%0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e63 %T Storing and Using Health Data in a Virtual Private Cloud %A Regola,Nathan %A Chawla,Nitesh V %+ Interdisciplinary Center for Network Science and Applications, Department of Computer Science and Engineering, University of Notre Dame, 384 Fitzpatrick Hall, Notre Dame, IN, 46556, United States, 1 574 631 1090, nchawla@nd.edu %K medical informatics %K HIPAA %D 2013 %7 13.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Electronic health records are being adopted at a rapid rate due to increased funding from the US federal government. Health data provide the opportunity to identify possible improvements in health care delivery by applying data mining and statistical methods to the data and will also enable a wide variety of new applications that will be meaningful to patients and medical professionals. Researchers are often granted access to health care data to assist in the data mining process, but HIPAA regulations mandate comprehensive safeguards to protect the data. Often universities (and presumably other research organizations) have an enterprise information technology infrastructure and a research infrastructure. Unfortunately, both of these infrastructures are generally not appropriate for sensitive research data such as HIPAA, as they require special accommodations on the part of the enterprise information technology (or increased security on the part of the research computing environment). Cloud computing, which is a concept that allows organizations to build complex infrastructures on leased resources, is rapidly evolving to the point that it is possible to build sophisticated network architectures with advanced security capabilities. We present a prototype infrastructure in Amazon’s Virtual Private Cloud to allow researchers and practitioners to utilize the data in a HIPAA-compliant environment. %M 23485880 %R 10.2196/jmir.2076 %U http://www.jmir.org/2013/3/e63/ %U https://doi.org/10.2196/jmir.2076 %U http://www.ncbi.nlm.nih.gov/pubmed/23485880 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e34 %T How User Characteristics Affect Use Patterns in Web-Based Illness Management Support for Patients with Breast and Prostate Cancer %A Børøsund,Elin %A Cvancarova,Milada %A Ekstedt,Mirjam %A Moore,Shirley M %A Ruland,Cornelia M %+ Centre for Shared Decision Making and Collaborative Care Research, Oslo University Hospital, P.O. Box 4950 Nydalen, Oslo, 0424, Norway, 47 23075452, elin.borosund@rr-research.no %K Web-based intervention %K Internet %K symptom management %K self-care %K use patterns %K user characteristics %K targeting %D 2013 %7 01.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Frequently eHealth applications are not used as intended and they have high attrition rates; therefore, a better understanding of patients’ need for support is warranted. Specifically, more research is needed to identify which system components target different patient groups and under what conditions. Objective: To explore user characteristics associated with the use of different system components of a Web-based illness management support system for cancer patients (WebChoice). Methods: For this secondary post hoc analysis of a large randomized controlled trial (RCT), in which WebChoice was tested among 325 breast cancer and prostate cancer patients who were followed with repeated measures for 1 year, usage patterns of 162 cancer patients in the intervention arm with access to WebChoice were extracted from the user log. Logistic regression was performed to identify patterns of associations between system use and patient characteristics. Latent class analyses (LCA) were performed to identify associations among the use of different system components and levels of social support, symptom distress, depression, self-efficacy, and health-related quality of life. Results: Approximately two-thirds (103/162, 63.6%) of the patients logged on to WebChoice more than once, and were defined as users. A high level of computer experience (odds ratio [OR] 3.77, 95% CI 1.20-11.91) and not having other illnesses in addition to cancer (OR 2.10, 95% CI 1.02-4.34) increased the overall probability of using WebChoice. LCA showed that both men with prostate cancer and women with breast cancer who had low scores on social support accompanied with high levels of symptom distress and high levels of depression were more likely to use the e-message component. For men with prostate cancer, these variables were also associated with high use of the self-management advice component. We found important differences between men with prostate cancer and women with breast cancer when associations between WebChoice use and each user characteristic were analyzed separately. High use of all components was associated with low levels of social support among women with breast cancer, but not among men with prostate cancer. High use of e-messages, advice, and the discussion forum were associated with high levels of depression among women with breast cancer, but not among men with prostate cancer. For men with prostate cancer (but not women with breast cancer), high use of symptom assessments, advice, and the discussion forum were associated with high levels of symptom distress. However, it is unclear whether these findings can be attributed to differences related to diagnosis, gender, or both. Conclusions: This study provides evidence that different user characteristics are associated with different use patterns. Such information is crucial to target Web-based support systems to different patient groups. LCA is a useful technique to identify subgroups of users. In our study, e-messages and self-management advice were highly used components for patients who had low levels of social support and high illness burden, suggesting that patients with these characteristics may find such tools particularly useful. Trial Registration: ClinicalTrials.gov NCT00710658; http://clinicaltrials.gov/ct2/show/NCT00710658 (Archived by WebCite at http://www.webcitation.org/6EmEWZiwz) %M 23454601 %R 10.2196/jmir.2285 %U http://www.jmir.org/2013/3/e34/ %U https://doi.org/10.2196/jmir.2285 %U http://www.ncbi.nlm.nih.gov/pubmed/23454601 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e64 %T Internet-Based Photoaging Within Australian Pharmacies to Promote Smoking Cessation: Randomized Controlled Trial %A Burford,Oksana %A Jiwa,Moyez %A Carter,Owen %A Parsons,Richard %A Hendrie,Delia %+ Curtin Health Innovation Research Institute, School of Pharmacy, Curtin University, GPO Box U1987, Perth, 6845, Australia, 61 8 9266 7201, O.Burford@curtin.edu.au %K smoking %K tobacco use disorder %K skin aging %D 2013 %7 26.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Tobacco smoking leads to death or disability and a drain on national resources. The literature suggests that cigarette smoking continues to be a major modifiable risk factor for a variety of diseases and that smokers aged 18-30 years are relatively resistant to antismoking messages due to their widely held belief that they will not be lifelong smokers. Objective: To conduct a randomized controlled trial (RCT) of a computer-generated photoaging intervention to promote smoking cessation among young adult smokers within a community pharmacy setting. Methods: A trial was designed with 80% power based on the effect size observed in a published pilot study; 160 subjects were recruited (80 allocated to the control group and 80 to the intervention group) from 8 metropolitan community pharmacies located around Perth city center in Western Australia. All participants received standardized smoking cessation advice. The intervention group participants were also digitally photoaged by using the Internet-based APRIL Face Aging software so they could preview images of themselves as a lifelong smoker and as a nonsmoker. Due to the nature of the intervention, the participants and researcher could not be blinded to the study. The main outcome measure was quit attempts at 6-month follow-up, both self-reported and biochemically validated through testing for carbon monoxide (CO), and nicotine dependence assessed via the Fagerström scale. Results: At 6-month follow-up, 5 of 80 control group participants (6.3%) suggested they had quit smoking, but only 1 of 80 control group participants (1.3%) consented to, and was confirmed by, CO validation. In the intervention group, 22 of 80 participants (27.5%) reported quitting, with 11 of 80 participants (13.8%) confirmed by CO testing. This difference in biochemically confirmed quit attempts was statistically significant (χ21=9.0, P=.003). A repeated measures analysis suggested the average intervention group smoking dependence score had also significantly dropped compared to control participants (P<.001). These differences remained statistically significant after adjustment for small differences in gender distribution and nicotine dependence between the groups. The mean cost of implementing the intervention was estimated at AU $5.79 per participant. The incremental cost-effectiveness ratio was AU $46 per additional quitter. The mean cost that participants indicated they were willing to pay for the digital aging service was AU $20.25 (SD 15.32). Conclusions: Demonstrating the detrimental effects on facial physical appearance by using a computer-generated simulation may be both effective and cost-effective at persuading young adult smokers to quit. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12609000885291; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12609000885291 (Archived by WebCite at http://www.webcitation.org/6F2kMt3kC) %M 23531984 %R 10.2196/jmir.2337 %U http://www.jmir.org/2013/3/e64/ %U https://doi.org/10.2196/jmir.2337 %U http://www.ncbi.nlm.nih.gov/pubmed/23531984 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e50 %T Prevalence and Characteristics of Smokers Interested in Internet-Based Smoking Cessation Interventions: Cross-sectional Findings From a National Household Survey %A Brown,Jamie %A Michie,Susan %A Raupach,Tobias %A West,Robert %+ Cancer Research UK Health Behaviour Research Centre, Department of Public Health and Epidemiology, University College London, 1-19 Torrington Place, London, WC1E 6BT, United Kingdom, 44 7717886880, jamie.brown@ucl.ac.uk %K smoking cessation intervention %K Internet-based %K website %K prevalence %K characteristic %D 2013 %7 18.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: An accurate and up-to-date estimate of the potential reach of Internet-based smoking cessation interventions (ISCIs) would improve calculations of impact while an understanding of the characteristics of potential users would facilitate the design of interventions. Objective: This study reports the prevalence and the sociodemographic, smoking, and Internet-use characteristics of smokers interested in using ISCIs in a nationally representative sample. Methods: Data were collected using cross-sectional household surveys of representative samples of adults in England. Interest in trying an Internet site or “app” that was proven to help with stopping smoking was assessed in 1128 adult smokers in addition to sociodemographic characteristics, dependence, motivation to quit, previous attempts to quit smoking, Internet and handheld computer access, and recent types of information searched online. Results: Of a representative sample of current smokers, 46.6% (95% CI 43.5%-49.6%) were interested in using an Internet-based smoking cessation intervention. In contrast, only 0.3% (95% CI 0%-0.7%) of smokers reported having used such an intervention to support their most recent quit attempt within the past year. After adjusting for all other background characteristics, interested smokers were younger (OR=0.98, 95% CI 0.97-0.99), reported stronger urges (OR=1.29, 95% CI 1.10-1.51), were more motivated to quit within 3 months (OR=2.16, 95% CI 1.54-3.02), and were more likely to have made a quit attempt in the past year (OR=1.76, 95% CI 1.30-2.37), access the Internet at least weekly (OR=2.17, 95% CI 1.40-3.36), have handheld computer access (OR=1.65, 95% CI 1.22-2.24), and have used the Internet to search for online smoking cessation information or support in past 3 months (OR=2.82, 95% CI 1.20-6.62). There was no association with social grade. Conclusions: Almost half of all smokers in England are interested in using online smoking cessation interventions, yet fewer than 1% have used them to support a quit attempt in the past year. Interest is not associated with social grade but is associated with being younger, more highly motivated, more cigarette dependent, having attempted to quit recently, having regular Internet and handheld computer access, and having recently searched for online smoking cessation information and support. %M 23506944 %R 10.2196/jmir.2342 %U http://www.jmir.org/2013/3/e50/ %U https://doi.org/10.2196/jmir.2342 %U http://www.ncbi.nlm.nih.gov/pubmed/23506944 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e57 %T Cost-Effectiveness and Cost-Utility of Internet-Based Computer Tailoring for Smoking Cessation %A Smit,Eline Suzanne %A Evers,Silvia MAA %A de Vries,Hein %A Hoving,Ciska %+ CAPHRI School for Public Health and Primary Care, Department of Health Promotion, Maastricht University, PO BOX 616, Maastricht, 6200 MD, Netherlands, 31 433882397, es.smit@maastrichtuniversity.nl %K randomized controlled trial %K economic evaluation %K smoking cessation %K Internet %K computer-tailoring %K general practice %D 2013 %7 14.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Although effective smoking cessation interventions exist, information is limited about their cost-effectiveness and cost-utility. Objective: To assess the cost-effectiveness and cost-utility of an Internet-based multiple computer-tailored smoking cessation program and tailored counseling by practice nurses working in Dutch general practices compared with an Internet-based multiple computer-tailored program only and care as usual. Methods: The economic evaluation was embedded in a randomized controlled trial, for which 91 practice nurses recruited 414 eligible smokers. Smokers were randomized to receive multiple tailoring and counseling (n=163), multiple tailoring only (n=132), or usual care (n=119). Self-reported cost and quality of life were assessed during a 12-month follow-up period. Prolonged abstinence and 24-hour and 7-day point prevalence abstinence were assessed at 12-month follow-up. The trial-based economic evaluation was conducted from a societal perspective. Uncertainty was accounted for by bootstrapping (1000 times) and sensitivity analyses. Results: No significant differences were found between the intervention arms with regard to baseline characteristics or effects on abstinence, quality of life, and addiction level. However, participants in the multiple tailoring and counseling group reported significantly more annual health care–related costs than participants in the usual care group. Cost-effectiveness analysis, using prolonged abstinence as the outcome measure, showed that the mere multiple computer-tailored program had the highest probability of being cost-effective. Compared with usual care, in this group €5100 had to be paid for each additional abstinent participant. With regard to cost-utility analyses, using quality of life as the outcome measure, usual care was probably most efficient. Conclusions: To our knowledge, this was the first study to determine the cost-effectiveness and cost-utility of an Internet-based smoking cessation program with and without counseling by a practice nurse. Although the Internet-based multiple computer-tailored program seemed to be the most cost-effective treatment, the cost-utility was probably highest for care as usual. However, to ease the interpretation of cost-effectiveness results, future research should aim at identifying an acceptable cutoff point for the willingness to pay per abstinent participant. %M 23491820 %R 10.2196/jmir.2059 %U http://www.jmir.org/2013/3/e57/ %U https://doi.org/10.2196/jmir.2059 %U http://www.ncbi.nlm.nih.gov/pubmed/23491820 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e45 %T Recruitment to Online Therapies for Depression: Pilot Cluster Randomized Controlled Trial %A Jones,Ray B %A Goldsmith,Lesley %A Hewson,Paul %A Williams,Christopher J %+ Plymouth University, Faculty of Health, Education, and Society, 3 Portland Villas, Plymouth, PL4 8AA, United Kingdom, 44 441752586532, ray.jones@plymouth.ac.uk %K cluster randomized trial %K pilot study %K online advertising %K depression %K MoodGym %K Living Life to the Full, LLTTF %K cCBT %K Google Analytics %K AdWords %K computerised CBT %D 2013 %7 05.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Raising awareness of online cognitive behavioral therapy (CBT) could benefit many people with depression, but we do not know how purchasing online advertising compares to placing free links from relevant local websites in increasing uptake. Objective: To pilot a cluster randomized controlled trial (RCT) comparing purchase of Google AdWords with placing free website links in raising awareness of online CBT resources for depression in order to better understand research design issues. Methods: We compared two online interventions with a control without intervention. The pilot RCT had 4 arms, each with 4 British postcode areas: (A) geographically targeted AdWords, (B) adverts placed on local websites by contacting website owners and requesting links be added, (C) both interventions, (D) control. Participants were directed to our research project website linking to two freely available online CBT resource sites (Moodgym and Living Life To The Full (LLTTF)) and two other depression support sites. We used data from (1) AdWords, (2) Google Analytics for our project website and for LLTTF, and (3) research project website. We compared two outcomes: (1) numbers with depression accessing the research project website, and then chose an onward link to one of the two CBT websites, and (2) numbers registering with LLTTF. We documented costs, and explored intervention and assessment methods to make general recommendations to inform researchers aiming to use similar methodologies in future studies. Results: Trying to place local website links appeared much less cost effective than AdWords and although may prove useful for service delivery, was not worth pursuing in the context of the current study design. Our AdWords intervention was effective in recruiting people to the project website but our location targeting “leaked” and was not as geographically specific as claimed. The impact on online CBT was also diluted by offering participants other choices of destinations. Measuring the impact on LLTTF use was difficult as the total number using LLTTF was less than 5% of all users and record linkage across websites was impossible. Confounding activity may have resulted in some increase in registrations in the control arm. Conclusions: Practitioners should consider online advertising to increase uptake of online therapy but need to check its additional value. A cluster RCT using location targeted adverts is feasible and this research design provides the best evidence of cost-effectiveness. Although our British pilot study is limited to online CBT for depression, a cluster RCT with similar design would be appropriate for other online treatments and countries and our recommendations may apply. They include ways of dealing with possible contamination (buffer zones and AdWords techniques), confounding factors (large number of clusters), advertising dose (in proportion to total number of users), record linkage (landing within target website), and length of study (4-6 months). Trial Registration: clinicaltrials.gov (Registration No. NCT01469689); http://clinicaltrials.gov/ct2/show/NCT01469689 (Archived by WebCite at http://www.webcitation.org/6EtTthDOp) %M 23462072 %R 10.2196/jmir.2367 %U http://www.jmir.org/2013/3/e45/ %U https://doi.org/10.2196/jmir.2367 %U http://www.ncbi.nlm.nih.gov/pubmed/23462072 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 15 %N 3 %P e69 %T The Effect of Program Design on Engagement With an Internet-Based Smoking Intervention: Randomized Factorial Trial %A McClure,Jennifer B %A Shortreed,Susan M %A Bogart,Andy %A Derry,Holly %A Riggs,Karin %A St John,Jackie %A Nair,Vijay %A An,Larry %+ Group Health Research Institute, 1730 Minor Ave., Suite 1600, Seattle, WA, 98101, United States, 1 206 287 2737, McClure.J@ghc.org %K smoking cessation %K utilization %K Internet %K behavioral research %K electronic mail %K motivation %D 2013 %7 25.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Participant engagement influences treatment effectiveness, but it is unknown which intervention design features increase treatment engagement for online smoking cessation programs. Objective: We explored the effects of 4 design features (ie, factors) on early engagement with an Internet-based, motivational smoking cessation program. Methods: Smokers (N=1865) were recruited from a large health care organization to participate in an online intervention study, regardless of their interest in quitting smoking. The program was intended to answer smokers’ questions about quitting in an effort to motivate and support cessation. Consistent with the screening phase in the multiphase optimization strategy (MOST), we used a 2-level, full-factorial design. Each person was randomized to 1 of 2 levels of each factor, including message tone (prescriptive vs motivational), navigation autonomy (dictated vs not), proactive email reminders (yes vs no), and inclusion of personally tailored testimonials (yes vs no). The effects of each factor level on program engagement during the first 2 months of enrollment were compared, including number of visits to the website resulting in intervention content views (as opposed to supplemental content views), number of intervention content areas viewed, number of intervention content pages viewed, and duration of time spent viewing this content, as applicable to each factor. Results: Adjusting for baseline readiness to quit, persons who received content written in a prescriptive tone made the same number of visits to the website as persons receiving content in a motivational tone, but viewed 1.17 times as many content areas (95% CI 1.08-1.28; P<.001) and 1.15 times as many pages (95% CI 1.04-1.28; P=.009). Time spent viewing materials did not differ among groups (P=.06). Persons required to view content in a dictated order based on their initial readiness to quit made the same number of visits as people able to freely navigate the site, but viewed fewer content areas (ratio of means 0.80, 95% CI 0.74-0.87; P<.001), 1.17 times as many pages (95% CI 1.06-1.31; P=.003), and spent 1.37 times more minutes online (95% CI 1.17-1.59; P<.001). Persons receiving proactive email reminders made 1.20 times as many visits (95% CI 1.09-1.33; P<.001), viewed a similar number of content areas as persons receiving no reminders, viewed 1.58 times as many pages (95% CI 1.48-1.68; P<.001), and spent 1.51 times as many minutes online (95% CI 1.29-1.77; P<.001) as those who did not receive proactive emails. Tailored testimonials did not significantly affect engagement. Conclusions: Using a prescriptive message tone, dictating content viewing order, and sending reminder emails each resulted in greater program engagement relative to the contrasting level of each experimental factor. The results require replication, but suggest that a more directive interaction style may be preferable for online cessation programs. Trial Registration: clinicaltrials.gov NCT00992264; http://clinicaltrials.gov/ct2/show/NCT00992264 (Archived by WebCite at http://www.webcitation.org/6F7H7lr3P) %M 23529377 %R 10.2196/jmir.2508 %U http://www.jmir.org/2013/3/e69/ %U https://doi.org/10.2196/jmir.2508 %U http://www.ncbi.nlm.nih.gov/pubmed/23529377 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e54 %T Using Text Messaging to Assess Adolescents' Health Information Needs: An Ecological Momentary Assessment %A Schnall,Rebecca %A Okoniewski,Anastasia %A Tiase,Victoria %A Low,Alexander %A Rodriguez,Martha %A Kaplan,Steven %+ Columbia University, School of Nursing, 617 W 168th Street, New York, NY, 10032, United States, 1 212 342 6886, rb897@columbia.edu %K text messaging %K ecological momentary assessment %K mobile health technology %D 2013 %7 06.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Use of mobile technology has made a huge impact on communication, access, and information/resource delivery to adolescents. Mobile technology is frequently used by adolescents. Objective: The purpose of this study was to understand the health information needs of adolescents in the context of their everyday lives and to assess how they meet their information needs. Methods: We gave 60 adolescents smartphones with unlimited text messaging and data for 30 days. Each smartphone had applications related to asthma, obesity, human immunodeficiency virus, and diet preinstalled on the phone. We sent text messages 3 times per week and asked the following questions: (1) What questions did you have about your health today? (2) Where did you look for an answer (mobile device, mobile application, online, friend, book, or parent)? (3) Was your question answered and how? (4) Anything else? Results: Our participants ranged from 13-18 years of age, 37 (62%) participants were male and 22 (37%) were female. Of the 60 participants, 71% (42/60) participants identified themselves as Hispanic and 77% (46/60) were frequent users of mobile devices. We had a 90% (1935/2150) response rate to our text messages. Participants sent a total of 1935 text messages in response to the ecological momentary assessment questions. Adolescents sent a total of 421 text messages related to a health information needs, and 516 text messages related to the source of information to the answers of their questions, which were related to parents, friends, online, mobile apps, teachers, or coaches. Conclusions: Text messaging technology is a useful tool for assessing adolescents’ health behavior in real-time. Adolescents are willing to use text messaging to report their health information. Findings from this study contribute to the evidence base on addressing the health information needs of adolescents. In particular, attention should be paid to issues related to diet and exercise. These findings may be the harbinger for future obesity prevention programs for adolescents. %M 23467200 %R 10.2196/jmir.2395 %U http://www.jmir.org/2013/3/e54/ %U https://doi.org/10.2196/jmir.2395 %U http://www.ncbi.nlm.nih.gov/pubmed/23467200 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e56 %T Physicians Interrupted by Mobile Devices in Hospitals: Understanding the Interaction Between Devices, Roles, and Duties %A Solvoll,Terje %A Scholl,Jeremiah %A Hartvigsen,Gunnar %+ University Hospital of North Norway, Norwegian Centre for Integrated Care and Telemedicine, Po. Box 35, Tromsø, 9038, Norway, 47 90932183, terje.solvoll@telemed.no %K Ethnography %K Mobile communication %K interruptions %K Context-aware computing %K Pervasive computing %K User-centered design methods %K Health care %K Pagers %K Wireless phones %K CSCW %K HCI %D 2013 %7 07.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: A common denominator of modern hospitals is a variety of communication problems. In particular, interruptions from mobile communication devices are a cause of great concern for many physicians. Objective: To characterize how interruptions from mobile devices disturb physicians in their daily work. The gathered knowledge will be subsequently used as input for the design and development of a context-sensitive communication system for mobile communications suitable for hospitals. Methods: This study adheres to an ethnographic and interpretive field research approach. The data gathering consisted of participant observations, non-structured and mostly ad hoc interviews, and open-ended discussions with a selected group of physicians. Eleven physicians were observed for a total of 135 hours during May and June 2009. Results: The study demonstrates to what degree physicians are interrupted by mobile devices in their daily work and in which situations they are interrupted, such as surgery, examinations, and during patients/relatives high-importance level conversations. The participants in the study expected, and also indicated, that wireless phones probably led to more interruptions immediately after their introduction in a clinic, when compared to a pager, but this changed after a short while. The unpleasant feeling experienced by the caller when interrupting someone by calling them differs compared to sending a page message, which leaves it up to the receiver when to return the call. Conclusions: Mobile devices, which frequently interrupt physicians in hospitals, are a problem for both physicians and patients. The results from this study contribute to knowledge being used as input for designing and developing a prototype for a context-sensitive communication system for mobile communication suitable for hospitals. We combined these findings with results from earlier studies and also involved actual users to develop the prototype, CallMeSmart. This system intends to reduce such interruptions and at the same time minimize the number of communication devices needed per user. %M 23470528 %R 10.2196/jmir.2473 %U http://www.jmir.org/2013/3/e56/ %U https://doi.org/10.2196/jmir.2473 %U http://www.ncbi.nlm.nih.gov/pubmed/23470528 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e53 %T A Text Messaging Intervention to Improve Heart Failure Self-Management After Hospital Discharge in a Largely African-American Population: Before-After Study %A Nundy,Shantanu %A Razi,Rabia R %A Dick,Jonathan J %A Smith,Bryan %A Mayo,Ainoa %A O'Connor,Anne %A Meltzer,David O %+ Section of General Internal Medicine, Department of Medicine, University of Chicago Medical Center, 5841 S Maryland Ave, MC2007, Chicago, IL, 60637, United States, 1 7737020620, shantanu.nundy@gmail.com %K heart failure %K self-care %K patient education %K cellular phone %K text messaging %K African Americans %D 2013 %7 11.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: There is increasing interest in finding novel approaches to reduce health disparities in readmissions for acute decompensated heart failure (ADHF). Text messaging is a promising platform for improving chronic disease self-management in low-income populations, yet is largely unexplored in ADHF. Objective: The purpose of this pre-post study was to assess the feasibility and acceptability of a text message–based (SMS: short message service) intervention in a largely African American population with ADHF and explore its effects on self-management. Methods: Hospitalized patients with ADHF were enrolled in an automated text message–based heart failure program for 30 days following discharge. Messages provided self-care reminders and patient education on diet, symptom recognition, and health care navigation. Demographic and cell phone usage data were collected on enrollment, and an exit survey was administered on completion. The Self-Care of Heart Failure Index (SCHFI) was administered preintervention and postintervention and compared using sample t tests (composite) and Wilcoxon rank sum tests (individual). Clinical data were collected through chart abstraction. Results: Of 51 patients approached for recruitment, 27 agreed to participate and 15 were enrolled (14 African-American, 1 White). Barriers to enrollment included not owning a personal cell phone (n=12), failing the Mini-Mental exam (n=3), needing a proxy (n=2), hard of hearing (n=1), and refusal (n=3). Another 3 participants left the study for health reasons and 3 others had technology issues. A total of 6 patients (5 African-American, 1 White) completed the postintervention surveys. The mean age was 50 years (range 23-69) and over half had Medicaid or were uninsured (60%, 9/15). The mean ejection fraction for those with systolic dysfunction was 22%, and at least two-thirds had a prior hospitalization in the past year. Participants strongly agreed that the program was easy to use (83%), reduced pills missed (66%), and decreased salt intake (66%). Maintenance (mean composite score 49 to 78, P=.003) and management (57 to 86, P=.002) improved at 4 weeks, whereas confidence did not change (57 to 75, P=.11). Of the 6 SCHFI items that showed a statistically significant improvement, 5 were specifically targeted by the texting intervention. Conclusions: Over half of ADHF patients in an urban, largely African American community were eligible and interested in participating in a text messaging program following discharge. Access to mobile phones was a significant barrier that should be addressed in future interventions. Among the participants who completed the study, we observed a high rate of satisfaction and preliminary evidence of improvements in heart failure self-management. %M 23478028 %R 10.2196/jmir.2317 %U http://www.jmir.org/2013/3/e53/ %U https://doi.org/10.2196/jmir.2317 %U http://www.ncbi.nlm.nih.gov/pubmed/23478028 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e42 %T Internal Versus External Motivation in Referral of Primary Care Patients with Depression to an Internet Support Group: Randomized Controlled Trial %A Van Voorhees,Benjamin W %A Hsiung,Robert C %A Marko-Holguin,Monika %A Houston,Thomas K %A Fogel,Joshua %A Lee,Royce %A Ford,Daniel E %+ Section of General Pediatrics Department of Pediatrics, University of Illinois at Chicago, 840 S Wood St, Suite 1437, MC 856, Chicago, IL, 60612, United States, 1 3129960023, bvanvoor@uic.edu %K depressive disorder %K Internet %K primary care %K support groups %D 2013 %7 12.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Depressive disorders and symptoms affect more than one-third of primary care patients, many of whom do not receive or do not complete treatment. Internet-based social support from peers could sustain depression treatment engagement and adherence. We do not know whether primary care patients will accept referral to such websites nor do we know which methods of referral would be most effective. Objective: We conducted a randomized clinical trial to determine whether (1) a simple generic referral card (control), (2) a patient-oriented brochure that provided examples of online postings and experience (internal motivation), or (3) a physician letter of recommendation (external motivation) would generate the greatest participation in a primary care Internet depression treatment support portal focused around an Internet support group (ISG). Methods: We used 3 offline methods to identify potential participants who had not used an ISG in the past 6 months. Eligibility was determined in part by a brief structured psychiatric interview based on the Patient Health Questionnaire-9 (PHQ-9). After consent and enrollment, participants were randomly assigned to 1 of 3 groups (control, internal motivation, or external motivation). We constructed a portal to connect primary care patients to both fact-based information and an established ISG (Psycho-Babble). The ISG allowed participants to view messages and then decide if they actually wished to register there. Participation in the portal and the ISG was assessed via automated activity tracking. Results: Fifty participants were assigned to the 3 groups: a motivation-neutral control group (n=18), an internal motivation group (n=19), and an external motivation group (n=13). Of these participants, 31 (62%) visited the portal; 27 (54%) visited the ISG itself. The internal motivation group showed significantly greater participation than the control group on several measures. The external motivation group spent significantly less time logged onto the portal than the control group. The internal motivation group showed significantly greater participation than the external motivation group on several measures. Conclusions: Referral of primary care patients with depressive disorders and symptoms to an ISG is feasible even if they have never previously used one. This may best be accomplished by enhancing their internal motivation. Trial Registration: Clinicaltrials.gov: NCT00886730; http://clinicaltrials.gov/show/NCT00886730 (Archived by WebCite at http://www.webcitation.org/6F4981fDN) %M 23482332 %R 10.2196/jmir.2197 %U http://www.jmir.org/2013/3/e42/ %U https://doi.org/10.2196/jmir.2197 %U http://www.ncbi.nlm.nih.gov/pubmed/23482332 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e46 %T Online Cognitive Behavioral Therapy for Bulimic Type Disorders, Delivered in the Community by a Nonclinician: Qualitative Study %A McClay,Carrie-Anne %A Waters,Louise %A McHale,Ciaran %A Schmidt,Ulrike %A Williams,Christopher %+ Institute of Health and Wellbeing, Mental Health and Wellbeing, University of Glasgow, Administration Building, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, United Kingdom, 44 0044 141 211 ext 39, chris.williams@glasgow.ac.uk %K bulimia nervosa %K self-help %K cCBT %K qualitative research %K cognitive behavioral therapy %D 2013 %7 15.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive behavioral therapy is recommended in the National Institute for Clinical Excellence guidelines for the treatment of bulimia nervosa. In order to make this treatment option more accessible to patients, interactive online CBT programs have been developed that can be used in the user’s own home, in privacy, and at their convenience. Studies investigating online CBT for bulimic type eating disorders have provided promising results and indicate that, with regular support from a clinician or trained support worker, online CBT can be effective in reducing bulimic symptoms. Two main factors distinguish this study from previous research in this area. First, the current study recruited a wide range of adults with bulimic type symptoms from the community. Second, the participants in the current study had used cCBT with support from a nonclinical support worker rather than a specialist eating disorder clinician. Objective: To investigate participants’ experiences of using an online self-help cognitive behavioral therapy (CBT) package (Overcoming Bulimia Online) for bulimia nervosa (BN) and eating disorders not otherwise specified (EDNOS). Methods: Eight participants with a mean age of 33.9 years took part in semi-structured interviews. Interviews were transcribed and analyzed using a 6-step thematic analysis process. Results: Saturation was achieved, and 7 themes were identified in the dataset. These were: (1) conceptualizing eating disorders, (2) help-seeking behavior, (3) aspects of the intervention, (4) motivation to use the online package, (5) privacy and secrecy with regard to their eating problems, (6) recovery and the future, and (7) participant engagement describing individuals’ thoughts on taking part in the online research study. Conclusions: Participants suggested that online CBT self-help represented a generally desirable and acceptable treatment option for those with bulimic type eating problems, despite some difficulties with motivation and implementation of some elements of the package. Trial Registration: International Standard Randomized Controlled Trial Number of the original RCT that this study is based on: ISRCTN41034162; http://www.controlled-trials.com/ISRCTN41034162 (Archived by WebCite at http://www.webcitation.org/6Ey9sBWTV) %M 23502689 %R 10.2196/jmir.2083 %U http://www.jmir.org/2013/3/e46/ %U https://doi.org/10.2196/jmir.2083 %U http://www.ncbi.nlm.nih.gov/pubmed/23502689 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e44 %T Utilizing Social Media to Study Information-Seeking and Ethical Issues in Gene Therapy %A Robillard,Julie M %A Whiteley,Louise %A Johnson,Thomas Wade %A Lim,Jonathan %A Wasserman,Wyeth W %A Illes,Judy %+ National Core for Neuroethics, Division of Neurology, Department of Medicine, University of British Columbia, 2211 Wesbrook Mall, Koerner Pavilion, Room S124, Vancouver, BC, V6T 2B5, Canada, 1 604 822 7920, jilles@mail.ubc.ca %K gene therapy %K social media %K content analysis %K ethics %K public opinion %D 2013 %7 04.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: The field of gene therapy is rapidly evolving, and while hopes of treating disorders of the central nervous system and ethical concerns have been articulated within the academic community, little is known about views and opinions of different stakeholder groups. Objective: To address this gap, we utilized social media to investigate the kind of information public users are seeking about gene therapy and the hopes, concerns, and attitudes they express. Methods: We conducted a content analysis of questions containing the keywords “gene therapy” from the Q&A site “Yahoo! Answers” for the 5-year period between 2006 and 2010. From the pool of questions retrieved (N=903), we identified those containing at least one theme related to ethics, environment, economics, law, or society (n=173) and then characterized the content of relevant answers (n=399) through emergent coding. Results: The results show that users seek a wide range of information regarding gene therapy, with requests for scientific information and ethical issues at the forefront of enquiry. The question sample reveals high expectations for gene therapy that range from cures for genetic and nongenetic diseases to pre- and postnatal enhancement of physiological attributes. Ethics questions are commonly expressed as fears about the impact of gene therapy on self and society. The answer sample echoes these concerns but further suggests that the acceptability of gene therapy varies depending on the specific application. Conclusions: Overall, the findings highlight the powerful role of social media as a rich resource for research into attitudes toward biomedicine and as a platform for knowledge exchange and public engagement for topics relating to health and disease. %M 23470490 %R 10.2196/jmir.2313 %U http://www.jmir.org/2013/3/e44/ %U https://doi.org/10.2196/jmir.2313 %U http://www.ncbi.nlm.nih.gov/pubmed/23470490 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e48 %T Using Information Technology and Social Networking for Recruitment of Research Participants: Experience From an Exploratory Study of Pediatric Klinefelter Syndrome %A Close,Sharron %A Smaldone,Arlene %A Fennoy,Ilene %A Reame,Nancy %A Grey,Margaret %+ Yale University, School of Nursing, 100 Church Street South Ste 132, New Haven, CT, 06536, United States, 1 914 420 4508, sharron.close@yale.edu %K patient recruitment %K research subject recruitment %K health information technology %K social networking %K Klinefelter syndrome %D 2013 %7 19.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Recruiting pediatric samples for research may be challenging due to parental mistrust of the research process, privacy concerns, and family time constraints. Recruitment of children with chronic and genetic conditions may further complicate the enrollment process. Objective: In this paper, we describe the methodological challenges of recruiting children for research and provide an exemplar of how the use of information technology (IT) strategies with social networking may improve access to difficult-to-reach pediatric research participants. Methods: We conducted a cross-sectional descriptive study of boys between the ages of 8 and 18 years with Klinefelter syndrome. This study presented unique challenges for recruitment of pediatric participants. These challenges are illustrated by the report of recruitment activities developed for the study. We reviewed the literature to explore the issues of recruiting children for research using conventional and IT approaches. Success rates of conventional recruitment approaches, such as brochures, flyers in medical offices, and physician referrals, are compared with IT-based outreach. The IT approaches included teleconferencing via a Klinefelter syndrome support group, services of a Web-based commercial recruitment-matching company, and the development of a university-affiliated research recruitment website with the use of paid advertising on a social networking website (Facebook). Results: Over a 3-month period, dissemination of over 150 recruitment brochures and flyers placed in a large urban hospital and hospital-affiliated clinical offices, with 850 letters to physicians and patients were not successful. Within the same period, face-to-face recruitment in the clinical setting yielded 4 (9%) participants. Using Web-based and social networking approaches, 39 (91%) agreed to participate in the study. With these approaches, 5 (12%) were recruited from the national Klinefelter syndrome advocacy group, 8 (19%) from local and teleconference support groups, 10 (23%) from a Web-based research recruitment program, and 16 (37%) from the university-affiliated recruitment website. For the initial 6 months, the university website was viewed approximately 2 to 3 times per day on average. An advertisement placed on a social networking site for 1 week increased website viewing to approximately 63 visits per day. Out of 112 families approached using all of these methods, 43 (38%) agreed to participate. Families who declined cited either travel distance to the study site (15, 22%) or unwillingness to disclose the Klinefelter syndrome diagnosis to their sons (54, 78%) as the reasons for nonparticipation. Conclusions: Use of Web-based technologies enhances the recruitment of difficult-to-reach populations. Of the many approaches employed in this study, the university-affiliated recruitment website supported by a Facebook advertisement appeared to be the most successful. Research grant budgets should include expenses for website registration and maintenance fees as well as online advertisements on social networking websites. Tracking of recruitment referral sources may be helpful in planning future recruitment campaigns. %M 23512442 %R 10.2196/jmir.2286 %U http://www.jmir.org/2013/3/e48/ %U https://doi.org/10.2196/jmir.2286 %U http://www.ncbi.nlm.nih.gov/pubmed/23512442 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e49 %T An Assessment of Incentive Versus Survey Length Trade-offs in a Web Survey of Radiologists %A Ziegenfuss,Jeanette Y %A Niederhauser,Blake D %A Kallmes,David %A Beebe,Timothy J %+ HealthPartners, 8170 33rd Ave S, Bloomington, MN, 55425, United States, 1 952 967 5020, Jeanette.Y.Ziegenfuss@HealthPartners.com %K survey methods %K Internet methods %K physician surveys %D 2013 %7 20.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: It is generally understood that shorter Web surveys and use of incentives result in higher response rates in Web surveys directed to health care providers. Less is known about potential respondent preference for reduced burden as compared to increased reward. Objective: To help elicit preference for minimized burden compared to reward for completion of a survey, we observed physician preferences for shorter Web surveys compared to incentives as well as incentive preference (small guaranteed incentive compared to larger lottery incentive) accompanying an electronic request to complete a survey. Methods: This was an observational study that accompanied a large Web survey study of radiology staff, fellows, and residents at select academic medical centers in the United States. With the request to complete the survey, potential respondents were offered three options: (1) a 10-minute Web survey with the chance to win an iPad, (2) a 10-minute Web survey with a guaranteed nominal incentive ($5 amazon.com gift card), or (3) a shorter (5-7 minute) Web survey with no incentive. A total of 254 individuals responded to the Web survey request. Results: Overwhelmingly, individuals chose a longer survey accompanied by an incentive compared to a shorter survey with no incentive (85% compared to 15%, P<.001). Of those opting for an incentive, a small, but not significant majority chose the chance to win an iPad over a guaranteed $5 gift card (56% compared to 44%). Conclusions: When given the choice, radiologists preferred a reward (either guaranteed or based on a lottery) to a less burdensome survey, indicating that researchers should focus more attention at increasing perceived benefits of completing a Web survey compared to decreasing perceived burden. %M 23514869 %R 10.2196/jmir.2322 %U http://www.jmir.org/2013/3/e49/ %U https://doi.org/10.2196/jmir.2322 %U http://www.ncbi.nlm.nih.gov/pubmed/23514869 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e65 %T Patient Experiences With Full Electronic Access to Health Records and Clinical Notes Through the My HealtheVet Personal Health Record Pilot: Qualitative Study %A Woods,Susan S %A Schwartz,Erin %A Tuepker,Anais %A Press,Nancy A %A Nazi,Kim M %A Turvey,Carolyn L %A Nichol,W. Paul %+ Portland VA Medical Center, Health Services Research & Development, 3710 S.W. US Veterans Hospital Road, P3HSRD, Portland, OR, 97239, United States, 1 5035044205, susan.woods@va.gov %K personal health records %K eHealth %K patient access to records %K veterans %K patient participation %D 2013 %7 27.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Full sharing of the electronic health record with patients has been identified as an important opportunity to engage patients in their health and health care. The My HealtheVet Pilot, the initial personal health record of the US Department of Veterans Affairs, allowed patients and their delegates to view and download content in their electronic health record, including clinical notes, laboratory tests, and imaging reports. Objective: A qualitative study with purposeful sampling sought to examine patients’ views and experiences with reading their health records, including their clinical notes, online. Methods: Five focus group sessions were conducted with patients and family members who enrolled in the My HealtheVet Pilot at the Portland Veterans Administration Medical Center, Oregon. A total of 30 patients enrolled in the My HealtheVet Pilot, and 6 family members who had accessed and viewed their electronic health records participated in the sessions. Results: Four themes characterized patient experiences with reading the full complement of their health information. Patients felt that seeing their records positively affected communication with providers and the health system, enhanced knowledge of their health and improved self-care, and allowed for greater participation in the quality of their care such as follow-up of abnormal test results or decision-making on when to seek care. While some patients felt that seeing previously undisclosed information, derogatory language, or inconsistencies in their notes caused challenges, they overwhelmingly felt that having more, rather than less, of their health record information provided benefits. Conclusions: Patients and their delegates had predominantly positive experiences with health record transparency and the open sharing of notes and test results. Viewing their records appears to empower patients and enhance their contributions to care, calling into question common provider concerns about the effect of full record access on patient well-being. While shared records may or may not impact overall clinic workload, it is likely to change providers’ work, necessitating new types of skills to communicate and partner with patients. %M 23535584 %R 10.2196/jmir.2356 %U http://www.jmir.org/2013/3/e65/ %U https://doi.org/10.2196/jmir.2356 %U http://www.ncbi.nlm.nih.gov/pubmed/23535584 %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 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 e51 %T Development and Testing of a Multidimensional iPhone Pain Assessment Application for Adolescents with Cancer %A Stinson,Jennifer N %A Jibb,Lindsay A %A Nguyen,Cynthia %A Nathan,Paul C %A Maloney,Anne Marie %A Dupuis,L Lee %A Gerstle,J Ted %A Alman,Benjamin %A Hopyan,Sevan %A Strahlendorf,Caron %A Portwine,Carol %A Johnston,Donna L %A Orr,Mike %+ The Hospital for Sick Children, 555 University Ave, Toronto, ON, , Canada, 1 416 813 8501 ext 4514, jennifer.stinson@sickkids.ca %K neoplasms %K pain %K child %K adolescent %K youth %K cellular phone %K game %D 2013 %7 08.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Pain is one of the most common and distressing symptoms reported by adolescents with cancer. Despite advancements in pain assessment and management research, pain due to cancer and/or its treatments continues to be poorly managed. Our research group has developed a native iPhone application (app) called Pain Squad to tackle the problem of poorly managed pain in the adolescent with cancer group. The app functions as an electronic pain diary and is unique in its ability to collect data on pain intensity, duration, location, and the impact pain has on an adolescent’s life (ie, relationships, school work, sleep, mood). It also evaluates medications and other physical and psychological pain management strategies used. Users are prompted twice daily at configurable times to complete 20 questions characterizing their pain and the app transmits results to a database for aggregate reporting through a Web interface. Each diary entry represents a pain case filed by an adolescent with cancer and a reward system (ie, moving up through law-enforcement team ranks, built-in videotaped acknowledgements from fictitious officers) encourages consistent use of the diary. Objective: Our objective was to design, develop, and test the usability, feasibility, compliance, and satisfaction of a game-based smartphone pain assessment tool for adolescents with cancer. Methods: We used both low- and high-fidelity qualitative usability testing with qualitative semi-structured, audio-taped interviews and iterative cycles to design and refine the iPhone based Pain Squad app. Qualitative thematic analysis of interviews using constant comparative methodology captured emergent themes related to app usability. Content validity was assessed using question importance-rating surveys completed by participants. Compliance and satisfaction data were collected following a 2-week feasibility trial where users were alarmed to record their pain twice daily on the app. Results: Thematic analysis of usability interviews showed the app to be appealing overall to adolescents. Analyses of both low- and high-fidelity testing resulted in minor revisions to the app to refine the theme and improve its usability. Adolescents resoundingly endorsed the game-based nature of the app and its virtual reward system. The importance of app pain diary questions was established by content validity analysis. Compliance with the app, assessed during feasibility testing, was high (mean 81%, SD 22%) and adolescents from this phase of the study found the app likeable, easy to use, and not bothersome to complete. Conclusions: A multifaceted usability approach demonstrated how the Pain Squad app could be made more appealing to children and adolescents with cancer. The game-based nature and built-in reward system of the app was appealing to adolescents and may have resulted in the high compliance rates and satisfaction ratings observed during clinical feasibility testing. %M 23475457 %R 10.2196/jmir.2350 %U http://www.jmir.org/2013/3/e51/ %U https://doi.org/10.2196/jmir.2350 %U http://www.ncbi.nlm.nih.gov/pubmed/23475457 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 15 %N 3 %P e72 %T A Smartphone-Based Intervention With Diaries and Therapist Feedback to Reduce Catastrophizing and Increase Functioning in Women With Chronic Widespread Pain. Part 2: 11-month Follow-up Results of a Randomized Trial %A Kristjánsdóttir,Ólöf Birna %A Fors,Egil A %A Eide,Erlend %A Finset,Arnstein %A Stensrud,Tonje Lauritzen %A van Dulmen,Sandra %A Wigers,Sigrid Hørven %A Eide,Hilde %+ Department of Behavioral Sciences in Medicine, Faculty of Medicine, University of Oslo, Postbox 1111, Oslo, 0317, Norway, 47 22851020, kristjansdottir@gmail.com %K Internet-based personalized feedback %K widespread chronic pain %K fibromyalgia %K pain management %K eHealth %K smartphone %K Internet %K cognitive therapy %K catastrophization %D 2013 %7 28.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based interventions are increasingly used to support self-management of individuals with chronic illnesses. Web-based interventions may also be effective in enhancing self-management for individuals with chronic pain, but little is known about long-term effects. Research on Web-based interventions to support self-management following participation in pain management programs is limited. Objective: The aim is to examine the long-term effects of a 4-week smartphone-intervention with diaries and therapist-written feedback following an inpatient chronic pain rehabilitation program, previously found to be effective at short-term and 5-month follow-ups. Methods: 140 women with chronic widespread pain, participating in a 4-week inpatient rehabilitation program, were randomized into two groups: with or without a smartphone intervention after the rehabilitation. The smartphone intervention consisted of one face-to-face individual session and 4 weeks of written communication via a smartphone, consisting of three diaries daily to elicit pain-related thoughts, feelings, and activities, as well as daily personalized written feedback based on cognitive behavioral principles from a therapist. Both groups were given access to an informational website to promote constructive self-management. Outcomes were measured with self-reported paper-and-pencil format questionnaires with catastrophizing as the primary outcome measure. Secondary outcomes included daily functioning and symptom levels, acceptance of pain, and emotional distress. Results: By the 11-month follow-up, the favorable between-group differences previously reported post-intervention and at 5-month follow-up on catastrophizing, acceptance, functioning, and symptom level were no longer evident (P>.10). However, there was more improvement in catastrophizing scores during the follow-up period in the intervention group (M=-2.36, SD 8.41) compared to the control group (M=.40, SD 7.20), P=.045. Also, per protocol within-group analysis showed a small positive effect (Cohen’s d=.33) on catastrophizing in the intervention group (P=.04) and no change in the control group from the smartphone intervention baseline to 11-month follow-up. A positive effect (Cohen’s d=.73) on acceptance was found within the intervention group (P<.001) but not in the control group. Small to large negative effects were found within the control group on functioning and symptom levels, emotional distress, and fatigue (P=.05) from the intervention baseline to the 11-month follow-up. Conclusion: The long-term results of this randomized trial are ambiguous. No significant between-group effect was found on the study variables at 11-month follow-up. However, the within-group analyses, comparing the baseline for the smartphone intervention to the 11-month data, indicated changes in the desired direction in catastrophizing and acceptance in the intervention group but not within the control group. This study provides modest evidence supporting the long-term effect of the intervention. Trial Registration: Clinicaltrials.gov NCT01236209; http://www.clinicaltrials.gov/ct2/show/NCT01236209 (Archived by WebCite at http://www.webcitation.org/6FF7KUXo0) %M 23538392 %R 10.2196/jmir.2442 %U http://www.jmir.org/2013/3/e72/ %U https://doi.org/10.2196/jmir.2442 %U http://www.ncbi.nlm.nih.gov/pubmed/23538392