%0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e203 %T A Web-Based Sexual Violence Bystander Intervention for Male College Students: Randomized Controlled Trial %A Salazar,Laura F %A Vivolo-Kantor,Alana %A Hardin,James %A Berkowitz,Alan %+ Georgia State University, School of Public Health, PO Box 3984, Atlanta, GA, 30302-3984, United States, 1 404 413 1396, lsalazar1@gsu.edu %K Internet %K sex offenses %K rape %K universities %K students %K public health %D 2014 %7 05.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Bystander intervention approaches offer promise for reducing rates of sexual violence on college campuses. Most interventions are in-person small-group formats, which limit their reach and reduce their overall public health impact. Objective: This study evaluated the efficacy of RealConsent, a Web-based bystander approach to sexual violence prevention, in enhancing prosocial intervening behaviors and preventing sexual violence perpetration. Methods: A random probability sample of 743 male undergraduate students (aged 18 to 24 years) attending a large, urban university located in the southeastern United States was recruited online and randomized to either RealConsent (n=376) or a Web-based general health promotion program (n=367). Participants were surveyed online at baseline, postintervention, and 6-months postintervention. RealConsent was delivered via a password-protected Web portal that contained six 30-minute media-based and interactive modules covering knowledge of informed consent, communication skills regarding sex, the role of alcohol and male socialization in sexual violence, empathy for rape victims, and bystander education. Primary outcomes were self-reported prosocial intervening behaviors and sexual violence perpetration. Secondary outcomes were theoretical mediators (eg, knowledge, attitudes). Results: At 6-month follow-up RealConsent participants intervened more often (P=.04) and engaged in less sexual violence perpetration (P=.04) compared to controls. In addition, RealConsent participants reported greater legal knowledge of sexual assault (P<.001), greater knowledge of effective consent (P<.001), less rape myths (P<.001), greater empathy for rape victims (P<.001), less negative date rape attitudes (P<.001), less hostility toward women (P=.01), greater intentions to intervene (P=.04), less hyper-gender ideology (P<.001), less positive outcome expectancies for nonconsensual sex (P=.03), more positive outcome expectancies for intervening (P<.001), and less comfort with other men’s inappropriate behaviors (P<.001). Conclusions: Our results support the efficacy of RealConsent. Due to its Web-based format, RealConsent has potential for broad-based dissemination thereby increasing its overall public health impact on sexual violence. Trial Registration: Clinicaltrials.gov: NCT01903876; http://clinicaltrials.gov/show/NCT01903876 (Archived by WebCite at http://www.webcitation.org/6S1PXxWKt). %M 25198417 %R 10.2196/jmir.3426 %U http://www.jmir.org/2014/9/e203/ %U https://doi.org/10.2196/jmir.3426 %U http://www.ncbi.nlm.nih.gov/pubmed/25198417 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e205 %T Facebook Apps for Smoking Cessation: A Review of Content and Adherence to Evidence-Based Guidelines %A Jacobs,Megan A %A Cobb,Caroline O %A Abroms,Lorien %A Graham,Amanda L %+ Schroeder Institute for Tobacco Research and Policy Studies, Legacy, 1724 Massachusetts Avenue, NW, Washington, DC, 20036, United States, 1 202 454 5753, mjacobs@legacyforhealth.org %K Facebook %K smoking cessation/methods %K social media %K apps %D 2014 %7 09.09.2014 %9 Short Paper %J J Med Internet Res %G English %X Background: Facebook is the most popular social network site, with over 1 billion users globally. There are millions of apps available within Facebook, many of which address health and health behavior change. Facebook may represent a promising channel to reach smokers with cessation interventions via apps. To date, there have been no published reports about Facebook apps for smoking cessation. Objective: The purpose of this study was to review the features and functionality of Facebook apps for smoking cessation and to determine the extent to which they adhere to evidence-based guidelines for tobacco dependence treatment. Methods: In August 2013, we searched Facebook and three top Internet search engines using smoking cessation keywords to identify relevant Facebook apps. Resultant apps were screened for eligibility (smoking cessation-related, English language, and functioning). Eligible apps were reviewed by 2 independent coders using a standardized coding scheme. Coding included content features (interactive, informational, and social) and adherence to an established 20-item index (possible score 0-40) derived from the US Public Health Service’s Clinical Practice Guidelines for Treating Tobacco Use and Dependence. Results: We screened 22 apps for eligibility; of these, 12 underwent full coding. Only 9 apps were available on Facebook. Facebook apps fell into three broad categories: public pledge to quit (n=3), quit-date–based calculator/tracker (n=4), or a multicomponent quit smoking program (n=2). All apps incorporated interactive, informational, and social features except for two quit-date–based calculator/trackers apps (lacked informational component). All apps allowed app-related posting within Facebook (ie, on self/other Facebook profile), and four had a within-app “community” feature to enable app users to communicate with each other. Adherence index summary scores among Facebook apps were low overall (mean 15.1, SD 7.8, range 7-30), with multicomponent apps scoring the highest. Conclusions: There are few smoking cessation apps available within Facebook. Among those available, adherence to cessation treatment guidelines was low. Smoking cessation interventions provided via the Facebook platform are a unique and as yet untapped treatment strategy that can harness existing social support and social networks for quitting. Research is needed to examine whether apps that adhere to clinical practice guidelines for tobacco dependence treatment are more effective in promoting cessation than those that do not. %M 25205129 %R 10.2196/jmir.3491 %U http://www.jmir.org/2014/9/e205/ %U https://doi.org/10.2196/jmir.3491 %U http://www.ncbi.nlm.nih.gov/pubmed/25205129 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e208 %T Norwegian General Practitioners’ Perspectives on Implementation of a Guided Web-Based Cognitive Behavioral Therapy for Depression: A Qualitative Study %A Wilhelmsen,Maja %A Høifødt,Ragnhild Sørensen %A Kolstrup,Nils %A Waterloo,Knut %A Eisemann,Martin %A Chenhall,Richard %A Risør,Mette Bech %+ Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Breivika, Tromsø, 9037, Norway, 47 99001559, maja.wilhelmsen@uit.no %K mental health %K Internet %K telemedicine %K qualitative research %K primary health care %K cognitive therapy %K depression %D 2014 %7 10.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous research suggests that Internet-based cognitive behavioral therapy (ICBT) has a positive effect on symptoms of depression. ICBT appears to be more effective with therapist support, but it is unclear what this support should comprise. General practitioners (GPs) have positive attitudes toward ICBT. However, ICBT is rarely used in regular care in general practice. More research is warranted to integrate the potential of ICBT as part of regular care. Objective: The aim of this study was to explore aspects perceived by GPs to affect the implementation of guided ICBT in daily practice. Understanding their perspectives may contribute to improving the treatment of depression in the context of general practice. Methods: A training package (3-day course) introducing a Norwegian translation of the ICBT program MoodGYM was developed and presented to GPs in Norway. Following training, GPs were asked to include guided ICBT in their regular care of patients with symptoms of depression by providing brief, face-to-face follow-up consultations between modules. We interviewed 11 GPs who had taken the course. Our interview guide comprised open questions that encouraged GPs to frame their responses using examples from their experiences when implementing ICBT. Thematic analysis was chosen to explore patterns across the data. Results: An overall belief that ICBT would benefit both the patients’ health and the GPs’ own work satisfaction prompted the GPs to take the ICBT course. ICBT motivated them to invest time and effort in improving treatment. The most important motivating aspects in MoodGYM were that a program based on cognitive behavioral therapy could add a structured agenda to their consultations and empower depressed patients. Organizational aspects, such as a lack of time and varied practice, inhibited the use of ICBT. Inadequate knowledge, recalling the program, and changing own habits were also challenging. The GPs were ambivalent about whether ICBT had a negative impact on the doctor–patient interaction in the module follow-ups. Generally, GPs made an effort to recommend MoodGYM, but the expected module follow-ups were often not provided to patients and instead the GPs returned to standard treatment. Conclusions: GPs’ feedback in the present study contribute to our understanding of the challenges of changing treatment for depression. Our findings indicated that recommending ICBT could add to the GP’s toolkit. Offering training and highlighting the following aspects may increase recommendation of ICBT by GPs: (1) ICBT is theory-based and credible, (2) ICBT increases the GPs’ work satisfaction by having a tool to offer, and (3) ICBT facilitates empowerment of patients in their own health. In addition, the present study also indicated that complex aspects must be accommodated before module follow-ups can be incorporated into GPs’ treatment of depression. %M 25208886 %R 10.2196/jmir.3556 %U http://www.jmir.org/2014/9/e208/ %U https://doi.org/10.2196/jmir.3556 %U http://www.ncbi.nlm.nih.gov/pubmed/25208886 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e186 %T A Web-Based Program Improves Physical Activity Outcomes in a Primary Care Angina Population: Randomized Controlled Trial %A Devi,Reena %A Powell,John %A Singh,Sally %+ Coventry University, Applied Research Centre in Health and Lifestyle Interventions, Priory Street, Coventry, CV1 5FB, United Kingdom, 44 24 7688 7688, reena.devi@coventry.ac.uk %K stable angina %K cardiac rehabilitation %K Web-based interventions %K secondary prevention %K primary health care %K physical activity %D 2014 %7 12.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Angina affects more than 50 million people worldwide. Secondary prevention interventions such as cardiac rehabilitation are not widely available for this population. An Internet-based version could offer a feasible alternative. Objective: Our aim was to examine the effectiveness of a Web-based cardiac rehabilitation program for those with angina. Methods: We conducted a randomized controlled trial, recruiting those diagnosed with angina from general practitioners (GPs) in primary care to an intervention or control group. Intervention group participants were offered a 6-week Web-based rehabilitation program (“ActivateYourHeart”). The program was introduced during a face-to-face appointment and then delivered via the Internet (no further face-to-face contact). The program contained information about the secondary prevention of coronary heart disease (CHD) and set each user goals around physical activity, diet, managing emotions, and smoking. Performance against goals was reviewed throughout the program and goals were then reset/modified. Participants completed an online exercise diary and communicated with rehabilitation specialists through an email link/synchronized chat room. Participants in the control group continued with GP treatment as usual, which consisted of being placed on a CHD register and attending an annual review. Outcomes were measured at 6-week and 6-month follow-ups during face-to-face assessments. The primary outcome measure was change in daily steps at 6 weeks, measured using an accelerometer. Secondary outcome measures were energy expenditure (EE), duration of sedentary activity (DSA), duration of moderate activity (DMA), weight, diastolic/systolic blood pressure, and body fat percentage. Self-assessed questionnaire outcomes included fat/fiber intake, anxiety/depression, self-efficacy, and quality of life (QOL). Results: A total of 94 participants were recruited and randomized to the intervention (n=48) or the usual care (n=46) group; 84 and 73 participants completed the 6-week and 6-month follow-ups, respectively. The mean number of log-ins to the program was 18.68 (SD 13.13, range 1-51), an average of 3 log-ins per week per participant. Change in daily steps walked at the 6-week follow-up was +497 (SD 2171) in the intervention group and –861 (SD 2534) in the control group (95% CI 263-2451, P=.02). Significant intervention effects were observed at the 6-week follow-up in EE (+43.94 kcal, 95% CI 43.93-309.98, P=.01), DSA (–7.79 minutes, 95% CI –55.01 to –7.01, P=.01), DMA (+6.31 minutes, 95% CI 6.01-51.20, P=.01), weight (–0.56 kg, 95% CI –1.78 to –0.15, P=.02), self-efficacy (95% CI 0.30-4.79, P=.03), emotional QOL score (95% CI 0.01-0.54, P=.04), and angina frequency (95% CI 8.57-35.05, P=.002). Significant benefits in angina frequency (95% CI 1.89-29.41, P=.02) and social QOL score (95% CI 0.05-0.54, P=.02) were also observed at the 6-month follow-up. Conclusions: An Internet-based secondary prevention intervention could be offered to those with angina. A larger pragmatic trial is required to provide definitive evidence of effectiveness and cost-effectiveness. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 90110503; http://www.controlled-trials.com/ISRCTN90110503/ISRCTN90110503 (Archived by WebCite at http://www.webcitation.org/6RYVOQFKM). %M 25217464 %R 10.2196/jmir.3340 %U http://www.jmir.org/2014/9/e186/ %U https://doi.org/10.2196/jmir.3340 %U http://www.ncbi.nlm.nih.gov/pubmed/25217464 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e209 %T Web-Based Intervention Programs for Depression: A Scoping Review and Evaluation %A Renton,Tian %A Tang,Herman %A Ennis,Naomi %A Cusimano,Michael D %A Bhalerao,Shree %A Schweizer,Tom A %A Topolovec-Vranic,Jane %+ Trauma and Neurosurgery Program, St Michael's Hospital, Bond 3-012, 30 Bond Street, Toronto, ON, M5B 1W8, Canada, 1 416 864 6060 ext 3421, topolovec-vranicj@smh.ca %K depression %K Web-based interventions %K interactive treatment %K health care access %K mental health %K technology %D 2014 %7 23.09.2014 %9 Review %J J Med Internet Res %G English %X Background: Although depression is known to affect millions of people worldwide, individuals seeking aid from qualified health care professionals are faced with a number of barriers to treatment including a lack of treatment resources, limited number of qualified service providers, stigma associated with diagnosis and treatment, prolonged wait times, cost, and barriers to accessibility such as transportation and clinic locations. The delivery of depression interventions through the Internet may provide a practical solution to addressing some of these barriers. Objective: The purpose of this scoping review was to answer the following questions: (1) What Web-delivered programs are currently available that offer an interactive treatment component for depression?, (2) What are the contents, accessibility, and usability of each identified program?, and (3) What tools, supports, and research evidence are available for each identified program? Methods: Using the popular search engines Google, Yahoo, and Bing (Canadian platforms), two reviewers independently searched for interactive Web-based interventions targeting the treatment of depression. The Beacon website, an information portal for online health applications, was also consulted. For each identified program, accessibility, usability, tools, support, and research evidence were evaluated and programs were categorized as evidence-based versus non-evidence-based if they had been the subject of at least one randomized controlled trial. Programs were scored using a 28-point rating system, and evidence- versus non-evidence-based programs were compared and contrasted. Although this review included all programs meeting exclusion and inclusion criteria found using the described search method, only English language Web-delivered depression programs were awarded an evaluation score. Results: The review identified 32 programs meeting inclusion criteria. There was a great deal of variability among the programs captured in this evaluation. Many of the programs were developed for general adolescent or adult audiences, with few (n=2) focusing on special populations (eg, military personnel, older adults). Cognitive behavioral therapy was the most common therapeutic approach used in the programs described. Program interactive components included mood assessments and supplementary homework sheets such as activity planning and goal setting. Only 12 of the programs had published evidence in support of their efficacy and treatment of depressive symptoms. Conclusions: There are a number of interactive depression interventions available through the Internet. Recommendations for future programs, or the adaptation of existing programs include offering a greater selection of alternative languages, removing registration restrictions, free trial periods for programs requiring user fees, and amending programs to meet the needs of special populations (eg, those with cognitive and/or visual impairments). Furthermore, discussion of specific and relevant topics to the target audience while also enhancing overall user control would contribute to a more accessible intervention tool. %M 25249003 %R 10.2196/jmir.3147 %U http://www.jmir.org/2014/9/e209/ %U https://doi.org/10.2196/jmir.3147 %U http://www.ncbi.nlm.nih.gov/pubmed/25249003 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e218 %T Effects of a Guided Web-Based Smoking Cessation Program With Telephone Counseling: A Cluster Randomized Controlled Trial %A Mehring,Michael %A Haag,Max %A Linde,Klaus %A Wagenpfeil,Stefan %A Schneider,Antonius %+ Institute of General Practice, Klinikum rechts der Isar, Technische Universität München, Orleansstr. 47, Munich, 81667, Germany, 49 614658914, michael.mehring@tum.de %K smoking cessation %K Web-based %K randomized controlled trial %K primary care %D 2014 %7 24.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Preliminary findings suggest that Web-based interventions may be effective in achieving significant smoking cessation. To date, very few findings are available for primary care patients, and especially for the involvement of general practitioners. Objective: Our goal was to examine the short-term effectiveness of a fully automated Web-based coaching program in combination with accompanied telephone counseling in smoking cessation in a primary care setting. Methods: The study was an unblinded cluster-randomized trial with an observation period of 12 weeks. Individuals recruited by general practitioners randomized to the intervention group participated in a Web-based coaching program based on education, motivation, exercise guidance, daily short message service (SMS) reminding, weekly feedback through Internet, and active monitoring by general practitioners. All components of the program are fully automated. Participants in the control group received usual care and advice from their practitioner without the Web-based coaching program. The main outcome was the biochemically confirmed smoking status after 12 weeks. Results: We recruited 168 participants (86 intervention group, 82 control group) into the study. For 51 participants from the intervention group and 70 participants from the control group, follow-up data were available both at baseline and 12 weeks. Very few patients (9.8%, 5/51) from the intervention group and from the control group (8.6%, 6/70) successfully managed smoking cessation (OR 0.86, 95% CI 0.25-3.0; P=.816). Similar results were found within the intent-to-treat analysis: 5.8% (5/86) of the intervention group and 7.3% (6/82) of the control group (OR 1.28, 95% CI 0.38-4.36; P=.694). The number of smoked cigarettes per day decreased on average by 9.3 in the intervention group and by 6.6 in the control group (2.7 mean difference; 95% CI -5.33 to -0.58; P=.045). After adjustment for the baseline value, age, gender, and height, this significance decreases (mean difference 2.2; 95% CI -4.7 to 0.3; P=.080). Conclusions: This trial did not show that the tested Web-based intervention was effective for achieving smoking cessation compared to usual care. The limited statistical power and the high drop-out rate may have reduced the study’s ability to detect significant differences between the groups. Further randomized controlled trials are needed in larger populations and to investigate the long-term outcome. Trial Registration: German Register for Clinical Trials, registration number DRKS00003067; http://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ ID=DRKS00003067 (Archived by WebCite at http://www.webcitation.org/6Sff1YZpx). %M 25253539 %R 10.2196/jmir.3536 %U http://www.jmir.org/2014/9/e218/ %U https://doi.org/10.2196/jmir.3536 %U http://www.ncbi.nlm.nih.gov/pubmed/25253539 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e226 %T Short-Term Effectiveness of Web-Based Guided Self-Help for Phobic Outpatients: Randomized Controlled Trial %A Kok,Robin N %A van Straten,Annemieke %A Beekman,Aartjan T F %A Cuijpers,Pim %+ Department of Clinical Psychology and the EMGO institute for Health and Care Research, VU University Amsterdam, van der Boechorststraat 1, Amsterdam, 1081 BT, Netherlands, 31 205983833, r.n.kok@vu.nl %K phobias %K phobic disorders %K anxiety disorders %K Web-based intervention %K Internet therapy %K randomized controlled trial %K outpatients %D 2014 %7 29.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based guided self-help has been successfully used in the general population, but it is unknown whether this method can be effectively used in outpatient clinics for patients waiting for face-to-face psychotherapy for phobias. Objective: The aim was to assess the clinical effectiveness of Phobias Under Control, an Internet-based intervention based on exposure therapy with weekly guidance. Methods: We conducted a randomized controlled trial, recruiting 212 outpatients scheduled to receive face-to-face psychotherapy for any type of phobia at an outpatient clinic. Participants suffering from at least 1 DSM-IV or ICD-10 classified phobia (social phobia, agoraphobia with or without panic disorder, and/or specific phobia as ascertained by a telephone interview at baseline) were randomly allocated to either a 5-week Internet-based guided self-help program based on exposure therapy with weekly student support followed by face-to-face psychotherapy (n=105) or a wait-list control group followed by face-to-face psychotherapy (n=107). Primary outcome was the Fear Questionnaire (FQ). Secondary outcomes were the Beck Anxiety Inventory (BAI) and Center of Epidemiological Studies-Depression scale (CES-D). Assessments took place by telephone at baseline (T0) and on the Internet at posttest (T1, self-assessment at 5 weeks after baseline). Missing data at T1 were imputed. Results: At posttest, analysis of covariance on the intention-to-treat sample showed significant but small effect sizes between intervention and control groups on the FQ (d=0.35, P=.02), CES-D (d=0.34, P=.03), and a nonsignificant effect size on the BAI (d=0.28. P=.05). Although initial acceptance was good, high nonresponse was observed, with 86 of 212 participants (40.5%) lost to follow-up at T1 and only 14 of 105 (13.3%) intervention participants finishing all 5 weeks. Conclusions: Phobias Under Control is modestly effective in lowering phobic and depressive symptoms in a relatively short period and may be clinically beneficial when implemented in routine outpatient practice. Trial Registration: Netherlands Trial Register NTR2233; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2233 (Archived by WebCite at http://www.webcitation.org/6O2ioOQSs). %M 25266929 %R 10.2196/jmir.3429 %U http://www.jmir.org/2014/9/e226/ %U https://doi.org/10.2196/jmir.3429 %U http://www.ncbi.nlm.nih.gov/pubmed/25266929 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e210 %T mHealth and Mobile Medical Apps: A Framework to Assess Risk and Promote Safer Use %A Lewis,Thomas Lorchan %A Wyatt,Jeremy C %+ Warwick Medical School, University of Warwick, Medical Teaching Centre, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom, 44 7876453511, tlewis@doctors.org.uk %K risk assessment %K medical app %K mobile health %K mobile phone %K patient safety %K smartphone %K mHealth %K medical informatics applications %D 2014 %7 15.09.2014 %9 Viewpoint %J J Med Internet Res %G English %X The use of mobile medical apps by clinicians and others has grown considerably since the introduction of mobile phones. Medical apps offer clinicians the ability to access medical knowledge and patient data at the point of care, but several studies have highlighted apps that could compromise patient safety and are potentially dangerous. This article identifies a range of different kinds of risks that medical apps can contribute to and important contextual variables that can modify these risks. We have also developed a simple generic risk framework that app users, developers, and other stakeholders can use to assess the likely risks posed by a specific app in a specific context. This should help app commissioners, developers, and users to manage risks and improve patient safety. %M 25223398 %R 10.2196/jmir.3133 %U http://www.jmir.org/2014/9/e210/ %U https://doi.org/10.2196/jmir.3133 %U http://www.ncbi.nlm.nih.gov/pubmed/25223398 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e216 %T Crowdsourcing Knowledge Discovery and Innovations in Medicine %A Celi,Leo Anthony %A Ippolito,Andrea %A Montgomery,Robert A %A Moses,Christopher %A Stone,David J %+ Institute for Medical Engineering and Science, Laboratory of Computational Physiology, Massachusetts Institute of Technology, 77 Massachusetts Avenue, E25-505, Cambridge, MA, 02139, United States, 1 617 253 7937, lceli@mit.edu %K knowledge discovery %K crowdsourcing %K innovation %K hackathon %D 2014 %7 19.09.2014 %9 Viewpoint %J J Med Internet Res %G English %X Clinicians face difficult treatment decisions in contexts that are not well addressed by available evidence as formulated based on research. The digitization of medicine provides an opportunity for clinicians to collaborate with researchers and data scientists on solutions to previously ambiguous and seemingly insolvable questions. But these groups tend to work in isolated environments, and do not communicate or interact effectively. Clinicians are typically buried in the weeds and exigencies of daily practice such that they do not recognize or act on ways to improve knowledge discovery. Researchers may not be able to identify the gaps in clinical knowledge. For data scientists, the main challenge is discerning what is relevant in a domain that is both unfamiliar and complex. Each type of domain expert can contribute skills unavailable to the other groups. “Health hackathons” and “data marathons”, in which diverse participants work together, can leverage the current ready availability of digital data to discover new knowledge. Utilizing the complementary skills and expertise of these talented, but functionally divided groups, innovations are formulated at the systems level. As a result, the knowledge discovery process is simultaneously democratized and improved, real problems are solved, cross-disciplinary collaboration is supported, and innovations are enabled. %M 25239002 %R 10.2196/jmir.3761 %U http://www.jmir.org/2014/9/e216/ %U https://doi.org/10.2196/jmir.3761 %U http://www.ncbi.nlm.nih.gov/pubmed/25239002 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e199 %T Prevention of Generalized Anxiety Disorder Using a Web Intervention, iChill: Randomized Controlled Trial %A Christensen,Helen %A Batterham,Philip %A Mackinnon,Andrew %A Griffiths,Kathleen M %A Kalia Hehir,Kanupriya %A Kenardy,Justin %A Gosling,John %A Bennett,Kylie %+ Black Dog Institute, University of New South Wales, Hospital Road, Prince of Wales Hospital, Randwick, Sydney, 2031, Australia, 61 293829288, h.christensen@blackdog.org.au %K anxiety disorders %K prevention %K early intervention %K Internet %K online systems %K cognitive behavioral therapy %D 2014 %7 02.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Generalized Anxiety Disorder (GAD) is a high prevalence, chronic disorder. Web-based interventions are acceptable, engaging, and can be delivered at scale. Few randomized controlled trials evaluate the effectiveness of prevention programs for anxiety, or the factors that improve effectiveness and engagement. Objective: The intent of the study was to evaluate the effectiveness of a Web-based program in preventing GAD symptoms in young adults, and to determine the role of telephone and email reminders. Methods: A 5-arm randomized controlled trial with 558 Internet users in the community, recruited via the Australian Electoral Roll, was conducted with 6- and 12-month follow-up. Five interventions were offered over a 10-week period. Group 1 (Active website) received a combined intervention of psycho-education, Internet-delivered Cognitive Behavioral Therapy (ICBT) for anxiety, physical activity promotion, and relaxation. Group 2 (Active website with telephone) received the identical Web program plus weekly telephone reminder calls. Group 3 (Active website with email) received the identical Web program plus weekly email reminders. Group 4 (Control) received a placebo website. Group 5 (Control with telephone) received the placebo website plus telephone calls. Main outcome measures were severity of anxiety symptoms as measured by the GAD 7-item scale (GAD-7) (at post-test, 6, and 12 months). Secondary measures were GAD caseness, measured by the Mini International Neuropsychiatric Interview (MINI) at 6 months, Centre for Epidemiologic Studies-Depression scale (CES-D), Anxiety Sensitivity Index (ASI), Penn State Worry Questionnaire (PSWQ), and Days out of Role. Results: GAD-7 symptoms reduced over post-test, 6-month, and 12-month follow-up. There were no significant differences between Group 4 (Control) and Groups 1 (Active website), 2 (Active website with telephone), 3 (Active website with email), or 5 (Control with telephone) at any follow-up. A total of 16 cases of GAD were identified at 6 months, comprising 6.7% (11/165) from the Active groups (1, 2, 3) and 4.5% (5/110) from the Control groups (4, 5), a difference that was not significant. CES-D, ASI, and PSWQ scores were significantly lower for the active website with email reminders at post-test, relative to the control website condition. Conclusions: Indicated prevention of GAD was not effective in reducing anxiety levels, measured by GAD-7. There were significant secondary effects for anxiety sensitivity, worry, and depression. Challenges for indicated prevention trials are discussed. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 76298775; http://www.controlled-trials.com/ISRCTN76298775 (Archived by WebCite at http://www.webcitation.org/6S9aB5MAq). %M 25270886 %R 10.2196/jmir.3507 %U http://www.jmir.org/2014/9/e199/ %U https://doi.org/10.2196/jmir.3507 %U http://www.ncbi.nlm.nih.gov/pubmed/25270886 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e206 %T Online and Social Networking Interventions for the Treatment of Depression in Young People: A Systematic Review %A Rice,Simon M %A Goodall,Joanne %A Hetrick,Sarah E %A Parker,Alexandra G %A Gilbertson,Tamsyn %A Amminger,G. Paul %A Davey,Christopher G %A McGorry,Patrick D %A Gleeson,John %A Alvarez-Jimenez,Mario %+ Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Rd, Parkville, Melbourne, 3052, Australia, 61 419497599, simon.rice@unimelb.edu.au %K Internet %K depression %K young adult %K adolescent %K social networking %K support groups %K review %D 2014 %7 16.09.2014 %9 Review %J J Med Internet Res %G English %X Background: Major depression accounts for the greatest burden of all diseases globally. The peak onset of depression occurs between adolescence and young adulthood, and for many individuals, depression displays a relapse-remitting and increasingly severe course. Given this, the development of cost-effective, acceptable, and population-focused interventions for depression is critical. A number of online interventions (both prevention and acute phase) have been tested in young people with promising results. As these interventions differ in content, clinician input, and modality, it is important to identify key features (or unhelpful functions) associated with treatment outcomes. Objective: A systematic review of the research literature was undertaken. The review was designed to focus on two aspects of online intervention: (1) standard approaches evaluating online intervention content in randomized controlled designs (Section 1), and (2) second-generation online interventions and services using social networking (eg, social networking sites and online support groups) in any type of research design (Section 2). Methods: Two specific literature searches were undertaken. There was no date range specified. The Section 1 search, which focused on randomized controlled trials, included only young people (12-25 years) and yielded 101 study abstracts, of which 15 met the review inclusion criteria. The Section 2 search, which included all study design types and was not restricted in terms of age, yielded 358 abstracts, of which 22 studies met the inclusion criteria. Information about the studies and their findings were extracted and tabulated for review. Results: The 15 studies identified in Section 1 described 10 trials testing eight different online interventions, all of which were based on a cognitive behavioral framework. All but one of the eight identified studies reported positive results; however, only five of the 15 studies used blinded interviewer administered outcomes with most trials using self-report data. Studies varied significantly in presentation of intervention content, treatment dose, and dropout. Only two studies included moderator or clinician input. Results for Section 2 were less consistent. None of the Section 2 studies reported controlled or randomized designs. With the exception of four studies, all included participants were younger than 25 years of age. Eight of the 16 social networking studies reported positive results for depression-related outcomes. The remaining studies were either mixed or negative. Findings for online support groups tended to be more positive; however, noteworthy risks were identified. Conclusions: Online interventions with a broad cognitive behavioral focus appear to be promising in reducing depression symptomology in young people. Further research is required into the effectiveness of online interventions delivering cognitive behavioral subcomponents, such as problem-solving therapy. Evidence for the use of social networking is less compelling, although limited by a lack of well-designed studies and social networking interventions. A range of future social networking therapeutic opportunities are highlighted. %M 25226790 %R 10.2196/jmir.3304 %U http://www.jmir.org/2014/9/e206/ %U https://doi.org/10.2196/jmir.3304 %U http://www.ncbi.nlm.nih.gov/pubmed/25226790 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e212 %T Internet Search and Krokodil in the Russian Federation: An Infoveillance Study %A Zheluk,Andrey %A Quinn,Casey %A Meylakhs,Peter %+ Menzies Centre for Health Policy, University of Sydney, D02 Victor Coppleson Building, University of Sydney, 2006, Australia, 61 29036522, andreyzheluk@gmail.com %K Russia %K search engine %K surveillance %K controlled substances %K designer drugs %K street drugs %D 2014 %7 18.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Krokodil is an informal term for a cheap injectable illicit drug domestically prepared from codeine-containing medication (CCM). The method of krokodil preparation may produce desomorphine as well as toxic reactants that cause extensive tissue necrosis. The first confirmed report of krokodil use in Russia took place in 2004. In 2012, reports of krokodil-related injection injuries began to appear beyond Russia in Western Europe and the United States. Objective: This exploratory study had two main objectives: (1) to determine if Internet search patterns could detect regularities in behavioral responses to Russian CCM policy at the population level, and (2) to determine if complementary data sources could explain the regularities we observed. Methods: First, we obtained krokodil-related search pattern data for each Russia subregion (oblast) between 2011 and 2012. Second, we analyzed several complementary data sources included krokodil-related court cases, and related search terms on both Google and Yandex to evaluate the characteristics of terms accompanying krokodil-related search queries. Results: In the 6 months preceding CCM sales restrictions, 21 of Russia's 83 oblasts had search rates higher than the national average (mean) of 16.67 searches per 100,000 population for terms associated with krokodil. In the 6 months following restrictions, mean national searches dropped to 9.65 per 100,000. Further, the number of oblasts recording a higher than average search rate dropped from 30 to 16. Second, we found krokodil-related court appearances were moderately positively correlated (Spearman correlation=.506, P≤.001) with behaviors consistent with an interest in the production and use of krokodil across Russia. Finally, Google Trends and Google and Yandex related terms suggested consistent public interest in the production and use of krokodil as well as for CCM as analgesic medication during the date range covered by this study. Conclusions: Illicit drug use data are generally regarded as difficult to obtain through traditional survey methods. Our analysis suggests it is plausible that Yandex search behavior served as a proxy for patterns of krokodil production and use during the date range we investigated. More generally, this study demonstrates the application of novel methods recently used by policy makers to both monitor illicit drug use and influence drug policy decision making. %M 25236385 %R 10.2196/jmir.3203 %U http://www.jmir.org/2014/9/e212/ %U https://doi.org/10.2196/jmir.3203 %U http://www.ncbi.nlm.nih.gov/pubmed/25236385 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e221 %T An Internet-Based Epidemiological Investigation of the Outbreak of H7N9 Avian Influenza A in China Since Early 2013 %A Mao,Chen %A Wu,Xin-Yin %A Fu,Xiao-Hong %A Di,Meng-Yang %A Yu,Yuan-Yuan %A Yuan,Jin-Qiu %A Yang,Zu-Yao %A Tang,Jin-Ling %+ School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, 4/F, School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, , China (Hong Kong), 852 22528779, jltang@cuhk.edu.hk %K influenza A virus, H7N9 subtype %K Internet %K big data %K disease outbreaks %K epidemiology %D 2014 %7 25.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: In early 2013, a new type of avian influenza, H7N9, emerged in China. It quickly became an issue of great public concern and a widely discussed topic on the Internet. A considerable volume of relevant information was made publicly available on the Internet through various sources. Objective: This study aimed to describe the outbreak of H7N9 in China based on data openly available on the Internet and to validate our investigation by comparing our findings with a well-conducted conventional field epidemiologic study. Methods: We searched publicly accessible Internet data on the H7N9 outbreak primarily from government and major mass media websites in China up to February 10, 2014. Two researchers independently extracted, compared, and confirmed the information of each confirmed H7N9 case using a self-designed data extraction form. We summarized the epidemiological and clinical characteristics of confirmed H7N9 cases and compared them with those from the field study. Results: According to our data updated until February 10, 2014, 334 confirmed H7N9 cases were identified. The median age was 58 years and 67.0% (219/327) were males. Cases were reported in 15 regions in China. Five family clusters were found. Of the 16.8% (56/334) of the cases with relevant data, 69.6% (39/56) reported a history of exposure to animals. Of the 1751 persons with a close contact with a confirmed case, 0.6% (11/1751) of them developed respiratory symptoms during the 7-day surveillance period. In the 97.9% (327/334) of the cases with relevant data, 21.7% (71/327) died, 20.8% (68/327) were discharged from a hospital, and 57.5% (188/327) were of uncertain status. We compared our findings before February 10, 2014 and those before December 1, 2013 with those from the conventional field study, which had the latter cutoff date of ours in data collection. Our study showed most epidemiological and clinical characteristics were similar to those in the field study, except for case fatality (71/327, 21.7% for our data before February 10; 45/138, 32.6% for our data before December 1; 47/139, 33.8% for the field study), time from illness onset to first medical care (4 days, 3 days, and 1 day), and time from illness onset to death (16.5 days, 17 days, and 21 days). Conclusions: Findings from our Internet-based investigation were similar to those from the conventional field study in most epidemiological and clinical aspects of the outbreak. Importantly, publicly available Internet data are open to any interested researchers and can thus greatly facilitate the investigation and control of such outbreaks. With improved efforts for Internet data provision, Internet-based investigation has a great potential to become a quick, economical, novel approach to investigating sudden issues of great public concern that involve a relatively small number of cases like this H7N9 outbreak. %M 25257217 %R 10.2196/jmir.3763 %U http://www.jmir.org/2014/9/e221/ %U https://doi.org/10.2196/jmir.3763 %U http://www.ncbi.nlm.nih.gov/pubmed/25257217 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e202 %T A Medical Consultation Service on Facebook: Descriptive Analysis of Questions Answered %A Helve,Otto %+ Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Stenbäckinkatu 11, PB 281, Helsinki, 00029 HUS, Finland, 358 505824426, otto.helve@helsinki.fi %K social media %K Internet %K health information %K health promotion %D 2014 %7 04.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media is used increasingly by the general public to access health information. However, a lack of models for health information distribution limits the presence of publicly funded services on social media sites. Objective: The goal of the study was to present a model for delivering child health information to parents through a social media site. Methods: A Facebook site was launched for 11 months based on a question-and-answer service produced by a pediatrician and open to Facebook users over 18 years old. If the answer did not include a further referral to a health care service provider, the question was considered comprehensively answered. The site was funded by a pharmaceutical company, and it included an advertisement of a pharmaceutical product for children’s fever and pain. Results: During the study, 768 questions were submitted: an average of 69.8 (SD 31.7) per month. There were 245,533 independent Facebook users on the site, with an average of 727.0 (SD 2280.6) per day. Infections were the most common theme in questions (355/768, 46.2%). Questions were more likely to be comprehensively answered if they were related to infections (279/355, 78.6%) than questions related to non-infectious symptoms (265/423, 64.2%, P=.003). Conclusions: On this site aimed at parents of small children, personalized answers were an effective way of delivering information. The service is likely to have reduced the need for further contacts with a health care service provider in more than half of the cases. The site could serve as a model for publicly funded health information distribution. %M 25189182 %R 10.2196/jmir.3194 %U http://www.jmir.org/2014/9/e202/ %U https://doi.org/10.2196/jmir.3194 %U http://www.ncbi.nlm.nih.gov/pubmed/25189182 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e215 %T Web-Based Self-Assessment Health Tools: Who Are the Users and What Is the Impact of Missing Input Information? %A Neufingerl,Nicole %A Cobain,Mark R %A Newson,Rachel S %+ Nutrition & Health Department, Unilever Research & Development, Olivier van Noortlaan 120, Vlaardingen, 3133 AT, Netherlands, 31 10460 ext 5155, nicole.neufingerl@unilever.com %K cardiovascular disease %K risk assessment %K Web applications %K consumer health information %K preventive health services %K cholesterol %K blood pressure %D 2014 %7 26.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based health applications, such as self-assessment tools, can aid in the early detection and prevention of diseases. However, there are concerns as to whether such tools actually reach users with elevated disease risk (where prevention efforts are still viable), and whether inaccurate or missing information on risk factors may lead to incorrect evaluations. Objective: This study aimed to evaluate (1) evaluate whether a Web-based cardiovascular disease (CVD) risk communication tool (Heart Age tool) was reaching users at risk of developing CVD, (2) the impact of awareness of total cholesterol (TC), HDL-cholesterol (HDL-C), and systolic blood pressure (SBP) values on the risk estimates, and (3) the key predictors of awareness and reporting of physiological risk factors. Methods: Heart Age is a tool available via a free open access website. Data from 2,744,091 first-time users aged 21-80 years with no prior heart disease were collected from 13 countries in 2009-2011. Users self-reported demographic and CVD risk factor information. Based on these data, an individual’s 10-year CVD risk was calculated according to Framingham CVD risk models and translated into a Heart Age. This is the age for which the individual’s reported CVD risk would be considered “normal”. Depending on the availability of known TC, HDL-C, and SBP values, different algorithms were applied. The impact of awareness of TC, HDL-C, and SBP values on Heart Age was determined using a subsample that had complete risk factor information. Results: Heart Age users (N=2,744,091) were mostly in their 20s (22.76%) and 40s (23.99%), female (56.03%), had multiple (mean 2.9, SD 1.4) risk factors, and a Heart Age exceeding their chronological age (mean 4.00, SD 6.43 years). The proportion of users unaware of their TC, HDL-C, or SBP values was high (77.47%, 93.03%, and 46.55% respectively). Lacking awareness of physiological risk factor values led to overestimation of Heart Age by an average 2.1-4.5 years depending on the (combination of) unknown risk factors (P<.001). Overestimation was greater in women than in men, increased with age, and decreased with increasing CVD risk. Awareness of physiological risk factor values was higher among diabetics (OR 1.47, 95% CI 1.46-1.50 and OR 1.74, 95% CI 1.71-1.77), those with family history of CVD (OR 1.22, 95% CI 1.22-1.23 and OR 1.43, 95% CI 1.42-1.44), and increased with age (OR 1.05, 95% CI 1.05-1.05 and OR 1.07, 95% CI 1.07-1.07). It was lower in smokers (OR 0.52, 95% CI 0.52-0.53 and OR 0.71, 95% CI 0.71-0.72) and decreased with increasing Heart Age (OR 0.92, 95% CI 0.92-0.92 and OR 0.97, 95% CI 0.96-0.97) (all P<.001). Conclusions: The Heart Age tool reached users with low-moderate CVD risk, but with multiple elevated CVD risk factors, and a heart age higher than their real age. This highlights that Web-based self-assessment health tools can be a useful means to interact with people who are at risk of developing disease, but where interventions are still viable. Missing information in the self-assessment health tools was shown to result in inaccurate self-health assessments. Subgroups at risk of not knowing their risk factors are identifiable and should be specifically targeted in health awareness programs. %M 25261155 %R 10.2196/jmir.3146 %U http://www.jmir.org/2014/9/e215/ %U https://doi.org/10.2196/jmir.3146 %U http://www.ncbi.nlm.nih.gov/pubmed/25261155 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e198 %T Estimation of Geographic Variation in Human Papillomavirus Vaccine Uptake in Men and Women: An Online Survey Using Facebook Recruitment %A Nelson,Erik J %A Hughes,John %A Oakes,J Michael %A Pankow,James S %A Kulasingam,Shalini L %+ School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, 1300 South Second Street, Suite 300, Minneapolis, MN, 55454, United States, 1 1 612 624 1818, nels6712@umn.edu %K online recruitment %K social media %K Facebook %K local estimation %K geographic variability %K human papillomavirus %K HPV %D 2014 %7 01.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Federally funded surveys of human papillomavirus (HPV) vaccine uptake are important for pinpointing geographically based health disparities. Although national and state level data are available, local (ie, county and postal code level) data are not due to small sample sizes, confidentiality concerns, and cost. Local level HPV vaccine uptake data may be feasible to obtain by targeting specific geographic areas through social media advertising and recruitment strategies, in combination with online surveys. Objective: Our goal was to use Facebook-based recruitment and online surveys to estimate local variation in HPV vaccine uptake among young men and women in Minnesota. Methods: From November 2012 to January 2013, men and women were recruited via a targeted Facebook advertisement campaign to complete an online survey about HPV vaccination practices. The Facebook advertisements were targeted to recruit men and women by location (25 mile radius of Minneapolis, Minnesota, United States), age (18-30 years), and language (English). Results: Of the 2079 men and women who responded to the Facebook advertisements and visited the study website, 1003 (48.2%) enrolled in the study and completed the survey. The average advertising cost per completed survey was US $1.36. Among those who reported their postal code, 90.6% (881/972) of the participants lived within the previously defined geographic study area. Receipt of 1 dose or more of HPV vaccine was reported by 65.6% women (351/535), and 13.0% (45/347) of men. These results differ from previously reported Minnesota state level estimates (53.8% for young women and 20.8% for young men) and from national estimates (34.5% for women and 2.3% for men). Conclusions: This study shows that recruiting a representative sample of young men and women based on county and postal code location to complete a survey on HPV vaccination uptake via the Internet is a cost-effective and feasible strategy. This study also highlights the need for local estimates to assess the variation in HPV vaccine uptake, as these estimates differ considerably from those obtained using survey data that are aggregated to the state or federal level. %M 25231937 %R 10.2196/jmir.3506 %U http://www.jmir.org/2014/9/e198/ %U https://doi.org/10.2196/jmir.3506 %U http://www.ncbi.nlm.nih.gov/pubmed/25231937 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e200 %T Baby Boomers’ Adoption of Consumer Health Technologies: Survey on Readiness and Barriers %A LeRouge,Cynthia %A Van Slyke,Craig %A Seale,Deborah %A Wright,Kevin %+ College for Public Health and Social Justice, Department of Health Management & Policy, Saint Louis University, 3545 Lafayette Avenue, Room 365, Saint Louis, MO, 63104, United States, 1 314 977 8195, lerouge@uw.edu %K baby boomer %K readiness %K adoption %K consumer health technology %K man-machine systems %K aging %K health %K human factors %K design %K user interfaces %K personal computing %D 2014 %7 08.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: As they age, baby boomers (born 1946-1964) will have increasing medical needs and are likely to place large demand on health care resources. Consumer health technologies may help stem rising health care needs and costs by improving provider-to-patient communication, health monitoring, and information access and enabling self-care. Research has not explored the degree to which baby boomers are ready for, or are currently embracing, specific consumer health technologies This study explores how baby boomers’ readiness to use various technologies for health purposes compares to other segments of the adult population. Objective: The goals of the study are to (1) examine what technologies baby boomers are ready to use for health purposes, (2) investigate barriers to baby boomers’ use of technology for health purposes, and (3) understand whether readiness for and barriers to baby boomers’ use of consumer health technologies differ from those of other younger and older consumers. Methods: Data were collected via a survey offered to a random sample of 3000 subscribers to a large pharmacy benefit management company. Respondents had the option to complete the survey online or by completing a paper-based version of the survey. Results: Data from 469 respondents (response rate 15.63%) were analyzed, including 258 baby boomers (aged 46-64 years), 72 younger (aged 18-45 years), and 139 older (age >64 years) participants. Baby boomers were found to be similar to the younger age group, but significantly more likely than the older age group to be ready to use 5 technologies for health purposes (health information websites, email, automated call centers, medical video conferencing, and texting). Baby boomers were less ready than the younger age group to adopt podcasts, kiosks, smartphones, blogs, and wikis for health care purposes. However, baby boomers were more likely than older adults to use smartphones and podcasts for health care purposes. Specific adoption barriers vary according to the technology. Conclusions: Baby boomers have commonalities with and distinctions from both younger and older adults in their readiness to adopt specific consumer health technologies and the barriers they experience to adoption. Baby boomers’ nuances regarding readiness to adopt and the barriers associated with the various forms of consumer health technology should be taken into account by those interested in promoting consumer health technologies use among baby boomers when developing applications, choosing technologies, preparing users for use, and in promotional tactics. %M 25199475 %R 10.2196/jmir.3049 %U http://www.jmir.org/2014/9/e200/ %U https://doi.org/10.2196/jmir.3049 %U http://www.ncbi.nlm.nih.gov/pubmed/25199475 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e207 %T Applying Computer Adaptive Testing to Optimize Online Assessment of Suicidal Behavior: A Simulation Study %A De Beurs,Derek Paul %A de Vries,Anton LM %A de Groot,Marieke H %A de Keijser,Jos %A Kerkhof,Ad JFM %+ EMGO Institute for Health and Care Research, van der Boechorststraat 1, Amsterdam, , Netherlands, 31 205982589, dp.de.beurs@vu.nl %K suicide %K psychometrics %K computing methodologies %K Internet %K suicidal ideation %K risk assessment %D 2014 %7 11.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet is used increasingly for both suicide research and prevention. To optimize online assessment of suicidal patients, there is a need for short, good-quality tools to assess elevated risk of future suicidal behavior. Computer adaptive testing (CAT) can be used to reduce response burden and improve accuracy, and make the available pencil-and-paper tools more appropriate for online administration. Objective: The aim was to test whether an item response–based computer adaptive simulation can be used to reduce the length of the Beck Scale for Suicide Ideation (BSS). Methods: The data used for our simulation was obtained from a large multicenter trial from The Netherlands: the Professionals in Training to STOP suicide (PITSTOP suicide) study. We applied a principal components analysis (PCA), confirmatory factor analysis (CFA), a graded response model (GRM), and simulated a CAT. Results: The scores of 505 patients were analyzed. Psychometric analyses showed the questionnaire to be unidimensional with good internal consistency. The computer adaptive simulation showed that for the estimation of elevation of risk of future suicidal behavior 4 items (instead of the full 19) were sufficient, on average. Conclusions: This study demonstrated that CAT can be applied successfully to reduce the length of the Dutch version of the BSS. We argue that the use of CAT can improve the accuracy and the response burden when assessing the risk of future suicidal behavior online. Because CAT can be daunting for clinicians and applied scientists, we offer a concrete example of our computer adaptive simulation of the Dutch version of the BSS at the end of the paper. %M 25213259 %R 10.2196/jmir.3511 %U http://www.jmir.org/2014/9/e207/ %U https://doi.org/10.2196/jmir.3511 %U http://www.ncbi.nlm.nih.gov/pubmed/25213259 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e204 %T The Management of Acute Adverse Effects of Breast Cancer Treatment in General Practice: A Video-Vignette Study %A Jiwa,Moyez %A Long,Anne %A Shaw,Tim %A Pagey,Georgina %A Halkett,Georgia %A Pillai,Vinita %A Meng,Xingqiong %+ Curtin University, GPO Box U1987, Perth, 6845, Australia, 61 8 9266 1768, m.jiwa@curtin.edu.au %K breast cancer %K treatment %K general practice %K adverse effects %K patient care planning %D 2014 %7 03.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: There has been a focus recently on the use of the Internet and email to deliver education interventions to general practitioners (GPs). The treatment of breast cancer may include surgery, radiotherapy, chemotherapy, and/or hormone treatment. These treatments may have acute adverse effects. GPs need more information on the diagnosis and management of specific adverse effects encountered immediately after cancer treatment. Objective: The goal was to evaluate an Internet-based educational program developed for GPs to advise patients with acute adverse effects following breast cancer treatment. Methods: During phase 1, participants viewed 6 video vignettes of actor-patients reporting 1 of 6 acute symptoms following surgery and chemotherapy and/or radiotherapy treatment. GPs indicated their diagnosis and proposed management through an online survey program. They received feedback about each scenario in the form of a specialist clinic letter, as if the patient had been seen at a specialist clinic after they had attended the GP. This letter incorporated extracts from local guidelines on the management of the symptoms presented. This feedback was sent to the GPs electronically on the same survey platform. In phase 2, all GPs were invited to manage similar cases as phase 1. Their proposed management was compared to the guidelines. McNemar test was used to compare data from phases 1 and 2, and logistic regression was used to explore the GP characteristics that were associated with inappropriate case management. Results: A total of 50 GPs participated. Participants were younger and more likely to be female than other GPs in Australia. For 5 of 6 vignettes in phase 1, management was consistent with expert opinion in the minority of cases (6%-46%). Participant demographic characteristics had a variable effect on different management decisions in phase 1. The variables modeled explained 15%-28% of the differences observed. Diagnosis and management improved significantly in phase 2, especially for diarrhea, neutropenia, and seroma sample cases. The proportion of incorrect management responses was reduced to a minimum (25.3%-49.3%) in phase 2. Conclusions: There was evidence that providing feedback by experts on specific cases had an impact on GPs’ knowledge about how to appropriately manage acute treatment adverse effects. This educational intervention could be targeted to support the implementation of shared care during cancer treatment. %M 25274131 %R 10.2196/jmir.3585 %U http://www.jmir.org/2014/9/e204/ %U https://doi.org/10.2196/jmir.3585 %U http://www.ncbi.nlm.nih.gov/pubmed/25274131 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e214 %T Comparison of Virtual Patient Simulation With Mannequin-Based Simulation for Improving Clinical Performances in Assessing and Managing Clinical Deterioration: Randomized Controlled Trial %A Liaw,Sok Ying %A Chan,Sally Wai-Chi %A Chen,Fun-Gee %A Hooi,Shing Chuan %A Siau,Chiang %+ Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Alice Lee Centre for Nursing Studies. Level 2, Clinical Research Centre, Block MD 11, 10 Medical Drive, Singapore 117597, , Singapore, 65 65167451, nurliaw@nus.edu.sg %K simulation %K education %K virtual patient %K deterioration %K clinical performance %K patient safety %D 2014 %7 17.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Virtual patient simulation has grown substantially in health care education. A virtual patient simulation was developed as a refresher training course to reinforce nursing clinical performance in assessing and managing deteriorating patients. Objective: The objective of this study was to describe the development of the virtual patient simulation and evaluate its efficacy, by comparing with a conventional mannequin-based simulation, for improving the nursing students’ performances in assessing and managing patients with clinical deterioration. Methods: A randomized controlled study was conducted with 57 third-year nursing students who were recruited through email. After a baseline evaluation of all participants’ clinical performance in a simulated environment, the experimental group received a 2-hour fully automated virtual patient simulation while the control group received 2-hour facilitator-led mannequin-based simulation training. All participants were then re-tested one day (first posttest) and 2.5 months (second posttest) after the intervention. The participants from the experimental group completed a survey to evaluate their learning experiences with the newly developed virtual patient simulation. Results: Compared to their baseline scores, both experimental and control groups demonstrated significant improvements (P<.001) in first and second post-test scores. While the experimental group had significantly lower (P<.05) second post-test scores compared with the first post-test scores, no significant difference (P=.94) was found between these two scores for the control group. The scores between groups did not differ significantly over time (P=.17). The virtual patient simulation was rated positively. Conclusions: A virtual patient simulation for a refreshing training course on assessing and managing clinical deterioration was developed. Although the randomized controlled study did not show that the virtual patient simulation was superior to mannequin-based simulation, both simulations have demonstrated to be effective refresher learning strategies for improving nursing students’ clinical performance. Given the greater resource requirements of mannequin-based simulation, the virtual patient simulation provides a more promising alternative learning strategy to mitigate the decay of clinical performance over time. %M 25230684 %R 10.2196/jmir.3322 %U http://www.jmir.org/2014/9/e214/ %U https://doi.org/10.2196/jmir.3322 %U http://www.ncbi.nlm.nih.gov/pubmed/25230684 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e220 %T Preparing Facilitators From Community-Based Organizations for Evidence-Based Intervention Training in Second Life %A Valladares,Angel Felix %A Aebersold,Michelle %A Tschannen,Dana %A Villarruel,Antonia Maria %+ University of Michigan, School of Nursing, 400 N Ingalls Street, 4156, Ann Arbor, MI, 48109, United States, 1 (734) 615 8498, mabersol@umich.edu %K evidence-based intervention %K virtual environment %K Second Life %K health education %K community-based organization %K facilitator training %K computer simulation %K distance education %K serious gaming %D 2014 %7 30.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: A major barrier to the use and scale-up of evidence-based interventions are challenges related to training and capacity building. A cost-effective and highly interactive multi-user virtual environment, Second Life (SL) is a promising alternative for comprehensive face-to-face facilitator training. Objective: The purpose of this study was to examine the feasibility of using SL to train facilitators from community-based organizations to use ¡Cuídate! (Take Care of Yourself), one of the few evidence-based interventions developed and tested with Latino youth to reduce sexual risk behaviors. Methods: We recruited 35 participants from community-based organizations throughout the United States to participate in the SL ¡Cuídate! Training of Facilitators. Preparation to use SL consisted of four phases: (1) recruitment and computer capacity screening, (2) enrollment, (3) orientation to the SL program, and (4) technical support throughout the synchronous training sessions. Technical difficulties, the associated cause, and the mitigation strategy implemented were recorded during each session. Participants completed evaluations including perceptions of self-efficacy and confidence to complete the necessary skills to participate in SL training. Results: Overall, participants reported high levels of self-efficacy for all skills necessary to participate in SL training. Based on an 11-point scale (0-10), self-efficacy to download and access the software was rated the highest: mean 8.29 (SD 2.19). Interacting with items in SL had the lowest mean score: mean 7.49 (SD 2.89). The majority of technical difficulties experienced by participants were related to inadequate Internet connections or computer malfunctions. Conclusions: Our findings support the feasibility of using SL for the ¡Cuídate! Training of Facilitators. The process used in this study to prepare participants to use SL can be used as a basis for other evidence-based intervention training in SL. This study is an important contribution to developing cost-effective and accessible training options for evidence-based interventions. %M 25270991 %R 10.2196/jmir.3606 %U http://www.jmir.org/2014/9/e220/ %U https://doi.org/10.2196/jmir.3606 %U http://www.ncbi.nlm.nih.gov/pubmed/25270991 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e213 %T Replacing Ambulatory Surgical Follow-Up Visits With Mobile App Home Monitoring: Modeling Cost-Effective Scenarios %A Armstrong,Kathleen A %A Semple,John L %A Coyte,Peter C %+ Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, 149 College Street, 5th Floor, Room 508, Toronto, ON, M5T 1P5, Canada, 1 416 978 8534, k.armstrong@mail.utoronto.ca %K cost-effectiveness %K ambulatory surgical procedures %K mobile apps %K ambulatory monitoring %D 2014 %7 22.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Women’s College Hospital (WCH) offers specialized surgical procedures, including ambulatory breast reconstruction in post-mastectomy breast cancer patients. Most patients receiving ambulatory surgery have low rates of postoperative events necessitating clinic visits. Increasingly, mobile monitoring and follow-up care is used to overcome the distance patients must travel to receive specialized care at a reduced cost to society. WCH has completed a feasibility study using a mobile app (QoC Health Inc, Toronto) that suggests high patient satisfaction and adequate detection of postoperative complications. Objective: The proposed cost-effectiveness study models the replacement of conventional, in-person postoperative follow-up care with mobile app follow-up care following ambulatory breast reconstruction in post-mastectomy breast cancer patients. Methods: This is a societal perspective cost-effectiveness analysis, wherein all costs are assessed irrespective of the payer. The patient/caregiver, health care system, and externally borne costs are calculated within the first postoperative month based on cost information provided by WCH and QoC Health Inc. The effectiveness of telemedicine and conventional follow-up care is measured as successful surgical outcomes at 30-days postoperative, and is modeled based on previous clinical trials containing similar patient populations and surgical risks. Results: This costing assumes that 1000 patients are enrolled in bring-your-own-device (BYOD) mobile app follow-up per year and that 1.64 in-person follow-ups are attended in the conventional arm within the first month postoperatively. The total cost difference between mobile app and in-person follow-up care is $245 CAD ($223 USD based on the current exchange rate), with in-person follow-up being more expensive ($381 CAD) than mobile app follow-up care ($136 CAD). This takes into account the total of health care system, patient, and external borne costs. If we examine health care system costs alone, in-person follow-up is $38 CAD ($35 USD) more expensive than mobile app follow-up care over the first postoperative month. The baseline difference in effect is modeled to be zero based on clinical trials examining the effectiveness of telephone follow-up care in similar patient populations. An incremental cost-effectiveness ratio (ICER) is not reportable in this scenario. An incremental net benefit (INB) is reportable, and reflects merely the cost difference between the two interventions for any willingness-to-pay value (INB=$245 CAD). The cost-effectiveness of mobile app follow-up even holds in scenarios where all mobile patients attend one in-person follow-up. Conclusions: Mobile app follow-up care is suitably targeted to low-risk postoperative ambulatory patients. It can be cost-effective from a societal and health care system perspective. %M 25245774 %R 10.2196/jmir.3528 %U http://www.jmir.org/2014/9/e213/ %U https://doi.org/10.2196/jmir.3528 %U http://www.ncbi.nlm.nih.gov/pubmed/25245774