Italy) at baseline and after 6, 12, 18, and 24 months of observation. Patients were evaluated first face-to-face by a psychologist and then, after 2 weeks, by another psychologist via videoconference in hospital. Results: This study showed no differences in the MMSE and ADAS-cog scores when the tests were administered face-to-face or by videoconference, except in patients with more pronounced cognitive deficits (MMSE<17), in which the assessment via videoconference overestimated the cognitive impairment (face to face, MMSE mean 13.9, SD 4.9 and ADAS-cog mean 9.0, SD 3.8; videoconference, MMSE mean 42.8, SD 12.5 and ADAS-cog mean 56.9, SD 5.5). Conclusions: We found that videoconferencing is a reliable approach to document cognitive stability or decline, and to measure treatment effects in patients with mild to moderate dementia. A more extended study is needed to confirm these results. %M 29752254 %R 10.2196/mental.8097 %U http://mental.jmir.org/2018/2/e31/ %U https://doi.org/10.2196/mental.8097 %U http://www.ncbi.nlm.nih.gov/pubmed/29752254 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e178 %T Assessing Competencies Needed to Engage With Digital Health Services: Development of the eHealth Literacy Assessment Toolkit %A Karnoe,Astrid %A Furstrand,Dorthe %A Christensen,Karl Bang %A Norgaard,Ole %A Kayser,Lars %+ Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, 1014, Denmark, 45 30436701, askn@sund.ku.dk %K health literacy %K computer literacy %K questionnaires %K telemedicine %K consumer health informatics %D 2018 %7 10.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: To achieve full potential in user-oriented eHealth projects, we need to ensure a match between the eHealth technology and the user’s eHealth literacy, described as knowledge and skills. However, there is a lack of multifaceted eHealth literacy assessment tools suitable for screening purposes. Objective: The objective of our study was to develop and validate an eHealth literacy assessment toolkit (eHLA) that assesses individuals’ health literacy and digital literacy using a mix of existing and newly developed scales. Methods: From 2011 to 2015, scales were continuously tested and developed in an iterative process, which led to 7 tools being included in the validation study. The eHLA validation version consisted of 4 health-related tools (tool 1: “functional health literacy,” tool 2: “health literacy self-assessment,” tool 3: “familiarity with health and health care,” and tool 4: “knowledge of health and disease”) and 3 digitally-related tools (tool 5: “technology familiarity,” tool 6: “technology confidence,” and tool 7: “incentives for engaging with technology”) that were tested in 475 respondents from a general population sample and an outpatient clinic. Statistical analyses examined floor and ceiling effects, interitem correlations, item-total correlations, and Cronbach coefficient alpha (CCA). Rasch models (RM) examined the fit of data. Tools were reduced in items to secure robust tools fit for screening purposes. Reductions were made based on psychometrics, face validity, and content validity. Results: Tool 1 was not reduced in items; it consequently consists of 10 items. The overall fit to the RM was acceptable (Anderson conditional likelihood ratio, CLR=10.8; df=9; P=.29), and CCA was .67. Tool 2 was reduced from 20 to 9 items. The overall fit to a log-linear RM was acceptable (Anderson CLR=78.4, df=45, P=.002), and CCA was .85. Tool 3 was reduced from 23 to 5 items. The final version showed excellent fit to a log-linear RM (Anderson CLR=47.7, df=40, P=.19), and CCA was .90. Tool 4 was reduced from 12 to 6 items. The fit to a log-linear RM was acceptable (Anderson CLR=42.1, df=18, P=.001), and CCA was .59. Tool 5 was reduced from 20 to 6 items. The fit to the RM was acceptable (Anderson CLR=30.3, df=17, P=.02), and CCA was .94. Tool 6 was reduced from 5 to 4 items. The fit to a log-linear RM taking local dependency (LD) into account was acceptable (Anderson CLR=26.1, df=21, P=.20), and CCA was .91. Tool 7 was reduced from 6 to 4 items. The fit to a log-linear RM taking LD and differential item functioning into account was acceptable (Anderson CLR=23.0, df=29, P=.78), and CCA was .90. Conclusions: The eHLA consists of 7 short, robust scales that assess individual’s knowledge and skills related to digital literacy and health literacy. %M 29748163 %R 10.2196/jmir.8347 %U http://www.jmir.org/2018/5/e178/ %U https://doi.org/10.2196/jmir.8347 %U http://www.ncbi.nlm.nih.gov/pubmed/29748163 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 1 %P e3 %T A Tool That Assesses the Evidence, Transparency, and Usability of Online Health Information: Development and Reliability Assessment %A Dobbins,Maureen %A Watson,Susannah %A Read,Kristin %A Graham,Kelly %A Yousefi Nooraie,Reza %A Levinson,Anthony J %+ The National Collaborating Centre for Methods and Tools, School of Nursing, McMaster University, Suite 210A, 175 Longwood Road South, Hamilton, ON, L8P0A1, Canada, 1 905 525 9140 ext 20455, dobbinsm@mcmaster.ca %K knowledge translation %K Consumer Health Information %K consumer health standards %K internet standards %K Patient Education as Topic %K Patient Education as standards %K critical appraisal %K online health information %K reliability analysis %D 2018 %7 07.05.2018 %9 Original Paper %J JMIR Aging %G English %X Background: The internet is commonly used by older adults to obtain health information and this trend has markedly increased in the past decade. However, studies illustrate that much of the available online health information is not informed by good quality evidence, developed in a transparent way, or easy to use. Furthermore, studies highlight that the general public lacks the skills necessary to distinguish between online products that are credible and trustworthy and those that are not. A number of tools have been developed to assess the evidence, transparency, and usability of online health information; however, many have not been assessed for reliability or ease of use. Objective: The first objective of this study was to determine if a tool assessing the evidence, transparency, and usability of online health information exists that is easy and quick to use and has good reliability. No such tool was identified, so the second objective was to develop such a tool and assess it for reliability when used to assess online health information on topics of relevant to optimal aging. Methods: An electronic database search was conducted between 2002 and 2012 to identify published papers describing tools that assessed the evidence, transparency, and usability of online health information. Papers were retained if the tool described was assessed for reliability, assessed the quality of evidence used to create online health information, and was quick and easy to use. When no one tool met expectations, a new instrument was developed and tested for reliability. Reliability between two raters was assessed using the intraclass correlation coefficient (ICC) for each item at two time points. SPSS Statistics 22 software was used for statistical analyses and a one-way random effects model was used to report the results. The overall ICC was assessed for the instrument as a whole in July 2015. The threshold for retaining items was ICC>0.60 (ie, “good” reliability). Results: All tools identified that evaluated online health information were either too complex, took a long time to complete, had poor reliability, or had not undergone reliability assessment. A new instrument was developed and assessed for reliability in April 2014. Three items had an ICC<0.60 (ie, “good” reliability). One of these items was removed (“minimal scrolling”) and two were retained but reworded for clarity. Four new items were added that assessed the level of research evidence that informed the online health information and the tool was retested in July 2015. The total ICC score showed excellent agreement with both single measures (ICC=0.988; CI 0.982–0.992) and average measures (ICC=0.994; CI 0.991–0.996). Conclusions: The results of this study suggest that this new tool is reliable for assessing the evidence, transparency, and usability of online health information that is relevant to optimal aging. %M 31518240 %R 10.2196/aging.9216 %U http://aging.jmir.org/2018/1/e3/ %U https://doi.org/10.2196/aging.9216 %U http://www.ncbi.nlm.nih.gov/pubmed/31518240 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e139 %T ComprehENotes, an Instrument to Assess Patient Reading Comprehension of Electronic Health Record Notes: Development and Validation %A Lalor,John P %A Wu,Hao %A Chen,Li %A Mazor,Kathleen M %A Yu,Hong %+ Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, AC7-059, Worcester, MA, 01605, United States, 1 508 856 3474, hong.yu@umassmed.edu %K electronic health records %K health literacy %K psychometrics %K crowdsourcing %D 2018 %7 25.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient portals are widely adopted in the United States and allow millions of patients access to their electronic health records (EHRs), including their EHR clinical notes. A patient’s ability to understand the information in the EHR is dependent on their overall health literacy. Although many tests of health literacy exist, none specifically focuses on EHR note comprehension. Objective: The aim of this paper was to develop an instrument to assess patients’ EHR note comprehension. Methods: We identified 6 common diseases or conditions (heart failure, diabetes, cancer, hypertension, chronic obstructive pulmonary disease, and liver failure) and selected 5 representative EHR notes for each disease or condition. One note that did not contain natural language text was removed. Questions were generated from these notes using Sentence Verification Technique and were analyzed using item response theory (IRT) to identify a set of questions that represent a good test of ability for EHR note comprehension. Results: Using Sentence Verification Technique, 154 questions were generated from the 29 EHR notes initially obtained. Of these, 83 were manually selected for inclusion in the Amazon Mechanical Turk crowdsourcing tasks and 55 were ultimately retained following IRT analysis. A follow-up validation with a second Amazon Mechanical Turk task and IRT analysis confirmed that the 55 questions test a latent ability dimension for EHR note comprehension. A short test of 14 items was created along with the 55-item test. Conclusions: We developed ComprehENotes, an instrument for assessing EHR note comprehension from existing EHR notes, gathered responses using crowdsourcing, and used IRT to analyze those responses, thus resulting in a set of questions to measure EHR note comprehension. Crowdsourced responses from Amazon Mechanical Turk can be used to estimate item parameters and select a subset of items for inclusion in the test set using IRT. The final set of questions is the first test of EHR note comprehension. %M 29695372 %R 10.2196/jmir.9380 %U http://www.jmir.org/2018/4/e139/ %U https://doi.org/10.2196/jmir.9380 %U http://www.ncbi.nlm.nih.gov/pubmed/29695372 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e103 %T Utilization of a Clinical Trial Management System for the Whole Clinical Trial Process as an Integrated Database: System Development %A Park,Yu Rang %A Yoon,Young Jo %A Koo,HaYeong %A Yoo,Soyoung %A Choi,Chang-Min %A Beck,Sung-Ho %A Kim,Tae Won %+ Clinical Research Center, Asan Institute of Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic Of Korea, 1 230103910, twkimmd@amc.seoul.kr %K clinical trial %K information systems %K academic medical center %K information technology %K privacy %D 2018 %7 24.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinical trials pose potential risks in both communications and management due to the various stakeholders involved when performing clinical trials. The academic medical center has a responsibility and obligation to conduct and manage clinical trials while maintaining a sufficiently high level of quality, therefore it is necessary to build an information technology system to support standardized clinical trial processes and comply with relevant regulations. Objective: The objective of the study was to address the challenges identified while performing clinical trials at an academic medical center, Asan Medical Center (AMC) in Korea, by developing and utilizing a clinical trial management system (CTMS) that complies with standardized processes from multiple departments or units, controlled vocabularies, security, and privacy regulations. Methods: This study describes the methods, considerations, and recommendations for the development and utilization of the CTMS as a consolidated research database in an academic medical center. A task force was formed to define and standardize the clinical trial performance process at the site level. On the basis of the agreed standardized process, the CTMS was designed and developed as an all-in-one system complying with privacy and security regulations. Results: In this study, the processes and standard mapped vocabularies of a clinical trial were established at the academic medical center. On the basis of these processes and vocabularies, a CTMS was built which interfaces with the existing trial systems such as the electronic institutional review board health information system, enterprise resource planning, and the barcode system. To protect patient data, the CTMS implements data governance and access rules, and excludes 21 personal health identifiers according to the Health Insurance Portability and Accountability Act (HIPAA) privacy rule and Korean privacy laws. Since December 2014, the CTMS has been successfully implemented and used by 881 internal and external users for managing 11,645 studies and 146,943 subjects. Conclusions: The CTMS was introduced in the Asan Medical Center to manage the large amounts of data involved with clinical trial operations. Inter- and intraunit control of data and resources can be easily conducted through the CTMS system. To our knowledge, this is the first CTMS developed in-house at an academic medical center side which can enhance the efficiency of clinical trial management in compliance with privacy and security laws. %M 29691212 %R 10.2196/jmir.9312 %U http://www.jmir.org/2018/4/e103/ %U https://doi.org/10.2196/jmir.9312 %U http://www.ncbi.nlm.nih.gov/pubmed/29691212 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e140 %T Using Plain Language and Adding Communication Technology to an Existing Health-Related Questionnaire to Help Generate Accurate Information: Qualitative Study %A Welbie,Marlies %A Wittink,Harriet %A Westerman,Marjan J %A Topper,Ilse %A Snoei,Josca %A Devillé,Walter LJM %+ Research Group Lifestyle and Health, Faculty of Health Care, University of Applied Sciences, Heidelberglaan 7, Utrecht, 3584 CS, Netherlands, 31 638763239, marlies.welbie@hu.nl %K educational status %K surveys and questionnaires %K physical therapy specialty %K qualitative research %D 2018 %7 23.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Low-educated patients are disadvantaged in using questionnaires within the health care setting because most health-related questionnaires do not take the educational background of patients into account. The Dutch Talking Touch Screen Questionnaire (DTTSQ) was developed in an attempt to meet the needs of low-educated patients by using plain language and adding communication technology to an existing paper-based questionnaire. For physical therapists to use the DTTSQ as part of their intake procedure, it needs to generate accurate information from all of their patients, independent of educational level. Objective: The aim of this study was to get a first impression of the information that is generated by the DTTSQ. To achieve this goal, response processes of physical therapy patients with diverse levels of education were analyzed. Methods: The qualitative Three-Step Test-Interview method was used to collect observational data on actual response behavior of 24 physical therapy patients with diverse levels of education. The interviews included both think-aloud and retrospective probing techniques. Results: Of the 24 respondents, 20 encountered one or more problems during their response process. The use of plain language and information and communication technology (ICT) appeared to have a positive effect on the comprehensibility of the DTTSQ. However, it also had some negative effects on the interpretation, retrieval, judgment, and response selection within the response processes of the participants in this study. No educational group in this research population stood out from the rest in the kind or number of problems that arose. All respondents recognized themselves in the outcomes of the questionnaire. Conclusions: The use of plain language and ICT within the DTTSQ had both positive and negative effects on the response processes of its target population. The results of this study emphasize the importance of earlier recommendations to accompany any adaption of any questionnaire to a new mode of delivery by demonstrating the difference and equivalence between the two different modes and to scientifically evaluate the applicability of the newly developed mode of the questionnaire in its intended setting. This is especially important in a digital era in which the use of plain language within health care is increasingly being advocated. %M 29685873 %R 10.2196/jmir.7940 %U http://www.jmir.org/2018/4/e140/ %U https://doi.org/10.2196/jmir.7940 %U http://www.ncbi.nlm.nih.gov/pubmed/29685873 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e138 %T The Korean eHealth Literacy Scale (K-eHEALS): Reliability and Validity Testing in Younger Adults Recruited Online %A Chung,SeonYoon %A Park,Bu Kyung %A Nahm,Eun-Shim %+ College of Nursing, Research Institute of Nursing Science, Kyungpook National University, 640 Gukchaebosang-ro Jung-gu, Daegu, 41944, Republic Of Korea, 82 53 420 4929, bukpark@knu.ac.kr %K eHEALS %K eHealth %K literacy %K reliability %K validity %D 2018 %7 20.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: In this digital era, eHealth literacy is an essential skill set to leverage health information available online to promote health outcomes. South Korea has an advanced health information technology infrastructure, including widespread use of the internet and mobile phones. A few studies have explored eHealth literacy in South Korea using translated versions of the eHEALS; however, they were not fully validated. A unified reliable and valid assessment tool is critical to assess and enhance the eHealth literacy level across the population. Objective: The aim was to develop a Korean version of eHealth Literacy Scale (K-eHEALS) and evaluate its reliability and validity employing healthy young adults in Korea. Methods: The K-eHEALS was developed based on eHEALS, a widely used tool that measures eHealth literacy, and was validated using a sample of 500 young adults recruited from a pool of a Korean internet survey panel. Content validity was assessed using the content validity index (CVI) for individual items and for scale. Construct validity was examined using exploratory factor analysis and hypothesis testing. The Cronbach alpha coefficient was used to determine the internal consistency and the Pearson correlation coefficient was used to evaluable the stability of the measure (n=55). Results: Both individual and scale CVIs were acceptable (individual CVIs>0.67; scale CVI=0.83). Single factors accounting for 50.3% of the variance in the scales were extracted revealing the unidimensional latent structure of K-eHEALS. Hypothesis testing showed significant association between eHealth literacy and hours of internet use per day, supporting the construct validity. Items of the K-eHEALS were internally consistent (Cronbach alpha=.88) and stable over a 1-month period (r=.754, P<.001). Conclusions: The findings of this study suggest that K-eHEALS is a valid and reliable measure of eHealth literacy in Korean young adults. Additional studies are needed with more diverse groups of adults in Korea. %M 29678800 %R 10.2196/jmir.8759 %U http://www.jmir.org/2018/4/e138/ %U https://doi.org/10.2196/jmir.8759 %U http://www.ncbi.nlm.nih.gov/pubmed/29678800 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e90 %T Assessing Therapeutic Alliance in the Context of mHealth Interventions for Mental Health Problems: Development of the Mobile Agnew Relationship Measure (mARM) Questionnaire %A Berry,Katherine %A Salter,Amy %A Morris,Rohan %A James,Susannah %A Bucci,Sandra %+ Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M139PL, United Kingdom, 44 1613060422, katherine.berry@manchester.ac.uk %K mobile health %K health care provider %K digital interventions %K therapeutic alliance %K mental health %K measure development %D 2018 %7 19.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health interventions in the form of smartphone apps aim to improve mental health and enable people access to support as and when needed without having to face the stigma they may experience in accessing services. If we are to evaluate mobile health (mHealth) apps and advance scientific understanding, we also need tools to help us understand in what ways mHealth interventions are effective or not. The concept of therapeutic alliance, a measure of the quality of the relationship between a health care provider and a service user, is a key factor in explaining the effects of mental health interventions. The Agnew Relationship Measure (ARM) is a well-validated measure of therapeutic alliance in face-to-face therapy. Objective: This study presented the first attempt to (1) explore service users’ views of the concept of relationship within mHealth mental health interventions and (2) adapt a well-validated face-to-face measure of therapeutic alliance, the Agnew Relationship Measure (ARM), for use with mHealth interventions. Methods: In stage 1, we interviewed 9 mental health service users about the concept of therapeutic alliance in the context of a digital health intervention and derived key themes from interview transcripts using thematic analysis. In stage 2, we used rating scales and open-ended questions to elicit views from 14 service users and 10 mental health staff about the content and face validity of the scale, which replaced the word “therapist” with the word “app.” In stage 3, we used the findings from stages 1 and 2 to adapt the measure with the support of a decision-making algorithm about which items to drop, retain, or adapt. Results: Findings suggested that service users do identify relationship concepts when thinking about mHealth interventions, including forming a bond with an app and the ability to be open with an app. However, there were key differences between relationships with health professionals and relationships with apps. For example, apps were not as tailored and responsive to each person’s unique needs. Furthermore, apps were not capable of portraying uniquely human-like qualities such as friendliness, collaboration, and agreement. We made a number of changes to the ARM that included revising 16 items; removing 4 items due to lack of suitable alternatives; and adding 1 item to capture a key theme derived from stage 1 of the study (“The app is like having a member of my care team in my pocket”). Conclusions: This study introduces the mHealth version of the ARM, the mARM, that has good face and content validity. We encourage researchers to include this easy-to-use tool in digital health intervention studies to gather further data about its psychometric properties and advance our understanding of how therapeutic alliance influences the efficacy of mHealth interventions. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 34966555; http://www.isrctn.com/ISRCTN34966555 (Archived by WebCite at http://www.webcitation.org/6ymBVwKif) %M 29674307 %R 10.2196/jmir.8252 %U http://www.jmir.org/2018/4/e90/ %U https://doi.org/10.2196/jmir.8252 %U http://www.ncbi.nlm.nih.gov/pubmed/29674307 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e89 %T Detecting Motor Impairment in Early Parkinson’s Disease via Natural Typing Interaction With Keyboards: Validation of the neuroQWERTY Approach in an Uncontrolled At-Home Setting %A Arroyo-Gallego,Teresa %A Ledesma-Carbayo,María J %A Butterworth,Ian %A Matarazzo,Michele %A Montero-Escribano,Paloma %A Puertas-Martín,Verónica %A Gray,Martha L %A Giancardo,Luca %A Sánchez-Ferro,Álvaro %+ Institute for Medical Engineering and Science, Massachusetts Institute of Technology, E25-413, 77 Massachusetts Avenue, Cambridge, MA, 02139, United States, 1 857 523 6281, tarroyog@mit.edu %K eHealth %K machine learning %K telemedicine %D 2018 %7 26.03.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Parkinson’s disease (PD) is the second most prevalent neurodegenerative disease and one of the most common forms of movement disorder. Although there is no known cure for PD, existing therapies can provide effective symptomatic relief. However, optimal titration is crucial to avoid adverse effects. Today, decision making for PD management is challenging because it relies on subjective clinical evaluations that require a visit to the clinic. This challenge has motivated recent research initiatives to develop tools that can be used by nonspecialists to assess psychomotor impairment. Among these emerging solutions, we recently reported the neuroQWERTY index, a new digital marker able to detect motor impairment in an early PD cohort through the analysis of the key press and release timing data collected during a controlled in-clinic typing task. Objective: The aim of this study was to extend the in-clinic implementation to an at-home implementation by validating the applicability of the neuroQWERTY approach in an uncontrolled at-home setting, using the typing data from subjects’ natural interaction with their laptop to enable remote and unobtrusive assessment of PD signs. Methods: We implemented the data-collection platform and software to enable access and storage of the typing data generated by users while using their computer at home. We recruited a total of 60 participants; of these participants 52 (25 people with Parkinson’s and 27 healthy controls) provided enough data to complete the analysis. Finally, to evaluate whether our in-clinic-built algorithm could be used in an uncontrolled at-home setting, we compared its performance on the data collected during the controlled typing task in the clinic and the results of our method using the data passively collected at home. Results: Despite the randomness and sparsity introduced by the uncontrolled setting, our algorithm performed nearly as well in the at-home data (area under the receiver operating characteristic curve [AUC] of 0.76 and sensitivity/specificity of 0.73/0.69) as it did when used to evaluate the in-clinic data (AUC 0.83 and sensitivity/specificity of 0.77/0.72). Moreover, the keystroke metrics presented a strong correlation between the 2 typing settings, which suggests a minimal influence of the in-clinic typing task in users’ normal typing. Conclusions: The finding that an algorithm trained on data from an in-clinic setting has comparable performance with that tested on data collected through naturalistic at-home computer use reinforces the hypothesis that subtle differences in motor function can be detected from typing behavior. This work represents another step toward an objective, user-convenient, and quasi-continuous monitoring tool for PD. %M 29581092 %R 10.2196/jmir.9462 %U http://www.jmir.org/2018/3/e89/ %U https://doi.org/10.2196/jmir.9462 %U http://www.ncbi.nlm.nih.gov/pubmed/29581092 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e108 %T Rapid and Accurate Behavioral Health Diagnostic Screening: Initial Validation Study of a Web-Based, Self-Report Tool (the SAGE-SR) %A Brodey,Benjamin %A Purcell,Susan E %A Rhea,Karen %A Maier,Philip %A First,Michael %A Zweede,Lisa %A Sinisterra,Manuela %A Nunn,M Brad %A Austin,Marie-Paule %A Brodey,Inger S %+ TeleSage, 201 East Rosemary Street, Chapel Hill, NC, 27514, United States, 1 919 942 8849, bb@telesage.com %K mental health %K differential diagnosis %K surveys and questionnaires %K self-report %K primary health care %K computer-assisted diagnosis %D 2018 %7 23.03.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The Structured Clinical Interview for DSM (SCID) is considered the gold standard assessment for accurate, reliable psychiatric diagnoses; however, because of its length, complexity, and training required, the SCID is rarely used outside of research. Objective: This paper aims to describe the development and initial validation of a Web-based, self-report screening instrument (the Screening Assessment for Guiding Evaluation-Self-Report, SAGE-SR) based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the SCID-5-Clinician Version (CV) intended to make accurate, broad-based behavioral health diagnostic screening more accessible within clinical care. Methods: First, study staff drafted approximately 1200 self-report items representing individual granular symptoms in the diagnostic criteria for the 8 primary SCID-CV modules. An expert panel iteratively reviewed, critiqued, and revised items. The resulting items were iteratively administered and revised through 3 rounds of cognitive interviewing with community mental health center participants. In the first 2 rounds, the SCID was also administered to participants to directly compare their Likert self-report and SCID responses. A second expert panel evaluated the final pool of items from cognitive interviewing and criteria in the DSM-5 to construct the SAGE-SR, a computerized adaptive instrument that uses branching logic from a screener section to administer appropriate follow-up questions to refine the differential diagnoses. The SAGE-SR was administered to healthy controls and outpatient mental health clinic clients to assess test duration and test-retest reliability. Cutoff scores for screening into follow-up diagnostic sections and criteria for inclusion of diagnoses in the differential diagnosis were evaluated. Results: The expert panel reduced the initial 1200 test items to 664 items that panel members agreed collectively represented the SCID items from the 8 targeted modules and DSM criteria for the covered diagnoses. These 664 items were iteratively submitted to 3 rounds of cognitive interviewing with 50 community mental health center participants; the expert panel reviewed session summaries and agreed on a final set of 661 clear and concise self-report items representing the desired criteria in the DSM-5. The SAGE-SR constructed from this item pool took an average of 14 min to complete in a nonclinical sample versus 24 min in a clinical sample. Responses to individual items can be combined to generate DSM criteria endorsements and differential diagnoses, as well as provide indices of individual symptom severity. Preliminary measures of test-retest reliability in a small, nonclinical sample were promising, with good to excellent reliability for screener items in 11 of 13 diagnostic screening modules (intraclass correlation coefficient [ICC] or kappa coefficients ranging from .60 to .90), with mania achieving fair test-retest reliability (ICC=.50) and other substance use endorsed too infrequently for analysis. Conclusions: The SAGE-SR is a computerized adaptive self-report instrument designed to provide rigorous differential diagnostic information to clinicians. %M 29572204 %R 10.2196/jmir.9428 %U http://www.jmir.org/2018/3/e108/ %U https://doi.org/10.2196/jmir.9428 %U http://www.ncbi.nlm.nih.gov/pubmed/29572204 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 5 %N 1 %P e1 %T Physiotherapy Questionnaires App to Deliver Main Musculoskeletal Assessment Questionnaires: Development and Validation Study %A Teixeira Neto,Nestor Cavalcante %A Lima,Yuri Lopes %A Almeida,Gabriel Peixoto Leão %A Bezerra,Márcio Almeida %A Lima,Pedro Olavo De Paula %A de Oliveira,Rodrigo Ribeiro %+ Department of Physical Therapy, Faculty of Medicine, Federal University of Ceará, 949 Rua Alexandre Baraúna, Fortaleza, 61760000, Brazil, 55 8533668632, rodrigo@ufc.br %K mobile phone %K Foot and Ankle Outcome Score %K American Orthopaedic Foot and Ankle Society %K musculoskeletal assessment questionnaires %K health survey %D 2018 %7 23.02.2018 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Patient-reported outcomes (PROs) translate subjective outcomes into objective data that can be quantified and analyzed. Nevertheless, the use of PROs in their traditional paper format is not practical for clinical practice due to limitations associated with the analysis and management of the data. To address the need for a viable way to group and utilize the main functioning assessment tools in the field of musculoskeletal disorders, the Physiotherapy Questionnaires app was developed. Objective: This study aims to explain the development of the app, to validate it using two questionnaires, and to analyze whether participants prefer to use the app or the paper version of the questionnaires. Methods: In the first stage, the app for an Android operational system was developed. In the second stage, the aim was to select questionnaires that were most often used in musculoskeletal clinical practice and research. The Foot and Ankle Outcome Score (FAOS) and American Orthopaedic Foot and Ankle Society (AOFAS) questionnaire were selected to validate the app. In total, 50 participants completed the paper and app versions of the AOFAS and 50 completed the FAOS. The study’s outcomes were the correlation of the data between the paper and app versions as well as the preference of the participants between the two versions. Results: The app was approved by experts after the adaptations of the layout for mobile phones and a total of 18 questionnaires were included in the app. Moreover, the app allows the generation of PDF and Excel files with the patients’ data. In regards to validity, the mean of the total scores of the FAOS were 91.54% (SD 8.86%) for the paper version and 91.74% (SD 9.20%) for the app. There was no statistically significant differences in the means of the total scores or the subscales (P=.11-.94). The mean total scores for the AOFAS were 93.94 (SD 8.47) for the paper version and 93.96 (SD 8.48) for the app. No statistically significant differences were found for the total scores for the AOFAS or the subscales (P>.99). The app showed excellent agreement with the paper version of the FAOS, with an ICC value of 0.98 for the total score (95% CI 0.98-0.99), which was also found for the AOFAS with the ICC for the total score of 0.99 (95% CI 0.98-0.99). For compliance, 72% (36/50) of the participants in the FAOS group and 94% (47/50) in the AOFAS group preferred the app version. Conclusions: The Physiotherapy Questionnaires app showed validity and high levels of compliance for the FAOS and AOFAS, which indicates it is not inferior to the paper version of these two questionnaires and confirms its viability and feasibility for use in clinical practice. %M 29475827 %R 10.2196/rehab.9247 %U http://rehab.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/rehab.9247 %U http://www.ncbi.nlm.nih.gov/pubmed/29475827 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e45 %T Mobile App Delivery of the EORTC QLQ-C30 Questionnaire to Assess Health-Related Quality of Life in Oncological Patients: Usability Study %A Kessel,Kerstin A %A Vogel,Marco ME %A Alles,Anna %A Dobiasch,Sophie %A Fischer,Hanna %A Combs,Stephanie E %+ Department of Radiation Oncology, Technical University of Munich, Ismaninger Straße 22, Munich, 81675, Germany, 49 0894140 ext 4502, kerstin.kessel@tum.de %K radiation oncology %K healthcare surveys %K mobile applications %K mobile apps %K telemedicine %K health-related quality of life %K questionnaires %K oncology  %D 2018 %7 20.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps are evolving in the medical field. However, ongoing discussions have questioned whether such apps are really valuable and whether patients will accept their use in day-to-day clinical life. Therefore, we initiated a usability study in our department. Objective: We present our results of the first app prototype and patient testing of health-related quality of life (HRQoL) assessment in oncological patients. Methods: We developed an app prototype for the iOS operating system within eight months in three phases: conception, initial development, and pilot testing. For the HRQoL assessment, we chose to implement only the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30; German version 3). Usability testing was conducted for three months. Participation was voluntary and pseudonymized. After completion of the QLQ-C30 questionnaire using iPads provided by our department, we performed a short survey with 10 questions. This survey inquired about patients’ opinions regarding general aspects, including technical advances in medicine, mobile and app assistance during cancer treatment, and the app-specific functions (eg, interface and navigation). Results: After logging into the app, the user can choose between starting a questionnaire, reviewing answers (administrators only), and logging out. The questionnaire is displayed with the same information, questions, and answers as on the original QLQ-C30 sheet. No alterations in wording were made. Usability was tested with 81 patients; median age was 55 years. The median time for completing the HRQoL questionnaire on the iPad was 4.0 minutes. Of all participants, 84% (68/81) owned a mobile device. Similarly, 84% (68/81) of participants would prefer a mobile version of the HRQoL questionnaire instead of a paper-based version. Using the app in daily life during and after cancer treatment would be supported by 83% (67/81) of participants. In the prototype version of the app, data were stored on the device; in the future, 79% (64/81) of the patients would agree to transfer data via the Internet. Conclusions: Our usability test showed good results regarding attractiveness, operability, and understandability. Moreover, our results demonstrate a high overall acceptance of mobile apps and telemedicine in oncology. The HRQoL assessment via the app was accepted thoroughly by patients, and individuals are keen to use it in clinical routines, while data privacy and security must be ensured. %M 29463489 %R 10.2196/mhealth.9486 %U http://mhealth.jmir.org/2018/2/e45/ %U https://doi.org/10.2196/mhealth.9486 %U http://www.ncbi.nlm.nih.gov/pubmed/29463489 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e54 %T Patient-Reported Measures for Person-Centered Coordinated Care: A Comparative Domain Map and Web-Based Compendium for Supporting Policy Development and Implementation %A Lloyd,Helen %A Wheat,Hannah %A Horrell,Jane %A Sugavanam,Thavapriya %A Fosh,Benjamin %A Valderas,Jose M %A Close,James %+ Community and Primary Care Research Group, Plymouth University Peninsula Schools of Medicine & Dentistry, ITTC Building, Davy Road, Plymouth Science Park, Derriford, Plymouth, PL6 8BX, United Kingdom, 44 1752764260, helen.lloyd-1@plymouth.ac.uk %K patient reported outcome measures %K quality of life %D 2018 %7 14.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient-reported measure (PRM) questionnaires were originally used in research to measure outcomes of intervention studies. They have now evolved into a diverse family of tools measuring a range of constructs including quality of life and experiences of care. Current health and social care policy increasingly advocates their use for embedding the patient voice into service redesign through new models of care such as person-centered coordinated care (P3C). If chosen carefully and used efficiently, these tools can help improve care delivery through a variety of novel ways, including system-level feedback for health care management and commissioning. Support and guidance on how to use these tools would be critical to achieve these goals. Objective: The objective of this study was to develop evidence-based guidance and support for the use of P3C-PRMs in health and social care policy through identification of PRMs that can be used to enhance the development of P3C, mapping P3C-PRMs against an existing model of domains of P3C, and integration and organization of the information in a user-friendly Web-based database. Methods: A pragmatic approach was used for the systematic identification of candidate P3C-PRMs, which aimed at balancing comprehensiveness and feasibility. This utilized a number of resources, including existing compendiums, peer-reviewed and gray literature (using a flexible search strategy), and stakeholder engagement (which included guidance for relevant clinical areas). A subset of those candidate measures (meeting prespecified eligibility criteria) was then mapped against a theoretical model of P3C, facilitating classification of the construct being measured and the subsequent generation of shortlists for generic P3C measures, specific aspects of P3C (eg, communication or decision making), and condition-specific measures (eg, diabetes, cancer) in priority areas, as highlighted by stakeholders. Results: In total, 328 P3C-PRMs were identified, which were used to populate a freely available Web-based database. Of these, 63 P3C-PRMs met the eligibility criteria for shortlisting and were classified according to their measurement constructs and mapped against the theoretical P3C model. We identified tools with the best coverage of P3C, thereby providing evidence of their content validity as outcome measures for new models of care. Transitions and medications were 2 areas currently poorly covered by existing measures. All the information is currently available at a user-friendly web-based portal (p3c.org.uk), which includes all relevant information on each measure, such as the constructs targeted and links to relevant literature, in addition to shortlists according to relevant constructs. Conclusions: A detailed compendium of P3C-PRMs has been developed using a pragmatic systematic approach supported by stakeholder engagement. Our user-friendly suite of tools is designed to act as a portal to the world of PRMs for P3C, and have utility for a broad audience, including (but not limited to) health care commissioners, managers, and researchers. %M 29444767 %R 10.2196/jmir.7789 %U http://www.jmir.org/2018/2/e54/ %U https://doi.org/10.2196/jmir.7789 %U http://www.ncbi.nlm.nih.gov/pubmed/29444767 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e12 %T Work Addiction Test Questionnaire to Assess Workaholism: Validation of French Version %A Ravoux,Hortense %A Pereira,Bruno %A Brousse,Georges %A Dewavrin,Samuel %A Cornet,Thomas %A Mermillod,Martial %A Mondillon,Laurie %A Vallet,Guillaume %A Moustafa,Farès %A Dutheil,Frédéric %+ Service Santé Travail Environnement, Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, Clermont-Ferrand, F-63000, France, 33 6 88 22 48 48, fred_dutheil@yahoo.fr %K behavior, addictive %K work %K validation studies as topic %K questionnaires %K social welfare %K health %K public health %D 2018 %7 13.02.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Work addiction is a significant public health problem with a growing prevalence. The Work Addiction Risk Test (WART) is the gold standard questionnaire to detect workaholism. Objective: The main objective of this study was to validate the French version of the WART. Methods: Questionnaires were proposed to voluntary French workers using the WittyFit software. There were no exclusion criteria. The questionnaire was administered anonymously for initial validity testing and readministered one week later for test-retest reliability. We also assessed the workers’ sociodemographic characteristics, as well as other measurements for external validity, such as stress, well-being, and coaddictions to tobacco, alcohol, and cannabis. Several psychometric properties of the French-WART were explored: acceptability, reliability (internal consistency [Cronbach alpha coefficient] and reproducibility [Lin concordance coefficient]), construct validity (correlation coefficients and principal component analysis), and external validity (correlation coefficients). Results: Among the 1580 workers using WittyFit, 187 (11.83%) agreed to complete the WART questionnaire. Of those, 128 completed the test-retest survey (68.4%). Acceptability found that all respondents had fully completed the questionnaire, with few floor or ceiling effects. Reliability was very good with a Cronbach alpha coefficient at .90 (internal consistency) and Lin concordance coefficient at .90 (95% CI .87-.94] with a difference on the retest of .04 (SD 4.9) (95% CI −9.6 to 9.7) (reproducibility). We identified three main dimensions (construct validity). Relationships between WART and stress and well-being confirmed its external validity. Conclusions: The French version of the WART is a valid and reliable instrument to assess work addiction with satisfactory psychometric properties. Used in occupational medicine, this tool would allow the diagnosis of work addiction and can be easily implemented in current practice. %M 29439945 %R 10.2196/mental.8215 %U http://mental.jmir.org/2018/1/e12/ %U https://doi.org/10.2196/mental.8215 %U http://www.ncbi.nlm.nih.gov/pubmed/29439945 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e36 %T A Multidimensional Tool Based on the eHealth Literacy Framework: Development and Initial Validity Testing of the eHealth Literacy Questionnaire (eHLQ) %A Kayser,Lars %A Karnoe,Astrid %A Furstrand,Dorthe %A Batterham,Roy %A Christensen,Karl Bang %A Elsworth,Gerald %A Osborne,Richard H %+ Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, Copenhagen, DK-1014, Denmark, 45 28757291, lk@sund.ku.dk %K eHealth %K health literacy %K computer literacy %K questionnaire design %D 2018 %7 12.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: For people to be able to access, understand, and benefit from the increasing digitalization of health services, it is critical that services are provided in a way that meets the user’s needs, resources, and competence. Objective: The objective of the study was to develop a questionnaire that captures the 7-dimensional eHealth Literacy Framework (eHLF). Methods: Draft items were created in parallel in English and Danish. The items were generated from 450 statements collected during the conceptual development of eHLF. In all, 57 items (7 to 9 items per scale) were generated and adjusted after cognitive testing. Items were tested in 475 people recruited from settings in which the scale was intended to be used (community and health care settings) and including people with a range of chronic conditions. Measurement properties were assessed using approaches from item response theory (IRT) and classical test theory (CTT) such as confirmatory factor analysis (CFA) and reliability using composite scale reliability (CSR); potential bias due to age and sex was evaluated using differential item functioning (DIF). Results: CFA confirmed the presence of the 7 a priori dimensions of eHLF. Following item analysis, a 35-item 7-scale questionnaire was constructed, covering (1) using technology to process health information (5 items, CSR=.84), (2) understanding of health concepts and language (5 items, CSR=.75), (3) ability to actively engage with digital services (5 items, CSR=.86), (4) feel safe and in control (5 items, CSR=.87), (5) motivated to engage with digital services (5 items, CSR=.84), (6) access to digital services that work (6 items, CSR=.77), and (7) digital services that suit individual needs (4 items, CSR=.85). A 7-factor CFA model, using small-variance priors for cross-loadings and residual correlations, had a satisfactory fit (posterior productive P value: .27, 95% CI for the difference between the observed and replicated chi-square values: −63.7 to 133.8). The CFA showed that all items loaded strongly on their respective factors. The IRT analysis showed that no items were found to have disordered thresholds. For most scales, discriminant validity was acceptable; however, 2 pairs of dimensions were highly correlated; dimensions 1 and 5 (r=.95), and dimensions 6 and 7 (r=.96). All dimensions were retained because of strong content differentiation and potential causal relationships between these dimensions. There is no evidence of DIF. Conclusions: The eHealth Literacy Questionnaire (eHLQ) is a multidimensional tool based on a well-defined a priori eHLF framework with robust properties. It has satisfactory evidence of construct validity and reliable measurement across a broad range of concepts (using both CTT and IRT traditions) in various groups. It is designed to be used to understand and evaluate people’s interaction with digital health services. %M 29434011 %R 10.2196/jmir.8371 %U https://www.jmir.org/2018/2/e36/ %U https://doi.org/10.2196/jmir.8371 %U http://www.ncbi.nlm.nih.gov/pubmed/29434011 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e47 %T Health Information Obtained From the Internet and Changes in Medical Decision Making: Questionnaire Development and Cross-Sectional Survey %A Chen,Yen-Yuan %A Li,Chia-Ming %A Liang,Jyh-Chong %A Tsai,Chin-Chung %+ Program of Learning Sciences, National Taiwan Normal University, No 161, Rd Heping E Sec 1, Da-An District, Taipei, 10647, Taiwan, 886 277345999, aljc@ntnu.edu.tw %K internet %K help-seeking behavior %K literacy %K decision making %D 2018 %7 12.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The increasing utilization of the internet has provided a better opportunity for people to search online for health information, which was not easily available to them in the past. Studies reported that searching on the internet for health information may potentially influence an individual’s decision making to change her health-seeking behaviors. Objective: The objectives of this study were to (1) develop and validate 2 questionnaires to estimate the strategies of problem-solving in medicine and utilization of online health information, (2) determine the association between searching online for health information and utilization of online health information, and (3) determine the association between online medical help-seeking and utilization of online health information. Methods: The Problem Solving in Medicine and Online Health Information Utilization questionnaires were developed and implemented in this study. We conducted confirmatory factor analysis to examine the structure of the factor loadings and intercorrelations for all the items and dimensions. We employed Pearson correlation coefficients for examining the correlations between each dimension of the Problem Solving in Medicine questionnaire and each dimension of the Online Health Information Utilization questionnaire. Furthermore, we conducted structure equation modeling for examining the possible linkage between each of the 6 dimensions of the Problem Solving in Medicine questionnaire and each of the 3 dimensions of the Online Health Information Utilization questionnaire. Results: A total of 457 patients participated in this study. Pearson correlation coefficients ranged from .12 to .41, all with statistical significance, implying that each dimension of the Problem Solving in Medicine questionnaire was significantly associated with each dimension of the Online Health Information Utilization questionnaire. Patients with the strategy of online health information search for solving medical problems positively predicted changes in medical decision making (P=.01), consulting with others (P<.001), and promoting self-efficacy on deliberating the online health information (P<.001) based on the online health information they obtained. Conclusions: Present health care professionals have a responsibility to acknowledge that patients’ medical decision making may be changed based on additional online health information. Health care professionals should assist patients’ medical decision making by initiating as much dialogue with patients as possible, providing credible and convincing health information to patients, and guiding patients where to look for accurate, comprehensive, and understandable online health information. By doing so, patients will avoid becoming overwhelmed with extraneous and often conflicting health information. Educational interventions to promote health information seekers’ ability to identify, locate, obtain, read, understand, evaluate, and effectively use online health information are highly encouraged. %M 29434017 %R 10.2196/jmir.9370 %U http://www.jmir.org/2018/2/e47/ %U https://doi.org/10.2196/jmir.9370 %U http://www.ncbi.nlm.nih.gov/pubmed/29434017 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e3 %T A Computer-Assisted Personal Interview App in Research Electronic Data Capture for Administering Time Trade-off Surveys (REDCap): Development and Pretest %A Oremus,Mark %A Sharafoddini,Anis %A Morgano,Gian Paolo %A Jin,Xuejing %A Xie,Feng %+ School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON,, Canada, 1 519 888 4567 ext 35129, moremus@uwaterloo.ca %K computer-assisted personal interview %K health-related quality-of-life %K REDCap %K time trade-off %D 2018 %7 23.01.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The time trade-off (TTO) task is a method of eliciting health utility scores, which range from 0 (equivalent to death) to 1 (equivalent to perfect health). These scores numerically represent a person’s health-related quality of life. Software apps exist to administer the TTO task; however, most of these apps are poorly documented and unavailable to researchers. Objective: To fill the void, we developed an online app to administer the TTO task for a research study that is examining general public proxy health-related quality of life estimates for persons with Alzheimer’s disease. This manuscript describes the development and pretest of the app. Methods: We used Research Electronic Data Capture (REDCap) to build the TTO app. The app’s modular structure and REDCap’s object-oriented environment facilitated development. After the TTO app was built, we recruited a purposive sample of 11 members of the general public to pretest its functionality and ease of use. Results: Feedback from the pretest group was positive. Minor modifications included clarity enhancements, such as rearranging some paragraph text into bullet points, labeling the app to delineate different question sections, and revising or deleting text. We also added a research question to enable the identification of respondents who know someone with Alzheimer’s disease. Conclusions: We developed an online app to administer the TTO task. Other researchers may access and customize the app for their own research purposes. %M 30684429 %R 10.2196/formative.8202 %U http://formative.jmir.org/2018/1/e3/ %U https://doi.org/10.2196/formative.8202 %U http://www.ncbi.nlm.nih.gov/pubmed/30684429 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e4 %T Health Information Technology Usability Evaluation Scale (Health-ITUES) for Usability Assessment of Mobile Health Technology: Validation Study %A Schnall,Rebecca %A Cho,Hwayoung %A Liu,Jianfang %+ School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, United States, 1 2123426886, rb897@columbia.edu %K mobile technology %K usability %K mobile health apps %K psychometric evaluation %D 2018 %7 05.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile technology has become a ubiquitous technology and can be particularly useful in the delivery of health interventions. This technology can allow us to deliver interventions to scale, cover broad geographic areas, and deliver technologies in highly tailored ways based on the preferences or characteristics of users. The broad use of mobile technologies supports the need for usability assessments of these tools. Although there have been a number of usability assessment instruments developed, none have been validated for use with mobile technologies. Objective: The goal of this work was to validate the Health Information Technology Usability Evaluation Scale (Health-ITUES), a customizable usability assessment instrument in a sample of community-dwelling adults who were testing the use of a new mobile health (mHealth) technology. Methods: A sample of 92 community-dwelling adults living with HIV used a new mobile app for symptom self-management and completed the Health-ITUES to assess the usability of the app. They also completed the Post-Study System Usability Questionnaire (PSSUQ), a widely used and well-validated usability assessment tool. Correlations between these scales and each of the subscales were assessed. Results: The subscales of the Health-ITUES showed high internal consistency reliability (Cronbach alpha=.85-.92). Each of the Health-ITUES subscales and the overall scale was moderately to strongly correlated with the PSSUQ scales (r=.46-.70), demonstrating the criterion validity of the Health-ITUES. Conclusions: The Health-ITUES has demonstrated reliability and validity for use in assessing the usability of mHealth technologies in community-dwelling adults living with a chronic illness. %M 29305343 %R 10.2196/mhealth.8851 %U http://mhealth.jmir.org/2018/1/e4/ %U https://doi.org/10.2196/mhealth.8851 %U http://www.ncbi.nlm.nih.gov/pubmed/29305343 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e1 %T Physical Activity Assessment Using an Activity Tracker in Patients with Rheumatoid Arthritis and Axial Spondyloarthritis: Prospective Observational Study %A Jacquemin,Charlotte %A Servy,Hervé %A Molto,Anna %A Sellam,Jérémie %A Foltz,Violaine %A Gandjbakhch,Frédérique %A Hudry,Christophe %A Mitrovic,Stéphane %A Fautrel,Bruno %A Gossec,Laure %+ Rheumatology Department, Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, 47-83 bd de l’hôpital, Paris, 75013, France, 33 688624123, jacquemin.charlotte@gmail.com %K fitness tracker %K exercise %K rheumatoid arthritis %K axial spondylarthritis %D 2018 %7 02.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity can be tracked using mobile devices and is recommended in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) management. The World Health Organization (WHO) recommends at least 150 min per week of moderate to vigorous physical activity (MVPA). Objective: The objectives of this study were to assess and compare physical activity and its patterns in patients with RA and axSpA using an activity tracker and to assess the feasibility of mobile devices in this population. Methods: This multicentric prospective observational study (ActConnect) included patients who had definite RA or axSpA, and a smartphone. Physical activity was assessed over 3 months using a mobile activity tracker, recording the number of steps per minute. The number of patients reaching the WHO recommendations was calculated. RA and axSpA were compared, using linear mixed models, for number of steps, proportion of morning steps, duration of total activity, and MVPA. Physical activity trajectories were identified using the K-means method, and factors related to the low activity trajectory were explored by logistic regression. Acceptability was assessed by the mean number of days the tracker was worn over the 3 months (ie, adherence), the percentage of wearing time, and by an acceptability questionnaire. Results: A total of 157 patients (83 RA and 74 axSpA) were analyzed; 36.3% (57/157) patients were males, and their mean age was 46 (standard deviation [SD] 12) years and mean disease duration was 11 (SD 9) years. RA and axSpA patients had similar physical activity levels of 16 (SD 11) and 15 (SD 12) min per day of MVPA (P=.80), respectively. Only 27.4% (43/157) patients reached the recommendations with a mean MVPA of 106 (SD 77) min per week. The following three trajectories were identified with constant activity: low (54.1% [85/157] of patients), moderate (42.7% [67/157] of patients), and high (3.2% [5/157] of patients) levels of MVPA. A higher body mass index was significantly related to less physical activity (odds ratio 1.12, 95% CI 1.11-1.14). The activity trackers were worn during a mean of 79 (SD 17) days over the 90 days follow-up. Overall, patients considered the use of the tracker very acceptable, with a mean score of 8 out 10. Conclusions: Patients with RA and axSpA performed insufficient physical activity with similar levels in both groups, despite the differences between the 2 diseases. Activity trackers allow longitudinal assessment of physical activity in these patients. The good adherence to this study and the good acceptability of wearing activity trackers confirmed the feasibility of the use of a mobile activity tracker in patients with rheumatic diseases. %M 29295810 %R 10.2196/mhealth.7948 %U http://mhealth.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/mhealth.7948 %U http://www.ncbi.nlm.nih.gov/pubmed/29295810 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e188 %T The Swedish Web Version of the Quality of Recovery Scale Adapted for Use in a Mobile App: Prospective Psychometric Evaluation Study %A Nilsson,Ulrica %A Dahlberg,Karuna %A Jaensson,Maria %+ School of Health Sciences, Faculty of Medicine and Health, Örebro University, Fakultetsgatan, Örebro, 70182, Sweden, 46 762132685, ulrica.nilsson@oru.se %K psychometric evaluation %K postoperative recovery %K Web version %K evaluation studies %K mobile application %K Quality of Recovery scale %D 2017 %7 3.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The 40-item Quality of Recovery (QoR-40) questionnaire is well validated for measuring self-assessed postoperative recovery. The Swedish version of the 40-item Quality of Recovery (QoR-40) has been developed into a Web-based questionnaire, the Swedish Web version of the Quality of Recovery (SwQoR) questionnaire, adapted for use in a mobile app, Recovery Assessment by Phone Points, or RAPP. Objective: The aim of this study was to test the validity, reliability, responsiveness, and clinical acceptability and feasibility of SwQoR. Methods: We conducted a prospective psychometric evaluation study including 494 patients aged ≥18 years undergoing day surgery at 4 different day-surgery departments in Sweden. SwQoR was completed daily on postoperative days 1 to 14. Results: All a priori hypotheses were confirmed, supporting convergent validity. There was excellent internal consistency (Cronbach alpha range .91-.93), split-half reliability (coefficient range .87-.93), and stability (ri=.99, 95% CI .96-.99; P<.001). Cohen d effect size was 1.00, with a standardized response mean of 1.2 and a percentage change from baseline of 59.1%. An exploratory factor analysis found 5 components explaining 57.8% of the total variance. We noted a floor effect only on postoperative day 14; we found no ceiling effect. Conclusions: SwQoR is valid, has excellent reliability and high responsiveness, and is clinically feasible for the systematic follow-up of patients’ postoperative recovery. %M 29229590 %R 10.2196/mhealth.9061 %U http://mhealth.jmir.org/2017/12/e188/ %U https://doi.org/10.2196/mhealth.9061 %U http://www.ncbi.nlm.nih.gov/pubmed/29229590 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 4 %P e58 %T The 12-item Self-Report World Health Organization Disability Assessment Schedule (WHODAS) 2.0 Administered Via the Internet to Individuals With Anxiety and Stress Disorders: A Psychometric Investigation Based on Data From Two Clinical Trials %A Axelsson,Erland %A Lindsäter,Elin %A Ljótsson,Brjánn %A Andersson,Erik %A Hedman-Lagerlöf,Erik %+ Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Nobels Väg 9, Stockholm, 171 65, Sweden, 46 70 617 10 39, erland.axelsson@ki.se %K disability %K Internet %K psychometrics %K questionnaire %K validity %K WHODAS %D 2017 %7 08.12.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a widespread measure of disability and functional impairment, which is bundled with the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) for use in psychiatry. Administering psychometric scales via the Internet is an effective way to reach respondents and allow for convenient handling of data. Objective: The aim was to study the psychometric properties of the 12-item self-report WHODAS 2.0 when administered online to individuals with anxiety and stress disorders. The WHODAS 2.0 was hypothesized to exhibit high internal consistency and be unidimensional. We also expected the WHODAS 2.0 to show high 2-week test-retest reliability, convergent validity (correlations approximately .50 to .90 with other self-report measures of functional impairment), that it would differentiate between patients with and without exhaustion disorder, and that it would respond to change in primary symptom domain. Methods: We administered the 12-item self-report WHODAS 2.0 online to patients with anxiety and stress disorders (N=160) enrolled in clinical trials of cognitive behavior therapy, and analyzed psychometric properties within a classical test theory framework. Scores were compared with well-established symptom and disability measures, and sensitivity to change was studied from pretreatment to posttreatment assessment. Results: The 12-item self-report WHODAS 2.0 showed high internal consistency (Cronbach alpha=.83-.92), high 2-week test-retest reliability (intraclass correlation coefficient=.83), adequate construct validity, and was sensitive to change. We found preliminary evidence for a three-factorial structure, but one strong factor accounted for a clear majority of the variance. Conclusions: We conclude that the 12-item self-report WHODAS 2.0 is a psychometrically sound instrument when administered online to individuals with anxiety and stress disorders, but that it is probably fruitful to also report the three subfactors to facilitate comparisons between studies. Trial Registration: Clinicaltrials.gov NCT02540317; https://clinicaltrials.gov/ct2/show/NCT02540317 (Archived by WebCite at http://www.webcitation.org/6vQEdYAem); Clinicaltrials.gov NCT02314065; https://clinicaltrials.gov/ct2/show/NCT02314065 (Archived by WebCite at http://www.webcitation.org/6vQEjlUU8) %M 29222080 %R 10.2196/mental.7497 %U http://mental.jmir.org/2017/4/e58/ %U https://doi.org/10.2196/mental.7497 %U http://www.ncbi.nlm.nih.gov/pubmed/29222080 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 2 %N 1 %P e3 %T Measurement of Skin Induration Size Using Smartphone Images and Photogrammetric Reconstruction: Pilot Study %A Dendere,Ronald %A Mutsvangwa,Tinashe %A Goliath,Rene %A Rangaka,Molebogeng X %A Abubakar,Ibrahim %A Douglas,Tania S %+ Medical Imaging Research Unit, Division of Biomedical Engineering, University of Cape Town, Anzio Road, Observatory, Cape Town, 7935, South Africa, 27 214066541, tania.douglas@uct.ac.za %K tuberculosis %K skin tests %K telemedicine %K computer assisted diagnosis %D 2017 %7 07.12.2017 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: The tuberculin skin test (TST) is the most common method for detecting latent tuberculosis infection (LTBI). The test requires that a patient return to the health facility or be visited by a health care worker 48 to 72 hours after the intradermal placement of tuberculin so that the size of the resulting skin induration, if any, can be measured. Objective: This study aimed to propose and evaluate an image-based method for measuring induration size from images captured using a smartphone camera. Methods: We imaged simulated skin indurations, ranging from 4.0 to 19 mm, in 10 subjects using a handheld smartphone, and performed three-dimensional reconstruction of the induration sites using photogrammetry software. An experienced TST reader measured the size of each induration using the standard clinical method. The experienced reader and an inexperienced observer both measured the size of each induration using the software. The agreement between measurements generated by the standard clinical and image-based methods was assessed using the intraclass correlation coefficient (ICC). Inter- and intraobserver agreement for the image-based method was similarly evaluated. Results: Results showed excellent agreement between the standard and image-based measurements performed by the experienced reader with an ICC value of .965. Inter- and intraobserver agreements were also excellent, indicating that experience in reading TSTs is not required with our proposed method. Conclusions: We conclude that the proposed smartphone image-based method is a potential alternative to standard induration size measurement and would enable remote data collection for LTBI screening. %R 10.2196/biomedeng.8333 %U http://biomedeng.jmir.org/2017/1/e3/ %U https://doi.org/10.2196/biomedeng.8333 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 11 %P e395 %T Attrition from Web-Based Cognitive Testing: A Repeated Measures Comparison of Gamification Techniques %A Lumsden,Jim %A Skinner,Andy %A Coyle,David %A Lawrence,Natalia %A Munafo,Marcus %+ UK Centre for Tobacco and Alcohol Studies, School of Experimental Psychology, University of Bristol, 12a Priory Rd, Bristol, BS8 1TU, United Kingdom, 44 117 92 88450, jim.lumsden@bristol.ac.uk %K behavioral research/methods %K games, experimental %K computers %K cognition %K Internet %K play and playthings/psychology %K boredom %K task performance and analysis %K executive function %K inhibition (psychology) %D 2017 %7 22.11.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The prospect of assessing cognition longitudinally and remotely is attractive to researchers, health practitioners, and pharmaceutical companies alike. However, such repeated testing regimes place a considerable burden on participants, and with cognitive tasks typically being regarded as effortful and unengaging, these studies may experience high levels of participant attrition. One potential solution is to gamify these tasks to make them more engaging: increasing participant willingness to take part and reducing attrition. However, such an approach must balance task validity with the introduction of entertaining gamelike elements. Objective: This study aims to investigate the effects of gamelike features on participant attrition using a between-subjects, longitudinal Web-based testing study. Methods: We used three variants of a common cognitive task, the Stop Signal Task (SST), with a single gamelike feature in each: one variant where points were rewarded for performing optimally; another where the task was given a graphical theme; and a third variant, which was a standard SST and served as a control condition. Participants completed four compulsory test sessions over 4 consecutive days before entering a 6-day voluntary testing period where they faced a daily decision to either drop out or continue taking part. Participants were paid for each session they completed. Results: A total of 482 participants signed up to take part in the study, with 265 completing the requisite four consecutive test sessions. No evidence of an effect of gamification on attrition was observed. A log-rank test showed no evidence of a difference in dropout rates between task variants (χ22=3.0, P=.22), and a one-way analysis of variance of the mean number of sessions completed per participant in each variant also showed no evidence of a difference (F2,262=1.534, P=.21, partial η2=0.012). Conclusions: Our findings raise doubts about the ability of gamification to reduce attrition from longitudinal cognitive testing studies. %M 29167090 %R 10.2196/jmir.8473 %U http://www.jmir.org/2017/11/e395/ %U https://doi.org/10.2196/jmir.8473 %U http://www.ncbi.nlm.nih.gov/pubmed/29167090 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 10 %P e211 %T Tapering Practices of Strongman Athletes: Test-Retest Reliability Study %A Winwood,Paul W %A Pritchard,Hayden J %A Keogh,Justin WL %+ Department of Sport and Recreation, Faculty of Community Wellbeing and Development, Toi Ohomai Institute of Technology, Windermere Drive, Tauranga, 3112, New Zealand, 64 075441525, paul.winwood@toiohomai.ac.nz %K Internet %K survey %K periodization %K implement training %K resistance training %D 2017 %7 31.10.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Little is currently known about the tapering practices of strongman athletes. We have developed an Internet-based comprehensive self-report questionnaire examining the training and tapering practices of strongman athletes. Objective: The objective of this study was to document the test-retest reliability of questions associated with the Internet-based comprehensive self-report questionnaire on the tapering practices of strongman athletes. The information will provide insight on the reliability and usefulness of the online questionnaire for use with strongman athletes. Methods: Invitations to complete an Internet questionnaire were sent via Facebook Messenger to identified strongman athletes. The survey consisted of four main areas of inquiry, including demographics and background information, training practices, tapering, and tapering practices. Of the 454 athletes that completed the survey over the 8-week period, 130 athletes responded on Facebook Messenger indicating that they intended to complete, or had completed, the survey. These participants were asked if they could complete the online questionnaire a second time for a test-retest reliability analysis. Sixty-four athletes (mean age 33.3 years, standard deviation [SD] 7.7; mean height 178.2 cm, SD 11.0; mean body mass 103.7 kg, SD 24.8) accepted this invitation and completed the survey for the second time after a minimum 7-day period from the date of their first completion. Agreement between athlete responses was measured using intraclass correlation coefficients (ICCs) and kappa statistics. Confidence intervals (at 95%) were reported for all measures and significance was set at P<.05. Results: Test-retest reliability for demographic and training practices items were significant (P<.001) and showed excellent (ICC range=.84 to .98) and fair to almost perfect agreement (κ range=.37-.85). Moderate to excellent agreements (ICC range=.56-.84; P<.01) were observed for all tapering practice measures except for the number of days athletes started their usual taper before a strongman competition (ICC=.30). When the number of days were categorized with additional analyses, moderate reliability was observed (κ=.43; P<.001). Fair to substantial agreement was observed for the majority of tapering practices measures (κrange=.38-.73; P<.001) except for how training frequency (κ=.26) and the percentage and type of resistance training performed, which changed in the taper (κ=.20). Good to excellent agreement (ICC=.62-.93; P<.05) was observed for items relating to strongman events and traditional exercises performed during the taper. Only the time at which the Farmer’s Walk was last performed before competition showed poor reliability (ICC=.27). Conclusions: We have developed a low cost, self-reported, online retrospective questionnaire, which provided stable and reliable answers for most of the demographic, training, and tapering practice questions. The results of this study support the inferences drawn from the Tapering Practices of Strongman Athletes Study. %M 29089292 %R 10.2196/resprot.8522 %U http://www.researchprotocols.org/2017/10/e211/ %U https://doi.org/10.2196/resprot.8522 %U http://www.ncbi.nlm.nih.gov/pubmed/29089292 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 4 %P e51 %T Assessing Therapist Competence: Development of a Performance-Based Measure and Its Comparison With a Web-Based Measure %A Cooper,Zafra %A Doll,Helen %A Bailey-Straebler,Suzanne %A Bohn,Kristin %A de Vries,Dian %A Murphy,Rebecca %A O'Connor,Marianne E %A Fairburn,Christopher G %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford,, United Kingdom, 1 2038094213, zafra.cooper@psych.ox.ac.uk %K therapist competence %K Web-based knowledge assessment %K skill assessment %K therapist training outcome %K scalable assessment %K eating disorders %K cognitive-behavioral treatment %D 2017 %7 31.10.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Recent research interest in how best to train therapists to deliver psychological treatments has highlighted the need for rigorous, but scalable, means of measuring therapist competence. There are at least two components involved in assessing therapist competence: the assessment of their knowledge of the treatment concerned, including how and when to use its strategies and procedures, and an evaluation of their ability to apply such knowledge skillfully in practice. While the assessment of therapists’ knowledge has the potential to be completed efficiently on the Web, the assessment of skill has generally involved a labor-intensive process carried out by clinicians, and as such, may not be suitable for assessing training outcome in certain circumstances. Objectives: The aims of this study were to develop and evaluate a role-play–based measure of skill suitable for assessing training outcome and to compare its performance with a highly scalable Web-based measure of applied knowledge. Methods: Using enhanced cognitive behavioral therapy (CBT-E) for eating disorders as an exemplar, clinical scenarios for role-play assessment were developed and piloted together with a rating scheme for assessing trainee therapists’ performance. These scenarios were evaluated by examining the performance of 93 therapists from different professional backgrounds and at different levels of training in implementing CBT-E. These therapists also completed a previously developed Web-based measure of applied knowledge, and the ability of the Web-based measure to efficiently predict competence on the role-play measure was investigated. Results: The role-play measure assessed performance at implementing a range of CBT-E procedures. The majority of the therapists rated their performance as moderately or closely resembling their usual clinical performance. Trained raters were able to achieve good-to-excellent reliability for averaged competence, with intraclass correlation coefficients ranging from .653 to 909. The measure was also sensitive to change, with scores being significantly higher after training than before as might be expected (mean difference 0.758, P<.001) even when taking account of repeated data (mean difference 0.667, P<.001). The major shortcoming of the role-play measure was that it required considerable time and resources. This shortcoming is inherent in the method. Given this, of most interest for assessing training outcome, scores on the Web-based measure efficiently predicted therapist competence, as judged by the role-play measure (with the Web-based measure having a positive predictive value of 77% and specificity of 78%). Conclusions: The results of this study suggest that while it was feasible and acceptable to assess performance using the newly developed role-play measure, the highly scalable Web-based measure could be used in certain circumstances as a substitute for the more labor-intensive, and hence, more costly role-play method. %M 29089289 %R 10.2196/mental.7704 %U http://mental.jmir.org/2017/4/e51/ %U https://doi.org/10.2196/mental.7704 %U http://www.ncbi.nlm.nih.gov/pubmed/29089289 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e163 %T A New Tool for Nutrition App Quality Evaluation (AQEL): Development, Validation, and Reliability Testing %A DiFilippo,Kristen Nicole %A Huang,Wenhao %A Chapman-Novakofski,Karen M %+ Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, 238 Bevier Hall, 905 S. Goodwin Ave, Urbana, IL, 61801, United States, 1 217 552 5777, kdifilip@illinois.edu %K evaluation %K mobile apps %K dietitians %K health education %K diet, food, and nutrition %D 2017 %7 27.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The extensive availability and increasing use of mobile apps for nutrition-based health interventions makes evaluation of the quality of these apps crucial for integration of apps into nutritional counseling. Objective: The goal of this research was the development, validation, and reliability testing of the app quality evaluation (AQEL) tool, an instrument for evaluating apps’ educational quality and technical functionality. Methods: Items for evaluating app quality were adapted from website evaluations, with additional items added to evaluate the specific characteristics of apps, resulting in 79 initial items. Expert panels of nutrition and technology professionals and app users reviewed items for face and content validation. After recommended revisions, nutrition experts completed a second AQEL review to ensure clarity. On the basis of 150 sets of responses using the revised AQEL, principal component analysis was completed, reducing AQEL into 5 factors that underwent reliability testing, including internal consistency, split-half reliability, test-retest reliability, and interrater reliability (IRR). Two additional modifiable constructs for evaluating apps based on the age and needs of the target audience as selected by the evaluator were also tested for construct reliability. IRR testing using intraclass correlations (ICC) with all 7 constructs was conducted, with 15 dietitians evaluating one app. Results: Development and validation resulted in the 51-item AQEL. These were reduced to 25 items in 5 factors after principal component analysis, plus 9 modifiable items in two constructs that were not included in principal component analysis. Internal consistency and split-half reliability of the following constructs derived from principal components analysis was good (Cronbach alpha >.80, Spearman-Brown coefficient >.80): behavior change potential, support of knowledge acquisition, app function, and skill development. App purpose split half-reliability was .65. Test-retest reliability showed no significant change over time (P>.05) for all but skill development (P=.001). Construct reliability was good for items assessing age appropriateness of apps for children, teens, and a general audience. In addition, construct reliability was acceptable for assessing app appropriateness for various target audiences (Cronbach alpha >.70). For the 5 main factors, ICC (1,k) was >.80, with a P value of <.05. When 15 nutrition professionals evaluated one app, ICC (2,15) was .98, with a P value of <.001 for all 7 constructs when the modifiable items were specified for adults seeking weight loss support. Conclusions: Our preliminary effort shows that AQEL is a valid, reliable instrument for evaluating nutrition apps’ qualities for clinical interventions by nutrition clinicians, educators, and researchers. Further efforts in validating AQEL in various contexts are needed. %M 29079554 %R 10.2196/mhealth.7441 %U http://mhealth.jmir.org/2017/10/e163/ %U https://doi.org/10.2196/mhealth.7441 %U http://www.ncbi.nlm.nih.gov/pubmed/29079554 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e346 %T Psychometric Properties of Patient-Facing eHealth Evaluation Measures: Systematic Review and Analysis %A Wakefield,Bonnie J %A Turvey,Carolyn L %A Nazi,Kim M %A Holman,John E %A Hogan,Timothy P %A Shimada,Stephanie L %A Kennedy,Diana R %+ The Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Healthcare System, 601 Hwy 6 West, Iowa City, IA, 52246, United States, 1 319 338 0581, wakefieldb@missouri.edu %K telemedicine %K computers %K evaluation %K use-effectiveness %K technology %K psychometrics %D 2017 %7 11.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Significant resources are being invested into eHealth technology to improve health care. Few resources have focused on evaluating the impact of use on patient outcomes A standardized set of metrics used across health systems and research will enable aggregation of data to inform improved implementation, clinical practice, and ultimately health outcomes associated with use of patient-facing eHealth technologies. Objective: The objective of this project was to conduct a systematic review to (1) identify existing instruments for eHealth research and implementation evaluation from the patient’s point of view, (2) characterize measurement components, and (3) assess psychometrics. Methods: Concepts from existing models and published studies of technology use and adoption were identified and used to inform a search strategy. Search terms were broadly categorized as platforms (eg, email), measurement (eg, survey), function/information use (eg, self-management), health care occupations (eg, nurse), and eHealth/telemedicine (eg, mHealth). A computerized database search was conducted through June 2014. Included articles (1) described development of an instrument, or (2) used an instrument that could be traced back to its original publication, or (3) modified an instrument, and (4) with full text in English language, and (5) focused on the patient perspective on technology, including patient preferences and satisfaction, engagement with technology, usability, competency and fluency with technology, computer literacy, and trust in and acceptance of technology. The review was limited to instruments that reported at least one psychometric property. Excluded were investigator-developed measures, disease-specific assessments delivered via technology or telephone (eg, a cancer-coping measure delivered via computer survey), and measures focused primarily on clinician use (eg, the electronic health record). Results: The search strategy yielded 47,320 articles. Following elimination of duplicates and non-English language publications (n=14,550) and books (n=27), another 31,647 articles were excluded through review of titles. Following a review of the abstracts of the remaining 1096 articles, 68 were retained for full-text review. Of these, 16 described an instrument and six used an instrument; one instrument was drawn from the GEM database, resulting in 23 articles for inclusion. None included a complete psychometric evaluation. The most frequently assessed property was internal consistency (21/23, 91%). Testing for aspects of validity ranged from 48% (11/23) to 78% (18/23). Approximately half (13/23, 57%) reported how to score the instrument. Only six (26%) assessed the readability of the instrument for end users, although all the measures rely on self-report. Conclusions: Although most measures identified in this review were published after the year 2000, rapidly changing technology makes instrument development challenging. Platform-agnostic measures need to be developed that focus on concepts important for use of any type of eHealth innovation. At present, there are important gaps in the availability of psychometrically sound measures to evaluate eHealth technologies. %M 29021128 %R 10.2196/jmir.7638 %U http://www.jmir.org/2017/10/e346/ %U https://doi.org/10.2196/jmir.7638 %U http://www.ncbi.nlm.nih.gov/pubmed/29021128 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 9 %P e302 %T Computerized Adaptive Testing Provides Reliable and Efficient Depression Measurement Using the CES-D Scale %A Loe,Bao Sheng %A Stillwell,David %A Gibbons,Chris %+ The Psychometrics Centre, Judge Business School, University of Cambridge, Trumpington Street, Cambridge,, United Kingdom, 44 01223765203, cg598@cam.ac.uk %K depression %K assessment %K psychometrics %K patient reported outcome measures %K patient outcome assessment %D 2017 %7 20.09.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The Center for Epidemiologic Studies Depression Scale (CES-D) is a measure of depressive symptomatology which is widely used internationally. Though previous attempts were made to shorten the CES-D scale, few have attempted to develop a Computerized Adaptive Test (CAT) version for the CES-D. Objective: The aim of this study was to provide evidence on the efficiency and accuracy of the CES-D when administered using CAT using an American sample group. Methods: We obtained a sample of 2060 responses to the CESD-D from US participants using the myPersonality application. The average age of participants was 26 years (range 19-77). We randomly split the sample into two groups to evaluate and validate the psychometric models. We used evaluation group data (n=1018) to assess dimensionality with both confirmatory factor and Mokken analysis. We conducted further psychometric assessments using item response theory (IRT), including assessments of item and scale fit to Samejima’s graded response model (GRM), local dependency and differential item functioning. We subsequently conducted two CAT simulations to evaluate the CES-D CAT using the validation group (n=1042). Results: Initial CFA results indicated a poor fit to the model and Mokken analysis revealed 3 items which did not conform to the same dimension as the rest of the items. We removed the 3 items and fit the remaining 17 items to GRM. We found no evidence of differential item functioning (DIF) between age and gender groups. Estimates of the level of CES-D trait score provided by the simulated CAT algorithm and the original CES-D trait score derived from original scale were correlated highly. The second CAT simulation conducted using real participant data demonstrated higher precision at the higher levels of depression spectrum. Conclusions: Depression assessments using the CES-D CAT can be more accurate and efficient than those made using the fixed-length assessment. %M 28931496 %R 10.2196/jmir.7453 %U http://www.jmir.org/2017/9/e302/ %U https://doi.org/10.2196/jmir.7453 %U http://www.ncbi.nlm.nih.gov/pubmed/28931496 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 9 %P e322 %T Reliability of an e-PRO Tool of EORTC QLQ-C30 for Measurement of Health-Related Quality of Life in Patients With Breast Cancer: Prospective Randomized Trial %A Wallwiener,Markus %A Matthies,Lina %A Simoes,Elisabeth %A Keilmann,Lucia %A Hartkopf,Andreas D %A Sokolov,Alexander N %A Walter,Christina B %A Sickenberger,Nina %A Wallwiener,Stephanie %A Feisst,Manuel %A Gass,Paul %A Fasching,Peter A %A Lux,Michael P %A Wallwiener,Diethelm %A Taran,Florin-Andrei %A Rom,Joachim %A Schneeweiss,Andreas %A Graf,Joachim %A Brucker,Sara Y %+ Gynecologic Oncology, National Center for Tumor Diseases, Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Im Neuenheimer Feld 440, Heidelberg,, Germany, 49 (0)6221563, markus.wallwiener@gmail.com %K breast cancer %K patient-reported outcomes %K HRQoL %K EORTC QLQ-C30 %K reliability %D 2017 %7 14.09.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Breast cancer represents the most common malignant disease in women worldwide. As currently systematic palliative treatment only has a limited effect on survival rates, the concept of health-related quality of life (HRQoL) is gaining more and more importance in the therapy setting of metastatic breast cancer. One of the major patient-reported outcomes (PROs) for measuring HRQoL in patients with breast cancer is provided by the European Organization for Research and Treatment of Cancer (EORTC). Currently, paper-based surveys still predominate, as only a few reliable and validated electronic-based questionnaires are available. Facing the possibilities associated with evolving digitalization in medicine, validation of electronic versions of well-established PRO is essential in order to contribute to comprehensive and holistic oncological care and to ensure high quality in cancer research. Objective: The aim of this study was to analyze the reliability of a tablet-based measuring application for EORTC QLQ-C30 in German language in patients with adjuvant and (curative) metastatic breast cancer. Methods: Paper- and tablet-based questionnaires were completed by a total of 106 female patients with adjuvant and metastatic breast cancer recruited as part of the e-PROCOM study. All patients were required to complete the electronic- (e-PRO) and paper-based versions of the HRQoL EORTC QLQ-C30 questionnaire. A frequency analysis was performed to determine descriptive sociodemographic characteristics. Both dimensions of reliability (parallel forms reliability [Wilcoxon test] and test of internal consistency [Spearman rho and agreement rates for single items, Pearson correlation and Kendall tau for each scale]) were analyzed. Results: High correlations were shown for both dimensions of reliability (parallel forms reliability and internal consistency) in the patient’s response behavior between paper- and electronic-based questionnaires. Regarding the test of parallel forms reliability, no significant differences were found in 27 of 30 single items and in 14 of 15 scales, whereas a statistically significant correlation in the test of consistency was found in all 30 single items and all 15 scales. Conclusions: The evaluated e-PRO version of the EORTC QLQ-C30 is reliable for patients with both adjuvant and metastatic breast cancer, showing a high correlation in almost all questions (and in many scales). Thus, we conclude that the validated paper-based PRO assessment and the e-PRO tool are equally valid. However, the reliability should also be analyzed in other prospective trials to ensure that usability is reliable in all patient groups. Trial Registration: ClinicalTrials.gov NCT03132506; https://clinicaltrials.gov/ct2/show/NCT03132506 (Archived by WebCite at http://www.webcitation.org/6tRcgQuou). %M 28912116 %R 10.2196/jmir.8210 %U http://www.jmir.org/2017/9/e322/ %U https://doi.org/10.2196/jmir.8210 %U http://www.ncbi.nlm.nih.gov/pubmed/28912116 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 3 %P e36 %T Assessing the Equivalence of Paper, Mobile Phone, and Tablet Survey Responses at a Community Mental Health Center Using Equivalent Halves of a ‘Gold-Standard’ Depression Item Bank %A Brodey,Benjamin B %A Gonzalez,Nicole L %A Elkin,Kathryn Ann %A Sasiela,W Jordan %A Brodey,Inger S %+ TeleSage, Inc., 201 E Rosemary Street, Chapel Hill, NC, 27514, United States, 1 886 942 8849, bb@telesage.com %K mobile phone %K tablet %K PROMIS %K depression %K item response theory %K outcomes tracking %K PORTAL %K TeleSage %K behavioral health %K special issue on computing and mental health %D 2017 %7 06.09.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: The computerized administration of self-report psychiatric diagnostic and outcomes assessments has risen in popularity. If results are similar enough across different administration modalities, then new administration technologies can be used interchangeably and the choice of technology can be based on other factors, such as convenience in the study design. An assessment based on item response theory (IRT), such as the Patient-Reported Outcomes Measurement Information System (PROMIS) depression item bank, offers new possibilities for assessing the effect of technology choice upon results. Objective: To create equivalent halves of the PROMIS depression item bank and to use these halves to compare survey responses and user satisfaction among administration modalities—paper, mobile phone, or tablet—with a community mental health care population. Methods: The 28 PROMIS depression items were divided into 2 halves based on content and simulations with an established PROMIS response data set. A total of 129 participants were recruited from an outpatient public sector mental health clinic based in Memphis. All participants took both nonoverlapping halves of the PROMIS IRT-based depression items (Part A and Part B): once using paper and pencil, and once using either a mobile phone or tablet. An 8-cell randomization was done on technology used, order of technologies used, and order of PROMIS Parts A and B. Both Parts A and B were administered as fixed-length assessments and both were scored using published PROMIS IRT parameters and algorithms. Results: All 129 participants received either Part A or B via paper assessment. Participants were also administered the opposite assessment, 63 using a mobile phone and 66 using a tablet. There was no significant difference in item response scores for Part A versus B. All 3 of the technologies yielded essentially identical assessment results and equivalent satisfaction levels. Conclusions: Our findings show that the PROMIS depression assessment can be divided into 2 equivalent halves, with the potential to simplify future experimental methodologies. Among community mental health care recipients, the PROMIS items function similarly whether administered via paper, tablet, or mobile phone. User satisfaction across modalities was also similar. Because paper, tablet, and mobile phone administrations yielded similar results, the choice of technology should be based on factors such as convenience and can even be changed during a study without adversely affecting the comparability of results. %M 28877861 %R 10.2196/mental.6805 %U http://mental.jmir.org/2017/3/e36/ %U https://doi.org/10.2196/mental.6805 %U http://www.ncbi.nlm.nih.gov/pubmed/28877861 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 8 %P e125 %T Validation of a Smartphone-Based Approach to In Situ Cognitive Fatigue Assessment %A Price,Edward %A Moore,George %A Galway,Leo %A Linden,Mark %+ Computer Science Research Institute, School of Computing, Ulster University, Jordanstown Campus, Shore Road, Newtownabbey, BT37 0QB, United Kingdom, 44 02890366584, g.moore@ulster.ac.uk %K mental fatigue %K fatigue %K acquired brain injury %K cognitive tests %K assistive technology %K smartphone %D 2017 %7 17.08.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Acquired Brain Injuries (ABIs) can result in multiple detrimental cognitive effects, such as reduced memory capability, concentration, and planning. These effects can lead to cognitive fatigue, which can exacerbate the symptoms of ABIs and hinder management and recovery. Assessing cognitive fatigue is difficult due to the largely subjective nature of the condition and existing assessment approaches. Traditional methods of assessment use self-assessment questionnaires delivered in a medical setting, but recent work has attempted to employ more objective cognitive tests as a way of evaluating cognitive fatigue. However, these tests are still predominantly delivered within a medical environment, limiting their utility and efficacy. Objective: The aim of this research was to investigate how cognitive fatigue can be accurately assessed in situ, during the quotidian activities of life. It was hypothesized that this assessment could be achieved through the use of mobile assistive technology to assess working memory, sustained attention, information processing speed, reaction time, and cognitive throughput. Methods: The study used a bespoke smartphone app to track daily cognitive performance, in order to assess potential levels of cognitive fatigue. Twenty-one participants with no prior reported brain injuries took place in a two-week study, resulting in 81 individual testing instances being collected. The smartphone app delivered three cognitive tests on a daily basis: (1) Spatial Span to measure visuospatial working memory; (2) Psychomotor Vigilance Task (PVT) to measure sustained attention, information processing speed, and reaction time; and (3) a Mental Arithmetic Test to measure cognitive throughput. A smartphone-optimized version of the Mental Fatigue Scale (MFS) self-assessment questionnaire was used as a baseline to assess the validity of the three cognitive tests, as the questionnaire has already been validated in multiple peer-reviewed studies. Results: The most highly correlated results were from the PVT, which showed a positive correlation with those from the prevalidated MFS, measuring 0.342 (P<.008). Scores from the cognitive tests were entered into a regression model and showed that only reaction time in the PVT was a significant predictor of fatigue (P=.016, F=2.682, 95% CI 9.0-84.2). Higher scores on the MFS were related to increases in reaction time during our mobile variant of the PVT. Conclusions: The results show that the PVT mobile cognitive test developed for this study could be used as a valid and reliable method for measuring cognitive fatigue in situ. This test would remove the subjectivity associated with established self-assessment approaches and the need for assessments to be performed in a medical setting. Based on our findings, future work could explore delivering a small set of tests with increased duration to further improve measurement reliability. Moreover, as the smartphone assessment tool can be used as part of everyday life, additional sources of data relating to physiological, psychological, and environmental context could be included within the analysis to improve the nature and precision of the assessment process. %M 28818818 %R 10.2196/mhealth.6333 %U http://mhealth.jmir.org/2017/8/e125/ %U https://doi.org/10.2196/mhealth.6333 %U http://www.ncbi.nlm.nih.gov/pubmed/28818818 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 3 %N 2 %P e11 %T Electronic-Based Patient-Reported Outcomes: Willingness, Needs, and Barriers in Adjuvant and Metastatic Breast Cancer Patients %A Hartkopf,Andreas D %A Graf,Joachim %A Simoes,Elisabeth %A Keilmann,Lucia %A Sickenberger,Nina %A Gass,Paul %A Wallwiener,Diethelm %A Matthies,Lina %A Taran,Florin-Andrei %A Lux,Michael P %A Wallwiener,Stephanie %A Belleville,Eric %A Sohn,Christof %A Fasching,Peter A %A Schneeweiss,Andreas %A Brucker,Sara Y %A Wallwiener,Markus %+ Hospital for General Obstetrics and Gynecology, National Cancer Center, University Hospital Heidelberg, Im Neuenheimer Feld 440, Heidelberg, 69120, Germany, 49 6221 56 36956, markus.wallwiener@gmail.com %K breast cancer %K patient-reported outcome measures %K electronic patient- reported outcome %K technical skills %K willingness to use %K needs and barriers %D 2017 %7 07.08.2017 %9 Original Paper %J JMIR Cancer %G English %X Background: Patient-reported outcomes (PROs) play an increasingly important role as an adjunct to clinical outcome parameters in measuring health-related quality of life (HRQoL). In fact, PROs are already the accepted gold standard for collecting data about patients’ subjective perception of their own state of health. Currently, paper-based surveys of PRO still predominate; however, knowledge regarding the feasibility of and barriers to electronic-based PRO (ePRO) acceptance remains limited. Objective: The objective of this trial was to analyze the willingness, specific needs, and barriers of adjuvant breast cancer (aBC) and metastatic breast cancer (mBC) patients in nonexposed (no exposure to electronic assessment) and exposed (after exposure to electronic assessment decision, whether a tablet-based questionnaire is favored) settings before implementing digital ePRO assessment in relation to health status. We also investigated whether providing support can increase the patients’ willingness to participate in such programs. Methods: The nonexposed patients only answered a paper-based questionnaire, whereas the exposed patients filled out both paper- and tablet-based questionnaires. The assessment comprised socioeconomic variables, HRQoL, preexisting technical skills, general attitude toward electronic-based surveys, and potential barriers in relation to health status. Furthermore, nonexposed patients were asked about the existing need for technological support structures. In the course of data evaluation, we performed a frequency analysis as well as chi-square tests and Wilcoxon signed-rank tests. Subsequently, relative risks analysis, univariate categorical regression (CATREG), and mediation analyses (Hayes’ bias-corrected bootstrap) were performed. Results: A total of 202 female breast cancer patients completed the PRO assessment (nonexposed group: n=96 patients; exposed group: n=106 patients). Self-reported technical skills were higher in exposed patients (2.79 vs 2.33, P ≤.001). Significant differences were found in relation to willingness to use ePRO (92.3% in the exposed group vs 59% in the nonexposed group; P=.001). Multiple barriers were identified, and most of them showed statistically significant differences in favor of the exposed patients (ie, data security [13% in the exposed patients vs 30% in the nonexposed patients; P=.003] and no prior technology usage [5% in the exposed group vs 15% in the nonexposed group; P=.02]), whereas the differences in disease burden (somatic dimension: 4% in the exposed group vs 9% in the nonexposed group; P=.13) showed no significance. In nonexposed patients, requests for support services were identified, which could increase their ePRO willingness. Conclusions: Significant barriers in relation to HRQoL, cancer-related restrictions, and especially the setting of the survey were identified in this trial. Thus, it is necessary to address and eliminate these barriers to ensure data accuracy and reliability for future ePRO assessments. Exposure seems to be a potential option to increase willingness to use ePRO and to reduce barriers. %M 28784595 %R 10.2196/cancer.6996 %U http://cancer.jmir.org/2017/2/e11/ %U https://doi.org/10.2196/cancer.6996 %U http://www.ncbi.nlm.nih.gov/pubmed/28784595 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 3 %N 2 %P e9 %T Development, Feasibility, and Small-Scale Implementation of a Web-Based Prognostic Tool—Surveillance, Epidemiology, and End Results Cancer Survival Calculator %A Henton,Michelle %A Gaglio,Bridget %A Cynkin,Laurie %A Feuer,Eric J %A Rabin,Borsika A %+ Clinical Effectiveness and Decision Science, Patient-Centered Outcomes Research Institute, 1828 L St. NW, Ste. 900, Washington, DC, 20036, United States, 1 202 370 9410, mhenton@pcori.org %K clinical decision-making %K communication %K neoplasms %K patient care team %K Internet %D 2017 %7 20.07.2017 %9 Original Paper %J JMIR Cancer %G English %X Background: Population datasets and the Internet are playing an ever-growing role in the way cancer information is made available to providers, patients, and their caregivers. The Surveillance, Epidemiology, and End Results Cancer Survival Calculator (SEER*CSC) is a Web-based cancer prognostic tool that uses SEER data, a large population dataset, to provide physicians with highly valid, evidence-based prognostic estimates for increasing shared decision-making and improving patient-provider communication of complex health information. Objective: The aim of this study was to develop, test, and implement SEER*CSC. Methods: An iterative approach was used to develop the SEER*CSC. Based on input from cancer patient advocacy groups and physicians, an initial version of the tool was developed. Next, providers from 4 health care delivery systems were recruited to do formal usability testing of SEER*CSC. A revised version of SEER*CSC was then implemented in two health care delivery sites using a real-world clinical implementation approach, and usage data were collected. Post-implementation follow-up interviews were conducted with site champions. Finally, patients from two cancer advocacy groups participated in usability testing. Results: Overall feedback of SEER*CSC from both providers and patients was positive, with providers noting that the tool was professional and reliable, and patients finding it to be informational and helpful to use when discussing their diagnosis with their provider. However, use during the small-scale implementation was low. Reasons for low usage included time to enter data, not having treatment options in the tool, and the tool not being incorporated into the electronic health record (EHR). Patients found the language in its current version to be too complex. Conclusions: The implementation and usability results showed that participants were enthusiastic about the use and features of SEER*CSC, but sustained implementation in a real-world clinical setting faced significant challenges. As a result of these findings, SEER*CSC is being redesigned with more accessible language for a public facing release. Meta-tools, which put different tools in context of each other, are needed to assist in understanding the strengths and limitations of various tools and their place in the clinical decision-making pathway. The continued development and eventual release of prognostic tools should include feedback from multidisciplinary health care teams, various stakeholder groups, patients, and caregivers. %M 28729232 %R 10.2196/cancer.7120 %U http://cancer.jmir.org/2017/2/e9/ %U https://doi.org/10.2196/cancer.7120 %U http://www.ncbi.nlm.nih.gov/pubmed/28729232 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e253 %T Ecological Momentary Assessment of Physical Activity: Validation Study %A Knell,Gregory %A Gabriel,Kelley Pettee %A Businelle,Michael S %A Shuval,Kerem %A Wetter,David W %A Kendzor,Darla E %+ Michael and Susan Dell Center for Healthy Living, Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center (UTHealth) at Houston, 7000 Fannin, #2528, Houston, TX, 77030, United States, 1 713 500 9678, gregory.knell@uth.tmc.edu %K accelerometry %K behavioral risk factor surveillance system %K ecological momentary assessment %K self-report %K data accuracy %D 2017 %7 18.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Ecological momentary assessment (EMA) may elicit physical activity (PA) estimates that are less prone to bias than traditional self-report measures while providing context. Objectives: The objective of this study was to examine the convergent validity of EMA-assessed PA compared with accelerometry. Methods: The participants self-reported their PA using International Physical Activity Questionnaire (IPAQ) and Behavioral Risk Factor Surveillance System (BRFSS) and wore an accelerometer while completing daily EMAs (delivered through the mobile phone) for 7 days. Weekly summary estimates included sedentary time and moderate-, vigorous-, and moderate-to vigorous-intensity physical activity (MVPA). Spearman coefficients and Lin’s concordance correlation coefficients (LCC) examined the linear association and agreement for EMA and the questionnaires as compared with accelerometry. Results: Participants were aged 43.3 (SD 13.1) years, 51.7% (123/238) were African American, 74.8% (178/238) were overweight or obese, and 63.0% (150/238) were low income. The linear associations of EMA and traditional self-reports with accelerometer estimates were statistically significant (P<.05) for sedentary time (EMA: ρ=.16), moderate-intensity PA (EMA: ρ=.29; BRFSS: ρ=.17; IPAQ: ρ=.24), and MVPA (EMA: ρ=.31; BRFSS: ρ=.17; IPAQ: ρ=.20). Only EMA estimates of PA were statistically significant compared with accelerometer for agreement. Conclusions: The mobile EMA showed better correlation and agreement to accelerometer estimates than traditional self-report methods. These findings suggest that mobile EMA may be a practical alternative to accelerometers to assess PA in free-living settings. %M 28720556 %R 10.2196/jmir.7602 %U http://www.jmir.org/2017/7/e253/ %U https://doi.org/10.2196/jmir.7602 %U http://www.ncbi.nlm.nih.gov/pubmed/28720556 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e186 %T Design and Evaluation of a Computer-Based 24-Hour Physical Activity Recall (cpar24) Instrument %A Kohler,Simone %A Behrens,Gundula %A Olden,Matthias %A Baumeister,Sebastian E %A Horsch,Alexander %A Fischer,Beate %A Leitzmann,Michael F %+ Department of Epidemiology and Preventive Medicine, University of Regensburg, Franz-Josef-Strauss-Allee 11, Regensburg, 93053, Germany, 49 941 944 ext 5217, Gundula.Behrens@klinik.uni-regensburg.de %K web-based method %K validity %K reliability %K usability %K lifestyle behavior %K physical activity %K sedentary behavior %D 2017 %7 30.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Widespread access to the Internet and an increasing number of Internet users offers the opportunity of using Web-based recalls to collect detailed physical activity data in epidemiologic studies. Objective: The aim of this investigation was to evaluate the validity and reliability of a computer-based 24-hour physical activity recall (cpar24) instrument with respect to the recalled 24-h period. Methods: A random sample of 67 German residents aged 22 to 70 years was instructed to wear an ActiGraph GT3X+ accelerometer for 3 days. Accelerometer counts per min were used to classify activities as sedentary (<100 counts per min), light (100-1951 counts per min), and moderate to vigorous (≥1952 counts per min). On day 3, participants were also requested to specify the type, intensity, timing, and context of all activities performed during day 2 using the cpar24. Using metabolic equivalent of task (MET), the cpar24 activities were classified as sedentary (<1.5 MET), light (1.5-2.9 MET), and moderate to vigorous (≥3.0 MET). The cpar24 was administered twice at a 3-h interval. The Spearman correlation coefficient (r) was used as primary measure of concurrent validity and test-retest reliability. Results: As compared with accelerometry, the cpar24 underestimated light activity by −123 min (median difference, P difference <.001) and overestimated moderate to vigorous activity by 89 min (P difference <.001). By comparison, time spent sedentary assessed by the 2 methods was similar (median difference=+7 min, P difference=.39). There was modest agreement between the cpar24 and accelerometry regarding sedentary (r=.54), light (r=.46), and moderate to vigorous (r=.50) activities. Reliability analyses revealed modest to high intraclass correlation coefficients for sedentary (r=.75), light (r=.65), and moderate to vigorous (r=.92) activities and no statistically significant differences between replicate cpar24 measurements (median difference for sedentary activities=+10 min, for light activities=−5 min, for moderate to vigorous activities=0 min, all P difference ≥.60). Conclusion: These data show that the cpar24 is a valid and reproducible Web-based measure of physical activity in adults. %M 28559229 %R 10.2196/jmir.7620 %U http://www.jmir.org/2017/5/e186/ %U https://doi.org/10.2196/jmir.7620 %U http://www.ncbi.nlm.nih.gov/pubmed/28559229 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e182 %T Prioritizing Measures of Digital Patient Engagement: A Delphi Expert Panel Study %A Garvin,Lynn A %A Simon,Steven R %+ Department of Health Law, Policy and Management, School of Public Health, Boston University, Talbot 342 W, 715 Albany Street, Boston, MA, 02118, United States, 1 617 414 1327, lagarvin@bu.edu %K patient reported outcome measures %K patient engagement %K patient-centered care %K personal health record %K health information technology %K veterans health %D 2017 %7 26.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Establishing a validated scale of patient engagement through use of information technology (ie, digital patient engagement) is the first step to understanding its role in health and health care quality, outcomes, and efficient implementation by health care providers and systems. Objective: The aim of this study was to develop and prioritize measures of digital patient engagement based on patients’ use of the US Department of Veterans Affairs (VA)’s MyHealtheVet (MHV) portal, focusing on the MHV/Blue Button and Secure Messaging functions. Methods: We aligned two models from the information systems and organizational behavior literatures to create a theory-based model of digital patient engagement. On the basis of this model, we conducted ten key informant interviews to identify potential measures from existing VA studies and consolidated the measures. We then conducted three rounds of modified Delphi rating by 12 national eHealth experts via Web-based surveys to prioritize the measures. Results: All 12 experts completed the study’s three rounds of modified Delphi ratings, resulting in two sets of final candidate measures representing digital patient engagement for Secure Messaging (58 measures) and MHV/Blue Button (71 measures). These measure sets map to Donabedian’s three types of quality measures: (1) antecedents (eg, patient demographics); (2) processes (eg, a novel measure of Web-based care quality); and (3) outcomes (eg, patient engagement). Conclusions: This national expert panel study using a modified Delphi technique prioritized candidate measures to assess digital patient engagement through patients’ use of VA’s My HealtheVet portal. The process yielded two robust measures sets prepared for future piloting and validation in surveys among Veterans. %M 28550008 %R 10.2196/jmir.4778 %U http://www.jmir.org/2017/5/e182/ %U https://doi.org/10.2196/jmir.4778 %U http://www.ncbi.nlm.nih.gov/pubmed/28550008 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e15 %T Clinical Insight Into Latent Variables of Psychiatric Questionnaires for Mood Symptom Self-Assessment %A Tsanas,Athanasios %A Saunders,Kate %A Bilderbeck,Amy %A Palmius,Niclas %A Goodwin,Guy %A De Vos,Maarten %+ Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Nine Edinburgh Bioquarter, 9 Little France road, Edinburgh, EH16 4UX, United Kingdom, 44 131 651 7884, Athanasios.Tsanas@ed.ac.uk %K bipolar disorder %K borderline personality disorder %K depression %K mania %K latent variable structure %K mood monitoring %K patient reported outcome measures %K mhealth %K mobile app %D 2017 %7 25.05.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: We recently described a new questionnaire to monitor mood called mood zoom (MZ). MZ comprises 6 items assessing mood symptoms on a 7-point Likert scale; we had previously used standard principal component analysis (PCA) to tentatively understand its properties, but the presence of multiple nonzero loadings obstructed the interpretation of its latent variables. Objective: The aim of this study was to rigorously investigate the internal properties and latent variables of MZ using an algorithmic approach which may lead to more interpretable results than PCA. Additionally, we explored three other widely used psychiatric questionnaires to investigate latent variable structure similarities with MZ: (1) Altman self-rating mania scale (ASRM), assessing mania; (2) quick inventory of depressive symptomatology (QIDS) self-report, assessing depression; and (3) generalized anxiety disorder (7-item) (GAD-7), assessing anxiety. Methods: We elicited responses from 131 participants: 48 bipolar disorder (BD), 32 borderline personality disorder (BPD), and 51 healthy controls (HC), collected longitudinally (median [interquartile range, IQR]: 363 [276] days). Participants were requested to complete ASRM, QIDS, and GAD-7 weekly (all 3 questionnaires were completed on the Web) and MZ daily (using a custom-based smartphone app). We applied sparse PCA (SPCA) to determine the latent variables for the four questionnaires, where a small subset of the original items contributes toward each latent variable. Results: We found that MZ had great consistency across the three cohorts studied. Three main principal components were derived using SPCA, which can be tentatively interpreted as (1) anxiety and sadness, (2) positive affect, and (3) irritability. The MZ principal component comprising anxiety and sadness explains most of the variance in BD and BPD, whereas the positive affect of MZ explains most of the variance in HC. The latent variables in ASRM were identical for the patient groups but different for HC; nevertheless, the latent variables shared common items across both the patient group and HC. On the contrary, QIDS had overall very different principal components across groups; sleep was a key element in HC and BD but was absent in BPD. In GAD-7, nervousness was the principal component explaining most of the variance in BD and HC. Conclusions: This study has important implications for understanding self-reported mood. MZ has a consistent, intuitively interpretable latent variable structure and hence may be a good instrument for generic mood assessment. Irritability appears to be the key distinguishing latent variable between BD and BPD and might be useful for differential diagnosis. Anxiety and sadness are closely interlinked, a finding that might inform treatment effects to jointly address these covarying symptoms. Anxiety and nervousness appear to be amongst the cardinal latent variable symptoms in BD and merit close attention in clinical practice. %M 28546141 %R 10.2196/mental.6917 %U http://mental.jmir.org/2017/2/e15/ %U https://doi.org/10.2196/mental.6917 %U http://www.ncbi.nlm.nih.gov/pubmed/28546141 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 5 %P e98 %T eMindLog: Self-Measurement of Anxiety and Depression Using Mobile Technology %A Penders,Thomas M %A Wuensch,Karl L %A Ninan,Philip T %+ Brody School of Medicine, Department of Psychiatry and Behavioral Medicine, East Carolina University, 621 W Main St, Washington, NC, 27889-4835, United States, 1 678 428 1655, ninanp@ecu.edu %K mobile %K anxiety %K depression %K internet %K measurement %D 2017 %7 24.05.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Quantifying anxiety and depressive experiences permits individuals to calibrate where they are and monitor intervention-associated changes. eMindLog is a novel self-report measure for anxiety and depression that is grounded in psychology with an organizing structure based on neuroscience. Objective: Our aim was to explore the psychometric properties of eMindLog in a nonclinical sample of subjects. Methods: In a cross-sectional study of eMindLog, a convenience sample of 198 adults provided informed consent and completed eMindLog and the Hospital Anxiety and Depression Scale (HADS) as a reference. Brain systems (eg, negative and positive valence systems, cognitive systems) and their functional states that drive behavior are measured daily as emotions, thoughts, and behaviors. Associated symptoms, quality of life, and functioning are assessed weekly. eMindLog offers ease of use and expediency, using mobile technology across multiple platforms, with dashboard reporting of scores. It enhances precision by providing distinct, nonoverlapping description of terms, and accuracy through guidance for scoring severity. Results: eMindLog daily total score had a Cronbach alpha of .94. Pearson correlation coefficient for eMindLog indexes for anxiety and sadness/anhedonia were r=.66 (P<.001) and r=.62 (P<.001) contrasted with the HADS anxiety and depression subscales respectively. Of 195 subjects, 23 (11.8%) had cross-sectional symptoms above the threshold for Generalized Anxiety Disorder and 29 (29/195, 14.9%) for Major Depressive Disorder. Factor analysis supported the theoretically derived index derivatives for anxiety, anger, sadness, and anhedonia. Conclusions: eMindLog is a novel self-measurement tool to measure anxiety and depression, demonstrating excellent reliability and strong validity in a nonclinical population. Further studies in clinical populations are necessary for fuller validation of its psychometric properties. Self-measurement of anxiety and depressive symptoms with precision and accuracy has several potential benefits, including case detection, tracking change over time, efficacy assessment of interventions, and exploration of potential biomarkers. %M 28539304 %R 10.2196/resprot.7447 %U http://www.researchprotocols.org/2017/5/e98/ %U https://doi.org/10.2196/resprot.7447 %U http://www.ncbi.nlm.nih.gov/pubmed/28539304 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 5 %P e99 %T Development of a Modular Research Platform to Create Medical Observational Studies for Mobile Devices %A Zens,Martin %A Grotejohann,Birgit %A Tassoni,Adrian %A Duttenhoefer,Fabian %A Südkamp,Norbert P %A Niemeyer,Philipp %+ Medical Center - University of Freiburg, Department of Orthopedics and Trauma Surgery, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, Freiburg, 79106, Germany, 49 1633374461, martin.zens@me.com %K mHealth %K telemedicine %K mobile health %K app-based study %K research platform %D 2017 %7 23.05.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Observational studies have proven to be a valuable resource in medical research, especially when performed on a large scale. Recently, mobile device-based observational studies have been discovered by an increasing number of researchers as a promising new source of information. However, the development and deployment of app-based studies is not trivial and requires profound programming skills. Objective: The aim of this project was to develop a modular online research platform that allows researchers to create medical studies for mobile devices without extensive programming skills. Methods: The platform approach for a modular research platform consists of three major components. A Web-based platform forms the researchers’ main workplace. This platform communicates via a shared database with a platform independent mobile app. Furthermore, a separate Web-based login platform for physicians and other health care professionals is outlined and completes the concept. Results: A prototype of the research platform has been developed and is currently in beta testing. Simple questionnaire studies can be created within minutes and published for testing purposes. Screenshots of an example study are provided, and the general working principle is displayed. Conclusions: In this project, we have created a basis for a novel research platform. The necessity and implications of a modular approach were displayed and an outline for future development given. International researchers are invited and encouraged to participate in this ongoing project %M 28536095 %R 10.2196/resprot.7705 %U http://www.researchprotocols.org/2017/5/e99/ %U https://doi.org/10.2196/resprot.7705 %U http://www.ncbi.nlm.nih.gov/pubmed/28536095 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 3 %N 1 %P e7 %T Assessing the Comparability of Paper and Electronic Versions of the EORTC QOL Module for Head and Neck Cancer: A Qualitative Study %A Norquist,Josephine %A Chirovsky,Diana %A Munshi,Teja %A Tolley,Chloe %A Panter,Charlotte %A Gater,Adam %+ Merck & Co., Inc., Mail Stop UG1C-60, 351 North Sumneytown Pike, PO Box 1000, Office 1D024, North Wales, NJ, PA 19454-1099, United States, 1 (267) 305 7477, josephine_norquist@merck.com %K ePRO %K comparability %K EORTC QLQ-C30 %K head and neck cancer %K quality of life questionnaire %D 2017 %7 12.05.2017 %9 Original Paper %J JMIR Cancer %G English %X Background: Patient-reported outcome (PRO) instruments are important tools for monitoring disease activity and response to treatment in clinical trials and clinical practice. In recent years, there have been movements away from traditional pen-and-paper PROs towards electronic administration. When using electronic PROs (ePROs), evidence that respondents complete ePROs in a similar way to their paper counterparts provides assurance that the two modes of administration are comparable or equivalent. The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 item (EORTC QLQ-C30) and associated disease-specific modules are among the most widely used PROs in oncology. Although studies have evaluated the comparability and equivalence of electronic and original paper versions of the EORTC QLQ-C30, no such studies have been conducted to date for the head and neck cancer specific module (EORTC QLQ-H&N35). Objective: This study aimed to qualitatively assess the comparability of paper and electronic versions of the EORTC QLQ-H&N35. Methods: Ten head and neck cancer patients in the United States underwent structured cognitive debriefing and usability interviews. An open randomized crossover design was used in which participants completed the two modes of administration allocated in a randomized order. Using a “think-aloud” process, participants were asked to speak their thoughts aloud while completing the EORTC QLQ-H&N35. They were thoroughly debriefed on their responses to determine consistency in interpretation and cognitive process when completing the instrument in both paper and electronic format. Results: Participants reported that the EORTC QLQ-H&N35 demonstrated excellent qualitative comparability between modes of administration. The proportion of noncomparable responses (ie, where the thought process used by participants for selecting responses appeared to be different) observed in the study was low (11/350 response pairs [35 items x 10 participants]; 3.1%). Evidence of noncomparability was observed for 9 of the 35 items of the EORTC QLQ-H&N35 and in no more than 2 participants per item. In addition, there were no apparent differences in level of comparability between individual participants or between modes of administration. Conclusions: Mode of administration does not affect participants’ response to, or interpretation of, items in the EORTC QLQ-H&N35. The findings from this study add to the existing evidence supporting the use of electronic versions of the EORTC instruments when migrated to electronic platforms according to best practice guidelines. %M 28500019 %R 10.2196/cancer.7202 %U http://cancer.jmir.org/2017/1/e7/ %U https://doi.org/10.2196/cancer.7202 %U http://www.ncbi.nlm.nih.gov/pubmed/28500019 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e158 %T The Development, Validation, and User Evaluation of Foodbook24: A Web-Based Dietary Assessment Tool Developed for the Irish Adult Population %A Timon,Claire M %A Blain,Richard J %A McNulty,Breige %A Kehoe,Laura %A Evans,Katie %A Walton,Janette %A Flynn,Albert %A Gibney,Eileen R %+ UCD, Institute of Food and Health, University College Dublin, Sceince Centre South, Befield, Dublin, Dublin 4, Ireland, 353 17162819, eileen.gibney@ucd.ie %K diet records %K Internet %K validity %K biomarkers %K method acceptability %K adults %D 2017 %7 11.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The application of technology in the area of dietary assessment has resulted in the development of an array of tools, which are often specifically designed for a particular country or region. Objective: The aim of this study was to describe the development, validation, and user evaluation of a Web-based dietary assessment tool “Foodbook24.” Methods: Foodbook24 is a Web-based, dietary assessment tool consisting of a 24-hour dietary recall (24HDR) and food frequency questionnaire (FFQ) alongside supplementary questionnaires. Validity of the 24HDR component was assessed by 40 participants, who completed 3 nonconsecutive, self-administered 24HDR using Foodbook24 and a 4-day semi-weighed food diary at separate time points. Participants also provided fasted blood samples and 24-hour urine collections for the identification of biomarkers of nutrient and food group intake during each recording period. Statistical analyses on the nutrient and food group intake data derived from each method were performed in SPSS version 20.0 (SPSS Inc). Mean nutrient intakes (and standard deviations) recorded using each method of dietary assessment were calculated. Spearman and Pearson correlations, Wilcoxon Signed Rank and Paired t test were used to investigate the agreement and differences between the nutritional output from Foodbook24 (test method) and the 4-day semi-weighed food diary (reference method). Urinary and plasma biomarkers of nutrient intake were used as an objective validation of Foodbook24. To investigate the user acceptability of Foodbook24, participants from different studies involved with Foodbook24 were asked to complete an evaluation questionnaire. Results: For nutrient intake, correlations between the dietary assessment methods were acceptable to very good in strength and statistically significant (range r=.32 to .75). There were some significant differences between reported mean intakes of micronutrients recorded by both methods; however, with the exception of protein (P=.03), there were no significant differences in the reporting of energy or macronutrient intake. Of the 19 food groups investigated in this analysis, there were significant differences between 6 food groups reported by both methods. Spearman correlations for biomarkers of nutrient and food group intake and reported intake were similar for both methods. A total of 118 participants evaluated the acceptability of Foodbook24. The tool was well-received and the majority, 67.8% (80/118), opted for Foodbook24 as the preferred method for future dietary intake assessment when compared against a traditional interviewer led recall and semi-weighed food diary. Conclusions: The results of this study demonstrate the validity and user acceptability of Foodbook24. The results also highlight the potential of Foodbook24, a Web-based dietary assessment method, and present a viable alternative to nutritional surveillance in Ireland. %M 28495662 %R 10.2196/jmir.6407 %U http://www.jmir.org/2017/5/e158/ %U https://doi.org/10.2196/jmir.6407 %U http://www.ncbi.nlm.nih.gov/pubmed/28495662 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 2 %P e13 %T A Web-Based Graphical Food Frequency Assessment System: Design, Development and Usability Metrics %A Franco,Rodrigo Zenun %A Alawadhi,Balqees %A Fallaize,Rosalind %A Lovegrove,Julie A %A Hwang,Faustina %+ Biomedical Engineering, School of Biological Sciences, University of Reading, Whiteknights Campus, Reading,, United Kingdom, 44 118 378 7668, rodrigo.zenun.franco@pgr.reading.ac.uk %K nutrition assessment %K FFQ %K food frequency questionnaire %K personalized nutrition %K nutrition informatics %K dietary intake %K usability %K SUS %D 2017 %7 08.05.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Food frequency questionnaires (FFQs) are well established in the nutrition field, but there remain important questions around how to develop online tools in a way that can facilitate wider uptake. Also, FFQ user acceptance and evaluation have not been investigated extensively. Objective: This paper presents a Web-based graphical food frequency assessment system that addresses challenges of reproducibility, scalability, mobile friendliness, security, and usability and also presents the utilization metrics and user feedback from a deployment study. Methods: The application design employs a single-page application Web architecture with back-end services (database, authentication, and authorization) provided by Google Firebase’s free plan. Its design and responsiveness take advantage of the Bootstrap framework. The FFQ was deployed in Kuwait as part of the EatWellQ8 study during 2016. The EatWellQ8 FFQ contains 146 food items (including drinks). Participants were recruited in Kuwait without financial incentive. Completion time was based on browser timestamps and usability was measured using the System Usability Scale (SUS), scoring between 0 and 100. Products with a SUS higher than 70 are considered to be good. Results: A total of 235 participants created accounts in the system, and 163 completed the FFQ. Of those 163 participants, 142 reported their gender (93 female, 49 male) and 144 reported their date of birth (mean age of 35 years, range from 18-65 years). The mean completion time for all FFQs (n=163), excluding periods of interruption, was 14.2 minutes (95% CI 13.3-15.1 minutes). Female participants (n=93) completed in 14.1 minutes (95% CI 12.9-15.3 minutes) and male participants (n=49) completed in 14.3 minutes (95% CI 12.6-15.9 minutes). Participants using laptops or desktops (n=69) completed the FFQ in an average of 13.9 minutes (95% CI 12.6-15.1 minutes) and participants using smartphones or tablets (n=91) completed in an average of 14.5 minutes (95% CI 13.2-15.8 minutes). The median SUS score (n=141) was 75.0 (interquartile range [IQR] 12.5), and 84% of the participants who completed the SUS classified the system either “good” (n=50) or “excellent” (n=69). Considering only participants using smartphones or tablets (n=80), the median score was 72.5 (IQR 12.5), slightly below the SUS median for desktops and laptops (n=58), which was 75.0 (IQR 12.5). No significant differences were found between genders or age groups (below and above the median) for the SUS or completion time. Conclusions: Taking into account all the requirements, the deployment used professional cloud computing at no cost, and the resulting system had good user acceptance. The results for smartphones/tablets were comparable with desktops/laptops. This work has potential to promote wider uptake of online tools that can assess dietary intake at scale. %M 28483746 %R 10.2196/humanfactors.7287 %U http://humanfactors.jmir.org/2017/2/e13/ %U https://doi.org/10.2196/humanfactors.7287 %U http://www.ncbi.nlm.nih.gov/pubmed/28483746 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e155 %T The Virtual Care Climate Questionnaire: Development and Validation of a Questionnaire Measuring Perceived Support for Autonomy in a Virtual Care Setting %A Smit,Eline Suzanne %A Dima,Alexandra Lelia %A Immerzeel,Stephanie Annette Maria %A van den Putte,Bas %A Williams,Geoffrey Colin %+ Amsterdam School of Communication Research/ASCoR, Department of Communication Science, University of Amsterdam, PO Box 15791, Amsterdam, 1001 NG, Netherlands, 31 (0)6 25258558, E.S.Smit@uva.nl %K questionnaire design %K validation studies %K psychometrics %K personal autonomy %K Internet %K health behavior %K health promotion %K self-determination theory %D 2017 %7 08.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based health behavior change interventions may be more effective if they offer autonomy-supportive communication facilitating the internalization of motivation for health behavior change. Yet, at this moment no validated tools exist to assess user-perceived autonomy-support of such interventions. Objective: The aim of this study was to develop and validate the virtual climate care questionnaire (VCCQ), a measure of perceived autonomy-support in a virtual care setting. Methods: Items were developed based on existing questionnaires and expert consultation and were pretested among experts and target populations. The virtual climate care questionnaire was administered in relation to Web-based interventions aimed at reducing consumption of alcohol (Study 1; N=230) or cannabis (Study 2; N=228). Item properties, structural validity, and reliability were examined with item-response and classical test theory methods, and convergent and divergent validity via correlations with relevant concepts. Results: In Study 1, 20 of 23 items formed a one-dimensional scale (alpha=.97; omega=.97; H=.66; mean 4.9 [SD 1.0]; range 1-7) that met the assumptions of monotonicity and invariant item ordering. In Study 2, 16 items fitted these criteria (alpha=.92; H=.45; omega=.93; mean 4.2 [SD 1.1]; range 1-7). Only 15 items remained in the questionnaire in both studies, thus we proceeded to the analyses of the questionnaire’s reliability and construct validity with a 15-item version of the virtual climate care questionnaire. Convergent validity of the resulting 15-item virtual climate care questionnaire was confirmed by positive associations with autonomous motivation (Study 1: r=.66, P<.001; Study 2: r=.37, P<.001) and perceived competence for reducing alcohol intake (Study 1: r=.52, P<.001). Divergent validity could only be confirmed by the nonsignificant association with perceived competence for learning (Study 2: r=.05, P=.48). Conclusions: The virtual climate care questionnaire accurately assessed participants’ perceived autonomy-support offered by two Web-based health behavior change interventions. Overall, the scale showed the expected properties and relationships with relevant concepts, and the studies presented suggest this first version of the virtual climate care questionnaire to be reasonably valid and reliable. As a result, the current version may cautiously be used in future research and practice to measure perceived support for autonomy within a virtual care climate. Future research efforts are required that focus on further investigating the virtual climate care questionnaire's divergent validity, on determining the virtual climate care questionnaire’s validity and reliability when used in the context of Web-based interventions aimed at improving nonaddictive or other health behaviors, and on developing and validating a short form virtual climate care questionnaire. %M 28483743 %R 10.2196/jmir.6714 %U http://www.jmir.org/2017/5/e155/ %U https://doi.org/10.2196/jmir.6714 %U http://www.ncbi.nlm.nih.gov/pubmed/28483743 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e119 %T Health Evaluation and Referral Assistant: A Randomized Controlled Trial of a Web-Based Screening, Brief Intervention, and Referral to Treatment System to Reduce Risky Alcohol Use Among Emergency Department Patients %A Haskins,Brianna L %A Davis-Martin,Rachel %A Abar,Beau %A Baumann,Brigitte M %A Harralson,Tina %A Boudreaux,Edwin D %+ University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 5084211400, brianna.haskins@umassmed.edu %K alcohol consumption %K intervention study %K emergency medicine %K referral and consultation %D 2017 %7 01.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Computer technologies hold promise for implementing alcohol screening, brief intervention, and referral to treatment (SBIRT). Questions concerning the most effective and appropriate SBIRT model remain. Objective: The aim of this study was to evaluate the impact of a computerized SBIRT system called the Health Evaluation and Referral Assistant (HERA) on risky alcohol use treatment initiation. Methods: Alcohol users (N=319) presenting to an emergency department (ED) were considered for enrollment. Those enrolled (n=212) were randomly assigned to the HERA, to complete a patient-administered assessment using a tablet computer, or a minimal-treatment control, and were followed for 3 months. Analyses compared alcohol treatment provider contact, treatment initiation, treatment completion, and alcohol use across condition using univariate comparisons, generalized estimating equations (GEEs), and post hoc chi-square analyses. Results: HERA participants (n=212; control=115; intervention=97) did not differ between conditions on initial contact with an alcohol treatment provider, treatment initiation, treatment completion, or change in risky alcohol use behavior. Subanalyses indicated that HERA participants, who accepted a faxed referral, were more likely to initiate contact with a treatment provider and initiate treatment for risky alcohol use, but were not more likely to continue engaging in treatment, or to complete treatment and change risky alcohol use behavior over the 3-month period following the ED visit. Conclusions: The HERA promoted initial contact with an alcohol treatment provider and initiation of treatment for those who accepted the faxed referral, but it did not lead to reduced risky alcohol use behavior. Factors which may have limited the HERA’s impact include lack of support for the intervention by clinical staff, the low intensity of the brief and stand-alone design of the intervention, and barriers related to patient follow-through, (eg, a lack of transportation or childcare, fees for services, or schedule conflicts). Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): NCT01153373; https://clinicaltrials.gov/ct2/show/NCT01153373 (Archived by WebCite at http://www.webcitation.org/6pHQEpuIF) %M 28461283 %R 10.2196/jmir.6812 %U http://www.jmir.org/2017/5/e119/ %U https://doi.org/10.2196/jmir.6812 %U http://www.ncbi.nlm.nih.gov/pubmed/28461283 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e114 %T A Psychometric Analysis of the Italian Version of the eHealth Literacy Scale Using Item Response and Classical Test Theory Methods %A Diviani,Nicola %A Dima,Alexandra Lelia %A Schulz,Peter Johannes %+ Department of Health Sciences & Health Policy, Faculty of Humanities and Social Sciences, University of Lucerne, Frohburgstrasse 3, Lucerne, 6002, Switzerland, 41 41 229 56 34, nicola.diviani@unilu.ch %K eHealth literacy %K eHEALS %K item response theory %K classical test theory %K validation %K Italian %D 2017 %7 11.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The eHealth Literacy Scale (eHEALS) is a tool to assess consumers’ comfort and skills in using information technologies for health. Although evidence exists of reliability and construct validity of the scale, less agreement exists on structural validity. Objective: The aim of this study was to validate the Italian version of the eHealth Literacy Scale (I-eHEALS) in a community sample with a focus on its structural validity, by applying psychometric techniques that account for item difficulty. Methods: Two Web-based surveys were conducted among a total of 296 people living in the Italian-speaking region of Switzerland (Ticino). After examining the latent variables underlying the observed variables of the Italian scale via principal component analysis (PCA), fit indices for two alternative models were calculated using confirmatory factor analysis (CFA). The scale structure was examined via parametric and nonparametric item response theory (IRT) analyses accounting for differences between items regarding the proportion of answers indicating high ability. Convergent validity was assessed by correlations with theoretically related constructs. Results: CFA showed a suboptimal model fit for both models. IRT analyses confirmed all items measure a single dimension as intended. Reliability and construct validity of the final scale were also confirmed. The contrasting results of factor analysis (FA) and IRT analyses highlight the importance of considering differences in item difficulty when examining health literacy scales. Conclusions: The findings support the reliability and validity of the translated scale and its use for assessing Italian-speaking consumers’ eHealth literacy. %M 28400356 %R 10.2196/jmir.6749 %U http://www.jmir.org/2017/4/e114/ %U https://doi.org/10.2196/jmir.6749 %U http://www.ncbi.nlm.nih.gov/pubmed/28400356 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e100 %T The Multimodal Assessment of Adult Attachment Security: Developing the Biometric Attachment Test %A Parra,Federico %A Miljkovitch,Raphaële %A Persiaux,Gwenaelle %A Morales,Michelle %A Scherer,Stefan %+ Institute for Creative Technologies, University of Southern California, 12015 E Waterfront Dr, Los Angeles, CA, 90094, United States, 33 782132695, federico.parra@hotmail.com %K psychometrics %K linguistics %K heart rate %K facial expression %K psychophysiology %K psychopathology %K COVAREP %K attachment %D 2017 %7 06.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Attachment theory has been proven essential for mental health, including psychopathology, development, and interpersonal relationships. Validated psychometric instruments to measure attachment abound but suffer from shortcomings common to traditional psychometrics. Recent developments in multimodal fusion and machine learning pave the way for new automated and objective psychometric instruments for adult attachment that combine psychophysiological, linguistic, and behavioral analyses in the assessment of the construct. Objective: The aim of this study was to present a new exposure-based, automatic, and objective adult-attachment assessment, the Biometric Attachment Test (BAT), which exposes participants to a short standardized set of visual and music stimuli, whereas their immediate reactions and verbal responses, captured by several computer sense modalities, are automatically analyzed for scoring and classification. We also aimed to empirically validate two of its assumptions: its capacity to measure attachment security and the viability of using themes as placeholders for rotating stimuli. Methods: A total of 59 French participants from the general population were assessed using the Adult Attachment Questionnaire (AAQ), the Adult Attachment Projective Picture System (AAP), and the Attachment Multiple Model Interview (AMMI) as ground truth for attachment security. They were then exposed to three different BAT stimuli sets, whereas their faces, voices, heart rate (HR), and electrodermal activity (EDA) were recorded. Psychophysiological features, such as skin-conductance response (SCR) and Bayevsky stress index; behavioral features, such as gaze and facial expressions; as well as linguistic and paralinguistic features, were automatically extracted. An exploratory analysis was conducted using correlation matrices to uncover the features that are most associated with attachment security. A confirmatory analysis was conducted by creating a single composite effects index and by testing it for correlations with attachment security. The stability of the theory-consistent features across three different stimuli sets was explored using repeated measures analysis of variances (ANOVAs). Results: In total, 46 theory-consistent correlations were found during the exploration (out of 65 total significant correlations). For example, attachment security as measured by the AAP was correlated with positive facial expressions (r=.36, P=.01). AMMI’s security with the father was inversely correlated with the low frequency (LF) of HRV (r=−.87, P=.03). Attachment security to partners as measured by the AAQ was inversely correlated with anger facial expression (r=−.43, P=.001). The confirmatory analysis showed that the composite effects index was significantly correlated to security in the AAP (r=.26, P=.05) and the AAQ (r=.30, P=.04) but not in the AMMI. Repeated measures ANOVAs conducted individually on each of the theory-consistent features revealed that only 7 of the 46 (15%) features had significantly different values among responses to three different stimuli sets. Conclusions: We were able to validate two of the instrument’s core assumptions: its capacity to measure attachment security and the viability of using themes as placeholders for rotating stimuli. Future validation of other of its dimensions, as well as the ongoing development of its scoring and classification algorithms is discussed. %M 28385683 %R 10.2196/jmir.6898 %U http://www.jmir.org/2017/4/e100/ %U https://doi.org/10.2196/jmir.6898 %U http://www.ncbi.nlm.nih.gov/pubmed/28385683 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 3 %N 1 %P e4 %T When Educational Material Is Delivered: A Mixed Methods Content Validation Study of the Information Assessment Method %A Badran,Hani %A Pluye,Pierre %A Grad,Roland %+ Information Technology Primary Care Research Group, Department of Family Medicine, McGill University, Department of Family Medicine, 3rd floor, 5858, chemin de la Côte-des-Neige, Montreal, QC, H3S 1Z1, Canada, 1 514 398 8483, pierre.pluye@mcgill.ca %K validity and reliability %K continuing education %K Internet %K electronic mail %K physicians, family %K knowledge translation %K primary health care %D 2017 %7 14.03.2017 %9 Original Paper %J JMIR Med Educ %G English %X Background: The Information Assessment Method (IAM) allows clinicians to report the cognitive impact, clinical relevance, intention to use, and expected patient health benefits associated with clinical information received by email. More than 15,000 Canadian physicians and pharmacists use the IAM in continuing education programs. In addition, information providers can use IAM ratings and feedback comments from clinicians to improve their products. Objective: Our general objective was to validate the IAM questionnaire for the delivery of educational material (ecological and logical content validity). Our specific objectives were to measure the relevance and evaluate the representativeness of IAM items for assessing information received by email. Methods: A 3-part mixed methods study was conducted (convergent design). In part 1 (quantitative longitudinal study), the relevance of IAM items was measured. Participants were 5596 physician members of the Canadian Medical Association who used the IAM. A total of 234,196 ratings were collected in 2012. The relevance of IAM items with respect to their main construct was calculated using descriptive statistics (relevance ratio R). In part 2 (qualitative descriptive study), the representativeness of IAM items was evaluated. A total of 15 family physicians completed semistructured face-to-face interviews. For each construct, we evaluated the representativeness of IAM items using a deductive-inductive thematic qualitative data analysis. In part 3 (mixing quantitative and qualitative parts), results from quantitative and qualitative analyses were reviewed, juxtaposed in a table, discussed with experts, and integrated. Thus, our final results are derived from the views of users (ecological content validation) and experts (logical content validation). Results: Of the 23 IAM items, 21 were validated for content, while 2 were removed. In part 1 (quantitative results), 21 items were deemed relevant, while 2 items were deemed not relevant (R=4.86% [N=234,196] and R=3.04% [n=45,394], respectively). In part 2 (qualitative results), 22 items were deemed representative, while 1 item was not representative. In part 3 (mixing quantitative and qualitative results), the content validity of 21 items was confirmed, and the 2 nonrelevant items were excluded. A fully validated version was generated (IAM-v2014). Conclusions: This study produced a content validated IAM questionnaire that is used by clinicians and information providers to assess the clinical information delivered in continuing education programs. %M 28292738 %R 10.2196/mededu.6415 %U http://mededu.jmir.org/2017/1/e4/ %U https://doi.org/10.2196/mededu.6415 %U http://www.ncbi.nlm.nih.gov/pubmed/28292738 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 3 %P e67 %T Assessing the Quality of Mobile Exercise Apps Based on the American College of Sports Medicine Guidelines: A Reliable and Valid Scoring Instrument %A Guo,Yi %A Bian,Jiang %A Leavitt,Trevor %A Vincent,Heather K %A Vander Zalm,Lindsey %A Teurlings,Tyler L %A Smith,Megan D %A Modave,François %+ Department of Health Outcomes and Policy, University of Florida, 2004 Mowry Road, Suite 2251 PO Box 100165, Gainesville, FL, 32610, United States, 1 352 294 5969, yiguo@ufl.edu %K mHealth %K mobile apps %K physical activity %K measures %D 2017 %7 07.03.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Regular physical activity can not only help with weight management, but also lower cardiovascular risks, cancer rates, and chronic disease burden. Yet, only approximately 20% of Americans currently meet the physical activity guidelines recommended by the US Department of Health and Human Services. With the rapid development of mobile technologies, mobile apps have the potential to improve participation rates in exercise programs, particularly if they are evidence-based and are of sufficient content quality. Objective: The goal of this study was to develop and test an instrument, which was designed to score the content quality of exercise program apps with respect to the exercise guidelines set forth by the American College of Sports Medicine (ACSM). Methods: We conducted two focus groups (N=14) to elicit input for developing a preliminary 27-item scoring instruments based on the ACSM exercise prescription guidelines. Three reviewers who were no sports medicine experts independently scored 28 exercise program apps using the instrument. Inter- and intra-rater reliability was assessed among the 3 reviewers. An expert reviewer, a Fellow of the ACSM, also scored the 28 apps to create criterion scores. Criterion validity was assessed by comparing nonexpert reviewers’ scores to the criterion scores. Results: Overall, inter- and intra-rater reliability was high with most coefficients being greater than .7. Inter-rater reliability coefficients ranged from .59 to .99, and intra-rater reliability coefficients ranged from .47 to 1.00. All reliability coefficients were statistically significant. Criterion validity was found to be excellent, with the weighted kappa statistics ranging from .67 to .99, indicating a substantial agreement between the scores of expert and nonexpert reviewers. Finally, all apps scored poorly against the ACSM exercise prescription guidelines. None of the apps received a score greater than 35, out of a possible maximal score of 70. Conclusions: We have developed and presented valid and reliable scoring instruments for exercise program apps. Our instrument may be useful for consumers and health care providers who are looking for apps that provide safe, progressive general exercise programs for health and fitness. %M 28270378 %R 10.2196/jmir.6976 %U http://www.jmir.org/2017/3/e67/ %U https://doi.org/10.2196/jmir.6976 %U http://www.ncbi.nlm.nih.gov/pubmed/28270378 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 1 %P e7 %T Applying Computerized Adaptive Testing to the Four-Dimensional Symptom Questionnaire (4DSQ): A Simulation Study %A Magnée,Tessa %A de Beurs,Derek P %A Terluin,Berend %A Verhaak,Peter F %+ Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-114, Utrecht, 3500BN, Netherlands, 31 302729854, t.magnee@nivel.nl %K item response theory %K Four-Dimensional Symptom Questionnaire %K computerized adaptive testing %K mental health %K general practice %D 2017 %7 21.02.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Efficient screening questionnaires are useful in general practice. Computerized adaptive testing (CAT) is a method to improve the efficiency of questionnaires, as only the items that are particularly informative for a certain responder are dynamically selected. Objective: The objective of this study was to test whether CAT could improve the efficiency of the Four-Dimensional Symptom Questionnaire (4DSQ), a frequently used self-report questionnaire designed to assess common psychosocial problems in general practice. Methods: A simulation study was conducted using a sample of Dutch patients visiting a general practitioner (GP) with psychological problems (n=379). Responders completed a paper-and-pencil version of the 50-item 4DSQ and a psychometric evaluation was performed to check if the data agreed with item response theory (IRT) assumptions. Next, a CAT simulation was performed for each of the four 4DSQ scales (distress, depression, anxiety, and somatization), based on the given responses as if they had been collected through CAT. The following two stopping rules were applied for the administration of items: (1) stop if measurement precision is below a predefined level, or (2) stop if more than half of the items of the subscale are administered. Results: In general, the items of each of the four scales agreed with IRT assumptions. Application of the first stopping rule reduced the length of the questionnaire by 38% (from 50 to 31 items on average). When the second stopping rule was also applied, the total number of items could be reduced by 56% (from 50 to 22 items on average). Conclusions: CAT seems useful for improving the efficiency of the 4DSQ by 56% without losing a considerable amount of measurement precision. The CAT version of the 4DSQ may be useful as part of an online assessment to investigate the severity of mental health problems of patients visiting a GP. This simulation study is the first step needed for the development a CAT version of the 4DSQ. A CAT version of the 4DSQ could be of high value for Dutch GPs since increasing numbers of patients with mental health problems are visiting the general practice. In further research, the results of a real-time CAT should be compared with the results of the administration of the full scale. %M 28223264 %R 10.2196/mental.6545 %U http://mental.jmir.org/2017/1/e7/ %U https://doi.org/10.2196/mental.6545 %U http://www.ncbi.nlm.nih.gov/pubmed/28223264 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 1 %P e27 %T Development of the Digital Health Literacy Instrument: Measuring a Broad Spectrum of Health 1.0 and Health 2.0 Skills %A van der Vaart,Rosalie %A Drossaert,Constance %+ Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 053 489 6049, c.h.c.drossaert@utwente.nl %K digital health literacy skills %K eHealth literacy %K measurement %K validity %K performance-based instrument %D 2017 %7 24.01.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: With the digitization of health care and the wide availability of Web-based applications, a broad set of skills is essential to properly use such facilities; these skills are called digital health literacy or eHealth literacy. Current instruments to measure digital health literacy focus only on information gathering (Health 1.0 skills) and do not pay attention to interactivity on the Web (Health 2.0). To measure the complete spectrum of Health 1.0 and Health 2.0 skills, including actual competencies, we developed a new instrument. The Digital Health Literacy Instrument (DHLI) measures operational skills, navigation skills, information searching, evaluating reliability, determining relevance, adding self-generated content, and protecting privacy. Objective: Our objective was to study the distributional properties, reliability, content validity, and construct validity of the DHLI’s self-report scale (21 items) and to explore the feasibility of an additional set of performance-based items (7 items). Methods: We used a paper-and-pencil survey among a sample of the general Dutch population, stratified by age, sex, and educational level (T1; N=200). The survey consisted of the DHLI, sociodemographics, Internet use, health status, health literacy and the eHealth Literacy Scale (eHEALS). After 2 weeks, we asked participants to complete the DHLI again (T2; n=67). Cronbach alpha and intraclass correlation analysis between T1 and T2 were used to investigate reliability. Principal component analysis was performed to determine content validity. Correlation analyses were used to determine the construct validity. Results: Respondents (107 female and 93 male) ranged in age from 18 to 84 years (mean 46.4, SD 19.0); 23.0% (46/200) had a lower educational level. Internal consistencies of the total scale (alpha=.87) and the subscales (alpha range .70-.89) were satisfactory, except for protecting privacy (alpha=.57). Distributional properties showed an approximately normal distribution. Test-retest analysis was satisfactory overall (total scale intraclass correlation coefficient=.77; subscale intraclass correlation coefficient range .49-.81). The performance-based items did not together form a single construct (alpha=.47) and should be interpreted individually. Results showed that more complex skills were reflected in a lower number of correct responses. Principal component analysis confirmed the theoretical structure of the self-report scale (76% explained variance). Correlations were as expected, showing significant relations with age (ρ=–.41, P<.001), education (ρ=.14, P=.047), Internet use (ρ=.39, P<.001), health-related Internet use (ρ=.27, P<.001), health status (ρ range .17-.27, P<.001), health literacy (ρ=.31, P<.001), and the eHEALS (ρ=.51, P<.001). Conclusions: This instrument can be accepted as a new self-report measure to assess digital health literacy, using multiple subscales. Its performance-based items provide an indication of actual skills but should be studied and adapted further. Future research should examine the acceptability of this instrument in other languages and among different populations. %M 28119275 %R 10.2196/jmir.6709 %U http://www.jmir.org/2017/1/e27/ %U https://doi.org/10.2196/jmir.6709 %U http://www.ncbi.nlm.nih.gov/pubmed/28119275 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e134 %T The Mobile Phone Affinity Scale: Enhancement and Refinement %A Bock,Beth C %A Lantini,Ryan %A Thind,Herpreet %A Walaska,Kristen %A Rosen,Rochelle K %A Fava,Joseph L %A Barnett,Nancy P %A Scott-Sheldon,Lori AJ %+ Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, United States, 1 401 793 8020, Bbock@lifespan.org %K mobile phone %K psychometrics %K assessment %K measure %D 2016 %7 15.12.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Existing instruments that assess individuals’ relationships with mobile phones tend to focus on negative constructs such as addiction or dependence, and appear to assume that high mobile phone use reflects pathology. Mobile phones can be beneficial for health behavior change, disease management, work productivity, and social connections, so there is a need for an instrument that provides a more balanced assessment of the various aspects of individuals’ relationships with mobile phones. Objective: The purpose of this research was to develop, revise, and validate the Mobile Phone Affinity Scale, a multi-scale instrument designed to assess key factors associated with mobile phone use. Methods: Participants (N=1058, mean age 33) were recruited from Amazon Mechanical Turk between March and April of 2016 to complete a survey that assessed participants’ mobile phone attitudes and use, anxious and depressive symptoms, and resilience. Results: Confirmatory factor analysis supported a 6-factor model. The final measure consisted of 24 items, with 4 items on each of 6 factors: Connectedness, Productivity, Empowerment, Anxious Attachment, Addiction, and Continuous Use. The subscales demonstrated strong internal consistency (Cronbach alpha range=0.76-0.88, mean 0.83), and high item factor loadings (range=0.57-0.87, mean 0.75). Tests for validity further demonstrated support for the individual subscales. Conclusions: Mobile phone affinity may have an important impact in the development and effectiveness of mobile health interventions, and continued research is needed to assess its predictive ability in health behavior change interventions delivered via mobile phones. %M 27979792 %R 10.2196/mhealth.6705 %U http://mhealth.jmir.org/2016/4/e134/ %U https://doi.org/10.2196/mhealth.6705 %U http://www.ncbi.nlm.nih.gov/pubmed/27979792 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 10 %P e277 %T A Multimedia Child Developmental Screening Checklist: Design and Validation %A Cheng,Hsin-Yi Kathy %A Chen,Li-Ying %A Cheng,Chih-Hsiu %A Ju,Yan-Ying %A Chen,Chia-Ling %A Tseng,Kevin C %+ Department of Industrial Design, College of Management, Chang Gung University, 259 Wen-Hua 1st Rd, Kwei-Shan, TaoYuan, 333, Taiwan, 886 32118800 ext 3509, ktseng@pddlab.org %K child development %K multimedia %K screening %K usability %K Web-based %K disability %D 2016 %7 24.10.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Identifying disability early in life confers long-term benefits for children. The Taipei City Child Development Screening tool, second version (Taipei II) provides checklists for 13 child age groups from 4 months to 6 years. However, the usability of a text-based screening tool largely depends on the literacy level and logical reasoning ability of the caregivers, as well as language barriers caused by increasing numbers of immigrants. Objective: The objectives of this study were to (1) design and develop a Web-based multimedia version of the current Taipei II developmental screening tool, and (2) investigate the measurement equivalence of this multimedia version to the original paper-based version. Methods: To develop the multimedia version of Taipei II, a team of experts created illustrations, translations, and dubbing of the original checklists. The developmental screening test was administered to a total of 390 primary caregivers of children aged between 4 months and 6 years. Results: Psychometric testing revealed excellent agreement between the paper and multimedia versions of Taipei II. Good to excellent reliabilities were demonstrated for all age groups for both the cross-mode similarity (mode intraclass correlation range 0.85-0.96) and the test-retest reliability (r=.93). Regarding the usability, the mean score was 4.80 (SD 0.03), indicating that users were satisfied with their multimedia website experience. Conclusions: The multimedia tool produced essentially equivalent results to the paper-based tool. In addition, it had numerous advantages, such as it can facilitate active participation and promote early screening of target populations. ClinicalTrial: Clinicaltrials.gov NCT02359591; https://clinicaltrials.gov/ct2/show/NCT02359591 (Archived by WebCite at http://www.webcitation.org/6l21mmdNn) %M 27777218 %R 10.2196/jmir.6249 %U http://www.jmir.org/2016/10/e277/ %U https://doi.org/10.2196/jmir.6249 %U http://www.ncbi.nlm.nih.gov/pubmed/27777218 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 9 %P e240 %T Electronic Quality of Life Assessment Using Computer-Adaptive Testing %A Gibbons,Chris %A Bower,Peter %A Lovell,Karina %A Valderas,Jose %A Skevington,Suzanne %+ Cambridge Centre for Health Services Research, University of Cambridge, 17 Mill Lane, Cambridge,, United Kingdom, +44 1223 765 203, drcgibbons@gmail.com %D 2016 %7 30.09.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Quality of life (QoL) questionnaires are desirable for clinical practice but can be time-consuming to administer and interpret, making their widespread adoption difficult. Objective: Our aim was to assess the performance of the World Health Organization Quality of Life (WHOQOL)-100 questionnaire as four item banks to facilitate adaptive testing using simulated computer adaptive tests (CATs) for physical, psychological, social, and environmental QoL. Methods: We used data from the UK WHOQOL-100 questionnaire (N=320) to calibrate item banks using item response theory, which included psychometric assessments of differential item functioning, local dependency, unidimensionality, and reliability. We simulated CATs to assess the number of items administered before prespecified levels of reliability was met. Results: The item banks (40 items) all displayed good model fit (P>.01) and were unidimensional (fewer than 5% of t tests significant), reliable (Person Separation Index>.70), and free from differential item functioning (no significant analysis of variance interaction) or local dependency (residual correlations < +.20). When matched for reliability, the item banks were between 45% and 75% shorter than paper-based WHOQOL measures. Across the four domains, a high standard of reliability (alpha>.90) could be gained with a median of 9 items. Conclusions: Using CAT, simulated assessments were as reliable as paper-based forms of the WHOQOL with a fraction of the number of items. These properties suggest that these item banks are suitable for computerized adaptive assessment. These item banks have the potential for international development using existing alternative language versions of the WHOQOL items. %M 27694100 %R 10.2196/jmir.6053 %U http://www.jmir.org/2016/9/e240/ %U https://doi.org/10.2196/jmir.6053 %U http://www.ncbi.nlm.nih.gov/pubmed/27694100 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 3 %P e192 %T Evaluation of the Swedish Web-Version of Quality of Recovery (SwQoR): Secondary Step in the Development of a Mobile Phone App to Measure Postoperative Recovery %A Dahlberg,Karuna %A Jaensson,Maria %A Eriksson,Mats %A Nilsson,Ulrica %+ School of Health Sciences, Örebro University, Örebro, 70182, Sweden, 46 19303000, karuna.dahlberg@oru.se %K mHealth %K ambulatory surgical procedures %K postoperative period %K mobile phones %D 2016 %7 28.09.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The majority of all surgeries are performed on an outpatient basis (day surgery). The Recovery Assessment by Phone Points (RAPP) app is an app for the Swedish Web-version of Quality of Recovery (SwQoR), developed to assess and follow-up on postoperative recovery after day surgery. Objectives: The objectives of this study are (1) to estimate the extent to which the paper and app versions of the SwQoR provide equivalent values; (2) to contribute evidence as to the feasibility and acceptability of a mobile phone Web-based app for measuring postoperative recovery after day surgery and enabling contact with a nurse; and (3) to contribute evidence as to the content validity of the SwQoR. Methods: Equivalence between the paper and app versions of the SwQoR was measured using a randomized crossover design, in which participants used both the paper and app version. Feasibility and acceptability was evaluated by a questionnaire containing 16 questions regarding the value of the app for follow-up care after day surgery. Content validity evaluation was based on responses by day surgery patients and the staff of the day surgery department. Results: A total of 69 participants completed the evaluation of equivalence between the paper and app versions of the SwQoR. The intraclass correlation coefficient (ICC) for the SwQoR was .89 (95% CI 0.83-0.93) and .13 to .90 for the items. Of the participants, 63 continued testing the app after discharge and completed the follow-up questionnaire. The median score was 69 (inter-quartile range, IQR 66-73), indicating a positive attitude toward using an app for follow-up after day surgery. A total of 18 patients and 12 staff members participated in the content validity evaluation. The item-level content validity index (I-CVI) for the staff group was in the 0.64 to 1.0 range, with a scale-level content validity index (S-CVI) of 0.88. For the patient group, I-CVI was in the range 0.30 to 0.92 and S-CVI was 0.67. The content validity evaluation of the SwQoR, together with three new items, led to a reduction from 34 to 24 items. Conclusions: Day surgery patients had positive attitudes toward using the app for follow-up after surgery, and stated a preference for using the app again if they were admitted for a future day surgery procedure. Equivalence between the app and paper version of the SwQoR was found, but at the item level, the ICC was less than .7 for 9 items. In the content validity evaluation of the SwQoR, staff found more items relevant than the patients, and no items found relevant by either staff or patients were excluded when revising the SwQoR. %M 27679867 %R 10.2196/resprot.5881 %U http://www.researchprotocols.org/2016/3/e192/ %U https://doi.org/10.2196/resprot.5881 %U http://www.ncbi.nlm.nih.gov/pubmed/27679867 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e234 %T Reliability and Validity of Assessing User Satisfaction With Web-Based Health Interventions %A Boß,Leif %A Lehr,Dirk %A Reis,Dorota %A Vis,Christiaan %A Riper,Heleen %A Berking,Matthias %A Ebert,David Daniel %+ Division of Online Health Training, Innovation Incubator, Leuphana University of Lueneburg, Scharnhorststr 1, C113, Lueneburg, 21335, Germany, 49 41316771710, boss@leuphana.de %K Internet %K mental health %K evaluation %K clinical effectiveness %K personal satisfaction %D 2016 %7 31.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The perspective of users should be taken into account in the evaluation of Web-based health interventions. Assessing the users’ satisfaction with the intervention they receive could enhance the evidence for the intervention effects. Thus, there is a need for valid and reliable measures to assess satisfaction with Web-based health interventions. Objective: The objective of this study was to analyze the reliability, factorial structure, and construct validity of the Client Satisfaction Questionnaire adapted to Internet-based interventions (CSQ-I). Methods: The psychometric quality of the CSQ-I was analyzed in user samples from 2 separate randomized controlled trials evaluating Web-based health interventions, one from a depression prevention intervention (sample 1, N=174) and the other from a stress management intervention (sample 2, N=111). At first, the underlying measurement model of the CSQ-I was analyzed to determine the internal consistency. The factorial structure of the scale and the measurement invariance across groups were tested by multigroup confirmatory factor analyses. Additionally, the construct validity of the scale was examined by comparing satisfaction scores with the primary clinical outcome. Results: Multigroup confirmatory analyses on the scale yielded a one-factorial structure with a good fit (root-mean-square error of approximation =.09, comparative fit index =.96, standardized root-mean-square residual =.05) that showed partial strong invariance across the 2 samples. The scale showed very good reliability, indicated by McDonald omegas of .95 in sample 1 and .93 in sample 2. Significant correlations with change in depressive symptoms (r=−.35, P<.001) and perceived stress (r=−.48, P<.001) demonstrated the construct validity of the scale. Conclusions: The proven internal consistency, factorial structure, and construct validity of the CSQ-I indicate a good overall psychometric quality of the measure to assess the user’s general satisfaction with Web-based interventions for depression and stress management. Multigroup analyses indicate its robustness across different samples. Thus, the CSQ-I seems to be a suitable measure to consider the user’s perspective in the overall evaluation of Web-based health interventions. %M 27582341 %R 10.2196/jmir.5952 %U http://www.jmir.org/2016/8/e234/ %U https://doi.org/10.2196/jmir.5952 %U http://www.ncbi.nlm.nih.gov/pubmed/27582341 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e230 %T Datathons and Software to Promote Reproducible Research %A Celi,Leo Anthony %A Lokhandwala,Sharukh %A Montgomery,Robert %A Moses,Christopher %A Naumann,Tristan %A Pollard,Tom %A Spitz,Daniel %A Stretch,Robert %+ Critical Data, Massachusetts Institute of Technology, 77 Massachusetts Avenue, E25-505, Cambridge, MA, 02139, United States, 1 617 253 7937, sharukh.lokhandwala@gmail.com %K reproducibility of findings %K big data %K database %K Internet %K medical informatics %D 2016 %7 24.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Datathons facilitate collaboration between clinicians, statisticians, and data scientists in order to answer important clinical questions. Previous datathons have resulted in numerous publications of interest to the critical care community and serve as a viable model for interdisciplinary collaboration. Objective: We report on an open-source software called Chatto that was created by members of our group, in the context of the second international Critical Care Datathon, held in September 2015. Methods: Datathon participants formed teams to discuss potential research questions and the methods required to address them. They were provided with the Chatto suite of tools to facilitate their teamwork. Each multidisciplinary team spent the next 2 days with clinicians working alongside data scientists to write code, extract and analyze data, and reformulate their queries in real time as needed. All projects were then presented on the last day of the datathon to a panel of judges that consisted of clinicians and scientists. Results: Use of Chatto was particularly effective in the datathon setting, enabling teams to reduce the time spent configuring their research environments to just a few minutes—a process that would normally take hours to days. Chatto continued to serve as a useful research tool after the conclusion of the datathon. Conclusions: This suite of tools fulfills two purposes: (1) facilitation of interdisciplinary teamwork through archiving and version control of datasets, analytical code, and team discussions, and (2) advancement of research reproducibility by functioning postpublication as an online environment in which independent investigators can rerun or modify analyses with relative ease. With the introduction of Chatto, we hope to solve a variety of challenges presented by collaborative data mining projects while improving research reproducibility. %M 27558834 %R 10.2196/jmir.6365 %U http://www.jmir.org/2016/8/e230/ %U https://doi.org/10.2196/jmir.6365 %U http://www.ncbi.nlm.nih.gov/pubmed/27558834 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e91 %T Using Personal Mobile Phones to Assess Dietary Intake in Free-Living Adolescents: Comparison of Face-to-Face Versus Telephone Training %A Segovia-Siapco,Gina %A Sabaté,Joan %+ Center for Nutrition, Healthy Lifestyle, and Disease Prevention, School of Public Health, Loma Linda University, 24951 No Circle Drive, Nichol Hall 1318, Loma Linda, CA, 92350, United States, 1 909 558 4300 ext 47110, gsiapco@llu.edu %K adolescents %K dietary assessment %K dietary records %K digital images %K follow-up %K mobile phones %K real-time support %K technology %D 2016 %7 29.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Traditional paper-based methods to assess food intake can be cumbersome for adolescents; use of mobile phones to track and photograph what they eat may be a more convenient, reliable, and compelling way to collect data. Objective: Our aims were to determine (1) the feasibility of using personal mobile phones to send food records with digital images (FRDIs) among free-living adolescents and (2) whether the quality of food records differed between a high-level intervention group (ie, face-to-face training plus real-time support) and a low-level intervention group (ie, telephone training plus next-day follow-up). Methods: Adolescents (N=42, 11 males and 31 females) aged 12-18 years who had a mobile phone with camera enrolled in the study via consecutive sampling. The first group (n=21) received face-to-face training while the second group (n=21) was trained via telephone. Participants received a fiducial marker (FM) and completed a 1-day FRDI using their mobile phones. At every eating occasion, participants were to (1) take clear images of their meals/food with a correctly placed fiducial marker before eating, (2) send the image immediately to a designated email address, (3) right after completing a meal, send a text message listing the time and name of the meal, foods eaten, and amounts eaten, and (4) before sleep, send an “end” text message to indicate completion of food recording. Those who received face-to-face training received real-time support during reporting; those trained by telephone received next-day follow-up. Descriptive statistics and comparison tests were used to determine performance of the groups. Results: All participants (N=42) who underwent training completed their 1-day FRDI. A significantly greater proportion of the low-level intervention group compared to the high-level intervention group placed their FM correctly in the image (95% vs 43%, P<.001), had complete information for each meal in their food record (95% vs 71%, P=.04), and had a higher overall score in meeting the criteria for food recording (4.3 vs 3.4 out of 5 points). Both groups had energy intake values that moderately correlated with their estimated energy requirements: low-intervention r=.55; high-intervention r=.51. Conclusions: Using personal mobile phones to report dietary intake via texting and digital images is feasible among free-living adolescents. Real-time support or high-level intervention does not guarantee better food recording quality among adolescents. %M 27473291 %R 10.2196/mhealth.5418 %U http://mhealth.jmir.org/2016/3/e91/ %U https://doi.org/10.2196/mhealth.5418 %U http://www.ncbi.nlm.nih.gov/pubmed/27473291 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 4 %N 2 %P e12 %T Validation of a Computerized, Game-based Assessment Strategy to Measure Training Effects on Motor-Cognitive Functions in People With Dementia %A Wiloth,Stefanie %A Lemke,Nele %A Werner,Christian %A Hauer,Klaus %+ AGAPLESION Bethanien Hospital, Geriatric Centre at the University of Heidelberg, Heidelberg, Germany, Research Department, Rohrbacher Straße 149, Heidelberg, 69126, Germany, 49 1739471446, stefanie.wiloth@gmail.com %K serious games %K computerized assessment %K validation %K motor-cognitive functions %K elderly %K older adults %K cognitive impairment %K dementia %D 2016 %7 18.7.2016 %9 Original Paper %J JMIR Serious Games %G English %X Background: Exergames often used for training purpose can also be applied to create assessments based on quantitative data derived from the game. A number of studies relate to these use functionalities developing specific assessment tasks by using the game software and provided good data on psychometric properties. However, (1) assessments often include tasks other than the original game task used for training and therefore relate to similar but not to identical or integrated performances trained, (2) people with diagnosed dementia have insufficiently been addressed in validation studies, and (3) studies did commonly not present validation data such as sensitivity to change, although this is a paramount objective for validation to evaluate responsiveness in intervention studies. Objective: Specific assessment parameters have been developed using quantitative data directly derived from the data stream during the game task of a training device (Physiomat). The aim of this study was to present data on construct validity, test–retest reliability, sensitivity to change, and feasibility of this internal assessment approach, which allows the quantification of Physiomat training effects on motor-cognitive functions in 105 multimorbid patients with mild-to-moderate dementia (mean age 82.7±5.9). Methods: Physiomat assessment includes various tasks at different complexity levels demanding balance and cognitive abilities. For construct validity, motor-cognitive Physiomat assessment tasks were compared with established motor and cognitive tests using Spearman’s rank correlations (rs). For test–retest reliability, we used intra-class correlations (ICC3,1) and focused on all Physiomat tasks. Sensitivity to change of trained Physiomat tasks was tested using Wilcoxon statistic and standardized response means (SRMs). Completion rate and time were calculated for feasibility. Results: Analyses have mostly shown moderate-to-high correlations between established motor as well as cognitive tests and simple (rs=−.22 to .68, P ≤.001-.03), moderate (rs=−.33 to .71, P ≤.001-.004), and complex motor-cognitive Physiomat tasks (rs=−.22 to .83, P ≤.001-.30) indicating a good construct validity. Moderate-to-high correlations between test and retest assessments were found for simple, moderate, and complex motor-cognitive tasks (ICC=.47-.83, P ≤.001) indicating good test–retest reliability. Sensitivity to change was good to excellent for Physiomat assessment as it reproduced significant improvements (P ≤.001) with mostly moderate-to-large effect sizes (SRM=0.5-2.0) regarding all trained tasks. Completion time averaged 25.8 minutes. Completion rate was high for initial Physiomat measures. No adverse events occurred during assessment. Conclusions: Overall, Physiomat proved to have good psychometric qualities in people with mild-to-moderate dementia representing a reliable, valid, responsive, and feasible assessment strategy for multimorbid older adults with or without cognitive impairment, which relates to identical and integrated performances trained by using the game. %M 27432746 %R 10.2196/games.5696 %U http://games.jmir.org/2016/2/e12/ %U https://doi.org/10.2196/games.5696 %U http://www.ncbi.nlm.nih.gov/pubmed/27432746 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e126 %T Using Visual Analogue Scales in eHealth: Non-Response Effects in a Lifestyle Intervention %A Kuhlmann,Tim %A Reips,Ulf-Dietrich %A Wienert,Julian %A Lippke,Sonia %+ Research Methods, Assessment & iScience, Department of Psychology, University of Konstanz, Universitätsstraße 10, Konstanz, 78454, Germany, 49 7531882895, tim.kuhlmann@uni-konstanz.de %K eHealth %K RCT %K VAS %K dropout %K visual analogue scale %K Internet science %K measurement %D 2016 %7 22.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Visual analogue scales (VASs) have been shown to be valid measurement instruments and a better alternative to Likert-type scales in Internet-based research, both empirically and theoretically [1,2]. Upsides include more differentiated responses, better measurement level, and less error. Their feasibility and properties in the context of eHealth, however, have not been examined so far. Objective: The present study examined VASs in the context of a lifestyle study conducted online, measuring the impact of VASs on distributional properties and non-response. Method: A sample of 446 participants with a mean age of 52.4 years (standard deviation (SD) = 12.1) took part in the study. The study was carried out as a randomized controlled trial, aimed at supporting participants over 8 weeks with an additional follow-up measurement. In addition to the randomized questionnaire, participants were further randomly assigned to either a Likert-type or VAS response scale version of the measures. Results: Results showed that SDs were lower for items answered via VASs, 2P (Y ≥ 47 | n=55, P=.5) < .001. Means did not differ across versions. Participants in the VAS version showed lower dropout rates than participants in the Likert version, odds ratio = 0.75, 90% CI (0.58-0.98), P=.04. Number of missing values did not differ between questionnaire versions. Conclusions: The VAS is shown to be a valid instrument in the eHealth context, offering advantages over Likert-type scales. The results of the study provide further support for the use of VASs in Internet-based research, extending the scope to senior samples in the health context. Trial Registration: Clinicaltrials.gov NCT01909349; https://clinicaltrials.gov/ct2/show/NCT01909349 (Archived by WebCite at http://www.webcitation.org/6h88sLw2Y) %M 27334562 %R 10.2196/jmir.5271 %U http://www.jmir.org/2016/6/e126/ %U https://doi.org/10.2196/jmir.5271 %U http://www.ncbi.nlm.nih.gov/pubmed/27334562 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 5 %N 2 %P e20 %T Relationship Between Difficulties in Daily Activities and Falling: Loco-Check as a Self-Assessment of Fall Risk %A Akahane,Manabu %A Maeyashiki,Akie %A Yoshihara,Shingo %A Tanaka,Yasuhito %A Imamura,Tomoaki %+ Faculty of Medicine, Department of Public Health, Health Management and Policy, Nara Medical University, Shijo 840, Kashihara, Nara 6348521, Japan, 81 744 22 3051 ext 2224, makahane@naramed-u.ac.jp %K accidental falls %K disability evaluation %K self-assessment %K activity of daily living %D 2016 %7 20.06.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: People aged 65 years or older accounted for 25.1% of the Japanese population in 2013, and this characterizes the country as a “super-aging society.” With increased aging, fall-related injuries are becoming important in Japan, because such injuries underlie the necessity for nursing care services. If people could evaluate their risk of falling using a simple self-check test, they would be able to take preventive measures such as exercise, muscle training, walking with a cane, or renovation of their surroundings to remove impediments. Loco-check is a checklist measure of early locomotive syndrome (circumstances in which elderly people need nursing care service or are at high risk of requiring the service within a short time), prepared by the Japanese Orthopaedic Association (JOA) in 2007, but it is unclear if there is any association between this measure and falls. Objective: To investigate the association between falls during the previous year and the 7 “loco-check” daily activity items and the total number of items endorsed, and sleep duration. Methods: We conducted an Internet panel survey. Subjects were 624 persons aged between 30 and 90 years. The general health condition of the participants, including their experience of falling, daily activities, and sleep duration, was investigated. A multivariate analysis was carried out using logistic regression to investigate the relationship between falls in the previous year and difficulties with specific daily activities and total number of difficulties (loco-check) endorsed, and sleep duration, adjusting for sex and age. Results: One-fourth of participants (157 persons) experienced at least one fall during the previous year. Fall rate of females (94/312: 30.1%) was significantly higher than that of males (63/312: 20.2%). Fall rate of persons aged more than 65 years (80/242: 33.1%) was significantly higher than that of younger persons (77/382: 20.2%). Logistic regression analysis revealed that daily activities such as “impossibility of getting across the road at a crossing before the traffic light changes” are significantly related to falling. Logistic regression analysis also demonstrated a relationship between the number of items endorsed on loco-check and incidence of falling, wherein persons who endorsed 4 or more items appear to be at higher risk for falls. However, logistic regression found no significant relationship between sleep duration and falling. Conclusions: Our study demonstrated a relationship between the number of loco-check items endorsed and the incidence of falling in the previous year. Endorsement of 4 or more items appeared to signal a high risk for falls. The short self-administered checklist can be a valuable tool for assessing the risk of falling and for initiating preventive measures. %M 27323871 %R 10.2196/ijmr.5590 %U http://www.i-jmr.org/2016/2/e20/ %U https://doi.org/10.2196/ijmr.5590 %U http://www.ncbi.nlm.nih.gov/pubmed/27323871 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e138 %T Web-Based Assessment of Mental Well-Being in Early Adolescence: A Reliability Study %A Hamann,Christoph %A Schultze-Lutter,Frauke %A Tarokh,Leila %+ University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstr. 111, Haus A, Bern, 3000, Switzerland, 41 31 932 8554, leila_tarokh@brown.edu %K early adolescence %K online assessment %K reliability %D 2016 %7 15.06.2016 %9 Short Paper %J J Med Internet Res %G English %X Background: The ever-increasing use of the Internet among adolescents represents an emerging opportunity for researchers to gain access to larger samples, which can be queried over several years longitudinally. Among adolescents, young adolescents (ages 11 to 13 years) are of particular interest to clinicians as this is a transitional stage, during which depressive and anxiety symptoms often emerge. However, it remains unclear whether these youngest adolescents can accurately answer questions about their mental well-being using a Web-based platform. Objective: The aim of the study was to examine the accuracy of responses obtained from Web-based questionnaires by comparing Web-based with paper-and-pencil versions of depression and anxiety questionnaires. Methods: The primary outcome was the score on the depression and anxiety questionnaires under two conditions: (1) paper-and-pencil and (2) Web-based versions. Twenty-eight adolescents (aged 11-13 years, mean age 12.78 years and SD 0.78; 18 females, 64%) were randomly assigned to complete either the paper-and-pencil or the Web-based questionnaire first. Intraclass correlation coefficients (ICCs) were calculated to measure intrarater reliability. Intraclass correlation coefficients were calculated separately for depression (Children’s Depression Inventory, CDI) and anxiety (Spence Children’s Anxiety Scale, SCAS) questionnaires. Results: On average, it took participants 17 minutes (SD 6) to answer 116 questions online. Intraclass correlation coefficient analysis revealed high intrarater reliability when comparing Web-based with paper-and-pencil responses for both CDI (ICC=.88; P<.001) and the SCAS (ICC=.95; P<.001). According to published criteria, both of these values are in the “almost perfect” category indicating the highest degree of reliability. Conclusions: The results of the study show an excellent reliability of Web-based assessment in 11- to 13-year-old children as compared with the standard paper-pencil assessment. Furthermore, we found that Web-based assessments with young adolescents are highly feasible, with all enrolled participants completing the Web-based form. As early adolescence is a time of remarkable social and behavioral changes, these findings open up new avenues for researchers from diverse fields who are interested in studying large samples of young adolescents over time. %M 27306932 %R 10.2196/jmir.5482 %U http://www.jmir.org/2016/6/e138/ %U https://doi.org/10.2196/jmir.5482 %U http://www.ncbi.nlm.nih.gov/pubmed/27306932 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e72 %T Development and Validation of the User Version of the Mobile Application Rating Scale (uMARS) %A Stoyanov,Stoyan R %A Hides,Leanne %A Kavanagh,David J %A Wilson,Hollie %+ Centre for Children’s Health Research, Institute of Health & Biomedical Innovation, School of Psychology and Counselling, Queensland University of Technology (QUT), CCHR, QUT, 62 Graham Street, Brisbane, QLD, 4101, Australia, 61 730697592, leanne.hides@qut.edu.au %K MARS %K mHealth %K eHealth %K app evaluation %K end user %K app trial %K mhealth trial %K user testing %K mobile application %K app rating %K reliability %K mobile health %K well being %K mental health %K smartphone %K cellphone %K telemedicine %K ehealth %K emental health %K e-therapy %K Internet %K online %K cognitive behavioral therapy %K anxiety %K anxiety disorders %K depression %K depressive disorder %K Australia %K research translation %K evidence-informed %K mHealth implementation %K mHealth evaluation %K randomized controlled trial %K RCT %D 2016 %7 10.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Mobile Application Rating Scale (MARS) provides a reliable method to assess the quality of mobile health (mHealth) apps. However, training and expertise in mHealth and the relevant health field is required to administer it. Objective: This study describes the development and reliability testing of an end-user version of the MARS (uMARS). Methods: The MARS was simplified and piloted with 13 young people to create the uMARS. The internal consistency and test-retest reliability of the uMARS was then examined in a second sample of 164 young people participating in a randomized controlled trial of a mHealth app. App ratings were collected using the uMARS at 1-, 3,- and 6-month follow up. Results: The uMARS had excellent internal consistency (alpha = .90), with high individual alphas for all subscales. The total score and subscales had good test-retest reliability over both 1-2 months and 3 months. Conclusions: The uMARS is a simple tool that can be reliably used by end-users to assess the quality of mHealth apps. %M 27287964 %R 10.2196/mhealth.5849 %U http://mhealth.jmir.org/2016/2/e72/ %U https://doi.org/10.2196/mhealth.5849 %U http://www.ncbi.nlm.nih.gov/pubmed/27287964 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 1 %P e28 %T Development and Implementation of Culturally Tailored Offline Mobile Health Surveys %A McIntosh,Scott %A Pérez-Ramos,José %A Demment,Margaret M %A Vélez Vega,Carmen %A Avendaño,Esteban %A Ossip,Deborah J %A Dye,Timothy D %+ School of Medicine & Dentistry, Department of Public Health Sciences, University of Rochester, CU420644, 265 Crittenden Blvd, Rochester, NY, 14642, United States, 1 585 802 9944, scott_mcintosh@urmc.rochester.edu %K mobile health %K survey research %K ethical review %D 2016 %7 02.06.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In low and middle income countries (LMICs), and other areas with low resources and unreliable access to the Internet, understanding the emerging best practices for the implementation of new mobile health (mHealth) technologies is needed for efficient and secure data management and for informing public health researchers. Innovations in mHealth technology can improve on previous methods, and dissemination of project development details and lessons learned during implementation are needed to provide lessons learned to stakeholders in both the United States and LMIC settings. Objective: The aims of this paper are to share implementation strategies and lessons learned from the development and implementation stages of two survey research projects using offline mobile technology, and to inform and prepare public health researchers and practitioners to implement new mobile technologies in survey research projects in LMICs. Methods: In 2015, two survey research projects were developed and piloted in Puerto Rico and pre-tested in Costa Rica to collect face-to-face data, get formative evaluation feedback, and to test the feasibility of an offline mobile data collection process. Fieldwork in each setting involved survey development, back translation with cultural tailoring, ethical review and approvals, data collector training, and piloting survey implementation on mobile tablets. Results: Critical processes and workflows for survey research projects in low resource settings were identified and implemented. This included developing a secure mobile data platform tailored to each survey, establishing user accessibility, and training and eliciting feedback from data collectors and on-site LMIC project partners. Conclusions: Formative and process evaluation strategies are necessary and useful for the development and implementation of survey research projects using emerging mHealth technologies in LMICs and other low resource settings. Lessons learned include: (1) plan institutional review board (IRB) approvals in multiple countries carefully to allow for development, implementation, and feedback, (2) in addition to testing the content of survey instruments, allow time and consideration for testing the use of novel mHealth technology (hardware and software), (3) incorporate training for and feedback from project staff, LMIC partner staff, and research participants, and (4) change methods accordingly, including content, as mHealth technology usage influences and is influenced by the content and structure of the survey instrument. Lessons learned from early phases of LMIC research projects using emerging mHealth technologies are critical for informing subsequent research methods and study designs. %M 27256208 %R 10.2196/publichealth.5408 %U http://publichealth.jmir.org/2016/1/e28/ %U https://doi.org/10.2196/publichealth.5408 %U http://www.ncbi.nlm.nih.gov/pubmed/27256208 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 4 %N 1 %P e9 %T Development and Reliability Evaluation of the Movement Rating Instrument for Virtual Reality Video Game Play %A Levac,Danielle %A Nawrotek,Joanna %A Deschenes,Emilie %A Giguere,Tia %A Serafin,Julie %A Bilodeau,Martin %A Sveistrup,Heidi %+ Northeastern University, Department of Physical Therapy, Movement and Rehabilitation Sciences, 407c Robinson Hall, 360 Huntington Avenue, Boston, MA, 02115, United States, 1 6173735198, d.levac@neu.edu %K active video games, virtual reality, physical therapy, movement, reliability %D 2016 %7 01.06.2016 %9 Original Paper %J JMIR Serious Games %G English %X Background: Virtual reality active video games are increasingly popular physical therapy interventions for children with cerebral palsy. However, physical therapists require educational resources to support decision making about game selection to match individual patient goals. Quantifying the movements elicited during virtual reality active video game play can inform individualized game selection in pediatric rehabilitation. Objective: The objectives of this study were to develop and evaluate the feasibility and reliability of the Movement Rating Instrument for Virtual Reality Game Play (MRI-VRGP). Methods: Item generation occurred through an iterative process of literature review and sample videotape viewing. The MRI-VRGP includes 25 items quantifying upper extremity, lower extremity, and total body movements. A total of 176 videotaped 90-second game play sessions involving 7 typically developing children and 4 children with cerebral palsy were rated by 3 raters trained in MRI-VRGP use. Children played 8 games on 2 virtual reality and active video game systems. Intraclass correlation coefficients (ICCs) determined intra-rater and interrater reliability. Results: Excellent intrarater reliability was evidenced by ICCs of >0.75 for 17 of the 25 items across the 3 raters. Interrater reliability estimates were less precise. Excellent interrater reliability was achieved for far reach upper extremity movements (ICC=0.92 [for right and ICC=0.90 for left) and for squat (ICC=0.80) and jump items (ICC=0.99), with 9 items achieving ICCs of >0.70, 12 items achieving ICCs of between 0.40 and 0.70, and 4 items achieving poor reliability (close-reach upper extremity-ICC=0.14 for right and ICC=0.07 for left) and single-leg stance (ICC=0.55 for right and ICC=0.27 for left). Conclusions: Poor video quality, differing item interpretations between raters, and difficulty quantifying the high-speed movements involved in game play affected reliability. With item definition clarification and further psychometric property evaluation, the MRI-VRGP could inform the content of educational resources for therapists by ranking games according to frequency and type of elicited body movements. %M 27251029 %R 10.2196/games.5528 %U http://games.jmir.org/2016/1/e9/ %U https://doi.org/10.2196/games.5528 %U http://www.ncbi.nlm.nih.gov/pubmed/27251029 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 4 %N 1 %P e7 %T A Serious Game for Clinical Assessment of Cognitive Status: Validation Study %A Tong,Tiffany %A Chignell,Mark %A Tierney,Mary C. %A Lee,Jacques %+ Interactive Media Lab, Department of Mechanical and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, ON,, Canada, 1 416 978 7581, tiffany.tong@mail.utoronto.ca %K cognitive assessments %K cognitive screening tools %K computerized assessments %K games %K human computer interaction %K human factors %K neuropsychological tests %K screening %K serious games %K tablet computers %K technology assessment %K usability %K validation studies %K video games %D 2016 %7 27.05.2016 %9 Original Paper %J JMIR Serious Games %G English %X Background: We propose the use of serious games to screen for abnormal cognitive status in situations where it may be too costly or impractical to use standard cognitive assessments (eg, emergency departments). If validated, serious games in health care could enable broader availability of efficient and engaging cognitive screening. Objective: The objective of this work is to demonstrate the feasibility of a game-based cognitive assessment delivered on tablet technology to a clinical sample and to conduct preliminary validation against standard mental status tools commonly used in elderly populations. Methods: We carried out a feasibility study in a hospital emergency department to evaluate the use of a serious game by elderly adults (N=146; age: mean 80.59, SD 6.00, range 70-94 years). We correlated game performance against a number of standard assessments, including the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and the Confusion Assessment Method (CAM). Results: After a series of modifications, the game could be used by a wide range of elderly patients in the emergency department demonstrating its feasibility for use with these users. Of 146 patients, 141 (96.6%) consented to participate and played our serious game. Refusals to play the game were typically due to concerns of family members rather than unwillingness of the patient to play the game. Performance on the serious game correlated significantly with the MoCA (r=–.339, P <.001) and MMSE (r=–.558, P <.001), and correlated (point-biserial correlation) with the CAM (r=.565, P <.001) and with other cognitive assessments. Conclusions: This research demonstrates the feasibility of using serious games in a clinical setting. Further research is required to demonstrate the validity and reliability of game-based assessments for clinical decision making. %M 27234145 %R 10.2196/games.5006 %U http://games.jmir.org/2016/1/e7/ %U https://doi.org/10.2196/games.5006 %U http://www.ncbi.nlm.nih.gov/pubmed/27234145 %0 Journal Article %@ 2369-2960 %I Gunther Eysenbach %V 2 %N 1 %P e24 %T Construct Validity of the eHealth Literacy Scale (eHEALS) Among Two Adult Populations: A Rasch Analysis %A Nguyen,Jennifer %A Moorhouse,Michael %A Curbow,Barbara %A Christie,Juliette %A Walsh-Childers,Kim %A Islam,Sabrina %+ Minority Cancer Research and Training (MiCaRT) Center, University of Florida Health Cancer Center, 6550 Sanger Road, Orlando, FL, 32827, United States, 1 4043137109, jennifernguyen@cop.ufl.edu %K eHealth %K eHEALS %K internet %K measurement %K rasch %K public health %D 2016 %7 20.05.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Internet has become a ubiquitous venue for information seeking, especially for health information. Public health practitioners have noticed the promise and potential of the Internet, however, little is known about individuals' skills of their eHealth literacy. The eHealth Literacy Scale, eHEALS, was designed to measure perceptions of individuals' eHealth literacy skills. Objective: The objective of the study was to examine the psychometric validity and reliability of the eHEALS with two adult populations using the Rasch Model. Methods: A college-aged sample and an Internet-based sample (Amazon's MTurk) were recruited to complete the eHEALS, demographic questions, and a health literacy scale. Using WINSTEPS and SPSS, unidimensionality, item fit, rating scale, item hierarchy, person ability-item match, and reliability were analyzed, compared, and contrasted against each sample and to other samples found in the literature. Results: An exploratory factor analysis supported unidimensionality in both samples. More than 90% of respondents from both samples fit the model. No items were outright misfitting. Both samples separated into three distinct groups. Conclusions: Based on the results, the eHEALS is a reliable and consistent measurement tool for a college sample and an Internet-based sample. As these individuals are most likely to use the Internet as a health resource, it is necessary to learn and know their skills versus perceiving that they can critically and successfully navigate the Internet. Further analyses are necessary to ensure that the eHEALS can serve as a standard eHealth literacy measure for public health. %M 27244771 %R 10.2196/publichealth.4967 %U http://publichealth.jmir.org/2016/1/e24/ %U https://doi.org/10.2196/publichealth.4967 %U http://www.ncbi.nlm.nih.gov/pubmed/27244771 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e15 %T Interrater Reliability of mHealth App Rating Measures: Analysis of Top Depression and Smoking Cessation Apps %A Powell,Adam C %A Torous,John %A Chan,Steven %A Raynor,Geoffrey Stephen %A Shwarts,Erik %A Shanahan,Meghan %A Landman,Adam B %+ Payer+Provider Syndicate, 8 Garrison St Ste 101, Boston, MA, MA, United States, 1 6179399168, powell@payerprovider.com %K mobile applications %K mental health %K evaluation studies %K health apps %K ratings %D 2016 %7 10.02.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: There are over 165,000 mHealth apps currently available to patients, but few have undergone an external quality review. Furthermore, no standardized review method exists, and little has been done to examine the consistency of the evaluation systems themselves. Objective: We sought to determine which measures for evaluating the quality of mHealth apps have the greatest interrater reliability. Methods: We identified 22 measures for evaluating the quality of apps from the literature. A panel of 6 reviewers reviewed the top 10 depression apps and 10 smoking cessation apps from the Apple iTunes App Store on these measures. Krippendorff’s alpha was calculated for each of the measures and reported by app category and in aggregate. Results: The measure for interactiveness and feedback was found to have the greatest overall interrater reliability (alpha=.69). Presence of password protection (alpha=.65), whether the app was uploaded by a health care agency (alpha=.63), the number of consumer ratings (alpha=.59), and several other measures had moderate interrater reliability (alphas>.5). There was the least agreement over whether apps had errors or performance issues (alpha=.15), stated advertising policies (alpha=.16), and were easy to use (alpha=.18). There were substantial differences in the interrater reliabilities of a number of measures when they were applied to depression versus smoking apps. Conclusions: We found wide variation in the interrater reliability of measures used to evaluate apps, and some measures are more robust across categories of apps than others. The measures with the highest degree of interrater reliability tended to be those that involved the least rater discretion. Clinical quality measures such as effectiveness, ease of use, and performance had relatively poor interrater reliability. Subsequent research is needed to determine consistent means for evaluating the performance of apps. Patients and clinicians should consider conducting their own assessments of apps, in conjunction with evaluating information from reviews. %M 26863986 %R 10.2196/mhealth.5176 %U http://mhealth.jmir.org/2016/1/e15/ %U https://doi.org/10.2196/mhealth.5176 %U http://www.ncbi.nlm.nih.gov/pubmed/26863986 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 1 %P e22 %T Estimating Skin Cancer Risk: Evaluating Mobile Computer-Adaptive Testing %A Djaja,Ngadiman %A Janda,Monika %A Olsen,Catherine M %A Whiteman,David C %A Chien,Tsair-Wei %+ Research Department, Chi-Mei Medical Center, No. 901, Chung Hwa Road, Yung Kung Dist., Tainan 710, Taiwan, Tainan, 710, Taiwan, 886 937399106, smile@mail.chimei.org.tw %K computer adaptive testing %K skin cancer risk scale %K non adaptive test %K Rasch analysis %K partial credit model %D 2016 %7 22.01.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Response burden is a major detriment to questionnaire completion rates. Computer adaptive testing may offer advantages over non-adaptive testing, including reduction of numbers of items required for precise measurement. Objective: Our aim was to compare the efficiency of non-adaptive (NAT) and computer adaptive testing (CAT) facilitated by Partial Credit Model (PCM)-derived calibration to estimate skin cancer risk. Methods: We used a random sample from a population-based Australian cohort study of skin cancer risk (N=43,794). All 30 items of the skin cancer risk scale were calibrated with the Rasch PCM. A total of 1000 cases generated following a normal distribution (mean [SD] 0 [1]) were simulated using three Rasch models with three fixed-item (dichotomous, rating scale, and partial credit) scenarios, respectively. We calculated the comparative efficiency and precision of CAT and NAT (shortening of questionnaire length and the count difference number ratio less than 5% using independent t tests). Results: We found that use of CAT led to smaller person standard error of the estimated measure than NAT, with substantially higher efficiency but no loss of precision, reducing response burden by 48%, 66%, and 66% for dichotomous, Rating Scale Model, and PCM models, respectively. Conclusions: CAT-based administrations of the skin cancer risk scale could substantially reduce participant burden without compromising measurement precision. A mobile computer adaptive test was developed to help people efficiently assess their skin cancer risk. %M 26800642 %R 10.2196/jmir.4736 %U http://www.jmir.org/2016/1/e22/ %U https://doi.org/10.2196/jmir.4736 %U http://www.ncbi.nlm.nih.gov/pubmed/26800642 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 5 %N 1 %P e3 %T Accuracy, Validity, and Reliability of an Electronic Visual Analog Scale for Pain on a Touch Screen Tablet in Healthy Older Adults: A Clinical Trial %A Bird,Marie-Louise %A Callisaya,Michele L %A Cannell,John %A Gibbons,Timothy %A Smith,Stuart T %A Ahuja,Kiran DK %+ School of Health Sciences, University of Tasmania, Locked Bag 1322, Launceston, , Australia, 61 363245478, Kiran.Ahuja@utas.edu.au %K pain %K VAS %K technology %K scale %D 2016 %7 14.01.2016 %9 Original Paper %J Interact J Med Res %G English %X Background: New technology for clinical data collection is rapidly evolving and may be useful for both researchers and clinicians; however, this new technology has not been tested for accuracy, reliability, or validity. Objective: This study aims to test the accuracy of visual analog scale (VAS) for pain on a newly designed application on the iPad (iPadVAS) and measure the reliability and validity of iPadVAS compared to a paper copy (paperVAS). Methods: Accuracy was determined by physically measuring an iPad scale on screen and comparing it to the results from the program, with a researcher collecting 101 data points. A total of 22 healthy community dwelling older adults were then recruited to test reliability and validity. Each participant completed 8 VAS (4 using each tool) in a randomized order. Reliability was measured using interclass correlation coefficient (ICC) and validity measured using Bland-Altman graphs and correlations. Results: Of the measurements for accuracy, 64 results were identical, 2 results were manually measured as being 1 mm higher than the program, and 35 as 1 mm lower. Reliability for the iPadVAS was excellent with individual ICC 0.90 (95% CI 0.82-0.95) and averaged ICC 0.97 (95% CI 0.95-1.0) observed. Linear regression demonstrated a strong relationship with a small negative bias towards the iPad (−2.6, SD 5.0) with limits of agreement from −12.4 to 7.1. Conclusions: The iPadVAS provides a convenient, user-friendly, and efficient way of collecting data from participants in measuring their current pain levels. It has potential use in documentation management and may encourage participatory healthcare. Trial Registration: Australia New Zealand Clinical Trials Registry (ANZCTR): 367297; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=367297&isReview=true (Archived by Webcite at http://www.webcitation.org/6d9xYoUbD). %M 26769149 %R 10.2196/ijmr.4910 %U http://www.i-jmr.org/2016/1/e3/ %U https://doi.org/10.2196/ijmr.4910 %U http://www.ncbi.nlm.nih.gov/pubmed/26769149 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 12 %P e273 %T Evaluation of a Web-Based Food Record for Children Using Direct Unobtrusive Lunch Observations: A Validation Study %A Medin,Anine Christine %A Astrup,Helene %A Kåsin,Britt Marlene %A Andersen,Lene Frost %+ Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Postboks 1046, Blindern, Oslo, 0317, Norway, 47 22851349, a.c.medin@medisin.uio.no %K children %K dietary records %K Internet %K observation %K validity %D 2015 %7 07.12.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: High-quality, Web-based dietary assessment tools for children are needed to reduce cost and improve user-friendliness when studying children’s dietary practices. Objective: To evaluate the first Web-based dietary assessment tool for children in Norway, the Web-based Food Record (WebFR), by comparing children’s true school lunch intake with recordings in the WebFR, using direct unobtrusive observation as the reference method. Methods: A total of 117 children, 8-9 years, from Bærum, Norway, were recruited from September to December 2013. Children completed 4 days of recordings in the WebFR, with parental assistance, and were observed during school lunch in the same period by 3 observers. Interobserver reliability assessments were satisfactory. Match, omission, and intrusion rates were calculated to assess the quality of the recordings in the WebFR for different food categories, and for all foods combined. Logistic regression analyses were used to investigate whether body mass index (BMI), parental educational level, parental ethnicity or family structure were associated with having a “low match rate” (≤70%). Results: Bread and milk were recorded with less bias than spreads, fruits, and vegetables. Mean (SD) for match, omission, and intrusion rates for all foods combined were 73% (27%), 27% (27%), and 19% (26%), respectively. Match rates were statistically significantly associated with parental educational level (low education 52% [32%] versus high 77% [24%], P=.008) and parental ethnicity (non-Norwegian 57% [28%] versus others 75% [26%], P=.04). Only parental ethnicity remained statistically significant in the logistic regression model, showing an adjusted odds ratio of 6.9 and a 95% confidence interval between 1.3 and 36.4. Conclusions: Compared with other similar studies, our results indicate that the WebFR is in line with, or better than most of other similar tools, yet enhancements could further improve the WebFR. %M 26680744 %R 10.2196/jmir.5031 %U http://www.jmir.org/2015/12/e273/ %U https://doi.org/10.2196/jmir.5031 %U http://www.ncbi.nlm.nih.gov/pubmed/26680744 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 1 %N 2 %P e11 %T Effect of Web-Based Versus Paper-Based Questionnaires and Follow-Up Strategies on Participation Rates of Dutch Childhood Cancer Survivors: A Randomized Controlled Trial %A Kilsdonk,Ellen %A van Dulmen-den Broeder,Eline %A van der Pal,Helena J %A Hollema,Nynke %A Kremer,Leontien C %A van den Heuvel-Eibrink,Marry M %A van Leeuwen,Flora E %A Jaspers,Monique W %A van den Berg,Marleen H %+ Centre for Human Factors Engineering of interactive Health Information Technology (HIT-lab), Department of Medical Informatics, Academic Medical Center, PO Box 22660, Amsterdam, 1100 DD, Netherlands, 31 205666204, e.kilsdonk@amc.uva.nl %K childhood cancer survivors %K follow-up strategies %K participation rates %K questionnaires %K questionnaire mode %D 2015 %7 24.11.2015 %9 Original Paper %J JMIR Cancer %G English %X Background: Questionnaires are widely used in survey research, especially in cohort studies. However, participation in questionnaire studies has been declining over the past decades. Because high participation rates are needed to limit the risk of selection bias and produce valid results, it is important to investigate invitation strategies which may improve participation. Objectives: The purpose of this study is to investigate the effect of Web-based versus paper-based questionnaires on participation rates in a questionnaire survey on late effects among childhood cancer survivors (CCSs). Methods: A total of 750 CCSs were randomized across 3 study arms. The initial invitation in study arms 1 and 2 consisted of a Web-based questionnaire only, whereas in study arm 3 this invitation was complemented with a paper-based version of the questionnaire. The first postal reminder, sent to the nonresponding CCSs in all 3 study arms, consisted of either a reminder letter only (study arms 1 and 3) or a reminder letter complemented with a paper-based questionnaire (study arm 2). The second postal reminder was restricted to CCSs in study arms 1 and 2, with only those in study arm 1 also receiving a paper-based questionnaire. CCSs in study arm 3 received a second reminder by telephone instead of by mail. In contrast to CCSs in study arm 3, CCSs in study arms 1 and 2 received a third reminder, this time by telephone. Results: Overall, 58.1% (436/750) of the CCSs participated in the survey. Participation rates were equal in all 3 study arms with 57.4% (143/249) in arm 1, 60.6% (152/251) in arm 2, and 56.4% (141/250) in arm 3 (P=.09). Participation rates of CCSs who received an initial invitation for the Web-based questionnaire only and CCSs who received an invitation to complete either a paper-based or Web-based questionnaire did not differ (P=.55). After the first postal reminder, participation rates of CCSs invited for the Web-based questionnaire only also did not differ compared with CCSs invited for both the Web-based and paper-based questionnaires (P=.48). In general, CCSs preferred the paper-based over the Web-based questionnaire, and those completing the paper-based questionnaire were more often unemployed (P=.004) and lower educated (P<.001). Conclusion: Invitation strategies offering a Web-based questionnaire without a paper-based alternative at first invitation can be used without compromising participation rates of CCS. Offering the choice between paper- and Web-based questionnaires seems to result in the highest accrual participation rate. Future research should look into the quality of the data delivered by both questionnaires filled in by respondents themselves. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 84711754; http://www.controlled-trials.com/ISRCTN84711754 (Archived by WebCite at http://www.webcitation.org/6c9ZB8paX) %M 28410161 %R 10.2196/cancer.3905 %U http://cancer.jmir.org/2015/2/e11/ %U https://doi.org/10.2196/cancer.3905 %U http://www.ncbi.nlm.nih.gov/pubmed/28410161 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 11 %P e266 %T Measuring Use of Health-Related Support on the Internet: Development of the Health Online Support Questionnaire (HOSQ) %A Mattsson,Susanne %A Olsson,Erik Martin Gustaf %A Alfonsson,Sven %A Johansson,Birgitta %A Carlsson,Maria %+ Lifestyle and Rehabilitation in Long Term Illness, Department of Public Health and Caring Sciences, Uppsala University, Husargatan 3, Box 564, Uppsala 75122, Sweden, 46 018 471 6622, susanne.mattsson@pubcare.uu.se %K social support %K questionnaires %K oncology %K Internet %D 2015 %7 20.11.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Social support plays an important role for the perceived health in people with health problems and chronic diseases. Provision of different kinds of support during the disease trajectory is crucial for many people. Online support is ubiquitous and represents a promising modality for people with chronic diseases. There are no existing instruments that measure various aspects of online support. Objective: The objective of this study was to create a generic questionnaire regarding health-related support online that can be applied to people with various health problems and illnesses. Additionally, we wanted to test the questionnaire in a cancer population to assess its adequacy in the context of severe disease. Methods: Initial items for the Health Online Support Questionnaire (HOSQ) were inspired by sociologist James House regarding social support. An exploratory factor analysis was conducted in healthy persons or with minor health problems (n=243) on 31 initial items. The scale was reduced to 18 items and the internal consistency and reliability of the scale was examined along with content validity. Further validation was conducted by a confirmatory analysis on the 18-item scale in a cancer population (n=215). In addition, data on demographics, health problems experienced, and Internet use were collected. Results: The exploratory factor analysis on the final 18-item scale resulted in 2 factors. After scrutinizing the content, these factors were labeled “reading” and “interacting” and they demonstrated good internal consistency (Cronbach alphas .88 and .77, respectively). The factors were confirmed in the cancer population. The response pattern revealed expected differences both between the interaction and reading scales and according to age, gender, education, and health problems thereby supporting the validity of the HOSQ. Conclusions: The HOSQ may be a reliable and valid instrument for measuring the use of online support for people with health problems, but the results ought to be replicated in more studies to confirm the results for different diagnoses. If the results of this study are corroborated by future studies, the HOSQ may be used as a basis for the development of different forms of support on the Internet. %M 26589638 %R 10.2196/jmir.4425 %U http://www.jmir.org/2015/11/e266/ %U https://doi.org/10.2196/jmir.4425 %U http://www.ncbi.nlm.nih.gov/pubmed/26589638 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e94 %T Basal Temperature Measurement Using a Multi-Sensor Armband in Australian Young Women: A Comparative Observational Study %A Wark,John D %A Henningham,Lucy %A Gorelik,Alexandra %A Jayasinghe,Yasmin %A Hartley,Stefanie %A Garland,Suzanne Marie %+ University of Melbourne, Department of Medicine, Royal Melbourne Hospital, Grattan Street, Parkville, 3052, Australia, 61 3 9342 7109, jdwark@unimelb.edu.au %K basal body temperature %K young female health initiative %K BodyMedia SenseWear %K ovulation %K menstrual cycle, young women %D 2015 %7 05.10.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The menstrual cycle is a key marker of health in women of reproductive age. Monitoring ovulation is useful in health studies involving young women. The upward shift in basal body temperature, which occurs shortly after ovulation and continues until the next menses, is a potentially useful marker of ovulation, which has been exploited in clinical and research settings. Objective: We investigated the utility of BodyMedia SenseWear (BMSW) in monitoring ovulation in young women by analyzing the correlation and agreement of basal temperatures measured using BMSW and a digital oral thermometer. Methods: Kappa statistics were used to determine the agreement in ovulation detection between the two devices, for each participant, under each form of analysis. Participants also completed an online questionnaire assessing the acceptability of both devices. Results: We recruited 16 participants with 15 of them providing analyzable data (11 OCP non-users, 4 OCP users). Weak to moderate correlations were observed between thermometer and BMSW temperature measurements averaged over 5 different time intervals. However, no agreement between methods was observed using Bland-Altman plots. There was a significant difference in the range of temperatures that each device recorded (thermometer: 35.3-37.2°C, BMSW: 29.7-36.7°C) with BMSW temperatures significantly lower than thermometer temperatures: mean 34.6°C (SD 1.2) versus 36.4°C (SD 0.3) respectively, P<.001. Poor agreement was observed between devices under quantitative analysis of ovulation while fair agreement was observed under visual analysis. Under both quantitative and visual analysis, there was 0% agreement for evidence of ovulation. Conclusions: This study demonstrated the importance of evaluating biomeasures collected using mobile monitoring devices by comparison with standard methods. It revealed a relatively poor correlation between BMSW and oral thermometer temperature readings and suggested that BMSW is unlikely to detect an upward shift in basal body temperature. Participant behavior suggested poor compliance in the use of BMSW for basal temperature measurement and that the basal body temperature method may not be suitable for use in unselected samples of young women. There is a need for research tools for monitoring ovulation that are simple, self-administered, and inexpensive, yet appealing to young women. %M 26441468 %R 10.2196/mhealth.4263 %U http://mhealth.jmir.org/2015/4/e94/ %U https://doi.org/10.2196/mhealth.4263 %U http://www.ncbi.nlm.nih.gov/pubmed/26441468 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 1 %N 2 %P e14 %T A Comparison of Self-Reported and Objective Physical Activity Measures in Young Australian Women %A Hartley,Stefanie %A Garland,Suzanne %A Young,Elisa %A Bennell,Kim Louise %A Tay,Ilona %A Gorelik,Alexandra %A Wark,John Dennis %+ The Royal Women's Hospital, Department of Molecular Microbiology & Infectious Diseases, Locked Bag 3000, Parkville, 3052, Australia, 61 3 8345 3670, suzanne.garland@thewomens.org.au %K physical activity %K exercise %K women’s health %K questionnaires %D 2015 %7 05.10.2015 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The evidence for beneficial effects of recommended levels of physical activity is overwhelming. However, 70% of Australians fail to meet these levels. In particular, physical activity participation by women falls sharply between ages 16 to 25 years. Further information about physical activity measures in young women is needed. Self-administered questionnaires are often used to measure physical activity given their ease of application, but known limitations, including recall bias, compromise the accuracy of data. Alternatives such as objective measures are commonly used to overcome this problem, but are more costly and time consuming. Objective: To compare the output between the Modified Active Australia Survey (MAAS), the International Physical Activity Questionnaire (IPAQ), and an objective physical activity measure—the SenseWear Armband (SWA)—to evaluate the test-retest reliability of the MAAS and to determine the acceptability of the SWA among young women. Methods: Young women from Victoria, Australia, aged 18 to 25 years who had participated in previous studies via Facebook advertising were recruited. Participants completed the two physical activity questionnaires online, immediately before and after wearing the armband for 7 consecutive days. Data from the SWA was blocked into 10-minute activity times. Follow-up IPAQ, MAAS, and SWA data were analyzed by comparing the total continuous and categorical activity scores, while concurrent validity of IPAQ and MAAS were analyzed by comparing follow-up scores. Test-retest reliability of MAAS was analyzed by comparing MAAS total physical activity scores at baseline and follow-up. Participants provided feedback in the follow-up questionnaire about their experience of wearing the armband to determine acceptability of the SWA. Data analyses included graphical (ie, Bland-Altman plot, scatterplot) and analytical (ie, canonical correlation, kappa statistic) methods to determine agreement between MAAS, IPAQ, and SWA data. Results: A total of 58 participants returned complete data. Comparisons between the MAAS and IPAQ questionnaires (n=52) showed moderate agreement for both categorical (kappa=.48, P<.001) and continuous data (r=.69, P<.001). Overall, the IPAQ tended to give higher scores. No significant correlation was observed between SWA and IPAQ or MAAS continuous data, for both minute-by-minute and blocked SWA data. The SWA tended to record lower scores than the questionnaires, suggesting participants tended to overreport their amount of physical activity. The test-retest analysis of MAAS showed moderate agreement for continuous outcomes (r=.44, P=.001). However, poor agreement was seen for categorical outcomes. The acceptability of the SWA to participants was high. Conclusions: Moderate agreement between the MAAS and IPAQ and moderate reliability of the MAAS indicates that the MAAS may be a suitable alternative to the IPAQ to assess total physical activity in young women, due to its shorter length and consequently lower participant burden. The SWA, and likely other monitoring devices, have the advantage over questionnaires of avoiding overreporting of self-reported physical activity, while being highly acceptable to participants. %M 27227132 %R 10.2196/publichealth.4259 %U http://publichealth.jmir.org/2015/2/e14/ %U https://doi.org/10.2196/publichealth.4259 %U http://www.ncbi.nlm.nih.gov/pubmed/27227132 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 9 %P e221 %T Designing and Testing an Inventory for Measuring Social Media Competency of Certified Health Education Specialists %A Alber,Julia M %A Bernhardt,Jay M %A Stellefson,Michael %A Weiler,Robert M %A Anderson-Lewis,Charkarra %A Miller,M David %A MacInnes,Jann %+ Center for Health Behavior Research, Perelman School of Medicine, University of Pennsylvania, 110 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, United States, 1 215 573 9894, alberj@upenn.edu %K social media %K health education %K professional competence %D 2015 %7 23.09.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media can promote healthy behaviors by facilitating engagement and collaboration among health professionals and the public. Thus, social media is quickly becoming a vital tool for health promotion. While guidelines and trainings exist for public health professionals, there are currently no standardized measures to assess individual social media competency among Certified Health Education Specialists (CHES) and Master Certified Health Education Specialists (MCHES). Objective: The aim of this study was to design, develop, and test the Social Media Competency Inventory (SMCI) for CHES and MCHES. Methods: The SMCI was designed in three sequential phases: (1) Conceptualization and Domain Specifications, (2) Item Development, and (3) Inventory Testing and Finalization. Phase 1 consisted of a literature review, concept operationalization, and expert reviews. Phase 2 involved an expert panel (n=4) review, think-aloud sessions with a small representative sample of CHES/MCHES (n=10), a pilot test (n=36), and classical test theory analyses to develop the initial version of the SMCI. Phase 3 included a field test of the SMCI with a random sample of CHES and MCHES (n=353), factor and Rasch analyses, and development of SMCI administration and interpretation guidelines. Results: Six constructs adapted from the unified theory of acceptance and use of technology and the integrated behavioral model were identified for assessing social media competency: (1) Social Media Self-Efficacy, (2) Social Media Experience, (3) Effort Expectancy, (4) Performance Expectancy, (5) Facilitating Conditions, and (6) Social Influence. The initial item pool included 148 items. After the pilot test, 16 items were removed or revised because of low item discrimination (r<.30), high interitem correlations (Ρ>.90), or based on feedback received from pilot participants. During the psychometric analysis of the field test data, 52 items were removed due to low discrimination, evidence of content redundancy, low R-squared value, or poor item infit or outfit. Psychometric analyses of the data revealed acceptable reliability evidence for the following scales: Social Media Self-Efficacy (alpha=.98, item reliability=.98, item separation=6.76), Social Media Experience (alpha=.98, item reliability=.98, item separation=6.24), Effort Expectancy(alpha =.74, item reliability=.95, item separation=4.15), Performance Expectancy (alpha =.81, item reliability=.99, item separation=10.09), Facilitating Conditions (alpha =.66, item reliability=.99, item separation=16.04), and Social Influence (alpha =.66, item reliability=.93, item separation=3.77). There was some evidence of local dependence among the scales, with several observed residual correlations above |.20|. Conclusions: Through the multistage instrument-development process, sufficient reliability and validity evidence was collected in support of the purpose and intended use of the SMCI. The SMCI can be used to assess the readiness of health education specialists to effectively use social media for health promotion research and practice. Future research should explore associations across constructs within the SMCI and evaluate the ability of SMCI scores to predict social media use and performance among CHES and MCHES. %M 26399428 %R 10.2196/jmir.4943 %U http://www.jmir.org/2015/9/e221/ %U https://doi.org/10.2196/jmir.4943 %U http://www.ncbi.nlm.nih.gov/pubmed/26399428 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 9 %P e218 %T The Diagnostic Validity and Reliability of an Internet-Based Clinical Assessment Program for Mental Disorders %A Nguyen,David Phong %A Klein,Britt %A Meyer,Denny %A Austin,David William %A Abbott,Jo-Anne M %+ National eTherapy Centre, Swinburne University of Technology, Burwood Road, Hawthorn, VIC, 3122, Australia, 61 402497855, dpnguyen@outlook.com %K Internet %K online %K mental health %K validity %K reliability %K assessment %K diagnosis %K screening %K anxiety %K depression %D 2015 %7 21.09.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based assessment has the potential to assist with the diagnosis of mental health disorders and overcome the barriers associated with traditional services (eg, cost, stigma, distance). Further to existing online screening programs available, there is an opportunity to deliver more comprehensive and accurate diagnostic tools to supplement the assessment and treatment of mental health disorders. Objective: The aim was to evaluate the diagnostic criterion validity and test-retest reliability of the electronic Psychological Assessment System (e-PASS), an online, self-report, multidisorder, clinical assessment and referral system. Methods: Participants were 616 adults residing in Australia, recruited online, and representing prospective e-PASS users. Following e-PASS completion, 158 participants underwent a telephone-administered structured clinical interview and 39 participants repeated the e-PASS within 25 days of initial completion. Results: With structured clinical interview results serving as the gold standard, diagnostic agreement with the e-PASS varied considerably from fair (eg, generalized anxiety disorder: κ=.37) to strong (eg, panic disorder: κ=.62). Although the e-PASS’ sensitivity also varied (0.43-0.86) the specificity was generally high (0.68-1.00). The e-PASS sensitivity generally improved when reducing the e-PASS threshold to a subclinical result. Test-retest reliability ranged from moderate (eg, specific phobia: κ=.54) to substantial (eg, bulimia nervosa: κ=.87). Conclusions: The e-PASS produces reliable diagnostic results and performs generally well in excluding mental disorders, although at the expense of sensitivity. For screening purposes, the e-PASS subclinical result generally appears better than a clinical result as a diagnostic indicator. Further development and evaluation is needed to support the use of online diagnostic assessment programs for mental disorders. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG). %M 26392066 %R 10.2196/jmir.4195 %U http://www.jmir.org/2015/9/e218/ %U https://doi.org/10.2196/jmir.4195 %U http://www.ncbi.nlm.nih.gov/pubmed/26392066 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 3 %P e96 %T Designing an Internationally Accessible Web-Based Questionnaire to Discover Risk Factors for Amyotrophic Lateral Sclerosis: A Case-Control Study %A Parkin Kullmann,Jane Alana %A Hayes,Susan %A Wang,Min-Xia %A Pamphlett,Roger %+ The University of Sydney, 94 Mallett St, Camperdown NSW, , Australia, 61 2 9351 0972, roger.pamphlett@sydney.edu.au %K amyotrophic lateral sclerosis (ALS) %K motor neuron disease (MND) %K web-based %K online %K questionnaire %K epidemiology %K risk factor %K case-control study %K international %K language translation %D 2015 %7 03.08.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with a typical survival of three to five years. Epidemiological studies using paper-based questionnaires in individual countries or continents have failed to find widely accepted risk factors for the disease. The advantages of online versus paper-based questionnaires have been extensively reviewed, but few online epidemiological studies into human neurodegenerative diseases have so far been undertaken. Objective: To design a Web-based questionnaire to identify environmental risk factors for ALS and enable international comparisons of these risk factors. Methods: A Web-based epidemiological questionnaire for ALS has been developed based on experience gained from administering a previous continent-wide paper-based questionnaire for this disease. New and modified questions have been added from our previous paper-based questionnaire, from literature searches, and from validated ALS questionnaires supplied by other investigators. New criteria to allow the separation of familial and sporadic ALS cases have been included. The questionnaire addresses many risk factors that have already been proposed for ALS, as well as a number that have not yet been rigorously examined. To encourage participation, responses are collected anonymously and no personally identifiable information is requested. The survey is being translated into a number of languages which will allow many people around the world to read and answer it in their own language. Results: After the questionnaire had been online for 4 months, it had 379 respondents compared to only 46 respondents for the same initial period using a paper-based questionnaire. The average age of the first 379 web questionnaire respondents was 54 years compared to the average age of 60 years for the first 379 paper questionnaire respondents. The questionnaire is soon to be promoted in a number of countries through ALS associations and disease registries. Conclusions: Web-based questionnaires are a time- and resource-efficient method for performing large epidemiological studies of neurodegenerative diseases such as ALS. The ability to compare risk factors between different countries using the same analysis tool will be of particular value for finding robust risk factors that underlie ALS. %M 26239255 %R 10.2196/resprot.4840 %U http://www.researchprotocols.org/2015/3/e96/ %U https://doi.org/10.2196/resprot.4840 %U http://www.ncbi.nlm.nih.gov/pubmed/26239255 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 3 %P e86 %T A Validation Study of the Web-Based Physical Activity Questionnaire Active-Q Against the GENEA Accelerometer %A Bonn,Stephanie Erika %A Bergman,Patrick %A Trolle Lagerros,Ylva %A Sjölander,Arvid %A Bälter,Katarina %+ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12a, Stockholm, SE-171 77, Sweden, 46 852482298, stephanie.bonn@ki.se %K accelerometer %K activity assessment %K epidemiology %K Internet %K self report %K validity %D 2015 %7 16.07.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Valid physical activity assessment in epidemiological studies is essential to study associations with various health outcomes. Objective: To validate the Web-based physical activity questionnaire Active-Q by comparing results of time spent at different physical activity levels with results from the GENEA accelerometer and to assess the reproducibility of Active-Q by comparing two admissions of the questionnaire. Methods: A total of 148 men (aged 33 to 86 years) responded to Active-Q twice and wore the accelerometer during seven consecutive days on two occasions. Time spent on six different physical activity levels including sedentary, light (LPA), moderate (MPA), and vigorous (VPA) as well as additional combined categories of sedentary-to-light and moderate-to-vigorous (MVPA) physical activity was assessed. Validity of Active-Q was determined using Spearman correlation coefficients with 95% confidence intervals (CI) and the Bland-Altman method. Reproducibility was assessed using intraclass correlation coefficients (ICCs) comparing two admissions of the questionnaire. Results: The validity correlation coefficients were statistically significant for time spent at all activity levels; sedentary (r=0.19, 95% CI: 0.04-0.34), LPA (r=0.15, 95% CI: 0.00-0.31), sedentary-to-light (r=0.35, 95% CI: 0.19-0.51), MPA (r=0.27, 95% CI: 0.12-0.42), VPA (r=0.54, 95% CI: 0.42-0.67), and MVPA (r=0.35, 95% CI: 0.21-0.48). The Bland-Altman plots showed a negative mean difference for time in LPA and positive mean differences for time spent in MPA, VPA and MVPA. The ICCs of test-retest reliability ranged between r=0.51-0.80 for the different activity levels in Active-Q. Conclusions: More moderate and vigorous activities and less light activities were reported in Active-Q compared to accelerometer measurements. Active-Q shows comparable validity and reproducibility to other physical activity questionnaires used today. %M 26183896 %R 10.2196/resprot.3896 %U http://www.researchprotocols.org/2015/3/e86/ %U https://doi.org/10.2196/resprot.3896 %U http://www.ncbi.nlm.nih.gov/pubmed/26183896 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 6 %P e158 %T Comparing Patients’ Opinions on the Hospital Discharge Process Collected With a Self-Reported Questionnaire Completed Via the Internet or Through a Telephone Survey: An Ancillary Study of the SENTIPAT Randomized Controlled Trial %A Couturier,Berengere %A Carrat,Fabrice %A Hejblum,Gilles %A , %+ Assistance Publique - Hôpitaux de Paris, Unité de Santé Publique, Hôpital Saint Antoine, 184 rue du Faubourg Saint Antoine, Paris, 75571, France, 33 (0)149283228, berengere.couturier@aphp.fr %K hospital information systems %K patient-centered care %K patient discharge %K patient satisfaction %K quality of health care %D 2015 %7 24.06.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Hospital discharge, a critical stage in the hospital-to-home transition of patient care, is a complex process with potential dysfunctions having an impact on patients’ health on their return home. No study has yet reported the feasibility and usefulness of an information system that would directly collect and transmit, via the Internet, volunteer patients’ opinions on their satisfaction concerning the organization of hospital discharge. Objective: Our primary objective was to compare patients’ opinions on the discharge process collected with 2 different methods: self-questionnaire completed on a dedicated website versus a telephone interview. The secondary goal was to estimate patient satisfaction. Methods: We created a questionnaire to examine hospital discharge according to 3 dimensions: discharge logistics organization, preplanned posthospital continuity-of-care organization, and patients’ impressions at the time of discharge. A satisfaction score (between 0 and 1) for each of those dimensions and an associated total score were calculated. Taking advantage of the randomized SENTIPAT trial that questioned patients recruited at hospital discharge about the evolution of their health after returning home and randomly assigned them to complete a self-questionnaire directly online or during a telephone interview, we conducted an ancillary study comparing satisfaction with the organization of hospital discharge for these 2 patient groups. The questionnaire was proposed to 1141 patients included in the trial who were hospitalized for ≥2 days, among whom 867 eligible patients had access to the Internet at home and were randomized to the Internet or telephone group. Results: Of the 1141 patients included, 755 (66.17%) completed the questionnaire. The response rates for the Internet (39.1%, 168/430) and telephone groups (87.2%, 381/437) differed significantly (P<.001), but their total satisfaction scores did not (P=.08) nor did the satisfaction subscores (P=.58 for discharge logistics organization, P=.12 for preplanned posthospital continuity-of-care organization, and P=.35 for patients’ impressions at the time of discharge). The total satisfaction score (median 0.83, IQR 0.72-0.92) indicated the patients’ high satisfaction. Conclusions: The direct transmission of personal health data via the Internet requires patients’ active participation and those planning surveys in the domain explored in this study should anticipate a lower response rate than that issued from a similar survey conducted by telephone interviews. Nevertheless, collecting patients’ opinions on their hospital discharge via the Internet proved operational; study results indicate that conducting such surveys via the Internet yields similar estimates to those obtained via a telephone survey. The results support the establishment of a permanent dedicated website that could also be used to obtain users’ opinions on other aspects of their hospital stay and follow-up. Trial Registration: Clinicaltrials.gov NCT01769261; http://clinicaltrials.gov/ct2/show/NCT01769261 (Archived by WebCite at http://www.webcitation.org/6ZDF5bdQb). %M 26109261 %R 10.2196/jmir.4379 %U http://www.jmir.org/2015/6/e158/ %U https://doi.org/10.2196/jmir.4379 %U http://www.ncbi.nlm.nih.gov/pubmed/26109261 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e67 %T Feasibility and Acceptability of Smartphone-Based Ecological Momentary Assessment of Alcohol Use Among African American Men Who Have Sex With Men in Baltimore %A Yang,Cui %A Linas,Beth %A Kirk,Gregory %A Bollinger,Robert %A Chang,Larry %A Chander,Geetanjali %A Siconolfi,Daniel %A Braxton,Sharif %A Rudolph,Abby %A Latkin,Carl %+ Johns Hopkins School of Public Health, Department of Health, Behavior and Society, 2213 McElderry St. 2n FL, Baltimore, MD, 21205, United States, 1 4105025368, cyang29@jhu.edu %K ecological momentary assessment (EMA) %K alcohol use %K HIV %K African American %K men who have sex with men (MSM) %D 2015 %7 17.06.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Alcohol use is a risk factor for the acquisition of human immunodeficiency virus (HIV) among African American men who have sex with men (MSM). Mobile phone-based ecological momentary assessments (EMA) could minimize bias due to retrospective recall and thus provide a better understanding of the social and structural context of alcohol use and its relationship with HIV-related risk behaviors in this population as well as other highly stigmatized populations. Objective: We describe the study design and the implementation, feasibility, reactivity, and acceptability of an EMA study of alcohol use and HIV-related behaviors among African American MSM in Baltimore. Methods: Participants were recruited through flyers and word-of-mouth in Baltimore from September 2013 to November 2014. Each participant was loaned an Android smartphone and instructed to respond to multiple prompts from the mobile app for 4 weeks. Data were collected through (1) random prompts delivered three times daily assessing participants’ location, activity, mood, and social context, (2) daily prompts capturing drinking and sex events occurring in the past 24 hours, and (3) event-contingent responses collecting participants’ self-reported episodes of drinking. Results: A total of 16 participants enrolled in the study. The current analyses focused on 15 participants who completed at least 24 days of follow-up (mean follow-up time 29 days; range 24-35 days). Study participants (N=15) were a median 38 years of age (range 27-62 years) with low levels of income and educational attainment. Ten individuals self-reported living with HIV/AIDS, over half reported drinking alcohol at least 2-3 times a week, and a third reported binge drinking (ie, 6 or more drinks on one occasion) on a weekly basis. Based on the Alcohol Use Disorders Identification Test (AUDIT) score, nearly half were classified as hazardous drinkers (score 8-15) and a fifth were likely dependent (score ≥16). A total of 140 participant-initiated events were reported, and 75% of 1308 random prompts and 81% of 436 daily prompts delivered were answered. Of seven devices used during the study, five were reported lost by participants. We did not observe strong reactivity effects, and self-reported acceptability to study procedures was uniformly favorable. Conclusions: This study provides evidence to support the feasibility and acceptability of using EMA methods for collecting data on alcohol use among African American men who have sex with men living in urban settings. These data provide the basis for future studies of EMA-informed mHealth interventions to promote the reduction of substance use and HIV risk-taking behaviors among African American MSM living in urban settings. %M 26085078 %R 10.2196/mhealth.4344 %U http://mhealth.jmir.org/2015/2/e67/ %U https://doi.org/10.2196/mhealth.4344 %U http://www.ncbi.nlm.nih.gov/pubmed/26085078 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 6 %P e149 %T Using Web-Based Questionnaires and Obstetric Records to Assess General Health Characteristics Among Pregnant Women: A Validation Study %A van Gelder,Marleen MHJ %A Schouten,Naomi PE %A Merkus,Peter JFM %A Verhaak,Chris M %A Roeleveld,Nel %A Roukema,Jolt %+ Department for Health Evidence, Radboud Institute for Health Sciences, Radboud university medical center, P.O. Box 9101, Nijmegen, 6500 HB, Netherlands, 31 24 3666126, Marleen.vanGelder@radboudumc.nl %K questionnaires %K medical records %K validation studies %K pregnancy %K chronic disease %K allergens %K blood pressure %K Internet %K PRIDE Study %D 2015 %7 16.06.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Self-reported medical history information is included in many studies. However, data on the validity of Web-based questionnaires assessing medical history are scarce. If proven to be valid, Web-based questionnaires may provide researchers with an efficient means to collect data on this parameter in large populations. Objective: The aim of this study was to assess the validity of a Web-based questionnaire on chronic medical conditions, allergies, and blood pressure readings against obstetric records and data from general practitioners. Methods: Self-reported questionnaire data were compared with obstetric records for 519 pregnant women participating in the Dutch PRegnancy and Infant DEvelopment (PRIDE) Study from July 2011 through November 2012. These women completed Web-based questionnaires around their first prenatal care visit and in gestational weeks 17 and 34. We calculated kappa statistics (κ) and the observed proportions of positive and negative agreement between the baseline questionnaire and obstetric records for chronic conditions and allergies. In case of inconsistencies between these 2 data sources, medical records from the woman’s general practitioner were consulted as the reference standard. For systolic and diastolic blood pressure, intraclass correlation coefficients (ICCs) were calculated for multiple data points. Results: Agreement between the baseline questionnaire and the obstetric record was substantial (κ=.61) for any chronic condition and moderate for any allergy (κ=.51). For specific conditions, we found high observed proportions of negative agreement (range 0.88-1.00) and on average moderate observed proportions of positive agreement with a wide range (range 0.19-0.90). Using the reference standard, the sensitivity of the Web-based questionnaire for chronic conditions and allergies was comparable to or even better than the sensitivity of the obstetric records, in particular for migraine (0.90 vs 0.40, P=.02), asthma (0.86 vs 0.61, P=.04), inhalation allergies (0.92 vs 0.74, P=.003), hay fever (0.90 vs 0.64, P=.001), and allergies to animals (0.89 vs 0.53, P=.01). However, some overreporting of allergies was observed in the questionnaire and for some nonsomatic conditions sensitivity of both measurement instruments was low. The ICCs for blood pressure readings ranged between 0.72 and 0.92 with very small mean differences between the 2 methods of data collection. Conclusions: Web-based questionnaires can be used to validly collect data on many chronic disorders, allergies, and blood pressure readings among pregnant women. %M 26081990 %R 10.2196/jmir.3847 %U http://www.jmir.org/2015/6/e149/ %U https://doi.org/10.2196/jmir.3847 %U http://www.ncbi.nlm.nih.gov/pubmed/26081990 %0 Journal Article %@ 2291-9694 %I Gunther Eysenbach %V 3 %N 2 %P e23 %T A Web-Based Tool for Patient Triage in Emergency Department Settings: Validation Using the Emergency Severity Index %A Elias,Pierre %A Damle,Ash %A Casale,Michael %A Branson,Kim %A Peterson,Nick %A Churi,Chaitanya %A Komatireddy,Ravi %A Feramisco,Jamison %+ Duke Clinical Research Institute, Duke University School of Medicine, DCRI 7th Floor, 2400 Pratt St, Durham, NC, 27705, United States, 1 407 782 2266, pierre.elias@duke.edu %K triage %K emergency severity index %K differential diagnosis %K clinical decision support %D 2015 %7 10.6.2015 %9 Original Paper %J JMIR Med Inform %G English %X Background: We evaluated the concordance between triage scores generated by a novel Internet clinical decision support tool, Clinical GPS (cGPS) (Lumiata Inc, San Mateo, CA), and the Emergency Severity Index (ESI), a well-established and clinically validated patient severity scale in use today. Although the ESI and cGPS use different underlying algorithms to calculate patient severity, both utilize a five-point integer scale with level 1 representing the highest severity. Objective: The objective of this study was to compare cGPS results with an established gold standard in emergency triage. Methods: We conducted a blinded trial comparing triage scores from the ESI: A Triage Tool for Emergency Department Care, Version 4, Implementation Handbook to those generated by cGPS from the text of 73 sample case vignettes. A weighted, quadratic kappa statistic was used to assess agreement between cGPS derived severity scores and those published in the ESI handbook for all 73 cases. Weighted kappa concordance was defined a priori as almost perfect (kappa > 0.8), substantial (0.6 < kappa < 0.8), moderate (0.4 < kappa < 0.6), fair (0.2 < kappa< 0.4), or slight (kappa < 0.2). Results: Of the 73 case vignettes, the cGPS severity score matched the ESI handbook score in 95% of cases (69/73 cases), in addition, the weighted, quadratic kappa statistic showed almost perfect agreement (kappa = 0.93, 95% CI 0.854-0.996). In the subanalysis of 41 case vignettes assigned ESI scores of level 1 or 2, the cGPS and ESI severity scores matched in 95% of cases (39/41 cases). Conclusions: These results indicate that the cGPS is a reliable indicator of triage severity, based on its comparison to a standardized index, the ESI. Future studies are needed to determine whether the cGPS can accurately assess the triage of patients in real clinical environments. %R 10.2196/medinform.3508 %U http://medinform.jmir.org/2015/2/e23/ %U https://doi.org/10.2196/medinform.3508 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 2 %P e20 %T Word Recall: Cognitive Performance Within Internet Surveys %A Runge,Shannon K %A Craig,Benjamin M %A Jim,Heather S %+ University of South Florida and Moffitt Cancer Center, MRC-CANCONT, 12902 Magnolia Dr., Tampa, FL, , United States, 1 813 745 1245, shannon.runge@moffitt.org %K cognition %K online surveys %K episodic memory %K Health and Retirement Study %K Women’s Health Valuation Study %D 2015 %7 02.06.2015 %9 Original Paper %J JMIR Mental Health %G English %X Background: The use of online surveys for data collection has increased exponentially, yet it is often unclear whether interview-based cognitive assessments (such as face-to-face or telephonic word recall tasks) can be adapted for use in application-based research settings. Objective: The objective of the current study was to compare and characterize the results of online word recall tasks to those of the Health and Retirement Study (HRS) and determine the feasibility and reliability of incorporating word recall tasks into application-based cognitive assessments. Methods: The results of the online immediate and delayed word recall assessment, included within the Women’s Health and Valuation (WHV) study, were compared to the results of the immediate and delayed recall tasks of Waves 5-11 (2000-2012) of the HRS. Results: Performance on the WHV immediate and delayed tasks demonstrated strong concordance with performance on the HRS tasks (ρc=.79, 95% CI 0.67-0.91), despite significant differences between study populations (P<.001) and study design. Sociodemographic characteristics and self-reported memory demonstrated similar relationships with performance on both the HRS and WHV tasks. Conclusions: The key finding of this study is that the HRS word recall tasks performed similarly when used as an online cognitive assessment in the WHV. Online administration of cognitive tests, which has the potential to significantly reduce participant and administrative burden, should be considered in future research studies and health assessments. %M 26543924 %R 10.2196/mental.3969 %U http://mental.jmir.org/2015/2/e20/ %U https://doi.org/10.2196/mental.3969 %U http://www.ncbi.nlm.nih.gov/pubmed/26543924 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 5 %P e131 %T The Relationship Between Balance Measured With a Modified Bathroom Scale and Falls and Disability in Older Adults: A 6-Month Follow-Up Study %A Vermeulen,Joan %A Neyens,Jacques CL %A Spreeuwenberg,Marieke D %A van Rossum,Erik %A Boessen,April BCG %A Sipers,Walther %A de Witte,Luc P %+ School for Public Health and Primary Care (CAPHRI), Department of Health Services Research, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, Netherlands, 31 433882199, j.vermeulen@maastrichtuniversity.nl %K telemonitoring %K balance %K bathroom scale %K older adults %K falls %K disability %K validity %D 2015 %7 27.05.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: There are indications that older adults who suffer from poor balance have an increased risk for adverse health outcomes, such as falls and disability. Monitoring the development of balance over time enables early detection of balance decline, which can identify older adults who could benefit from interventions aimed at prevention of these adverse outcomes. An innovative and easy-to-use device that can be used by older adults for home-based monitoring of balance is a modified bathroom scale. Objective: The objective of this paper is to study the relationship between balance scores obtained with a modified bathroom scale and falls and disability in a sample of older adults. Methods: For this 6-month follow-up study, participants were recruited via physiotherapists working in a nursing home, geriatricians, exercise classes, and at an event about health for older adults. Inclusion criteria were being aged 65 years or older, being able to stand on a bathroom scale independently, and able to provide informed consent. A total of 41 nursing home patients and 139 community-dwelling older adults stepped onto the modified bathroom scale three consecutive times at baseline to measure their balance. Their mean balance scores on a scale from 0 to 16 were calculated—higher scores indicated better balance. Questionnaires were used to study falls and disability at baseline and after 6 months of follow-up. The cross-sectional relationship between balance and falls and disability at baseline was studied using t tests and Spearman rank correlations. Univariate and multivariate logistic regression analyses were conducted to study the relationship between balance measured at baseline and falls and disability development after 6 months of follow-up. Results: A total of 128 participants with complete datasets—25.8% (33/128) male—and a mean age of 75.33 years (SD 6.26) were included in the analyses of this study. Balance scores of participants who reported at baseline that they had fallen at least once in the past 6 months were lower compared to nonfallers—8.9 and 11.2, respectively (P<.001). The correlation between mean balance score and disability sum-score at baseline was -.51 (P<.001). No significant associations were found between balance at baseline and falls after 6 months of follow-up. Baseline balance scores were significantly associated with the development of disability after 6 months of follow-up in the univariate analysis—odds ratio (OR) 0.86 (95% CI 0.76-0.98)—but not in the multivariate analysis when correcting for age, gender, baseline disability, and falls at follow-up—OR 0.94 (95% CI 0.79-1.11). Conclusions: There is a cross-sectional relationship between balance measured by a modified bathroom scale and falls and disability in older adults. Despite this cross-sectional relationship, longitudinal data showed that balance scores have no predictive value for falls and might only have limited predictive value for disability development after 6 months of follow-up. %M 26018423 %R 10.2196/jmir.3802 %U http://www.jmir.org/2015/5/e131/ %U https://doi.org/10.2196/jmir.3802 %U http://www.ncbi.nlm.nih.gov/pubmed/26018423 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e39 %T Testing the Feasibility and Psychometric Properties of a Mobile Diary (myWHI) in Adolescents and Young Adults With Headaches %A Huguet,Anna %A McGrath,Patrick J %A Wheaton,Michael %A Mackinnon,Sean P %A Rozario,Sharlene %A Tougas,Michelle E %A Stinson,Jennifer N %A MacLean,Cathy %+ IWK Health Centre, Centre for Research in Family Health, 5850/5980 University Avenue, 8th Floor Children’s Building, Room K8527, PO Box 9, Halifax, NS, B3K 6R8, Canada, 1 902 470 7521, anna.huguet@iwk.nshealth.ca %K headache %K diary %K smartphone %K feasibility %K psychometric properties %D 2015 %7 08.05.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Headaches are prevalent among teens and young adults. Self-monitoring is essential for managing headaches and can be accomplished with the help of electronic headache diaries. An increasing number of electronic headache diaries exist, yet the absence of quality standards compromises their use for research and clinical purposes. Objective: Our goal was to develop and test the usability, feasibility, and psychometric properties of an electronic diary iPhone application for self-monitoring by adolescents and young adults with headaches. Methods: We used an iterative participatory design to develop and test our electronic headache diary. Participants aged 14-28 years old with recurrent headaches were recruited internationally. Screening and consent were conducted online. Following completion of an online pre-questionnaire, participants downloaded the diary to use in their natural environment for 14 days. An online post-questionnaire was completed following testing. The diary’s usability and feasibility were tested first and determined to be complete when improvements to the diary did not result in a statistically significant impact on indicators of feasibility and adherence. Interviews were conducted with participants of usability and feasibility testing. The psychometric properties of the diary were then tested, and a case study analysis of one participant was completed. Results: Three cycles to test the usability and feasibility were conducted. Each cycle included 11-19 unique participants ranging in age from 16 to 28 years. Following the testing period for each cycle, 15% to 25% of participants took part in the post-cycle interview. Participants perceived the final version of the diary as useful, easy to learn, and efficient to use. Psychometric properties were then tested with a sample of 65 participants (6 aged 14-17 years old; 59 aged 18-28 years old). All items in the diary had substantial between- and within-subjects variability (percent of variance for the two participant groups ranged from 20.64 to 75.60 and 23.74 to 79.21, respectively). Moreover, the Migraine Disability Assessment (MIDAS) included in the diary had adequate between-subjects reliability (R1F=0.66, RKF=0.98), but low within-subjects reliability (RC=0.51). Critical elements of the diary demonstrated adequate convergent and concurrent validity, particularly in the older age group (18-28 years). The validity of some critical elements of the diary could not be explored in the younger age group due to the small subgroup size. The case study provides an example of the potential utility of the diary. Conclusions: Our electronic headache diary was shown to be a usable and feasible self-monitoring tool when used by adolescents and young adults with headaches for 14 days. This study provides preliminary support of its psychometric properties. Our diary has the potential for helping users to better understand their headaches and, consequently, to change behaviors to improve self-management of their headaches. Its effectiveness as a component of an intervention will be the focus of future research. %M 25956377 %R 10.2196/mhealth.3879 %U http://mhealth.jmir.org/2015/2/e39/ %U https://doi.org/10.2196/mhealth.3879 %U http://www.ncbi.nlm.nih.gov/pubmed/25956377 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 4 %P e107 %T Using a 3D Virtual Supermarket to Measure Food Purchase Behavior: A Validation Study %A Waterlander,Wilma Elzeline %A Jiang,Yannan %A Steenhuis,Ingrid Hendrika Margaretha %A Ni Mhurchu,Cliona %+ National Institute for Health Innovation, School of Population Health, University of Auckland, Tamaki Campus, 261 Morrin Road, Auckland, 1072, New Zealand, 64 09 9234612, w.waterlander@auckland.ac.nz %K virtual reality %K user-computer interface %K software validation %K nutrition policy %K food %K behavior %K public health %D 2015 %7 28.04.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: There is increasing recognition that supermarkets are an important environment for health-promoting interventions such as fiscal food policies or front-of-pack nutrition labeling. However, due to the complexities of undertaking such research in the real world, well-designed randomized controlled trials on these kinds of interventions are lacking. The Virtual Supermarket is a 3-dimensional computerized research environment designed to enable experimental studies in a supermarket setting without the complexity or costs normally associated with undertaking such research. Objective: The primary objective was to validate the Virtual Supermarket by comparing virtual and real-life food purchasing behavior. A secondary objective was to obtain participant feedback on perceived sense of “presence” (the subjective experience of being in one place or environment even if physically located in another) in the Virtual Supermarket. Methods: Eligible main household shoppers (New Zealand adults aged ≥18 years) were asked to conduct 3 shopping occasions in the Virtual Supermarket over 3 consecutive weeks, complete the validated Presence Questionnaire Items Stems, and collect their real supermarket grocery till receipts for that same period. Proportional expenditure (NZ$) and the proportion of products purchased over 18 major food groups were compared between the virtual and real supermarkets. Data were analyzed using repeated measures mixed models. Results: A total of 123 participants consented to take part in the study. In total, 69.9% (86/123) completed 1 shop in the Virtual Supermarket, 64.2% (79/123) completed 2 shops, 60.2% (74/123) completed 3 shops, and 48.8% (60/123) returned their real supermarket till receipts. The 4 food groups with the highest relative expenditures were the same for the virtual and real supermarkets: fresh fruit and vegetables (virtual estimate: 14.3%; real: 17.4%), bread and bakery (virtual: 10.0%; real: 8.2%), dairy (virtual: 19.1%; real: 12.6%), and meat and fish (virtual: 16.5%; real: 16.8%). Significant differences in proportional expenditures were observed for 6 food groups, with largest differences (virtual – real) for dairy (in expenditure 6.5%, P<.001; in items 2.2%, P=.04) and fresh fruit and vegetables (in expenditure: –3.1%, P=.04; in items: 5.9%, P=.002). There was no trend of overspending in the Virtual Supermarket and participants experienced a medium-to-high presence (88%, 73/83 scored medium; 8%, 7/83 scored high). Conclusions: Shopping patterns in the Virtual Supermarket were comparable to those in real life. Overall, the Virtual Supermarket is a valid tool to measure food purchasing behavior. Nevertheless, it is important to improve the functionality of some food categories, in particular fruit and vegetables and dairy. The results of this validation will assist in making further improvements to the software and with optimization of the internal and external validity of this innovative methodology. %M 25921185 %R 10.2196/jmir.3774 %U http://www.jmir.org/2015/4/e107/ %U https://doi.org/10.2196/jmir.3774 %U http://www.ncbi.nlm.nih.gov/pubmed/25921185 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e38 %T A New Mobile Phone-Based Tool for Assessing Energy and Certain Food Intakes in Young Children: A Validation Study %A Henriksson,Hanna %A Bonn,Stephanie E %A Bergström,Anna %A Bälter,Katarina %A Bälter,Olle %A Delisle,Christine %A Forsum,Elisabet %A Löf,Marie %+ Karolinska Institutet, Department of Biosciences and Nutrition, Novum, Huddinge, 14183, Sweden, 46 734426417, marie.lof@ki.se %K cell phone %K digital camera %K food intake %K energy intake %K child %K DLW %K FFQ %D 2015 %7 24.04.2015 %9 Short Paper %J JMIR mHealth uHealth %G English %X Background: Childhood obesity is an increasing health problem globally. Obesity may be established already at pre-school age. Further research in this area requires accurate and easy-to-use methods for assessing the intake of energy and foods. Traditional methods have limited accuracy, and place large demands on the study participants and researchers. Mobile phones offer possibilities for methodological advancements in this area since they are readily available, enable instant digitalization of collected data, and also contain a camera to photograph pre- and post-meal food items. We have recently developed a new tool for assessing energy and food intake in children using mobile phones called the Tool for Energy Balance in Children (TECH). Objective: The main aims of our study are to (1) compare energy intake by means of TECH with total energy expenditure (TEE) measured using a criterion method, the doubly labeled water (DLW) method, and (2) to compare intakes of fruits and berries, vegetables, juice, and sweetened beverages assessed by means of TECH with intakes obtained using a Web-based food frequency questionnaire (KidMeal-Q) in 3 year olds. Methods: In this study, 30 Swedish 3 year olds were included. Energy intake using TECH was compared to TEE measured using the DLW method. Intakes of vegetables, fruits and berries, juice, as well as sweetened beverages were assessed using TECH and compared to the corresponding intakes assessed using KidMeal-Q. Wilcoxon matched pairs test, Spearman rank order correlations, and the Bland-Altman procedure were applied. Results: The mean energy intake, assessed by TECH, was 5400 kJ/24h (SD 1500). This value was not significantly different (P=.23) from TEE (5070 kJ/24h, SD 600). However, the limits of agreement (2 standard deviations) in the Bland-Altman plot for energy intake estimated using TECH compared to TEE were wide (2990 kJ/24h), and TECH overestimated high and underestimated low energy intakes. The Bland-Altman plots for foods showed similar patterns. The mean intakes of vegetables, fruits and berries, juice, and sweetened beverages estimated using TECH were not significantly different from the corresponding intakes estimated using KidMeal-Q. Moderate but statistically significant correlations (ρ=.42-.46, P=.01-.02) between TECH and KidMeal-Q were observed for intakes of vegetables, fruits and berries, and juice, but not for sweetened beverages. Conclusion: We found that one day of recordings using TECH was not able to accurately estimate intakes of energy or certain foods in 3 year old children. %M 25910494 %R 10.2196/mhealth.3670 %U http://mhealth.jmir.org/2015/2/e38/ %U https://doi.org/10.2196/mhealth.3670 %U http://www.ncbi.nlm.nih.gov/pubmed/25910494 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 2 %P e12 %T Factor Structure of the Internet Addiction Test in Online Gamers and Poker Players %A Khazaal,Yasser %A Achab,Sophia %A Billieux,Joel %A Thorens,Gabriel %A Zullino,Daniele %A Dufour,Magali %A Rothen,Stéphane %+ Geneva University Hospitals, Grand Pré 70C, Geneva, 1206, Switzerland, 41 223725550, yasser.khazaal@hcuge.ch %K Internet addiction %K Internet Addiction Test (IAT) %K poker players %K World of Warcraft %K massively multiplayer online role playing %K validation %K factorial structure %D 2015 %7 22.04.2015 %9 Original Paper %J JMIR Mental Health %G English %X Background: The Internet Addiction Test (IAT) is the most widely used questionnaire to screen for problematic Internet use. Nevertheless, its factorial structure is still debated, which complicates comparisons among existing studies. Most previous studies were performed with students or community samples despite the probability of there being more problematic Internet use among users of specific applications, such as online gaming or gambling. Objective: To assess the factorial structure of a modified version of the IAT that addresses specific applications, such as video games and online poker. Methods: Two adult samples—one sample of Internet gamers (n=920) and one sample of online poker players (n=214)—were recruited and completed an online version of the modified IAT. Both samples were split into two subsamples. Two principal component analyses (PCAs) followed by two confirmatory factor analyses (CFAs) were run separately. Results: The results of principal component analysis indicated that a one-factor model fit the data well across both samples. In consideration of the weakness of some IAT items, a 17-item modified version of the IAT was proposed. Conclusions: This study assessed, for the first time, the factorial structure of a modified version of an Internet-administered IAT on a sample of Internet gamers and a sample of online poker players. The scale seems appropriate for the assessment of such online behaviors. Further studies on the modified 17-item IAT version are needed. %M 26543917 %R 10.2196/mental.3805 %U http://mental.jmir.org/2015/2/e12/ %U https://doi.org/10.2196/mental.3805 %U http://www.ncbi.nlm.nih.gov/pubmed/26543917 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 1 %P e8 %T Utilizing a Personal Smartphone Custom App to Assess the Patient Health Questionnaire-9 (PHQ-9) Depressive Symptoms in Patients With Major Depressive Disorder %A Torous,John %A Staples,Patrick %A Shanahan,Meghan %A Lin,Charlie %A Peck,Pamela %A Keshavan,Matcheri %A Onnela,Jukka-Pekka %+ Harvard Longwood Psychiatry Residency Training Prorgam, 330 Brookline Ave, Boston, MA, 02115, United States, 1 (617) 667 6700 ext 11315, jtorous@bidmc.harvard.edu %K medical informatics %K mobile health %K depression %D 2015 %7 24.03.2015 %9 Original Paper %J JMIR Mental Health %G English %X Background: Accurate reporting of patient symptoms is critical for diagnosis and therapeutic monitoring in psychiatry. Smartphones offer an accessible, low-cost means to collect patient symptoms in real time and aid in care. Objective: To investigate adherence among psychiatric outpatients diagnosed with major depressive disorder in utilizing their personal smartphones to run a custom app to monitor Patient Health Questionnaire-9 (PHQ-9) depression symptoms, as well as to examine the correlation of these scores to traditionally administered (paper-and-pencil) PHQ-9 scores. Methods: A total of 13 patients with major depressive disorder, referred by their clinicians, received standard outpatient treatment and, in addition, utilized their personal smartphones to run the study app to monitor their symptoms. Subjects downloaded and used the Mindful Moods app on their personal smartphone to complete up to three survey sessions per day, during which a randomized subset of PHQ-9 symptoms of major depressive disorder were assessed on a Likert scale. The study lasted 29 or 30 days without additional follow-up. Outcome measures included adherence, measured by the percentage of completed survey sessions, and estimates of daily PHQ-9 scores collected from the smartphone app, as well as from the traditionally administered PHQ-9. Results: Overall adherence was 77.78% (903/1161) and varied with time of day. PHQ-9 estimates collected from the app strongly correlated (r=.84) with traditionally administered PHQ-9 scores, but app-collected scores were 3.02 (SD 2.25) points higher on average. More subjects reported suicidal ideation using the app than they did on the traditionally administered PHQ-9. Conclusions: Patients with major depressive disorder are able to utilize an app on their personal smartphones to self-assess their symptoms of major depressive disorder with high levels of adherence. These app-collected results correlate with the traditionally administered PHQ-9. Scores recorded from the app may potentially be more sensitive and better able to capture suicidality than the traditional PHQ-9. %M 26543914 %R 10.2196/mental.3889 %U http://mental.jmir.org/2015/1/e8/ %U https://doi.org/10.2196/mental.3889 %U http://www.ncbi.nlm.nih.gov/pubmed/26543914 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 3 %P e73 %T Web-Based Self-Reported Height, Weight, and Body Mass Index Among Swedish Adolescents: A Validation Study %A Ekström,Sandra %A Kull,Inger %A Nilsson,Sara %A Bergström,Anna %+ Institute of Environmental Medicine, Karolinska Institutet, BOX 210, Stockholm, 17177, Sweden, 46 852487010, Sandra.Ekstrom@ki.se %K adolescent %K body height %K body weight %K body mass index %K validity %K Internet %D 2015 %7 18.03.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-collected height and weight are increasingly used in epidemiological studies; however, the validity has rarely been evaluated. Objective: The aim of the study was to validate self-reported height, weight, and corresponding body mass index (BMI) among Swedish adolescents aged approximately 16 years. A secondary aim was to investigate possible prediction factors for validity of self-reported BMI. Methods: The study included 1698 adolescents from the population-based cohort BAMSE. Height and weight were collected through a Web-based questionnaire and subsequently measured using standard procedures. Differences between reported and measured height, weight, and corresponding BMI were compared by t tests and agreement was evaluated by Pearson correlation and Bland-Altman plots. Multivariable linear regression analysis was used to investigate whether lifestyle and demographic factors predicted validity of self-reported BMI. Results: On average, weight was underestimated by 1.1 kg and height was overestimated by 0.5 cm, leading to an underestimation of BMI by 0.5 kg/m2. Correlation coefficients were .98 for height, .97 for weight, and .94 for BMI, and highly significant. Females underestimated weight to a higher extent than males and overweight and obese participants underestimated weight to a higher extent than normal-weight participants, which resulted in higher underestimation of BMI. Underweight participants, on the contrary, overestimated weight and correspondingly BMI. Overall, a high proportion of participants were classified into the correct BMI category; however, among overweight and obese participants, only 60.2% (139/231) and 46% (20/44) were correctly classified, respectively. In the multivariable prediction model, only gender and BMI status significantly predicted discrepancy between reported and measured BMI. Conclusions: Web-collected BMI may be used as a valid, quick, and cost-effective alternative to measured BMI among Swedish adolescents. The accuracy of self-reported BMI declines with increasing BMI and self-reported BMI should not be used to estimate the prevalence of overweight or obesity. %M 25791395 %R 10.2196/jmir.3947 %U http://www.jmir.org/2015/3/e73/ %U https://doi.org/10.2196/jmir.3947 %U http://www.ncbi.nlm.nih.gov/pubmed/25791395 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e30 %T A Mobile Phone Food Record App to Digitally Capture Dietary Intake for Adolescents in a Free-Living Environment: Usability Study %A Casperson,Shanon L %A Sieling,Jared %A Moon,Jon %A Johnson,LuAnn %A Roemmich,James N %A Whigham,Leah %+ Grand Forks Human Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, 2420 2nd Ave N., Grand Forks, ND, , United States, 1 701 795 8497, shanon.casperson@ars.usda.gov %K adolescents %K dietary food records %K smartphone app %K dietary assessment %K food record app %D 2015 %7 13.03.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile technologies are emerging as valuable tools to collect and assess dietary intake. Adolescents readily accept and adopt new technologies; thus, a food record app (FRapp) may be a useful tool to better understand adolescents’ dietary intake and eating patterns. Objective: We sought to determine the amenability of adolescents, in a free-living environment with minimal parental input, to use the FRapp to record their dietary intake. Methods: Eighteen community-dwelling adolescents (11-14 years) received detailed instructions to record their dietary intake for 3-7 days using the FRapp. Participants were instructed to capture before and after images of all foods and beverages consumed and to include a fiducial marker in the image. Participants were also asked to provide text descriptors including amount and type of all foods and beverages consumed. Results: Eight of 18 participants were able to follow all instructions: included pre- and post-meal images, a fiducial marker, and a text descriptor and collected diet records on 2 weekdays and 1 weekend day. Dietary intake was recorded on average for 3.2 (SD 1.3 days; 68% weekdays and 32% weekend days) with an average of 2.2 (SD 1.1) eating events per day per participant. A total of 143 eating events were recorded, of which 109 had at least one associated image and 34 were recorded with text only. Of the 109 eating events with images, 66 included all foods, beverages and a fiducial marker and 44 included both a pre- and post-meal image. Text was included with 78 of the captured images. Of the meals recorded, 36, 33, 35, and 39 were breakfasts, lunches, dinners, and snacks, respectively. Conclusions: These data suggest that mobile devices equipped with an app to record dietary intake will be used by adolescents in a free-living environment; however, a minority of participants followed all directions. User-friendly mobile food record apps may increase participant amenability, increasing our understanding of adolescent dietary intake and eating patterns. To improve data collection, the FRapp should deliver prompts for tasks, such as capturing images before and after each eating event, including the fiducial marker in the image, providing complete and accurate text information, and ensuring all eating events are recorded and should be customizable to individuals and to different situations. Trial Registration: Clinicaltrials.gov NCT01803997. http://clinicaltrials.gov/ct2/show/NCT01803997 (Archived at: http://www.webcitation.org/6WiV1vxoR). %M 25775506 %R 10.2196/mhealth.3324 %U http://mhealth.jmir.org/2015/1/e30/ %U https://doi.org/10.2196/mhealth.3324 %U http://www.ncbi.nlm.nih.gov/pubmed/25775506 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e27 %T Mobile App Rating Scale: A New Tool for Assessing the Quality of Health Mobile Apps %A Stoyanov,Stoyan R %A Hides,Leanne %A Kavanagh,David J %A Zelenko,Oksana %A Tjondronegoro,Dian %A Mani,Madhavan %+ Institute of Health & Biomedical Innovation, School of Psychology and Counselling, Queensland University of Technology (QUT), 60 Musk Avenue, Brisbane, QLD, , Australia, 61 731386144, leanne.hides@qut.edu.au %K well being %K mental health %K e-health %K mobile health (mhealth) %K mobile application %K assessment %K rating %K scale development %D 2015 %7 11.03.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: The use of mobile apps for health and well being promotion has grown exponentially in recent years. Yet, there is currently no app-quality assessment tool beyond “star”-ratings. Objective: The objective of this study was to develop a reliable, multidimensional measure for trialling, classifying, and rating the quality of mobile health apps. Methods: A literature search was conducted to identify articles containing explicit Web or app quality rating criteria published between January 2000 and January 2013. Existing criteria for the assessment of app quality were categorized by an expert panel to develop the new Mobile App Rating Scale (MARS) subscales, items, descriptors, and anchors. There were sixty well being apps that were randomly selected using an iTunes search for MARS rating. There were ten that were used to pilot the rating procedure, and the remaining 50 provided data on interrater reliability. Results: There were 372 explicit criteria for assessing Web or app quality that were extracted from 25 published papers, conference proceedings, and Internet resources. There were five broad categories of criteria that were identified including four objective quality scales: engagement, functionality, aesthetics, and information quality; and one subjective quality scale; which were refined into the 23-item MARS. The MARS demonstrated excellent internal consistency (alpha = .90) and interrater reliability intraclass correlation coefficient (ICC = .79). Conclusions: The MARS is a simple, objective, and reliable tool for classifying and assessing the quality of mobile health apps. It can also be used to provide a checklist for the design and development of new high quality health apps. %M 25760773 %R 10.2196/mhealth.3422 %U http://mhealth.jmir.org/2015/1/e27/ %U https://doi.org/10.2196/mhealth.3422 %U http://www.ncbi.nlm.nih.gov/pubmed/25760773 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 2 %P e41 %T FRAT-up, a Web-based Fall-Risk Assessment Tool for Elderly People Living in the Community %A Cattelani,Luca %A Palumbo,Pierpaolo %A Palmerini,Luca %A Bandinelli,Stefania %A Becker,Clemens %A Chesani,Federico %A Chiari,Lorenzo %+ Department of Computer Science and Engineering - DISI, University of Bologna, Viale Risorgimento 2, Bologna, 40136, Italy, 39 051 2093086, federico.chesani@unibo.it %K accidental falls %K odds ratio %K risk assessment %K risk factors %K ROC curve %K aged %D 2015 %7 18.02.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: About 30% of people over 65 are subject to at least one unintentional fall a year. Fall prevention protocols and interventions can decrease the number of falls. To be effective, a prevention strategy requires a prior step to evaluate the fall risk of the subjects. Despite extensive research, existing assessment tools for fall risk have been insufficient for predicting falls. Objective: The goal of this study is to present a novel web-based fall-risk assessment tool (FRAT-up) and to evaluate its accuracy in predicting falls, within a context of community-dwelling persons aged 65 and up. Methods: FRAT-up is based on the assumption that a subject’s fall risk is given by the contribution of their exposure to each of the known fall-risk factors. Many scientific studies have investigated the relationship between falls and risk factors. The majority of these studies adopted statistical approaches, usually providing quantitative information such as odds ratios. FRAT-up exploits these numerical results to compute how each single factor contributes to the overall fall risk. FRAT-up is based on a formal ontology that enlists a number of known risk factors, together with quantitative findings in terms of odds ratios. From such information, an automatic algorithm generates a rule-based probabilistic logic program, that is, a set of rules for each risk factor. The rule-based program takes the health profile of the subject (in terms of exposure to the risk factors) and computes the fall risk. A Web-based interface allows users to input health profiles and to visualize the risk assessment for the given subject. FRAT-up has been evaluated on the InCHIANTI Study dataset, a representative population-based study of older persons living in the Chianti area (Tuscany, Italy). We compared reported falls with predicted ones and computed performance indicators. Results: The obtained area under curve of the receiver operating characteristic was 0.642 (95% CI 0.614-0.669), while the Brier score was 0.174. The Hosmer-Lemeshow test indicated statistical significance of miscalibration. Conclusions: FRAT-up is a web-based tool for evaluating the fall risk of people aged 65 or up living in the community. Validation results of fall risks computed by FRAT-up show that its performance is comparable to externally validated state-of-the-art tools. A prototype is freely available through a web-based interface. Trial Registration: ClinicalTrials.gov NCT01331512 (The InChianti Follow-Up Study); http://clinicaltrials.gov/show/NCT01331512 (Archived by WebCite at http://www.webcitation.org/6UDrrRuaR). %M 25693419 %R 10.2196/jmir.4064 %U http://www.jmir.org/2015/2/e41/ %U https://doi.org/10.2196/jmir.4064 %U http://www.ncbi.nlm.nih.gov/pubmed/25693419 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 1 %P e15 %T Bringing Feedback in From the Outback via a Generic and Preference-Sensitive Instrument for Course Quality Assessment %A Kaltoft,Mette K %A Nielsen,Jesper B %A Salkeld,Glenn %A Lander,Jo %A Dowie,Jack %+ Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, United Kingdom, 44 2079272034, jack.dowie@lshtm.ac.uk %K medical education %K nursing education %K course assessment %K course evaluation %K student feedback %K Internet %K personalization %D 2015 %7 13.02.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Much effort and many resources have been put into developing ways of eliciting valid and informative student feedback on courses in medical, nursing, and other health professional schools. Whatever their motivation, items, and setting, the response rates have usually been disappointingly low, and there seems to be an acceptance that the results are potentially biased. Objective: The objective of the study was to look at an innovative approach to course assessment by students in the health professions. This approach was designed to make it an integral part of their educational experience, rather than a marginal, terminal, and optional add-on as “feedback”. It becomes a weighted, but ungraded, part of the course assignment requirements. Methods: A ten-item, two-part Internet instrument, MyCourseQuality (MCQ-10D), was developed following a purposive review of previous instruments. Shorthand labels for the criteria are: Content, Organization, Perspective, Presentations, Materials, Relevance, Workload, Support, Interactivity, and Assessment. The assessment is unique in being dually personalized. In part 1, at the beginning of the course, the student enters their importance weights for the ten criteria. In part 2, at its completion, they rate the course on the same criteria. Their ratings and weightings are combined in a simple expected-value calculation to produce their dually personalized and decomposable MCQ score. Satisfactory (technical) completion of both parts contributes 10% of the marks available in the course. Providers are required to make the relevant characteristics of the course fully transparent at enrollment, and the course is to be rated as offered. A separate item appended to the survey allows students to suggest changes to what is offered. Students also complete (anonymously) the standard feedback form in the setting concerned. Results: Piloting in a medical school and health professional school will establish the organizational feasibility and acceptability of the approach (a version of which has been employed in one medical school previously), as well as its impact on provider behavior and intentions, and on student engagement and responsiveness. The priorities for future improvements in terms of the specified criteria are identified at both individual and group level. The group results from MCQ will be compared with those from the standard feedback questionnaire, which will also be completed anonymously by the same students (or some percentage of them). Conclusions: We present a protocol for the piloting of a student-centered, dually personalized course quality instrument that forms part of the assignment requirements and is therefore an integral part of the course. If, and how, such an essentially formative Student-Reported Outcome or Experience Measure can be used summatively, at unit or program level, remains to be determined, and is not our concern here. %M 25720558 %R 10.2196/resprot.4012 %U http://www.researchprotocols.org/2015/1/e15/ %U https://doi.org/10.2196/resprot.4012 %U http://www.ncbi.nlm.nih.gov/pubmed/25720558 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 1 %P e21 %T Validity of Electronic Diet Recording Nutrient Estimates Compared to Dietitian Analysis of Diet Records: Randomized Controlled Trial %A Raatz,Susan K %A Scheett,Angela J %A Johnson,LuAnn K %A Jahns,Lisa %+ United States Department of Agriculture, Agricultural Research Service, Grand Forks Human Nutrition Research Center, 2420 2nd Avenue N, Grand Forks, ND, 58201, United States, 1 7017958294, susan.raatz@ars.usda.gov %K diet records %K nutrition assessment %K electronic data %D 2015 %7 20.01.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Dietary intake assessment with diet records (DR) is a standard research and practice tool in nutrition. Manual entry and analysis of DR is time-consuming and expensive. New electronic tools for diet entry by clients and research participants may reduce the cost and effort of nutrient intake estimation. Objective: To determine the validity of electronic diet recording, we compared responses to 3-day DR kept by Tap & Track software for the Apple iPod Touch and records kept on the Nutrihand website to DR coded and analyzed by a research dietitian into a customized US Department of Agriculture (USDA) nutrient analysis program, entitled GRAND (Grand Forks Research Analysis of Nutrient Data). Methods: Adult participants (n=19) enrolled in a crossover-designed clinical trial. During each of two washout periods, participants kept a written 3-day DR. In addition, they were randomly assigned to enter their DR in a Web-based dietary analysis program (Nutrihand) or a handheld electronic device (Tap & Track). They completed an additional 3-day DR and the alternate electronic diet recording methods during the second washout. Entries resulted in 228 daily diet records or 12 for each of 19 participants. Means of nutrient intake were calculated for each method. Concordance of the intake estimates were determined by Bland-Altman plots. Coefficients of determination (R2) were calculated for each comparison to assess the strength of the linear relationship between methods. Results: No significant differences were observed between the mean nutrient values for energy, carbohydrate, protein, fat, saturated fatty acids, total fiber, or sodium between the recorded DR analyzed in GRAND and either Nutrihand or Tap & Track, or for total sugars comparing GRAND and Tap & Track. Reported values for total sugars were significantly reduced (P<.05) comparing Nutrihand to GRAND. Coefficients of determination (R2) for Nutrihand and Tap & Track compared to DR entries into GRAND, respectively, were energy .56, .01; carbohydrate .58, .08; total fiber .65, .37; sugar .78, .41; protein .44, .03; fat .36, .03; saturated fatty acids .23, .03; sodium .20, .00; and for Nutrihand only for cholesterol .88; vitamin A .02; vitamin C .37; calcium .05; and iron .77. Bland-Altman analysis demonstrates high variability in individual responses for both electronic capture programs with higher 95% limits of agreement for dietary intake recorded on Tap & Track. Conclusions: In comparison to dietitian-entered 3-day DR, electronic methods resulted in no significant difference in mean nutrient estimates but exhibited larger variability, particularly the Tap & Track program. However, electronic DR provided mean estimates of energy, macronutrients, and some micronutrients, which approximated those of the dietitian-analyzed DR and may be appropriate for dietary monitoring of groups. Electronic diet assessment methods have the potential to reduce the cost and burden of DR analysis for nutrition research and clinical practice. Trial Registration: Clinicaltrials.gov NCT01183520; http://clinicaltrials.gov/ct2/show/NCT01183520 (Archived by WebCite at http://www.webcitation.org/6VSdYznKX). %M 25604640 %R 10.2196/jmir.3744 %U http://www.jmir.org/2015/1/e21/ %U https://doi.org/10.2196/jmir.3744 %U http://www.ncbi.nlm.nih.gov/pubmed/25604640 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 1 %P e5 %T An Accumulated Activity Effective Index for Promoting Physical Activity: A Design and Development Study in a Mobile and Pervasive Health Context %A Liu,Chung-Tse %A Chan,Chia-Tai %+ Department of Biomedical Engineering, National Yang-Ming University, No.155, Sec.2, Linong Street, Taipei, , Taiwan, 886 2 2826 7000 ext 7371, ctchan@ym.edu.tw %K accumulated activity effective index (AAEI) %K physical activity %K activity level %D 2015 %7 06.01.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Increased physical activity has become a principal personal health goal worldwide because sufficient physical activity can reduce the risk of many adverse conditions. Motivating individuals to increase their levels of physical activity can increase life expectancy and contribute to a healthy life. Sharing and comparison of physical activity information by using the Internet, with fewer privacy concerns, might also help encourage people to promote and maintain sufficient physical activity. To promote and manage physical activity, an accumulated activity effective index (AAEI) is proposed in this paper. Objective: The purpose of the AAEI design is to maintain and promote physical activity. The public can easily accept a clear indicator that reveals the current status of physical activity. The AAEI is not only an assessment and tracking tool for personal physical activity, but is also useful for goal setting and for sharing content with the Internet community. Methods: The AAEI is derived from input in the form of accumulated physical activity, and evaluates the status of physical activities and days spent exercising. The term AAEI(t1,t2) is an index of the accumulated physical activity in the time interval (t1,t2), where the base unit of time is the day. The AAEI is determined according to accumulated physical activity and is adjusted using the previous status of physical activity. The previous status of physical activity is estimated according to the number of days spent exercising and the accumulated physical activity that has been performed. An analysis of the AAEI performance was conducted using a simulation model and a real-world trial with 2 participants. Results: The AAEI increased as the physical activity and days spent exercising accumulated. Conversely, the AAEI decreased with lack of physical activity and increased resting days. In simulation, the shape of the AAEI line indicated different types of exercise. The moving average AAEI represented long-term exercise. In the real-world trial, the AAEI confirmed that the simulation results were comparable to actual conditions. Conclusions: The AAEI proposed in this paper is a method that can be used to evaluate the status of a person’s physical activity. The AAEI is a simple numeric indication that is estimated by analyzing accumulated physical activity and the average number of days spent exercising. The AAEI is suitable for tracking personal physical activity, reminding the user of achievement goals, and allows data sharing by using the Internet. The results have demonstrated that the AAEI is a useful tool for physical activity management. %M 25563899 %R 10.2196/resprot.3336 %U http://www.researchprotocols.org/2015/1/e5/ %U https://doi.org/10.2196/resprot.3336 %U http://www.ncbi.nlm.nih.gov/pubmed/25563899 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 12 %P e292 %T Consumer Participation in Quality Improvements for Chronic Disease Care: Development and Evaluation of an Interactive Patient-Centered Survey to Identify Preferred Service Initiatives %A Fradgley,Elizabeth A %A Paul,Christine L %A Bryant,Jamie %A Roos,Ian A %A Henskens,Frans A %A Paul,David J %+ Priority Research Centre for Health Behaviour, School of Medicine and Public Health & Hunter Medical Research Institute, University of Newcastle, HMRI Building, Level 4 West, Callaghan, 2305, Australia, 61 02 4042 0642, elizabeth.fradgley@newcastle.edu.au %K ambulatory care %K health care surveys %K patient-centered care %K consumer participation %K medical oncology %K chronic disease %K cardiology %K neurology %D 2014 %7 19.12.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: With increasing attention given to the quality of chronic disease care, a measurement approach that empowers consumers to participate in improving quality of care and enables health services to systematically introduce patient-centered initiatives is needed. A Web-based survey with complex adaptive questioning and interactive survey items would allow consumers to easily identify and prioritize detailed service initiatives. Objective: The aim was to develop and test a Web-based survey capable of identifying and prioritizing patient-centered initiatives in chronic disease outpatient services. Testing included (1) test-retest reliability, (2) patient-perceived acceptability of the survey content and delivery mode, and (3) average completion time, completion rates, and Flesch-Kincaid reading score. Methods: In Phase I, the Web-based Consumer Preferences Survey was developed based on a structured literature review and iterative feedback from expert groups of service providers and consumers. The touchscreen survey contained 23 general initiatives, 110 specific initiatives available through adaptive questioning, and a relative prioritization exercise. In Phase II, a pilot study was conducted within 4 outpatient clinics to evaluate the reliability properties, patient-perceived acceptability, and feasibility of the survey. Eligible participants were approached to complete the survey while waiting for an appointment or receiving intravenous therapy. The age and gender of nonconsenters was estimated to ascertain consent bias. Participants with a subsequent appointment within 14 days were asked to complete the survey for a second time. Results: A total of 741 of 1042 individuals consented to participate (71.11% consent), 529 of 741 completed all survey content (78.9% completion), and 39 of 68 completed the test-retest component. Substantial or moderate reliability (Cohen’s kappa>0.4) was reported for 16 of 20 general initiatives with observed percentage agreement ranging from 82.1%-100.0%. The majority of participants indicated the Web-based survey was easy to complete (97.9%, 531/543) and comprehensive (93.1%, 505/543). Participants also reported the interactive relative prioritization exercise was easy to complete (97.0%, 189/195) and helped them to decide which initiatives were of most importance (84.6%, 165/195). Average completion time was 8.54 minutes (SD 3.91) and the Flesch-Kincaid reading level was 6.8. Overall, 84.6% (447/529) of participants indicated a willingness to complete a similar survey again. Conclusions: The Web-based Consumer Preferences Survey is sufficiently reliable and highly acceptable to patients. Based on completion times and reading level, this tool could be integrated in routine clinical practice and allows consumers to easily participate in quality evaluation. Results provide a comprehensive list of patient-prioritized initiatives for patients with major chronic conditions and delivers practice-ready evidence to guide improvements in patient-centered care. %M 25532217 %R 10.2196/jmir.3545 %U http://www.jmir.org/2014/12/e292/ %U https://doi.org/10.2196/jmir.3545 %U http://www.ncbi.nlm.nih.gov/pubmed/25532217 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 1 %N 1 %P e4 %T Acceptance of New Technology: A Usability Test of a Computerized Adaptive Test for Fatigue in Rheumatoid Arthritis %A Nikolaus,Stephanie %A Bode,Christina %A Taal,Erik %A Vonkeman,Harald E %A Glas,Cees AW %A van de Laar,Mart AFJ %+ University of Twente, Department of Psychology, Health & Technology, PO Box 217, Enschede, 7500 AE, Netherlands, 31 534896044, c.bode@utwente.nl %K usability test %K technology acceptance %K computerized adaptive test (CAT) %K fatigue %K rheumatoid arthritis %D 2014 %7 04.12.2014 %9 Original Paper %J JMIR Human Factors %G English %X Background: Little is known about the acceptance and usability of computerized adaptive tests (CATs) among patients with rheumatoid arthritis (RA). The main difference between completing a CAT and a traditional questionnaire concerns item presentation. CATs only provide one item at a time on the screen, and skipping forward or backward to review and change already given answers is often not possible. Objective: The objective of this study was to examine how patients with RA experience a Web-based CAT for fatigue. Methods: In individual sessions, participants filled in the CAT while thinking aloud, and were subsequently interviewed about their experience with the new instrument. The technology acceptance model (TAM) was used to structure the results. Results: The participants were 15 patients with RA. They perceived the CAT as clear, brief, and easy to use. They were positive about answering one question per screen, the changing response options, layout, progress bar, and item number. There were 40% (6/15) of the participants that also mentioned that they experienced the completion of the CAT as useful and pleasant, and liked the adaptive test mechanism. However, some participants noted that not all items were applicable to everybody, and that the wordings of questions within the severity dimension were often similar. Conclusions: Participants perceived the “CAT Fatigue RA” as easy to use, and also its usefulness was expressed. A 2.0 version has been improved according to the participants’ comments, and is currently being used in a validation study before it will be implemented in daily clinical practice. Our results give a first indication that CAT methodology may outperform traditional questionnaires not merely on measurement precision, but also on usability and acceptance valuation. %M 27025404 %R 10.2196/humanfactors.3424 %U http://humanfactors.jmir.org/2014/1/e4/ %U https://doi.org/10.2196/humanfactors.3424 %U http://www.ncbi.nlm.nih.gov/pubmed/27025404 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 4 %P e50 %T Development and Evaluation of an iPad App for Measuring the Cost of a Nutritious Diet %A Palermo,Claire %A Perera-Schulz,Dharani %A Kannan,Anitha %A Truby,Helen %A Shiell,Alan %A Emilda,Sindhu %A Quenette,Steve %+ Department of Nutrition and Dietetics, Monash University, Level 1, 264 Ferntree Gully Road, Notting Hill, 3168, Australia, 61 3 99024270, claire.palermo@monash.edu %K portable digital device %K iPad %K healthy food %K food cost %D 2014 %7 04.12.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Monitoring food costs informs governments of the affordability of healthy diets. Many countries have adopted a standardized healthy food basket. The Victorian Healthy Food Basket contains 44 food items necessary to meet the nutritional requirements of four different Australian family types for a fortnight. Objective: The aim of this study was to describe the development of a new iPad app as core to the implementation of the Victorian Healthy Food Basket. The app significantly automates the data collection. We evaluate if the new technology enhanced the quality and efficacy of the research. Methods: Time taken for data collection and entry was recorded. Semi-structured evaluative interviews were conducted with five field workers during the pilot of the iPad app. Field workers were familiar with previous manual data collection methods. Qualitative process evaluation data was summarized against key evaluation questions. Results: Field workers reported that using the iPad for data collection resulted in increased data accuracy, time savings, and efficient data management, and was preferred over manual collection. Conclusions: Portable digital devices may be considered to improve and extend data collection in the field of food cost monitoring. %M 25486678 %R 10.2196/mhealth.3314 %U http://mhealth.jmir.org/2014/4/e50/ %U https://doi.org/10.2196/mhealth.3314 %U http://www.ncbi.nlm.nih.gov/pubmed/25486678 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 12 %P e268 %T Interformat Reliability of Digital Psychiatric Self-Report Questionnaires: A Systematic Review %A Alfonsson,Sven %A Maathz,Pernilla %A Hursti,Timo %+ U-CARE, Department of Public Health and Caring Sciences, Uppsala University, A11, Dag Hammarskjölds väg BMC, Uppsala, 751 22, Sweden, 46 0184716194, sven.alfonsson@pubcare.uu.se %K psychometric %K reliability %K questionnaire %K psychotherapy %K computer %K Internet %D 2014 %7 03.12.2014 %9 Review %J J Med Internet Res %G English %X Background: Research on Internet-based interventions typically use digital versions of pen and paper self-report symptom scales. However, adaptation into the digital format could affect the psychometric properties of established self-report scales. Several studies have investigated differences between digital and pen and paper versions of instruments, but no systematic review of the results has yet been done. Objective: This review aims to assess the interformat reliability of self-report symptom scales used in digital or online psychotherapy research. Methods: Three databases (MEDLINE, Embase, and PsycINFO) were systematically reviewed for studies investigating the reliability between digital and pen and paper versions of psychiatric symptom scales. Results: From a total of 1504 publications, 33 were included in the review, and interformat reliability of 40 different symptom scales was assessed. Significant differences in mean total scores between formats were found in 10 of 62 analyses. These differences were found in just a few studies, which indicates that the results were due to study effects and sample effects rather than unreliable instruments. The interformat reliability ranged from r=.35 to r=.99; however, the majority of instruments showed a strong correlation between format scores. The quality of the included studies varied, and several studies had insufficient power to detect small differences between formats. Conclusions: When digital versions of self-report symptom scales are compared to pen and paper versions, most scales show high interformat reliability. This supports the reliability of results obtained in psychotherapy research on the Internet and the comparability of the results to traditional psychotherapy research. There are, however, some instruments that consistently show low interformat reliability, suggesting that these conclusions cannot be generalized to all questionnaires. Most studies had at least some methodological issues with insufficient statistical power being the most common issue. Future studies should preferably provide information about the transformation of the instrument into digital format and the procedure for data collection in more detail. %M 25472463 %R 10.2196/jmir.3395 %U http://www.jmir.org/2014/12/e268/ %U https://doi.org/10.2196/jmir.3395 %U http://www.ncbi.nlm.nih.gov/pubmed/25472463 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 11 %P e246 %T Assessment of a New Web-Based Sexual Concurrency Measurement Tool for Men Who Have Sex With Men %A Rosenberg,Eli S %A Rothenberg,Richard B %A Kleinbaum,David G %A Stephenson,Rob B %A Sullivan,Patrick S %+ Department of Epidemiology, Emory University Rollins School of Public Health, 1518 Clifton Rd., Atlanta, GA, 30322, United States, 1 4047128897, esrose2@emory.edu %K HIV %K sexual networks %K questionnaires %K concurrency %K MSM %K sexual network measurement %K online questionnaire %D 2014 %7 10.11.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Men who have sex with men (MSM) are the most affected risk group in the United States’ human immunodeficiency virus (HIV) epidemic. Sexual concurrency, the overlapping of partnerships in time, accelerates HIV transmission in populations and has been documented at high levels among MSM. However, concurrency is challenging to measure empirically and variations in assessment techniques used (primarily the date overlap and direct question approaches) and the outcomes derived from them have led to heterogeneity and questionable validity of estimates among MSM and other populations. Objective: The aim was to evaluate a novel Web-based and interactive partnership-timing module designed for measuring concurrency among MSM, and to compare outcomes measured by the partnership-timing module to those of typical approaches in an online study of MSM. Methods: In an online study of MSM aged ≥18 years, we assessed concurrency by using the direct question method and by gathering the dates of first and last sex, with enhanced programming logic, for each reported partner in the previous 6 months. From these methods, we computed multiple concurrency cumulative prevalence outcomes: direct question, day resolution / date overlap, and month resolution / date overlap including both 1-month ties and excluding ties. We additionally computed variants of the UNAIDS point prevalence outcome. The partnership-timing module was also administered. It uses an interactive month resolution calendar to improve recall and follow-up questions to resolve temporal ambiguities, combines elements of the direct question and date overlap approaches. The agreement between the partnership-timing module and other concurrency outcomes was assessed with percent agreement, kappa statistic (κ), and matched odds ratios at the individual, dyad, and triad levels of analysis. Results: Among 2737 MSM who completed the partnership section of the partnership-timing module, 41.07% (1124/2737) of individuals had concurrent partners in the previous 6 months. The partnership-timing module had the highest degree of agreement with the direct question. Agreement was lower with date overlap outcomes (agreement range 79%-81%, κ range .55-.59) and lowest with the UNAIDS outcome at 5 months before interview (65% agreement, κ=.14, 95% CI .12-.16). All agreements declined after excluding individuals with 1 sex partner (always classified as not engaging in concurrency), although the highest agreement was still observed with the direct question technique (81% agreement, κ=.59, 95% CI .55-.63). Similar patterns in agreement were observed with dyad- and triad-level outcomes. Conclusions: The partnership-timing module showed strong concurrency detection ability and agreement with previous measures. These levels of agreement were greater than others have reported among previous measures. The partnership-timing module may be well suited to quantifying concurrency among MSM at multiple levels of analysis. %M 25386801 %R 10.2196/jmir.3211 %U http://www.jmir.org/2014/11/e246/ %U https://doi.org/10.2196/jmir.3211 %U http://www.ncbi.nlm.nih.gov/pubmed/25386801 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 11 %P e244 %T Finding Collaborators: Toward Interactive Discovery Tools for Research Network Systems %A Borromeo,Charles D %A Schleyer,Titus K %A Becich,Michael J %A Hochheiser,Harry %+ Department of Biomedical Informatics, University of Pittsburgh, 5607 Baum Blvd, Pittsburgh, PA, 15206, United States, 1 4126487898, chb69@pitt.edu %K translational medical research %K cooperative behavior %K interprofessional relations %K interdisciplinary studies %K information systems %K information services %D 2014 %7 04.11.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Research networking systems hold great promise for helping biomedical scientists identify collaborators with the expertise needed to build interdisciplinary teams. Although efforts to date have focused primarily on collecting and aggregating information, less attention has been paid to the design of end-user tools for using these collections to identify collaborators. To be effective, collaborator search tools must provide researchers with easy access to information relevant to their collaboration needs. Objective: The aim was to study user requirements and preferences for research networking system collaborator search tools and to design and evaluate a functional prototype. Methods: Paper prototypes exploring possible interface designs were presented to 18 participants in semistructured interviews aimed at eliciting collaborator search needs. Interview data were coded and analyzed to identify recurrent themes and related software requirements. Analysis results and elements from paper prototypes were used to design a Web-based prototype using the D3 JavaScript library and VIVO data. Preliminary usability studies asked 20 participants to use the tool and to provide feedback through semistructured interviews and completion of the System Usability Scale (SUS). Results: Initial interviews identified consensus regarding several novel requirements for collaborator search tools, including chronological display of publication and research funding information, the need for conjunctive keyword searches, and tools for tracking candidate collaborators. Participant responses were positive (SUS score: mean 76.4%, SD 13.9). Opportunities for improving the interface design were identified. Conclusions: Interactive, timeline-based displays that support comparison of researcher productivity in funding and publication have the potential to effectively support searching for collaborators. Further refinement and longitudinal studies may be needed to better understand the implications of collaborator search tools for researcher workflows. %M 25370463 %R 10.2196/jmir.3444 %U http://www.jmir.org/2014/11/e244/ %U https://doi.org/10.2196/jmir.3444 %U http://www.ncbi.nlm.nih.gov/pubmed/25370463 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 3 %N 4 %P e14 %T Validity and Usability of Low-Cost Accelerometers for Internet-Based Self-Monitoring of Physical Activity in Patients With Chronic Obstructive Pulmonary Disease %A Vooijs,Martijn %A Alpay,Laurence L %A Snoeck-Stroband,Jiska B %A Beerthuizen,Thijs %A Siemonsma,Petra C %A Abbink,Jannie J %A Sont,Jacob K %A Rövekamp,Ton A %+ Rijnlands Rehabilitation Center, Department of Cardiac and Pulmonary Rehabilitation, Wassenaarseweg 501, Leiden, 2333AL, Netherlands, 31 715195300, m.vooijs@rrc.nl %K accelerometers %K activity monitoring %K chronic obstructive pulmonary disease %K validity %K usability %D 2014 %7 27.10.2014 %9 Original Paper %J Interact J Med Res %G English %X Background: The importance of regular physical activity for patients with chronic obstructive pulmonary disease (COPD) is well-established. However, many patients do not meet the recommended daily amount. Accelerometers might provide patients with the information needed to increase physical activity in daily life. Objective: Our objective was to assess the validity and usability of low-cost Internet-connected accelerometers. Furthermore we explored patients’ preferences with regards to the presentation of and feedback on monitored physical activity. Methods: To assess concurrent validity we conducted a field validation study with patients who wore two low-cost accelerometers, Fitbit and Physical Activity Monitor (PAM), at the same time along with a sophisticated multisensor accelerometer (SenseWear Armband) for 48 hours. Data on energy expenditure assessed from registrations from the two low-cost accelerometers were compared to the well validated SenseWear Armband which served as a reference criterion. Usability was examined in a cross-over study with patients who, in succession, wore the Fitbit and the PAM for 7 consecutive days and filled out a 16 item questionnaire with regards to the use of the corresponding device Results: The agreement between energy expenditure (METs) from the SenseWear Armband with METs estimated by the Fitbit and PAM was good (r=.77) and moderate (r=.41), respectively. The regression model that was developed for the Fitbit explained 92% whereas the PAM-model could explain 89% of total variance in METs measured by the SenseWear. With regards to the usability, both the Fitbit and PAM were well rated on all items. There were no significant differences between the two devices. Conclusions: The low-cost Fitbit and PAM are valid and usable devices to measure physical activity in patients with COPD. These devices may be useful in long-term interventions aiming at increasing physical activity levels in these patients. %M 25347989 %R 10.2196/ijmr.3056 %U http://www.i-jmr.org/2014/4/e14/ %U https://doi.org/10.2196/ijmr.3056 %U http://www.ncbi.nlm.nih.gov/pubmed/25347989 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 10 %P e230 %T Identifying Problematic Internet Users: Development and Validation of the Internet Motive Questionnaire for Adolescents (IMQ-A) %A Bischof-Kastner,Christina %A Kuntsche,Emmanuel %A Wolstein,Jörg %+ Institute of Psychology, Faculty of Humanities, University of Bamberg, Markusstraße 8a, Bamberg, 96047, Germany, 49 951 863 2045, joerg.wolstein@uni-bamberg.de %K Internet %K adolescents %K questionnaires %K validation %K addictive behavior %K statistical factor analysis %D 2014 %7 09.10.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Internationally, up to 15.1% of intensive Internet use among adolescents is dysfunctional. To provide a basis for early intervention and preventive measures, understanding the motives behind intensive Internet use is important. Objective: This study aims to develop a questionnaire, the Internet Motive Questionnaire for Adolescents (IMQ-A), as a theory-based measurement for identifying the underlying motives for high-risk Internet use. More precisely, the aim was to confirm the 4-factor structure (ie, social, enhancement, coping, and conformity motives) as well as its construct and concurrent validity. Another aim was to identify the motivational differences between high-risk and low-risk Internet users. Methods: A sample of 101 German adolescents (female: 52.5%, 53/101; age: mean 15.9, SD 1.3 years) was recruited. High-risk users (n=47) and low-risk users (n=54) were identified based on a screening measure for online addiction behavior in children and adolescents (Online-Suchtverhalten-Skala, OSVK-S). Here, “high-risk” Internet use means use that exceeds the level of intensive Internet use (OSVK-S sum score ≥7). Results: The confirmatory factor analysis confirmed the IMQ-A’s 4-factor structure. A reliability analysis revealed good internal consistencies of the subscales (.71 up to .86). Moreover, regression analyses confirmed that the enhancement and coping motive groups significantly predicted high-risk Internet consumption and the OSVK-S sum score. A mixed-model ANOVA confirmed that adolescents mainly access the Internet for social motives, followed by enhancement and coping motives, and that high-risk users access the Internet more frequently for coping and enhancement motives than low-risk users. Low-risk users were primarily motivated socially. Conclusions: The IMQ-A enables the assessment of motives related to adolescent Internet use and thus the identification of populations at risk. The questionnaire enables the development of preventive measures or early intervention programs, especially dealing with internal motives of Internet consumption. %M 25299174 %R 10.2196/jmir.3398 %U http://www.jmir.org/2014/10/e230/ %U https://doi.org/10.2196/jmir.3398 %U http://www.ncbi.nlm.nih.gov/pubmed/25299174 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 3 %N 4 %P e50 %T Development and Validation of Questionnaires Exploring Health Care Professionals' Intention to Use Wiki-Based Reminders to Promote Best Practices in Trauma %A Archambault,Patrick Michel %A Gagnon,Susie %A Gagnon,Marie-Pierre %A Turcotte,Stéphane %A Lapointe,Jean %A Fleet,Richard %A Côté,Mario %A Beaupré,Pierre %A Le Sage,Natalie %A Émond,Marcel %A Légaré,France %+ Département de médecine familiale et médecine d'urgence, Université Laval, 1050, avenue de la Médecine, Québec, QC, G1V 0A6, Canada, 1 418 835 7121 ext 3905, patrick.m.archambault@gmail.com %K knowledge translation %K wiki %K collaborative writing applications %K decision support tools %K health informatics %K Theory of Planned Behavior %K trauma care %K traumatic brain injury %K interprofessional collaboration %D 2014 %7 03.10.2014 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Little is known about factors influencing professionals’ use of wikis. Objective: We developed and validated two questionnaires to assess health care professionals’ intention to use wiki-based reminders for the management of trauma patients. Methods: We developed questionnaires for emergency physicians (EPs) and allied health professions (AHPs) based on the Theory of Planned Behavior and adapted them to the salient beliefs of each, identified in an earlier study. Items measured demographics and direct and indirect theoretical constructs. We piloted the questionnaires with 2 focus groups (5 EPs and 5 AHPs) to identify problems of wording and length. Based on feedback, we adjusted the wording and combined certain items. A new convenience sample of 25 EPs and 26 AHPs then performed a test-retest of the questionnaires at a 2-week interval. We assessed internal consistency using Cronbach alpha coefficients and temporal stability of items with an agreement intraclass correlation coefficient (ICC). Results: Five EPs and 5 AHPs (3 nurses, 1 respiratory therapist, and 1 pharmacist) formed 2 focus groups; 25 EPs and 26 AHPs (12 nurses, 7 respiratory therapists, and 7 pharmacists) completed the test and retest. The EP questionnaire test-retest scores for consistency (Cronbach alpha) and stability (ICC) were intention (test: Cronbach alpha=.94; retest: Cronbach alpha=.98; ICC=.89), attitude (.74, .72, .70), subjective norm (.79, .78, .75), perceived behavioral control (.67, .65, .66), attitudinal beliefs (.94, .86, .60), normative beliefs (.83, .87, .79), and control beliefs barriers (.58, .67, .78) and facilitators (.97, .85, .30). The AHP questionnaire scores for consistency and stability were: intention (test Cronbach alpha=.69, retest Cronbach alpha=.81, ICC=.48), attitude (.85, .87, .83), subjective norm (.47, .82, .62), perceived behavioral control (.55, .62, .60), attitudinal beliefs (.92, .91, .82), normative beliefs (.85, .90, .74), and control beliefs barriers (.58, .55, .66) and facilitators (.72, .94, –.05). To improve the psychometric properties of both questionnaires, we reformulated poorly consistent or unstable items. Conclusions: Our new theory-based questionnaires to measure health care professionals’ intention to use wiki-based reminders have adequate validity and reliability for use in large surveys. In the long run, they can be used to develop a theory-based implementation intervention for a wiki promoting best practices in trauma care. %M 25281856 %R 10.2196/resprot.3762 %U http://www.jmir.org/2014/4/e50/ %U https://doi.org/10.2196/resprot.3762 %U http://www.ncbi.nlm.nih.gov/pubmed/25281856 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e207 %T Applying Computer Adaptive Testing to Optimize Online Assessment of Suicidal Behavior: A Simulation Study %A De Beurs,Derek Paul %A de Vries,Anton LM %A de Groot,Marieke H %A de Keijser,Jos %A Kerkhof,Ad JFM %+ EMGO Institute for Health and Care Research, van der Boechorststraat 1, Amsterdam, , Netherlands, 31 205982589, dp.de.beurs@vu.nl %K suicide %K psychometrics %K computing methodologies %K Internet %K suicidal ideation %K risk assessment %D 2014 %7 11.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet is used increasingly for both suicide research and prevention. To optimize online assessment of suicidal patients, there is a need for short, good-quality tools to assess elevated risk of future suicidal behavior. Computer adaptive testing (CAT) can be used to reduce response burden and improve accuracy, and make the available pencil-and-paper tools more appropriate for online administration. Objective: The aim was to test whether an item response–based computer adaptive simulation can be used to reduce the length of the Beck Scale for Suicide Ideation (BSS). Methods: The data used for our simulation was obtained from a large multicenter trial from The Netherlands: the Professionals in Training to STOP suicide (PITSTOP suicide) study. We applied a principal components analysis (PCA), confirmatory factor analysis (CFA), a graded response model (GRM), and simulated a CAT. Results: The scores of 505 patients were analyzed. Psychometric analyses showed the questionnaire to be unidimensional with good internal consistency. The computer adaptive simulation showed that for the estimation of elevation of risk of future suicidal behavior 4 items (instead of the full 19) were sufficient, on average. Conclusions: This study demonstrated that CAT can be applied successfully to reduce the length of the Dutch version of the BSS. We argue that the use of CAT can improve the accuracy and the response burden when assessing the risk of future suicidal behavior online. Because CAT can be daunting for clinicians and applied scientists, we offer a concrete example of our computer adaptive simulation of the Dutch version of the BSS at the end of the paper. %M 25213259 %R 10.2196/jmir.3511 %U http://www.jmir.org/2014/9/e207/ %U https://doi.org/10.2196/jmir.3511 %U http://www.ncbi.nlm.nih.gov/pubmed/25213259 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 8 %P e190 %T Online Dietary Intake Estimation: Reproducibility and Validity of the Food4Me Food Frequency Questionnaire Against a 4-Day Weighed Food Record %A Fallaize,Rosalind %A Forster,Hannah %A Macready,Anna L %A Walsh,Marianne C %A Mathers,John C %A Brennan,Lorraine %A Gibney,Eileen R %A Gibney,Michael J %A Lovegrove,Julie A %+ Hugh Sinclair Unit of Human Nutrition and Institute for Cardiovascular and Metabolic Research, Department of Food and Nutritional Sciences, University of Reading, Whiteknights, PO Box 226, Reading, RG6 6AP, United Kingdom, 44 118 378 6418, j.a.lovegrove@reading.ac.uk %K food frequency questionnaire %K weighed food record %K validity %K reproducibility %K dietary assessment %K Food4Me %K Web-based %D 2014 %7 11.08.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Advances in nutritional assessment are continuing to embrace developments in computer technology. The online Food4Me food frequency questionnaire (FFQ) was created as an electronic system for the collection of nutrient intake data. To ensure its accuracy in assessing both nutrient and food group intake, further validation against data obtained using a reliable, but independent, instrument and assessment of its reproducibility are required. Objective: The aim was to assess the reproducibility and validity of the Food4Me FFQ against a 4-day weighed food record (WFR). Methods: Reproducibility of the Food4Me FFQ was assessed using test-retest methodology by asking participants to complete the FFQ on 2 occasions 4 weeks apart. To assess the validity of the Food4Me FFQ against the 4-day WFR, half the participants were also asked to complete a 4-day WFR 1 week after the first administration of the Food4Me FFQ. Level of agreement between nutrient and food group intakes estimated by the repeated Food4Me FFQ and the Food4Me FFQ and 4-day WFR were evaluated using Bland-Altman methodology and classification into quartiles of daily intake. Crude unadjusted correlation coefficients were also calculated for nutrient and food group intakes. Results: In total, 100 people participated in the assessment of reproducibility (mean age 32, SD 12 years), and 49 of these (mean age 27, SD 8 years) also took part in the assessment of validity. Crude unadjusted correlations for repeated Food4Me FFQ ranged from .65 (vitamin D) to .90 (alcohol). The mean cross-classification into “exact agreement plus adjacent” was 92% for both nutrient and food group intakes, and Bland-Altman plots showed good agreement for energy-adjusted macronutrient intakes. Agreement between the Food4Me FFQ and 4-day WFR varied, with crude unadjusted correlations ranging from .23 (vitamin D) to .65 (protein, % total energy) for nutrient intakes and .11 (soups, sauces and miscellaneous foods) to .73 (yogurts) for food group intake. The mean cross-classification into “exact agreement plus adjacent” was 80% and 78% for nutrient and food group intake, respectively. There were no significant differences between energy intakes estimated using the Food4Me FFQ and 4-day WFR, and Bland-Altman plots showed good agreement for both energy and energy-controlled nutrient intakes. Conclusions: The results demonstrate that the online Food4Me FFQ is reproducible for assessing nutrient and food group intake and has moderate agreement with the 4-day WFR for assessing energy and energy-adjusted nutrient intakes. The Food4Me FFQ is a suitable online tool for assessing dietary intake in healthy adults. %M 25113936 %R 10.2196/jmir.3355 %U http://www.jmir.org/2014/8/e190/ %U https://doi.org/10.2196/jmir.3355 %U http://www.ncbi.nlm.nih.gov/pubmed/25113936 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 7 %P e175 %T A Web-Based Non-Intrusive Ambient System to Measure and Classify Activities of Daily Living %A Stucki,Reto A %A Urwyler,Prabitha %A Rampa,Luca %A Müri,René %A Mosimann,Urs P %A Nef,Tobias %+ Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, 3010, Switzerland, 41 31 632 46 97, tobias.nef@artorg.unibe.ch %K ADL classifier %K forward chaining inference engine %K rule-based %K wireless sensor system %K dementia %K Alzheimer %K behavior pattern %K activity monitoring %K assistive technology %K smart homes %D 2014 %7 21.07.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of older adults in the global population is increasing. This demographic shift leads to an increasing prevalence of age-associated disorders, such as Alzheimer’s disease and other types of dementia. With the progression of the disease, the risk for institutional care increases, which contrasts with the desire of most patients to stay in their home environment. Despite doctors’ and caregivers’ awareness of the patient’s cognitive status, they are often uncertain about its consequences on activities of daily living (ADL). To provide effective care, they need to know how patients cope with ADL, in particular, the estimation of risks associated with the cognitive decline. The occurrence, performance, and duration of different ADL are important indicators of functional ability. The patient’s ability to cope with these activities is traditionally assessed with questionnaires, which has disadvantages (eg, lack of reliability and sensitivity). Several groups have proposed sensor-based systems to recognize and quantify these activities in the patient’s home. Combined with Web technology, these systems can inform caregivers about their patients in real-time (eg, via smartphone). Objective: We hypothesize that a non-intrusive system, which does not use body-mounted sensors, video-based imaging, and microphone recordings would be better suited for use in dementia patients. Since it does not require patient’s attention and compliance, such a system might be well accepted by patients. We present a passive, Web-based, non-intrusive, assistive technology system that recognizes and classifies ADL. Methods: The components of this novel assistive technology system were wireless sensors distributed in every room of the participant’s home and a central computer unit (CCU). The environmental data were acquired for 20 days (per participant) and then stored and processed on the CCU. In consultation with medical experts, eight ADL were classified. Results: In this study, 10 healthy participants (6 women, 4 men; mean age 48.8 years; SD 20.0 years; age range 28-79 years) were included. For explorative purposes, one female Alzheimer patient (Montreal Cognitive Assessment score=23, Timed Up and Go=19.8 seconds, Trail Making Test A=84.3 seconds, Trail Making Test B=146 seconds) was measured in parallel with the healthy subjects. In total, 1317 ADL were performed by the participants, 1211 ADL were classified correctly, and 106 ADL were missed. This led to an overall sensitivity of 91.27% and a specificity of 92.52%. Each subject performed an average of 134.8 ADL (SD 75). Conclusions: The non-intrusive wireless sensor system can acquire environmental data essential for the classification of activities of daily living. By analyzing retrieved data, it is possible to distinguish and assign data patterns to subjects' specific activities and to identify eight different activities in daily living. The Web-based technology allows the system to improve care and provides valuable information about the patient in real-time. %M 25048461 %R 10.2196/jmir.3465 %U http://www.jmir.org/2014/7/e175/ %U https://doi.org/10.2196/jmir.3465 %U http://www.ncbi.nlm.nih.gov/pubmed/25048461 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 3 %N 3 %P e38 %T A Comparison of Tablet Computer and Paper-Based Questionnaires in Healthy Aging Research %A Fanning,Jason %A McAuley,Edward %+ Exercise Psychology Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Freer Hall, 906 S Goodwin Ave, Urbana, IL, 61801, United States, 1 217 300 5306, fanning4@illinois.edu %K healthy aging %K questionnaire %K tablet computer %K behavioral psychology %D 2014 %7 16.07.2014 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Digital questionnaire delivery offers many advantages to investigators and participants alike; however, evidence supporting digital questionnaire delivery via touchscreen device in the older adult population is lacking. Objective: The objective of this study was to compare the use of tablet computer-delivered and printed questionnaires as vehicles for the collection of psychosocial data from older adults to determine whether this digital platform would be readily adopted by the sample, and to identify whether tablet delivery influences the content of data received. Methods: The participants completed three questionnaires using both delivery methods, followed by a brief evaluation. Results: A nonparametric one-sample binomial test indicated a significantly greater proportion of individuals preferred the tablet-delivered questionnaires (z=4.96, SE 3.428, P<.001). Paired sample t tests and Wilcoxon sign-rank tests indicated that measures collected by each method were not significantly different (all P≥.273). Ease of use of the tablet interface and anxiety while completing the digital questionnaires were significantly correlated with preferences, (rs=.665, P<.001 and rs=.552, P<.001, respectively). Participants most frequently reported that the tablet delivery increased speed of use and improved data entry, although navigation was perceived as being more difficult. By comparison, participants felt that the paper packet was easier to read and navigate, but was slow and cumbersome, and they disliked the lack of dynamic features. Conclusions: This study provides preliminary evidence suggesting that questionnaires delivered to older adults using contemporary tablet computers may be acceptable and do not substantively influence the content of the collected data. %M 25048799 %R 10.2196/resprot.3291 %U http://www.researchprotocols.org/2014/3/e38/ %U https://doi.org/10.2196/resprot.3291 %U http://www.ncbi.nlm.nih.gov/pubmed/25048799 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 7 %P e173 %T Longitudinal Accuracy of Web-Based Self-Reported Weights: Results From the Hopkins POWER Trial %A Jerome,Gerald J %A Dalcin,Arlene %A Coughlin,Janelle W %A Fitzpatrick,Stephanie %A Wang,Nae-Yuh %A Durkin,Nowella %A Yeh,Hsin-Chieh %A Charleston,Jeanne %A Pozefsky,Thomas %A Daumit,Gail L %A Clark,Jeanne M %A Louis,Thomas A %A Appel,Lawrence J %+ Department of Kinesiology, Towson University, 8000 York Road, Towson, MD, 21252, United States, 1 410 704 5283, gjerome@towson.edu %K self-report %K weight loss %K obesity %K Internet %D 2014 %7 15.07.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Websites and phone apps are increasingly used to track weights during weight loss interventions, yet the longitudinal accuracy of these self-reported weights is uncertain. Objective: Our goal was to compare the longitudinal accuracy of self-reported weights entered online during the course of a randomized weight loss trial to measurements taken in the clinic. We aimed to determine if accuracy of self-reported weight is associated with weight loss and to determine the extent of misclassification in achieving 5% weight loss when using self-reported compared to clinic weights. Methods: This study examined the accuracy of self-reported weights recorded online among intervention participants in the Hopkins Practice-Based Opportunities for Weight Reduction (POWER) trial, a randomized trial examining the effectiveness of two lifestyle-based weight loss interventions compared to a control group among obese adult patients with at least one cardiovascular risk factor. One treatment group was offered telephonic coaching and the other group was offered in-person individual coaching and group sessions. All intervention participants (n=277) received a digital scale and were asked to track their weight weekly on a study website. Research staff used a standard protocol to measure weight in the clinic. Differences (self-reported weight – clinic weight) indicate if self-report under (-) or over (+) estimated clinic weight using the self-reported weight that was closest in time to the clinic weight and was within a window ranging from the day of the clinic visit to 7 days before the 6-month (n=225) and 24-month (n=191) clinic visits. The absolute value of the differences (absolute difference) describes the overall accuracy. Results: Underestimation of self-reported weights increased significantly from 6 months (mean -0.5kg, SD 1.0kg) to 24 months (mean -1.1kg, SD 2.0kg; P=.002). The average absolute difference also increased from 6 months (mean 0.7kg, SD 0.8kg) to 24 months (mean 1.3, SD 1.8kg; P<.001). Participants who achieved the study weight loss goal at 24 months (based on clinic weights) had lower absolute differences (P=.01) compared to those who did not meet this goal. At 24 months, there was 9% misclassification of weight loss goal success when using self-reported weight compared to clinic weight as an outcome. At 24 months, those with self-reported weights (n=191) had three times the weight loss compared to those (n=73) without self-reported weights (P<.001). Conclusions: Underestimation of weight increased over time and was associated with less weight loss. In addition to intervention adherence, weight loss programs should emphasize accuracy in self-reporting. Trial Registration: ClinicalTrials.gov: NCT00783315; http://clinicaltrials.gov/show/NCT00783315 (Archived by WebCite at http://www.webcitation.org/6R4gDAK5K). %M 25042773 %R 10.2196/jmir.3332 %U http://www.jmir.org/2014/7/e173/ %U https://doi.org/10.2196/jmir.3332 %U http://www.ncbi.nlm.nih.gov/pubmed/25042773 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 7 %P e171 %T Social Network Sites as a Mode to Collect Health Data: A Systematic Review %A Alshaikh,Fahdah %A Ramzan,Farzan %A Rawaf,Salman %A Majeed,Azeem %+ School of Public Health, Department of Primary Care and Public Health, Imperial College London, 324 The Reynolds Building, St Dunstan’s Road, London, W6 8RP, United Kingdom, 44 (0)20 7594 7386, fahdah.alshaikh09@imperial.ac.uk %K social network %K social media %K Internet %K systematic review %K young people %K health education %K health behaviors %D 2014 %7 14.07.2014 %9 Review %J J Med Internet Res %G English %X Background: To date, health research literature has focused on social network sites (SNS) either as tools to deliver health care, to study the effect of these networks on behavior, or to analyze Web health content. Less is known about the effectiveness of these sites as a method for collecting data for health research and the means to use such powerful tools in health research. Objective: The objective of this study was to systematically review the available literature and explore the use of SNS as a mode of collecting data for health research. The review aims to answer four questions: Does health research employ SNS as method for collecting data? Is data quality affected by the mode of data collection? What types of participants were reached by SNS? What are the strengths and limitations of SNS? Methods: The literature was reviewed systematically in March 2013 by searching the databases MEDLINE, Embase, and PsycINFO, using the Ovid and PubMed interface from 1996 to the third week of March 2013. The search results were examined by 2 reviewers, and exclusion, inclusion, and quality assessment were carried out based on a pre-set protocol. Results: The inclusion criteria were met by 10 studies and results were analyzed descriptively to answer the review questions. There were four main results. (1) SNS have been used as a data collection tool by health researchers; all but 1 of the included studies were cross-sectional and quantitative. (2) Data quality indicators that were reported include response rate, cost, timeliness, missing data/completion rate, and validity. However, comparison was carried out only for response rate and cost as it was unclear how other reported indicators were measured. (3) The most targeted population were females and younger people. (4) All studies stated that SNS is an effective recruitment method but that it may introduce a sampling bias. Conclusions: SNS has a role in health research, but we need to ascertain how to use it effectively without affecting the quality of research. The field of SNS is growing rapidly, and it is necessary to take advantage of the strengths of this tool and to avoid its limitations by effective research design. This review provides an important insight for scholars who plan to conduct research using SNS. %M 25048247 %R 10.2196/jmir.3050 %U http://www.jmir.org/2014/7/e171/ %U https://doi.org/10.2196/jmir.3050 %U http://www.ncbi.nlm.nih.gov/pubmed/25048247 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 6 %P e150 %T Online Dietary Intake Estimation: The Food4Me Food Frequency Questionnaire %A Forster,Hannah %A Fallaize,Rosalind %A Gallagher,Caroline %A O’Donovan,Clare B %A Woolhead,Clara %A Walsh,Marianne C %A Macready,Anna L %A Lovegrove,Julie A %A Mathers,John C %A Gibney,Michael J %A Brennan,Lorraine %A Gibney,Eileen R %+ UCD Institute of Food and Health, University College Dublin, Science Centre South,, Belfield,, Dublin, , Ireland, 353 1 716 2819, eileen.gibney@ucd.ie %K food frequency questionnaire %K online dietary assessment tool %K Food4Me %K dietary assessment %K Web-based %D 2014 %7 09.06.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Dietary assessment methods are important tools for nutrition research. Online dietary assessment tools have the potential to become invaluable methods of assessing dietary intake because, compared with traditional methods, they have many advantages including the automatic storage of input data and the immediate generation of nutritional outputs. Objective: The aim of this study was to develop an online food frequency questionnaire (FFQ) for dietary data collection in the “Food4Me” study and to compare this with the validated European Prospective Investigation of Cancer (EPIC) Norfolk printed FFQ. Methods: The Food4Me FFQ used in this analysis was developed to consist of 157 food items. Standardized color photographs were incorporated in the development of the Food4Me FFQ to facilitate accurate quantification of the portion size of each food item. Participants were recruited in two centers (Dublin, Ireland and Reading, United Kingdom) and each received the online Food4Me FFQ and the printed EPIC-Norfolk FFQ in random order. Participants completed the Food4Me FFQ online and, for most food items, participants were requested to choose their usual serving size among seven possibilities from a range of portion size pictures. The level of agreement between the two methods was evaluated for both nutrient and food group intakes using the Bland and Altman method and classification into quartiles of daily intake. Correlations were calculated for nutrient and food group intakes. Results: A total of 113 participants were recruited with a mean age of 30 (SD 10) years (40.7% male, 46/113; 59.3%, 67/113 female). Cross-classification into exact plus adjacent quartiles ranged from 77% to 97% at the nutrient level and 77% to 99% at the food group level. Agreement at the nutrient level was highest for alcohol (97%) and lowest for percent energy from polyunsaturated fatty acids (77%). Crude unadjusted correlations for nutrients ranged between .43 and .86. Agreement at the food group level was highest for “other fruits” (eg, apples, pears, oranges) and lowest for “cakes, pastries, and buns”. For food groups, correlations ranged between .41 and .90. Conclusions: The results demonstrate that the online Food4Me FFQ has good agreement with the validated printed EPIC-Norfolk FFQ for assessing both nutrient and food group intakes, rendering it a useful tool for ranking individuals based on nutrient and food group intakes. %M 24911957 %R 10.2196/jmir.3105 %U http://www.jmir.org/2014/6/e150/ %U https://doi.org/10.2196/jmir.3105 %U http://www.ncbi.nlm.nih.gov/pubmed/24911957 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 5 %P e127 %T Pain-QuILT: Clinical Feasibility of a Web-Based Visual Pain Assessment Tool in Adults With Chronic Pain %A Lalloo,Chitra %A Kumbhare,Dinesh %A Stinson,Jennifer N %A Henry,James L %+ Medical Sciences Graduate Program, Faculty of Health Sciences, McMaster University, HSC-4N35, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada, 1 905 525 9140, lallooc@mcmaster.ca %K chronic pain %K assessment tool %K Internet %K clinical feasibility %D 2014 %7 12.05.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic pain is a prevalent and debilitating problem. Accurate and timely pain assessment is critical to pain management. In particular, pain needs to be consistently tracked over time in order to gauge the effectiveness of different treatments. In current clinical practice, paper-based questionnaires are the norm for pain assessment. However, these methods are not conducive to capturing or tracking the complex sensations of chronic pain. Pain-QuILT (previously called the Iconic Pain Assessment Tool) is a Web-based tool for the visual self-report and tracking of pain (quality, intensity, location, tracker) in the form of time-stamped records. It has been iteratively developed and evaluated in adolescents and adults with chronic pain, including usability testing and content validation. Clinical feasibility is an important stepping-stone toward widespread implementation of a new tool. Our group has demonstrated Pain-QuILT clinical feasibility in the context of a pediatric chronic pain clinic. We sought to extend these findings by evaluating Pain-QuILT clinical feasibility from the perspective of adults with chronic pain, in comparison with standard paper-based methods (McGill Pain Questionnaire [MPQ] and Brief Pain Inventory [BPI]). Objective: The goal of our study was to assess Pain-QuILT for (1) ease of use, (2) time for completion, (3) patient preferences, and (4) to explore the patterns of self-reported pain across the Pain-QuILT, MPQ, and BPI. Methods: Participants were recruited during a scheduled follow-up visit at a hospital-affiliated pain management and physical rehabilitation clinic in southwestern Ontario. Participants self-reported their current pain using the Pain-QuILT, MPQ, and BPI (randomized order). A semistructured interview format was used to capture participant preferences for pain self-report. Results: The sample consisted of 50 adults (54% female, 27/50) with a mean age of 50 years. Pain-QuILT was rated as significantly easier to use than both the MPQ and BPI (P<.01) and was also associated with the fewest difficulties in completion. On average, the time to complete each tool was less than 5 minutes. A majority of participants (58%, 29/50) preferred Pain-QuILT for reporting their pain over alternate methods (16%, 8/50 for MPQ; 14%, 7/50 for BPI; 12%, 6/50 for “other”). The most commonly chosen pain descriptors on MPQ were matched with Pain-QuILT across 91% of categories. There was a moderate-to-high correlation between Pain-QuILT and BPI scores for pain intensity (r=.70, P<.01). Conclusions: The results of this clinical feasibility study in adults with chronic pain are consistent with our previously published pediatric findings. Specifically, data indicate that Pain-QuILT is (1) easy to use, (2) quick to complete, (3) preferred by a majority of patients, and (4) correlated as expected with validated pain measures. As a digital, patient-friendly method of assessing and tracking pain, we conclude that Pain-QuILT has potential to add significant value as one standard component of chronic pain management. %M 24819478 %R 10.2196/jmir.3292 %U http://www.jmir.org/2014/5/e127/ %U https://doi.org/10.2196/jmir.3292 %U http://www.ncbi.nlm.nih.gov/pubmed/24819478 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 4 %P e115 %T Electronic Versus Paper-Based Assessment of Health-Related Quality of Life Specific to HIV Disease: Reliability Study of the PROQOL-HIV Questionnaire %A Duracinsky,Martin %A Lalanne,Christophe %A Goujard,Cécile %A Herrmann,Susan %A Cheung-Lung,Christian %A Brosseau,Jean-Paul %A Schwartz,Yannick %A Chassany,Olivier %+ Université Paris-Diderot, Sorbonne Paris-Cité, Unité de Méthodologie des critères d’évaluation (Patient-Reported Outcomes), EA Recherche Clinique Coordonnée Ville-Hôpital, Méthodologies et Société (ED 393), Carré historique de l'Hôpital Saint-Louis, porte 23, 1 avenue Claude Vellefaux, Paris cedex 10, 75475, France, 33 1 40 27 57 48, duracinsky.m@gmail.com %K HIV %K quality of life %K patient-reported outcomes %K electronic records %K reliability %D 2014 %7 25.04.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic patient-reported outcomes (PRO) provide quick and usually reliable assessments of patients’ health-related quality of life (HRQL). Objective: An electronic version of the Patient-Reported Outcomes Quality of Life-human immunodeficiency virus (PROQOL-HIV) questionnaire was developed, and its face validity and reliability were assessed using standard psychometric methods. Methods: A sample of 80 French outpatients (66% male, 52/79; mean age 46.7 years, SD 10.9) were recruited. Paper-based and electronic questionnaires were completed in a randomized crossover design (2-7 day interval). Biomedical data were collected. Questionnaire version and order effects were tested on full-scale scores in a 2-way ANOVA with patients as random effects. Test-retest reliability was evaluated using Pearson and intraclass correlation coefficients (ICC, with 95% confidence interval) for each dimension. Usability testing was carried out from patients’ survey reports, specifically, general satisfaction, ease of completion, quality and clarity of user interface, and motivation to participate in follow-up PROQOL-HIV electronic assessments. Results: Questionnaire version and administration order effects (N=59 complete cases) were not significant at the 5% level, and no interaction was found between these 2 factors (P=.94). Reliability indexes were acceptable, with Pearson correlations greater than .7 and ICCs ranging from .708 to .939; scores were not statistically different between the two versions. A total of 63 (79%) complete patients’ survey reports were available, and 55% of patients (30/55) reported being satisfied and interested in electronic assessment of their HRQL in clinical follow-up. Individual ratings of PROQOL-HIV user interface (85%-100% of positive responses) confirmed user interface clarity and usability. Conclusions: The electronic PROQOL-HIV introduces minor modifications to the original paper-based version, following International Society for Pharmacoeconomics and Outcomes Research (ISPOR) ePRO Task Force guidelines, and shows good reliability and face validity. Patients can complete the computerized PROQOL-HIV questionnaire and the scores from the paper or electronic versions share comparable accuracy and interpretation. %M 24769643 %R 10.2196/jmir.3330 %U http://www.jmir.org/2014/4/e115/ %U https://doi.org/10.2196/jmir.3330 %U http://www.ncbi.nlm.nih.gov/pubmed/24769643 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 3 %P e80 %T Animated Randomness, Avatars, Movement, and Personalization in Risk Graphics %A Witteman,Holly O %A Fuhrel-Forbis,Andrea %A Wijeysundera,Harindra C %A Exe,Nicole %A Dickson,Mark %A Holtzman,Lisa %A Kahn,Valerie C %A Zikmund-Fisher,Brian J %+ Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, 1050 avenue de la Médecine, Pavillon Ferdinand-Vandry 2881-F, Quebec City, QC, G1V 0A6, Canada, 1 418 656 2131 ext 3981, holly@witteman.ca %K risk graphics %K health communication %K cardiovascular disease %K animation %K avatar %K pictograph %K icon array %D 2014 %7 18.03.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Risk communication involves conveying two inherently difficult concepts about the nature of risk: the underlying random distribution of outcomes and how a population-based proportion applies to an individual. Objective: The objective of this study was to test whether 4 design factors in icon arrays—animated random dispersal of risk events, avatars to represent an individual, personalization (operationalized as choosing the avatar’s color), and a moving avatar—might help convey randomness and how a given risk applies to an individual, thereby better aligning risk perceptions with risk estimates. Methods: A diverse sample of 3630 adults with no previous heart disease or stroke completed an online nested factorial experiment in which they entered personal health data into a risk calculator that estimated 10-year risk of cardiovascular disease based on a robust and validated model. We randomly assigned them to view their results in 1 of 10 risk graphics that used different combinations of the 4 design factors. We measured participants’ risk perceptions as our primary outcome, as well as behavioral intentions and recall of the risk estimate. We also assessed subjective numeracy, whether or not participants knew anyone who had died of cardiovascular causes, and whether or not they knew their blood pressure and cholesterol as potential moderators. Results: Animated randomness was associated with better alignment between risk estimates and risk perceptions (F1,3576=6.12, P=.01); however, it also led to lower scores on healthy lifestyle intentions (F1,3572=11.1, P<.001). Using an avatar increased risk perceptions overall (F1,3576=4.61, P=.03) and most significantly increased risk perceptions among those who did not know a particular person who had experienced the grave outcomes of cardiovascular disease (F1,3576=5.88, P=.02). Using an avatar also better aligned actual risk estimates with intentions to see a doctor (F1,3556=6.38, P=.01). No design factors had main effects on recall, but animated randomness was associated with better recall for those at lower risk and worse recall for those at higher risk (F1,3544=7.06, P=.01). Conclusions: Animated randomness may help people better understand the random nature of risk. However, in the context of cardiovascular risk, such understanding may result in lower healthy lifestyle intentions. Therefore, whether or not to display randomness may depend on whether one’s goal is to persuade or to inform. Avatars show promise for helping people grasp how population-based statistics map to an individual case. %M 24642037 %R 10.2196/jmir.2895 %U http://www.jmir.org/2014/3/e80/ %U https://doi.org/10.2196/jmir.2895 %U http://www.ncbi.nlm.nih.gov/pubmed/24642037 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 2 %P e59 %T Relative Validity of Micronutrient and Fiber Intake Assessed With Two New Interactive Meal- and Web-Based Food Frequency Questionnaires %A Christensen,Sara E %A Möller,Elisabeth %A Bonn,Stephanie E %A Ploner,Alexander %A Bälter,Olle %A Lissner,Lauren %A Bälter,Katarina %+ Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Nobels väg 12a, Stockholm, SE-171 77, Sweden, 46 8 52482361, sara.christensen@ki.se %K validity %K reproducibility %K FFQ %K micronutrients %K weighed food record %K Internet %K adult %D 2014 %7 21.02.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: The meal- and Web-based food frequency questionnaires, Meal-Q and MiniMeal-Q, were developed for cost-efficient assessment of dietary intake in epidemiological studies. Objective: The objective of this study was to evaluate the relative validity of micronutrient and fiber intake assessed with Meal-Q and MiniMeal-Q. The reproducibility of Meal-Q was also evaluated. Methods: A total of 163 volunteer men and women aged between 20 and 63 years were recruited from Stockholm County, Sweden. Assessment of micronutrient and fiber intake with the 174-item Meal-Q was compared to a Web-based 7-day weighed food record (WFR). Two administered Meal-Q questionnaires were compared for reproducibility. The 126-item MiniMeal-Q, developed after the validation study, was evaluated in a simulated validation by using truncated Meal-Q data. Results: The study population consisted of approximately 80% women (129/163) with a mean age of 33 years (SD 12) who were highly educated (130/163, 80% with >12 years of education) on average. Cross-classification of quartiles with the WFR placed 69% to 90% in the same/adjacent quartile for Meal-Q and 67% to 89% for MiniMeal-Q. Bland-Altman plots with the WFR and the questionnaires showed large variances and a trend of increasing underestimation with increasing intakes. Deattenuated and energy-adjusted Spearman rank correlations between the questionnaires and the WFR were in the range ρ=.25-.69, excluding sodium that was not statistically significant. Cross-classifications of quartiles of the 2 Meal-Q administrations placed 86% to 97% in the same/adjacent quartile. Intraclass correlation coefficients for energy-adjusted intakes were in the range of .50-.76. Conclusions: With the exception of sodium, this validation study demonstrates Meal-Q and MiniMeal-Q to be useful methods for ranking micronutrient and fiber intake in epidemiological studies with Web-based data collection. %M 24565605 %R 10.2196/jmir.2965 %U http://www.jmir.org/2014/2/e59/ %U https://doi.org/10.2196/jmir.2965 %U http://www.ncbi.nlm.nih.gov/pubmed/24565605 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 2 %P e38 %T Validation and Reliability of a Smartphone Application for the International Prostate Symptom Score Questionnaire: A Randomized Repeated Measures Crossover Study %A Kim,Jae Heon %A Kwon,Soon-Sun %A Shim,Sung Ryul %A Sun,Hwa Yeon %A Ko,Young Myoung %A Chun,Dong-Il %A Yang,Won Jae %A Song,Yun Seob %+ Department of Urology, Soonchunhyang University, College of Medicine, Soonchunhyang University Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul, 140-743, Korea, Republic Of, 82 2 709 9377, yssong@schmc.ac.kr %K smartphone %K International Prostate Symptom Score %K lower urinary tract symptoms %K health survey %K questionnaires %D 2014 %7 10.02.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphone-based assessment may be a useful diagnostic and monitoring tool for patients. There have been many attempts to create a smartphone diagnostic tool for clinical use in various medical fields but few have demonstrated scientific validity. Objective: The purpose of this study was to develop a smartphone application of the International Prostate Symptom Score (IPSS) and to demonstrate its validity and reliability. Methods: From June 2012 to May 2013, a total of 1581 male participants (≥40 years old), with or without lower urinary tract symptoms (LUTS), visited our urology clinic via the health improvement center at Soonchunhyang University Hospital (Republic of Korea) and were enrolled in this study. A randomized repeated measures crossover design was employed using a smartphone application of the IPSS and the conventional paper form of the IPSS. Paired t test under a hypothesis of non-inferior trial was conducted. For the reliability test, the intraclass correlation coefficient (ICC) was measured. Results: The total score of the IPSS (P=.289) and each item of the IPSS (P=.157-1.000) showed no differences between the paper version and the smartphone version of the IPSS. The mild, moderate, and severe LUTS groups showed no differences between the two versions of the IPSS. A significant correlation was noted in the total group (ICC=.935, P<.001). The mild, moderate, and severe LUTS groups also showed significant correlations (ICC=.616, .549, and .548 respectively, all P<.001).There was selection bias in this study, as only participants who had smartphones could participate. Conclusions: The validity and reliability of the smartphone application version were comparable to the conventional paper version of the IPSS. The smartphone application of the IPSS could be an effective method for measuring lower urinary tract symptoms. %M 24513507 %R 10.2196/jmir.3042 %U http://www.jmir.org/2014/2/e38/ %U https://doi.org/10.2196/jmir.3042 %U http://www.ncbi.nlm.nih.gov/pubmed/24513507 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 1 %P e2 %T The Psychometric Properties of CollaboRATE: A Fast and Frugal Patient-Reported Measure of the Shared Decision-Making Process %A Barr,Paul James %A Thompson,Rachel %A Walsh,Thom %A Grande,Stuart W %A Ozanne,Elissa M %A Elwyn,Glyn %+ The Dartmouth Center for Health Care Delivery Science, Dartmouth College, 37 Dewey Field Road, Hanover, NH, 03755, United States, 1 1 603 646 2295, glynelwyn@gmail.com %K decision making %K physician-patient relations %K psychometrics/Instrumentation %K patient participation %K questionnaires %K Internet %D 2014 %7 03.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient-centered health care is a central component of current health policy agendas. Shared decision making (SDM) is considered to be the pinnacle of patient engagement and methods to promote this are becoming commonplace. However, the measurement of SDM continues to prove challenging. Reviews have highlighted the need for a patient-reported measure of SDM that is practical, valid, and reliable to assist implementation efforts. In consultation with patients, we developed CollaboRATE, a 3-item measure of the SDM process. Objective: There is a need for scalable patient-reported measure of the SDM process. In the current project, we assessed the psychometric properties of CollaboRATE. Methods: A representative sample of the US population were recruited online and were randomly allocated to view 1 of 6 simulated doctor-patient encounters in January 2013. Three dimensions of SDM were manipulated in the encounters: (1) explanation of the health issue, (2) elicitation of patient preferences, and (3) integration of patient preferences. Participants then completed CollaboRATE (possible scores 0-100) in addition to 2 other patient-reported measures of SDM: the 9-item Shared Decision Decision Making Questionnaire (SDM-Q-9) and the Doctor Facilitation subscale of the Patient’s Perceived Involvement in Care Scale (PICS). A subsample of participants was resurveyed between 7 and 14 days after the initial survey. We assessed CollaboRATE’s discriminative, concurrent, and divergent validity, intrarater reliability, and sensitivity to change. Results: The final sample consisted of 1341 participants. CollaboRATE demonstrated discriminative validity, with a significant increase in CollaboRATE score as the number of core dimensions of SDM increased from zero (mean score: 46.0, 95% CI 42.4-49.6) to 3 (mean score 85.8, 95% CI 83.2-88.4). CollaboRATE also demonstrated concurrent validity with other measures of SDM, excellent intrarater reliability, and sensitivity to change; however, divergent validity was not demonstrated. Conclusions: The fast and frugal nature of CollaboRATE lends itself to routine clinical use. Further assessment of CollaboRATE in real-world settings is required. %M 24389354 %R 10.2196/jmir.3085 %U http://www.jmir.org/2014/1/e2/ %U https://doi.org/10.2196/jmir.3085 %U http://www.ncbi.nlm.nih.gov/pubmed/24389354 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 12 %P e270 %T Puzzling With Online Games (BAM-COG): Reliability, Validity, and Feasibility of an Online Self-Monitor for Cognitive Performance in Aging Adults %A Aalbers,Teun %A Baars,Maria A E %A Olde Rikkert,Marcel G M %A Kessels,Roy P C %+ Radboud University Medical Center, Department of Geriatric Medicine, Reinier Postlaan 4, Nijmegen, 6500 HB, Netherlands, 31 243619807, teun.aalbers@radboudumc.nl %K cognitive testing %K brain aging %K games %K validity %K reliability %K self-monitoring %K Internet %K eHealth %D 2013 %7 03.12.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Online interventions are aiming increasingly at cognitive outcome measures but so far no easy and fast self-monitors for cognition have been validated or proven reliable and feasible. Objective: This study examines a new instrument called the Brain Aging Monitor–Cognitive Assessment Battery (BAM-COG) for its alternate forms reliability, face and content validity, and convergent and divergent validity. Also, reference values are provided. Methods: The BAM-COG consists of four easily accessible, short, yet challenging puzzle games that have been developed to measure working memory (“Conveyer Belt”), visuospatial short-term memory (“Sunshine”), episodic recognition memory (“Viewpoint”), and planning (“Papyrinth”). A total of 641 participants were recruited for this study. Of these, 397 adults, 40 years and older (mean 54.9, SD 9.6), were eligible for analysis. Study participants played all games three times with 14 days in between sets. Face and content validity were based on expert opinion. Alternate forms reliability (AFR) was measured by comparing scores on different versions of the BAM-COG and expressed with an intraclass correlation (ICC: two-way mixed; consistency at 95%). Convergent validity (CV) was provided by comparing BAM-COG scores to gold-standard paper-and-pencil and computer-assisted cognitive assessment. Divergent validity (DV) was measured by comparing BAM-COG scores to the National Adult Reading Test IQ (NART-IQ) estimate. Both CV and DV are expressed as Spearman rho correlation coefficients. Results: Three out of four games showed adequate results on AFR, CV, and DV measures. The games Conveyer Belt, Sunshine, and Papyrinth have AFR ICCs of .420, .426, and .645 respectively. Also, these games had good to very good CV correlations: rho=.577 (P=.001), rho=.669 (P<.001), and rho=.400 (P=.04), respectively. Last, as expected, DV correlations were low: rho=−.029 (P=.44), rho=−.029 (P=.45), and rho=−.134 (P=.28) respectively. The game Viewpoint provided less desirable results with an AFR ICC of .167, CV rho=.202 (P=.15), and DV rho=−.162 (P=.21). Conclusions: This study provides evidence for the use of the BAM-COG test battery as a feasible, reliable, and valid tool to monitor cognitive performance in healthy adults in an online setting. Three out of four games have good psychometric characteristics to measure working memory, visuospatial short-term memory, and planning capacity. %M 24300212 %R 10.2196/jmir.2860 %U http://www.jmir.org/2013/12/e270/ %U https://doi.org/10.2196/jmir.2860 %U http://www.ncbi.nlm.nih.gov/pubmed/24300212 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 10 %P e230 %T Integrating Patient Reported Outcomes With Clinical Cancer Registry Data: A Feasibility Study of the Electronic Patient-Reported Outcomes From Cancer Survivors (ePOCS) System %A Ashley,Laura %A Jones,Helen %A Thomas,James %A Newsham,Alex %A Downing,Amy %A Morris,Eva %A Brown,Julia %A Velikova,Galina %A Forman,David %A Wright,Penny %+ School of Social, Psychological and Communication Sciences, Faculty of Health and Social Sciences, Leeds Metropolitan University, Calverley Building, City Campus, Leeds, LS1 3HE, United Kingdom, 44 (0)113 8124970, l.j.ashley@leedsmet.ac.uk %K cancer %K oncology %K patient reported outcomes %K patient reported outcome measures %K health-related quality of life %K survivorship %K cancer registry %K electronic data capture %K health information technology %K Internet %D 2013 %7 25.10.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Routine measurement of Patient Reported Outcomes (PROs) linked with clinical data across the patient pathway is increasingly important for informing future care planning. The innovative electronic Patient-reported Outcomes from Cancer Survivors (ePOCS) system was developed to integrate PROs, collected online at specified post-diagnostic time-points, with clinical and treatment data in cancer registries. Objective: This study tested the technical and clinical feasibility of ePOCS by running the system with a sample of potentially curable breast, colorectal, and prostate cancer patients in their first 15 months post diagnosis. Methods: Patients completed questionnaires comprising multiple Patient Reported Outcome Measures (PROMs) via ePOCS within 6 months (T1), and at 9 (T2) and 15 (T3) months, post diagnosis. Feasibility outcomes included system informatics performance, patient recruitment, retention, representativeness and questionnaire completion (response rate), patient feedback, and administration burden involved in running the system. Results: ePOCS ran efficiently with few technical problems. Patient participation was 55.21% (636/1152) overall, although varied by approach mode, and was considerably higher among patients approached face-to-face (61.4%, 490/798) than by telephone (48.8%, 21/43) or letter (41.0%, 125/305). Older and less affluent patients were less likely to join (both P<.001). Most non-consenters (71.1%, 234/329) cited information technology reasons (ie, difficulty using a computer). Questionnaires were fully or partially completed by 85.1% (541/636) of invited participants at T1 (80 questions total), 70.0% (442/631) at T2 (102-108 questions), and 66.3% (414/624) at T3 (148-154 questions), and fully completed at all three time-points by 57.6% (344/597) of participants. Reminders (mainly via email) effectively prompted responses. The PROs were successfully linked with cancer registry data for 100% of patients (N=636). Participant feedback was encouraging and positive, with most patients reporting that they found ePOCS easy to use and that, if asked, they would continue using the system long-term (86.2%, 361/419). ePOCS was not administratively burdensome to run day-to-day, and patient-initiated inquiries averaged just 11 inquiries per month. Conclusions: The informatics underlying the ePOCS system demonstrated successful proof-of-concept – the system successfully linked PROs with registry data for 100% of the patients. The majority of patients were keen to engage. Participation rates are likely to improve as the Internet becomes more universally adopted. ePOCS can help overcome the challenges of routinely collecting PROs and linking with clinical data, which is integral for treatment and supportive care planning and for targeting service provision. %M 24161667 %R 10.2196/jmir.2764 %U http://www.jmir.org/2013/10/e230/ %U https://doi.org/10.2196/jmir.2764 %U http://www.ncbi.nlm.nih.gov/pubmed/24161667 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 10 %P e232 %T Can a Novel Web-Based Computer Test Predict Poor Simulated Driving Performance? A Pilot Study With Healthy and Cognitive-Impaired Participants %A Nef,Tobias %A Müri,René M %A Bieri,Rahel %A Jäger,Michael %A Bethencourt,Nora %A Tarnanas,Ioannis %A Mosimann,Urs P %+ Gerontechnology and Rehabilitation Group, University of Bern, Murtenstrasse 50, Bern, 3010, Switzerland, 41 31 632 88 17, Rene.muri@insel.ch %K cognitive impairment %K Web-based cognitive test %K computer-based tests %K driving simulation %D 2013 %7 18.10.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Driving a car is a complex instrumental activity of daily living and driving performance is very sensitive to cognitive impairment. The assessment of driving-relevant cognition in older drivers is challenging and requires reliable and valid tests with good sensitivity and specificity to predict safe driving. Driving simulators can be used to test fitness to drive. Several studies have found strong correlation between driving simulator performance and on-the-road driving. However, access to driving simulators is restricted to specialists and simulators are too expensive, large, and complex to allow easy access to older drivers or physicians advising them. An easily accessible, Web-based, cognitive screening test could offer a solution to this problem. The World Wide Web allows easy dissemination of the test software and implementation of the scoring algorithm on a central server, allowing generation of a dynamically growing database with normative values and ensures that all users have access to the same up-to-date normative values. Objective: In this pilot study, we present the novel Web-based Bern Cognitive Screening Test (wBCST) and investigate whether it can predict poor simulated driving performance in healthy and cognitive-impaired participants. Methods: The wBCST performance and simulated driving performance have been analyzed in 26 healthy younger and 44 healthy older participants as well as in 10 older participants with cognitive impairment. Correlations between the two tests were calculated. Also, simulated driving performance was used to group the participants into good performers (n=70) and poor performers (n=10). A receiver-operating characteristic analysis was calculated to determine sensitivity and specificity of the wBCST in predicting simulated driving performance. Results: The mean wBCST score of the participants with poor simulated driving performance was reduced by 52%, compared to participants with good simulated driving performance (P<.001). The area under the receiver-operating characteristic curve was 0.80 with a 95% confidence interval 0.68-0.92. Conclusions: When selecting a 75% test score as the cutoff, the novel test has 83% sensitivity, 70% specificity, and 81% efficiency, which are good values for a screening test. Overall, in this pilot study, the novel Web-based computer test appears to be a promising tool for supporting clinicians in fitness-to-drive assessments of older drivers. The Web-based distribution and scoring on a central computer will facilitate further evaluation of the novel test setup. We expect that in the near future, Web-based computer tests will become a valid and reliable tool for clinicians, for example, when assessing fitness to drive in older drivers. %M 24144946 %R 10.2196/jmir.2943 %U http://www.jmir.org/2013/10/e232/ %U https://doi.org/10.2196/jmir.2943 %U http://www.ncbi.nlm.nih.gov/pubmed/24144946 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 10 %P e229 %T Telephone Versus Internet Administration of Self-Report Measures of Social Anxiety, Depressive Symptoms, and Insomnia: Psychometric Evaluation of a Method to Reduce the Impact of Missing Data %A Hedman,Erik %A Ljótsson,Brjánn %A Blom,Kerstin %A El Alaoui,Samir %A Kraepelien,Martin %A Rück,Christian %A Andersson,Gerhard %A Svanborg,Cecilia %A Lindefors,Nils %A Kaldo,Viktor %+ Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Retzius väg 8, Stockholm, 171 77, Sweden, 46 08 524 800 00, kire.hedman@ki.se %K Internet %K telephone %K self-report measures %K missing data %K method validation %D 2013 %7 18.10.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-administered self-report measures of social anxiety, depressive symptoms, and sleep difficulties are widely used in clinical trials and in clinical routine care, but data loss is a common problem that could render skewed estimates of symptom levels and treatment effects. One way of reducing the negative impact of missing data could be to use telephone administration of self-report measures as a means to complete the data missing from the online data collection. Objective: The aim of the study was to compare the convergence of telephone and Internet administration of self-report measures of social anxiety, depressive symptoms, and sleep difficulties. Methods: The Liebowitz Social Anxiety Scale-Self-Report (LSAS-SR), Montgomery-Åsberg Depression Rating Scale-Self-Rated (MADRS-S), and the Insomnia Severity Index (ISI) were administered over the telephone and via the Internet to a clinical sample (N=82) of psychiatric patients at a clinic specializing in Internet-delivered treatment. Shortened versions of the LSAS-SR and the ISI were used when administered via telephone. Results: As predicted, the results showed that the estimates produced by the two administration formats were highly correlated (r=.82-.91; P<.001) and internal consistencies were high in both administration formats (telephone: Cronbach alpha=.76-.86 and Internet: Cronbach alpha=.79-.93). The correlation coefficients were similar across questionnaires and the shorter versions of the questionnaires used in the telephone administration of the LSAS-SR and ISI performed in general equally well compared to when the full scale was used, as was the case with the MADRS-S. Conclusions: Telephone administration of self-report questionnaires is a valid method that can be used to reduce data loss in routine psychiatric practice as well as in clinical trials, thereby contributing to more accurate symptom estimates. %M 24140566 %R 10.2196/jmir.2818 %U http://www.jmir.org/2013/10/e229/ %U https://doi.org/10.2196/jmir.2818 %U http://www.ncbi.nlm.nih.gov/pubmed/24140566 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 10 %P e225 %T Internet Addiction Test (IAT): Which is the Best Factorial Solution? %A Faraci,Palmira %A Craparo,Giuseppe %A Messina,Roberta %A Severino,Sergio %+ University of Enna "Kore", Faculty of Human and Social Sciences, Cittadella Universitaria, Enna, 94100, Italy, 39 0935536536, giuseppe.craparo@unikore.it %K IAT %K Internet %K addiction %K factorial structure %K psychometric properties %K structural validity %D 2013 %7 09.10.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet Addiction Test (IAT) by Kimberly Young is one of the most utilized diagnostic instruments for Internet addiction. Although many studies have documented psychometric properties of the IAT, consensus on the optimal overall structure of the instrument has yet to emerge since previous analyses yielded markedly different factor analytic results. Objective: The objective of this study was to evaluate the psychometric properties of the Italian version of the IAT, specifically testing the factor structure stability across cultures. Methods: In order to determine the dimensional structure underlying the questionnaire, both exploratory and confirmatory factor analyses were performed. The reliability of the questionnaire was computed by the Cronbach alpha coefficient. Results: Data analyses were conducted on a sample of 485 college students (32.3%, 157/485 males and 67.7%, 328/485 females) with a mean age of 24.05 years (SD 7.3, range 17-47). Results showed 176/485 (36.3%) participants with IAT score from 40 to 69, revealing excessive Internet use, and 11/485 (1.9%) participants with IAT score from 70 to 100, suggesting significant problems because of Internet use. The IAT Italian version showed good psychometric properties, in terms of internal consistency and factorial validity. Alpha values were satisfactory for both the one-factor solution (Cronbach alpha=.91), and the two-factor solution (Cronbach alpha=.88 and Cronbach alpha=.79). The one-factor solution comprised 20 items, explaining 36.18% of the variance. The two-factor solution, accounting for 42.15% of the variance, showed 11 items loading on Factor 1 (Emotional and Cognitive Preoccupation with the Internet) and 7 items on Factor 2 (Loss of Control and Interference with Daily Life). Goodness-of-fit indexes (NNFI: Non-Normed Fit Index; CFI: Comparative Fit Index; RMSEA: Root Mean Square Error of Approximation; SRMR: Standardized Root Mean Square Residual) from confirmatory factor analyses conducted on a random half subsample of participants (n=243) were satisfactory in both factorial solutions: two-factor model (χ2132= 354.17, P<.001, χ2/df=2.68, NNFI=.99, CFI=.99, RMSEA=.02 [90% CI 0.000-0.038], and SRMR=.07), and one-factor model (χ2169=483.79, P<.001, χ2/df=2.86, NNFI=.98, CFI=.99, RMSEA=.02 [90% CI 0.000-0.039], and SRMR=.07). Conclusions: Our study was aimed at determining the most parsimonious and veridical representation of the structure of Internet addiction as measured by the IAT. Based on our findings, support was provided for both single and two-factor models, with slightly strong support for the bidimensionality of the instrument. Given the inconsistency of the factor analytic literature of the IAT, researchers should exercise caution when using the instrument, dividing the scale into factors or subscales. Additional research examining the cross-cultural stability of factor solutions is still needed. %M 24184961 %R 10.2196/jmir.2935 %U http://www.jmir.org/2013/10/e225/ %U https://doi.org/10.2196/jmir.2935 %U http://www.ncbi.nlm.nih.gov/pubmed/24184961 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 9 %P e214 %T Monitoring Dietary Intake and Physical Activity Electronically: Feasibility, Usability, and Ecological Validity of a Mobile-Based Ecological Momentary Assessment Tool %A Spook,Jorinde Eline %A Paulussen,Theo %A Kok,Gerjo %A Van Empelen,Pepijn %+ Faculty of Psychology and Neuroscience, Department of Work and Social Psychology, Maastricht University, Universiteitssingel 40, Maastricht, 6200MD, Netherlands, 31 888661715, jorinde.spook@tno.nl %K mobile-based Ecological Momentary Assessment (mEMA) %K feasibility %K usability %K ecological validity %K dietary intake %K physical activity %D 2013 %7 24.09.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the growing body of research on complex lifestyle behaviors (eg, Dietary Intake [DI] and Physical Activity [PA]), monitoring of these behaviors has been hampered by a lack of suitable methods. A possible solution to this deficiency is mobile-based Ecological Momentary Assessment (mEMA), which enables researchers to collect data on participants’ states in real-time by means of a smartphone application. However, feasibility, usability, and ecological validity need to be anticipated and managed in order to enhance the validity of mEMA. Objective: To examine the feasibility, usability, and ecological validity of a mEMA application (app) with regard to DI and PA among Dutch vocational education students. Methods: The students (n=30) participated in the mEMA study for seven consecutive days. They downloaded the mEMA app on their smartphone. Feasibility and usability of the mEMA app were evaluated by completing an online evaluation after seven days of participation. Ecological validity was measured by assessing the degree to which the content of the mEMA app approximated the real-world setting that was being examined, through several multiple-choice questions. Results: Compliance rates, as registered by the mEMA app, declined 46% over a seven-day period, while self-reported compliance, as measured with an online evaluation questionnaire afterwards, indicated a smaller decrease in compliance (29%). The students evaluated the mEMA app as feasible and usable. Ecological validity analyses showed that all DI and almost all PA multiple-choice options were covered with the compound response categories. Conclusions: The mEMA app offers the opportunity to assess complex health behaviors (eg, DI and PA) in real-time settings, in which specifically routinized behaviors are involved. However, the mEMA app faced several challenges that needed to be overcome in order to improve its validity. Overall, the present study showed that the mEMA app is a usable and ecologically valid tool to measure DI and PA behaviors among vocational education students, but compliance is still limited. %M 24067298 %R 10.2196/jmir.2617 %U http://www.jmir.org/2013/9/e214/ %U https://doi.org/10.2196/jmir.2617 %U http://www.ncbi.nlm.nih.gov/pubmed/24067298 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 2 %N 2 %P e36 %T Development of an Electronic Alcohol Screening and Brief Intervention Program for Hospital Outpatients With Unhealthy Alcohol Use %A Johnson,Natalie A %A Kypri,Kypros %A Attia,John %+ School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, HMRI Building, Callaghan, NSW, 2308, Australia, 61 240420552, natalie.johnson@newcastle.edu.au %K alcohol %K drinking %K screening %K brief intervention %K hospital %K outpatients %K Internet %D 2013 %7 20.09.2013 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Alcohol screening and brief intervention is recommended for widespread implementation in health care systems, but it is not used routinely in most countries for a variety of reasons. Electronic screening and brief intervention (e-SBI), in which patients complete a Web-based questionnaire and are provided with personalized feedback on their drinking, is a promising alternative to practitioner delivered intervention, but its efficacy in the hospital outpatient setting has not been established. Objective: The objective of our study was to establish the feasibility of conducting a full-scale randomized controlled trial to determine whether e-SBI reduces alcohol consumption in hospital outpatients with hazardous or harmful drinking. Methods: The study was conducted in the outpatient department of a large public hospital in Newcastle (population 540,000), Australia. Adults with appointments at a broad range of medical and surgical outpatient clinics were invited to complete an e-SBI program on a laptop, and to report their impressions via a short questionnaire. Follow-up assessments were conducted 2-8 weeks later by email and post. Results: We approached 172 outpatients and 108/172 (62.8%) agreed to participate. Of the 106 patients capable of self-administering the e-SBI, 7/106 (6.6%) did not complete it (3 due to technical problems and 4 because they were called for their appointment), 15/106 (14.2%) indicated that they had not consumed any alcohol in the past 12 months, 43/106 (40.6%) screened negative for unhealthy alcohol use (scored less than 5 on the Alcohol Use Disorders Identification Test Consumption [AUDIT-C] questions), 33/106 (31.1%) screened positive for hazardous or harmful drinking (AUDIT-C score 5-9), and 8/106 (7.5%) screened positive for possible alcohol dependence (AUDIT-C score 10-12). Among the subgroup with hazardous or harmful drinking, 27/33 (82%) found the feedback on their drinking very, quite, or somewhat useful, 33/33 (100%) thought the intervention would appeal to most or some of the people who attend the service, and 22/30 (73%) completed the follow-up. We also found that some well established procedures used in trials of e-SBI in the primary care setting did not translate to the hospital outpatient setting (1) we experienced delays because the e-SBI program had to be developed and maintained by the health service’s information technology staff for security reasons, (2) recruiting patients as they left the reception desk was impractical because patients tended to arrive at the beginning of the clinics with few arrivals thereafter, and (3) use of a laptop in a fixed location resulted in some patients rushing through the e-SBI so they could return to their seat in the area they had been advised to wait in. Conclusions: e-SBI is acceptable to outpatients and with some adaptation to organizational and physical conditions, it is feasible to recruit and screen patients and to deliver the intervention without disrupting normal service provision. This suggests that e-SBI could be provided routinely in this important setting if shown to be efficacious. %M 24055787 %R 10.2196/resprot.2697 %U http://www.researchprotocols.org/2013/2/e36/ %U https://doi.org/10.2196/resprot.2697 %U http://www.ncbi.nlm.nih.gov/pubmed/24055787 %0 Journal Article %@ 1923-2195 %I Gunther Eysenbach %V 2 %N 2 %P e9 %T Development of a Questionnaire and Cross-Sectional Survey of Patient eHealth Readiness and eHealth Inequalities %A Jones,Ray %+ University of Plymouth, Faculty of Health, Education, and Society, 3 Portland Villas, Plymouth, PL4 8AA, United Kingdom, 44 7972563340, ray.jones@plymouth.ac.uk %K eHealth readiness %K eHealth inequalities %K digital divide %K questionnaire development %D 2013 %7 02.09.2013 %9 Original Paper %J Med 2.0 %G English %X Background: Many speak of the digital divide, but variation in the opportunity of patients to use the Internet for health (patient eHealth readiness) is not a binary difference, rather a distribution influenced by personal capability, provision of services, support, and cost. Digital divisions in health have been addressed by various initiatives, but there was no comprehensive validated measure to know if they are effective that could be used in randomized controlled trials (RCTs) covering both non-Internet-users and the range of Internet-users. Objective: The aim of this study was to develop and validate a self-completed questionnaire and scoring system to assess patient eHealth readiness by examining the spread of scores and eHealth inequalities. The intended use of this questionnaire and scores is in RCTs of interventions aiming to improve patient eHealth readiness and reduce eHealth inequalities. Methods: Based on four factors identified from the literature, a self-completed questionnaire, using a pragmatic combination of factual and attitude questions, was drafted and piloted in three stages. This was followed by a final population-based, cross-sectional household survey of 344 people used to refine the scoring system. Results: The Patient eHealth Readiness Questionnaire (PERQ) includes questions used to calculate four subscores: patients’ perception of (1) provision, (2) their personal ability and confidence, (3) their interpersonal support, and (4) relative costs in using the Internet for health. These were combined into an overall PERQ score (0-9) which could be used in intervention studies. Reduction in standard deviation of the scores represents reduction in eHealth inequalities. Conclusions: PERQ appears acceptable for participants in British studies. The scores produced appear valid and will enable assessment of the effectiveness of interventions to improve patient eHealth readiness and reduce eHealth inequalities. Such methods need continued evolution and redevelopment for other environments. Full documentation and data have been published to allow others to develop the tool further. %M 25075244 %R 10.2196/med20.2559 %U http://www.medicine20.com/2013/2/e9/ %U https://doi.org/10.2196/med20.2559 %U http://www.ncbi.nlm.nih.gov/pubmed/25075244 %0 Journal Article %@ 1923-2195 %I Gunther Eysenbach %V 2 %N 2 %P e8 %T Validity and Reliability of the eHealth Analysis and Steering Instrument %A Blanson Henkemans,Olivier A %A Dusseldorp,Elise ML %A Keijsers,Jolanda FEM %A Kessens,Judith M %A Neerincx,Mark A %A Otten,Wilma %+ Nederlandse Organisatie voor Toegepast Natuurwetenschappelijk Onderzoek (TNO), Department Lifestyle, Room 208, Wassenaarseweg 56, Leiden, 2333AL, Netherlands, 31 888666186, olivier.blansonhenkemans@tno.nl %K self-care %K psychometrics %K validity %K reliability %K scale analysis %K effectiveness %K self-management support %D 2013 %7 22.08.2013 %9 Original Paper %J Med 2.0 %G English %X Background: eHealth services can contribute to individuals’ self-management, that is, performing lifestyle-related activities and decision making, to maintain a good health, or to mitigate the effect of an (chronic) illness on their health. But how effective are these services? Conducting a randomized controlled trial (RCT) is the golden standard to answer such a question, but takes extensive time and effort. The eHealth Analysis and Steering Instrument (eASI) offers a quick, but not dirty alternative. The eASI surveys how eHealth services score on 3 dimensions (ie, utility, usability, and content) and 12 underlying categories (ie, insight in health condition, self-management decision making, performance of self-management, involving the social environment, interaction, personalization, persuasion, description of health issue, factors of influence, goal of eHealth service, implementation, and evidence). However, there are no data on its validity and reliability. Objective: The objective of our study was to assess the construct and predictive validity and interrater reliability of the eASI. Methods: We found 16 eHealth services supporting self-management published in the literature, whose effectiveness was evaluated in an RCT and the service itself was available for rating. Participants (N=16) rated these services with the eASI. We analyzed the correlation of eASI items with the underlying three dimensions (construct validity), the correlation between the eASI score and the eHealth services’ effect size observed in the RCT (predictive validity), and the interrater agreement. Results: Three items did not fit with the other items and dimensions and were removed from the eASI; 4 items were replaced from the utility to the content dimension. The interrater reliabilities of the dimensions and the total score were moderate (total, κ=.53, and content, κ=.55) and substantial (utility, κ=.69, and usability, κ=.63). The adjusted eASI explained variance in the eHealth services’ effect sizes (R2=.31, P<.001), as did the dimensions utility (R2=.49, P<.001) and usability (R2=.18, P=.021). Usability explained variance in the effect size on health outcomes (R2=.13, P=.028). Conclusions: After removing 3 items and replacing 4 items to another dimension, the eASI (3 dimensions, 11 categories, and 32 items) has a good construct validity and predictive validity. The eASI scales are moderately to highly reliable. Accordingly, the eASI can predict how effective an eHealth service is in regard to supporting self-management. Due to a small pool of available eHealth services, it is advised to reevaluate the eASI in the future with more services. %M 25075243 %R 10.2196/med20.2571 %U http://www.medicine20.com/2013/2/e8/ %U https://doi.org/10.2196/med20.2571 %U http://www.ncbi.nlm.nih.gov/pubmed/25075243 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 2 %N 2 %P e31 %T Assessment of Diet and Physical Activity of Brazilian Schoolchildren: Usability Testing of a Web-Based Questionnaire %A da Costa,Filipe Ferreira %A Schmoelz,Camilie Pacheco %A Davies,Vanessa Fernandes %A Di Pietro,Patrícia Faria %A Kupek,Emil %A de Assis,Maria Alice Altenburg %+ Graduate Course in Physical Education, Department of Physical Education, Federal University of Santa Catarina, Programa de Pós-graduação em Educação Física, Universidade Federal de Santa Catarina, Florianopolis, 88040-900, Brazil, 55 48 3721 801, filipefcosta@outlook.com %K usability testing %K questionnaire %K physical activity %K diet %K children %D 2013 %7 19.08.2013 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Information and communication technology (ICT) has been used with increasing frequency for the assessment of diet and physical activity in health surveys. A number of Web-based questionnaires have been developed for children and adolescents. However, their usability characteristics have scarcely been reported, despite their potential importance for improving the feasibility and validity of ICT-based methods. Objective: The objective of this study was to describe the usability evaluation of the Consumo Alimentar e Atividade Física de Escolares (CAAFE) questionnaire (Food Consumption and Physical Activity Questionnaire for schoolchildren), a new Web-based survey tool for the self-assessment of diet and physical activity by schoolchildren. Methods: A total of 114 schoolchildren aged 6 to 12 years took part in questionnaire usability testing carried out in computer classrooms at five elementary schools in the city of Florianopolis, Brazil. Schoolchildren used a personal computer (PC) equipped with software for recording what is on the computer screen and the children’s speech during usability testing. Quantitative and qualitative analyses took into account objective usability metrics such as error counts and time to complete a task. Data on the main difficulties in accomplishing the task and the level of satisfaction expressed by the children were assessed by the observers using a standardized form and interviews with the children. Descriptive statistics and content analysis were used to summarize both the quantitative and the qualitative aspects of the data obtained. Results: The mean time for completing the questionnaire was 13.7 minutes (SD 3.68). Compared to the children in 2nd or 3rd grades, those in 4th or 5th grades spent less time completing the questionnaire (median 12.4 vs 13.3 minutes, P=.022), asked for help less frequently (median 0 vs 1.0 count, P=.005), had a lower error count (median 2.0 vs 8.0 count, P<.001), and obtained a higher overall performance score (median 73.0 vs 68.0, P=.005). Children with a PC at home spent less time completing the questionnaire (median 12.3 vs 14.9 minutes, P<.001), had a lower overall error count (median 2.0 vs 9.0 count, P=.03), and had a higher performance score (median 72.0 vs 64.0, P=.005) compared to the children without a PC at home. The most common difficulty in completing the questionnaire was in using the scroll bar. The majority of children reported a positive evaluation (liked a lot or liked) for the four design elements, which were evaluated. Conclusions: The results of the present study provided feedback to improve the final version of the CAAFE questionnaire. Quantitative data showed minor errors and system failures, while qualitative data indicated that, overall, the children enjoyed the CAAFE questionnaire. Grade levels and PC use must be taken into account in Web-based tools designed for children. %M 23958804 %R 10.2196/resprot.2646 %U http://www.researchprotocols.org/2013/2/e31/ %U https://doi.org/10.2196/resprot.2646 %U http://www.ncbi.nlm.nih.gov/pubmed/23958804 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 7 %P e139 %T An Easily Accessible Web-Based Minimization Random Allocation System for Clinical Trials %A Xiao,Lan %A Huang,Qiwen %A Yank,Veronica %A Ma,Jun %+ Research Institute, Palo Alto Medical Foundation, Ames Building, 795 EL Camino Real, Palo Alto, CA, United States, 1 650 853 4809, maj@pamfri.org %K randomized controlled trials %K randomization %K minimization %K adaptive randomization %K Kullback–Leibler divergence %K Web-based %D 2013 %7 19.07.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Minimization as an adaptive allocation technique has been recommended in the literature for use in randomized clinical trials. However, it remains uncommonly used due in part to a lack of easily accessible implementation tools. Objective: To provide clinical trialists with a robust, flexible, and readily accessible tool for implementing covariate-adaptive biased-coin randomization. Methods: We developed a Web-based random allocation system, MinimRan, that applies Pocock–Simon (for trials with 2 or more arms) and 2-way (currently limited to 2-arm trials) minimization methods for trials using only categorical prognostic factors or the symmetric Kullback–Leibler divergence minimization method for trials (currently limited to 2-arm trials) using continuous prognostic factors with or without categorical factors, in covariate-adaptive biased-coin randomization. Results: In this paper, we describe the system’s essential statistical and computer programming features and provide as an example the randomization results generated by it in a recently completed trial. The system can be used in single- and double-blind trials as well as single-center and multicenter trials. Conclusions: We expect the system to facilitate the translation of the 3 validated random allocation methods into broad, efficient clinical research practice. %M 23872035 %R 10.2196/jmir.2392 %U http://www.jmir.org/2013/7/e139/ %U https://doi.org/10.2196/jmir.2392 %U http://www.ncbi.nlm.nih.gov/pubmed/23872035 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 7 %P e132 %T Internet Use Frequency and Patient-Centered Care: Measuring Patient Preferences for Participation Using the Health Information Wants Questionnaire %A Xie,Bo %A Wang,Mo %A Feldman,Robert %A Zhou,Le %+ School of Nursing & School of Information, University of Texas at Austin, 1710 Red River Street, Austin, TX, 78712, United States, 1 512 232 5788, boxie@utexas.edu %K patient-centered care %K patient preference %K shared decision-making %K patient participation %K Internet %D 2013 %7 01.07.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet is bringing fundamental changes to medical practice through improved access to health information and participation in decision making. However, patient preferences for participation in health care vary greatly. Promoting patient-centered health care requires an understanding of the relationship between Internet use and a broader range of preferences for participation than previously measured. Objective: To explore (1) whether there is a significant relationship between Internet use frequency and patients’ overall preferences for obtaining health information and decision-making autonomy, and (2) whether the relationships between Internet use frequency and information and decision-making preferences differ with respect to different aspects of health conditions. Methods: The Health Information Wants Questionnaire (HIWQ) was administered to gather data about patients’ preferences for the (1) amount of information desired about different aspects of a health condition, and (2) level of decision-making autonomy desired across those same aspects. Results: The study sample included 438 individuals: 226 undergraduates (mean age 20; SD 2.15) and 212 community-dwelling older adults (mean age 72; SD 9.00). A significant difference was found between the younger and older age groups’ Internet use frequencies, with the younger age group having significantly more frequent Internet use than the older age group (younger age group mean 5.98, SD 0.33; older age group mean 3.50, SD 2.00; t436=17.42, P<.01). Internet use frequency was positively related to the overall preference rating (γ=.15, P<.05), suggesting that frequent Internet users preferred significantly more information and decision making than infrequent Internet users. The relationships between Internet use frequency and different types of preferences varied: compared with infrequent Internet users, frequent Internet users preferred more information but less decision making for diagnosis (γ=.57, P<.01); more information and more decision-making autonomy for laboratory test (γ=.15, P<.05), complementary and alternative medicine (γ=.32, P<.01), and self-care (γ=.15, P<.05); and less information but more decision-making autonomy for the psychosocial (γ=-.51, P<.01) and health care provider (γ=-.27, P<.05) aspects. No significant difference was found between frequent and infrequent Internet users in their preferences for treatment information and decision making. Conclusions: Internet use frequency has a positive relationship with the overall preferences for obtaining health information and decision-making autonomy, but its relationship with different types of preferences varies. These findings have important implications for medical practice. %M 23816979 %R 10.2196/jmir.2615 %U http://www.jmir.org/2013/7/e132/ %U https://doi.org/10.2196/jmir.2615 %U http://www.ncbi.nlm.nih.gov/pubmed/23816979 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 6 %P e111 %T Comparison of Physical Activity Measures Using Mobile Phone-Based CalFit and Actigraph %A Donaire-Gonzalez,David %A de Nazelle,Audrey %A Seto,Edmund %A Mendez,Michelle %A Nieuwenhuijsen,Mark J %A Jerrett,Michael %+ Center for Research in Environmental Epidemiology (CREAL), C Doctor Aiguader, 88., Barcelona, Catalonia, 08003, Spain, 34 93 2147337, mnieuwenhuijsen@creal.cat %K cellular phone %K accelerometry %K global positioning systems %K motor activity %K monitoring %K physiologic %D 2013 %7 13.06.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Epidemiological studies on physical activity often lack inexpensive, objective, valid, and reproducible tools for measuring physical activity levels of participants. Novel sensing technologies built into smartphones offer the potential to fill this gap. Objective: We sought to validate estimates of physical activity and determine the usability for large population-based studies of the smartphone-based CalFit software. Methods: A sample of 36 participants from Barcelona, Spain, wore a smartphone with CalFit software and an Actigraph GT3X accelerometer for 5 days. The ease of use (usability) and physical activity measures from both devices were compared, including vertical axis counts (VT) and duration and energy expenditure predictions for light, moderate, and vigorous intensity from Freedson’s algorithm. Statistical analyses included (1) Kruskal-Wallis rank sum test for usability measures, (2) Spearman correlation and linear regression for VT counts, (3) concordance correlation coefficient (CCC), and (4) Bland-Altman plots for duration and energy expenditure measures. Results: Approximately 64% (23/36) of participants were women. Mean age was 31 years (SD 8) and mean body mass index was 22 kg/m2 (SD 2). In total, 25/36 (69%) participants recorded at least 3 days with at least 10 recorded hours of physical activity using CalFit. The linear association and correlations for VT counts were high (adjusted R2=0.85; correlation coefficient .932, 95% CI 0.931-0.933). CCCs showed high agreement for duration and energy expenditure measures (from 0.83 to 0.91). Conclusions: The CalFit system had lower usability than the Actigraph GT3X because the application lacked a means to turn itself on each time the smartphone was powered on. The CalFit system may provide valid estimates to quantify and classify physical activity. CalFit may prove to be more cost-effective and easily deployed for large-scale population health studies than other specialized instruments because cell phones are already carried by many people. %M 23896156 %R 10.2196/jmir.2470 %U http://www.jmir.org/2013/6/e111/ %U https://doi.org/10.2196/jmir.2470 %U http://www.ncbi.nlm.nih.gov/pubmed/23896156 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 6 %P e116 %T Collecting Maternal Health Information From HIV-Positive Pregnant Women Using Mobile Phone-Assisted Face-to-Face Interviews in Southern Africa %A van Heerden,Alastair %A Norris,Shane %A Tollman,Stephen %A Richter,Linda %A Rotheram-Borus,Mary Jane %+ Human Sciences Research Council, PO Box 90, Msunduzi, Pietermaritzburg, 3201, South Africa, 27 333245015, avanheerden@hsrc.ac.za %K mobile phones %K human immunodeficiency virus %K mobile health %D 2013 %7 10.06.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Most of the world’s women living with human immunodeficiency virus (HIV) reside in sub-Saharan Africa. Although efforts to reduce mother-to-child transmission are underway, obtaining complete and accurate data from rural clinical sites to track progress presents a major challenge. Objective: To describe the acceptability and feasibility of mobile phones as a tool for clinic-based face-to-face data collection with pregnant women living with HIV in South Africa. Methods: As part of a larger clinic-based trial, 16 interviewers were trained to conduct mobile phone–assisted personal interviews (MPAPI). These interviewers (participant group 1) completed the same short questionnaire based on items from the Technology Acceptance Model at 3 different time points. Questions were asked before training, after training, and 3 months after deployment to clinic facilities. In addition, before the start of the primary intervention trial in which this substudy was undertaken, 12 mothers living with HIV (MLH) took part in a focus group discussion exploring the acceptability of MPAPI (participant group 2). Finally, a sample of MLH (n=512) enrolled in the primary trial were asked to assess their experience of being interviewed by MPAPI (participant group 3). Results: Acceptability of the method was found to be high among the 16 interviewers in group 1. Perceived usefulness was reported to be slightly higher than perceived ease of use across the 3 time points. After 3 months of field use, interviewer perceptions of both perceived ease of use and perceived usefulness were found to be higher than before training. The feasibility of conducting MPAPI interviews in this setting was found to be high. Network coverage was available in all clinics and hardware, software, cost, and secure transmission to the data center presented no significant challenges over the 21-month period. For the 12 MHL participants in group 2, anxiety about the multimedia capabilities of the phone was evident. Their concern centered on the possibility that their privacy may be invaded by interviewers using the mobile phone camera to photograph them. For participants in group 3, having the interviewer sit beside vs across from the interviewee during the MPAPI interview was received positively by 94.7% of MHL. Privacy (6.3%) and confidentiality (5.3%) concerns were low for group 3 MHL. Conclusions: Mobile phones were found both to be acceptable and feasible in the collection of maternal and child health data from women living with HIV in South Africa. Trial Registration: Clinicaltrials.gov NCT00972699; http://clinicaltrials.gov/ct2/show/NCT00972699 (Archived by WebCite at http://clinicaltrials.gov/ct2/show/NCT00972699) %M 23748182 %R 10.2196/jmir.2207 %U http://www.jmir.org/2013/6/e116/ %U https://doi.org/10.2196/jmir.2207 %U http://www.ncbi.nlm.nih.gov/pubmed/23748182 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 6 %P e109 %T Two New Meal- and Web-Based Interactive Food Frequency Questionnaires: Validation of Energy and Macronutrient Intake %A Christensen,Sara E %A Möller,Elisabeth %A Bonn,Stephanie E %A Ploner,Alexander %A Wright,Antony %A Sjölander,Arvid %A Bälter,Olle %A Lissner,Lauren %A Bälter,Katarina %+ Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Nobels väg 12a, Stockholm, SE-171 77, Sweden, 46 852482361, sara.christensen@ki.se %K validity %K reproducibility %K food frequency questionnaire %K Internet %K weighed food record %K doubly labeled water %K adult %D 2013 %7 05.06.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Meal-Q and its shorter version, MiniMeal-Q, are 2 new Web-based food frequency questionnaires. Their meal-based and interactive format was designed to promote ease of use and to minimize answering time, desirable improvements in large epidemiological studies. Objective: We evaluated the validity of energy and macronutrient intake assessed with Meal-Q and MiniMeal-Q as well as the reproducibility of Meal-Q. Methods: Healthy volunteers aged 20-63 years recruited from Stockholm County filled out the 174-item Meal-Q. The questionnaire was compared to 7-day weighed food records (WFR; n=163), for energy and macronutrient intake, and to doubly labeled water (DLW; n=39), for total energy expenditure. In addition, the 126-item MiniMeal-Q was evaluated in a simulated validation using truncated Meal-Q data. We also assessed the answering time and ease of use of both questionnaires. Results: Bland-Altman plots showed a varying bias within the intake range for all validity comparisons. Cross-classification of quartiles placed 70%-86% in the same/adjacent quartile with WFR and 77% with DLW. Deattenuated and energy-adjusted Pearson correlation coefficients with the WFR ranged from r=0.33-0.74 for macronutrients and was r=0.18 for energy. Correlations with DLW were r=0.42 for Meal-Q and r=0.38 for MiniMeal-Q. Intraclass correlations for Meal-Q ranged from r=0.57-0.90. Median answering time was 17 minutes for Meal-Q and 7 minutes for MiniMeal-Q, and participants rated both questionnaires as easy to use. Conclusions: Meal-Q and MiniMeal-Q are easy to use and have short answering times. The ranking agreement is good for most of the nutrients for both questionnaires and Meal-Q shows fair reproducibility. %M 23739995 %R 10.2196/jmir.2458 %U http://www.jmir.org/2013/6/e109/ %U https://doi.org/10.2196/jmir.2458 %U http://www.ncbi.nlm.nih.gov/pubmed/23739995 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 4 %P e55 %T Attitudes of Patients Toward Adoption of 3D Technology in Pain Assessment: Qualitative Perspective %A Spyridonis,Fotios %A Ghinea,Gheorghita %A Frank,Andrew O %+ Brunel University, Department of Information Systems and Computing, Kingston Lane, Uxbridge, UB8 3PH, United Kingdom, 44 1895265503, fotios.spyridonis@brunel.ac.uk %K pain assessment %K 3-dimensional image %K health care systems %K health care delivery %K patient acceptance of health care %K qualitative research %D 2013 %7 10.04.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Past research has revealed that insufficient pain assessment could, and often, has negative implications on the provision of quality health care. While current available clinical approaches have proven to be valid interventions, they are expensive and can often fail in providing efficient pain measurements. The increase in the prevalence of pain calls for more intuitive pain assessment solutions. Computerized alternatives have already been proposed both in the literature and in commerce, but may lack essential qualities such as accuracy of the collected clinical information and effective patient-clinician interaction. In response to this concern, 3-dimensional (3D) technology could become the innovative intervention needed to support and improve the pain assessment process. Objective: The purpose of this analysis was to describe qualitative findings from a study which was designed to explore patients’ perceptions of adopting 3D technology in the assessment of their pain experience related to important themes that might positively or negatively influence the quality of the pain assessment process. Methods: The perceptions of 60 individuals with some form of pain in the area of Greater London were collected through semi-structured interviews. Of the 60 respondents, 24 (43%) produced usable responses and were analyzed for content using principles of the grounded theory approach and thematic analysis, in order to gain insight into the participants’ beliefs and attitudes towards adopting 3D technology in pain assessment. Results: The analysis identified 4 high-level core themes that were representative of the participants’ responses. These themes indicated that most respondents valued “the potential of 3D technology to facilitate better assessment of pain” as the most useful outcome of adopting a 3D approach. Respondents also expressed their opinions on the usability of the 3D approach, with no important concerns reported about its perceived ease of use. Our findings finally, showed that respondents appreciated the perceived clinical utility of the proposed approach, which could further have an influence on their intention to use it. Conclusions: These findings highlighted factors that are seen as essential for improving the assessment of pain, and demonstrated the need for a strong focus on patient-clinician communication. The participants of this analysis believed that the introduction of 3D technology in the process might be a useful mechanism for such a positive health care outcome. The study’s findings could also be used to make recommendations concerning the potential for inclusion of 3D technology in current clinical pain tools for the purpose of improving the quality of health care. %M 23575479 %R 10.2196/jmir.2427 %U http://www.jmir.org/2013/4/e55/ %U https://doi.org/10.2196/jmir.2427 %U http://www.ncbi.nlm.nih.gov/pubmed/23575479 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e61 %T Measuring Physical Activity in a Cardiac Rehabilitation Population Using a Smartphone-Based Questionnaire %A Pfaeffli,Leila %A Maddison,Ralph %A Jiang,Yannan %A Dalleck,Lance %A Löf,Marie %+ The National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand, 64 9 373 7599 ext 84728, l.pfaeffli@nihi.auckland.ac.nz %K cellular phone %K self report %K motor activity %K bias %K cardiovascular diseases %D 2013 %7 22.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Questionnaires are commonly used to assess physical activity in large population-based studies because of their low cost and convenience. Many self-report physical activity questionnaires have been shown to be valid and reliable measures, but they are subject to measurement errors and misreporting, often due to lengthy recall periods. Mobile phones offer a novel approach to measure self-reported physical activity on a daily basis and offer real-time data collection with the potential to enhance recall. Objective: The aims of this study were to determine the convergent validity of a mobile phone physical activity (MobilePAL) questionnaire against accelerometry in people with cardiovascular disease (CVD), and to compare how the MobilePAL questionnaire performed compared with the commonly used self-recall International Physical Activity Questionnaire (IPAQ). Methods: Thirty adults aged 49 to 85 years with CVD were recruited from a local exercise-based cardiac rehabilitation clinic in Auckland, New Zealand. All participants completed a demographics questionnaire and underwent a 6-minute walk test at the first visit. Subsequently, participants were temporarily provided a smartphone (with the MobilePAL questionnaire preloaded that asked 2 questions daily) and an accelerometer, which was to be worn for 7 days. After 1 week, a follow-up visit was completed during which the smartphone and accelerometer were returned, and participants completed the IPAQ. Results: Average daily physical activity level measured using the MobilePAL questionnaire showed moderate correlation (r=.45; P=.01) with daily activity counts per minute (Acc_CPM) and estimated metabolic equivalents (MET) (r=.45; P=.01) measured using the accelerometer. Both MobilePAL (beta=.42; P=.008) and age (beta=–.48, P=.002) were significantly associated with Acc_CPM (adjusted R2=.40). When IPAQ-derived energy expenditure, measured in MET-minutes per week (IPAQ_met), was considered in the predicted model, both IPAQ_met (beta=.51; P=.001) and age (beta=–.36; P=.016) made unique contributions (adjusted R2=.47, F2,27=13.58; P<.001).There was also a significant association between the MobilePAL and IPAQ measures (r=.49, beta=.51; P=.007). Conclusions: A mobile phone–delivered questionnaire is a relatively reliable and valid measure of physical activity in a CVD cohort. Reliability and validity measures in the present study are comparable to existing self-report measures. Given their ubiquitous use, mobile phones may be an effective method for physical activity surveillance data collection. %M 23524251 %R 10.2196/jmir.2419 %U http://www.jmir.org/2013/3/e61/ %U https://doi.org/10.2196/jmir.2419 %U http://www.ncbi.nlm.nih.gov/pubmed/23524251 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e47 %T Comparison of Web-Based and Paper-Based Administration of ADHD Questionnaires for Adults %A Hirsch,Oliver %A Hauschild,Franziska %A Schmidt,Martin H %A Baum,Erika %A Christiansen,Hanna %+ Faculty of Medicine, Department of General Practice/Family Medicine, Philipps University Marburg, Karl-von-Frisch-Str.4, Marburg, 35043, Germany, 49 64212826520, oliver.hirsch@staff.uni-marburg.de %K computers %K Attention-Deficit/Hyperactivity Disorder %K questionnaires %K Internet %K psychometrics %D 2013 %7 21.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Satisfactory psychometric properties in offline questionnaires do not guarantee the same outcome in Web-based versions. Any construct that is measured online should be compared to a paper-based assessment so that the appropriateness of online questionnaire data can be tested. Little research has been done in this area regarding Attention-Deficit/Hyperactivity Disorder (ADHD) in adults. Objective: The objective was to simultaneously collect paper-based and Web-based ADHD questionnaire data in adults not diagnosed with ADHD in order to compare the two data sources regarding their equivalence in raw scores, in measures of reliability, and in factorial structures. Methods: Data from the German versions of the Connors Adult ADHD Rating Scales (CAARS-S), the Wender Utah Rating Scale (WURS-k), and the ADHD Self Rating Scale (ADHS-SB) were collected via online and paper questionnaires in a cross-sectional study with convenience sampling. We performed confirmatory factor analyses to examine the postulated factor structures in both groups separately and multiple group confirmatory factor analyses to test whether the postulated factor structures of the questionnaires were equivalent across groups. With Cronbach alpha, we investigated the internal consistency of the postulated factors in the different questionnaires. Mann-Whitney U tests with the effect size “Probability of Superiority (PS)” were used to compare absolute values in the questionnaires between the two groups. Results: In the paper-based sample, there were 311 subjects (73.3% female); in the online sample, we reached 255 subjects (69% female). The paper-based sample had a mean age of 39.2 years (SD 18.6); the Web-based sample had a mean age of 30.4 years (SD 10.5) and had a higher educational background. The original four factor structure of the CAARS-S could be replicated in both samples, but factor loadings were different. The Web-based sample had significantly higher total scores on three scales. The five-factor structure of the German short form of the WURS-k could be replicated only in the Web-based sample. The Web-based sample had substantially higher total scores, and nearly 40% of the Web-based sample scored above the clinically relevant cut-off value. The three-factor structure of the ADHS-SB could be replicated in both samples, but factor loadings were different. Women in the Web-based sample had substantially higher total scores, and 30% of the Web-based sample scored above the clinically relevant cut-off value. Internal consistencies in all questionnaires were acceptable to high in both groups. Conclusions: Data from the Web-based administration of ADHD questionnaires for adults should not be used for the extraction of population norms. Separate norms should be established for ADHD online questionnaires. General psychometric properties of ADHD questionnaires (factor structure, internal consistency) were largely unaffected by sampling bias. Extended validity studies of existing ADHD questionnaires should be performed by including subjects with a diagnosis of ADHD and by randomizing them to Web- or paper-based administration. %M 23518816 %R 10.2196/jmir.2225 %U http://www.jmir.org/2013/3/e47/ %U https://doi.org/10.2196/jmir.2225 %U http://www.ncbi.nlm.nih.gov/pubmed/23518816 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 1 %P e13 %T An Interactive Internet-Based Plate for Assessing Lunchtime Food Intake: A Validation Study on Male Employees %A Svensson,Madeleine %A Bellocco,Rino %A Bakkman,Linda %A Trolle Lagerros,Ylva %+ Karolinska Institutet, Department of Medicine, Unit of Clinical Epidemiology, T2, Stockholm, 171 76, Sweden, 46 8 517 791 73, Madeleine.Svensson@hh.se %K diet %K epidemiology %K Internet %K methods %K nutrition %K validation %K Web %D 2013 %7 18.01.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Misreporting food intake is common because most health screenings rely on self-reports. The more accurate methods (eg, weighing food) are costly, time consuming, and impractical. Objectives: We developed a new instrument for reporting food intake—an Internet-based interactive virtual food plate. The objective of this study was to validate this instrument’s ability to assess lunch intake. Methods: Participants were asked to compose an ordinary lunch meal using both a virtual and a real lunch plate (with real food on a real plate). The participants ate their real lunch meals on-site. Before and after pictures of the composed lunch meals were taken. Both meals included identical food items. Participants were randomized to start with either instrument. The 2 instruments were compared using correlation and concordance measures (total energy intake, nutritional components, quantity of food, and participant characteristics). Results: A total of 55 men (median age: 45 years, median body mass index [BMI]: 25.8 kg/m2) participated. We found an overall overestimation of reported median energy intake using the computer plate (3044 kJ, interquartile range [IQR] 1202 kJ) compared with the real lunch plate (2734 kJ, IQR 1051 kJ, P<.001). Spearman rank correlations and concordance correlations for energy intake and nutritional components ranged between 0.58 to 0.79 and 0.65 to 0.81, respectively. Conclusion: Although it slightly overestimated, our computer plate provides promising results in assessing lunch intake. %M 23335728 %R 10.2196/jmir.2217 %U http://www.jmir.org/2013/1/e13/ %U https://doi.org/10.2196/jmir.2217 %U http://www.ncbi.nlm.nih.gov/pubmed/23335728 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 5 %P e136 %T The Umeå University Database of Facial Expressions: A Validation Study %A Samuelsson,Hanna %A Jarnvik,Karl %A Henningsson,Hanna %A Andersson,Josefin %A Carlbring,Per %+ Department of Psychology, University of Umeå, IP, Umeå, SE90187, Sweden, 46 907867833, per@carlbring.se %K Face %K Expression %K Stimulus set %K Emotion %K Multiracial %K Validity %K Reliability %D 2012 %7 09.10.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: A set of face stimuli, called the Umeå University Database of Facial Expressions, is described. The set consists of 30 female and 30 male models aged 17–67 years (M = 30.19, SD = 10.66). Each model shows seven different facial expressions (angry, surprised, happy, sad, neutral, afraid, and disgusted). Most models are ethnic Swedes but models of Central European, Arabic, and Asian origin are also included. Objective: Creating and validating a new database of facial expressions that can be used for scientific experiments. Methods: The images, presented in random order one at a time, were validated by 526 volunteers rating on average 125 images on seven 10-point Likert-type scales ranging from “completely disagree” to “completely agree” for each emotion. Results: The proportion of the aggregated results that were correctly classified was considered to be high (M = 88%). Conclusions: The results lend empirical support for the validity of this set of facial expressions. The set can be used freely by the scientific community. %M 23047935 %R 10.2196/jmir.2196 %U http://www.jmir.org/2012/5/e136/ %U https://doi.org/10.2196/jmir.2196 %U http://www.ncbi.nlm.nih.gov/pubmed/23047935 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 5 %P e123 %T Validation of Web-Based Physical Activity Measurement Systems Using Doubly Labeled Water %A Namba,Hideyuki %A Yamaguchi,Yukio %A Yamada,Yosuke %A Tokushima,Satoru %A Hatamoto,Yoichi %A Sagayama,Hiroyuki %A Kimura,Misaka %A Higaki,Yasuki %A Tanaka,Hiroaki %+ Faculty of Sports and Health Science, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180, Japan, 81 92 871 6631 ext 6759, hnanba@fukuoka-u.ac.jp %K Physical activity %K energy expenditure %K doubly labeled water %K Japan %D 2012 %7 25.09.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Online or Web-based measurement systems have been proposed as convenient methods for collecting physical activity data. We developed two Web-based physical activity systems—the 24-hour Physical Activity Record Web (24hPAR WEB) and 7 days Recall Web (7daysRecall WEB). Objective: To examine the validity of two Web-based physical activity measurement systems using the doubly labeled water (DLW) method. Methods: We assessed the validity of the 24hPAR WEB and 7daysRecall WEB in 20 individuals, aged 25 to 61 years. The order of email distribution and subsequent completion of the two Web-based measurements systems was randomized. Each measurement tool was used for a week. The participants’ activity energy expenditure (AEE) and total energy expenditure (TEE) were assessed over each week using the DLW method and compared with the respective energy expenditures estimated using the Web-based systems. Results: The mean AEE was 3.90 (SD 1.43) MJ estimated using the 24hPAR WEB and 3.67 (SD 1.48) MJ measured by the DLW method. The Pearson correlation for AEE between the two methods was r = .679 (P < .001). The Bland-Altman 95% limits of agreement ranged from –2.10 to 2.57 MJ between the two methods. The Pearson correlation for TEE between the two methods was r = .874 (P < .001). The mean AEE was 4.29 (SD 1.94) MJ using the 7daysRecall WEB and 3.80 (SD 1.36) MJ by the DLW method. The Pearson correlation for AEE between the two methods was r = .144 (P = .54). The Bland-Altman 95% limits of agreement ranged from –3.83 to 4.81 MJ between the two methods. The Pearson correlation for TEE between the two methods was r = .590 (P = .006). The average input times using terminal devices were 8 minutes and 10 seconds for the 24hPAR WEB and 6 minutes and 38 seconds for the 7daysRecall WEB. Conclusions: Both Web-based systems were found to be effective methods for collecting physical activity data and are appropriate for use in epidemiological studies. Because the measurement accuracy of the 24hPAR WEB was moderate to high, it could be suitable for evaluating the effect of interventions on individuals as well as for examining physical activity behavior. %M 23010345 %R 10.2196/jmir.2253 %U http://www.jmir.org/2012/5/e123/ %U https://doi.org/10.2196/jmir.2253 %U http://www.ncbi.nlm.nih.gov/pubmed/23010345 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 4 %P e97 %T Adoption, Acceptability, and Accuracy of an Online Clinical Trial Matching Website for Breast Cancer %A Cohen,Ellyn %A Belkora,Jeff %A Tyler,Joanne %A Schreiner,Joan %A Deering,Mary Jo %A Grama,Lakshmi %A Duggan,Brenda %A Illi,Julie %A Pederson,Julia %A Anand,Aprajita %A Teng,Alexandra %A McCreary,Erin %A Moore,Dan %A Tripathy,Debu %A Hogarth,Michael %A Lieberman,Morton %A Park,John %A Esserman,Laura %+ Carol Franc Buck Breast Care Center, University of California San Francisco, 3450 California Street, San Francisco, CA, 94118, United States, 1 415 476 0264, elly.cohen@ucsfmedctr.org %K Breast cancer %K clinical trials %K cancer information %D 2012 %7 11.07.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Less than 5% of breast cancer patients participate in clinical trials. To increase patients’ awareness and access to trials, we created BreastCancerTrials.org, a clinical trial matching website. BreastCancerTrials.org matched patients to trials based on their self-reported breast cancer history. It also provided a messaging platform through which patients could self-refer themselves to participating research sites. Objective: To assess adoption by research sites, acceptability to patients, and patients’ accuracy in providing information to BreastCancerTrials.org. Methods: We approached 13 research sites in Northern California to list their trials on BreastCancerTrials.org. For adoption, we examined the willingness of contacted research sites to collaborate with BreastCancerTrials.org. For acceptability, we analyzed usage statistics of visitors who completed the BreastCancerTrials.org health history questionnaire in the first 14 months after launch and surveyed users who visited the website during its first year about their experience. For accuracy, we compared the self-reported health history of 20 patients against their medical records. The health history questionnaire was divided into four sections: About Me, personal information including date of birth and sex; My Health as of Today, current status including cancer stage, menopausal status, and sites with evidence of disease; My Cancer, diagnostic information such as hormone and human epidermal growth factor receptor 2 status; and My Treatment, an itemized record of past treatment including responses to therapy. Results: A total of 12 sites contributed 55 trials. Regarding acceptability, 733 visitors registered on the website; 428 reported their health history; and 407 matched to at least one trial. Of 375 patients who were sent a survey, 75 responded (20%); 23 of the 75 (31%) contacted a research site, 12 of the 23 (52%) were eligible for a trial, and 5 of the 12 (42%) reported enrolling. As for accuracy, 20 clinic visitors reported 1456 health history items, 1324 of which matched their clinic record (90.93%). Conclusions: BreastCancerTrials.org was adopted by research sites. Patients found it acceptable and were able to provide accurate information for trial matching. Based on our findings, we launched an upgraded version of BreastCancerTrials.org as a national service in October 2008. %M 22784878 %R 10.2196/jmir.1855 %U http://www.jmir.org/2012/4/e97/ %U https://doi.org/10.2196/jmir.1855 %U http://www.ncbi.nlm.nih.gov/pubmed/22784878 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e56 %T How is an Electronic Screening and Brief Intervention Tool on Alcohol Use Received in a Student Population? A Qualitative and Quantitative Evaluation %A Fraeyman,Jessica %A Van Royen,Paul %A Vriesacker,Bart %A De Mey,Leen %A Van Hal,Guido %+ Epidemiology and Social Medicine, Medical Sociology and Health Policy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk (Antwerp), 2610, Belgium, 32 32652855, jessica.fraeyman@ua.ac.be %K Alcohol %K students %K intervention %D 2012 %7 23.04.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: A previous study among Antwerp college and university students showed that more male (10.2%–11.1%) than female (1.8%–6.2%) students are at risk for problematic alcohol use. The current literature shows promising results in terms of feasibility and effectiveness for the use of brief electronic interventions to address this health problem in college and university students. We evaluated this type of intervention and cite existing literature on the topic. Objective: To develop a website, www.eentjeteveel.be, to motivate college and university students with problematic alcohol use to reduce alcohol consumption and increase their willingness to seek help. Method: The website contained a questionnaire (Alcohol Use Disorders Identification Test [AUDIT]) for students to test their alcohol use. According to their answers, the students immediately received personalized feedback (personal AUDIT score and additional information on risks associated with alcohol use) and a suggestion for further action. Afterward, students could send an email to a student counselor for questions, guidance, or advice. To obtain in-depth qualitative information on the opinions and experiences of students, we held 5 focus group discussions. The topics were publicity, experiences, impressions, and effects of the website. We analyzed the quantitative results of the online test in SPSS 15.0. Results: More than 3500 students visited www.eentjeteveel.be; over half were men (55.0%). A total of 34 students participated in the focus group discussions. The mixture of quantitative and qualitative methods to evaluate the intervention allowed a thorough analysis and provided complementary results. The intervention was well received by the student population. However, some minor aspects should be reconsidered, such as website publicity and providing students with options that were added after intermediate evaluation. The intervention increased the motivation of students to think about their alcohol use but could not stimulate them to change their behavior. The website attracted relatively more male than female students and more students in the high-risk group than in the low-risk group. The high-risk group was more inclined to seek advice or guidance (23/400, 6%; χ22 = 32.4, P < .001) than the low-risk group (34/1714, 2%; χ22 = 32.4, P < .001). Conclusions: We gained unique insight into students’ experiences, opinions, and perceptions with regard to the intervention. The results show that the intervention was positively received in the population, and the willingness to seek help was increased. However, real behavior change needs further research. The results of this study can assist health providers and researchers in better understanding college and university students’ perceptions of eHealth initiatives. %M 22525340 %R 10.2196/jmir.1869 %U http://www.jmir.org/2012/2/e56/ %U https://doi.org/10.2196/jmir.1869 %U http://www.ncbi.nlm.nih.gov/pubmed/22525340 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e58 %T Novel Technologies for Assessing Dietary Intake: Evaluating the Usability of a Mobile Telephone Food Record Among Adults and Adolescents %A Daugherty,Bethany L %A Schap,TusaRebecca E %A Ettienne-Gittens,Reynolette %A Zhu,Fengqing M %A Bosch,Marc %A Delp,Edward J %A Ebert,David S %A Kerr,Deborah A %A Boushey,Carol J %+ Epidemiology Program, University of Hawaii Cancer Center, 1236 Lauhala Street, Honolulu, HI, 96813, United States, 1 808 564 5915, cjboushey@cc.hawaii.edu %K Mobile telephone food record %K dietary assessment %K technology %K image analysis %K volume estimation %D 2012 %7 13.04.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: The development of a mobile telephone food record has the potential to ameliorate much of the burden associated with current methods of dietary assessment. When using the mobile telephone food record, respondents capture an image of their foods and beverages before and after eating. Methods of image analysis and volume estimation allow for automatic identification and volume estimation of foods. To obtain a suitable image, all foods and beverages and a fiducial marker must be included in the image. Objective: To evaluate a defined set of skills among adolescents and adults when using the mobile telephone food record to capture images and to compare the perceptions and preferences between adults and adolescents regarding their use of the mobile telephone food record. Methods: We recruited 135 volunteers (78 adolescents, 57 adults) to use the mobile telephone food record for one or two meals under controlled conditions. Volunteers received instruction for using the mobile telephone food record prior to their first meal, captured images of foods and beverages before and after eating, and participated in a feedback session. We used chi-square for comparisons of the set of skills, preferences, and perceptions between the adults and adolescents, and McNemar test for comparisons within the adolescents and adults. Results: Adults were more likely than adolescents to include all foods and beverages in the before and after images, but both age groups had difficulty including the entire fiducial marker. Compared with adolescents, significantly more adults had to capture more than one image before (38% vs 58%, P = .03) and after (25% vs 50%, P = .008) meal session 1 to obtain a suitable image. Despite being less efficient when using the mobile telephone food record, adults were more likely than adolescents to perceive remembering to capture images as easy (P < .001). Conclusions: A majority of both age groups were able to follow the defined set of skills; however, adults were less efficient when using the mobile telephone food record. Additional interactive training will likely be necessary for all users to provide extra practice in capturing images before entering a free-living situation. These results will inform age-specific development of the mobile telephone food record that may translate to a more accurate method of dietary assessment. %M 22504018 %R 10.2196/jmir.1967 %U http://www.jmir.org/2012/2/e58/ %U https://doi.org/10.2196/jmir.1967 %U http://www.ncbi.nlm.nih.gov/pubmed/22504018 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 1 %P e29 %T Active-Q: Validation of the Web-Based Physical Activity Questionnaire Using Doubly Labeled Water %A Bonn,Stephanie Erika %A Trolle Lagerros,Ylva %A Christensen,Sara Elisabeth %A Möller,Elisabeth %A Wright,Antony %A Sjölander,Arvid %A Bälter,Katarina %+ Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels väg 12a, Stockholm, SE-171 77, Sweden, 46 8 524 822 98, stephanie.bonn@ki.se %K activity assessment %K epidemiology %K Internet %K total energy expenditure %D 2012 %7 15.02.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Increased use of the Internet provides new opportunities for collecting data in large studies. The aim of our new Web-based questionnaire, Active-Q, is to assess total physical activity and inactivity in adults. Active-Q assesses habitual activity during the past year via questions in four different domains: (1) daily occupation, (2) transportation to and from daily occupation, (3) leisure time activities, and (4) sporting activities. Objective: The objective of our study is to validate Active-Q’s energy expenditure estimates using the doubly labeled water (DLW) method, and to assess the reproducibility of Active-Q by comparing the results of the questionnaire completed by the same group on two occasions. Methods: The validity and reproducibility of Active-Q were assessed in a group of 37 individuals, aged 20 to 65 years. Active-Q was distributed via email to the participants. The total energy expenditure of the participants was assessed using DLW for 11 consecutive days. Results: The median time to complete Active-Q was 6.1 minutes. The majority of participants (27/37, 73%) reported that the questionnaire was “easy” or “very easy” to answer. On average, Active-Q overestimated the total daily energy expenditure by 440 kJ compared with the DLW. The Spearman correlation between the two methods was r = 0.52 (P < .001). The intraclass correlation coefficient for total energy expenditure between the results of Active-Q completed on two occasions was 0.83 (95% CI 0.73-0.93). Conclusions: Active-Q is a valid and reproducible method of assessing total energy expenditure. It is also a user-friendly method and suitable for Web-based data collection in large epidemiological studies. %M 22356755 %R 10.2196/jmir.1974 %U http://www.jmir.org/2012/1/e29/ %U https://doi.org/10.2196/jmir.1974 %U http://www.ncbi.nlm.nih.gov/pubmed/22356755 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 4 %P e126 %T CONSORT-EHEALTH: Improving and Standardizing Evaluation Reports of Web-based and Mobile Health Interventions %A Eysenbach,Gunther %A , %+ University Health Network, Centre for Global eHealth Innovation & Techna Institute, 190 Elizabeth St, Toronto, ON, M4L3Y7, Canada, 1 416 7866970, geysenba@uhnres.utoronto.ca %K evaluation %K Internet %K mobile health %K reporting standards %K publishing standards %K guidelines %K quality control %K randomized controlled trials as topic %K medical informatics %D 2011 %7 31.12.2011 %9 Editorial %J J Med Internet Res %G English %X Background: Web-based and mobile health interventions (also called “Internet interventions” or "eHealth/mHealth interventions") are tools or treatments, typically behaviorally based, that are operationalized and transformed for delivery via the Internet or mobile platforms. These include electronic tools for patients, informal caregivers, healthy consumers, and health care providers. The Consolidated Standards of Reporting Trials (CONSORT) statement was developed to improve the suboptimal reporting of randomized controlled trials (RCTs). While the CONSORT statement can be applied to provide broad guidance on how eHealth and mHealth trials should be reported, RCTs of web-based interventions pose very specific issues and challenges, in particular related to reporting sufficient details of the intervention to allow replication and theory-building. Objective: To develop a checklist, dubbed CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth), as an extension of the CONSORT statement that provides guidance for authors of eHealth and mHealth interventions. Methods: A literature review was conducted, followed by a survey among eHealth experts and a workshop. Results: A checklist instrument was constructed as an extension of the CONSORT statement. The instrument has been adopted by the Journal of Medical Internet Research (JMIR) and authors of eHealth RCTs are required to submit an electronic checklist explaining how they addressed each subitem. Conclusions: CONSORT-EHEALTH has the potential to improve reporting and provides a basis for evaluating the validity and applicability of eHealth trials. Subitems describing how the intervention should be reported can also be used for non-RCT evaluation reports. As part of the development process, an evaluation component is essential; therefore, feedback from authors will be solicited, and a before-after study will evaluate whether reporting has been improved. %M 22209829 %R 10.2196/jmir.1923 %U http://www.jmir.org/2011/4/e126/ %U https://doi.org/10.2196/jmir.1923 %U http://www.ncbi.nlm.nih.gov/pubmed/22209829 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 3 %P e69 %T Development and Validation of the Online Social Support for Smokers Scale %A Graham,Amanda L %A Papandonatos,George D %A Kang,Hakmook %A Moreno,Jose L %A Abrams,David B %+ Schroeder Institute for Tobacco Research and Policy Studies, American Legacy Foundation, 1724 Massachusetts Avenue, NW, Washington, DC, 20036, United States, 1 202 454 5938, agraham@legacyforhealth.org %K Psychometrics %K social support %K Internet %K smoking cessation %D 2011 %7 28.09.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: Social networks play an important role in smoking. Provision of social support during cessation is a cornerstone of treatment. Online social networks for cessation are ubiquitous and represent a promising modality for smokers to receive and provide the support necessary for cessation. There are no existing measures specific to online social support for smoking cessation. Objective: The objective was to develop a measure of social support to be used in online smoking cessation treatment research. Methods: Initial items for the Online Social Support for Smokers Scale (OS4) were based on existing theory and scales delineated in various taxonomies. Preliminary field analysis (N = 73) was conducted on 23 initial items to optimize the scale. Further development was conducted on a refined 15-item scale in the context of a large randomized trial of Internet and telephone cessation treatment with follow-ups at 3, 6, 12, and 18 months. In all, 1326 participants were randomized to an enhanced Internet arm that included a large online social network; psychometric analyses employed 3-month follow-up data from those reporting use of the enhanced Internet intervention at least once (n = 873). Items were subjected to a factor analysis, and the internal consistency reliability of the scale was examined along with construct and criterion validity. Other measures used in the study included demographics, nicotine dependence, partner support for cessation, general social support, social integration, stress, depression, health status, online community use, Internet use behaviors, intervention satisfaction, and 30-day point prevalence abstinence. Results: The final 12-item OS4 scale demonstrated high internal consistency reliability (Cronbach alphas .86-.89) across demographic and smoking strata of interest. The OS4 also demonstrated good construct and criterion validity, with the directionality of the observed associations providing support for most a priori hypotheses. Significant Pearson correlations were observed between the OS4 and the Partner Interaction Questionnaire (PIQ) Positive subscale (ρ = .24, P < .001). As hypothesized, participants with the highest OS4 scores were more likely to have actively participated in the enhanced Internet community and to have high levels of satisfaction with the enhanced Internet intervention. In logistic regression analyses, the OS4 was highly predictive of 30-day point-prevalence abstinence at 6, 12, and 18 months (all P values <.001). The odds of abstinence at 6 months rose by 48% for each standard unit increase in online social support (95% confidence interval [CI] 1.17 - 1.71), dropping only slightly to 37% at 12 and 18 months (95% CI 1.17 - 1.59). Conclusions: The OS4 is a brief, reliable, and valid instrument for measuring online social support for smoking cessation. Results should be replicated and extended, but this study suggests the OS4 can be used to advance theory, understand mechanisms, and potentially help to improve the tailoring of Internet-based smoking cessation treatments. It can also inspire development of similar measures for other online health-related intervention research. Trial registration: Clinicaltrials.gov #NCT00282009; http://clinicaltrials.gov/ct2/show/NCT00282009 (Archived by WebCite at http://www.webcitation.org/60XNj3xM6) %M 21955465 %R 10.2196/jmir.1801 %U http://www.jmir.org/2011/3/e69/ %U https://doi.org/10.2196/jmir.1801 %U http://www.ncbi.nlm.nih.gov/pubmed/21955465