%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e21 %T Facebook Groups for the Management of Chronic Diseases %A Partridge,Stephanie R %A Gallagher,Patrick %A Freeman,Becky %A Gallagher,Robyn %+ Sydney Nursing School, Charles Perkins Centre, The University of Sydney, Room 2210, Level 2, Building D17, The University of Sydney, Sydney, 2006, Australia, 61 2 86270279, robyn.gallagher@sydney.edu.au %K social media, prevention, intervention, Facebook %D 2018 %7 17.01.2018 %9 Viewpoint %J J Med Internet Res %G English %X The use of Facebook groups by health care researchers and professionals for chronic disease management, namely type 2 diabetes mellitus and coronary heart disease, is in its early stages and challenges are emerging. While Facebook groups offer great potential to deliver health support, research of Facebook groups for chronic disease management remains in its infancy, with robust evidence not yet available. Designing Facebook groups that are acceptable to users, health care researchers as well as health care professionals is a challenge, and there is a poor fit with traditional research and evaluation methods. Key recommendations for future research of Facebook groups for chronic disease management include: (1) iterative content development with input from the target patient population; (2) further understanding of the potential role of group “champions”; (3) ensuring the social media policies of health care institutions allow for real time online communication; and (4) utilizing comprehensive evaluation strategies, including the use of process evaluations. %M 29343460 %R 10.2196/jmir.7558 %U http://www.jmir.org/2018/1/e21/ %U https://doi.org/10.2196/jmir.7558 %U http://www.ncbi.nlm.nih.gov/pubmed/29343460 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e1 %T A Perioperative eHealth Program to Enhance Postoperative Recovery After Abdominal Surgery: Process Evaluation of a Randomized Controlled Trial %A van der Meij,Eva %A Huirne,Judith AF %A ten Cate,A Dorien %A Stockmann,Hein BAC %A Scholten,Piet C %A Davids,Paul HP %A Bonjer,H Jaap %A Anema,Johannes R %+ Amsterdam Public Health Research Institute, Department of Public and Occupational Health, VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam,, Netherlands, 31 204450703, ev.vandermeij@vumc.nl %K telemedicine %K cholecystectomy %K surgical procedures, operative %K perioperative care %K convalescence %K process assessment %D 2018 %7 02.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic health (eHealth) interventions have proven effective, but implementation in clinical practice is difficult. More research focusing on the implementation process of eHealth interventions is necessary. Objective: The objective of this study was to describe the process evaluation of a perioperative eHealth intervention, aiming to enhance recovery after laparoscopic abdominal surgery. Methods: A process evaluation was carried out alongside a multicenter randomized controlled trial. Patients aged between 18 and 75 years who were scheduled for a laparoscopic cholecystectomy, hernia inguinal surgery, or laparoscopic adnexal surgery were included. The eHealth intervention comprised a website and mobile phone app with the possibility to develop a personalized convalescence plan, a section with information about the surgical procedure and the recovery period, the possibility to ask questions via an electronic consultation (eConsult), and an activity tracker. The process evaluation was carried out using the model of Linnan and Steckler, measuring components such as reach, dose delivered, dose received, fidelity, and participants’ attitudes. Implementation scores were calculated based on the average of the four components. Quantitative data were collected by means of an electronic questionnaire, a logistic database, a weblog, and medical files. Qualitative data were collected by conducting interviews with a subsample of the study participants. Results: A total of 344 of the 863 eligible patients were included in the study, which accounted for a reach of 39.9%, and 173 participants were randomized to the intervention group. The implementation scores of the different functions of the intervention ranged between 60% and 65%. The website, mobile phone app, and activity tracker were rated 7.3 to 7.6 on a scale of 1 to 10. Almost all participants who were interviewed about the eConsult function rated it as being of additional value if combined with the usual care but not as a replacement for usual care. Conclusions: Although participants were overall satisfied with the intervention, the implementation scores of the different functions of the intervention were fair. More research is needed to evaluate the barriers and facilitators for implementation of this perioperative eHealth intervention in normal practice outside study setting. Trial Registration: Netherlands Trial Registry NTR4699; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4699 (Archived by WebCite at http://www.webcitation.org/6vr02V4KK) %M 29295808 %R 10.2196/jmir.8338 %U http://www.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/jmir.8338 %U http://www.ncbi.nlm.nih.gov/pubmed/29295808 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e9 %T Turning Good Intentions Into Actions by Using the Health Action Process Approach to Predict Adherence to Internet-Based Depression Prevention: Secondary Analysis of a Randomized Controlled Trial %A Zarski,Anna-Carlotta %A Berking,Matthias %A Reis,Dorota %A Lehr,Dirk %A Buntrock,Claudia %A Schwarzer,Ralf %A Ebert,David Daniel %+ Friedrich-Alexander-University Erlangen-Nürnberg, Nägelsbachstraße 25a, Erlangen,, Germany, 49 9131 85 67570, Anna-Carlotta.Zarski@fau.de %K health action process approach %K adherence %K Internet intervention %K depression prevention %D 2018 %7 11.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Many individuals engaging in Internet-based interventions fail to complete these treatments as intended. The processes responsible for treatment adherence in Internet-based interventions are still poorly understood. Objective: The aim of this study was to investigate to what extent adherence in an Internet-based intervention can be predicted by motivational and volitional factors outlined in the health action process approach (HAPA). Methods: This study investigated motivational and volitional factors included in HAPA in a randomized controlled trial to predict treatment adherence of N=101 individuals with subclinical depression in the intervention group of a depression prevention intervention (GET.ON Mood Enhancer). Adherence was operationalized as the number of completed treatment modules. Using longitudinal structural equation modeling, HAPA variables (motivational, maintenance, and recovery self-efficacy, outcome expectancies, intention, and planning) were assessed at baseline and their associations with adherence 7 weeks later. Results: Planning predicted adherence. Better planning was, in turn, associated with higher levels of maintenance self-efficacy, and the latter significantly affected treatment adherence via planning. The other hypothesized direct associations were not significant. In total, the HAPA variables accounted for 14% of variance in treatment adherence. Conclusions: Planning emerged as the strongest predictor of treatment adherence in highly motivated participants in an Internet-based intervention out of all HAPA variables investigated. Findings are in line with the hypothesis that planning facilitates the translation of good intentions into actions. The findings imply that systematically fostering planning skills and maintenance self-efficacy prior to or during Internet-based interventions would help participants to successfully complete these treatments. Trial Registration: German Clinical Trials Register DRKS00005973; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00005973 (Archived by WebCite at http://www.webcitation.org/6uxCy64sy). %M 29326097 %R 10.2196/jmir.8814 %U https://www.jmir.org/2018/1/e9/ %U https://doi.org/10.2196/jmir.8814 %U http://www.ncbi.nlm.nih.gov/pubmed/29326097 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e17 %T A Tailored Web-Based Intervention to Improve Parenting Risk and Protective Factors for Adolescent Depression and Anxiety Problems: Postintervention Findings From a Randomized Controlled Trial %A Yap,Marie Bee Hui %A Mahtani,Shireen %A Rapee,Ronald M %A Nicolas,Claire %A Lawrence,Katherine A %A Mackinnon,Andrew %A Jorm,Anthony F %+ Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, 18 Innovation Walk, Clayton, 3800, Australia, 61 399050723, marie.yap@monash.edu %K family %K anxiety %K parenting %K depression %K adolescent %K Internet %K mental health %K preventive health services %D 2018 %7 19.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression and anxiety disorders in young people are a global health concern. Parents have an important role in reducing the risk of these disorders, but cost-effective, evidence-based interventions for parents that can be widely disseminated are lacking. Objective: This study aimed to examine the postintervention effects of the Partners in Parenting (PiP) program on parenting risk and protective factors for adolescent depression and anxiety, and on adolescent depression and anxiety symptoms. Methods: A two-arm randomized controlled trial was conducted with 359 parent-adolescent dyads, recruited primarily through schools across Australia. Parents and adolescents were assessed at baseline and 3 months later (postintervention). Parents in the intervention condition received PiP, a tailored Web-based parenting intervention designed following Persuasive Systems Design (PSD) principles to target parenting factors associated with adolescents’ risk for depression and anxiety problems. PiP comprises a tailored feedback report highlighting each parent’s strengths and areas for improvement, followed by a set of interactive modules (up to nine) that is specifically recommended for the parent based on individually identified areas for improvement. Parents in the active-control condition received a standardized package of five Web-based factsheets about adolescent development and well-being. Parents in both conditions received a 5-min weekly call to encourage progress through their allocated program to completion. Both programs were delivered weekly via the trial website. The primary outcome measure at postintervention was parent-reported changes in parenting risk and protective factors, which were measured using the Parenting to Reduce Adolescent Depression and Anxiety Scale (PRADAS). Secondary outcome measures were the adolescent-report PRADAS, the parent- and child-report Short Mood and Feelings Questionnaire (depressive symptoms), and parent- and child-report Spence Children’s Anxiety Scale (anxiety symptoms). Results: Parents in the intervention condition completed a mean of 73.7% of their intended personalized PiP program. A total of 318 parents (88.6%, 318/359) and 308 adolescents (92.8%, 308/332) completed the postintervention assessment. Attrition was handled using mixed model of repeated measures analysis of variance. As hypothesized, we found a significant condition-by-time interaction on the PRADAS, with a medium effect size, Cohen d=0.57, 95% CI 0.34-0.79. No significant differences between conditions were found at postintervention on any of the secondary outcome measures, with adolescent depressive (parent-report only) and anxiety (both parent- and adolescent-report) symptoms decreasing significantly from baseline to postintervention in both conditions. Conclusions: The fully automated PiP intervention showed promising short-term effects on parenting behaviors that are associated with adolescents’ risk for depression and anxiety. Long-term follow-up is required to ascertain whether these effects translate into reduced adolescent depression and anxiety problems. The intervention may be useful as a low-cost universal public health program to increase parenting practices believed to benefit adolescents’ mental health. Trial Registration: Australia New Zealand Clinical Trials Registry: ACTRN12615000328572; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx? id=368274 (Archived by WebCite at http://www.webcitation.org/6qgsZ3Aqj) %M 29351895 %R 10.2196/jmir.9139 %U http://www.jmir.org/2018/1/e17/ %U https://doi.org/10.2196/jmir.9139 %U http://www.ncbi.nlm.nih.gov/pubmed/29351895 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e12 %T Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Dental Anxiety: Open Trial %A Shahnavaz,Shervin %A Hedman-Lagerlöf,Erik %A Hasselblad,Tove %A Reuterskiöld,Lena %A Kaldo,Viktor %A Dahllöf,Göran %+ Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Box 4064, 14104, Huddinge,, Sweden, 46 8 52488091, shervin.shahnavaz@ki.se %K cognitive behavioral therapy %K dental fear %K dental phobia %K dentistry %K internet-based treatment %K pediatric dentistry %K psychology %K self efficacy %D 2018 %7 22.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive behavioral therapy (CBT) is an evidence-based method for treating specific phobias, but access to treatment is difficult, especially for children and adolescents with dental anxiety. Psychologist-guided Internet-based CBT (ICBT) may be an effective way of increasing accessibility while maintaining treatment effects. Objective: The aim of this study was to test the hypothesis that psychologist-guided ICBT improves school-aged children’s and adolescents’ ability to manage dental anxiety by (1) decreasing avoidance and affecting the phobia diagnosis and (2) decreasing the dental fear and increasing the target groups’ self-efficacy. The study also aimed to examine the feasibility and acceptability of this novel treatment. Methods: This was an open, uncontrolled trial with assessments at baseline, posttreatment, and the 1-year follow-up. The study enrolled and treated 18 participants. The primary outcome was level of avoidance behaviors, as measured by the picture-guided behavioral avoidance test (PG-BAT). The secondary outcome was a diagnostic evaluation with the parents conducted by a psychologist. The specific phobia section of the structured interview Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL) was used. Other outcome measures included level of dental anxiety and self-efficacy. The ICBT, which employed exposure therapy, comprised 12 modules of texts, animations, dentistry-related video clips, and an exercise package (including dental instruments). Participants accessed the treatment through an Internet-based treatment platform and received Web-based guidance from a psychologist. Treatment also included training at dental clinics. Feasibility and acceptability were assessed by measures of engagement, adherence, compliance, completed measures, patient and parent satisfaction scale, and staff acceptability. Results: The level of avoidance (according to the primary outcome measure PG-BAT) and dental anxiety decreased and self-efficacy increased significantly (P<.001), within-group effect sizes for both the primary outcome (Cohen d=1.5), and other outcomes were large in the range of 0.9 and 1.5. According to K-SADS-PL, 53% (8/15) of the participants were free from diagnosable dental anxiety at the 1-year follow-up. At the 1-year follow-up, improvements were maintained and clinically significant, with 60% (9/15) of participants who had been unable to manage intraoral injection of local anesthetics before ICBT reporting having accomplished this task at a dental clinic. The target group showed improvement in all the outcome measures. High levels of feasibility and acceptability were observed for the treatment. Conclusions: ICBT is a promising and feasible treatment for dental anxiety in children and adolescents. Integrating it into routine pediatric dental care would increase access to an effective psychological treatment. The results of this open trial must be replicated in controlled studies. %M 29358158 %R 10.2196/jmir.7803 %U http://www.jmir.org/2018/1/e12/ %U https://doi.org/10.2196/jmir.7803 %U http://www.ncbi.nlm.nih.gov/pubmed/29358158 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e37 %T Implementing a Mobile Health System to Integrate the Treatment of Addiction Into Primary Care: A Hybrid Implementation-Effectiveness Study %A Quanbeck,Andrew %A Gustafson,David H %A Marsch,Lisa A %A Chih,Ming-Yuan %A Kornfield,Rachel %A McTavish,Fiona %A Johnson,Roberta %A Brown,Randall T %A Mares,Marie-Louise %A Shah,Dhavan V %+ Department of Family Medicine and Community Health, University of Wisconsin - Madison, 1100 Delaplaine Ct, Madison, WI, 53715, United States, 1 608 263 4550, arquanbe@wisc.edu %K mobile health %K mHealth %K evidence-based practice %K behavioral medicine %D 2018 %7 30.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the near ubiquity of mobile phones, little research has been conducted on the implementation of mobile health (mHealth) apps to treat patients in primary care. Although primary care clinicians routinely treat chronic conditions such as asthma and diabetes, they rarely treat addiction, a common chronic condition. Instead, addiction is most often treated in the US health care system, if it is treated at all, in a separate behavioral health system. mHealth could help integrate addiction treatment in primary care. Objective: The objective of this paper was to report the effects of implementing an mHealth system for addiction in primary care on both patients and clinicians. Methods: In this implementation research trial, an evidence-based mHealth system named Seva was introduced sequentially over 36 months to a maximum of 100 patients with substance use disorders (SUDs) in each of three federally qualified health centers (FQHCs; primary care clinics that serve patients regardless of their ability to pay). This paper reports on patient and clinician outcomes organized according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Results: The outcomes according to the RE-AIM framework are as follows: Reach—Seva reached 8.31% (268/3226) of appropriate patients. Reach was limited by our ability to pay for phones and data plans for a maximum of 100 patients per clinic. Effectiveness—Patients who were given Seva had significant improvements in their risky drinking days (44% reduction, (0.7-1.25)/1.25, P=.04), illicit drug-use days (34% reduction, (2.14-3.22)/3.22, P=.01), quality of life, human immunodeficiency virus screening rates, and number of hospitalizations. Through Seva, patients also provided peer support to one another in ways that are novel in primary care settings. Adoption—Patients sustained high levels of Seva use—between 53% and 60% of the patients at the 3 sites accessed Seva during the last week of the 12-month implementation period. Among clinicians, use of the technology was less robust than use by patients, with only a handful of clinicians using Seva in each clinic and behavioral health providers making most referrals to Seva in 2 of the 3 clinics. Implementation—At 2 sites, implementation plans were realized successfully; they were delayed in the third. Maintenance—Use of Seva dropped when grant funding stopped paying for the mobile phones and data plans. Two of the 3 clinics wanted to maintain the use of Seva, but they struggled to find funding to support this. Conclusions: Implementing an mHealth system can improve care among primary care patients with SUDs, and patients using the system can support one another in their recovery. Among clinicians, however, implementation requires figuring out how information from the mHealth system will be used and making mHealth data available in the electronic health (eHealth) record. In addition, paying for an mHealth system remains a challenge. %M 29382624 %R 10.2196/jmir.8928 %U http://www.jmir.org/2018/1/e37/ %U https://doi.org/10.2196/jmir.8928 %U http://www.ncbi.nlm.nih.gov/pubmed/29382624 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e42 %T Web-Delivered Cognitive Behavioral Therapy for Distressed Cancer Patients: Randomized Controlled Trial %A Chambers,Suzanne K %A Ritterband,Lee M %A Thorndike,Frances %A Nielsen,Lisa %A Aitken,Joanne F %A Clutton,Samantha %A Scuffham,Paul A %A Youl,Philippa %A Morris,Bronwyn %A Baade,Peter D %A Dunn,Jeff %+ Menzies Health Institute Queensland, Griffith University, Griffith Health Centre, Gold Coast,, Australia, 61 7 5678 8664, suzanne.chambers@griffith.edu.au %K cancer %K mental health %K psychological distress %K randomized controlled trial (RCT) %K health services delivery %D 2018 %7 31.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based interventions present a potentially cost-effective approach to supporting self-management for cancer patients; however, further evidence for acceptability and effectiveness is needed. Objective: The goal of our research was to assess the effectiveness of an individualized Web-based cognitive behavioral therapy (CBT) intervention on improving psychological and quality of life outcomes in cancer patients with elevated psychological distress. Methods: A total of 163 distressed cancer patients (111 female, 68.1%) were recruited through the Queensland Cancer Registry and the Cancer Council Queensland Cancer Helpline and randomly assigned to either a Web-based tailored CBT intervention (CancerCope) (79/163) or a static patient education website (84/163). At baseline and 8-week follow-up we assessed primary outcomes of psychological and cancer-specific distress and unmet psychological supportive care needs and secondary outcomes of positive adjustment and quality of life. Results: Intention-to-treat analyses showed no evidence of a statistically significant intervention effect on primary or secondary outcomes. However, per-protocol analyses found a greater decrease for the CancerCope group in psychological distress (P=.04), cancer-specific distress (P=.02), and unmet psychological care needs (P=.03) from baseline to 8 weeks compared with the patient education group. Younger patients were more likely to complete the CancerCope intervention. Conclusions: This online CBT intervention was associated with greater decreases in distress for those patients who more closely adhered to the program. Given the low costs and high accessibility of this intervention approach, even if only effective for subgroups of patients, the potential impact may be substantial. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12613001026718; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364768&isReview=true (Archived by WebCite at http://www.webcitation.org/6uPvpcovl) %M 29386173 %R 10.2196/jmir.8850 %U http://www.jmir.org/2018/1/e42/ %U https://doi.org/10.2196/jmir.8850 %U http://www.ncbi.nlm.nih.gov/pubmed/29386173 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e18 %T A Patient-Held Smartcard With a Unique Identifier and an mHealth Platform to Improve the Availability of Prenatal Test Results in Rural Nigeria: Demonstration Study %A Gbadamosi,Semiu Olatunde %A Eze,Chuka %A Olawepo,John Olajide %A Iwelunmor,Juliet %A Sarpong,Daniel F %A Ogidi,Amaka Grace %A Patel,Dina %A Oko,John Okpanachi %A Onoka,Chima %A Ezeanolue,Echezona Edozie %+ Global Health Initiative, School of Community Health Sciences, University of Nevada, Las Vegas, 4505 S. Maryland Parkway, Las Vegas, NV, 89154-1026, United States, 1 702 895 4950, semiu.gbadamosi@unlv.edu %K mHealth %K prenatal screening %K HIV %K hepatitis B %K sickle cell disease %K Nigeria %K telemedicine %K prenatal diagnosis %K infectious disease transmission, vertical %D 2018 %7 15.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Community-based strategies to test for HIV, hepatitis B virus (HBV), and sickle cell disease (SCD) have expanded opportunities to increase the proportion of pregnant women who are aware of their diagnosis. In order to use this information to implement evidence-based interventions, these results have to be available to skilled health providers at the point of delivery. Most electronic health platforms are dependent on the availability of reliable Internet connectivity and, thus, have limited use in many rural and resource-limited settings. Objective: Here we describe our work on the development and deployment of an integrated mHealth platform that is able to capture medical information, including test results, and encrypt it into a patient-held smartcard that can be read at the point of delivery without the need for an Internet connection. Methods: We engaged a team of implementation scientists, public health experts, and information technology specialists in a requirement-gathering process to inform the design of a prototype for a platform that uses smartcard technology, database deployment, and mobile phone app development. Key design decisions focused on usability, scalability, and security. Results: We successfully designed an integrated mHealth platform and deployed it in 4 health facilities across Benue State, Nigeria. We developed the Vitira Health platform to store test results of HIV, HBV, and SCD in a database, and securely encrypt the results on a Quick Response code embedded on a smartcard. We used a mobile app to read the contents on the smartcard without the need for Internet connectivity. Conclusions: Our findings indicate that it is possible to develop a patient-held smartcard and an mHealth platform that contains vital health information that can be read at the point of delivery using a mobile phone-based app without an Internet connection. Trial Registration: ClinicalTrials.gov NCT03027258; https://clinicaltrials.gov/ct2/show/NCT03027258 (Archived by WebCite at http://www.webcitation.org/6owR2D0kE) %M 29335234 %R 10.2196/jmir.8716 %U http://www.jmir.org/2018/1/e18/ %U https://doi.org/10.2196/jmir.8716 %U http://www.ncbi.nlm.nih.gov/pubmed/29335234 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e14 %T Leveraging Social Networking Sites for an Autoimmune Hepatitis Genetic Repository: Pilot Study to Evaluate Feasibility %A Comerford,Megan %A Fogel,Rachel %A Bailey,James Robert %A Chilukuri,Prianka %A Chalasani,Naga %A Lammert,Craig Steven %+ Division of Digestive and Liver Diseases, Indiana University School of Medicine, 702 Rotary Circle, Indianapolis, IN,, United States, 1 317 274 6492, clammert@iu.edu %K autoimmune hepatitis %K social media %K rare disease %D 2018 %7 18.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Conventional approaches to participant recruitment are often inadequate in rare disease investigation. Social networking sites such as Facebook may provide a vehicle to circumvent common research limitations and pitfalls. We report our preliminary experience with Facebook-based methodology for participant recruitment and participation into an ongoing study of autoimmune hepatitis (AIH). Objective: The goal of our research was to conduct a pilot study to assess whether a Facebook-based methodology is capable of recruiting geographically widespread participants into AIH patient-oriented research and obtaining quality phenotypic data. Methods: We established a Facebook community, the Autoimmune Hepatitis Research Network (AHRN), in 2014 to provide a secure and reputable distillation of current literature and AIH research opportunities. Quarterly advertisements for our ongoing observational AIH study were posted on the AHRN over 2 years. Interested and self-reported AIH participants were subsequently enrolled after review of study materials and completion of an informed consent by our study coordinator. Participants returned completed study materials, including epidemiologic questionnaires and genetic material, to our facility via mail. Outside medical records were obtained and reviewed by a study physician. Results: We successfully obtained all study materials from 29 participants with self-reported AIH within 2 years from 20 different states. Liver biopsy results were available for 90% (26/29) of participants, of which 81% (21/29) had findings consistent with AIH, 15% (4/29) were suggestive of AIH with features of primary biliary cholangitis (PBC), and 4% (1/29) had PBC alone. A total of 83% (24/29) had at least 2 of 3 proposed criteria: positive autoimmune markers, consistent histologic findings of AIH on liver biopsy, and reported treatment with immunosuppressant medications. Self-reported and physician records were discrepant for immunosuppressant medications or for AIH/PBC diagnoses in 4 patients. Conclusions: Facebook can be an effective ancillary tool for facilitating patient-oriented research in rare diseases. A social media-based approach transcends established limitations in rare disease research and can further develop research communities. %M 29348111 %R 10.2196/jmir.7683 %U http://www.jmir.org/2018/1/e14/ %U https://doi.org/10.2196/jmir.7683 %U http://www.ncbi.nlm.nih.gov/pubmed/29348111 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e2 %T From eHealth to iHealth: Transition to Participatory and Personalized Medicine in Mental Health %A Berrouiguet,Sofian %A Perez-Rodriguez,Mercedes M %A Larsen,Mark %A Baca-García,Enrique %A Courtet,Philippe %A Oquendo,Maria %+ Lab-STICC, IMT Atlantique, Université Bretagne Loire, Boulevard Tanguy Prigent, Technopole iroise, Brest,, France, 33 6 68 20 41 78, sofian.berrouiguet@gmail.com %K data mining %K decision making %K mobile phone %K Web app %K mental health %D 2018 %7 03.01.2018 %9 Viewpoint %J J Med Internet Res %G English %X Clinical assessment in psychiatry is commonly based on findings from brief, regularly scheduled in-person appointments. Although critically important, this approach reduces assessment to cross-sectional observations that miss essential information about disease course. The mental health provider makes all medical decisions based on this limited information. Thanks to recent technological advances such as mobile phones and other personal devices, electronic health (eHealth) data collection strategies now can provide access to real-time patient self-report data during the interval between visits. Since mobile phones are generally kept on at all times and carried everywhere, they are an ideal platform for the broad implementation of ecological momentary assessment technology. Integration of these tools into medical practice has heralded the eHealth era. Intelligent health (iHealth) further builds on and expands eHealth by adding novel built-in data analysis approaches based on (1) incorporation of new technologies into clinical practice to enhance real-time self-monitoring, (2) extension of assessment to the patient’s environment including caregivers, and (3) data processing using data mining to support medical decision making and personalized medicine. This will shift mental health care from a reactive to a proactive and personalized discipline. %M 29298748 %R 10.2196/jmir.7412 %U http://www.jmir.org/2018/1/e2/ %U https://doi.org/10.2196/jmir.7412 %U http://www.ncbi.nlm.nih.gov/pubmed/29298748 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e33 %T Gender Differences in and the Relationships Between Social Anxiety and Problematic Internet Use: Canonical Analysis %A Baloğlu,Mustafa %A Özteke Kozan,Hatice İrem %A Kesici,Şahin %+ Department of Special Education, Faculty of Education, Hacettepe University, Beytepe Campus, Ankara, 06610, Turkey, 90 3127806315, baloglu@hotmail.com %K anxiety %K Internet %K sex characteristics %K social anxiety disorder %K addictive behavior %D 2018 %7 24.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The cognitive-behavioral model of problematic Internet use (PIU) proposes that psychological well-being is associated with specific thoughts and behaviors on the Internet. Hence, there is growing concern that PIU is associated with psychological impairments. Objective: Given the proposal of gender schema theory and social role theory, men and women are predisposed to experience social anxiety and engage in Internet use differently. Thus, an investigation of gender differences in these areas is warranted. According to the cognitive-behavioral model of PIU, social anxiety is associated with specific cognitions and behaviors on the Internet. Thus, an investigation of the association between social anxiety and PIU is essential. In addition, research that takes into account the multidimensional nature of social anxiety and PIU is lacking. Therefore, this study aimed to explore multivariate gender differences in and the relationships between social anxiety and PIU. Methods: Participants included 505 college students, of whom 241 (47.7%) were women and 264 (52.3%) were men. Participants’ ages ranged from 18 to 22 years, with a mean age of 20.34 (SD=1.16). The Social Anxiety Scale and Problematic Internet Use Scale were used in data collection. Multivariate analysis of variance (MANOVA) and canonical correlation analysis were used. Results: Mean differences between men and women were not statistically significant in social anxiety (λ=.02, F3,501=2.47, P=.06). In all three PIU dimensions, men scored higher than women, and MANOVA shows that multivariate difference was statistically significant (λ=.94, F3,501=10.69, P<.001). Of the canonical correlation functions computed for men, only the first was significant (Rc=.43, λ=.78, χ29=64.7, P<.001) and accounted for 19% of the overlapping variance. Similarly, only the first canonical function was significant for women (Rc=.36, λ=.87, χ29=33.9, P<.001), which accounted for 13% of the overlapping variance. Conclusions: On the basis of the findings, we conclude that enhanced educational opportunities for women and their increasing role in the society have led women to become more active and thus closed the gap in social anxiety levels between men and women. We found that men showed more difficulties than women in terms of running away from personal problems (ie, social benefit), used the Internet more excessively, and experienced more interpersonal problems with significant others due to Internet use. We conclude that men are under a greater risk of social impairments due to PIU. Our overall conclusion is that there is a substantial amount of association between social anxiety and PIU and the association is stronger for men than it is for women. We advise that future research continue to investigate PIU and social anxiety as multidimensional constructs. %M 29367182 %R 10.2196/jmir.8947 %U http://www.jmir.org/2018/1/e33/ %U https://doi.org/10.2196/jmir.8947 %U http://www.ncbi.nlm.nih.gov/pubmed/29367182 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e4 %T Evidence From Web-Based Dietary Search Patterns to the Role of B12 Deficiency in Non-Specific Chronic Pain: A Large-Scale Observational Study %A Giat,Eitan %A Yom-Tov,Elad %+ Microsoft Research, 13 Shenkar St, Herzeliya, 46875, Israel, 972 747111359, eladyt@yahoo.com %K B12 deficiency %K diet %K Internet searches %K neuropsychiatric symptoms %K neuropathy %D 2018 %7 05.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Profound vitamin B12 deficiency is a known cause of disease, but the role of low or intermediate levels of B12 in the development of neuropathy and other neuropsychiatric symptoms, as well as the relationship between eating meat and B12 levels, is unclear. Objective: The objective of our study was to investigate the role of low or intermediate levels of B12 in the development of neuropathy and other neuropsychiatric symptoms. Methods: We used food-related Internet search patterns from a sample of 8.5 million people based in the US as a proxy for B12 intake and correlated these searches with Internet searches related to possible effects of B12 deficiency. Results: Food-related search patterns were highly correlated with known consumption and food-related searches (ρ=.69). Awareness of B12 deficiency was associated with a higher consumption of B12-rich foods and with queries for B12 supplements. Searches for terms related to neurological disorders were correlated with searches for B12-poor foods, in contrast with control terms. Popular medicines, those having fewer indications, and those which are predominantly used to treat pain, were more strongly correlated with the ability to predict neuropathic pain queries using the B12 contents of food. Conclusions: Our findings show that Internet search patterns are a useful way of investigating health questions in large populations, and suggest that low B12 intake may be associated with a broader spectrum of neurological disorders than previously thought. %M 29305340 %R 10.2196/jmir.8667 %U http://www.jmir.org/2018/1/e4/ %U https://doi.org/10.2196/jmir.8667 %U http://www.ncbi.nlm.nih.gov/pubmed/29305340 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e6 %T Relationship Between State-Level Google Online Search Volume and Cancer Incidence in the United States: Retrospective Study %A Phillips,Charles A %A Barz Leahy,Allison %A Li,Yimei %A Schapira,Marilyn M %A Bailey,L Charles %A Merchant,Raina M %+ Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia, University of Pennsylvania, Roberts Center for Pediatric Research, 11th Fl., 2716 South Street, Philadelphia, PA,, United States, 1 267 496 0161, phillipsc2@email.chop.edu %K Google %K cancer %K incidence %K Internet %K infodemiology %D 2018 %7 08.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: In the United States, cancer is common, with high morbidity and mortality; cancer incidence varies between states. Online searches reflect public awareness, which could be driven by the underlying regional cancer epidemiology. Objective: The objective of our study was to characterize the relationship between cancer incidence and online Google search volumes in the United States for 6 common cancers. A secondary objective was to evaluate the association of search activity with cancer-related public events and celebrity news coverage. Methods: We performed a population-based, retrospective study of state-level cancer incidence from 2004 through 2013 reported by the Centers for Disease Control and Prevention for breast, prostate, colon, lung, and uterine cancers and leukemia compared to Google Trends (GT) relative search volume (RSV), a metric designed by Google to allow interest in search topics to be compared between regions. Participants included persons in the United States who searched for cancer terms on Google. The primary measures were the correlation between annual state-level cancer incidence and RSV as determined by Spearman correlation and linear regression with RSV and year as independent variables and cancer incidence as the dependent variable. Temporal associations between search activity and events raising public awareness such as cancer awareness months and cancer-related celebrity news were described. Results: At the state level, RSV was significantly correlated to incidence for breast (r=.18, P=.001), prostate (r=–.27, P<.001), lung (r=.33, P<.001), and uterine cancers (r=.39, P<.001) and leukemia (r=.13, P=.003) but not colon cancer (r=–.02, P=.66). After adjusting for time, state-level RSV was positively correlated to cancer incidence for all cancers: breast (P<.001, 95% CI 0.06 to 0.19), prostate (P=.38, 95% CI –0.08 to 0.22), lung (P<.001, 95% CI 0.33 to 0.46), colon (P<.001, 95% CI 0.11 to 0.17), and uterine cancers (P<.001, 95% CI 0.07 to 0.12) and leukemia (P<.001, 95% CI 0.01 to 0.03). Temporal associations in GT were noted with breast cancer awareness month but not with other cancer awareness months and celebrity events. Conclusions: Cancer incidence is correlated with online search volume at the state level. Search patterns were temporally associated with cancer awareness months and celebrity announcements. Online searches reflect public awareness. Advancing understanding of online search patterns could augment traditional epidemiologic surveillance, provide opportunities for targeted patient engagement, and allow public information campaigns to be evaluated in ways previously unable to be measured. %M 29311051 %R 10.2196/jmir.8870 %U http://www.jmir.org/2018/1/e6/ %U https://doi.org/10.2196/jmir.8870 %U http://www.ncbi.nlm.nih.gov/pubmed/29311051 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e10 %T Exploring Entertainment Medicine and Professionalization of Self-Care: Interview Study Among Doctors on the Potential Effects of Digital Self-Tracking %A Gabriels,Katleen %A Moerenhout,Tania %+ Philosophy & Ethics, Department of Industrial Engineering & Innovation Sciences, Eindhoven University of Technology, Office: IPO 1.07, Postbus 513, Eindhoven, 5600 MB, Netherlands, 31 40 247 5161, k.gabriels@tue.nl %K mobile applications %K wearable electronic devices %K self-recorded health data %K self care %K quantified self %K qualitative research %D 2018 %7 12.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Nowadays, digital self-tracking devices offer a plethora of possibilities to both healthy and chronically ill users who want to closely examine their body. This study suggests that self-tracking in a private setting will lead to shifting understandings in professional care. To provide more insight into these shifts, this paper seeks to lay bare the promises and challenges of self-tracking while staying close to the everyday professional experience of the physician. Objective: The aim of this study was to (1) offer an analysis of how medical doctors evaluate self-tracking methods in their practice and (2) explore the anticipated shifts that digital self-care will bring about in relation to our findings and those of other studies. Methods: A total of 12 in-depth semistructured interviews with general practitioners (GPs) and cardiologists were conducted in Flanders, Belgium, from November 2015 to November 2016. Thematic analysis was applied to examine the transcripts in an iterative process. Results: Four major themes arose in our body of data: (1) the patient as health manager, (2) health obsession and medicalization, (3) information management, and (4) shifting roles of the doctors and impact on the health care organization. Our research findings show a nuanced understanding of the potentials and pitfalls of different forms of self-tracking. The necessity of contextualization of self-tracking data and a professionalization of self-care through digital devices come to the fore as important overarching concepts. Conclusions: This interview study with Belgian doctors examines the potentials and challenges of self-monitoring while focusing on the everyday professional experience of the physician. The dialogue between our dataset and the existing literature affords a fine-grained image of digital self-care and its current meaning in a medical-professional landscape. %M 29330140 %R 10.2196/jmir.8040 %U http://www.jmir.org/2018/1/e10/ %U https://doi.org/10.2196/jmir.8040 %U http://www.ncbi.nlm.nih.gov/pubmed/29330140 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e26 %T A Natural Language Processing System That Links Medical Terms in Electronic Health Record Notes to Lay Definitions: System Development Using Physician Reviews %A Chen,Jinying %A Druhl,Emily %A Polepalli Ramesh,Balaji %A Houston,Thomas K %A Brandt,Cynthia A %A Zulman,Donna M %A Vimalananda,Varsha G %A Malkani,Samir %A Yu,Hong %+ Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, United States, 1 774 455 3527, jinying.chen@umassmed.edu %K electronic health records %K natural language processing %K consumer health informatics %K usability testing %K computer software %D 2018 %7 22.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Many health care systems now allow patients to access their electronic health record (EHR) notes online through patient portals. Medical jargon in EHR notes can confuse patients, which may interfere with potential benefits of patient access to EHR notes. Objective: The aim of this study was to develop and evaluate the usability and content quality of NoteAid, a Web-based natural language processing system that links medical terms in EHR notes to lay definitions, that is, definitions easily understood by lay people. Methods: NoteAid incorporates two core components: CoDeMed, a lexical resource of lay definitions for medical terms, and MedLink, a computational unit that links medical terms to lay definitions. We developed innovative computational methods, including an adapted distant supervision algorithm to prioritize medical terms important for EHR comprehension to facilitate the effort of building CoDeMed. Ten physician domain experts evaluated the user interface and content quality of NoteAid. The evaluation protocol included a cognitive walkthrough session and a postsession questionnaire. Physician feedback sessions were audio-recorded. We used standard content analysis methods to analyze qualitative data from these sessions. Results: Physician feedback was mixed. Positive feedback on NoteAid included (1) Easy to use, (2) Good visual display, (3) Satisfactory system speed, and (4) Adequate lay definitions. Opportunities for improvement arising from evaluation sessions and feedback included (1) improving the display of definitions for partially matched terms, (2) including more medical terms in CoDeMed, (3) improving the handling of terms whose definitions vary depending on different contexts, and (4) standardizing the scope of definitions for medicines. On the basis of these results, we have improved NoteAid’s user interface and a number of definitions, and added 4502 more definitions in CoDeMed. Conclusions: Physician evaluation yielded useful feedback for content validation and refinement of this innovative tool that has the potential to improve patient EHR comprehension and experience using patient portals. Future ongoing work will develop algorithms to handle ambiguous medical terms and test and evaluate NoteAid with patients. %M 29358159 %R 10.2196/jmir.8669 %U http://www.jmir.org/2018/1/e26/ %U https://doi.org/10.2196/jmir.8669 %U http://www.ncbi.nlm.nih.gov/pubmed/29358159 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e31 %T eHealth Technologies, Multimorbidity, and the Office Visit: Qualitative Interview Study on the Perspectives of Physicians and Nurses %A Macdonald,Graham G %A Townsend,Anne F %A Adam,Paul %A Li,Linda C %A Kerr,Sheila %A McDonald,Michael %A Backman,Catherine L %+ Arthritis Research Canada, 5591 No 3 Road, Richmond, BC,, Canada, 1 6046794405, gmacdonald@arthritisresearch.ca %K eHealth %K patient-physician relationship %K relational ethics %K multimorbidity %K online information seeking %K email %K office visit %K health professional perspective %D 2018 %7 26.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth is a broad term referring to the application of information and communication technologies in the health sector, ranging from health records to telemedicine and multiple forms of health education and digital tools. By providing increased and anytime access to information, opportunities to exchange experiences with others, and self-management support, eHealth has been heralded as transformational. It has created a group of informed, engaged, and empowered patients as partners, equipped to take part in shared decision making and effectively self-manage chronic illness. Less attention has been given to health care professionals’ (HCPs) experiences of the role of eHealth in patient encounters. Objective: The objective of this study was to examine HCPs’ perspectives on how eHealth affects their relationships with patients living with multiple chronic conditions, as well as its ethical and practical ramifications. Methods: We interviewed HCPs about their experiences with eHealth and its impact on the office visit. Eligible participants needed to report a caseload of ≥25% of patients with multimorbidity to address issues of managing complex chronic conditions and coordination of care. We used a semistructured discussion guide for in-depth interviews, and follow-up interviews served to clarify and expand upon initial discussions. Constant comparisons and a narrative approach guided the analyses, and a relational ethics conceptual lens was applied to the data to identify emergent themes. Results: A total of 12 physicians and nurses (6 male, 6 female; median years of practice=13) participated. eHealth tools most frequently described were Web-based educational resources for patients and Web-based resources for HCPs such as curated scientific summaries on diagnostic criteria, clinical therapies, and dosage calculators. Analysis centered on a grand theme of the two-way conversation between HCPs and patients, which addresses a general recentering of the ethical relationship between HCPs and patients around engagement. Subthemes explain the evolution of the two-way conversation, and having, using, and supporting the two-way conversation with patients, primarily as this relates to achieving adherence and health outcomes. Conclusions: Emerging ethical concerns were related to the ambiguity of the ideal of empowered patients and the ways in which health professionals described enacting those ideals in practice, showing how the cultural shift toward truly mutually respectful and collaborative practice is in transition. HCPs aim to act in the best interests of their patients; the challenge is to benefit from emergent technologies that may enhance patient-HCP interactions and effective care, while abiding by regulations, dealing with the strictures of the technology itself, and managing changing demands on their time. %M 29374004 %R 10.2196/jmir.8983 %U http://www.jmir.org/2018/1/e31/ %U https://doi.org/10.2196/jmir.8983 %U http://www.ncbi.nlm.nih.gov/pubmed/29374004 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e16 %T Evaluation Criteria of Noninvasive Telemonitoring for Patients With Heart Failure: Systematic Review %A Farnia,Troskah %A Jaulent,Marie-Christine %A Steichen,Olivier %+ Department of Internal Medicine, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, 4 Rue de la Chine, Paris,, France, 33 1 56 01 78 31, olivier.steichen@aphp.fr %K telemedicine %K outcome and process assessment (health care) %K program evaluation %K heart failure %D 2018 %7 16.01.2018 %9 Review %J J Med Internet Res %G English %X Background: Telemonitoring can improve heart failure (HF) management, but there is no standardized evaluation framework to comprehensively evaluate its impact. Objective: Our objectives were to list the criteria used in published evaluations of noninvasive HF telemonitoring projects, describe how they are used in the evaluation studies, and organize them into a consistent scheme. Methods: Articles published from January 1990 to August 2015 were obtained through MEDLINE, Web of Science, and EMBASE. Articles were eligible if they were original reports of a noninvasive HF telemonitoring evaluation study in the English language. Studies of implantable telemonitoring devices were excluded. Each selected article was screened to extract the description of the telemonitoring project and the evaluation process and criteria. A qualitative synthesis was performed. Results: We identified and reviewed 128 articles leading to 52 evaluation criteria classified into 6 dimensions: clinical, economic, user perspective, educational, organizational, and technical. The clinical and economic impacts were evaluated in more than 70% of studies, whereas the educational, organizational, and technical impacts were studied in fewer than 15%. User perspective was the most frequently covered dimension in the development phase of telemonitoring projects, whereas clinical and economic impacts were the focus of later phases. Conclusions: Telemonitoring evaluation frameworks should cover all 6 dimensions appropriately distributed along the telemonitoring project lifecycle. Our next goal is to build such a comprehensive evaluation framework for telemonitoring and test it on an ongoing noninvasive HF telemonitoring project. %M 29339348 %R 10.2196/jmir.7873 %U http://www.jmir.org/2018/1/e16/ %U https://doi.org/10.2196/jmir.7873 %U http://www.ncbi.nlm.nih.gov/pubmed/29339348 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e23 %T Effect of Contract Compliance Rate to a Fourth-Generation Telehealth Program on the Risk of Hospitalization in Patients With Chronic Kidney Disease: Retrospective Cohort Study %A Hung,Chi-Sheng %A Lee,Jenkuang %A Chen,Ying-Hsien %A Huang,Ching-Chang %A Wu,Vin-Cent %A Wu,Hui-Wen %A Chuang,Pao-Yu %A Ho,Yi-Lwun %+ Telehealth Center, National Taiwan University Hospital, #7, Chung-Shan South Road, Taipei,, Taiwan, 886 2 2312 3456, ylho@ntu.edu.tw %K telehealth %K contract compliance rate %K chronic kidney disease %D 2018 %7 24.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic kidney disease (CKD) is prevalent in Taiwan and it is associated with high all-cause mortality. We have shown in a previous paper that a fourth-generation telehealth program is associated with lower all-cause mortality compared to usual care with a hazard ratio of 0.866 (95% CI 0.837-0.896). Objective: This study aimed to evaluate the effect of renal function status on hospitalization among patients receiving this program and to evaluate the relationship between contract compliance rate to the program and risk of hospitalization in patients with CKD. Methods: We retrospectively analyzed 715 patients receiving the telehealth care program. Contract compliance rate was defined as the percentage of days covered by the telehealth service before hospitalization. Patients were stratified into three groups according to renal function status: (1) normal renal function, (2) CKD, or (3) end-stage renal disease (ESRD) and on maintenance dialysis. The outcome measurements were first cardiovascular and all-cause hospitalizations. The association between contract compliance rate, renal function status, and hospitalization risk was analyzed with a Cox proportional hazards model with time-dependent covariates. Results: The median follow-up duration was 694 days (IQR 338-1163). Contract compliance rate had a triphasic relationship with cardiovascular and all-cause hospitalizations. Patients with low or very high contract compliance rates were associated with a higher risk of hospitalization. Patients with CKD or ESRD were also associated with a higher risk of hospitalization. Moreover, we observed a significant interaction between the effects of renal function status and contract compliance rate on the risk of hospitalization: patients with ESRD, who were on dialysis, had an increased risk of hospitalization at a lower contract compliance rate, compared with patients with normal renal function or CKD. Conclusions: Our study showed that there was a triphasic relationship between contract compliance rate to the telehealth program and risk of hospitalization. Renal function status was associated with risk of hospitalization among these patients, and there was a significant interaction with contract compliance rate. %M 29367185 %R 10.2196/jmir.8914 %U http://www.jmir.org/2018/1/e23/ %U https://doi.org/10.2196/jmir.8914 %U http://www.ncbi.nlm.nih.gov/pubmed/29367185 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e38 %T Remote Collaborative Depression Care Program for Adolescents in Araucanía Region, Chile: Randomized Controlled Trial %A Martínez,Vania %A Rojas,Graciela %A Martínez,Pablo %A Zitko,Pedro %A Irarrázaval,Matías %A Luttges,Carolina %A Araya,Ricardo %+ Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Av. La Paz 1003, Recoleta, Santiago,, Chile, 56 229788601, graciela.rojas.castillo@gmail.com %K primary health care %K depression %K adolescents %K Internet %K telemedicine %K medically underserved area %D 2018 %7 31.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite evidence on efficacious interventions, a great proportion of depressed adolescents do not receive evidence-based treatment and have no access to specialized mental health care. Remote collaborative depression care (RCDC) may help to reduce the gap between needs and specialized mental health services. Objective: The objective of this study was to assess the feasibility, acceptability, and effectiveness of an RCDC intervention for adolescents with major depressive disorder (MDD) living in the Araucanía Region, Chile. Methods: A cluster randomized, assessor-blind trial was carried out at 16 primary care centers in the Araucanía Region, Chile. Before randomization, all participating primary care teams were trained in clinical guidelines for the treatment of adolescent depression. Adolescents (N=143; 13-19 years) with MDD were recruited. The intervention group (RCDC, N=65) received a 3-month RCDC treatment that included continuous remote supervision by psychiatrists located in Santiago, Chile’s capital city, through shared electronic health records (SEHR) and phone patient monitoring. The control group (enhanced usual care or EUC; N=78) received EUC by clinicians who were encouraged to follow clinical guidelines. Recruitment and response rates and the use of the SEHR system were registered; patient adherence and satisfaction with the treatment and clinician satisfaction with RCDC were assessed at 12-week follow-up; and depressive symptoms and health-related quality of life (HRQoL) were evaluated at baseline and 12-weeks follow-up. Results: More than 60.3% (143/237) of the original estimated sample size was recruited, and a response rate of 90.9% (130/143) was achieved at 12-week follow-up. A mean (SD) of 3.5 (4.0) messages per patient were written on the SEHR system by primary care teams. A third of the patients showed an optimal adherence to psychopharmacological treatment, and adolescents in the RCDC intervention group were more satisfied with psychological assistance than those in EUC group. Primary care clinicians were satisfied with the RCDC intervention, valuing its usefulness. There were no significant differences in depressive symptoms or HRQoL between groups. Satisfaction with psychological care, in both groups, was related to a significant change in depressive symptomatology at 12-weeks follow-up (beta=−4.3, 95% CI −7.2 to −1.3). Conclusions: This is the first trial of its kind in Latin America that includes adolescents from vulnerable backgrounds, with an intervention that proved to be feasible and well accepted by both patients and primary care clinicians. Design and implementation issues may explain similar effectiveness across arms. The effectiveness of the intervention seems to be comparable with an already nationwide established treatment program that proved to be highly efficacious under controlled conditions. Trial Registration: ClinicalTrials.gov: NCT01860443; https://clinicaltrials.gov/ct2/show/NCT01860443 (Archived by WebCite at http://www.webcitation.org/6wafMKlTY) %M 29386172 %R 10.2196/jmir.8021 %U https://www.jmir.org/2018/1/e38/ %U https://doi.org/10.2196/jmir.8021 %U http://www.ncbi.nlm.nih.gov/pubmed/29386172 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e24 %T Paper- or Web-Based Questionnaire Invitations as a Method for Data Collection: Cross-Sectional Comparative Study of Differences in Response Rate, Completeness of Data, and Financial Cost %A Ebert,Jonas Fynboe %A Huibers,Linda %A Christensen,Bo %A Christensen,Morten Bondo %+ Department of Public Health, Research Unit for General Practice, Aarhus University, Bartholins Allé 2, Aarhus, 8000, Denmark, 45 25309292, jonasebert@ph.au.dk %K questionnaire study %K response rate %K completeness of data %K financial costs %K missing values %K selection bias %K digital post %K digital survey invitation %K Web-based questionnaire %D 2018 %7 23.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Paper questionnaires have traditionally been the first choice for data collection in research. However, declining response rates over the past decade have increased the risk of selection bias in cross-sectional studies. The growing use of the Internet offers new ways of collecting data, but trials using Web-based questionnaires have so far seen mixed results. A secure, online digital mailbox (e-Boks) linked to a civil registration number became mandatory for all Danish citizens in 2014 (exemption granted only in extraordinary cases). Approximately 89% of the Danish population have a digital mailbox, which is used for correspondence with public authorities. Objective: We aimed to compare response rates, completeness of data, and financial costs for different invitation methods: traditional surface mail and digital mail. Methods: We designed a cross-sectional comparative study. An invitation to participate in a survey on help-seeking behavior in out-of-hours care was sent to two groups of randomly selected citizens from age groups 30-39 and 50-59 years and parents to those aged 0-4 years using either traditional surface mail (paper group) or digital mail sent to a secure online mailbox (digital group). Costs per respondent were measured by adding up all costs for handling, dispatch, printing, and work salary and then dividing the total figure by the number of respondents. Data completeness was assessed by comparing the number of missing values between the two methods. Socioeconomic variables (age, gender, family income, education duration, immigrant status, and job status) were compared both between respondents and nonrespondents and within these groups to evaluate the degree of selection bias. Results: A total 3600 citizens were invited in each group; 1303 (36.29%) responded to the digital invitation and 1653 (45.99%) to the paper invitation (difference 9.66%, 95% CI 7.40-11.92). The costs were €1.51 per respondent for the digital group and €15.67 for paper group respondents. Paper questionnaires generally had more missing values; this was significant in five of 17 variables (P<.05). Substantial differences were found in the socioeconomic variables between respondents and nonrespondents, whereas only minor differences were seen within the groups of respondents and nonrespondents. Conclusions: Although we found lower response rates for Web-based invitations, this solution was more cost-effective (by a factor of 10) and had slightly lower numbers of missing values than questionnaires sent with paper invitations. Analyses of socioeconomic variables showed almost no difference between nonrespondents in both groups, which could imply that the lower response rate in the digital group does not necessarily increase the level of selection bias. Invitations to questionnaire studies via digital mail may be an excellent option for collecting research data in the future. This study may serve as the foundational pillar of digital data collection in health care research in Scandinavia and other countries considering implementing similar systems. %M 29362206 %R 10.2196/jmir.8353 %U http://www.jmir.org/2018/1/e24/ %U https://doi.org/10.2196/jmir.8353 %U http://www.ncbi.nlm.nih.gov/pubmed/29362206 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e32 %T Intrapersonal Variation in Goal Setting and Achievement in Health Coaching: Cross-Sectional Retrospective Analysis %A Wallace,Anne M %A Bogard,Matthew T %A Zbikowski,Susan M %+ Wellness Science and Analytics, Humana, Inc, 500 West Main Street, Louisville, KY, 40202, United States, 1 513 768 2615, awallace44@gmail.com %K health coaching %K health risks %K chronic conditions %K behavior change %D 2018 %7 26.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic conditions in the United States are among the most costly and preventable of all health problems. Research suggests health coaching is an effective strategy for reducing health risks including decreases in weight, blood pressure, lipids, and blood glucose. Much less is known about how and when coaching works. Objective: The aim of this study was to conduct an analysis of intrapersonal variations in participants’ progression in health coaching, examining gender and age-related differences. Methods: This was a cross-sectional, retrospective analysis of 35,333 health coaching participants between 2012 and 2016. Differences in number of goals and activities set and completed, and number of interactions were assessed using negative binomial models. Differences in goal type were assessed using logistic regression for gender and using the Welch test for age to account for unequal variances. Results: Participants choosing online coaching were more likely to be younger and female (P<.001). Gender and age differences were found for the types of goals set by participants. Regarding program activity, women set and completed 12% more action steps than men (P<.001), averaging 21% more interactions than men (P<.001); no gender differences were found in number of goals completed (P=.12), although the percentage of males and females completing goals was significantly different at 60 and 120 days postenrollment (P<.001). Results indicated significant age-related differences in all aspects of program activity: number of interactions, goals set and completed, action steps set and completed (all P values <.01), as well as significant differences in percentage of individuals completing initial goals within 30 days, with older individuals completing more than younger individuals did (all P values <.001). Conclusions: This study found significant intrapersonal variation in how people participate in and progress through a coaching program. Age-related variations were found in all aspects of coaching activity, from modality preference and initial choice of goal type (eg, weight management, tobacco cessation) to goal completion, whereas gender-related differences were demonstrated for all program activities except number of goals set and completed. These findings indicate that to maximize behavior change, coaches need to personalize the coaching experience to the individual. %M 29374005 %R 10.2196/jmir.8892 %U http://www.jmir.org/2018/1/e32/ %U https://doi.org/10.2196/jmir.8892 %U http://www.ncbi.nlm.nih.gov/pubmed/29374005 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e7 %T Identifying Opinion Leaders to Promote Organ Donation on Social Media: Network Study %A Shi,Jingyuan %A Salmon,Charles T %+ Department of Communication Studies, Hong Kong Baptist University, 5 Hereford Road, Communication and Visual Arts Building, Kowloon Tong, Hong Kong,, China (Hong Kong), 852 34118137, jolieshi@hkbu.edu.hk %K social media %K health promotion %K organ donation %K opinion leaders %K social network analysis %D 2018 %7 09.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: In the recent years, social networking sites (SNSs, also called social media) have been adopted in organ donation campaigns, and recruiting opinion leaders for such campaigns has been found effective in promoting behavioral changes. Objective: The aim of this paper was to focus on the dissemination of organ donation tweets on Weibo, the Chinese equivalent of Twitter, and to examine the opinion leadership in the retweet network of popular organ donation messages using social network analysis. It also aimed to investigate how personal and social attributes contribute to a user’s opinion leadership on the topic of organ donation. Methods: All messages about organ donation posted on Weibo from January 1, 2015 to December 31, 2015 were extracted using Python Web crawler. A retweet network with 505,047 nodes and 545,312 edges of the popular messages (n=206) was constructed and analyzed. The local and global opinion leaderships were measured using network metrics, and the roles of personal attributes, professional knowledge, and social positions in obtaining the opinion leadership were examined using general linear model. Results: The findings revealed that personal attributes, professional knowledge, and social positions predicted individual’s local opinion leadership in the retweet network of popular organ donation messages. Alternatively, personal attributes and social positions, but not professional knowledge, were significantly associated with global opinion leadership. Conclusions: The findings of this study indicate that health campaign designers may recruit peer leaders in SNS organ donation promotions to facilitate information sharing among the target audience. Users who are unverified, active, well connected, and experienced with information and communications technology (ICT) will accelerate the sharing of organ donation messages in the global environment. Medical professionals such as organ transplant surgeons who can wield a great amount of influence on their direct connections could also effectively participate in promoting organ donation on social media. %M 29317384 %R 10.2196/jmir.7643 %U http://www.jmir.org/2018/1/e7/ %U https://doi.org/10.2196/jmir.7643 %U http://www.ncbi.nlm.nih.gov/pubmed/29317384 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 12 %P e426 %T Efficacy of a Web-Based Safety Decision Aid for Women Experiencing Intimate Partner Violence: Randomized Controlled Trial %A Koziol-McLain,Jane %A Vandal,Alain C %A Wilson,Denise %A Nada-Raja,Shyamala %A Dobbs,Terry %A McLean,Christine %A Sisk,Rose %A Eden,Karen B %A Glass,Nancy E %+ Centre for Interdisciplinary Trauma Research, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand, 64 9 921 9670, jane.koziol-mclain@aut.ac.nz %K eHealth %K intimate partner violence %K randomized controlled trial %K New Zealand %K depression %K population groups %D 2018 %7 10.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Intimate partner violence (IPV) is a human rights violation and leading health burden for women. Safety planning is a hallmark of specialist family violence intervention, yet only a small proportion of women access formal services. A Web-based safety decision aid may reach a wide audience of women experiencing IPV and offer the opportunity to prioritize and plan for safety for themselves and their families. Objective: The aim of this study was to test the efficacy of a Web-based safety decision aid (isafe) for women experiencing IPV. Methods: We conducted a fully automated Web-based two-arm parallel randomized controlled trial (RCT) in a general population of New Zealand women who had experienced IPV in the past 6 months. Computer-generated randomization was based on a minimization scheme with stratification by severity of violence and children. Women were randomly assigned to the password-protected intervention website (safety priority setting, danger assessment, and tailored action plan components) or control website (standard, nonindividualized information). Primary endpoints were self-reported mental health (Center for Epidemiologic Studies Depression Scale-Revised, CESD-R) and IPV exposure (Severity of Violence Against Women Scale, SVAWS) at 12-month follow-up. Analyses were by intention to treat. Results: Women were recruited from September 2012 to September 2014. Participants were aged between 16 and 60 years, 27% (111/412) self-identified as Māori (indigenous New Zealand), and 51% (210/412) reported at baseline that they were unsure of their future plans for their partner relationship. Among the 412 women recruited, retention at 12 months was 87%. The adjusted estimated intervention effect for SVAWS was −12.44 (95% CI −23.35 to −1.54) for Māori and 0.76 (95% CI −5.57 to 7.09) for non-Māori. The adjusted intervention effect for CESD-R was −7.75 (95% CI −15.57 to 0.07) for Māori and 1.36 (−3.16 to 5.88) for non-Māori. No study-related adverse events were reported. Conclusions: The interactive, individualized Web-based isafe decision aid was effective in reducing IPV exposure limited to indigenous Māori women. Discovery of a treatment effect in a population group that experiences significant health disparities is a welcome, important finding. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12612000708853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12612000708853 (Archived by Webcite at http://www.webcitation/61MGuVXdK) %M 29321125 %R 10.2196/jmir.8617 %U http://www.jmir.org/2017/12/e426/ %U https://doi.org/10.2196/jmir.8617 %U http://www.ncbi.nlm.nih.gov/pubmed/29321125 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e13 %T Testimonials and Informational Videos on Branded Prescription Drug Websites: Experimental Study to Assess Influence on Consumer Knowledge and Perceptions %A Sullivan,Helen W %A O'Donoghue,Amie C %A Gard Read,Jennifer %A Amoozegar,Jacqueline B %A Aikin,Kathryn J %A Rupert,Douglas J %+ US Food and Drug Administration, 10903 New Hampshire Ave, Bldg 51, Silver Spring, MD, 20993, United States, 1 301 796 1200, helen.sullivan@fda.hhs.gov %K Internet %K marketing %K drug prescriptions %K risk %D 2018 %7 23.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Direct-to-consumer (DTC) promotion of prescription drugs can affect consumer behaviors and health outcomes, and Internet drug promotion is growing rapidly. Branded drug websites often capitalize on the multimedia capabilities of the Internet by using videos to emphasize drug benefits and characteristics. However, it is unknown how such videos affect consumer processing of drug information. Objective: This study aimed to examine how videos on prescription drug websites, and the inclusion of risk information in those videos, influence consumer knowledge and perceptions. Methods: We conducted an experimental study in which online panel participants with acid reflux (n=1070) or high blood pressure (n=1055) were randomly assigned to view 1 of the 10 fictitious prescription drug websites and complete a short questionnaire. On each website, we manipulated the type of video (patient testimonial, mechanism of action animation, or none) and whether the video mentioned drug risks. Results: Participants who viewed any video were less likely to recognize drug risks presented only in the website text (P≤.01). Including risk information in videos increased participants’ recognition of the risks presented in the videos (P≤.01). However, in some cases, including risk information in videos decreased participants’ recognition of the risks not presented in the videos (ie, risks presented in text only; P≤.04). Participants who viewed a video without drug risk information thought that the website placed more emphasis on benefits, compared with participants who viewed the video with drug risk information (P≤.01). Compared with participants who viewed a video without drug risk information, participants who viewed a video with drug risk information thought that the drug was less effective in the high blood pressure sample (P=.03) and thought that risks were more serious in the acid reflux sample (P=.01). There were no significant differences between risk and nonrisk video conditions on other perception measures (P>.05). In addition, we noted a few differences among the types of videos. Conclusions: Including risks in branded drug website videos may increase in-video risk retention at the expense of text-only risk retention. %M 29362205 %R 10.2196/jmir.7959 %U http://www.jmir.org/2018/1/e13/ %U https://doi.org/10.2196/jmir.7959 %U http://www.ncbi.nlm.nih.gov/pubmed/29362205 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e11 %T “Why Do They Need to Check Me?” Patient Participation Through eHealth and the Doctor-Patient Relationship: Qualitative Study %A Grünloh,Christiane %A Myreteg,Gunilla %A Cajander,Åsa %A Rexhepi,Hanife %+ Institute of Informatics, Technische Hochschule Köln, University of Applied Sciences, Steinmüllerallee 1, Gummersbach, 51643, Germany, 49 2261 8196 6238, christiane.gruenloh@th-koeln.de %K patient accessible electronic health records %K medical records %K personal health records %K eHealth services for patients %K patient portal %K physicians %K patient empowerment %K patient participation %K doctor-patient relationship %D 2018 %7 15.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Roles in the doctor-patient relationship are changing and patient participation in health care is increasingly emphasized. Electronic health (eHealth) services such as patient accessible electronic health records (PAEHRs) have been implemented to support patient participation. Little is known about practical use of PAEHR and its effect on roles of doctors and patients. Objective: This qualitative study aimed to investigate how physicians view the idea of patient participation, in particular in relation to the PAEHR system. Hereby, the paper aims to contribute to a deeper understanding of physicians’ constructions of PAEHR, roles in the doctor-patient relationship, and levels and limits of involvement. Methods: A total of 12 semistructured interviews were conducted with physicians in different fields. Interviews were transcribed, translated, and a theoretically informed thematic analysis was performed. Results: Two important aspects were identified that are related to the doctor-patient relationship: roles and involvement. The physicians viewed their role as being the ones to take on the responsibility, determining treatment options, and to be someone who should be trusted. In relation to the patient’s role, lack of skills (technical or regarding medical jargon), motives to read, and patients’ characteristics were aspects identified in the interviews. Patients were often referred to as static entities disregarding their potential to develop skills and knowledge over time. Involvement captures aspects that support or hinder patients to take an active role in their care. Conclusions: Literature of at least two decades suggests an overall agreement that the paternalistic approach in health care is inappropriate, and a collaborative process with patients should be adopted. Although the physicians in this study stated that they, in principle, were in favor of patient participation, the analysis found little support in their descriptions of their daily practice that participation is actualized. As seen from the results, paternalistic practices are still present, even if professionals might not be aware of this. This can create a conflict between patients who strive to become more informed and their questions being interpreted as signs of critique and mistrust toward the physician. We thus believe that the full potential of PAEHRs is not reached yet and argue that the concept of patient empowerment is problematic as it triggers an interpretation of “power” in health care as a zero-sum, which is not helpful for the maintenance of the relationship between the actors. Patient involvement is often discussed merely in relation to decision making; however, this study emphasizes the need to include also sensemaking and learning activities. This would provide an alternative understanding of patients asking questions, not in terms of “monitoring the doctor” but to make sense of the situation. %M 29335237 %R 10.2196/jmir.8444 %U http://www.jmir.org/2018/1/e11/ %U https://doi.org/10.2196/jmir.8444 %U http://www.ncbi.nlm.nih.gov/pubmed/29335237 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e19 %T The Use of Online Health Forums by Patients With Chronic Cough: Qualitative Study %A Sinha,Ashnish %A Porter,Tom %A Wilson,Andrew %+ Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom, 44 1603 591257, ashnish@doctors.org.uk %K cough %K chronic disease %K Internet %K eHealth %K health impact assessment %K information systems %K help-seeking behavior %K social support %D 2018 %7 24.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Online health discussion forums are used by different patient groups for sharing advice and information. Chronic cough is a common problem, and people with chronic cough use online health forums alongside formal medical therapies. Objective: The objective of this study was to assess how chronic cough sufferers use online health forums, including the treatment advice they share with one another and the possible clinical uses of online forums in chronic cough. Methods: Three open-access health forums were searched for threads related to chronic cough. Identified threads were screened against inclusion and exclusion criteria adapted from the British Thoracic Society (BTS) Guidelines related to chronic cough diagnosis. Included data were subjected to qualitative thematic analysis. All study data were cross-validated by a second author and discrepancies were resolved. Results: In total, 96 threads were included in the analysis, consisting of posts by 223 forum users. Three main themes were identified: the effect of chronic cough on the lives of patients, the treatment advice shared between users, and the provision of support within forums. Conclusions: Chronic cough symptoms had impacts on multiple aspects of patients’ health and well-being. To try and combat these issues, forum users suggested a variety of treatments to one another, ranging from mainstream traditional therapies to odd alternative remedies. The provision of support and empathy were also prominent themes in discussion threads. Online forums themselves may provide increasing benefit to users through the addition of a moderator. %M 29367181 %R 10.2196/jmir.7975 %U http://www.jmir.org/2018/1/e19/ %U https://doi.org/10.2196/jmir.7975 %U http://www.ncbi.nlm.nih.gov/pubmed/29367181 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e22 %T Prediction of Incident Hypertension Within the Next Year: Prospective Study Using Statewide Electronic Health Records and Machine Learning %A Ye,Chengyin %A Fu,Tianyun %A Hao,Shiying %A Zhang,Yan %A Wang,Oliver %A Jin,Bo %A Xia,Minjie %A Liu,Modi %A Zhou,Xin %A Wu,Qian %A Guo,Yanting %A Zhu,Chunqing %A Li,Yu-Ming %A Culver,Devore S %A Alfreds,Shaun T %A Stearns,Frank %A Sylvester,Karl G %A Widen,Eric %A McElhinney,Doff %A Ling,Xuefeng %+ Department of Surgery, Stanford University, S370, 300 Pasteur Drive, Stanford, CA, 94305, United States, 1 6504279198, bxling@stanford.edu %K hypertension %K risk assessment %K electronic health records %K multiple chronic conditions %K mental disorders %K social determinants of health %D 2018 %7 30.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: As a high-prevalence health condition, hypertension is clinically costly, difficult to manage, and often leads to severe and life-threatening diseases such as cardiovascular disease (CVD) and stroke. Objective: The aim of this study was to develop and validate prospectively a risk prediction model of incident essential hypertension within the following year. Methods: Data from individual patient electronic health records (EHRs) were extracted from the Maine Health Information Exchange network. Retrospective (N=823,627, calendar year 2013) and prospective (N=680,810, calendar year 2014) cohorts were formed. A machine learning algorithm, XGBoost, was adopted in the process of feature selection and model building. It generated an ensemble of classification trees and assigned a final predictive risk score to each individual. Results: The 1-year incident hypertension risk model attained areas under the curve (AUCs) of 0.917 and 0.870 in the retrospective and prospective cohorts, respectively. Risk scores were calculated and stratified into five risk categories, with 4526 out of 381,544 patients (1.19%) in the lowest risk category (score 0-0.05) and 21,050 out of 41,329 patients (50.93%) in the highest risk category (score 0.4-1) receiving a diagnosis of incident hypertension in the following 1 year. Type 2 diabetes, lipid disorders, CVDs, mental illness, clinical utilization indicators, and socioeconomic determinants were recognized as driving or associated features of incident essential hypertension. The very high risk population mainly comprised elderly (age>50 years) individuals with multiple chronic conditions, especially those receiving medications for mental disorders. Disparities were also found in social determinants, including some community-level factors associated with higher risk and others that were protective against hypertension. Conclusions: With statewide EHR datasets, our study prospectively validated an accurate 1-year risk prediction model for incident essential hypertension. Our real-time predictive analytic model has been deployed in the state of Maine, providing implications in interventions for hypertension and related diseases and hopefully enhancing hypertension care. %M 29382633 %R 10.2196/jmir.9268 %U http://www.jmir.org/2018/1/e22/ %U https://doi.org/10.2196/jmir.9268 %U http://www.ncbi.nlm.nih.gov/pubmed/29382633 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e30 %T How Experts’ Use of Medical Technical Jargon in Different Types of Online Health Forums Affects Perceived Information Credibility: Randomized Experiment With Laypersons %A Zimmermann,Maria %A Jucks,Regina %+ Institute for Psychology in Education, Department of Psychology and Sport Science, University of Münster, Fliednerstraße 21, Münster, 48149, Germany, 49 251 8339482, maria.zimmermann@uni-muenster.de %K trust %K health communication %K social media %K information seeking behavior %K language %D 2018 %7 23.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Online health forums are widely used, but the quality of advice differs as much as the knowledge backgrounds of the audience members who receive the advice. It is important to understand how people judge the information given online. In line with the communication accommodation theory (CAT), online forums represent specific social contexts of communication which can present either accommodative or nonaccommodative language to an audience. Accordingly, use of accommodative or nonaccommodative language might affect people’s perceived trust in the communicator. Objective: The objective of this study was to investigate how experts who use accommodative (vs nonaccommodative) language are evaluated by passive users of an online forum. Methods: Participants (n=98) took part in an online experiment and read experts’ posts about 10 nutrition myths. Following a 2 x 2 mixed design, experts’ posts were written using either low or high amounts of medical technical jargon (MTJ) (within factor) and were directed at different audiences (mainly other medical experts [in a professional forum] vs a user group mainly comprising laypersons [in an advisory forum]) (between factor). Accommodation occurred where experts used high amounts of MTJ to address other medical experts in the professional forum; it also occurred when experts used low amounts of MTJ to address laypersons in the advisory forum. Conversely, nonaccommodation occurred when experts used high amounts of MTJ in the advisory forum and low amounts of MTJ in the professional forum. In each condition, participants evaluated the credibility of the information, the trustworthiness of the experts, and the accommodation by the experts. Results: Overall, participants judged the credibility of information to be higher when experts used MTJ that was accommodative to the designated audience, F1,95=3.10, P=.04, ηp2=.031. In addition, participants judged the experts in professional forums to be more trustworthy than experts in advisory forums (all F1,96≥3.54, P ≤.03, ηp2≥.036). Moreover, participants rated experts who used high amounts of MTJ to have higher competence (F1,96=37.54, P<.001, ηp2=.28], lower integrity (F1,96=10.77, P=.001, ηp2=.101), and lower benevolence (F1,96=9.75, P=.002, ηp2=.092), as well as to have lower perceived accommodation to the audience (all F1,96≥72.17, P<.001, ηp2≥.43) compared with experts who used low MTJ. Conclusions: To provide health information online that is perceived as credible, experts should consider using similar language as the language used by the addressed audience. As it is often impossible to determine the exact makeup of an online audience, further research might investigate whether having experts explicitly declare which audience they intend to address can help people to more reliably assess an expert’s trustworthiness. Furthermore, as people assess information differently depending on the context of online communication, it would be valuable for research to consider other aspects of the context beyond those of the audience. %M 29362212 %R 10.2196/jmir.8346 %U http://www.jmir.org/2018/1/e30/ %U https://doi.org/10.2196/jmir.8346 %U http://www.ncbi.nlm.nih.gov/pubmed/29362212 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e5 %T Digital Clinical Communication for Families and Caregivers of Children or Young People With Short- or Long-Term Conditions: Rapid Review %A Armoiry,Xavier %A Sturt,Jackie %A Phelps,Emma Elizabeth %A Walker,Clare-Louise %A Court,Rachel %A Taggart,Frances %A Sutcliffe,Paul %A Griffiths,Frances %A Atherton,Helen %+ Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom, 44 02476522534, f.e.griffiths@warwick.ac.uk %K digital clinical communication %K professional-family relations %K family %K caregivers %K young adult %K children %K child health %D 2018 %7 05.01.2018 %9 Review %J J Med Internet Res %G English %X Background: The communication relationship between parents of children or young people with health conditions and health professionals is an important part of treatment, but it is unclear how far the use of digital clinical communication tools may affect this relationship. Objective: The objective of our study was to describe, assess the feasibility of, and explore the impact of digital clinical communication between families or caregivers and health professionals. Methods: We searched the literature using 5 electronic databases. We considered all types of study design published in the English language from January 2009 to August 2015. The population of interest included families and caregivers of children and young people aged less than 26 years with any type of health condition. The intervention was any technology permitting 2-way communication. Results: We included 31 articles. The main designs were randomized controlled trials (RCTs; n=10), cross-sectional studies (n=9), pre- and postintervention uncontrolled (pre/post) studies (n=7), and qualitative interview studies (n=2); 6 had mixed-methods designs. In the majority of cases, we considered the quality rating to be fair. Many different types of health condition were represented. A breadth of digital communication tools were included: videoconferencing or videoconsultation (n=14), and Web messaging or emails (n=12). Health care professionals were mainly therapists or cognitive behavioral therapists (n=10), physicians (n=8), and nurses (n=6). Studies were very heterogeneous in terms of outcomes. Interventions were mainly evaluated using satisfaction or acceptance, or outcomes relating to feasibility. Clinical outcomes were rarely used. The RCTs showed that digital clinical communication had no impact in comparison with standard care. Uncontrolled pre/post studies showed good rates of satisfaction or acceptance. Some economic studies suggested that digital clinical communication may save costs. Conclusions: This rapid review showed an emerging body of literature on the use of digital clinical communication to improve families’ and caregivers’ involvement in the health management of children or young people. Further research with appropriate study designs and longer-term outcome measures should be encouraged. Trial Registration: PROSPERO CRD42016035467; http://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD 42016 035467(Archived by WebCite at http://www.webcitation.org/6vpgZU1FU) %M 29305339 %R 10.2196/jmir.7999 %U http://www.jmir.org/2018/1/e5/ %U https://doi.org/10.2196/jmir.7999 %U http://www.ncbi.nlm.nih.gov/pubmed/29305339 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e3 %T Technological Health Intervention in Population Aging to Assist People to Work Smarter not Harder: Qualitative Study %A Chen,Sonia Chien-I %+ Connected Health Innovation Centre, Department of Leadership and Management, Ulster University, Shore Road, Newtownabbey, BT37 0QB, United Kingdom, 44 918192281, drsoniachen@mail.com %K health care %K innovation %K eHealth %K technology %K smart health %K Taiwanese health care %D 2018 %7 04.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Technology-based health care has been promoted as an effective tool to enable clinicians to work smarter. However, some health stakeholders believe technology will compel users to work harder by creating extra work. Objective: The objective of this study was to investigate how and why electronic health (eHealth) has been applied in Taiwan and to suggest implications that may inspire other countries facing similar challenges. Methods: A qualitative methodology was adopted to obtain insightful inputs from deeper probing. Taiwan was selected as a typical case study, given its aging population, advanced technology, and comprehensive health care system. This study investigated 38 stakeholders in the health care ecosystem through in-depth interviews and focus groups, which provides an open, flexible, and enlightening way to study complex, dynamic, and interactive situations through informal conversation or a more structured, directed discussion. Results: First, respondents indicated that the use of technology can enable seamless patient care and clinical benefits such as flexibility in time management. Second, the results suggested that a leader’s vision, authority, and management skills might influence success in health care innovation. Finally, the results implied that both internal and external organizational governance are highly relevant for implementing technology-based innovation in health care. Conclusions: This study provided Taiwanese perspectives on how to intelligently use technology to benefit health care and debated the perception that technology prevents human interaction between clinicians and patients. %M 29301736 %R 10.2196/jmir.8977 %U http://www.jmir.org/2018/1/e3/ %U https://doi.org/10.2196/jmir.8977 %U http://www.ncbi.nlm.nih.gov/pubmed/29301736 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e35 %T Unhappy Patients Are Not Alike: Content Analysis of the Negative Comments from China's Good Doctor Website %A Zhang,Wei %A Deng,Zhaohua %A Hong,Ziying %A Evans,Richard %A Ma,Jingdong %A Zhang,Hui %+ Institute of Smart Health, School of Medicine and Health Management, Huazhong University of Science and Technology, No. 13 Hangkong Road, Qiaokou District, Wuhan, 430030, China, 86 15926318828, zh-deng@hust.edu.cn %K patient satisfaction %K physician-patient relationship %K Good Doctors website %K patient complaint. %D 2018 %7 25.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: With the rise in popularity of Web 2.0 technologies, the sharing of patient experiences about physicians on online forums and medical websites has become a common practice. However, negative comments posted by patients are considered to be more influential by other patients and physicians than those that are satisfactory. Objective: The aim of this study was to analyze negative comments posted online about physicians and to identify possible solutions to improve patient satisfaction, as well as their relationship with physicians. Methods: A Java-based program was developed to collect patient comments on the Good Doctor website, one of the most popular online health communities in China. A total of 3012 negative comments concerning 1029 physicians (mean 2.93 [SD 4.14]) from 5 highly ranked hospitals in Beijing were extracted for content analysis. An initial coding framework was constructed with 2 research assistants involved in the codification. Results: Analysis, based on the collected 3012 negative comments, revealed that unhappy patients are not alike and that their complaints cover a wide range of issues experienced throughout the whole process of medical consultation. Among them, physicians in Obstetrics and Gynecology (606/3012, 20.12%; P=.001) and Internal Medicine (487/3012, 16.17%; P=.80) received the most negative comments. For negative comments per physician, Dermatology and Sexually Transmitted Diseases (mean 5.72, P<.001) and Andrology (mean 5, P=.02) ranked the highest. Complaints relating to insufficient medical consultation duration (577/3012, 19.16%), physician impatience (527/3012, 17.50%), and perceived poor therapeutic effect (370/3012, 12.28%) received the highest number of negative comments. Specific groups of people, such as those accompanying older patients or children, traveling patients, or very important person registrants, were shown to demonstrate little tolerance for poor medical service. Conclusions: Analysis of online patient complaints provides an innovative approach to understand factors associated with patient dissatisfaction. The outcomes of this study could be of benefit to hospitals or physicians seeking to improve their delivery of patient-centered services. Patients are expected to be more understanding of overloaded physicians’ workloads, which are impacted by China’s stretched medical resources, as efforts are made to build more harmonious physician-patient relationships. %M 29371176 %R 10.2196/jmir.8223 %U http://www.jmir.org/2018/1/e35/ %U https://doi.org/10.2196/jmir.8223 %U http://www.ncbi.nlm.nih.gov/pubmed/29371176