%0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 1 %P e7 %T Skin Self-Examination Education for Early Detection of Melanoma: A Randomized Controlled Trial of Internet, Workbook, and In-Person Interventions %A Robinson,June K %A Gaber,Rikki %A Hultgren,Brittney %A Eilers,Steven %A Blatt,Hanz %A Stapleton,Jerod %A Mallett,Kimberly %A Turrisi,Rob %A Duffecy,Jenna %A Begale,Mark %A Martini,Mary %A Bilimoria,Karl %A Wayne,Jeffrey %+ Northwestern University, Department of Dermatology, Feinberg School of Medicine, Arkes Family Pavilion, Suite 1260, 676 N St Clair St, Chicago, IL, 60611, United States, 1 312 926 7449, june-robinson@northwestern.edu %K melanoma %K early detection of cancer %K educational techniques %K health education %K behavioral research %K online education %K electronic interactive education %D 2014 %7 13.1.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Early detection of melanoma improves survival. Since many melanoma patients and their spouses seek the care of a physician after discovering their melanoma, an ongoing study will determine the efficacy of teaching at-risk melanoma patients and their skin check partner how to conduct skin self-examinations (SSEs). Internet-based health behavior interventions have proven efficacious in creating behavior change in patients to better prevent, detect, or cope with their health issues. The efficacy of electronic interactive SSE educational intervention provided on a tablet device has not previously been determined. Objective: The electronic interactive educational intervention was created to develop a scalable, effective intervention to enhance performance and accuracy of SSE among those at-risk to develop melanoma. The intervention in the office was conducted using one of the following three methods: (1) in-person through a facilitator, (2) with a paper workbook, or (3) with a tablet device used in the clinical office. Differences related to method of delivery were elucidated by having the melanoma patient and their skin check partner provide a self-report of their confidence in performing SSE and take a knowledge-based test immediately after receiving the intervention. Methods: The three interventions used 9 of the 26 behavioral change techniques defined by Abraham and Michie to promote planning of monthly SSE, encourage performing SSE, and reinforce self-efficacy by praising correct responses to knowledge-based decision making and offering helpful suggestions to improve performance. In creating the electronic interactive SSE educational intervention, the educational content was taken directly from both the scripted in-person presentation delivered with Microsoft PowerPoint by a trained facilitator and the paper workbook training arms of the study. Enrollment totaled 500 pairs (melanoma patient and their SSE partner) with randomization of 165 pairs to the in-person, 165 pairs to the workbook, and 70 pairs to electronic interactive SSE educational intervention. Results: The demographic survey data showed no significant mean differences between groups in age, education, or income. The tablet usability survey given to the first 30 tablet pairs found that, overall, participants found the electronic interactive intervention easy to use and that the video of the doctor-patient-partner dialogue accompanying the dermatologist’s examination was particularly helpful in understanding what they were asked to do for the study. The interactive group proved to be just as good as the workbook group in self-confidence of scoring moles, and just as good as both the workbook and the in-person intervention groups in self-confidence of monitoring their moles. While the in-person intervention performed significantly better on a skill-based quiz, the electronic interactive group performed significantly better than the workbook group. The electronic interactive and in-person interventions were more efficient (30 minutes), while the workbook took longer (45 minutes). Conclusions: This study suggests that an electronic interactive intervention can deliver skills training comparable to other training methods, and the experience can be accommodated during the customary outpatient office visit with the physician. Further testing of the electronic interactive intervention’s role in the anxiety of the pair and pair-discovered melanomas upon self-screening will elucidate the impact of these tools on outcomes in at-risk patient populations. ClinicalTrial: ClinicalTrials.gov NCT01013844; http://clinicaltrials.gov/show/NCT01013844 (Archived by WebCite at http://www.webcitation.org/6LvGGSTKK). %R 10.2196/jmir.2883 %U http://www.jmir.org/2014/1/e7/ %U https://doi.org/10.2196/jmir.2883 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e5 %T Using Ecological Momentary Assessment to Test the Effectiveness of a Web-Based Brief Alcohol Intervention Over Time Among Heavy-Drinking Students: Randomized Controlled Trial %A Voogt,Carmen %A Kuntsche,Emmanuel %A Kleinjan,Marloes %A Poelen,Evelien %A Engels,Rutger %+ Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, Nijmegen, 9104 6500 HE, Netherlands, 31 24 36 12705, c.voogt@bsi.ru.nl %K intervention study %K drinking %K students %D 2014 %7 08.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based brief alcohol interventions are effective in reducing alcohol use among students when measured at limited follow-up time points. To date, no studies have tested Web-based brief alcohol intervention effectiveness over time by using a large number of measurements. Objective: Testing whether the What Do You Drink (WDYD) Web-based brief alcohol intervention can sustain a reduction in alcohol use among heavy-drinking students aged 18-24 years at 1-, 3-, and 6-month follow-up intervals. Methods: A purely Web-based, 2-arm, parallel-group randomized controlled trial applying an ecological momentary assessment approach with 30 weekly measurements was conducted in the Netherlands (2010-2011). Participants were recruited offline and online. A total of 907 participants were randomized into the experimental condition (n=456) including the single-session and fully automated WDYD intervention, or into the control condition (n=451) including assessment only. Weekly alcohol consumption and frequency of binge drinking were the self-assessed outcome measures. Results: Attrition rates of the 907 participants were 110 (12.1%), 130 (14.3%), and 162 (17.9%) at 1-, 3-, and 6-month follow-up intervals, respectively. Latent growth curve analyses according to the intention-to-treat principle revealed that participants in the experimental condition had significantly lower weekly alcohol consumption compared to participants in the control condition that was sustained at 3-month follow-up (intercept=–2.60, P<.001; slope=0.16, P=.08). Additional linear regression analyses indicated that this intercept difference resulted from significantly higher levels of alcohol units per week for participants in the control condition compared to those in the experimental condition at 1-month (beta=–2.56, SE 0.74, Cohen’s d=0.20, P=.001), 3-month (beta=–1.76, SE 0.60, Cohen’s d=0.13, P=.003), and 6-month (beta=–1.21, SE 0.58, Cohen’s d=0.09, P=.04) follow-up intervals. Latent growth curve analyses further indicated that participants in the experimental condition had a significantly lower frequency of binge drinking compared to participants in the control condition that was sustained at 6-month follow-up (intercept=–0.14, P=.01; slope=0.004, P=.19). This intercept difference resulted from higher levels in this outcome for participants in the control condition relative to participants in the experimental condition at 1-month (beta=–1.15, SE 0.06, Cohen’s d=0.16, P=.01), 3-month (beta=–0.12, SE 0.05, Cohen’s d=0.09, P=.01), and 6-month (beta=–0.09, SE 0.05, Cohen’s d=0.03, P=.045) follow-up intervals. Conclusions: The WDYD intervention was shown to be effective in preventing an increase in weekly alcohol consumption and frequency of binge drinking directly after the intervention. This effect was sustained 3 and 6 months after the intervention. Trial Registration: Netherlands Trial Register NTR2665; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2665 (Archived by WebCite at http://webcitation.org/6LuQVn12M). %M 24401555 %R 10.2196/jmir.2817 %U http://www.jmir.org/2014/1/e5/ %U https://doi.org/10.2196/jmir.2817 %U http://www.ncbi.nlm.nih.gov/pubmed/24401555 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e17 %T Effectiveness of Web-Based Tailored Advice on Parents’ Child Safety Behaviors: Randomized Controlled Trial %A van Beelen,Mirjam Elisabeth Johanna %A Beirens,Tinneke Monique Jozef %A den Hertog,Paul %A van Beeck,Eduard Ferdinand %A Raat,Hein %+ Erasmus MC – University Medical Centre Rotterdam, Department of Public Health, Postbox 2040, Rotterdam, 3000 CA, Netherlands, 31 10 703 8580, h.raat@erasmusmc.nl %K child %K eHealth %K injury %K parent %K prevention %K primary care %K RCT %K safety %D 2014 %7 24.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Injuries at home are a major cause of death, disability, and loss of quality of life among young children. Despite current safety education, required safety behavior of parents is often lacking. To prevent various childhood disorders, the application of Web-based tools has increased the effectiveness of health promotion efforts. Therefore, an intervention with Web-based, tailored, safety advice combined with personal counseling (E-Health4Uth home safety) was developed and applied. Objective: To evaluate the effect of E-Health4Uth home safety on parents’ safety behaviors with regard to the prevention of falls, poisoning, drowning, and burns. Methods: A randomized controlled trial was conducted (2009-2011) among parents visiting well-baby clinics in the Netherlands. Parents were randomly assigned to the intervention group (E-Health4Uth home safety intervention) or to the control condition consisting of usual care. Parents in the intervention condition completed a Web-based safety behavior assessment questionnaire; the resulting tailored safety advice was discussed with their child health care professional at a well-baby visit (age approximately 11 months). Parents in the control condition received counseling using generic safety information leaflets at this well-baby visit. Parents’ child safety behaviors were derived from self-report questionnaires at baseline (age 7 months) and at follow-up (age 17 months). Each specific safety behavior was classified as safe/unsafe and a total risk score was calculated. Logistic and linear regression analyses were used to reveal differences in safety behavior between the intervention and the control condition at follow-up. Results: A total of 1292 parents (response rate 44.79%) were analyzed. At follow-up, parents in the intervention condition (n=643) showed significantly less unsafe behavior compared to parents in the control condition (n=649): top of staircase (23.91% vs 32.19%; OR 0.65, 95% CI 0.50-0.85); bottom of staircase (63.53% vs 71.94%; OR 0.69, 95% CI 0.53-0.88); top and bottom of staircase (68.94% vs 78.28%; OR 0.62, 95% CI 0.48-0.81); storage of cleaning products (30.33% vs 39.91%; OR 0.67, 95% CI 0.53-0.85); bathing of the child (23.46% vs 32.25%; OR 0.65, 95% CI 0.51-0.84); drinking hot fluids (34.84% vs 41.73%; OR 0.76, 95% CI 0.61-0.96); using rear hotplates (79.34% vs 85.27%; OR 0.67, 95% CI 0.50-0.90); and the total risk score in which a higher score indicates more unsafe behavior (mean 13.63, SD 6.12 vs mean 15.34, SD 6.07; beta –1.59, 95% CI –2.26 to –0.93). There were no significant differences for other specific behaviors between the two study conditions. Conclusions: Compared to generic written materials, the E-Health4Uth home safety intervention seems more effective in promoting parents’ safety behavior for safe staircases, storage of cleaning products, bathing, drinking hot fluids, and cooking. This study supports the application of Web-based, tailored, safety advice for the prevention of unintentional injuries in the youth health care setting. Trial Registration: Nederlands Trial Register: NTR1836; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1836 (Archived by WebCite at http://www.webcitation.org/6MPIGQxpx). %M 24463421 %R 10.2196/jmir.2521 %U http://www.jmir.org/2014/1/e17/ %U https://doi.org/10.2196/jmir.2521 %U http://www.ncbi.nlm.nih.gov/pubmed/24463421 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e26 %T Effects of a Web-Based Tailored Multiple-Lifestyle Intervention for Adults: A Two-Year Randomized Controlled Trial Comparing Sequential and Simultaneous Delivery Modes %A Schulz,Daniela N %A Kremers,Stef PJ %A Vandelanotte,Corneel %A van Adrichem,Mathieu JG %A Schneider,Francine %A Candel,Math JJM %A de Vries,Hein %+ CAPHRI School for Public Health and Primary Care, Department of Health Promotion, Maastricht University, P Debyeplein 1, Maastricht, 6229 HA, Netherlands, 31 43 388 2832, dn.schulz@maastrichtuniversity.nl %K multiple behavior change %K Web-based intervention %K computer tailoring %K effectiveness %K physical activity %K fruit consumption %K vegetable consumption %K alcohol intake %K smoking %D 2014 %7 27.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based computer-tailored interventions for multiple health behaviors can have a significant public health impact. Yet, few randomized controlled trials have tested this assumption. Objective: The objective of this paper was to test the effects of a sequential and simultaneous Web-based tailored intervention on multiple lifestyle behaviors. Methods: A randomized controlled trial was conducted with 3 tailoring conditions (ie, sequential, simultaneous, and control conditions) in the Netherlands in 2009-2012. Follow-up measurements took place after 12 and 24 months. The intervention content was based on the I-Change model. In a health risk appraisal, all respondents (N=5055) received feedback on their lifestyle behaviors that indicated whether they complied with the Dutch guidelines for physical activity, vegetable consumption, fruit consumption, alcohol intake, and smoking. Participants in the sequential (n=1736) and simultaneous (n=1638) conditions received tailored motivational feedback to change unhealthy behaviors one at a time (sequential) or all at the same time (simultaneous). Mixed model analyses were performed as primary analyses; regression analyses were done as sensitivity analyses. An overall risk score was used as outcome measure, then effects on the 5 individual lifestyle behaviors were assessed and a process evaluation was performed regarding exposure to and appreciation of the intervention. Results: Both tailoring strategies were associated with small self-reported behavioral changes. The sequential condition had the most significant effects compared to the control condition after 12 months (T1, effect size=0.28). After 24 months (T2), the simultaneous condition was most effective (effect size=0.18). All 5 individual lifestyle behaviors changed over time, but few effects differed significantly between the conditions. At both follow-ups, the sequential condition had significant changes in smoking abstinence compared to the simultaneous condition (T1 effect size=0.31; T2 effect size=0.41). The sequential condition was more effective in decreasing alcohol consumption than the control condition at 24 months (effect size=0.27). Change was predicted by the amount of exposure to the intervention (total visiting time: beta=–.06; P=.01; total number of visits: beta=–.11; P<.001). Both interventions were appreciated well by respondents without significant differences between conditions. Conclusions: Although evidence was found for the effectiveness of both programs, no simple conclusive finding could be drawn about which intervention mode was more effective. The best kind of intervention may depend on the behavior that is targeted or on personal preferences and motivation. Further research is needed to identify moderators of intervention effectiveness. The results need to be interpreted in view of the high and selective dropout rates, multiple comparisons, and modest effect sizes. However, a large number of people were reached at low cost and behavioral change was achieved after 2 years. Trial Registration: Nederlands Trial Register: NTR 2168; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2168 (Archived by WebCite at http://www.webcitation.org/6MbUqttYB). %M 24472854 %R 10.2196/jmir.3094 %U http://www.jmir.org/2014/1/e26/ %U https://doi.org/10.2196/jmir.3094 %U http://www.ncbi.nlm.nih.gov/pubmed/24472854 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e25 %T Perceptions of Successful Cues to Action and Opportunities to Augment Behavioral Triggers in Diabetes Self-Management: Qualitative Analysis of a Mobile Intervention for Low-Income Latinos With Diabetes %A Burner,Elizabeth R %A Menchine,Michael D %A Kubicek,Katrina %A Robles,Marisela %A Arora,Sanjay %+ Keck School of Medicine of the University of Southern California, Department of Emergency Medicine, 1200 N State St, Room 1011, Los Angeles, CA, 90033, United States, 1 3232266667, eburner@usc.edu %K diabetes %K Latinos %K cellular phone %D 2014 %7 29.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: The increasing prevalence of diabetes and the associated cost of managing this complicated disease have a significant impact on public health outcomes and health expenditures, especially among resource-poor Latino patients. Mobile health (mHealth) may be the solution to reaching this group and improving their health. Objective: In this qualitative study, we examined nuances of motivation, intention, and triggers to action effected by TExT-MED (Trial to Examine Text Messaging for Emergency Department patient with Diabetes), an mHealth intervention tailored to low-income, urban Latinos with diabetes. TExT-MED is a fully-automated, text message-based program designed to increase knowledge, self-efficacy, and subsequent disease management and glycemic control. Methods: We conducted 5 focus group interviews with 24 people who participated in TExT-MED. We employed a modified grounded theory analytic approach—an iterative process of coding and immersion in the data used to recognize the patterns and links between concepts voiced by the participants. We coded data to identify themes of participant experiences, motivations, and responses to the program. We organized themes into a theory of TExT-MED’s action. Results: Participants enjoyed their experience with TExT-MED and believed it improved their diabetes management. Through analysis of the transcripts, we identified that the strengths of the program were messages that cued specific behaviors such as medication reminders and challenge messages. Our analysis also revealed that increasing personalization of message delivery and content could augment these cues. Conclusions: This in-depth qualitative analysis of TExT-MED shows that low-income Latino patients will accept text messages as a behavioral intervention. This mHealth intervention acts as a behavioral trigger rather than an education platform. Personalization is an opportunity to enhance these cues to action and further research should be conducted on the ideal forms of personalization. %M 24476784 %R 10.2196/jmir.2881 %U http://www.jmir.org/2014/1/e25/ %U https://doi.org/10.2196/jmir.2881 %U http://www.ncbi.nlm.nih.gov/pubmed/24476784 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e8 %T Mind the Gap: Social Media Engagement by Public Health Researchers %A Keller,Brett %A Labrique,Alain %A Jain,Kriti M %A Pekosz,Andrew %A Levine,Orin %+ Johns Hopkins School of Public Health, Department of International Health and Department of Epidemiology, 615 North Wolfe St, E5543, Baltimore, MD, 21205, United States, 1 443 287 4744, alabriqu@jhsph.edu %K Internet %K social media %K public health %K blogging %D 2014 %7 14.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: The traditional vertical system of sharing information from sources of scientific authority passed down to the public through local health authorities and clinicians risks being made obsolete by emerging technologies that facilitate rapid horizontal information sharing. The rise of Public Health 2.0 requires professional acknowledgment that a new and substantive forum of public discourse about public health exists on social media, such as forums, blogs, Facebook, and Twitter. Objective: Some public health professionals have used social media in innovative ways: to surveil populations, gauge public opinion, disseminate health information, and promote mutually beneficial interactions between public health professionals and the lay public. Although innovation is on the rise, most in the public health establishment remain skeptical of this rapidly evolving landscape or are unclear about how it could be used. We sought to evaluate the extent to which public health professionals are engaged in these spaces. Methods: We conducted a survey of professorial- and scientist-track faculty at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, USA. We asked all available faculty via email to complete a 30-question survey about respondent characteristics, beliefs about social media, and usage of specific technologies, including blogs, Facebook, Twitter, and YouTube. Results: A total of 181 (19.8%) of 912 professor- and scientist-track faculty provided usable responses. The majority of respondents rarely used major social media platforms. Of these 181 respondents, 97 (53.6%) had used YouTube, 84 (46.4%) had used Facebook, 55 (30.4%) had read blogs, and 12 (6.6%) had used Twitter in the prior month. More recent degree completion was the best predictor of higher usage of social media. In all, 122 (67.4%) agreed that social media is important for disseminating information, whereas only 55 (30.4%) agreed that social media is useful for their research. In all, 43 (23.8%) said social media was helpful for professional career advancement, whereas 72 (39.8%) said it was not. Only 43 (23.8%) faculty said they would employ a full- or part-time social media consultant, and 30 (16.6%) currently employed one. Conclusions: Despite near-universal appreciation of the potential for social media to serve as a component of public health strategy, a small minority are actually engaged in this space professionally, whereas most are either disinterested or actively opposed to professional engagement. Social media is seen by most as more useful for spreading information than obtaining it. As public discourse on a number of critical health topics continues to be influenced and sometimes shaped by discussions online from Twitter to Facebook, it would seem that greater discourse is needed about when and how public health professionals should engage in these media, and also how personal, institutional, and professional barriers to greater use of social media may be overcome. %M 24425670 %R 10.2196/jmir.2982 %U http://www.jmir.org/2014/1/e8/ %U https://doi.org/10.2196/jmir.2982 %U http://www.ncbi.nlm.nih.gov/pubmed/24425670 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e30 %T Caught in the Web: A Review of Web-Based Suicide Prevention %A Lai,Mee Huong %A Maniam,Thambu %A Chan,Lai Fong %A Ravindran,Arun V %+ Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, 56000, Malaysia, 60 3 91455555 ext 6143, laifchan@gmail.com %K suicide prevention %K Web-based %K Internet %D 2014 %7 28.01.2014 %9 Review %J J Med Internet Res %G English %X Background: Suicide is a serious and increasing problem worldwide. The emergence of the digital world has had a tremendous impact on people’s lives, both negative and positive, including an impact on suicidal behaviors. Objective: Our aim was to perform a review of the published literature on Web-based suicide prevention strategies, focusing on their efficacy, benefits, and challenges. Methods: The EBSCOhost (Medline, PsycINFO, CINAHL), OvidSP, the Cochrane Library, and ScienceDirect databases were searched for literature regarding Web-based suicide prevention strategies from 1997 to 2013 according to the modified PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The selected articles were subjected to quality rating and data extraction. Results: Good quality literature was surprisingly sparse, with only 15 fulfilling criteria for inclusion in the review, and most were rated as being medium to low quality. Internet-based cognitive behavior therapy (iCBT) reduced suicidal ideation in the general population in two randomized controlled trial (effect sizes, d=0.04-0.45) and in a clinical audit of depressed primary care patients. Descriptive studies reported improved accessibility and reduced barriers to treatment with Internet among students. Besides automated iCBT, preventive strategies were mainly interactive (email communication, online individual or supervised group support) or information-based (website postings). The benefits and potential challenges of accessibility, anonymity, and text-based communication as key components for Web-based suicide prevention strategies were emphasized. Conclusions: There is preliminary evidence that suggests the probable benefit of Web-based strategies in suicide prevention. Future larger systematic research is needed to confirm the effectiveness and risk benefit ratio of such strategies. %M 24472876 %R 10.2196/jmir.2973 %U http://www.jmir.org/2014/1/e30/ %U https://doi.org/10.2196/jmir.2973 %U http://www.ncbi.nlm.nih.gov/pubmed/24472876 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e20 %T Importance of Internet Surveillance in Public Health Emergency Control and Prevention: Evidence From a Digital Epidemiologic Study During Avian Influenza A H7N9 Outbreaks %A Gu,Hua %A Chen,Bin %A Zhu,Honghong %A Jiang,Tao %A Wang,Xinyi %A Chen,Lei %A Jiang,Zhenggang %A Zheng,Dawei %A Jiang,Jianmin %+ Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Rd, Binjiang District, Hangzhou, 310051, China, 86 571 87115009, jmjiang@cdc.zj.cn %K influenza A virus, H7N9 subtype %K Internet %K surveillance %K disease outbreak %D 2014 %7 17.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Outbreaks of human infection with a new avian influenza A H7N9 virus occurred in China in the spring of 2013. Control and prevention of a new human infectious disease outbreak can be strongly affected by public reaction and social impact through the Internet and social media. Objective: This study aimed to investigate the potential roles of Internet surveillance in control and prevention of the human H7N9 outbreaks. Methods: Official data for the human H7N9 outbreaks were collected via the China National Health and Family Planning Committee website from March 31 to April 24, 2013. We obtained daily posted and forwarded number of blogs for the keyword “H7N9” from Sina microblog website and a daily Baidu Attention Index (BAI) from Baidu website, which reflected public attention to the outbreak. Rumors identified and confirmed by the authorities were collected from Baidu search engine. Results: Both daily posted and forwarded number and BAI for keyword H7N9 increased quickly during the first 3 days of the outbreaks and remained at a high level for 5 days. The total daily posted and forwarded number for H7N9 on Sina microblog peaked at 850,000 on April 3, from zero blogs before March 31, increasing to 97,726 on April 1 and to 370,607 on April 2, and remaining above 500,000 from April 5-8 before declining to 208,524 on April 12. The total daily BAI showed a similar pattern of change to the total daily posted and forwarded number over time from March 31 to April 12. When the outbreak locations spread, especially into other areas of the same province/city and the capital, Beijing, daily posted and forwarded number and BAI increased again to a peak at 368,500 and 116,911, respectively. The median daily BAI during the studied 25 days was significantly higher among the 7 provinces/cities with reported human H7N9 cases than the 2 provinces without any cases (P<.001). So were the median daily posted and forwarded number and daily BAI in each province/city except Anhui province. We retrieved a total of 32 confirmed rumors spread across 19 provinces/cities in China. In all, 84% (27/32) of rumors were disseminated and transmitted by social media. Conclusions: The first 3 days of an epidemic is a critical period for the authorities to take appropriate action through Internet surveillance to prevent and control the epidemic, including preparation of personnel, technology, and other resources; information release; collection of public opinion and reaction; and clarification, prevention, and control of rumors. Internet surveillance can be used as an efficient and economical tool to prevent and control public health emergencies, such as H7N9 outbreaks. %M 24440770 %R 10.2196/jmir.2911 %U http://www.jmir.org/2014/1/e20/ %U https://doi.org/10.2196/jmir.2911 %U http://www.ncbi.nlm.nih.gov/pubmed/24440770 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e22 %T Guess Who’s Not Coming to Dinner? Evaluating Online Restaurant Reservations for Disease Surveillance %A Nsoesie,Elaine O %A Buckeridge,David L %A Brownstein,John S %+ Children's Hospital Informatics Program, Boston Children's Hospital, 1 Autumn St #14, Boston, MA, 02215, United States, 1 857 218 5108, onelaine@vt.edu %K population surveillance %K restaurants %K epidemics %K outbreaks %D 2014 %7 22.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Alternative data sources are used increasingly to augment traditional public health surveillance systems. Examples include over-the-counter medication sales and school absenteeism. Objective: We sought to determine if an increase in restaurant table availabilities was associated with an increase in disease incidence, specifically influenza-like illness (ILI). Methods: Restaurant table availability was monitored using OpenTable, an online restaurant table reservation site. A daily search was performed for restaurants with available tables for 2 at the hour and at half past the hour for 22 distinct times: between 11:00 am-3:30 pm for lunch and between 6:00-11:30 PM for dinner. In the United States, we examined table availability for restaurants in Boston, Atlanta, Baltimore, and Miami. For Mexico, we studied table availabilities in Cancun, Mexico City, Puebla, Monterrey, and Guadalajara. Time series of restaurant use was compared with Google Flu Trends and ILI at the state and national levels for the United States and Mexico using the cross-correlation function. Results: Differences in restaurant use were observed across sampling times and regions. We also noted similarities in time series trends between data on influenza activity and restaurant use. In some settings, significant correlations greater than 70% were noted between data on restaurant use and ILI trends. Conclusions: This study introduces and demonstrates the potential value of restaurant use data for event surveillance. %M 24451921 %R 10.2196/jmir.2998 %U http://www.jmir.org/2014/1/e22/ %U https://doi.org/10.2196/jmir.2998 %U http://www.ncbi.nlm.nih.gov/pubmed/24451921 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e16 %T Older Adult Experience of Online Diagnosis: Results From a Scenario-Based Think-Aloud Protocol %A Luger,Tana M %A Houston,Thomas K %A Suls,Jerry %+ eHealth Quality Enhancement Research Initiative, Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veteran's Hospital, Building 70 (152), 200 Springs Road, Bedford, MA, 01730, United States, 1 781 687 2642, Tana.Luger2@va.gov %K information seeking behavior %K Internet %K age factors %D 2014 %7 16.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Searching for online information to interpret symptoms is an increasingly prevalent activity among patients, even among older adults. As older adults typically have complex health care needs, their risk of misinterpreting symptoms via online self-diagnosis may be greater. However, limited research has been conducted with older adults in the areas of symptom interpretation and human-computer interaction. Objective: The intent of the study was to describe the processes that a sample of older adults may use to diagnose symptoms online as well as the processes that predict accurate diagnosis. Methods: We conducted a series of “think-aloud” protocols with 79 adults aged 50 years or older. Participants received one of two vignettes that depicted symptoms of illness. Participants talked out loud about their thoughts and actions while attempting to diagnose the symptoms with and without the help of common Internet tools (Google and WebMD’s Symptom Checker). Think-aloud content was categorized using an adapted Q-sort and general inductive approach. We then compared the think-aloud content of participants who were accurate in their diagnosis with those who were not. Results: Nineteen descriptive codes were identified from the think-aloud content. The codes touched upon Web navigation, attempts to organize and evaluate online health information, and strategies to diagnose symptoms. Participants most frequently relied on a strategy where they reviewed and then rejected the online diagnoses if they contained additional symptoms than those that were depicted in the vignette. Finally, participants who were inaccurate in their diagnosis reported being confused by the diagnosis task, lacking confidence in their diagnosis, and using their past experiences with illness to guide diagnosis more frequently than those participants who accurately diagnosed the symptoms. Conclusions: Older adult participants tended to rely on matching strategies to interpret symptoms, but many still utilized existing medical knowledge and previous illness experiences as a guide for diagnosis. Many participants also had difficulty navigating the Internet tools, which suggests an increased need for navigation aids in Web design. Furthermore, participants who were inaccurate in their diagnosis had more difficulty with the Internet tools and confusion with the task than those who were accurate. Future work in this area may want to utilize additional study design such as eye-tracking to further understand the coordination between Web navigation, online symptom information processing, and diagnostic strategies. %M 24434479 %R 10.2196/jmir.2924 %U http://www.jmir.org/2014/1/e16/ %U https://doi.org/10.2196/jmir.2924 %U http://www.ncbi.nlm.nih.gov/pubmed/24434479 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e1 %T Evaluating a Web-Based Health Risk Assessment With Tailored Feedback: What Does an Expert Focus Group Yield Compared to a Web-Based End-User Survey? %A Vosbergen,Sandra %A Mahieu,Guy R %A Laan,Eva K %A Kraaijenhagen,Roderik A %A Jaspers,Monique WM %A Peek,Niels %+ Academic Medical Center, Department of Medical Informatics, Room J1b-110.1, PO Box 226600, Amsterdam, 1100DD, Netherlands, 31 20 5667872, n.b.peek@amc.uva.nl %K health risk assessment %K health information systems %K qualitative research %K evaluation %K end users %K professional review %K designers %K optimization %D 2014 %7 02.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Increasingly, Web-based health applications are developed for the prevention and management of chronic diseases. However, their reach and utilization is often disappointing. Qualitative evaluations post-implementation can be used to inform the optimization process and ultimately enhance their adoption. In current practice, such evaluations are mainly performed with end-user surveys. However, a review approach by experts in a focus group may be easier to administer and might provide similar results. Objective: The aim of this study was to assess whether industrial design engineers in a focus group would address the same issues as end users in a Web-based survey when evaluating a commercial Web-based health risk assessment (HRA) with tailored feedback. Methods: Seven Dutch companies used the HRA as part of their corporate health management strategy. Employees using the HRA (N=2289) and 10 independent industrial designers were invited to participate in the study. The HRA consisted of four components: (1) an electronic health questionnaire, (2) biometric measurements, (3) laboratory evaluation, and (4) individually tailored feedback generated by decision support software. After participating in the HRA as end users, both end users and designers evaluated the program. End users completed an evaluation questionnaire that included a free-text field. Designers participated in a focus group discussion. Constructs from user satisfaction and technology acceptance theories were used to categorize and compare the remarks from both evaluations. Results: We assessed and qualitatively analyzed 294 remarks of 189 end users and 337 remarks of 6 industrial designers, pertaining to 295 issues in total. Of those, 137 issues were addressed in the end-user survey and 148 issues in the designer focus group. Only 7.3% (10/137) of the issues addressed in the survey were also addressed in the focus group. End users made more remarks about the usefulness of the HRA and prior expectations that were not met. Designers made more remarks about how the information was presented to end users, quality of the feedback provided by the HRA, recommendations on the marketing and on how to create more unity in the design of the HRA, and on how to improve the HRA based on these issues. Conclusions: End-user surveys should not be substituted for expert focus groups. Issues identified by end users in the survey and designers in the focus group differed considerably, and the focus group produced a lot of new issues. The issues addressed in the focus group often focused on different aspects of user satisfaction and technology acceptance than those addressed by the survey participants; when they did focus on the same aspects, then the nature of issues differed considerably in content. %M 24384408 %R 10.2196/jmir.2517 %U http://www.jmir.org/2014/1/e1/ %U https://doi.org/10.2196/jmir.2517 %U http://www.ncbi.nlm.nih.gov/pubmed/24384408 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e4 %T How Accurate is Web-Based Self-Reported Height, Weight, and Body Mass Index in Young Adults? %A Pursey,Kirrilly %A Burrows,Tracy L %A Stanwell,Peter %A Collins,Clare E %+ Faculty of Health and Medicine, Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 0249215514, Tracy.Burrows@newcastle.edu.au %K Internet %K height %K weight %K body mass index %K self-report %D 2014 %7 07.01.2014 %9 Short Paper %J J Med Internet Res %G English %X Background: Web-based approaches are an effective and convenient medium to deliver eHealth interventions. However, few studies have attempted to evaluate the accuracy of online self-reported weight, and only one has assessed the accuracy of online self-reported height and body mass index (BMI). Objective: This study aimed to validate online self-reported height, weight, and calculated BMI against objectively measured data in young Australian adults. Methods: Participants aged 18-35 years were recruited via advertisements on social media sites and reported their current height and weight as part of an online survey. They then subsequently had the same measures objectively assessed by a trained researcher. Results: Self-reported height was significantly overestimated by a mean of 1.36 cm (SD 1.93; P<.001), while self-reported weight was significantly underestimated by –0.55 kg (SD 2.03; P<.001). Calculated BMI was also underestimated by –0.56 kg/m2 (SD 0.08; P<.001). The discrepancy in reporting resulted in the misclassification of the BMI category of three participants. Measured and self-reported data were strongly positively correlated (height: r=.98, weight: r=.99, BMI: r=.99; P<.001). When accuracy was evaluated by BMI category and gender, weight remained significantly underreported by females (P=.002) and overweight/obese participants (P=.02). Conclusions: There was moderate to high agreement between self-reported and measured anthropometric data. Findings suggest that online self-reported height and weight can be a valid method of collecting anthropometric data. %M 24398335 %R 10.2196/jmir.2909 %U http://www.jmir.org/2014/1/e4/ %U https://doi.org/10.2196/jmir.2909 %U http://www.ncbi.nlm.nih.gov/pubmed/24398335 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e9 %T Internet and Mobile Technology Use Among Urban African American Parents: Survey Study of a Clinical Population %A Mitchell,Stephanie J %A Godoy,Leandra %A Shabazz,Kanya %A Horn,Ivor B %+ Children's National Medical Center, Division of General Pediatrics/Center for Translational Science, George Washington University School of Medicine, 111 Michigan Ave, NW, Washington, DC, 20010, United States, 1 202 476 6908, ihorn@childrensnational.org %K health communication %K mobile phone %K social networking, African Americans %K pediatrics %D 2014 %7 13.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: There is considerable potential for mobile technologies to empower pediatric patients and families by improving their communication with health professionals. National surveys suggest minority parents frequently communicate via mobile technology, but it is uncertain how amenable they are to receiving health care information in this format. Although the low cost and far reach characteristics of mobile health (mHealth) technology makes it advantageous for communication with minority parents, data on acceptance are needed. Objective: The objective of the study was to determine utilization of mobile and Internet technology by African American parents in an urban, underserved population, and to assess their interest in receiving health information via text messaging or other technologies (eg, social media and the Internet). Methods: A survey was administered to parents of children aged 1-12 years covered by public insurance receiving care at 3 pediatric primary care centers in Washington, DC. Results: The African American sample (N=302) was composed of primarily single (75.8%, 229/302) mothers. Almost half had more than a high school education (47.7%, 144/302) and incomes above US $25,000 per year (43.0%, 130/302). Most (97.0%, 293/302) reported owning a cell phone, of which 91.1% (275/302) used it to text and 78.5% (237/302) used it to access the Internet. Most had service plans with unlimited text and data, but 26.5% (80/302) experienced service interruptions in the previous year. Home Internet access was more prevalent among those with higher income (86.2%, 112/130), but it was still relatively pervasive among lower income families (66.9%, 83/124). In adjusted logistic regression models, African American mothers with income greater than US $25,000 annually were 4 times as likely to own a tablet computer than their lower income counterparts. Of the participants, 80.8% (244/302) used social networking, primarily Facebook, and 74.2% (224/302) were interested in joining a social networking group about a health topic concerning their child. Although relatively few African American mothers (17.9%, 54/302) shared health information via texting, there was strong interest in receiving health information via mobile phones (87.4%, 264/302). There was no significant difference in Internet/mobile device use or interest in using these outlets to send/receive information about their children’s health between parents of healthy children and parents of children with chronic health conditions. Conclusions: Urban African American parents are active users of the Internet and mobile technology for social interactions, but they are less likely to use it for accessing or communicating health information. However, most parents expressed an interest in receiving health information or utilizing social networking to learn more about health topics. Mobile technology and social networks may be an underutilized method of providing health information to underserved minority populations. %M 24418967 %R 10.2196/jmir.2673 %U http://www.jmir.org/2014/1/e9/ %U https://doi.org/10.2196/jmir.2673 %U http://www.ncbi.nlm.nih.gov/pubmed/24418967 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e11 %T Biological Calibration for Web-Based Hearing Tests: Evaluation of the Methods %A Masalski,Marcin %A Grysiński,Tomasz %A Kręcicki,Tomasz %+ Department and Clinic of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, Wybrzeże L Pasteura 1, Wrocław, 50-367, Poland, 48 71 734 37 00, marcin.masalski@pwr.wroc.pl %K pure-tone audiometry %K computer-assisted instruction %K self-examination %D 2014 %7 15.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Online hearing tests conducted in home settings on a personal computer (PC) require prior calibration. Biological calibration consists of approximating the reference sound level via the hearing threshold of a person with normal hearing. Objective: The objective of this study was to identify the error of the proposed methods of biological calibration, their duration, and the subjective difficulty in conducting these tests via PC. Methods: Seven methods have been proposed for measuring the calibration coefficients. All measurements were performed in reference to the hearing threshold of a normal-hearing person. Three methods were proposed for determining the reference sound level on the basis of these calibration coefficients. Methods were compared for the estimated error, duration, and difficulty of the calibration. Web-based self-assessed measurements of the calibration coefficients were carried out in 3 series: (1) at a otolaryngology clinic, (2) at the participant’s home, and (3) again at the clinic. Additionally, in series 1 and 3, pure-tone audiometry was conducted and series 3 was followed by an offline questionnaire concerning the difficulty of the calibration. Participants were recruited offline from coworkers of the Department and Clinic of Otolaryngology, Wroclaw Medical University, Poland. Results: All 25 participants, aged 22-35 years (median 27) completed all tests and filled in the questionnaire. The smallest standard deviation of the calibration coefficient in the test-retest measurement was obtained at the level of 3.87 dB (95% CI 3.52-4.29) for the modulated signal presented in accordance with the rules of Bekesy’s audiometry. The method is characterized by moderate duration time and a relatively simple procedure. The simplest and shortest method was the method of self-adjustment of the sound volume to the barely audible level. In the test-retest measurement, the deviation of this method equaled 4.97 dB (95% CI 4.53-5.51). Among methods determining the reference sound level, the levels determined independently for each frequency revealed the smallest error. The estimated standard deviations of the difference in the hearing threshold between the examination conducted on a biologically calibrated PC and pure-tone audiometry varied from 7.27 dB (95% CI 6.71-7.93) to 10.38 dB (95% CI 9.11-12.03), depending on the calibration method. Conclusions: In this study, an analysis of biological calibration was performed and the presented results included calibration error, calibration time, and calibration difficulty. These values determine potential applications of Web-based hearing tests conducted in home settings and are decisive factors when selecting the calibration method. If there are no substantial time limitations, it is advisable to use Bekesy method and determine the reference sound level independently at each frequency because this approach is characterized by the lowest error. %M 24429353 %R 10.2196/jmir.2798 %U http://www.jmir.org/2014/1/e11/ %U https://doi.org/10.2196/jmir.2798 %U http://www.ncbi.nlm.nih.gov/pubmed/24429353 %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 16 %N 1 %P e15 %T Impact of Patient Access to Internet Health Records on Glaucoma Medication: Randomized Controlled Trial %A Kashiwagi,Kenji %A Tsukahara,Shigeo %+ Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, 409-3898, Japan, 81 552731111 ext 2372, kenjik@yamanashi.ac.jp %K Internet %K glaucoma %K intraocular pressure %K personal health record %K medication %D 2014 %7 15.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Glaucoma is one of the leading causes of blindness. Reduction of intraocular pressure is the only proven way to prevent progression of glaucomatous optic neuropathy. The majority of glaucoma patients need to use antiglaucoma ophthalmic solutions over the course of their life. Thus, good adherence and persistency of glaucoma treatment are important factors for better glaucoma care. Objective: The purpose of this study was to investigate the impact of an Internet-based glaucoma care support system on glaucoma medication use. Methods: Patients were randomly divided into two groups. The non–Internet access (NIA) group consisted of patients who had access to the Internet-based glaucoma care support system during the 4-year period only when they were examined by ophthalmologists. The Internet access (IA) group consisted of patients who had the same Internet-based glaucoma care support system access as the NIA group for the first 2 years following enrollment but who were also given free access to the glaucoma care support system for the remaining 2 years. Changes in glaucoma medication use were investigated. Results: In total, 81 patients in the IA group and 90 patients in the NIA group satisfied the study protocol. The number of antiglaucoma ophthalmic solutions used during the study period significantly increased in the NIA group (P<.03) but not in the IA group. The percentages of patients with unchanged, increased, and decreased antiglaucoma ophthalmic solution use during the study period were 61.1% (55/90), 17.8% (16/90), and 3.3% (3/90), respectively, in the NIA group, and 56.8% (46/81), 8.6% (7/81), and 13.6% (11/81), respectively, in the IA group (P<.001). Internet access significantly shifted from an increasing intraocular pressure trend to a decreasing trend in the IA group (P=.002) among the patients who did not have any medication changes. Conclusions: Allowing patients to browse their medical data may reduce the use and improve the effectiveness of glaucoma medication. Trial Registration: UMIN-CTR Clinical Trial Number: UMIN000006982; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type=summary&recptno=R000008238&language=E (Archived by WebCite at http://www.webcitation.org/6MRPQeEAv). %M 24429379 %R 10.2196/jmir.2795 %U http://www.jmir.org/2014/1/e15/ %U https://doi.org/10.2196/jmir.2795 %U http://www.ncbi.nlm.nih.gov/pubmed/24429379 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e10 %T Sources of Information and Behavioral Patterns in Online Health Forums: Observational Study %A Sudau,Fabian %A Friede,Tim %A Grabowski,Jens %A Koschack,Janka %A Makedonski,Philip %A Himmel,Wolfgang %+ Institute of Computer Science, Georg-August-University Göttingen, Goldschmidtstraße 7, Göttingen, 37077, Germany, 49 551 39 172022, fabian.sudau@cs.uni-goettingen.de %K Internet utilization %K information dissemination %K data mining %K social media %K social networks %K multiple sclerosis %K CCSVI %D 2014 %7 14.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Increasing numbers of patients are raising their voice in online forums. This shift is welcome as an act of patient autonomy, reflected in the term “expert patient”. At the same time, there is considerable concern that patients can be easily misguided by pseudoscientific research and debate. Little is known about the sources of information used in health-related online forums, how users apply this information, and how they behave in such forums. Objective: The intent of the study was to identify (1) the sources of information used in online health-related forums, and (2) the roles and behavior of active forum visitors in introducing and disseminating this information. Methods: This observational study used the largest German multiple sclerosis (MS) online forum as a database, analyzing the user debate about the recently proposed and controversial Chronic Cerebrospinal Venous Insufficiency (CCSVI) hypothesis. After extracting all posts and then filtering relevant CCSVI posts between 01 January 2008 and 17 August 2012, we first identified hyperlinks to scientific publications and other information sources used or referenced in the posts. Employing k-means clustering, we then analyzed the users’ preference for sources of information and their general posting habits. Results: Of 139,912 posts from 11,997 threads, 8628 posts discussed or at least mentioned CCSVI. We detected hyperlinks pointing to CCSVI-related scientific publications in 31 posts. In contrast, 2829 different URLs were posted to the forum, most frequently referring to social media, such as YouTube or Facebook. We identified a total of 6 different roles of hyperlink posters including Social Media Fans, Organization Followers, and Balanced Source Users. Apart from the large and nonspecific residual category of the “average user”, several specific behavior patterns were identified, such as the small but relevant groups of CCSVI-Focused Responders or CCSVI Activators. Conclusions: The bulk of the observed contributions were not based on scientific results, but on various social media sources. These sources seem to contain mostly opinions and personal experience. A small group of people with distinct behavioral patterns played a core role in fuelling the discussion about CCSVI. %M 24425598 %R 10.2196/jmir.2875 %U http://www.jmir.org/2014/1/e10/ %U https://doi.org/10.2196/jmir.2875 %U http://www.ncbi.nlm.nih.gov/pubmed/24425598 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e24 %T The Influence of Two Different Invitation Letters on Chlamydia Testing Participation: Randomized Controlled Trial %A ten Hoor,Gill %A Hoebe,Christian JPA %A van Bergen,Jan EAM %A Brouwers,Elfi EHG %A Ruiter,Robert AC %A Kok,Gerjo %+ Maastricht University, Department of Work & Social Psychology, PO Box 616, Maastricht, 6200MD, Netherlands, 31 433881617, gill.tenhoor@maastrichtuniversity.nl %K invitation letter %K chlamydia %K screening %K testing %K behavior change theories %D 2014 %7 30.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: In the Netherlands, screening for chlamydia (the most prevalent sexually transmitted infection worldwide) is a relatively simple and free procedure. Via an invitation letter sent by the public health services (PHS), people are asked to visit a website to request a test kit. They can then do a chlamydia test at home, send it anonymously to a laboratory, and, within two weeks, they can review their test results online and be treated by their general practitioner or the PHS. Unfortunately, the participation rates are low and the process is believed to be not (cost-) effective. Objective: The objective of this study was to assess whether the low participation rate of screening for chlamydia at home, via an invitation letter asking to visit a website and request a test kit, could be improved by optimizing the invitation letter through systematically applied behavior change theories and evidence. Methods: The original letter and a revised letter were randomly sent out to 13,551 citizens, 16 to 29 years old, in a Dutch municipality. Using behavior change theories, the revised letter sought to increase motivation to conduct chlamydia screening tests. The revised letter was tailored to beliefs that were found in earlier studies: risk perception, advantages and disadvantages (attitude), moral norm, social influence, and response- and self-efficacy. Revisions to the new letter also sought to avoid possible unwanted resistance caused when people feel pressured, and included prompts to trigger the desired behavior. Results: No significant differences in test package requests were found between the two letters. There were also no differences between the original and revised letters in the rates of returned tests (11.80%, 581/4922 vs 11.07%, 549/4961) or positive test results (4.8%, 23/484 vs 4.1%, 19/460). It is evident that the new letter did not improve participation compared to the original letter. Conclusions: It is clear that the approach of inviting the target population through a letter does not lead to higher participation rates for chlamydia screening. Other approaches have to be developed and pilot tested. %M 24480721 %R 10.2196/jmir.2907 %U http://www.jmir.org/2014/1/e24/ %U https://doi.org/10.2196/jmir.2907 %U http://www.ncbi.nlm.nih.gov/pubmed/24480721 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e21 %T Engaging With a Wiki Related to Knowledge Translation: A Survey of WhatisKT Wiki Users %A Mathew,Deepa %A McKibbon,K Ann %A Lokker,Cynthia %A Colquhoun,Heather %+ Health Information Research Unit, Department of Clinical Epidemiology and Biostatistics, McMaster University, CRL 125, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada, 1 905 525 9140 ext 22208, lokkerc@mcmaster.ca %K knowledge translation %K wiki %K usability %D 2014 %7 21.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: In 2008, WhatisKT wiki was launched as a collaborative platform for knowledge translation (KT) researchers and stakeholders to debate the use and definitions of KT-related terms. The wiki has definitions for over 110 terms from disciplines including health care, information technology, education, accounting, and business. WhatisKT wiki has over 115 registered users. Approximately 73,000 unique visitors have visited the wiki since 2008. Despite annual increases in visitors and regular maintenance of the wiki, no visitors have contributed content or started a discussion. Objective: We surveyed wiki users to gain an understanding of the perceived value of the website, reasons for not engaging in the wiki, and suggestions to facilitate collaboration and improve the usability of the wiki. Methods: We surveyed three cohorts: KT Canada members who were previously invited to join the wiki, registered wiki members, and unregistered visitors. The first two cohorts completed a Web-based survey that included the System Usability Scale (SUS) questionnaire to assess usability; additionally 3 participants were interviewed. Unregistered wiki visitors were surveyed with polls posted on the wiki. The study received ethics approval from the McMaster University Faculty of Health Sciences Research Ethics Board. Results: Twenty-three participants completed the Web-based and SUS surveys; 15 participants indicated that they would collaborate on the wiki. The mean SUS score of 67 (95% CI 56-77) indicated that the wiki could be considered for design improvements. Study participants indicated that the wiki could be improved by email notification regarding new terms, better grouping of terms, user friendly interface, and training for users interested in editing content. Conclusions: The findings from this survey will be used to enhance the design and content of WhatisKT wiki. Further feedback from participants will be used to make the wiki an ideal collaboration platform for KT researchers interested in terminology. %M 24449712 %R 10.2196/jmir.3001 %U http://www.jmir.org/2014/1/e21/ %U https://doi.org/10.2196/jmir.3001 %U http://www.ncbi.nlm.nih.gov/pubmed/24449712 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e19 %T The Effects on Health Behavior and Health Outcomes of Internet-Based Asynchronous Communication Between Health Providers and Patients With a Chronic Condition: A Systematic Review %A de Jong,Catharina Carolina %A Ros,Wynand JG %A Schrijvers,Guus %+ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, PO Box 85500, Utrecht, 3508 GA, Netherlands, 31 623908387, c.c.dejong-8@umcutrecht.nl %K chronic disease %K telecommunications %K Internet %K telemedicine %K health services %K delivery of health care %K medical informatics %K electronic mail %K self-care %K self-efficacy %D 2014 %7 16.01.2014 %9 Review %J J Med Internet Res %G English %X Background: In support of professional practice, asynchronous communication between the patient and the provider is implemented separately or in combination with Internet-based self-management interventions. This interaction occurs primarily through electronic messaging or discussion boards. There is little evidence as to whether it is a useful tool for chronically ill patients to support their self-management and increase the effectiveness of interventions. Objective: The aim of our study was to review the use and usability of patient-provider asynchronous communication for chronically ill patients and the effects of such communication on health behavior, health outcomes, and patient satisfaction. Methods: A literature search was performed using PubMed and Embase. The quality of the articles was appraised according to the National Institute for Health and Clinical Excellence (NICE) criteria. The use and usability of the asynchronous communication was analyzed by examining the frequency of use and the number of users of the interventions with asynchronous communication, as well as of separate electronic messaging. The effectiveness of asynchronous communication was analyzed by examining effects on health behavior, health outcomes, and patient satisfaction. Results: Patients’ knowledge concerning their chronic condition increased and they seemed to appreciate being able to communicate asynchronously with their providers. They not only had specific questions but also wanted to communicate about feeling ill. A decrease in visits to the physician was shown in two studies (P=.07, P=.07). Increases in self-management/self-efficacy for patients with back pain, dyspnea, and heart failure were found. Positive health outcomes were shown in 12 studies, where the clinical outcomes for diabetic patients (HbA1c level) and for asthmatic patients (forced expiratory volume [FEV]) improved. Physical symptoms improved in five studies. Five studies generated a variety of positive psychosocial outcomes. Conclusions: The effect of asynchronous communication is not shown unequivocally in these studies. Patients seem to be interested in using email. Patients are willing to participate and are taking the initiative to discuss health issues with their providers. Additional testing of the effects of asynchronous communication on self-management in chronically ill patients is needed. %M 24434570 %R 10.2196/jmir.3000 %U http://www.jmir.org/2014/1/e19/ %U https://doi.org/10.2196/jmir.3000 %U http://www.ncbi.nlm.nih.gov/pubmed/24434570 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e3 %T Virtual Patients in Primary Care: Developing a Reusable Model That Fosters Reflective Practice and Clinical Reasoning %A Salminen,Helena %A Zary,Nabil %A Björklund,Karin %A Toth-Pal,Eva %A Leanderson,Charlotte %+ Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 12, Huddinge, 14183, Sweden, 46 8 52488701, helena.salminen@ki.se %K virtual patients %K clinical reasoning %K reflection %K primary care %K medical education %D 2014 %7 06.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Primary care is an integral part of the medical curriculum at Karolinska Institutet, Sweden. It is present at every stage of the students’ education. Virtual patients (VPs) may support learning processes and be a valuable complement in teaching communication skills, patient-centeredness, clinical reasoning, and reflective thinking. Current literature on virtual patients lacks reports on how to design and use virtual patients with a primary care perspective. Objective: The objective of this study was to create a model for a virtual patient in primary care that facilitates medical students’ reflective practice and clinical reasoning. The main research question was how to design a virtual patient model with embedded process skills suitable for primary care education. Methods: The VP model was developed using the Open Tufts University Sciences Knowledgebase (OpenTUSK) virtual patient system as a prototyping tool. Both the VP model and the case created using the developed model were validated by a group of 10 experienced primary care physicians and then further improved by a work group of faculty involved in the medical program. The students’ opinions on the VP were investigated through focus group interviews with 14 students and the results analyzed using content analysis. Results: The VP primary care model was based on a patient-centered model of consultation modified according to the Calgary-Cambridge Guides, and the learning outcomes of the study program in medicine were taken into account. The VP primary care model is based on Kolb’s learning theories and consists of several learning cycles. Each learning cycle includes a didactic inventory and then provides the student with a concrete experience (video, pictures, and other material) and preformulated feedback. The students’ learning process was visualized by requiring the students to expose their clinical reasoning and reflections in-action in every learning cycle. Content analysis of the focus group interviews showed good acceptance of the model by students. The VP was regarded as an intermediate learning activity and a complement to both the theoretical and the clinical part of the education, filling out gaps in clinical knowledge. The content of the VP case was regarded as authentic and the students appreciated the immediate feedback. The students found the structure of the model interactive and easy to follow. The students also reported that the VP case supported their self-directed learning and reflective ability. Conclusions: We have built a new VP model for primary care with embedded communication training and iterated learning cycles that in pilot testing showed good acceptance by students, supporting their self-directed learning and reflective thinking. %M 24394603 %R 10.2196/jmir.2616 %U http://www.jmir.org/2014/1/e3/ %U https://doi.org/10.2196/jmir.2616 %U http://www.ncbi.nlm.nih.gov/pubmed/24394603 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e23 %T A Framework for Different Levels of Integration of Computational Models Into Web-Based Virtual Patients %A Kononowicz,Andrzej A %A Narracott,Andrew J %A Manini,Simone %A Bayley,Martin J %A Lawford,Patricia V %A McCormack,Keith %A Zary,Nabil %+ Digital Patient Lab, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18A, Stockholm, 171 77, Sweden, 46 8 524 83626, andrzej.kononowicz@ki.se %K computer simulation %K computer-assisted instruction %K education, medical %K medical informatics applications %D 2014 %7 23.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Virtual patients are increasingly common tools used in health care education to foster learning of clinical reasoning skills. One potential way to expand their functionality is to augment virtual patients’ interactivity by enriching them with computational models of physiological and pathological processes. Objective: The primary goal of this paper was to propose a conceptual framework for the integration of computational models within virtual patients, with particular focus on (1) characteristics to be addressed while preparing the integration, (2) the extent of the integration, (3) strategies to achieve integration, and (4) methods for evaluating the feasibility of integration. An additional goal was to pilot the first investigation of changing framework variables on altering perceptions of integration. Methods: The framework was constructed using an iterative process informed by Soft System Methodology. The Virtual Physiological Human (VPH) initiative has been used as a source of new computational models. The technical challenges associated with development of virtual patients enhanced by computational models are discussed from the perspectives of a number of different stakeholders. Concrete design and evaluation steps are discussed in the context of an exemplar virtual patient employing the results of the VPH ARCH project, as well as improvements for future iterations. Results: The proposed framework consists of four main elements. The first element is a list of feasibility features characterizing the integration process from three perspectives: the computational modelling researcher, the health care educationalist, and the virtual patient system developer. The second element included three integration levels: basic, where a single set of simulation outcomes is generated for specific nodes in the activity graph; intermediate, involving pre-generation of simulation datasets over a range of input parameters; advanced, including dynamic solution of the model. The third element is the description of four integration strategies, and the last element consisted of evaluation profiles specifying the relevant feasibility features and acceptance thresholds for specific purposes. The group of experts who evaluated the virtual patient exemplar found higher integration more interesting, but at the same time they were more concerned with the validity of the result. The observed differences were not statistically significant. Conclusions: This paper outlines a framework for the integration of computational models into virtual patients. The opportunities and challenges of model exploitation are discussed from a number of user perspectives, considering different levels of model integration. The long-term aim for future research is to isolate the most crucial factors in the framework and to determine their influence on the integration outcome. %M 24463466 %R 10.2196/jmir.2593 %U http://www.jmir.org/2014/1/e23/ %U https://doi.org/10.2196/jmir.2593 %U http://www.ncbi.nlm.nih.gov/pubmed/24463466 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e12 %T Online Activity and Participation in Treatment Affects the Perceived Efficacy of Social Health Networks Among Patients With Chronic Illness %A Magnezi,Racheli %A Bergman,Yoav S %A Grosberg,Dafna %+ Department of Public Health and Health Systems Management Program, Bar Ilan University, Department of Management, Ramat Gan, 52900, Israel, 972 35317128, magnezir@biu.ac.il %K Internet %K social health network %K Patient Activation Measure (PAM) %K online health network %D 2014 %7 10.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of online health-related social networks for support, peer-to-peer connections, and obtaining health information has increased dramatically. Participation in an online health-related social network can enhance patients’ self-efficacy and empowerment, as they are given knowledge and tools to manage their chronic health condition more effectively. Thus, we can deduce that patient activation, the extent to which individuals are able to manage their own health care, also increases. However, little is known about the effects of participation in online health-related social networks and patient activation on the perceived usefulness of a website across disease groups. Objective: The intent of the study was to evaluate the effects and benefits of participation in an online health-related social network and to determine which variables predict perceived site usefulness, while examining patient activation. Methods: Data were collected from “Camoni”, the first health-related social network in the Hebrew language. It offers medical advice, including blogs, forums, support groups, internal mail, chats, and an opportunity to consult with experts. This study focused on the site’s five largest and most active communities: diabetes, heart disease, kidney disease, spinal injury, and depression/anxiety. Recruitment was conducted during a three-month period in which a link to the study questionnaire was displayed on the Camoni home page. Three questionnaires were used: a 13-item measure of perceived usefulness (Cronbach alpha=.93) to estimate the extent to which an individual found the website helpful and informative, a 9-item measure of active involvement in the website (Cronbach alpha=.84), and The Patient Activation Measure (PAM-13, Cronbach alpha=.86), which assesses a patient’s level of active participation in his or her health care. Results: There were 296 participants. Men 30-39 years of age scored higher in active involvement than those 40-49 years (P=.03), 50-64 years (P=.004), or 65+ years (P=.01). Respondents 20-29 years of age scored higher in perceived usefulness than those 50-64 years (P=.04) and those 65+ years (P=.049). Those aged 20-29 years scored significantly lower on the PAM-13 scale than those aged 30-39 years (P=.01) and 50-64 years (P=.049). Men and women had similar PAM-13 scores (F9,283=0.17, P=.76). Several variables were significant predictors of perceived usefulness. Age was a negative predictor; younger age was indicative of higher perceived usefulness. Active involvement was a positive predictor. There was a negative relationship found between PAM-13 scores and perceived usefulness, as taking a less active role in one’s own medical care predicted higher perceived website usefulness. A trend toward higher frequency of website activity was associated with increased perception of usefulness. Conclusions: Online health-related social networks can be particularly helpful to individuals with lower patient activation. Our findings add information regarding the social and medical importance of such websites, which are gradually becoming an inseparable part of day-to-day chronic disease management in the community. %M 24413148 %R 10.2196/jmir.2630 %U http://www.jmir.org/2014/1/e12/ %U https://doi.org/10.2196/jmir.2630 %U http://www.ncbi.nlm.nih.gov/pubmed/24413148 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e6 %T Keywords to Recruit Spanish- and English-Speaking Participants: Evidence From an Online Postpartum Depression Randomized Controlled Trial %A Barrera,Alinne Z %A Kelman,Alex R %A Muñoz,Ricardo F %+ Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, United States, 1 650 433 3854, abarrera@paloaltou.edu %K Internet intervention %K prevention %K depression, postpartum %K research subject recruitment %K women %K Spanish speaking %D 2014 %7 09.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: One of the advantages of Internet-based research is the ability to efficiently recruit large, diverse samples of international participants. Currently, there is a dearth of information on the behind-the-scenes process to setting up successful online recruitment tools. Objective: The objective of the study was to examine the comparative impact of Spanish- and English-language keywords for a Google AdWords campaign to recruit pregnant women to an Internet intervention and to describe the characteristics of those who enrolled in the trial. Methods: Spanish- and English-language Google AdWords campaigns were created to advertise and recruit pregnant women to a Web-based randomized controlled trial for the prevention of postpartum depression, the Mothers and Babies/Mamás y Bebés Internet Project. Search engine users who clicked on the ads in response to keyword queries (eg, pregnancy, depression and pregnancy) were directed to the fully automated study website. Data on the performance of keywords associated with each Google ad reflect Web user queries from February 2009 to June 2012. Demographic information, self-reported depression symptom scores, major depressive episode status, and Internet use data were collected from enrolled participants before randomization in the intervention study. Results: The Google ads received high exposure (12,983,196 impressions) and interest (176,295 clicks) from a global sample of Web users; 6745 pregnant women consented to participate and 2575 completed enrollment in the intervention study. Keywords that were descriptive of pregnancy and distress or pregnancy and health resulted in higher consent and enrollment rates (ie, high-performing ads). In both languages, broad keywords (eg, pregnancy) had the highest exposure, more consented participants, and greatest cost per consent (up to US $25.77 per consent). The online ads recruited a predominantly Spanish-speaking sample from Latin America of Mestizo racial identity. The English-speaking sample was also diverse with most participants residing in regions of Asia and Africa. Spanish-speaking participants were significantly more likely to be of Latino ethnic background, not married, completed fewer years of formal education, and were more likely to have accessed the Internet for depression information (P<.001). Conclusions: The Internet is an effective method for reaching an international sample of pregnant women interested in online interventions to manage changes in their mood during the perinatal period. To increase efficiency, Internet advertisements need to be monitored and tailored to reflect the target population’s conceptualization of health issues being studied. Trial Registration: ClinicalTrials.gov NCT00816725; http://clinicaltrials.gov/show/NCT00816725 (Archived by WebCite at http://www.webcitation.org/6LumonjZP). %M 24407163 %R 10.2196/jmir.2999 %U http://www.jmir.org/2014/1/e6/ %U https://doi.org/10.2196/jmir.2999 %U http://www.ncbi.nlm.nih.gov/pubmed/24407163 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e18 %T Using Google AdWords for International Multilingual Recruitment to Health Research Websites %A Gross,Margaret S %A Liu,Nancy H %A Contreras,Omar %A Muñoz,Ricardo F %A Leykin,Yan %+ University of California, 3333 California St, Suite 465, San Francisco, CA, 94143, United States, 1 415 476 8799, yan.leykin@ucsf.edu %K Internet recruitment %K multinational %K online %K Internet research %K recruitment costs %D 2014 %7 20.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Google AdWords, the placement of sponsored links in Google search results, is a potent method of recruitment to Internet-based health studies and interventions. However, the performance of Google AdWords varies considerably depending on the language and the location of the target audience. Objective: Our goal was to describe differences in AdWords performance when recruiting participants to the same study conducted in four languages and to determine whether AdWords campaigns can be optimized in order to increase recruitment while decreasing costs. Methods: Google AdWords were used to recruit participants to the Mood Screener, a multilingual online depression screening tool available in English, Russian, Spanish, and Chinese. Two distinct recruitment periods are described: (1) “Unmanaged”, a 6-month period in which ads were allowed to run using only the AdWords tool itself, with no human intervention, and (2) “Managed”, a separate 7-week period during which we systematically sought to optimize our recruitment campaigns. Results: During 6 months of unmanaged recruitment, our ads were shown over 1.3 million times, resulting in over 60,000 site visits. The average click-through rate (ratio of ads clicked to ads displayed) varied from 1.86% for Chinese ads to 8.48% for Russian ads, as did the average cost-per-click (from US $0.20 for Chinese ads to US $0.50 for English ads). Although Chinese speakers’ click-through rate was lowest, their rate of consenting to participate was the highest, at 3.62%, with English speakers exhibiting the lowest consent rate (0.97%). The conversion cost (cost to recruit a consenting participant) varied from US $10.80 for Russian speakers to US $51.88 for English speakers. During the 7 weeks of “managed” recruitment, we attempted to improve AdWords’ performance in regards to the consent rate and cost by systematically deleting underperforming ads and adjusting keywords. We were able to increase the number of people who consent after coming to the site by 91.8% while also decreasing per-consent cost by 23.3%. Conclusions: Our results illustrate the need to linguistically and culturally adapt Google AdWords campaigns and to manage them carefully to ensure the most cost-effective results. %M 24446166 %R 10.2196/jmir.2986 %U http://www.jmir.org/2014/1/e18/ %U https://doi.org/10.2196/jmir.2986 %U http://www.ncbi.nlm.nih.gov/pubmed/24446166 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 1 %P e27 %T Understanding the Usage of Content in a Mental Health Intervention for Depression: An Analysis of Log Data %A Van Gemert-Pijnen,Julia EWC %A Kelders,Saskia M %A Bohlmeijer,Ernst T %+ University of Twente, Department of Psychology, Health and Technology, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 534896050, j.vangemert-pijnen@utwente.nl %K mental health %K depression %K Web-based intervention %K acceptance commitment therapy %D 2014 %7 31.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based interventions for the early treatment of depressive symptoms can be considered effective in reducing mental complaints. However, there is a limited understanding of which elements in an intervention contribute to effectiveness. For efficiency and effectiveness of interventions, insight is needed into the use of content and persuasive features. Objective: The aims of this study were (1) to illustrate how log data can be used to understand the uptake of the content of a Web-based intervention that is based on the acceptance and commitment therapy (ACT) and (2) to discover how log data can be of value for improving the incorporation of content in Web-based interventions. Methods: Data from 206 participants (out of the 239) who started the first nine lessons of the Web-based intervention, Living to the Full, were used for a secondary analysis of a subset of the log data of the parent study about adherence to the intervention. The log files used in this study were per lesson: login, start mindfulness, download mindfulness, view success story, view feedback message, start multimedia, turn on text-message coach, turn off text-message coach, and view text message. Differences in usage between lessons were explored with repeated measures ANOVAs (analysis of variance). Differences between groups were explored with one-way ANOVAs. To explore the possible predictive value of the login per lesson quartiles on the outcome measures, four linear regressions were used with login quartiles as predictor and with the outcome measures (Center for Epidemiologic Studies—Depression [CES-D] and the Hospital Anxiety and Depression Scale—Anxiety [HADS-A] on post-intervention and follow-up) as dependent variables. Results: A significant decrease in logins and in the use of content and persuasive features over time was observed. The usage of features varied significantly during the treatment process. The usage of persuasive features increased during the third part of the ACT (commitment to value-based living), which might indicate that at that stage motivational support was relevant. Higher logins over time (9 weeks) corresponded with a higher usage of features (in most cases significant); when predicting depressive symptoms at post-intervention, the linear regression yielded a significant model with login quartile as a significant predictor (explained variance is 2.7%). Conclusions: A better integration of content and persuasive features in the design of the intervention and a better intra-usability of features within the system are needed to identify which combination of features works best for whom. Pattern recognition can be used to tailor the intervention based on usage patterns from the earlier lessons and to support the uptake of content essential for therapy. An adaptable interface for a modular composition of therapy features supposes a dynamic approach for Web-based treatment; not a predefined path for all, but a flexible way to go through all features that have to be used. %M 24486914 %R 10.2196/jmir.2991 %U http://www.jmir.org/2014/1/e27/ %U https://doi.org/10.2196/jmir.2991 %U http://www.ncbi.nlm.nih.gov/pubmed/24486914 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e39 %T Title Correction: Sources of Information and Behavioral Patterns in Online Health Forums: Observational Study %A Sudau,Fabian %A Friede,Tim %A Grabowski,Jens %A Koschack,Janka %A Makedonski,Philip %A Himmel,Wolfgang %+ Institute of Computer Science, Georg-August-University Göttingen, Goldschmidtstraße 7, Göttingen, 37077, Germany, 49 551 39 17202, fabian.sudau@cs.uni-goettingen.de %D 2014 %7 31.01.2014 %9 Corrigenda and Addenda %J J Med Internet Res %G English %X %M 30583454 %R 10.2196/jmir.3280 %U http://www.jmir.org/2014/1/e39/ %U https://doi.org/10.2196/jmir.3280 %U http://www.ncbi.nlm.nih.gov/pubmed/30583454