%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23588 %T The Effect of Information and Communication Technology and Social Networking Site Use on Older People’s Well-Being in Relation to Loneliness: Review of Experimental Studies %A Casanova,Georgia %A Zaccaria,Daniele %A Rolandi,Elena %A Guaita,Antonio %+ Centre for Socio-Economic Research on Ageing, National Institute of Health & Science on Ageing, Istituto di Ricovero e Cura a Carattere Scientifico, Via Santa Margherita 5, Ancona, Italy, 39 347 0836007, g.casanova@inrca.it %K review %K aging %K loneliness %K older people’s well-being %K ICTs %K social network sites %D 2021 %7 1.3.2021 %9 Review %J J Med Internet Res %G English %X Background: In the last decades, the relationship between social networking sites (SNSs) and older people’s loneliness is gaining specific relevance. Studies in this field are often based on qualitative methods to study in-depth self-perceived issues, including loneliness and well-being, or quantitative surveys to report the links between information and communication technologies (ICTs) and older people’s well-being or loneliness. However, these nonexperimental methods are unable to deeply analyze the causal relationship. Moreover, the research on older people’s SNS use is still scant, especially regarding its impact on health and well-being. In recent years, the existing review studies have separately focused their attention on loneliness and social isolation of older people or on the use of ICTs and SNSs in elderly populations without addressing the relationship between the former and the latter. This thorough qualitative review provides an analysis of research performed using an experimental or quasi-experimental design that investigates the causal effect of ICT and SNS use on elderly people’s well-being related to loneliness. Objective: The aims of this review are to contrast and compare research designs (sampling and recruitment, evaluation tools, interventions) and the findings of these studies and highlight their limitations. Methods: Using an approach that integrates the methodological framework for scoping studies and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews, we identified 11 articles that met our inclusion criteria. A thematic and content analysis was performed based on the ex post categorization of the data on the selected studies, and the data were summarized in tables. Results: The analysis of the selected articles showed that: (1) ICT use is positively but weakly related to the different measures of older people’s well-being and loneliness, (2) overall, the studies under review lack a sound experimental design, (3) the main limitations of these studies lie in the lack of rigor in the sampling method and in the recruitment strategy. Conclusions: The analysis of the reviewed studies confirms the existence of a beneficial effect of ICT use on the well-being of older people in terms of reduced loneliness. However, the causal relationship is often found to be weak. This review highlights the need to study these issues further with adequate methodological rigor. %M 33439127 %R 10.2196/23588 %U https://www.jmir.org/2021/3/e23588 %U https://doi.org/10.2196/23588 %U http://www.ncbi.nlm.nih.gov/pubmed/33439127 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e17023 %T Compliance With Mobile Ecological Momentary Assessment of Self-Reported Health-Related Behaviors and Psychological Constructs in Adults: Systematic Review and Meta-analysis %A Williams,Marie T %A Lewthwaite,Hayley %A Fraysse,François %A Gajewska,Alexandra %A Ignatavicius,Jordan %A Ferrar,Katia %+ Innovation, Implementation And Clinical Translation in Health, Allied Health and Human Performance, University of South Australia, City East Campus, North Terrace, Adelaide, 5000, Australia, 61 8 8302 1153, Marie.Williams@unisa.edu.au %K mobile momentary ecological assessment %K adult %K compliance %K systematic review %K meta-analysis %K mobile phone %D 2021 %7 3.3.2021 %9 Review %J J Med Internet Res %G English %X Background: Mobile ecological momentary assessment (mEMA) permits real-time capture of self-reported participant behaviors and perceptual experiences. Reporting of mEMA protocols and compliance has been identified as problematic within systematic reviews of children, youth, and specific clinical populations of adults. Objective: This study aimed to describe the use of mEMA for self-reported behaviors and psychological constructs, mEMA protocol and compliance reporting, and associations between key components of mEMA protocols and compliance in studies of nonclinical and clinical samples of adults. Methods: In total, 9 electronic databases were searched (2006-2016) for observational studies reporting compliance to mEMA for health-related data from adults (>18 years) in nonclinical and clinical settings. Screening and data extraction were undertaken by independent reviewers, with discrepancies resolved by consensus. Narrative synthesis described participants, mEMA target, protocol, and compliance. Random effects meta-analysis explored factors associated with cohort compliance (monitoring duration, daily prompt frequency or schedule, device type, training, incentives, and burden score). Random effects analysis of variance (P≤.05) assessed differences between nonclinical and clinical data sets. Results: Of the 168 eligible studies, 97/105 (57.7%) reported compliance in unique data sets (nonclinical=64/105 [61%], clinical=41/105 [39%]). The most common self-reported mEMA target was affect (primary target: 31/105, 29.5% data sets; secondary target: 50/105, 47.6% data sets). The median duration of the mEMA protocol was 7 days (nonclinical=7, clinical=12). Most protocols used a single time-based (random or interval) prompt type (69/105, 65.7%); median prompt frequency was 5 per day. The median number of items per prompt was similar for nonclinical (8) and clinical data sets (10). More than half of the data sets reported mEMA training (84/105, 80%) and provision of participant incentives (66/105, 62.9%). Less than half of the data sets reported number of prompts delivered (22/105, 21%), answered (43/105, 41%), criterion for valid mEMA data (37/105, 35.2%), or response latency (38/105, 36.2%). Meta-analysis (nonclinical=41, clinical=27) estimated an overall compliance of 81.9% (95% CI 79.1-84.4), with no significant difference between nonclinical and clinical data sets or estimates before or after data exclusions. Compliance was associated with prompts per day and items per prompt for nonclinical data sets. Although widespread heterogeneity existed across analysis (I2>90%), no compelling relationship was identified between key features of mEMA protocols representing burden and mEMA compliance. Conclusions: In this 10-year sample of studies using the mEMA of self-reported health-related behaviors and psychological constructs in adult nonclinical and clinical populations, mEMA was applied across contexts and health conditions and to collect a range of health-related data. There was inconsistent reporting of compliance and key features within protocols, which limited the ability to confidently identify components of mEMA schedules likely to have a specific impact on compliance. %M 33656451 %R 10.2196/17023 %U https://www.jmir.org/2021/3/e17023 %U https://doi.org/10.2196/17023 %U http://www.ncbi.nlm.nih.gov/pubmed/33656451 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24638 %T Acceptance and Use of Home-Based Electronic Symptom Self-Reporting Systems in Patients With Cancer: Systematic Review %A Cho,Youmin %A Zhang,Huiting %A Harris,Marcelline Ruth %A Gong,Yang %A Smith,Ellen Lavoie %A Jiang,Yun %+ University of Michigan School of Nursing, 400 North Ingalls, Ann Arbor, MI, 48109, United States, 1 734 763 3705, jiangyu@umich.edu %K symptom %K self report %K telemedicine %K technology %K internet %K mobile phone %K patient preference %K cancer %K patient-reported outcomes %D 2021 %7 12.3.2021 %9 Review %J J Med Internet Res %G English %X Background: Electronic symptom self-reporting systems (e-SRS) have been shown to improve symptoms and survival in patients with cancer. However, patient engagement in using e-SRS for voluntary symptom self-reporting is less optimal. Multiple factors can potentially affect patients’ acceptance and engagement in using home-based e-SRS. However, such factors have not been fully explored in cancer populations. Objective: The aim of this study is to understand the acceptance and use of home-based e-SRS by patients with cancer and identify associated facilitators and barriers. Methods: PubMed, CINAHL, Scopus, and PsycINFO (January 2010 to March 2020) were searched using a combination of Medical Subject Headings (MeSH) terms and keywords such as symptom self-reporting, electronic/technology, cancer, and their synonyms. Included studies focused on the use of home-based e-SRS by patients with cancer and their families. Studies on patients’ use of e-SRS in clinical settings only were excluded. Of the 3740 papers retrieved, 33 were included in the final review. Factors associated with patient acceptance and use of e-SRS were extracted and synthesized. Results: Most e-SRS were web based (22/33, 66%) or mobile app based (9/33, 27%). The e-SRS initial acceptance, represented by patient enrollment rates, ranged from 40% (22/55) to 100% (100/100). High e-SRS acceptance was rated by 69% (59/85) to 77.6% (337/434) of the patients after they used the system. The e-SRS use, measured by patients’ response rates to questionnaires (ranging from 1596/3521, 45.33% to 92%) or system log-on rates (ranging from 4/12, 33% to 99/100, 99%), declined over time in general patterns. Few studies (n=7) reported e-SRS use beyond 6 months, with the response rates ranging from 62% (40/64) to 85.1% (541/636) and the log-on rates ranging from 63.6% (103/162) to 77% (49/64). The availability of compatible devices and technical support, interactive system features, information accessibility, privacy, questionnaire quality, patient physical/psychosocial status, and age were associated with patient acceptance and use of home-based e-SRS. Conclusions: Acceptance and use of home-based e-SRS by patients with cancer varied significantly across studies, as assessed by a variety of approaches. The lack of access to technology has remained a barrier to e-SRS adoption. Interactive system features and personalized questionnaires may increase patient engagement. More studies are needed to further understand patients’ long-term use of home-based e-SRS behavior patterns to develop personalized interventions to support symptom self-management and self-reporting of patients with cancer for optimal health outcomes. %M 33709929 %R 10.2196/24638 %U https://www.jmir.org/2021/3/e24638 %U https://doi.org/10.2196/24638 %U http://www.ncbi.nlm.nih.gov/pubmed/33709929 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e18048 %T Impact of Web-Based Sharing and Viewing of Self-Harm–Related Videos and Photographs on Young People: Systematic Review %A Marchant,Amanda %A Hawton,Keith %A Burns,Lauren %A Stewart,Anne %A John,Ann %+ Swansea University Medical School, Singleton Park, Swansea, SA2 8PP, United Kingdom, 44 1792602568, A.John@swansea.ac.uk %K self-harm %K suicide %K social media %K internet %K systematic review %D 2021 %7 19.3.2021 %9 Review %J J Med Internet Res %G English %X Background: Given recent moves to remove or blur self-harm imagery or content on the web, it is important to understand the impact of posting, viewing, and reposting self-harm images on young people. Objective: The aim of this study is to systematically review research related to the emotional and behavioral impact on children and young people who view or share web-based self-harm–related videos or images. Methods: We searched databases (including Embase, PsychINFO, and MEDLINE) from January 1991 to February 2019. Search terms were categorized into internet use, images nonspecific and specific to the internet, and self-harm and suicide. Stepwise screening against specified criteria and data extraction were completed by two independent reviewers. Eligible articles were quality assessed, and a narrative synthesis was conducted. Results: A total of 19 independent studies (20 articles) were included. Of these, 4 studies focused on images, 10 (11 articles) on videos, and 5 on both. There were 4 quantitative, 9 qualitative, and 7 mixed methods articles. In total, 11 articles were rated as high quality. There has been an increase in graphic self-harm imagery over time. Potentially harmful content congregated on platforms with little moderation, anonymity, and easy search functions for images. A range of reactions and intentions were reported in relation to posting or viewing images of self-harm: from empathy, a sense of solidarity, and the use of images to give or receive help to potentially harmful ones suggesting new methods, normalization, and exacerbation of self-harm. Viewing images as an alternative to self-harm or a creative outlet were regarded in 2 studies as positive impacts. Reactions of anger, hostility, and ambivalence have been reported. There was some evidence of the role of imitation and reinforcement, driven partly by the number of comments and wound severity, but this was not supported by time series analyses. Conclusions: Although the results of this review support concern related to safety and exacerbation of self-harm through viewing images of self-harm, there may be potential for positive impacts in some of those exposed. Future research should evaluate the effectiveness and potential harms of current posting restrictions, incorporate user perspectives, and develop recovery-oriented content. Clinicians assessing distressed young people should ask about internet use, including access to self-harm images, as part of their assessment. %M 33739289 %R 10.2196/18048 %U https://www.jmir.org/2021/3/e18048 %U https://doi.org/10.2196/18048 %U http://www.ncbi.nlm.nih.gov/pubmed/33739289 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23475 %T Diabetology 4.0: Scoping Review of Novel Insights and Possibilities Offered by Digitalization %A Eberle,Claudia %A Stichling,Stefanie %A Löhnert,Maxine %+ Medicine with Specialization in Internal Medicine and General Medicine, Hochschule Fulda - University of Applied Sciences, Leipziger Strasse 123, Fulda, 36037, Germany, 49 661 9640 ext 6328, claudia.eberle@hs-fulda.de %K diabetes mellitus %K telemedicine %K mobile apps %K electronic health records %K digital technology %K eHealth %K mobile phone %D 2021 %7 24.3.2021 %9 Review %J J Med Internet Res %G English %X Background: The increasing prevalence of diabetes mellitus and associated morbidity worldwide justifies the need to create new approaches and strategies for diabetes therapy. Therefore, the ongoing digitalization offers novel opportunities in this field. Objective: The aim of this study is to provide an updated overview of available technologies, possibilities, and novel insights into diabetes therapy 4.0. Methods: A scoping review was carried out, and a literature search was performed using electronic databases (MEDLINE [PubMed], Cochrane Library, Embase, CINAHL, and Web of Science). The results were categorized according to the type of technology presented. Results: Different types of technology (eg, glucose monitoring systems, insulin pens, insulin pumps, closed-loop systems, mobile health apps, telemedicine, and electronic medical records) may help to improve diabetes treatment. These improvements primarily affect glycemic control. However, they may also help in increasing the autonomy and quality of life of people who are diagnosed with diabetes mellitus. Conclusions: Diabetes technologies have developed rapidly over the last few years and offer novel insights into diabetes therapy and a chance to improve and individualize diabetes treatment. Challenges that need to be addressed in the following years relate to data security, interoperability, and the development of standards. %M 33759789 %R 10.2196/23475 %U https://www.jmir.org/2021/3/e23475 %U https://doi.org/10.2196/23475 %U http://www.ncbi.nlm.nih.gov/pubmed/33759789 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23533 %T Human Coaching Methodologies for Automatic Electronic Coaching (eCoaching) as Behavioral Interventions With Information and Communication Technology: Systematic Review %A Chatterjee,Ayan %A Gerdes,Martin %A Prinz,Andreas %A Martinez,Santiago %+ Department for Information and Communication Technologies, Centre for e-Health, University of Agder, Jon Lilletuns Vei 9, Grimstad, 4879, Norway, 47 38141000, ayan.chatterjee@uia.no %K coaching %K electronic coaching %K human behavior %K healthy lifestyle %K persuasive technology %D 2021 %7 24.3.2021 %9 Review %J J Med Internet Res %G English %X Background: We systematically reviewed the literature on human coaching to identify different coaching processes as behavioral interventions and methods within those processes. We then reviewed how those identified coaching processes and the used methods can be utilized to improve an electronic coaching (eCoaching) process for the promotion of a healthy lifestyle with the support of information and communication technology (ICT). Objective: This study aimed to identify coaching and eCoaching processes as behavioral interventions and the methods behind these processes. Here, we mainly looked at processes (and corresponding models that describe coaching as certain processes) and the methods that were used within the different processes. Several methods will be part of multiple processes. Certain processes (or the corresponding models) will be applicable for both human coaching and eCoaching. Methods: We performed a systematic literature review to search the scientific databases EBSCOhost, Scopus, ACM, Nature, SpringerLink, IEEE Xplore, MDPI, Google Scholar, and PubMed for publications that included personal coaching (from 2000 to 2019) and persuasive eCoaching as behavioral interventions for a healthy lifestyle (from 2014 to 2019). The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) framework was used for the evidence-based systematic review and meta-analysis. Results: The systematic search resulted in 79 publications, including 72 papers and seven books. Of these, 53 were related to behavioral interventions by eCoaching and the remaining 26 were related to human coaching. The most utilized persuasive eCoaching methods were personalization (n=19), interaction and cocreation (n=17), technology adoption for behavior change (n= 17), goal setting and evaluation (n=16), persuasion (n=15), automation (n=14), and lifestyle change (n=14). The most relevant methods for human coaching were behavior (n=23), methodology (n=10), psychology (n=9), and mentoring (n=6). Here, “n” signifies the total number of articles where the respective method was identified. In this study, we focused on different coaching methods to understand the psychology, behavioral science, coaching philosophy, and essential coaching processes for effective coaching. We have discussed how we can integrate the obtained knowledge into the eCoaching process for healthy lifestyle management using ICT. We identified that knowledge, coaching skills, observation, interaction, ethics, trust, efficacy study, coaching experience, pragmatism, intervention, goal setting, and evaluation of coaching processes are relevant for eCoaching. Conclusions: This systematic literature review selected processes, associated methods, strengths, and limitations for behavioral interventions from established coaching models. The identified methods of coaching point toward integrating human psychology in eCoaching to develop effective intervention plans for healthy lifestyle management and overcome the existing limitations of human coaching. %M 33759793 %R 10.2196/23533 %U https://www.jmir.org/2021/3/e23533 %U https://doi.org/10.2196/23533 %U http://www.ncbi.nlm.nih.gov/pubmed/33759793 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24387 %T Barriers to and Facilitators of User Engagement With Digital Mental Health Interventions: Systematic Review %A Borghouts,Judith %A Eikey,Elizabeth %A Mark,Gloria %A De Leon,Cinthia %A Schueller,Stephen M %A Schneider,Margaret %A Stadnick,Nicole %A Zheng,Kai %A Mukamel,Dana %A Sorkin,Dara H %+ University of California Irvine, 6210 Donald Bren Hall, Irvine, CA, 92697-3425, United States, 1 9498240246, jborghou@uci.edu %K mHealth %K eHealth %K mental health %K depression %K anxiety %K behavior %K mobile phone %D 2021 %7 24.3.2021 %9 Review %J J Med Internet Res %G English %X Background: Digital mental health interventions (DMHIs), which deliver mental health support via technologies such as mobile apps, can increase access to mental health support, and many studies have demonstrated their effectiveness in improving symptoms. However, user engagement varies, with regard to a user’s uptake and sustained interactions with these interventions. Objective: This systematic review aims to identify common barriers and facilitators that influence user engagement with DMHIs. Methods: A systematic search was conducted in the SCOPUS, PubMed, PsycINFO, Web of Science, and Cochrane Library databases. Empirical studies that report qualitative and/or quantitative data were included. Results: A total of 208 articles met the inclusion criteria. The included articles used a variety of methodologies, including interviews, surveys, focus groups, workshops, field studies, and analysis of user reviews. Factors extracted for coding were related to the end user, the program or content offered by the intervention, and the technology and implementation environment. Common barriers included severe mental health issues that hampered engagement, technical issues, and a lack of personalization. Common facilitators were social connectedness facilitated by the intervention, increased insight into health, and a feeling of being in control of one’s own health. Conclusions: Although previous research suggests that DMHIs can be useful in supporting mental health, contextual factors are important determinants of whether users actually engage with these interventions. The factors identified in this review can provide guidance when evaluating DMHIs to help explain and understand user engagement and can inform the design and development of new digital interventions. %M 33759801 %R 10.2196/24387 %U https://www.jmir.org/2021/3/e24387 %U https://doi.org/10.2196/24387 %U http://www.ncbi.nlm.nih.gov/pubmed/33759801 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25698 %T The Value of Applying Ethical Principles in Telehealth Practices: Systematic Review %A Keenan,Amanda Jane %A Tsourtos,George %A Tieman,Jennifer %+ College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, 5042, Australia, 61 8 7221 8418, keen0076@flinders.edu.au %K telehealth %K ethics %K telemedicine %K ethical %K telecare %K review %K patient experience %K care %K effectiveness %K framework %D 2021 %7 30.3.2021 %9 Review %J J Med Internet Res %G English %X Background: As the use of technology to deliver health services is increasing rapidly and has further intensified during the COVID-19 pandemic, these initiatives may fail if ethical impacts are not fully identified and acted upon by practitioners. Ignoring the ethical impacts of information and communication technology health service delivery creates an unintended risk for patients and can lead to reduced effectiveness, noncompliance, and harm, undermining the best intentions of governments and clinicians. Objective: Our aim was to explore how ethical considerations or impacts may be different, greater, or more variable in information and communication technology methods versus face-to-face health care delivery models, and how they may be applied in practice. Methods: We undertook a systemic literature review to provide a critical overview of existing research into the incorporation of ethical principles into telehealth practice. Six databases were searched between March 2016 to May 2016 and again in December 2020 to provide the benefit of currency. A combination of broad terms (“ethics,” “ethical,” “health,” and “care”) with the restrictive terms of “telehealth” and “telemedicine” was used in keyword searches. Thematic analysis and synthesis of each paper was conducted, aligned to the framework developed by Beauchamp and Childress. Results: From the 49 papers reviewed, authors identified or discussed the following ethical principles in relation to telehealth practice: autonomy (69% of authors, 34/49), professional–patient relationship (53% of authors, 26/49), nonmaleficence (41% of authors, 20/49), beneficence (39%, of authors, 19/49), and justice (39% of authors, 19/49). Conclusions: Although a small number of studies identified ethical issues associated with telehealth practice and discussed their potential impact on service quality and effectiveness, there is limited research on how ethical principles are incorporated into clinical practice. Several studies proposed frameworks, codes of conduct, or guidelines, but there was little discussion or evidence of how these recommendations are being used to improve ethical telehealth practice. %M 33783366 %R 10.2196/25698 %U https://www.jmir.org/2021/3/e25698 %U https://doi.org/10.2196/25698 %U http://www.ncbi.nlm.nih.gov/pubmed/33783366 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24602 %T Blended Self-Management Interventions to Reduce Disease Burden in Patients With Chronic Obstructive Pulmonary Disease and Asthma: Systematic Review and Meta-analysis %A Song,Xiaoyue %A Hallensleben,Cynthia %A Zhang,Weihong %A Jiang,Zongliang %A Shen,Hongxia %A Gobbens,Robbert J J %A Kleij,Rianne M J J Van Der %A Chavannes,Niels H %A Versluis,Anke %+ Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands, 31 613836216, x.song@lumc.nl %K blended intervention %K COPD %K asthma %K meta-analysis %K systematic review %D 2021 %7 31.3.2021 %9 Review %J J Med Internet Res %G English %X Background: Chronic obstructive pulmonary disease (COPD) and asthma have a high prevalence and disease burden. Blended self-management interventions, which combine eHealth with face-to-face interventions, can help reduce the disease burden. Objective: This systematic review and meta-analysis aims to examine the effectiveness of blended self-management interventions on health-related effectiveness and process outcomes for people with COPD or asthma. Methods: PubMed, Web of Science, COCHRANE Library, Emcare, and Embase were searched in December 2018 and updated in November 2020. Study quality was assessed using the Cochrane risk of bias (ROB) 2 tool and the Grading of Recommendations, Assessment, Development, and Evaluation. Results: A total of 15 COPD and 7 asthma randomized controlled trials were included in this study. The meta-analysis of COPD studies found that the blended intervention showed a small improvement in exercise capacity (standardized mean difference [SMD] 0.48; 95% CI 0.10-0.85) and a significant improvement in the quality of life (QoL; SMD 0.81; 95% CI 0.11-1.51). Blended intervention also reduced the admission rate (relative ratio [RR] 0.61; 95% CI 0.38-0.97). In the COPD systematic review, regarding the exacerbation frequency, both studies found that the intervention reduced exacerbation frequency (RR 0.38; 95% CI 0.26-0.56). A large effect was found on BMI (d=0.81; 95% CI 0.25-1.34); however, the effect was inconclusive because only 1 study was included. Regarding medication adherence, 2 of 3 studies found a moderate effect (d=0.73; 95% CI 0.50-0.96), and 1 study reported a mixed effect. Regarding self-management ability, 1 study reported a large effect (d=1.15; 95% CI 0.66-1.62), and no effect was reported in that study. No effect was found on other process outcomes. The meta-analysis of asthma studies found that blended intervention had a small improvement in lung function (SMD 0.40; 95% CI 0.18-0.62) and QoL (SMD 0.36; 95% CI 0.21-0.50) and a moderate improvement in asthma control (SMD 0.67; 95% CI 0.40-0.93). A large effect was found on BMI (d=1.42; 95% CI 0.28-2.42) and exercise capacity (d=1.50; 95% CI 0.35-2.50); however, 1 study was included per outcome. There was no effect on other outcomes. Furthermore, the majority of the 22 studies showed some concerns about the ROB, and the quality of evidence varied. Conclusions: In patients with COPD, the blended self-management interventions had mixed effects on health-related outcomes, with the strongest evidence found for exercise capacity, QoL, and admission rate. Furthermore, the review suggested that the interventions resulted in small effects on lung function and QoL and a moderate effect on asthma control in patients with asthma. There is some evidence for the effectiveness of blended self-management interventions for patients with COPD and asthma; however, more research is needed. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019119894; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=119894 %M 33788700 %R 10.2196/24602 %U https://www.jmir.org/2021/3/e24602 %U https://doi.org/10.2196/24602 %U http://www.ncbi.nlm.nih.gov/pubmed/33788700 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25173 %T Guidelines for Conducting Virtual Cognitive Interviews During a Pandemic %A Shepperd,James A %A Pogge,Gabrielle %A Hunleth,Jean M %A Ruiz,Sienna %A Waters,Erika A %+ Department of Psychology, University of Florida, 945 Center Drive, Gainesville, FL, 32611, United States, 1 352 273 2165, shepperd@ufl.edu %K cognitive interview %K COVID-19 %K guidelines %K teleresearch %K pandemic %K tablet computer %K telehealth %K training %D 2021 %7 11.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X The COVID-19 pandemic has challenged researchers working in physical contact with research participants. Cognitive interviews examine whether study components (most often questionnaire items) are worded or structured in a manner that allows study participants to interpret the items in a way intended by the researcher. We developed guidelines to conduct cognitive interviews virtually to accommodate interviewees who have limited access to the internet. The guidelines describe the essential communication and safety equipment requirements and outline a procedure for collecting responses while maintaining the safety of the participants and researchers. Furthermore, the guidelines provide suggestions regarding training of participants to use the technology, encouraging them to respond aloud (a potential challenge given that the researcher is not physically present with the participant), and testing and deploying the equipment prior to the interview. Finally, the guidelines emphasize the need to adapt the interview to the circumstances and anticipate potential problems that might arise. %M 33577464 %R 10.2196/25173 %U https://www.jmir.org/2021/3/e25173 %U https://doi.org/10.2196/25173 %U http://www.ncbi.nlm.nih.gov/pubmed/33577464 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23984 %T HOPES: An Integrative Digital Phenotyping Platform for Data Collection, Monitoring, and Machine Learning %A Wang,Xuancong %A Vouk,Nikola %A Heaukulani,Creighton %A Buddhika,Thisum %A Martanto,Wijaya %A Lee,Jimmy %A Morris,Robert JT %+ Office for Healthcare Transformation, Ministry of Health, 1 Maritime Square, #12-10 Harbourfront Centre, Singapore, 099253, Singapore, 65 66793209, creighton.heaukulani@moht.com.sg %K digital phenotyping %K eHealth %K mHealth %K mobile phone %K phenotype %K data collection %K outpatient monitoring %K machine learning %D 2021 %7 15.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X The collection of data from a personal digital device to characterize current health conditions and behaviors that determine how an individual’s health will evolve has been called digital phenotyping. In this paper, we describe the development of and early experiences with a comprehensive digital phenotyping platform: Health Outcomes through Positive Engagement and Self-Empowerment (HOPES). HOPES is based on the open-source Beiwe platform but adds a wider range of data collection, including the integration of wearable devices and further sensor collection from smartphones. Requirements were partly derived from a concurrent clinical trial for schizophrenia that required the development of significant capabilities in HOPES for security, privacy, ease of use, and scalability, based on a careful combination of public cloud and on-premises operation. We describe new data pipelines to clean, process, present, and analyze data. This includes a set of dashboards customized to the needs of research study operations and clinical care. A test use case for HOPES was described by analyzing the digital behavior of 22 participants during the SARS-CoV-2 pandemic. %M 33720028 %R 10.2196/23984 %U https://www.jmir.org/2021/3/e23984 %U https://doi.org/10.2196/23984 %U http://www.ncbi.nlm.nih.gov/pubmed/33720028 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24948 %T Using Narrative Evidence to Convey Health Information on Social Media: The Case of COVID-19 %A Gesser-Edelsburg,Anat %+ School of Public Health, University of Haifa, 199 Aba Khoushy Ave, Mount Carmel, Haifa, 3498838, Israel, 972 544243530, ageser@univ.haifa.ac.il %K health and risk communication %K social media %K narrative evidence %K crisis %K pandemic %K misinformation %K infodemic %K infodemiology %K COVID-19 %K policy %K segmentation %K barrier reduction %K role models %K empathy and support %K strengthening self/community-efficacy %K coping tools %K preventing stigmatization %K at-risk populations %K communicating uncertainty %K positive deviance %K tailor messaging %K targeted behavioral change %D 2021 %7 15.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X During disease outbreaks or pandemics, policy makers must convey information to the public for informative purposes (eg, morbidity or mortality rates). They must also motivate members of the public to cooperate with the guidelines, specifically by changing their usual behavior. Policy makers have traditionally adopted a didactic and formalistic stance by conveying dry, statistics-based health information to the public. They have not yet considered the alternative of providing health information in the form of narrative evidence, using stories that address both cognitive and emotional aspects. The aim of this viewpoint paper is to introduce policy makers to the advantages of using narrative evidence to provide health information during a disease outbreak or pandemic such as COVID-19. Throughout human history, authorities have tended to employ apocalyptic narratives during disease outbreaks or pandemics. This viewpoint paper proposes an alternative coping narrative that includes the following components: segmentation; barrier reduction; role models; empathy and support; strengthening self-efficacy, community efficacy, and coping tools; preventing stigmatization of at-risk populations; and communicating uncertainty. It also discusses five conditions for using narrative evidence to produce an effective communication campaign on social media: (1) identifying narratives that reveal the needs, personal experiences, and questions of different subgroups to tailor messaging to produce targeted behavioral change; (2) providing separate and distinct treatment of each information unit or theory that arises on social networks; (3) identifying positive deviants who found creative solutions for stress during the COVID-19 crisis not found by other members of the community; (4) creating different stories of coping; and (5) maintaining a dialogue with population subgroups (eg, skeptical and hesitant groups). The paper concludes by proposing criteria for evaluating the effectiveness of a narrative. %M 33674257 %R 10.2196/24948 %U https://www.jmir.org/2021/3/e24948 %U https://doi.org/10.2196/24948 %U http://www.ncbi.nlm.nih.gov/pubmed/33674257 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e13999 %T Googling for Neurological Disorders: From Seeking Health-Related Information to Patient Empowerment, Advocacy, and Open, Public Self-Disclosure in the Neurology 2.0 Era %A Martini,Mariano %A Bragazzi,Nicola Luigi %+ Department of Health Sciences, School of Public Health, University of Genoa, Via Antonio Pastore 1, Genoa, 16132, Italy, 39 3279769965, robertobragazzi@gmail.com %K advocacy %K health information seeking %K neurological disorders %K open self-disclosure %D 2021 %7 26.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X Since its introduction, the internet has played a major role in reshaping patient-physician communication and interactions, having fostered a shift from a paternalistic to a patient-centered model. Because of its dynamic nature, the internet has been used as a platform to not only disseminate knowledge—favored by improved access to an increasing wealth of available resources—but also to spread advocacy and awareness, contribute to fund-raising, and facilitate open, public self-disclosure of one’s own disease, thus eliminating any taboo and reducing the stigma associated with it. The era of Medicine 2.0 is characterized by openness, collaboration, participation, and social networking. The current situation is completely different from the time when Lorenzo Odone’s parents, after his diagnosis of adrenoleukodystrophy, decided to attend medical school in order to collect information about a devastating, unknown disease and had to contend with medical authorities at that establishment to convince them of the alleged effectiveness and safety of their discovered therapeutics. Orphan and rare neurological diseases have currently received recognition on web-based resources. However, while the intention is not to ridicule Odone’s family legacy and the “complicated lessons” they have reported, some issues should be carefully addressed by health authorities, such as the reputability, reliability, and accuracy of material available on the internet and prevention of the dissemination of material that could instill illusions and unjustified hopes in individuals seeking medical treatment. Neurologists should be aware of such digital resources, participate in web-based activities, and recommend select high-quality websites to their patients. %M 30946019 %R 10.2196/13999 %U https://www.jmir.org/2021/3/e13999 %U https://doi.org/10.2196/13999 %U http://www.ncbi.nlm.nih.gov/pubmed/30946019 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24134 %T A Novel Mobile App (Heali) for Disease Treatment in Participants With Irritable Bowel Syndrome: Randomized Controlled Pilot Trial %A Rafferty,Aaron J %A Hall,Rick %A Johnston,Carol S %+ College of Health Solutions, Arizona State University, HLTHN 532 Phoenix Downtown Campus, Phoenix, AZ, 85004, United States, 1 602 496 2539, Carol.johnston@asu.edu %K irritable bowel syndrome %K artificial intelligence %K mobile app %K low FODMAP diet %K randomized controlled trial %D 2021 %7 2.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: A diet high in fermentable, oligo-, di-, monosaccharides and polyols (FODMAPs) has been shown to exacerbate symptoms of irritable bowel syndrome (IBS). Previous literature reports significant improvement in IBS symptoms with initiation of a low FODMAP diet (LFD) and monitored reintroduction. However, dietary adherence to the LFD is difficult, with patients stating that the information given by health care providers is often generalized and nonspecific, requiring them to search for supplementary information to fit their needs. Objective: The aim of our study was to determine whether Heali, a novel artificial intelligence dietary mobile app can improve adherence to the LFD, IBS symptom severity, and quality of life outcomes in adults with IBS or IBS-like symptoms over a 4-week period. Methods: Participants were randomized into 2 groups: the control group (CON), in which participants received educational materials, and the experimental group (APP), in which participants received access to the mobile app and educational materials. Over the course of this unblinded online trial, all participants completed a battery of 5 questionnaires at baseline and at the end of the trial to document IBS symptoms, quality of life, LFD knowledge, and LFD adherence. Results: We enrolled 58 participants in the study (29 in each group), and 25 participants completed the study in its entirety (11 and 14 for the CON and APP groups, respectively). Final, per-protocol analyses showed greater improvement in quality of life score for the APP group compared to the CON group (31.1 and 11.8, respectively; P=.04). Reduction in total IBS symptom severity score was 24% greater for the APP group versus the CON group. Although this did not achieve significance (–170 vs –138 respectively; P=.37), the reduction in the subscore for bowel habit dissatisfaction was 2-fold greater for the APP group than for the CON group (P=.05). Conclusions: This initial study provides preliminary evidence that Heali may provide therapeutic benefit to its users, specifically improvements in quality of life and bowel habits. Although this study was underpowered, findings from this study warrant further research in a larger sample of participants to test the efficacy of Heali app use to improve outcomes for patients with IBS. Trial Registration: ClinicalTrials.gov NCT04256551; https://clinicaltrials.gov/ct2/show/NCT04256551 %M 33650977 %R 10.2196/24134 %U https://www.jmir.org/2021/3/e24134 %U https://doi.org/10.2196/24134 %U http://www.ncbi.nlm.nih.gov/pubmed/33650977 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e19309 %T Development of a Web-Based Mindfulness Program for People With Multiple Sclerosis: Qualitative Co-Design Study %A Sesel,Amy-Lee %A Sharpe,Louise %A Beadnall,Heidi N %A Barnett,Michael H %A Szabo,Marianna %A Naismith,Sharon L %+ School of Psychology, University of Sydney, Camperdown NSW, Sydney, 2006, Australia, 61 2 9351 4558, amy-lee.sesel@sydney.edu.au %K multiple sclerosis %K mindfulness %K depression %K program development %K internet intervention %K qualitative research %D 2021 %7 2.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mindfulness-based stress reduction is an efficacious treatment for people with chronic health problems; however, it is highly intensive and time-consuming, which is a barrier for service provision. Objective: This study aims to develop an internet-delivered adapted version of mindfulness-based stress reduction for people with multiple sclerosis to make the intervention more accessible. Methods: We co-designed a web-based mindfulness program with end users, that is, people with multiple sclerosis (N=19). Iterative feedback was also collected from a subsample of the initial group of end users (n=11), and the program was reviewed by experts (n=8). Results: We identified three main themes common to people with multiple sclerosis: dealing with uncertainty and fears for the future, grief and loss, and social isolation. These themes were incorporated into narratives throughout the program. People with multiple sclerosis who reviewed the program gave feedback that the program was relatable, feasible, and acceptable. Experts agreed that the program appropriately represented the main tenets of mindfulness. Iterative feedback was used to further refine the program. Conclusions: The web-based mindfulness program that we developed was viewed positively by both experts and end users. The program reflects common concerns for people with multiple sclerosis and has the potential to meet important unmet psychological needs. A randomized controlled trial was planned to determine the efficacy of the program. %M 33650980 %R 10.2196/19309 %U https://www.jmir.org/2021/3/e19309 %U https://doi.org/10.2196/19309 %U http://www.ncbi.nlm.nih.gov/pubmed/33650980 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e20829 %T Evaluating a Hybrid Web-Based Training Program for Panic Disorder and Agoraphobia: Randomized Controlled Trial %A Ebenfeld,Lara %A Lehr,Dirk %A Ebert,David Daniel %A Kleine Stegemann,Stefan %A Riper,Heleen %A Funk,Burkhardt %A Berking,Matthias %+ Leuphana University, Universitätsallee 1, Lüneburg, 21335, Germany, 49 4131 677 1708, lara.ebenfeld@gmail.com %K panic disorder %K agoraphobia %K treatment %K internet %K mobile phone %K randomized controlled trial %D 2021 %7 4.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous studies provide evidence for the effectiveness of web-based interventions for panic disorder with and without agoraphobia. Smartphone-based technologies hold significant potential for further enhancing the accessibility and efficacy of such interventions. Objective: This randomized controlled trial aims to evaluate the efficacy of a guided, hybrid web-based training program based on cognitive behavioral therapy for adults with symptoms of panic disorder. Methods: Participants (N=92) with total scores in the Panic and Agoraphobia Scale ranging from 9 to 28 were recruited from the general population and allocated either to a hybrid intervention (GET.ON Panic) or to a wait-list control group. The primary outcome was the reduction in panic symptoms, as self-assessed using a web-based version of the Panic and Agoraphobia Scale. Results: Analysis of covariance-based intention-to-treat analyses revealed a significantly stronger decrease in panic symptoms posttreatment (F=9.77; P=.002; Cohen d=0.66; 95% CI 0.24-1.08) in the intervention group than in the wait-list control group. Comparisons between groups of the follow-up measures at 3 and 6 months yielded even stronger effects (3-month follow-up: F=17.40, P<.001, Cohen d=0.89, 95% CI 0.46-1.31; 6-month follow-up: F=14.63, P<.001, Cohen d=0.81, 95% CI 0.38-1.24). Conclusions: Hybrid web-based training programs may help reduce the symptoms of panic disorder and hence play an important role in improving health care for patients with this debilitating disorder. Trial Registration: German Clinical Trial Register DRKS00005223; https://tinyurl.com/f4zt5ran International Registered Report Identifier (IRRID): RR2-10.1186/1745-6215-15-427 %M 33661121 %R 10.2196/20829 %U https://www.jmir.org/2021/3/e20829 %U https://doi.org/10.2196/20829 %U http://www.ncbi.nlm.nih.gov/pubmed/33661121 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e18433 %T Association of Spontaneous and Induced Self-Affirmation With Smoking Cessation in Users of a Mobile App: Randomized Controlled Trial %A Seaman,Elizabeth L %A Robinson,Cendrine D %A Crane,David %A Taber,Jennifer M %A Ferrer,Rebecca A %A Harris,Peter R %A Klein,William M P %+ CDC Foundation, 600 Peachtree Street NE, Suite 1000, Atlanta, GA, 30308, United States, 1 4438524139, eseaman@cdcfoundation.org %K smoking cessation %K smartphone %K mHealth %K sadness %K self-affirmation %K spontaneous self-affirmation %K apps %K mobile phone %D 2021 %7 5.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Most smokers attempt to stop using cigarettes numerous times before successfully quitting. Cigarette cravings may undermine perceived competence to quit and thus constitute psychological threats to the individual’s self-concept. Self-affirmation may promote smoking cessation by offsetting these threats. Objective: This study examines whether self-affirmation is associated with smoking cessation in the context of a cessation app. Two types of self-affirmation are examined: tendency to spontaneously self-affirm, and self-affirmation inductions added to a publicly available smoking cessation app (Smoke-Free Quit Smoking Now). In addition, this study explores whether optimism and emotional states (happiness, anger, anxiousness, hopefulness, sadness) predict smoking cessation. Methods: All users who met the inclusion criteria, provided consent to participate, and completed a baseline assessment, including all individual difference measures, were randomized to 1 of 4 conditions. Half of the participants were randomly assigned to complete a self-affirmation induction upon study entry. Orthogonally, half of the participants were randomly assigned to receive self-affirming text notifications during their quit attempt or to receive conventional notifications. The induction and the text notifications were fully automated, and all data were collected through self-assessments in the app. Self-reported smoking cessation was assessed 1 month and 3 months following study entry. Results: The study enrolled 7899 participants; 647 completed the 1-month follow-up. Using an intent-to-treat analysis at the 1-month follow-up, 7.2% (569/7899) of participants self-reported not smoking in the previous week and 6.4% (503/7899) self-reported not smoking in the previous month. Greater tendency to spontaneously self-affirm predicted a greater likelihood of cessation (P<.001) at 1 month after controlling for smoking-related variables. Neither self-affirmation induction influenced cessation. In addition, spontaneous self-affirmation did not moderate the relationship between self-affirmation inductions and cessation. Greater baseline sadness was associated with a lower likelihood of reporting successful cessation. Optimism predicted past-week cessation at the 1-month follow-up, and both happiness and anger predicted past-month cessation at the 1-month follow-up; however, none of these potential predictors moderated the relationship between self-affirmation conditions and successful cessation. Conclusions: Spontaneous self-affirmation may be an important psychological resource for managing threats to self-concept during the smoking cessation process. Sadness may hinder quit attempts. Future research can explicate how spontaneous versus induced self-affirmation can promote smoking cessation and examine boundary conditions for the effectiveness of disseminated self-affirmation interventions. Trial Registration: ISRCTN Registry 56646695; https://www.isrctn.com/ISRCTN56646695 %M 33666561 %R 10.2196/18433 %U https://www.jmir.org/2021/3/e18433 %U https://doi.org/10.2196/18433 %U http://www.ncbi.nlm.nih.gov/pubmed/33666561 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25885 %T Designing the Optimal Digital Health Intervention for Patients’ Use Before and After Elective Orthopedic Surgery: Qualitative Study %A Robinson,Anna %A Slight,Robert D %A Husband,Andrew K %A Slight,Sarah P %+ School of Pharmacy, Newcastle University, King George VI Building, Newcastle University, Newcastle upon Tyne, NE1 7RU, United Kingdom, 44 191 208 6000, Sarah.slight@newcastle.ac.uk %K digital technology %K orthopedic surgery %K behavior change %K perioperative care %K prehabilitation %K qualitative research %K mHealth %K eHealth %K mobile phone %D 2021 %7 8.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Health behavior changes made by patients during the perioperative period can impact the outcomes and success of elective surgeries. However, there remains a limited understanding of how best to support patients during this time, particularly through the use of digital health interventions. Recognizing and understanding the potential unmet needs of elective orthopedic surgery patients is central to motivating healthier behavior change, improving recovery, and optimizing overall surgical success in the short and long term. Objective: The aim of this study is to explore patient perspectives on technology features that would help support them to change their lifestyle behaviors during the pre- and postoperative periods, and that could potentially maintain long-term healthy lifestyles following recovery. Methods: Semistructured interviews with pre- and postoperative elective orthopedic patients were conducted between May and June 2020 using telephone and video call–based software. Patient perspectives on the use of digital technologies to complement current surgical care and support with lifestyle behavior changes were discussed. Interviews were audio recorded and transcribed verbatim. Reflexive thematic analysis enabled the development of themes from the data, with QSR NVivo software (version 12) facilitating data management. Ethical approval was obtained from the National Health Service Health Research Authority. Results: A total of 18 participants were interviewed. Four themes were developed from the data regarding the design and functionality of digital technologies to best support the perioperative journey. These center around an intervention’s ability to incorporate interactive, user-centered features; direct a descriptive and structured recovery; enable customizable, patient-controlled settings; and deliver both general and specific surgical advice in a timely manner. Interventions that are initiated preoperatively and continued postoperatively were perceived as beneficial. Interventions designed with personalized milestones were found to better guide patients through a structured recovery. Individualized tailoring of preparatory and recovery information was desired by patients with previously high levels of physical activity before surgery. The use of personalized progression-based exercises further encouraged physical recovery; game-like rewards and incentives were regarded as motivational for making and sustaining health behavior change. In-built video calling and messaging features offered connectivity with peers and clinicians for supported care delivery. Conclusions: Specific intervention design and functionality features can provide better, structured support for elective orthopedic patients across the entire surgical journey and beyond. This study provides much-needed evidence relating to the optimal design and timing of digital interventions for elective orthopedic surgical patients. Findings from this study suggest a desire for personalized perioperative care, in turn, supporting patients to make health behavior changes to optimize surgical success. These findings should be used to influence future co-design projects to enable the design and implementation of patient-focused, tailored, and targeted digital health technologies within modern health care settings. %M 33683208 %R 10.2196/25885 %U https://www.jmir.org/2021/3/e25885 %U https://doi.org/10.2196/25885 %U http://www.ncbi.nlm.nih.gov/pubmed/33683208 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24380 %T Online Mindfulness-Based Cognitive Behavioral Therapy Intervention for Youth With Major Depressive Disorders: Randomized Controlled Trial %A Ritvo,Paul %A Knyahnytska,Yuliya %A Pirbaglou,Meysam %A Wang,Wei %A Tomlinson,George %A Zhao,Haoyu %A Linklater,Renee %A Bai,Shari %A Kirk,Megan %A Katz,Joel %A Harber,Lillian %A Daskalakis,Zafiris %+ Department of Psychiatry, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, United States, 1 (858) 534 2230, zdaskalakis@health.ucsd.edu %K intervention study %K telemedicine %K electronic CBT %K clinical trial %K depression %K cognitive behavioral therapy %K CBT %K online therapy %K online intervention %K youth %K young adult %D 2021 %7 10.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Approximately 70% of mental health disorders appear prior to 25 years of age and can become chronic when ineffectively treated. Individuals between 18 and 25 years old are significantly more likely to experience mental health disorders, substance dependencies, and suicidality. Treatment progress, capitalizing on the tendencies of youth to communicate online, can strategically address depressive disorders. Objective: We performed a randomized controlled trial (RCT) that compared online mindfulness-based cognitive behavioral therapy (CBT-M) combined with standard psychiatric care to standard psychiatric care alone in youth (18-30 years old) diagnosed with major depressive disorder. Methods: Forty-five participants were randomly assigned to CBT-M and standard care (n=22) or to standard psychiatric care alone (n=23). All participants were provided standard psychiatric care (ie, 1 session per month), while participants in the experimental group received an additional intervention consisting of the CBT-M online software program. Interaction with online workbooks was combined with navigation coaching delivered by phone and secure text messaging. Results: In a two-level linear mixed-effects model intention-to-treat analysis, significant between-group differences were found for the Beck Depression Inventory-II score (difference –8.54, P=.01), Quick Inventory of Depressive Symptoms score (difference –4.94, P=.001), Beck Anxiety Inventory score (difference –11.29, P<.001), and Brief Pain Inventory score (difference –1.99, P=.03), while marginal differences were found for the Five Facet Mindfulness Questionnaire–Nonjudging subscale (difference –2.68, P=.05). Conclusions: These results confirm that youth depression can be effectively treated with online CBT-M that can be delivered with less geographic restriction. Trial Registration: Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052 %M 33688840 %R 10.2196/24380 %U https://www.jmir.org/2021/3/e24380 %U https://doi.org/10.2196/24380 %U http://www.ncbi.nlm.nih.gov/pubmed/33688840 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24135 %T Electronic Health Risk Behavior Screening With Integrated Feedback Among Adolescents in Primary Care: Randomized Controlled Trial %A Richardson,Laura %A Parker,Elizabeth Oshrin %A Zhou,Chuan %A Kientz,Julie %A Ozer,Elizabeth %A McCarty,Carolyn %+ Seattle Children's Research Institute, 1900 9th Ave, Seattle, WA, 98101, United States, 1 (206) 884 7300, laura.richardson@seattlechildrens.org %K adolescent health services %K primary care %D 2021 %7 12.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Health risk behaviors are the most common sources of morbidity among adolescents. Adolescent health guidelines (Guidelines for Preventive Services by the AMA and Bright Futures by the Maternal Child Health Bureau) recommend screening and counseling, but the implementation is inconsistent. Objective: This study aims to test the efficacy of electronic risk behavior screening with integrated patient-facing feedback on the delivery of adolescent-reported clinician counseling and risk behaviors over time. Methods: This was a randomized controlled trial comparing an electronic tool to usual care in five pediatric clinics in the Pacific Northwest. A total of 300 participants aged 13-18 years who attended a well-care visit between September 30, 2016, and January 12, 2018, were included. Adolescents were randomized after consent by employing a 1:1 balanced age, sex, and clinic stratified schema with 150 adolescents in the intervention group and 150 in the control group. Intervention adolescents received electronic screening with integrated feedback, and the clinicians received a summary report of the results. Control adolescents received usual care. Outcomes, assessed via online survey methods, included adolescent-reported receipt of counseling during the visit (measured a day after the visit) and health risk behavior change (measured at 3 and 6 months after the visit). Results: Of the original 300 participants, 94% (n=282), 94.3% (n=283), and 94.6% (n=284) completed follow-up surveys at 1 day, 3 months, and 6 months, respectively, with similar levels of attrition across study arms. The mean risk behavior score at baseline was 2.86 (SD 2.33) for intervention adolescents and 3.10 (SD 2.52) for control adolescents (score potential range 0-21). After adjusting for age, gender, and random effect of the clinic, intervention adolescents were 36% more likely to report having received counseling for endorsed risk behaviors than control adolescents (adjusted rate ratio 1.36, 95% CI 1.04 to 1.78) 1 day after the well-care visit. Both the intervention and control groups reported decreased risk behaviors at the 3- and 6-month follow-up assessments, with no significant group differences in risk behavior scores at either time point (3-month group difference: β=−.15, 95% CI −0.57 to −0.01, P=.05; 6-month group difference: β=−.12, 95% CI −0.29 to 0.52, P=.57). Conclusions: Although electronic health screening with integrated feedback improves the delivery of counseling by clinicians, the impact on risk behaviors is modest and, in this study, not significantly different from usual care. More research is needed to identify effective strategies to reduce risk in the context of well-care. Trial Registration: ClinicalTrials.gov NCT02882919; https://clinicaltrials.gov/ct2/show/NCT02882919 %M 33709942 %R 10.2196/24135 %U https://www.jmir.org/2021/3/e24135 %U https://doi.org/10.2196/24135 %U http://www.ncbi.nlm.nih.gov/pubmed/33709942 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24906 %T Risk Factors and Leadership in a Digitalized Working World and Their Effects on Employees’ Stress and Resources: Web-Based Questionnaire Study %A Bregenzer,Anita %A Jimenez,Paulino %+ Institute of Psychology, University of Graz, Universitätsplatz 2, Graz, 8010, Austria, 43 316380 ext 5128, paul.jimenez@uni-graz.at %K digitalization %K leadership %K new ways of working %K resources %K stress %D 2021 %7 12.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In today’s world of work, the digitalization of work and communication processes is increasing, and will increase even further. This increase in digitalization at the workplace brings many new aspects of working life to light, such as working in virtual teams, mobile working, expectations of being constantly available, and the need for support in adapting and learning new digital tools. These changes to the workplace can contain risks that might harm the well-being of employees. Leaders can support the well-being of their employees in terms of protecting and replenishing their work-related resources to cope with critical work demands. This so-called health-promoting leadership could serve as a buffer between risk at the workplace and critical outcomes, such as stress, by amplifying work-related resources. Objective: This study’s aims were twofold. First, we wanted to investigate if risk factors related to higher digitalization at the workplace can be identified and if these risk factors have an impairing effect on the well-being of employees (eg, higher stress and lower resources). Second, we wanted to investigate if the health-impairing effects of these risk factors can be reduced by health-promoting leadership. Methods: A total of 1412 employees from Austria, Germany, and Switzerland took part in this online study and provided information on their perceived risks at the workplace, their leaders’ health-promoting behaviors, and their work-related stress and resources. Results: The results of a hierarchical regression analysis showed that all four risk factors of digital work (distributed team work, mobile work, constant availability, and inefficient technical support) were related to higher stress at the workplace. In addition, distributed team work and inefficient technical support were associated with lower work-related resources. A possible buffer effect of health-promoting leadership between these risks and employee well-being was visible for inefficient technical support. In particular, in the case of having fewer support opportunities in learning and using digital tools, leaders could weaken the potential critical effects on stress. As for the other risk factors, leaders might engage in a different leadership behavior to improve their employees’ well-being, as the physical distance between leaders and employees in virtual team work or mobile work could make health-promoting leadership more difficult. Conclusions: In a digitalized working world, solutions are needed to create working conditions that benefit employees. The results of this study strongly support the importance of investigating risk factors associated with an increase in digitalization at the workplace in addition to traditional risk factors. As for leadership, leaders need to show leadership behavior adapted to a digitalized workplace in order to reduce employee stress and increase work-related resources. %M 33709933 %R 10.2196/24906 %U https://www.jmir.org/2021/3/e24906 %U https://doi.org/10.2196/24906 %U http://www.ncbi.nlm.nih.gov/pubmed/33709933 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e22564 %T An Interactive Web-Based Sexual Health Literacy Program for Safe Sex Practice for Female Chinese University Students: Multicenter Randomized Controlled Trial %A Wong,Janet Yuen-Ha %A Zhang,Wen %A Wu,Yongda %A Choi,Edmond Pui Hang %A Lo,Herman Hay Ming %A Wong,Wendy %A Chio,Jasmine Hin Man %A Tam,Hau Lin Cherry %A Ngai,Fei Wan %A Tarrant,Marie %A Wang,Man Ping %A Ngan,Hextan Yuen-Sheung %A Fong,Daniel Yee-Tak %+ School of Nursing, University of Hong Kong, Pokfulam, Hong Kong SAR, Hong Kong, 852 39176645, dytfong@hku.hk %K sexual health %K eHealth %K women's health %K sex education %K health literacy %D 2021 %7 12.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexual health concerns among young adults worldwide help to motivate preventative practices against sexually transmitted infections. To foster better sexual health, sexual health literacy must be enhanced. Little research has been conducted on the impact of gender power dynamics on sexual health, such as sexual coercion, even though the prevalence of sexual coercion remains high in China. Objective: This study describes the development and systematic evaluation of a web-based sexual health literacy intervention called “Smart Girlfriend” for female Chinese university students. Methods: A multicenter randomized controlled trial was conducted with 781 female university students at 5 universities with dormitories in Hong Kong. Inclusion criteria were used to select unmarried, female, Chinese university students who were ≥18 years old and had not received a sexual health intervention in the past 12 months. Participants were randomly assigned to 2 groups: one group received an interactive web-based sexual health literacy intervention and the other group received a single webpage of online information about condom use. The intervention content was based on the Health Belief Model and the Continuum of Conflict and Control theory. The primary outcome was self-reported consistency of condom use with every partner at 3-month and 6-month follow-up assessments, analyzed using zero/one inflated beta (ZOIB) regression. The secondary outcome was an appraisal of the knowledge, attitudes, norms, and self-efficacy of condom use using the 25-item Multidimensional Condom Attitudes Scale (MCAS). The intention to treat was applied in analyses. Results: Of 1503 individuals that were screened, 781 (52%) were randomized into 2 groups. The retention rates at the 3-month and 6-month follow-ups were 92% and 91%, respectively. Most participants were born locally (536/746, 72%), and 18% (134/746) self-reported as a sexual minority. ZOIB results regarding the consistency of condom use were not significant [model 1: odds ratio (OR) 2.25 with a 95% credible interval (CrI) of 0.84-6.36; model 2: OR 8.03 (95% CrI 0.22-330.31); model 3: OR 1.21 (95% CrI 0.78-1.86)]. Consistency in the intervention group was 5% higher (95% CI −1.90 to 11.63) than the control group at the 3-month follow-up, and 1% higher (95% CI −5.81 to 8·02) at the 6-month follow-up. MCAS scores at the 3-month follow-up were significantly higher in the intervention group (mean 122.51, SD 15.97) than the control group (mean 119.86, SD 15.85; P=.02). Conclusions: An interactive web-based sexual health literacy program did not significantly increase the consistency of condom use compared to a single webpage of condom use information; however, it did temporarily improve knowledge, attitudes, norms, and self-efficacy regarding condom use. Future revisions of this intervention should be personalized and delivered with a proactive approach. Trial Registration: ClinicalTrials.gov NCT03695679; https://clinicaltrials.gov/ct2/show/NCT03695679 %M 33709941 %R 10.2196/22564 %U https://www.jmir.org/2021/3/e22564 %U https://doi.org/10.2196/22564 %U http://www.ncbi.nlm.nih.gov/pubmed/33709941 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e22465 %T Web-Based Dietary and Physical Activity Intervention Programs for Patients With Hypertension: Scoping Review %A Baderol Allam,Fatimah Najihah %A Ab Hamid,Mohd Ramadan %A Buhari,Siti Sabariah %A Md Noor,Harrinni %+ Centre for Dietetics Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Malaysia, 60 332584424, ramadan7230@uitm.edu.my %K hypertension %K blood pressure %K education %K website-based %K dietary intake %K physical activity %D 2021 %7 15.3.2021 %9 Review %J J Med Internet Res %G English %X Background: Hypertension is the root cause of many chronic diseases. Lifestyle changes (ie, dietary alterations and physical activity) are seen to be an important step in the prevention and treatment of hypertension. Educating people through web-based interventional programs could offer an effective solution and help these patients with hypertension in the existing health care scenario. Objective: In this study, the researchers conducted a scoping literature review of the web-based dietary changes and physical activity–related intervention programs designed for the patients with hypertension and identified the methodologies, effectiveness, protocols, and theories, which could affect and improve existing clinical activities. Methods: This review followed the scoping review methodology to identify and process the peer-reviewed studies published between 2010 and 2020. The literature searches were conducted on the following electronic databases: PubMed, Web of Science, MEDLINE (Medical Literature Analysis and Retrieval System Online), ScienceDirect, Scopus, and Google Scholar. By using relevant search terms, studies were included if they offered information related to the web-based intervention tools, specifically dietary and physical activity intervention for patients with hypertension. Studies written or translated in English language and published within the date range (January 2010 to March 2020) were included. Results: Overall, 1441 articles were initially identified. The reviewers included 35 articles after removing duplicates and screening titles. Only 21 articles were assessed for full review, and 15 were kept for analysis. The researchers selected 15 web-based intervention articles published on the topic of hypertension from 7 countries. A few of these 15 web-based tools (4, 27%) included more than 3 functions and provided a lot of important information (such as appointments, health records, or viewable care). Several tools were standalone tools (11, 73%), while most of the tools supported communication intervention–related lifestyle or behavioral changes (13, 87%) and medication adherence (6, 40%). It was found that physicians (9, 60%), allied health professionals (5, 33%), and nurses (5, 33%) were the health care providers who generally used these tools for communicating with their patients. More than half of the above tools (10, 67%) were assessed by different researchers in randomized controlled trials, while 5 tools (33%) were investigated in nonrandomized studies. Conclusions: We identified many web-based intervention programs for patients with hypertension from the literature databases. The findings indicate that numerous benefits can be derived after using a web-based dietary and physical activity intervention program for hypertension focusing on lifestyle changes. However, developers need to consider the preferences of the patients with regard to the information or the design features while developing or modifying web-based educational websites. These tools could be used for designing a patient-tailored website intervention program that is based on diet and physical activities for patients with hypertension. %M 33720036 %R 10.2196/22465 %U https://www.jmir.org/2021/3/e22465 %U https://doi.org/10.2196/22465 %U http://www.ncbi.nlm.nih.gov/pubmed/33720036 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24926 %T Developing a Web-Based Shared Decision-Making Tool for Fertility Preservation Among Reproductive-Age Women With Breast Cancer: An Action Research Approach %A Tseng,Ling-Ming %A Lien,Pei-Ju %A Huang,Chen-Yu %A Tsai,Yi-Fang %A Chao,Ta-Chung %A Huang,Sheng-Miauh %+ MacKay Medical College, Department of Nursing, No. 46, Section 3, Zhongzheng Road, Sanzhi District, New Taipei City, 252, Taiwan, 886 2 26360303 ext 1316, r910862@yahoo.com.tw %K breast cancer %K shared decision making %K website %K action research %K fertility preservation %D 2021 %7 17.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The pregnancy rate after cancer treatment for female survivors is lower than that of the general population. Future infertility is a significant concern for patients with breast cancer and is associated with a poor quality of life. Reproductive-age patients with breast cancer have safe options when choosing a type of fertility preservation method to be applied. Better information and support resources aimed at women to support their decision making are needed. Objective: The objective of this study was to develop a web-based shared decision-making tool for helping patients with breast cancer make decisions on fertility preservation. Methods: We used the action research cycle of observing, reflecting, planning, and acting to develop a web-based shared decision-making tool. The following four phrases were applied: (1) observe and reflect—collect and analyze the decision-making experiences of patients and health care providers; (2) reflect and plan—apply the initial results to create a paper design and modify the content; (3) plan and act—brainstorm about the web pages and modify the content; (4) act and observe—evaluate the effectiveness and refine the website’s shared decision-making tool. Interviews, group meetings, and constant dialogue were conducted between the various participants at each step. Effectiveness was evaluated using the Preparation for Decision-Making scale. Results: Five major parts were developed with the use of the action research approach. The Introduction (part 1) describes the severity of cancer treatment and infertility. Options (part 2) provides the knowledge of fertility preservation. The shared decision-making tool was designed as a step-by-step process (part 3) that involves the comparison of options, patient values, and preferences; their knowledge regarding infertility and options; and reaching a collective decision. Resources (part 4) provides information on the hospitals that provide such services, and References (part 5) lists all the literature cited in the website. The results show the web-based shared decision-making meets both patients’ and health providers’ needs and helps reproductive-age patients with breast cancer make decisions about fertility preservation. Conclusions: We have created the first web-based shared decision-making tool for making fertility preservation decisions in Taiwan. We believe female patients of reproductive age will find the tool useful and its use will become widespread, which should increase patient autonomy and improve communication about fertility preservation with clinicians. Trial Registration: Clinicaltrials.gov NCT04602910; https://clinicaltrials.gov/ct2/show/NCT04602910 %M 33729164 %R 10.2196/24926 %U https://www.jmir.org/2021/3/e24926 %U https://doi.org/10.2196/24926 %U http://www.ncbi.nlm.nih.gov/pubmed/33729164 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e22548 %T In-Clinic Versus Web-Based Multidisciplinary Exercise-Based Rehabilitation for Treatment of Low Back Pain: Prospective Clinical Trial in an Integrated Practice Unit Model %A Raiszadeh,Kamshad %A Tapicer,Jonathan %A Taitano,Lissa %A Wu,Jonathan %A Shahidi,Bahar %+ Department of Orthopaedic Surgery, University of California San Diego, 9500 Gilman Dr, MC0863, San Diego, CA, United States, 1 858 822 0439, bshahidi@health.ucsd.edu %K low back pain %K telehealth %K online therapy %K physical therapy %K integrated practice unit %K rehabilitation %D 2021 %7 18.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The recent onset of the COVID-19 pandemic has highlighted the need to reduce barriers to access physical therapy and associated care through the use of web-based programs and telehealth for those seeking treatment for low back pain (LBP). Despite this need, few studies have compared the effectiveness of clinic-based versus web-based or telehealth services. Objective: This study aims to compare the clinical outcomes of clinic-based multidisciplinary therapy in an integrated practice unit (C-IPU) model with online integrated multidisciplinary therapy (O-IPU) in individuals undergoing conservative care for LBP. Methods: A total of 1090 participants were prospectively recruited to participate in a clinical trial registry (NCT04081896) through the SpineZone rehabilitation IPU program. All participants provided informed consent. Participants were allocated to the C-IPU (N=988) or O-IPU (N=102) groups based on their personal preferences. The C-IPU program consisted of a high-intensity machine-based core muscle resistance training program, whereas the O-IPU program consisted of therapist-directed home core strengthening exercises through a web-based platform. Changes in LBP symptom severity (Numeric Pain Rating Scale), disability (Oswestry Disability Index), goal achievement (Patient-Specific Functional Scale), and frequency of opioid use were compared between the C-IPU and O-IPU groups using multivariate linear regression modeling adjusted for age, gender, treatment number, program duration, and baseline pain and disability. Results: Approximately 93.03% (1014/1090) of the participants completed their recommended programs, with no group differences in dropout rates (P=.78). The C-IPU group showed greater pain relief (P<.001) and reductions in disability (P=.002) than the O-IPU group, whereas the O-IPU group reported greater improvements in goal achievement (P<.001). Both programs resulted in reduced opioid use frequency, with 19.0% (188/988) and 21.5% (22/102) of participants reporting cessation of opioid use for C-IPU and O-IPU programs, respectively, leaving only 5.59% (61/1090) of participants reporting opioid use at the end of their treatment. Conclusions: Both in-clinic and web-based multidisciplinary programs are beneficial in reducing pain, disability, and opioid use and in improving goal achievement. The differences between these self-selected groups shed light on patient characteristics, which require further investigation and could help clinicians optimize these programs. Trial Registration: ClinicalTrials.gov NCT04081896; https://clinicaltrials.gov/ct2/show/NCT04081896 %M 33734088 %R 10.2196/22548 %U https://www.jmir.org/2021/3/e22548 %U https://doi.org/10.2196/22548 %U http://www.ncbi.nlm.nih.gov/pubmed/33734088 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e18517 %T Attitudes and Engagement of Pregnant and Postnatal Women With a Web-Based Emotional Health Tool (Mummatters): Cross-sectional Study %A Reilly,Nicole %A Austin,Marie-Paule %+ Centre for Health Service Development, Australian Health Services Research Institute, University of Wollongong, Building 234 (iC Enterprise 1), Innovation Campus, Wollongong, 2522, Australia, 61 0242218045, nreilly@uow.edu.au %K pregnancy %K postpartum %K self-assessment %K depression %K risk %D 2021 %7 26.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mummatters is a web-based health tool that allows women to self-assess the symptoms of depression and the presence of psychosocial risk factors throughout pregnancy and the postnatal period. It aims to increase women’s awareness of their own symptoms or risk factors and their knowledge of the available support options, to encourage engagement with these support options (as appropriate), and to facilitate communication about emotional health issues between women and their health care providers. Objective: The aim of this study is to report the uptake of mummatters; the sociodemographic and psychosocial risk profiles of a subsample of users; and the acceptability, credibility, perceived effect, and motivational appeal of the tool. The help-seeking behaviors of the subsample of users and barriers to help seeking were also examined. Methods: Mummatters was launched in November 2016. Women who completed the mummatters baseline assessment were invited to complete a web-based follow-up survey 1 month later. Results: A total of 2817 women downloaded and used mummatters between November 13, 2016, and May 22, 2018, and 140 women participated in the follow-up study. Approximately half of these women (51%; 72/140) were Whooley positive (possible depression), and 43% (60/140) had an elevated psychosocial risk score on the Antenatal Risk Questionnaire. Mummatters was rated favorably by pregnant and postnatal women in terms of its acceptability (94%-99%), credibility (93%-97%), appeal (78%-91%), and potential to affect a range of health behaviors specific to supporting emotional wellness during the perinatal period (78%-93%). Whooley-positive women were more likely to speak with their families than with a health care provider about their emotional health. Normalizing symptoms and stigma were key barriers to seeking help. Conclusions: Although mummatters was rated positively by consumers, only 53% (19/36) to 61% (22/36) of women with possible depression reported speaking to their health care providers about their emotional health. There was a trend for more prominent barriers to seeking help among postnatal women than among pregnant women. Future studies that investigate whether social barriers to seeking help are greater once a woman has an infant are warranted. Such barriers potentially place these women at greater risk of remaining untreated, as the demands on them are greater. %M 33769302 %R 10.2196/18517 %U https://www.jmir.org/2021/3/e18517 %U https://doi.org/10.2196/18517 %U http://www.ncbi.nlm.nih.gov/pubmed/33769302 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24366 %T Blended Acceptance and Commitment Therapy Versus Face-to-face Cognitive Behavioral Therapy for Older Adults With Anxiety Symptoms in Primary Care: Pragmatic Single-blind Cluster Randomized Trial %A Witlox,Maartje %A Garnefski,Nadia %A Kraaij,Vivian %A de Waal,Margot W M %A Smit,Filip %A Bohlmeijer,Ernst %A Spinhoven,Philip %+ Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, Netherlands, 31 0611858085, m.witlox@fsw.leidenuniv.nl %K acceptance and commitment therapy %K anxiety %K older adults %K internet interventions %K cognitive behavioral therapy %D 2021 %7 26.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Anxiety symptoms in older adults are prevalent and disabling but often go untreated. Most trials on psychological interventions for anxiety in later life have examined the effectiveness of face-to-face cognitive behavioral therapy (CBT). To bridge the current treatment gap, other treatment approaches and delivery formats should also be evaluated. Objective: This study is the first to examine the effectiveness of a brief blended acceptance and commitment therapy (ACT) intervention for older adults with anxiety symptoms, compared with a face-to-face CBT intervention. Methods: Adults aged between 55-75 years (n=314) with mild to moderately severe anxiety symptoms were recruited from general practices and cluster randomized to either blended ACT or face-to-face CBT. Assessments were performed at baseline (T0), posttreatment (T1), and at 6- and 12-month follow-ups (T2 and T3, respectively). The primary outcome was anxiety symptom severity (Generalized Anxiety Disorder-7). Secondary outcomes were positive mental health, depression symptom severity, functional impairment, presence of Diagnostic and Statistical Manual of Mental Disorders V anxiety disorders, and treatment satisfaction. Results: Conditions did not differ significantly regarding changes in anxiety symptom severity during the study period (T0-T1: B=.18, P=.73; T1-T2: B=−.63, P=.26; T1-T3: B=−.33, P=.59). Large reductions in anxiety symptom severity (Cohen d≥0.96) were found in both conditions post treatment, and these were maintained at the 12-month follow-up. The rates of clinically significant changes in anxiety symptoms were also not different for the blended ACT group and CBT group (χ21=0.2, P=.68). Regarding secondary outcomes, long-term effects on positive mental health were significantly stronger in the blended ACT group (B=.27, P=.03, Cohen d=0.29), and treatment satisfaction was significantly higher for blended ACT than CBT (B=3.19, P<.001, Cohen d=0.78). No other differences between the conditions were observed in the secondary outcomes. Conclusions: The results show that blended ACT is a valuable treatment alternative to CBT for anxiety in later life. Trial Registration: Netherlands Trial Register TRIAL NL6131 (NTR6270); https://www.trialregister.nl/trial/6131 %M 33769293 %R 10.2196/24366 %U https://www.jmir.org/2021/3/e24366 %U https://doi.org/10.2196/24366 %U http://www.ncbi.nlm.nih.gov/pubmed/33769293 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25031 %T Mobile HIV Testing Through Social Networking Platforms: Comparative Study %A Chiou,Piao-Yi %A Ko,Nai-Ying %A Chien,Chien-Yu %+ School of Nursing, College of Medicine, National Taiwan University, No 2-1, Xuzhou Road, Zhongzheng District, Taipei City, 100, Taiwan, 886 2 23123456 ext 88427, purechiou2@gmail.com %K HIV testing %K internet-based intervention %K men who have sex with men %K mobile apps %K mobile phone %K risk-taking %K social networking %K voluntary counseling and testing %D 2021 %7 26.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Improving HIV screening in key populations is a crucial strategy to achieve the goal of eliminating AIDS in 2030. Social networking platforms can be used to recruit high risk-taking men who have sex with men (MSM) to promote the delivery of voluntary counseling and testing (VCT) as mobile HIV testing. Therefore, client recruitment and availability of mobile HIV testing through social networking platforms requires further evaluation. Objective: The aim of this study is to compare the effects of targeting high risk-taking MSM and HIV case finding between two mobile HIV testing recruitment approaches: through the traditional website-based approach and through social networking platforms. Methods: A comparative study design and propensity score matching was applied. The traditional VCT model, that is, the control group, recruited MSM through a website, and a trained research assistant visited the walk-in testing station at a gay village on Friday and Saturday nights. The social networking VCT model, the experimental group, recruited MSM from social networking platforms by periodically reloading into and conducting web-based discussions on dating apps and Facebook. The participants then referred to others in their social networks via a popular messenger app in Taiwan. The test was conducted at a designated time and place during weekdays by a trained research assistant. Across both modes of contact, before the mobile HIV testing, participants needed to provide demographic characteristics and respond to a questionnaire about HIV risk-taking behaviors. Results: We recruited 831 MSM over 6 months, with a completion rate of 8.56% (616/7200) in the traditional VCT model and 20.71% (215/1038) in the social networking VCT model. After propensity score matching, there were 215 MSM in each group (mean age 29.97, SD 7.61 years). The social networking model was more likely to reach MSM with HIV risk-taking behaviors, that is, those seeking sexual activity through social media, having multiple sexual partners and unprotected anal intercourse, having experience of recreational drug use, and never having or not regularly having an HIV test, compared with the traditional model. HIV positive rates (incidence rate ratio 3.40, 95% CI 1.089-10.584; P=.03) and clinic referral rates (incidence rate ratio 0.03, 95% CI 0.001-0.585; P=.006) were significantly higher among those in the social networking VCT model than in the traditional VCT model. Conclusions: Through effective recruitment strategies on social networking platforms, the social networking VCT mode can be smoothly promoted, as compared with the traditional VCT model, to target high risk-taking MSM and increase testing outcomes. %M 33769298 %R 10.2196/25031 %U https://www.jmir.org/2021/3/e25031 %U https://doi.org/10.2196/25031 %U http://www.ncbi.nlm.nih.gov/pubmed/33769298 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25786 %T A Smartphone-Delivered Ecological Momentary Intervention for Problem Gambling (GamblingLess: Curb Your Urge): Single-Arm Acceptability and Feasibility Trial %A Hawker,Chloe O %A Merkouris,Stephanie S %A Youssef,George J %A Dowling,Nicki A %+ Deakin University, 1 Gheringhap St, Geelong, 3220, Australia, 61 03 9244 5610, chawker@deakin.edu.au %K gambling %K craving %K urge %K self-efficacy %K relapse %K smartphone %K self-help %K treatment %K ecological momentary assessment %K ecological momentary intervention %K mobile phone %D 2021 %7 26.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Low uptake rates of traditional gambling treatments highlight the need for innovative treatment modalities. Smartphone apps can provide unprecedented access to real-time ecological momentary interventions (EMIs) delivered in people’s everyday lives. Objective: This study aims to examine the acceptability, feasibility, and preliminary effectiveness of GamblingLess: Curb Your Urge, the first smartphone app–delivered EMI that aims to prevent gambling episodes by reducing craving intensity in people seeking help for gambling problems. Methods: This study was a single-arm, 5-week acceptability and feasibility trial (1-week baseline and 4-week intervention periods) involving ecological momentary assessments (EMAs) delivered 3 times daily. The EMAs measured gambling episodes, cravings, and self-efficacy. Web-based evaluations at baseline, postintervention, and 1-month follow-up measured gambling outcomes (severity, cravings, frequency, expenditure, and self-efficacy) and the intervention’s perceived helpfulness, relevance, burden, satisfaction, and impact in relation to gambling cravings. Results: A total of 36 participants, of whom 22/36 (61%) were male and 34/36 (94%) were problem gamblers, completed the baseline measures, with 61% (22/36) completing the postintervention evaluation and 58% (21/36) completing the follow-up evaluation. The intervention was considered acceptable, as participants perceived all intervention content to be above average in helpfulness and the EMA to be highly relevant but somewhat burdensome. Participants reported that they were satisfied with the intervention and that the intervention improved their knowledge, attitudes, awareness, behavior change, intention to change, and help-seeking behavior for gambling cravings. Regarding the intervention’s feasibility, compliance rates for the EMA (51%) and EMI (15%) were low; however, the intervention was used 166 times, including 59 uses within 60 minutes of EMA completion and 107 on-demand uses. Regarding the intervention’s preliminary effectiveness, descriptive EMA data showed that, compared with the baseline period, 71% and 72% reductions in the average number of gambling episodes and craving occurrences were reported in the intervention period, respectively. In addition, clustered paired-sample two-tailed t tests revealed a significant 5.4% reduction in real-time craving intensity (P=.01) immediately after intervention use, which increased to 10.5% (P=.01), where use was recommended based on craving occurrence. At the group level, significant medium-to-large reductions were observed in mean gambling symptom severity (P=.01 and .003), cravings (P=.03 and .02), frequency (P=.01 and .004), and expenditure (P=.04 and .003) at postintervention and follow-up; moreover, increased mean gambling self-efficacy and craving self-efficacy (P=.01 and .01) were observed at postintervention and increased gambling self-efficacy (P=.04) was observed at follow-up. At the individual level, over a quarter of participants (6/22, 27% to 10/21, 48%) could be categorized as recovered or improved regarding their gambling symptom severity and cravings. Conclusions: The results support the acceptability, feasibility, and preliminary effectiveness of this app-delivered EMI for preventing gambling episodes through craving management in people with gambling problems, which has implications for extending the reach of evidence-based treatment to moments of vulnerability in people’s everyday lives. %M 33769294 %R 10.2196/25786 %U https://www.jmir.org/2021/3/e25786 %U https://doi.org/10.2196/25786 %U http://www.ncbi.nlm.nih.gov/pubmed/33769294 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26399 %T Health Care Students’ Knowledge of and Attitudes, Beliefs, and Practices Toward the French COVID-19 App: Cross-sectional Questionnaire Study %A Montagni,Ilaria %A Roussel,Nicolas %A Thiébaut,Rodolphe %A Tzourio,Christophe %+ Bordeaux Population Health Research Center, U1219, Bordeaux University, INSERM, 146 rue Léo Saignat, Bordeaux, 33000, France, 33 05 57 57 16 5, ilaria.montagni@u-bordeaux.fr %K contact tracing %K COVID-19 %K mobile app %K students %K field survey %K app %K survey %K monitoring %K knowledge %K attitude %K belief %K practice %K communication %K use %D 2021 %7 3.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Many countries worldwide have developed mobile phone apps capable of supporting instantaneous contact tracing to control the COVID-19 pandemic. In France, a few people have downloaded and are using the StopCovid contact tracing app. Students in the health domain are of particular concern in terms of app uptake. Exploring their use and opinions about the app can inform improvements and diffusion of StopCovid among young people. Objective: The aim of this study is to investigate health care students’ knowledge of and attitudes, beliefs, and practices (KABP) toward the StopCovid app. Methods: A field survey was conducted among 318 students at the health sciences campus of the University of Bordeaux, France, between September 25 and October 16, 2020. A quota sampling method was used, and descriptive statistics and univariate analyses were performed. Results: Of the 318 respondents, 77.3% (n=246) had heard about the app, but only 11.3% (n=36) had downloaded it, and 4.7% (n=15) were still using it at the time of the survey. Among the 210 participants who had heard about the app but did not download it, the main reasons for not using the app were a belief that it was not effective given its limited diffusion (n=37, 17.6%), a lack of interest (n=37, 17.6%), and distrust in the data security and fear of being geolocated (n=33, 15.7%). Among the 72 students who had not heard of the app and were given a brief description of its functioning and confidentiality policy, 52.7% (n=38) said they would use it. Participants reported that the main solution for increasing the use of the app would be better communication about it (227/318, 71.4%). Conclusions: Even among health students, the contact tracing app was poorly used. The findings suggest that improved communication about its advantages and simplicity of use as well as clarifying false beliefs about it could help improve uptake. %M 33566793 %R 10.2196/26399 %U https://www.jmir.org/2021/3/e26399 %U https://doi.org/10.2196/26399 %U http://www.ncbi.nlm.nih.gov/pubmed/33566793 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23144 %T Investigating Associations Between Screen Time and Symptomatology in Individuals With Serious Mental Illness: Longitudinal Observational Study %A Henson,Philip %A Rodriguez-Villa,Elena %A Torous,John %+ Beth Israel Deaconess Medical Center, Harvard Medical School, 75 Fenwood Rd, Office 618, Boston, MA, 02115, United States, 1 6177541213, jtorous@bidmc.harvard.edu %K mHealth %K schizophrenia %K apps %K mobile %K screen time %D 2021 %7 10.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Increasing screen time exposure from digital devices like smartphones has shown a variety of mixed associations with cognition, behavior, and well-being in adults and children but little is known about its associations with symptomatology in individuals with serious mental illness. Objective: To determine the range of associations between screen time and symptoms of individuals with mental illness, we utilized a method called specification curve analysis. Methods: In this observational study, we recruited smartphone-owning adults (≥18 years old) with schizophrenia and healthy controls. We installed 2 research-source smartphone apps, mindLAMP and Beiwe, to collect survey results, cognitive test results, and screen time metrics over a period of 3 months. Surveys were scheduled for twice a week, but participants were instructed to take the surveys naturally as much or as little as they wanted. Screen time was collected continuously in the background. A total of 140 participants was recruited from the outpatient clinic population as well as through general public advertising. Age-matched, smartphone-owning healthy controls were also part of the recruitment pool. A specification curve analysis was a priori designed to explore the relationship between every combination of independent variable and dependent variable in order to demonstrate to what degree screen time relates to symptoms in individuals with serious mental illness. Results: The sample consisted of 88 participants (54 with schizophrenia and 34 healthy controls) who completed both the initial and follow-up visits, completed at least one self-reported survey, and had a minimum passive data cutoff of 5 consecutive days. While we found an association between smartphone screen time metrics and cognition (adjusted R2=0.107, P<.001), specification curve analysis revealed a wide range of heterogenous associations with screen time from very negative to very positive. The effects differed based on diagnostic group, age bracket, type of regression model used, and the specific independent and dependent variables selected for analysis. Conclusions: The associations between screen time and mental health in patients with schizophrenia are heterogenous when examined with methods that reduce analytical bias. The heterogeneity in associations suggests that complex and personalized potential effects must be understood in the greater context of an individual. This analysis of longitudinally collected screen time data shows potential for future research that could benefit from high resolution metrics on smartphone use. %M 33688835 %R 10.2196/23144 %U https://www.jmir.org/2021/3/e23144 %U https://doi.org/10.2196/23144 %U http://www.ncbi.nlm.nih.gov/pubmed/33688835 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24023 %T Development of a Smartphone App to Predict and Improve the Rates of Suicidal Ideation Among Transgender Persons (TransLife): Qualitative Study %A Dubov,Alex %A Fraenkel,Liana %A Goldstein,Zil %A Arroyo,Hansel %A McKellar,Derek %A Shoptaw,Steve %+ School of Behavioral Health, Loma Linda University, 11065 Campus Street, Loma Linda, CA, 92350, United States, 1 9095581900, adubov@llu.edu %K mobile health %K mHealth %K mobile app %K pilot study %K qualitative research %K user-centered design %K acceptability study %K health services for transgender persons %K suicide prevention %K mental health %K mobile phone %D 2021 %7 24.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Transgender people are at a high risk of suicidal ideation, suicide attempts, and deaths. Among transgender individuals, 77% and 41% engage in suicidal ideation and suicide attempt in their lifetime, respectively, which exceeds the general population rates (9.2% and 2.7%, respectively). Traditionally, suicide risk factors have been studied over a long period between measurements, making it difficult to understand the short-term variability in suicide risk. Mobile phone apps offer an opportunity to understand the immediate precursors of suicidality through the assessment of behaviors and moods in real time. This is the first study to use a mobile phone app (TransLife) to understand the short-term risk factors for suicide among transgender individuals. Objective: This study aims to beta test the usability of an evidence-informed mobile health (mHealth) suicide prevention phone app, TransLife. The primary aims are to obtain preliminary data on user engagement and satisfaction with the app, and to assess the feasibility of completing ecological momentary assessments (mood logs) within the app. Methods: We used qualitative methods and an exploratory research approach that combined naturalistic app use, focus groups, and semistructured phone interviews. The focus group was informed about the development of the prototype. We conducted a 3-week evaluation to determine engagement and obtain detailed user feedback about the app. After participation in the pilot, phone-based, semistructured, and audio-recorded exit interviews were conducted with the research participants. Results: In total, 16 transgender individuals participated in this study. On average, users logged in 4 (SD 2.7) times a week and spent approximately 5 (SD 3.5) minutes on the app per log-in. A total of 6 major themes emerged in this study. These themes focused on the app’s functionality, satisfaction with using the app, perceived ease of use, perceived safety of providing personal data within the app, trusting the app enough to share personal feelings, and features that make this app engaging. These themes suggest that TransLife is an engaging, useful, and acceptable mHealth intervention. Participants reported that the app was easy to use and understand, supported mental self-care, promoted self-awareness, and helped them identify triggers of negative moods. Conclusions: The results of this pilot study indicate that TransLife is an engaging, acceptable, and potentially effective mHealth intervention. Transgender participants reported many advantages of using TransLife, such as being able to track their mood, connecting to the community, and accessing local resources. This study provides initial support for the acceptability and usability of TransLife as an mHealth intervention designed for the transgender community. %M 33596181 %R 10.2196/24023 %U https://www.jmir.org/2021/3/e24023 %U https://doi.org/10.2196/24023 %U http://www.ncbi.nlm.nih.gov/pubmed/33596181 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e17908 %T Evaluating Glycemic Control in Patients of South Asian Origin With Type 2 Diabetes Using a Digital Therapeutic Platform: Analysis of Real-World Data %A Krishnakumar,Arjun %A Verma,Ritika %A Chawla,Rajeev %A Sosale,Aravind %A Saboo,Banshi %A Joshi,Shilpa %A Shaikh,Maaz %A Shah,Abhishek %A Kolwankar,Siddhesh %A Mattoo,Vinod %+ Wellthy Therapeutics Pvt Ltd, 20, Nagin Mahal, 5th Floor, 82, Veer Nariman Road, Churchgate, Mumbai, 400020, India, 91 9833962132, sid.kolwankar@wellthy.care %K digital therapeutics %K type 2 diabetes %K behavior change %K diabetes self-management %K lifestyle intervention %K mobile phone %D 2021 %7 25.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital therapeutics are evidence-based therapeutic interventions driven by high-quality software programs for the treatment, prevention, or management of a medical disorder or disease. Many studies in the western population have shown the effectiveness of mobile app–based digital therapeutics for improving glycemic control in patients with type 2 diabetes (T2D). However, few studies have assessed similar outcomes in the South Asian population. Objective: This study aims to investigate the real-world effectiveness of the Wellthy CARE digital therapeutic for improving glycemic control among the South Asian population of Indian origin. Methods: We analyzed deidentified data from 102 patients with T2D from India enrolled in a 16-week structured self-management program delivered using the Wellthy CARE mobile app. Patients recorded their meals, weight, physical activity, and blood sugar in the app, and they received lessons on self-care behaviors (healthy eating, being active, monitoring, medication adherence, problem solving, healthy coping, and reducing risks); feedback provided by an artificial intelligence–powered chatbot; and periodic interactions with certified diabetes educators via voice calls and chats. The primary outcome of the program was a change in glycated hemoglobin A1c (HbA1c). Secondary outcomes included the difference between preintervention and postintervention fasting blood glucose (FBG) and postprandial blood glucose (PPBG) levels; changes in BMI and weight at the completion of 16 weeks; and the association between program engagement and the changes in HbA1c, FBG, and PPBG levels. Results: At the end of 16 weeks, the average change in HbA1c was –0.49% (n=102; 95% CI −0.73 to 0.25; P<.001). Of all the patients, 63.7% (65/102) had improved HbA1c levels, with a mean change of −1.16% (n=65; 95% CI −1.40 to −0.92; P<.001). The mean preintervention and postintervention FBG levels were 145 mg/dL (n=51; 95% CI 135-155) and 134 mg/dL (n=51; 95% CI 122-146; P=.02) and PPBG levels were 188 mg/dL (n=51; 95% CI 172-203) and 166 mg/dL (n=51; 95% CI 153-180; P=.03), respectively. The mean changes in BMI and weight were –0.47 kg/m2 (n=59; 95% CI −0.22 to −0.71; P<.001) and –1.32 kg (n=59; 95% CI −0.63 to −2.01; P<.001), respectively. There was a stepwise decrease in HbA1c, FBG, and PPBG levels as the program engagement increased. Patients in the highest tertile of program engagement had a significantly higher reduction in HbA1c (−0.84% vs −0.06%; P=.02), FBG (−21.4 mg/dL vs −0.18 mg/dL; P=.02), and PPBG levels (−22.03 mg/dL vs 2.35 mg/dL; P=.002) than those in the lowest tertile. Conclusions: The use of the Wellthy CARE digital therapeutic for patients with T2D showed a significant reduction in the levels of HbA1c, FBG, and PPBG after 16 weeks. A higher level of participation showed improved glycemic control, suggesting the potential of the Wellthy CARE platform for better management of the disease. %M 33764306 %R 10.2196/17908 %U https://www.jmir.org/2021/3/e17908 %U https://doi.org/10.2196/17908 %U http://www.ncbi.nlm.nih.gov/pubmed/33764306 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23970 %T Public Interest in Cosmetic Surgical and Minimally Invasive Plastic Procedures During the COVID-19 Pandemic: Infodemiology Study of Twitter Data %A Liu,Wenhui %A Wei,Zhiru %A Cheng,Xu %A Pang,Ran %A Zhang,Han %A Li,Guangshuai %+ Plastic and Reconstructive Surgery, First Affiliated Hospital, Zhengzhou University, 1 Jianshe E Road, Erqi District, Zhengzhou, , China, 86 0371 66862241, liguangshuai@zzu.edu.cn %K COVID-19 %K Twitter %K Google Trends %K plastic procedure %K trend %K survey %K surgery %K social media %D 2021 %7 16.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The unprecedented COVID-19 pandemic has brought drastic changes to the field of plastic surgery. It is critical for stakeholders in this field to identify the changes in public interest in plastic procedures to be adequately prepared to meet the challenges of the pandemic. Objective: The aim of this study is to examine tweets related to the public interest in plastic procedures during the COVID-19 pandemic and to help stakeholders in the field of plastic surgery adjust their practices and sustain their operations during the current difficult situation of the pandemic. Methods: Using a web crawler, 73,963 publicly accessible tweets about the most common cosmetic surgical and minimally invasive plastic procedures were collected. The tweets were grouped into three phases, and the tweeting frequencies and Google Trends indices were examined. Tweeting frequency, sentiment, and word frequency analyses were performed with Python modules. Results: Tweeting frequency increased by 24.0% in phase 2 and decreased by 9.1% in phase 3. Tweets about breast augmentation, liposuction, and abdominoplasty (“tummy tuck”) procedures consecutively increased over the three phases of the pandemic. Interest in Botox and chemical peel procedures revived first when the lockdown was lifted. The COVID-19 pandemic was associated with a negative impact on public sentiment about plastic procedures. The word frequency pattern significantly changed after phase 1 and then remained relatively stable. Conclusions: According to Twitter data, the public maintained their interest in plastic procedures during the COVID-19 pandemic. Stakeholders should consider refocusing on breast augmentation, liposuction, and abdominoplasty procedures during the current phase of the pandemic. In the case of a second wave of COVID-19, stakeholders should prepare for a temporary surge of Botox and chemical peel procedures. %M 33608248 %R 10.2196/23970 %U https://www.jmir.org/2021/3/e23970 %U https://doi.org/10.2196/23970 %U http://www.ncbi.nlm.nih.gov/pubmed/33608248 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26516 %T Cost-effectiveness of a Telemonitoring Program for Patients With Heart Failure During the COVID-19 Pandemic in Hong Kong: Model Development and Data Analysis %A Jiang,Xinchan %A Yao,Jiaqi %A You,Joyce Hoi-Sze %+ School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Shatin, NT, Hong Kong, China (Hong Kong), 852 39436830, joyceyou@cuhk.edu.hk %K telemonitoring %K mobile health %K smartphone %K heart failure %K COVID-19 %K health care avoidance %K cost-effectiveness %D 2021 %7 3.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has caused patients to avoid seeking medical care. Provision of telemonitoring programs in addition to usual care has demonstrated improved effectiveness in managing patients with heart failure (HF). Objective: We aimed to examine the potential clinical and health economic outcomes of a telemonitoring program for management of patients with HF during the COVID-19 pandemic from the perspective of health care providers in Hong Kong. Methods: A Markov model was designed to compare the outcomes of a care under COVID-19 (CUC) group and a telemonitoring plus CUC group (telemonitoring group) in a hypothetical cohort of older patients with HF in Hong Kong. The model outcome measures were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Sensitivity analyses were performed to examine the model assumptions and the robustness of the base-case results. Results: In the base-case analysis, the telemonitoring group showed a higher QALY gain (1.9007) at a higher cost (US $15,888) compared to the CUC group (1.8345 QALYs at US $15,603). Adopting US $48,937/QALY (1 × the gross domestic product per capita of Hong Kong) as the willingness-to-pay threshold, telemonitoring was accepted as a highly cost-effective strategy, with an incremental cost-effective ratio of US $4292/QALY. No threshold value was identified in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis, telemonitoring was accepted as cost-effective in 99.22% of 10,000 Monte Carlo simulations. Conclusions: Compared to the current outpatient care alone under the COVID-19 pandemic, the addition of telemonitoring-mediated management to the current care for patients with HF appears to be a highly cost-effective strategy from the perspective of health care providers in Hong Kong. %M 33656440 %R 10.2196/26516 %U https://www.jmir.org/2021/3/e26516 %U https://doi.org/10.2196/26516 %U http://www.ncbi.nlm.nih.gov/pubmed/33656440 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23595 %T Predicting Outcomes in Patients Undergoing Pancreatectomy Using Wearable Technology and Machine Learning: Prospective Cohort Study %A Cos,Heidy %A Li,Dingwen %A Williams,Gregory %A Chininis,Jeffrey %A Dai,Ruixuan %A Zhang,Jingwen %A Srivastava,Rohit %A Raper,Lacey %A Sanford,Dominic %A Hawkins,William %A Lu,Chenyang %A Hammill,Chet W %+ Barnes-Jewish Hospital and the Alvin J Siteman Cancer Center, 660 S Euclid Ave, Campus Box 8109, St Louis, MO, 63110, United States, 1 3142731809, hammillc@wustl.edu %K pancreatectomy %K pancreatic cancer %K telemonitoring %K remote monitoring %K machine learning %K wearable technology %K activity %D 2021 %7 18.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Pancreatic cancer is the third leading cause of cancer-related deaths, and although pancreatectomy is currently the only curative treatment, it is associated with significant morbidity. Objective: The objective of this study was to evaluate the utility of wearable telemonitoring technologies to predict treatment outcomes using patient activity metrics and machine learning. Methods: In this prospective, single-center, single-cohort study, patients scheduled for pancreatectomy were provided with a wearable telemonitoring device to be worn prior to surgery. Patient clinical data were collected and all patients were evaluated using the American College of Surgeons National Surgical Quality Improvement Program surgical risk calculator (ACS-NSQIP SRC). Machine learning models were developed to predict whether patients would have a textbook outcome and compared with the ACS-NSQIP SRC using area under the receiver operating characteristic (AUROC) curves. Results: Between February 2019 and February 2020, 48 patients completed the study. Patient activity metrics were collected over an average of 27.8 days before surgery. Patients took an average of 4162.1 (SD 4052.6) steps per day and had an average heart rate of 75.6 (SD 14.8) beats per minute. Twenty-eight (58%) patients had a textbook outcome after pancreatectomy. The group of 20 (42%) patients who did not have a textbook outcome included 14 patients with severe complications and 11 patients requiring readmission. The ACS-NSQIP SRC had an AUROC curve of 0.6333 to predict failure to achieve a textbook outcome, while our model combining patient clinical characteristics and patient activity data achieved the highest performance with an AUROC curve of 0.7875. Conclusions: Machine learning models outperformed ACS-NSQIP SRC estimates in predicting textbook outcomes after pancreatectomy. The highest performance was observed when machine learning models incorporated patient clinical characteristics and activity metrics. %M 33734096 %R 10.2196/23595 %U https://www.jmir.org/2021/3/e23595 %U https://doi.org/10.2196/23595 %U http://www.ncbi.nlm.nih.gov/pubmed/33734096 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23742 %T Acceptance of Telerheumatology by Rheumatologists and General Practitioners in Germany: Nationwide Cross-sectional Survey Study %A Muehlensiepen,Felix %A Knitza,Johannes %A Marquardt,Wenke %A Engler,Jennifer %A Hueber,Axel %A Welcker,Martin %+ Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf bei Berlin, 15562, Germany, 49 33638 83501, Felix.Muehlensiepen@mhb-fontane.de %K telemedicine %K eHealth %K mHealth %K rheumatology %K primary care %K health services research %K COVID-19 %D 2021 %7 29.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The worldwide burden of musculoskeletal diseases is increasing. The number of newly registered rheumatologists has stagnated. Primary care, which takes up a key role in early detection of rheumatic disease, is working at full capacity. COVID-19 and its containment impede rheumatological treatment. Telemedicine in rheumatology (telerheumatology) could support rheumatologists and general practitioners. Objective: The goal of this study was to investigate acceptance and preferences related to the use of telerheumatology care among German rheumatologists and general practitioners. Methods: A nationwide, cross-sectional, self-completed, paper-based survey on telerheumatology care was conducted among outpatient rheumatologists and general practitioners during the pre-COVID-19 period. Results: A total of 73.3% (349/476) of survey participants rated their knowledge of telemedicine as unsatisfactory, poor, or very poor. The majority of survey participants (358/480, 74.6%) answered that they do not currently use telemedicine, although 62.3% (291/467) would like to. Barriers to the implementation of telemedicine include the purchase of technology equipment (182/292, 62.3%), administration (181/292, 62.0%), and poor reimbursement (156/292, 53.4%). A total of 69.6% (117/168) of the surveyed physicians reckoned that telemedicine could be used in rheumatology. Surveyed physicians would prefer to use telemedicine to communicate directly with other physicians (370/455, 81.3%) than to communicate with patients (213/455, 46.8%). Among treatment phases, 64.4% (291/452) of participants would choose to use telemedicine during follow-up. Half of the participants would choose telecounseling as a specific approach to improve rheumatology care (91/170, 53.5%). Conclusions: Before COVID-19 appeared, our results indicated generally low use but high acceptance of the implementation of telerheumatology among physicians. Participants indicated that the lack of a structural framework was a barrier to the effective implementation of telerheumatology. Training courses should be introduced to address the limited knowledge on the part of physicians in the use of telemedicine. More research into telerheumatology is required. This includes large-scale randomized controlled trials, economic analyses, and the exploration of user preferences. %M 33690147 %R 10.2196/23742 %U https://www.jmir.org/2021/3/e23742 %U https://doi.org/10.2196/23742 %U http://www.ncbi.nlm.nih.gov/pubmed/33690147 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e18876 %T Association of Mobile Instant Messaging Chat Group Participation With Family Functioning and Well-Being: Population-Based Cross-sectional Study %A Zhao,Sheng Zhi %A Luk,Tzu Tsun %A Guo,Ningyuan %A Wang,Man Ping %A Lai,Agnes Yuen Kwan %A Wong,Bonny Yee Man %A Fong,Daniel Yee Tak %A Chan,Sophia Siu Chee %A Lam,Tai Hing %+ School of Nursing, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 3917 6636, mpwang@hku.hk %K mobile instant messaging %K chat groups %K family communication %K family well-being %K family functioning %D 2021 %7 15.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Convenient and quality family communication improves family functioning and well-being. Using mobile instant messaging (IM) for family communication is increasingly popular, but its association with family functioning and family well-being has not been reported. Objective: The aim of this study was to examine the association of the use of family IM chat groups with family functioning and well-being, and the mediating effect of family communication quality among Chinese adults in Hong Kong. Methods: We analyzed data from the Family and Health Information Trend Survey (FHInTS), a territory-wide, probability-based telephone survey conducted in 2017. The quality of family communication, family functioning, and well-being was assessed using the Family Communication Scale; Family Adaptation, Partnership, Growth, Affection, and Resolve (APGAR) Scale; and Family Well-Being Scale (family heath, harmony, and happiness), respectively. Respondents also reported the number of family IM chat groups (0, 1, 2, ≥3), and numbers of IM messages received (<1, 1-2, 3-10, 11-20, >20) and sent (<1, 1-2, 3-10, 11-20, >20) daily. The frequency of family IM chat interaction (range 0-8) was calculated by combining the number of messages received from and sent to the family IM chat groups daily. Covariates included sociodemographic characteristics and the frequency of family face-to-face communication (often, sometimes, seldom, or never). Data were weighted by sex, age, and education of the general population. Adjusted β coefficients of family functioning and well-being in relation to having a family IM chat group, and numbers of messages received and sent were calculated. The mediation effects of family communication on these associations were assessed, controlling for the covariates. Results: A random sample of 1638 Chinese adults (45.6% men; 78.1% aged 25 to 64 years) were interviewed (response rate: 74.4%). Female, younger age, being married or cohabiting, higher education, higher income, better family functioning, and well-being were associated with having at least one family IM chat group (all P<.01). Higher scores of family communication, family APGAR, and family well-being were associated with having more family IM chat groups and more messages received from and sent to family IM chat groups daily (all P for trend <.01). More frequent family IM chat interaction was associated with higher scores of family communication, family APGAR, and family well-being (β=.16-.83, all P for trend <.001). The associations of family IM chat interaction with family functioning and well-being were moderately (51.0%-59.6%) mediated by family communication. Conclusions: Use of a family IM chat group was associated with higher family functioning and well-being, and the association was partially mediated by family communication. %M 33720034 %R 10.2196/18876 %U https://www.jmir.org/2021/3/e18876 %U https://doi.org/10.2196/18876 %U http://www.ncbi.nlm.nih.gov/pubmed/33720034 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23662 %T Trends and Characteristics of the US Adult Population’s Behavioral Patterns in Web-Based Prescription Filling: National Survey Study %A Yang,Lin-Ya %A Lyons,Jennifer G %A Erickson,Steven R %A Wu,Chung-Hsuen %+ School of Pharmacy, College of Pharmacy, Taipei Medical University, No 250, Wu-hsing St, Xinyi District, Taipei, 11031, Taiwan, 886 227361661 ext 6180, chunghwu@tmu.edu.tw %K internet %K prescription %K online pharmacy %K National Health Interview Survey %K trend %D 2021 %7 16.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Filling a prescription on the web has become an alternative to in-person pharmacies for individuals to access their medications. However, the adoption of web-based filling has been gradual, and the use patterns remain to be unclear. Objective: This study aims to estimate the trend and prevalence of web-based prescription-filling behavior and identify associated factors among adults in the United States. Methods: We used data from the US National Health Interview Survey (NHIS) from 2009 to 2018. Adult respondents (aged ≥18 years and over) self-reported their behavior of web-based prescription filling, which was defined as having filled a prescription using the internet in the past 12 months during the survey year. We reported trends using weighted percentages adjusted by the NHIS complex sampling design. We used descriptive statistics and multivariable logistic regression models to examine trends and identify factors associated with web-based prescription-filling behavior. Results: The estimated number of adults reporting web-based prescription-filling behavior significantly increased from 13,319,877 (13,319,877/225,217,942, 5.91%) in 2009 to 28,308,262 (28,308,262/246,611,125, 11.48%) in 2018 (P<.001). Those who were more likely to report filling a prescription on the web were aged between 35 and 74 years, female, White, and frequent users of the computer or internet; these adults also reported higher education, higher income, insurance coverage, and poorer health status. Conclusions: Web-based prescription-filling behavior among US adults has increased significantly from 2009 to 2018. Health care providers should be aware of the upward trend in the use of web-based pharmacies and ensure the clinical safety of web-based prescriptions. %M 33724193 %R 10.2196/23662 %U https://www.jmir.org/2021/3/e23662 %U https://doi.org/10.2196/23662 %U http://www.ncbi.nlm.nih.gov/pubmed/33724193 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e17438 %T Opportunities and Challenges for Digital Social Prescribing in Mental Health: Questionnaire Study %A Patel,Shivani %A Craigen,Gerry %A Pinto da Costa,Mariana %A Inkster,Becky %+ South London and Maudsley NHS Trust, Denmark Hill, London, United Kingdom, 44 3228 6000 ext 1234, shivaninpatel183@gmail.com %K mental health %K technology %K psychiatry %K mobile phone %D 2021 %7 9.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The concept of digital social prescription usually refers to social prescriptions that are facilitated by using technology. Tools that enable such digital social prescriptions may be beneficial in recommending nonmedical activities to people with mental illness. As these tools are still somewhat novel and emerging, little is known about their potential advantages and disadvantages. Objective: The objective of this study is to identify the potential opportunities and challenges that may arise from digital social prescriptions. Methods: We developed a qualitative questionnaire that was disseminated through social media (Facebook and Twitter). A purposive sample targeting digital mental health experts and nonexperts was approached. The questionnaire asked participants’ views about digital social prescription; the core elements linked with a definition of digital social prescription; and the strengths, weaknesses, opportunities, and threats associated with digital social prescription. Results: Four core elements were recommended to define the concept of digital social prescription: digital, facilitate, user, and social. The main strength identified was the possibility to rapidly start using digital social prescription tools, which were perceived as cost-effective. The main weaknesses were their poor adherence and difficulties with using such tools. The main opportunities were an increased access to social prescription services and the prevention of serious mental illness. The main threats were certain groups being disadvantaged, patients being subject to unintended negative consequences, and issues relating to confidentiality and data protection. Conclusions: Although digital social prescriptions may be able to effectively augment the social prescriptions, a careful consideration of practical challenges and data ethics is imperative in the design and implementation of such technologies. %M 33687338 %R 10.2196/17438 %U https://www.jmir.org/2021/3/e17438 %U https://doi.org/10.2196/17438 %U http://www.ncbi.nlm.nih.gov/pubmed/33687338 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23087 %T Informatics Methodology Used in the Web-Based Portal of the NASCITA Cohort Study: Development and Implementation Study %A Zanetti,Michele %A Clavenna,Antonio %A Pandolfini,Chiara %A Pansieri,Claudia %A Calati,Maria Grazia %A Cartabia,Massimo %A Miglio,Daniela %A Bonati,Maurizio %+ Laboratory for Mother and Child Health, Department of Public Health, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, Milan, 20156, Italy, 39 02 3901 4478, chiara.pandolfini@marionegri.it %K internet %K computer systems %K cohort studies %K pediatricians %K infant %K newborn %D 2021 %7 12.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Many diseases occurring in adults can be pinned down to early childhood and birth cohorts are the optimal means to study this connection. Birth cohorts have contributed to the understanding of many diseases and their risk factors. Objective: To improve the knowledge of the health status of Italian children early on and how it is affected by social and health determinants, we set up a longitudinal, prospective, national-level, population-based birth cohort, the NASCITA study (NAscere e creSCere in ITAlia). The main aim of this cohort is to evaluate physical, cognitive, and psychological development; health status; and health resource use in the first 6 years of life in newborns, and potential associated factors. A web-based system was set up with the aim to host the cohort; provide ongoing information to pediatricians and to families; and facilitate accurate data input, monitoring, and analysis. This article describes the informatics methodology used to set up and maintain the NASCITA cohort with its web-based platform, and provides a general description of the data on children aged over 7 months. Methods: Family pediatricians were contacted for participation in the cohort and enrolled newborns from April 2019 to July 2020 at their first well-child visit. Information collected included basic data that are part of those routinely collected by the family pediatricians, but also parental data, such as medical history, characteristics and lifestyle, and indoor and outdoor environment. A specific web portal for the NASCITA cohort study was developed and an electronic case report form for data input was created and tested. Interactive data charts, including growth curves, are being made available to pediatricians with their patients’ data. Newsletters covering the current biomedical literature on child cohorts are periodically being put up for pediatricians, and, for parents, evidence-based information on common illnesses and problems in children. Results: The entire cohort population consists of 5166 children, with 139 participating pediatricians, distributed throughout Italy. The number of children enrolled per pediatrician ranged from 1 to 100. The 5166 enrolled children represent 66.55% (5166/7763) of the children born in all of 2018 covered by the same pediatricians participating in the cohort. The number of children aged over 7 months at the time of these analyses, and for whom the most complete data were available upon initial analyses, was 4386 (2226/4381 males [50.81%] and 142/4370 twins [3.25%]). The age of the mothers at birth of the 4386 children ranged from 16 to 54 years. Most newborns’ mothers (3758/4367, 86.05%) were born in Italy, followed by mothers born in Romania (101/4367, 2.31%), Albania (75/4367, 1.72%), and Morocco (60/4367, 1.37%). Concerning the newborns, 138/4386 (3.15%) were born with malformations and 352/4386 (8.03%) had a disease, most commonly neonatal respiratory distress syndrome (n=52), neonatal jaundice (n=46), and neonatal hypoglycemia (n=45). Conclusions: The NASCITA cohort is well underway and the population size will permit significant conclusions to be drawn. The key role of pediatricians in obtaining clinical data directly, along with the national-level representativity, will make the findings even more solid. In addition to promoting accurate data input, the multiple functions of the web portal, with its interactive platform, help maintain a solid relationship with the pediatricians and keep parents informed and interested in participating. Trial Registration: ClinicalTrials.gov NCT03894566; https://clinicaltrials.gov/ct2/show/NCT03894566 %M 33709930 %R 10.2196/23087 %U https://www.jmir.org/2021/3/e23087 %U https://doi.org/10.2196/23087 %U http://www.ncbi.nlm.nih.gov/pubmed/33709930 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24930 %T A Semiautomated Classification System for Producing Service Directories in Social and Health Care (DESDE-AND): Maturity Assessment Study %A Romero-Lopez-Alberca,Cristina %A Alonso-Trujillo,Federico %A Almenara-Abellan,Jose Luis %A Salinas-Perez,Jose A %A Gutierrez-Colosia,Mencia R %A Gonzalez-Caballero,Juan-Luis %A Pinzon Pulido,Sandra %A Salvador-Carulla,Luis %+ Agencia de Servicios Sociales y Dependencia de Andalucía, Junta de Andalucía, C/ Seda 5 - Polígono Hytasa, Sevilla, 41071, Spain, 34 609548503, federico.alonso@juntadeandalucia.es %K DESDE-LTC %K DESDE-AND %K services coding %K service directories %K decision support system %K impact analysis %K maturity %D 2021 %7 15.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: DESDE-LTC (Description and Evaluation of Services and DirectoriEs for Long-Term Care) is an international classification system that allows standardized coding and comparisons between different territories and care sectors, such as health and social care, in defined geographic areas. We adapted DESDE-LTC into a computer tool (DESDE-AND) for compiling a directory of care services in Andalucia, Spain. Objective: The aim of this study was to evaluate the maturity of DESDE-AND. A secondary objective of this study is to show the practicality of a new combined set of standard evaluation tools for measuring the maturity of health technology products. Methods: A system for semiautomated coding of service provision has been co-designed. A panel of 23 domain experts and a group of 68 end users participated in its maturity assessment that included its technology readiness level (TRL), usability, validity, adoption (Adoption Impact Ladder [AIL]), and overall degree of maturity [implementation maturity model [IMM]). We piloted the prototype in an urban environment (Seville, Spain). Results: The prototype was demonstrated in an operational environment (TRL 7). Sixty-eight different care services were coded, generating fact sheets for each service and its geolocation map. The observed agreement was 90%, with moderate reliability. The tool was partially adopted by the regional government of Andalucia (Spain), reaching a level 5 in adoption (AIL) and a level 4 in maturity (IMM) and is ready for full implementation. Conclusions: DESDE-AND is a usable and manageable system for coding and compiling service directories and it can be used as a core module of decision support systems to guide planning in complex cross-sectoral areas such as combined social and health care. %M 33720035 %R 10.2196/24930 %U https://www.jmir.org/2021/3/e24930 %U https://doi.org/10.2196/24930 %U http://www.ncbi.nlm.nih.gov/pubmed/33720035 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e15846 %T Effects of Information Architecture on the Effectiveness and User Experience of Web-Based Patient Education in Middle-Aged and Older Adults: Online Randomized Experiment %A Dekkers,Tessa %A Melles,Marijke %A Vehmeijer,Stephan B W %A de Ridder,Huib %+ Faculty of Behavioural, Management and Social sciences, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 534899741, t.dekkers@utwente.nl %K user-computer interface %K total joint replacement %K user-centered design %K health education %K mobile phone %K computer-assisted instruction %K patient education as topic %K models, theoretical %K middle aged %K aged %K humans %K internet %D 2021 %7 3.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based patient education is increasingly offered to improve patients’ ability to learn, remember, and apply health information. Efficient organization, display, and structural design, that is, information architecture (IA), can support patients’ ability to independently use web-based patient education. However, the role of IA in the context of web-based patient education has not been examined systematically. Objective: To support intervention designers in making informed choices that enhance patients’ learning, this paper describes a randomized experiment on the effects of IA on the effectiveness, use, and user experience of a patient education website and examines the theoretical mechanisms that explain these effects. Methods: Middle-aged and older adults with self-reported hip or knee joint complaints were recruited to use and evaluate 1 of 3 patient education websites containing information on total joint replacement surgery. Each website contained the same textual content based on an existing leaflet but differed in the employed IA design (tunnel, hierarchical, or matrix design). Participants rated the websites on satisfaction, engagement, control, relevance, trust, and novelty and completed an objective knowledge test. Analyses of variance and structural equation modeling were used to examine the effects of IA and construct a theoretical model. Results: We included 215 participants in our analysis. IA did not affect knowledge gain (P=.36) or overall satisfaction (P=.07) directly. However, tunnel (mean 3.22, SD 0.67) and matrix (mean 3.17, SD 0.69) architectures were found to provide more emotional support compared with hierarchical architectures (mean 2.86, SD 0.60; P=.002). Furthermore, increased perceptions of personal relevance in the tunnel IA (β=.18) were found to improve satisfaction (β=.17) indirectly. Increased perceptions of active control in the matrix IA (β=.11) also improved satisfaction (β=.27) indirectly. The final model of the IA effects explained 74.3% of the variance in satisfaction and 6.8% of the variance in knowledge and achieved excellent fit (χ217,215=14.7; P=.62; root mean square error of approximation=0.000; 95% CI [0.000-0.053]; comparative fit index=1.00; standardized root mean square residual=0.044). Conclusions: IA has small but notable effects on users’ experiences with web-based health education interventions. Web-based patient education designers can employ tunnel IA designs to guide users through sequentially ordered content or matrix IA to offer users more control over navigation. Both improve user satisfaction by increasing user perceptions of relevance (tunnel) and active control (matrix). Although additional research is needed, hierarchical IA designs are currently not recommended, as hierarchical content is perceived as less supportive, engaging, and relevant, which may diminish the use and, in turn, the effect of the educational intervention. %M 33656446 %R 10.2196/15846 %U https://www.jmir.org/2021/3/e15846 %U https://doi.org/10.2196/15846 %U http://www.ncbi.nlm.nih.gov/pubmed/33656446 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24006 %T User-Centered Development of a Web Platform Supporting Community-Based Health Care Organizations for Older Persons in Need of Support: Qualitative Focus Group Study %A Biehl,Verena %A Becker,Heidrun %A Ogrin,Alenka %A Reissner,Alenka %A Burger,Johannes %A Glaessel,Andrea %+ Institute of Health Sciences, Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, Winterthur, CH-8401, Switzerland, 41 58 934 4397, andrea.glaessel@zhaw.ch %K community-based health care services %K older persons in need of support %K user-centered design %K focus groups %K qualitative research %K web platform %D 2021 %7 10.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The ongoing changes in population demographics increase the relevance of dignified aging across Europe. Community-based health care (CBHC) organizations are necessary to provide sustainable strategies for organizing care for older persons in need of support. To support the digitalization of these organizations, new business models and suitable web platforms are necessary. Objective: This study, which is part of the European Active and Assisted Living (AAL) project called “ICareCoops”, aimed to explore concepts, approaches, and workflows of CBHC organizations to achieve a comprehensive understanding of extant services offered and relevant requirements to support these services with information and computer technology (ICT) solutions. Methods: A qualitative study with six focus groups (FGs) with 40 participants was conducted in Switzerland and Slovenia to identify potential stakeholders’ needs and requirements for the user-centered development of a web platform. Data were collected from three different stakeholder groups: (1) older persons in need of support as care receivers, (2) significant others of older persons in need of support, and (3) managers or care providers of CBHC organizations. A semistructured interview guide with open questions was used for data collection. FG sessions were audio-recorded and transcribed verbatim. Thematic content analysis was used to analyze the content of the FG sessions. To assist with further web platform development, the responses of the FG participants were translated into user stories to describe technical requirements. Results: By analyzing the transcripts, five main categories were identified: (1) ICT usage behavior of users, (2) challenges of web platform usage, (3) content and technical requirements for the web platform, (4) form and services of CBHC organizations, and (5) rationales of CBHC organizations. The main issues identified were the need for seniors to have individual contact with the CBHC organization and the possibility to coordinate routine services via the web platform, such as ordering meals-on-wheels or booking a caregiver to accompany an older person to the doctor. Conclusions: The majority of participants showed a lack of familiarity with the usage of ICT. Nevertheless, they were open-minded regarding web platform usage to facilitate workflows and to benefit CBHC organizations. Cooperatives as an organizational model demonstrate a high potential to address users’ needs. Therefore, the web platform offers an essential tool for innovative health care models in the future. Searching for care services, contacting care providers, and communicating with care providers was preferred via personal contact and seemed to be the key element for user acceptance and for the successful implementation of a web platform like “ICareCoops” to support CBHC organizations. %M 33688837 %R 10.2196/24006 %U https://www.jmir.org/2021/3/e24006 %U https://doi.org/10.2196/24006 %U http://www.ncbi.nlm.nih.gov/pubmed/33688837 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25505 %T A Clinical Communication Tool (Loop) for Team-Based Care in Pediatric and Adult Care Settings: Hybrid Mixed Methods Implementation Study %A Husain,Amna %A Cohen,Eyal %A Dubrowski,Raluca %A Jamieson,Trevor %A Kurahashi,Allison Miyoshi %A Lokuge,Bhadra %A Rapoport,Adam %A Saunders,Stephanie %A Stasiulis,Elaine %A Stinson,Jennifer %A Subramaniam,Saranjah %A Wegier,Pete %A Barwick,Melanie %+ Temmy Latner Centre for Palliative Care, Sinai Health, 60 Murray St, 4th Floor, Toronto, ON, M5T 3L9, Canada, 1 416 586 4800 ext 7884, amna.husain@utoronto.ca %K coordination of care %K complexity %K internet communication technology %K collaborative care %K implementation science %K theory of behavior %K interprofessional team %K patient engagement %K social networking technology %K user-centered design %K Consolidated Framework for Implementation Research %K Quality Improvement Framework %K Implementation Outcome Taxonomy %D 2021 %7 3.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Communication within the circle of care is central to coordinated, safe, and effective care; yet patients, caregivers, and health care providers often experience poor communication and fragmented care. Through a sequential program of research, the Loop Research Collaborative developed a web-based, asynchronous clinical communication system for team-based care. Loop assembles the circle of care centered on a patient, in private networking spaces called Patient Loops. The patient, their caregiver, or both are part of the Patient Loop. The communication is threaded, it can be filtered and sorted in multiple ways, it is securely stored, and can be exported for upload to a medical record. Objective: The objective of this study was to implement and evaluate Loop. The study reporting adheres to the Standards for Reporting Implementation Research. Methods: The study was a hybrid type II mixed methods design to simultaneously evaluate Loop’s clinical and implementation effectiveness, and implementation barriers and facilitators in 6 health care sites. Data included monthly user check-in interviews and bimonthly surveys to capture patient or caregiver experience of continuity of care, in-depth interviews to explore barriers and facilitators based on the Consolidated Framework for Implementation Research (CFIR), and Loop usage extracted directly from the Loop system. Results: We recruited 25 initiating health care providers across 6 sites who then identified patients or caregivers for recruitment. Of 147 patient or caregiver participants who were assessed and met screening criteria, 57 consented and 52 were enrolled on Loop, creating 52 Patient Loops. Across all Patient Loops, 96 additional health care providers consented to join the Loop teams. Loop usage was followed for up to 8 months. The median number of messages exchanged per team was 1 (range 0-28). The monthly check-in and CFIR interviews showed that although participants acknowledged that Loop could potentially fill a gap, existing modes of communication, workflows, incentives, and the lack of integration with the hospital electronic medical records and patient portals were barriers to its adoption. While participants acknowledged Loop’s potential value for engaging the patient and caregiver, and for improving communication within the patient’s circle of care, Loop’s relative advantage was not realized during the study and there was insufficient tension for change. Missing data limited the analysis of continuity of care. Conclusions: Fundamental structural and implementation challenges persist toward realizing Loop’s potential as a shared system of asynchronous communication. Barriers include health information system integration; system, organizational, and individual tension for change; and a fee structure for health care provider compensation for asynchronous communication. %M 33656445 %R 10.2196/25505 %U https://www.jmir.org/2021/3/e25505 %U https://doi.org/10.2196/25505 %U http://www.ncbi.nlm.nih.gov/pubmed/33656445 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e15032 %T An 11-Item Measure of User- and Human-Centered Design for Personal Health Tools (UCD-11): Development and Validation %A Witteman,Holly O %A Vaisson,Gratianne %A Provencher,Thierry %A Chipenda Dansokho,Selma %A Colquhoun,Heather %A Dugas,Michele %A Fagerlin,Angela %A Giguere,Anik MC %A Haslett,Lynne %A Hoffman,Aubri %A Ivers,Noah M %A Légaré,France %A Trottier,Marie-Eve %A Stacey,Dawn %A Volk,Robert J %A Renaud,Jean-Sébastien %+ Université Laval, 1050, avenue de la Médecine, Quebec City, QC, Canada, 1 418 656 2131, holly.witteman@fmed.ulaval.ca %K patient-centered care %K patient participation %K health services research %K validation studies as topic %K surveys and questionnaires %K humans %K user-centred design, human-centred design %K user-centered design %K human-centered design %K co-design %K instrument %K scale %K index %K patient and public involvement %D 2021 %7 16.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Researchers developing personal health tools employ a range of approaches to involve prospective users in design and development. Objective: The aim of this paper was to develop a validated measure of the human- or user-centeredness of design and development processes for personal health tools. Methods: We conducted a psychometric analysis of data from a previous systematic review of the design and development processes of 348 personal health tools. Using a conceptual framework of user-centered design, our team of patients, caregivers, health professionals, tool developers, and researchers analyzed how specific practices in tool design and development might be combined and used as a measure. We prioritized variables according to their importance within the conceptual framework and validated the resultant measure using principal component analysis with Varimax rotation, classical item analysis, and confirmatory factor analysis. Results: We retained 11 items in a 3-factor structure explaining 68% of the variance in the data. The Cronbach alpha was .72. Confirmatory factor analysis supported our hypothesis of a latent construct of user-centeredness. Items were whether or not: (1) patient, family, caregiver, or surrogate users were involved in the steps that help tool developers understand users or (2) develop a prototype, (3) asked their opinions, (4) observed using the tool or (5) involved in steps intended to evaluate the tool, (6) the process had 3 or more iterative cycles, (7) changes between cycles were explicitly reported, (8) health professionals were asked their opinion and (9) consulted before the first prototype was developed or (10) between initial and final prototypes, and (11) a panel of other experts was involved. Conclusions: The User-Centered Design 11-item measure (UCD-11) may be used to quantitatively document the user/human-centeredness of design and development processes of patient-centered tools. By building an evidence base about such processes, we can help ensure that tools are adapted to people who will use them, rather than requiring people to adapt to tools. %M 33724194 %R 10.2196/15032 %U https://www.jmir.org/2021/3/e15032 %U https://doi.org/10.2196/15032 %U http://www.ncbi.nlm.nih.gov/pubmed/33724194 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24313 %T Adaptation of Extended Reality Smart Glasses for Core Nursing Skill Training Among Undergraduate Nursing Students: Usability and Feasibility Study %A Kim,Sun Kyung %A Lee,Youngho %A Yoon,Hyoseok %A Choi,Jongmyung %+ Department of Biomedicine, Health & Life Convergence Sciences, BK21 Four, Mokpo National University, 1666, Yeongsan-ro, Cheonggye-myeon, Muan-gun, Jeollanam-do, Muan, Republic of Korea, 82 614506292, skkim@mokpo.ac.kr %K nursing education %K skill training %K self-practice %K smart glass %K usability %K feasibility %D 2021 %7 2.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Skill training in nursing education has been highly dependent on self-training because of Korea’s high student-faculty ratio. Students tend to have a passive attitude in self-practice, and it is hard to expect effective learning outcomes with traditional checklist-dependent self-practice. Smart glasses have a high potential to assist nursing students with timely information, and a hands-free device does not interrupt performance. Objective: This study aimed to develop a smart glass–based nursing skill training program and evaluate its usability and feasibility for the implementation of self-practice. Methods: We conducted a usability and feasibility study with 30 undergraduate nursing students during a 2-hour open lab for self-practice of core nursing skills, wearing smart glasses for visualized guidance. The usability test was conducted using a 16-item self-reporting questionnaire and 7 open-ended questions. Learning satisfaction was assessed using a 7-item questionnaire. The number of practice sessions was recorded, and perceived competency in core nursing skills was measured before and after the intervention. At the final evaluation, performance accuracy and time consumed for completion were recorded. Results: Smart glass–assisted self-practice of nursing skills was perceived as helpful, convenient, and interesting. Participants reported improved recollection of sequences of skills, and perceived competency was significantly improved. Several issues were raised by participants regarding smart glasses, including small screen size, touch sensors, fogged lenses with masks, heaviness, and heat after a period of time. Conclusions: Smart glasses have the potential to assist self-practice, providing timely information at students’ own paces. Having both hands free from holding a device, participants reported the convenience of learning as they could practice and view the information simultaneously. Further revision correcting reported issues would improve the applicability of smart glasses in other areas of nursing education. %M 33650975 %R 10.2196/24313 %U https://www.jmir.org/2021/3/e24313 %U https://doi.org/10.2196/24313 %U http://www.ncbi.nlm.nih.gov/pubmed/33650975 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e21196 %T Assessment of Diagnostic Competences With Standardized Patients Versus Virtual Patients: Experimental Study in the Context of History Taking %A Fink,Maximilian C %A Reitmeier,Victoria %A Stadler,Matthias %A Siebeck,Matthias %A Fischer,Frank %A Fischer,Martin R %+ Institute for Medical Education, University Hospital, LMU Munich, Pettenkoferstraße 8a, Munich, 80336, Germany, 49 089 4400 57428, maximilian.fink@yahoo.com %K clinical reasoning %K medical education %K performance-based assessment %K simulation %K standardized patient %K virtual patient %D 2021 %7 4.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Standardized patients (SPs) have been one of the popular assessment methods in clinical teaching for decades, although they are resource intensive. Nowadays, simulated virtual patients (VPs) are increasingly used because they are permanently available and fully scalable to a large audience. However, empirical studies comparing the differential effects of these assessment methods are lacking. Similarly, the relationships between key variables associated with diagnostic competences (ie, diagnostic accuracy and evidence generation) in these assessment methods still require further research. Objective: The aim of this study is to compare perceived authenticity, cognitive load, and diagnostic competences in performance-based assessment using SPs and VPs. This study also aims to examine the relationships of perceived authenticity, cognitive load, and quality of evidence generation with diagnostic accuracy. Methods: We conducted an experimental study with 86 medical students (mean 26.03 years, SD 4.71) focusing on history taking in dyspnea cases. Participants solved three cases with SPs and three cases with VPs in this repeated measures study. After each case, students provided a diagnosis and rated perceived authenticity and cognitive load. The provided diagnosis was scored in terms of diagnostic accuracy; the questions asked by the medical students were rated with respect to their quality of evidence generation. In addition to regular null hypothesis testing, this study used equivalence testing to investigate the absence of meaningful effects. Results: Perceived authenticity (1-tailed t81=11.12; P<.001) was higher for SPs than for VPs. The correlation between diagnostic accuracy and perceived authenticity was very small (r=0.05) and neither equivalent (P=.09) nor statistically significant (P=.32). Cognitive load was equivalent in both assessment methods (t82=2.81; P=.003). Intrinsic cognitive load (1-tailed r=−0.30; P=.003) and extraneous load (1-tailed r=−0.29; P=.003) correlated negatively with the combined score for diagnostic accuracy. The quality of evidence generation was positively related to diagnostic accuracy for VPs (1-tailed r=0.38; P<.001); this finding did not hold for SPs (1-tailed r=0.05; P=.32). Comparing both assessment methods with each other, diagnostic accuracy was higher for SPs than for VPs (2-tailed t85=2.49; P=.01). Conclusions: The results on perceived authenticity demonstrate that learners experience SPs as more authentic than VPs. As higher amounts of intrinsic and extraneous cognitive loads are detrimental to performance, both types of cognitive load must be monitored and manipulated systematically in the assessment. Diagnostic accuracy was higher for SPs than for VPs, which could potentially negatively affect students’ grades with VPs. We identify and discuss possible reasons for this performance difference between both assessment methods. %M 33661122 %R 10.2196/21196 %U https://www.jmir.org/2021/3/e21196 %U https://doi.org/10.2196/21196 %U http://www.ncbi.nlm.nih.gov/pubmed/33661122 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e22345 %T Basic Medical Training for Refugees via Collaborative Blended Learning: Quasi-Experimental Design %A Lovey,Thibault %A O'Keeffe,Paul %A Petignat,Ianis %+ InZone, University of Geneva, Boulevard Pont d'Arve 28, Geneva, 1205, Switzerland, 41 223799533, Paul.okeeffe@unige.ch %K refugees %K blended learning %K basic medical training %K higher education in emergencies %K innovation %K mobile phone %D 2021 %7 24.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Globally, there is an excess of 68.5 million people who have been forced to leave their homes and seek sanctuary elsewhere because of poverty, persecution, conflict, violence, and human rights violations. Although international humanitarian responses usually focus on ensuring that the basic needs of these people are being met, there is growing attention on the role that development-oriented interventions can play in the longer term. Higher education in a refugee context is one such intervention that can equip refugees with the knowledge and skills they need to serve their communities and move forward. Objective: This study aims to evaluate the outcomes and effectiveness of the University of Geneva InZone-Raft Basic Medical Training Course in the Kakuma refugee camp in Kenya compared with a previous incarnation of the same course in the Dadaab refugee camp in Kenya. Methods: We used a quasi-experimental design to compare the posttest scores of both inequivalent student groups: control group (n=18) and intervention group (n=16). Factors that influenced refugee students’ knowledge acquisition, the amount of knowledge they acquired, and their academic outcomes were assessed, and the pedagogical evolution of the project is presented. Results: We found that the Kakuma intervention course yielded better outcomes and was more effective in terms of learning than the Dadaab control course. Of the 16 students who took part in the intervention course, 10 (63%) completed the program successfully and received accreditation from the University of Geneva. We observed that they received new knowledge well and scored higher on all learning modalities than those in the control course. Comparison of written and oral examinations between the courses showed statistical significance for the intervention group in written and oral exams (two-tailed: P=.006 and P=.05; one-tailed: P=.003 and P=.03, respectively). The Kakuma course was not effective in addressing electricity and internet access problems, nor in reducing the challenge of tight deadlines in the syllabus. Pedagogical adjustments to the intervention course improved student involvement, with higher participation rates in quizzes (10/11, 91%), and overall satisfaction and learning. Conclusions: The intervention group—with an improved mode of delivery, better contextualized content, and further interaction—reached a higher level of medical knowledge acquisition and developed more complex questions on medical topics than the control group. The positive outcome of this project shows that given the right resources and support, refugees can contribute to the improvement and development of health care in their communities. Nonetheless, a more focused effort is necessary to meet the educational needs of refugee learners and better understand their living conditions. %M 33759802 %R 10.2196/22345 %U https://www.jmir.org/2021/3/e22345 %U https://doi.org/10.2196/22345 %U http://www.ncbi.nlm.nih.gov/pubmed/33759802 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25722 %T Linguistic Analysis of Online Communication About a Novel Persecutory Belief System (Gangstalking): Mixed Methods Study %A Lustig,Andrew %A Brookes,Gavin %A Hunt,Daniel %+ Department of Psychiatry, Faculty of Medicine, University of Toronto, 1051 Queen Street West, Toronto, ON, M6J1H3, Canada, 1 416 535 8501 ext 32841, andrew.lustig@camh.ca %K internet %K discourse analysis %K psychosis %K delusions %K linguistics %K language %K online discourse %K corpus linguistics %K computer mediated communication %K schizophrenia %K eHealth %D 2021 %7 5.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Gangstalking is a novel persecutory belief system whereby those affected believe they are being followed, stalked, and harassed by a large number of people, often numbering in the thousands. The harassment is experienced as an accretion of innumerable individually benign acts such as people clearing their throat, muttering under their breath, or giving dirty looks as they pass on the street. Individuals affected by this belief system congregate in online fora to seek support, share experiences, and interact with other like-minded individuals. Such people identify themselves as targeted individuals. Objective: The objective of the study was to characterize the linguistic and rhetorical practices used by contributors to the gangstalking forum to construct, develop, and contest the gangstalking belief system. Methods: This mixed methods study employed corpus linguistics, which involves using computational techniques to examine recurring linguistic patterns in large, digitized bodies of authentic language data. Discourse analysis is an approach to text analysis which focuses on the ways in which linguistic choices made by text creators contribute to particular functions and representations. We assembled a 225,000-word corpus of postings on a gangstalking support forum. We analyzed these data using keyword analysis, collocation analysis, and manual examination of concordances to identify discursive and rhetorical practices among self-identified targeted individuals. Results: The gangstalking forum served as a site of discursive contest between 2 opposing worldviews. One is that gangstalking is a widespread, insidious, and centrally coordinated system of persecution employing community members, figures of authority, and state actors. This was the dominant discourse in the study corpus. The opposing view is a medicalized discourse supporting gangstalking as a form of mental disorder. Contributors used linguistic practices such as presupposition, nominalization, and the use of specialized jargon to construct gangstalking as real and external to the individual affected. Although contributors generally rejected the notion that they were affected by mental disorder, in some instances, they did label others in the forum as impacted/affected by mental illness if their accounts if their accounts were deemed to be too extreme or bizarre. Those affected demonstrated a concern with accumulating evidence to prove their position to incredulous others. Conclusions: The study found that contributors to the study corpus accomplished a number of tasks. They used linguistic practices to co-construct an internally coherent and systematized persecutory belief system. They advanced a position that gangstalking is real and contested the medicalizing discourse that gangstalking is a form of mental disorder. They supported one another by sharing similar experiences and providing encouragement and advice. Finally, they commiserated over the challenges of proving the existence of gangstalking. %M 33666560 %R 10.2196/25722 %U https://www.jmir.org/2021/3/e25722 %U https://doi.org/10.2196/25722 %U http://www.ncbi.nlm.nih.gov/pubmed/33666560 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e21435 %T Toward a Multivariate Prediction Model of Pharmacological Treatment for Women With Gestational Diabetes Mellitus: Algorithm Development and Validation %A Velardo,Carmelo %A Clifton,David %A Hamblin,Steven %A Khan,Rabia %A Tarassenko,Lionel %A Mackillop,Lucy %+ Sensyne Health, plc, Schrodinger Building, Heatley Road, Oxford, OX4 4GE, United Kingdom, 44 0330 058 1845, carmelo.velardo@sensynehealth.com %K gestational diabetes mellitus %K mobile health %K machine learning %K algorithms %D 2021 %7 10.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Successful management of gestational diabetes mellitus (GDM) reduces the risk of morbidity in women and newborns. A woman’s blood glucose readings and risk factors are used by clinical staff to make decisions regarding the initiation of pharmacological treatment in women with GDM. Mobile health (mHealth) solutions allow the real-time follow-up of women with GDM and allow timely treatment and management. Machine learning offers the opportunity to quickly analyze large quantities of data to automatically flag women at risk of requiring pharmacological treatment. Objective: The aim of this study is to assess whether data collected through an mHealth system can be analyzed to automatically evaluate the switch to pharmacological treatment from diet-based management of GDM. Methods: We collected data from 3029 patients to design a machine learning model that can identify when a woman with GDM needs to switch to medications (insulin or metformin) by analyzing the data related to blood glucose and other risk factors. Results: Through the analysis of 411,785 blood glucose readings, we designed a machine learning model that can predict the timing of initiation of pharmacological treatment. After 100 experimental repetitions, we obtained an average area under the receiver operating characteristic curve of 0.80 (SD 0.02) and an algorithm that allows the flexibility of setting the operating point rather than relying on a static heuristic method, which is currently used in clinical practice. Conclusions: Using real-time data collected via an mHealth system may further improve the timeliness of the intervention and potentially improve patient care. Further real-time clinical testing will enable the validation of our algorithm using real-world data. %M 33688832 %R 10.2196/21435 %U https://www.jmir.org/2021/3/e21435 %U https://doi.org/10.2196/21435 %U http://www.ncbi.nlm.nih.gov/pubmed/33688832 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24122 %T The Perceived Impact and Usability of a Care Management and Coordination System in Delivering Services to Vulnerable Populations: Mixed Methods Study %A Rizvi,Rubina %A VanHouten,Courtney %A Bright,Tiffani J %A McKillop,Mollie M %A Alevy,Shira %A Brotman,David %A Sands-Lincoln,Megan %A Snowdon,Jane %A Robinson,Barbie J %A Staats,Carolyn %A Jackson,Gretchen P %A Kassler,William J %+ IBM Watson Health, 75 Binney St, Cambridge, MA, 02142, United States, 1 952 237 7660, rubina.rizvi@ibm.com %K vulnerable population %K managed care %K data integration %K advanced technologies %K usability %K mixed methods study %D 2021 %7 12.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: People with complex needs, such as those experiencing homelessness, require concurrent, seamless support from multiple social service agencies. Sonoma County, California has one of the nation’s largest homeless populations among largely suburban communities. To support client-centered care, the county deployed a Care Management and Coordination System (CMCS). This system comprised the Watson Care Manager (WCM), a front-end system, and Connect 360, which is an integrated data hub that aggregates information from various systems into a single client record. Objective: The aim of this study is to evaluate the perceived impact and usability of WCM in delivering services to the homeless population in Sonoma County. Methods: A mixed methods study was conducted to identify ways in which WCM helps to coordinate care. Interviews, observations, and surveys were conducted, and transcripts and field notes were thematically analyzed and directed by a grounded theory approach. Responses to the Technology Acceptance Model survey were analyzed. Results: A total of 16 participants were interviewed, including WCM users (n=8) and department leadership members (n=8). In total, 3 interdisciplinary team meetings were observed, and 8 WCM users were surveyed. WCM provided a central shared platform where client-related, up-to-date, comprehensive, and reliable information from participating agencies was consolidated. Factors that facilitated WCM use were users’ enthusiasm regarding the tool functionalities, scalability, and agency collaboration. Constraining factors included the suboptimal awareness of care delivery goals and functionality of the system among the community, sensitivities about data sharing and legal requirements, and constrained funding from government and nongovernment organizations. Overall, users found WCM to be a useful tool that was easy to use and helped to enhance performance. Conclusions: WCM supports the delivery of care to individuals with complex needs. Integration of data and information in a CMCS can facilitate coordinated care. Future research should examine WCM and similar CMCSs in diverse populations and settings. %M 33709928 %R 10.2196/24122 %U https://www.jmir.org/2021/3/e24122 %U https://doi.org/10.2196/24122 %U http://www.ncbi.nlm.nih.gov/pubmed/33709928 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23137 %T Key Variables for Effective eHealth Designs for Individuals With and Without Mental Health Disorders: 2^12-4 Fractional Factorial Experiment %A Rotondi,Armando J %A Grady,Jonathan %A Hanusa,Barbara H %A Haas,Gretchen L %A Spring,Michael R %A Abebe,Kaleab Z %A Luther,James %A Gurklis,John %+ Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Health Care System, Department of Veterans Affairs, Research Office Bld, (151R-U), University Drive C, Pittsburgh, PA, 15240, United States, 1 412 360 2369, armandorotondi1@gmail.com %K schizophrenia %K severe mental illness %K eHealth %K eHealth design %K website %K usability %K website design %K website usability %K fractional factorial design %D 2021 %7 24.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth applications not only offer the potential to increase service convenience and responsiveness but also expand the ability to tailor services to improve relevance, engagement, and use. To achieve these goals, it is critical that the designs are intuitive. Limited research exists on designs that work for those with a severe mental illness (SMI), many of whom have difficulty traveling for treatments, reject or infrequently seek treatment, and tend to discontinue treatments for significant periods. Objective: This study aims to evaluate the influence of 12 design variables (eg, navigational depth, reading level, and use of navigational lists) on the usability of eHealth application websites for those with and without SMI. Methods: A 212-4 fractional factorial experiment was used to specify the designs of 256 eHealth websites. This approach systematically varied the 12 design variables. The final destination contents of all websites were identical, and only the designs of the navigational pages varied. The 12 design elements were manipulated systematically to allow the assessment of combinations of design elements rather than only one element at a time. Of the 256 websites, participants (n=222) sought the same information on 8 randomly selected websites. Mixed effect regressions, which accounted for the dependency of the 8 observations within participants, were used to test for main effects and interactions on the ability and time to find information. Classification and regression tree analyses were used to identify effects among the 12 variables on participants’ abilities to locate information, for the sample overall and each of the 3 diagnostic groups of participants (schizophrenia spectrum disorder [SSD], other mental illnesses, and no mental illness). Results: The best and worst designs were identified for each of these 4 groups. The depth of a website’s navigation, that is, the number of screens users needed to navigate to find the desired content, had the greatest influence on usability (ability to find information) and efficiency (time to find information). The worst performing designs for those with SSD had a 9% success rate, and the best had a 51% success rate: the navigational designs made a 42% difference in usability. For the group with other mental illnesses, the design made a 50% difference, and for those with no mental illness, a 55% difference was observed. The designs with the highest usability had several key design similarities, as did those with the poorest usability. Conclusions: It is possible to identify evidence-based strategies for designing eHealth applications that result in significantly better performance. These improvements in design benefit all users. For those with SSD or other SMIs, there are designs that are highly effective. Both the best and worst designs have key similarities but vary in some characteristics. %M 33759796 %R 10.2196/23137 %U https://www.jmir.org/2021/3/e23137 %U https://doi.org/10.2196/23137 %U http://www.ncbi.nlm.nih.gov/pubmed/33759796 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e22099 %T Design Guidelines of a Computer-Based Intervention for Computer Vision Syndrome: Focus Group Study and Real-World Deployment %A Hwang,Youjin %A Shin,Donghoon %A Eun,Jinsu %A Suh,Bongwon %A Lee,Joonhwan %+ Human Computer Interaction and Design Lab, Seoul National University, 64-406, Gwanak ro 1, Gwanak gu, Seoul, 08826, Republic of Korea, 82 02 880 6450, joonhwan@snu.ac.kr %K computer-based intervention %K computer vision syndrome %K system interface %K deployment study %D 2021 %7 29.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Prolonged time of computer use increases the prevalence of ocular problems, including eye strain, tired eyes, irritation, redness, blurred vision, and double vision, which are collectively referred to as computer vision syndrome (CVS). Approximately 70% of computer users have vision-related problems. For these reasons, properly designed interventions for users with CVS are required. To design an effective screen intervention for preventing or improving CVS, we must understand the effective interfaces of computer-based interventions. Objective: In this study, we aimed to explore the interface elements of computer-based interventions for CVS to set design guidelines based on the pros and cons of each interface element. Methods: We conducted an iterative user study to achieve our research objective. First, we conducted a workshop to evaluate the overall interface elements that were included in previous systems for CVS (n=7). Through the workshop, participants evaluated existing interface elements. Based on the evaluation results, we eliminated the elements that negatively affect intervention outcomes. Second, we designed our prototype system LiquidEye that includes multiple interface options (n=11). Interface options included interface elements that were positively evaluated in the workshop study. Lastly, we deployed LiquidEye in the real world to see how the included elements affected the intervention outcomes. Participants used LiquidEye for 14 days, and during this period, we collected participants’ daily logs (n=680). Additionally, we conducted prestudy and poststudy surveys, and poststudy interviews to explore how each interface element affects participation in the system. Results: User data logs collected from the 14 days of deployment were analyzed with multiple regression analysis to explore the interface elements affecting user participation in the intervention (LiquidEye). Statistically significant elements were the instruction page of the eye resting strategy (P=.01), goal setting of the resting period (P=.009), compliment feedback after completing resting (P<.001), a mid-size popup window (P=.02), and CVS symptom-like effects (P=.004). Conclusions: Based on the study results, we suggested design implications to consider when designing computer-based interventions for CVS. The sophisticated design of the customization interface can make it possible for users to use the system more interactively, which can result in higher engagement in managing eye conditions. There are important technical challenges that still need to be addressed, but given the fact that this study was able to clarify the various factors related to computer-based interventions, the findings are expected to contribute greatly to the research of various computer-based intervention designs in the future. %M 33779568 %R 10.2196/22099 %U https://www.jmir.org/2021/3/e22099 %U https://doi.org/10.2196/22099 %U http://www.ncbi.nlm.nih.gov/pubmed/33779568 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e21839 %T A Uniquely Targeted, Mobile App-Based HIV Prevention Intervention for Young Transgender Women: Adaptation and Usability Study %A Kuhns,Lisa M %A Hereth,Jane %A Garofalo,Robert %A Hidalgo,Marco %A Johnson,Amy K %A Schnall,Rebecca %A Reisner,Sari L %A Belzer,Marvin %A Mimiaga,Matthew J %+ Ann & Robert H Lurie Children's Hospital of Chicago, Potocsnak Family Division of Adolescent and Young Adult Medicine, 225 E Chicago Avenue, Box 161, Chicago, IL, 60611, United States, 1 312 227 7760, lkuhns@luriechildrens.org %K transgender persons %K HIV %K mobile app %K mHealth %K mobile phone %D 2021 %7 31.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Young transgender women (YTW) are a key population for HIV-related risk reduction, yet very few interventions have been developed to meet their needs. Mobile health interventions with the potential for both efficacy and wide reach are a promising strategy to reduce HIV risk among YTW. Objective: This study aims to adapt an efficacious group-based intervention to a mobile app, Project LifeSkills, to reduce HIV risk among YTW, and to test its acceptability and usability. Methods: The group-based intervention was adapted to a mobile app, LifeSkills Mobile, with input from an expert advisory group and feedback from YTW collected during user-centered design sessions. A beta version of the app was then tested in a usability evaluation using a think-aloud protocol with debriefing interviews, recordings of screen activity, and assessments of usability via the Post-Study System Usability Questionnaire (PSSUQ) and the Health Information Technology Usability Evaluation Scale (Health-ITUES). Results: YTW (n=8; age: mean 24 years, SD 3 years; racial or ethnic minority: 7/8, 88%) provided feedback on the app prototype in design sessions and then tested a beta version of the app in a usability trial (n=10; age: mean 24 years, SD 3 years; racial or ethnic minority: 8/10, 80%). Both usability ratings (Health-ITUES: mean 4.59, SD 0.86; scale range: 1-5) and ratings for satisfaction and accessibility (PSSUQ: mean 4.64, SD 0.90; scale range 1-5) were in the good to excellent range. No functional bugs were identified, and all mobile activities were deployed as expected. Participant feedback from the usability interviews indicated very good salience of the intervention content among the focal population. Participants’ suggestions to further increase app engagement included adding animation, adding audio, and reducing the amount text. Conclusions: We conclude that the LifeSkills Mobile app is a highly usable and engaging mobile app for HIV prevention among YTW. %M 33787503 %R 10.2196/21839 %U https://www.jmir.org/2021/3/e21839 %U https://doi.org/10.2196/21839 %U http://www.ncbi.nlm.nih.gov/pubmed/33787503 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25208 %T Comparative Success of Recruitment Strategies for an Exercise Intervention Trial Among Women With Polycystic Ovary Syndrome: Observational Study %A Benham,Jamie L %A Booth,Jane E %A Friedenreich,Christine M %A Rabi,Doreen M %A Sigal,Ronald J %+ Department of Medicine, Cumming School of Medicine, University of Calgary, Richmond Road Diagnostic and Treatment Centre, Room 1898, 1820 Richmond Road SW, Calgary, AB, T2T 5C7, Canada, 1 403 955 8327, rsigal@ucalgary.ca %K aerobic exercise %K exercise %K exercise training %K ovary %K polycystic ovary syndrome %K recruitment %K well-being %K women’s health %D 2021 %7 30.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective and efficient participant recruitment is a key determinant of the success of a research program. Previously reported recruitment strategies have displayed variable success rates in studies on women with polycystic ovary syndrome (PCOS). Objective: This study aimed to evaluate the effectiveness and cost per participant of the recruitment strategies that we used in a prospective randomized controlled trial to examine the effects of exercise training among inactive women with PCOS, who are aged 18-40 years. Methods: The 4 recruitment methods we used were as follows: (1) referral by health care providers or by word of mouth, (2) media (eg, local newspaper stories and radio interviews), (3) Facebook advertisements, and (4) unpaid advertisements including posters and websites. The proportions of potential, eligible, and enrolled participants recruited with each method were determined and compared using tests of proportion. The time investment and cost per participant enrolled were calculated for each recruitment strategy. Results: Of 200 potential participants screened, 98 (49%) were recruited from unpaid advertisements (posters and websites), 70 (35%) from Facebook advertisements, 16 (8%) by referral, and 16 (8%) from traditional media (newspaper and radio). Every potential participant was recruited from separate means (ie, no participant was approached through more than one recruitment method). A total of 109 (54.5%) women were deemed eligible for participation in the trial, and 60 (30.0%) were enrolled. The proportion of potential participants who completed the trial was higher for those recruited from traditional media than from Facebook advertisements (n=7/16, 44% vs n=13/70, 19%, respectively; P=.03) or unpaid advertisements (n=7/16, 44% vs n=13/98, 13%, respectively; P=.002). The cost per participant was Can $18.21 (US $14.46) for Facebook advertisements and Can $43.88 (US $34.85) for unpaid advertisements. There were no direct trial costs for referrals or traditional media. Conclusions: For this trial, each method was important for recruiting inactive women with PCOS because no participant reported learning about the trial through more than one method. Unpaid advertisements and Facebook advertisements helped recruit the largest number of participants in the trial, the former resulting in a higher cost per participant than the latter. Trial Registration: ClinicalTrials.gov NCT03362918; https://clinicaltrials.gov/ct2/show/NCT03362918 %M 33783363 %R 10.2196/25208 %U https://www.jmir.org/2021/3/e25208 %U https://doi.org/10.2196/25208 %U http://www.ncbi.nlm.nih.gov/pubmed/33783363 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e22618 %T Using the Ensuring Quality Information for Patients Tool to Assess Patient Information on Appendicitis Websites: Systematic Search and Evaluation %A Ghani,Shahi %A Fan,Ka Siu %A Fan,Ka Hay %A Lenti,Lorenzo %A Raptis,Dimitri %+ St George's, University of London, Cranmer Terrace, Tooting, London, SW17 0RE, United Kingdom, 44 7772 075720, shahi92@hotmail.com %K appendicitis %K patient information %K EQIP tool %K quality %K tool %K surgery %K online health information %K internet %K health-seeking %K behavior %K review %D 2021 %7 26.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Appendicitis is a common surgical problem among the young adult population, who are likely to use the internet to obtain medical information. This information may determine the health-seeking behavior of an individual and may delay medical attention. Little is known regarding the quality of patient information on appendicitis on the internet, as this has not been previously studied. Objective: The aim of our study was to identify the quality of information regarding appendicitis on websites intended for the public. Methods: We conducted a systematic review of information on appendicitis available online using the following 4 search terms in google: “appendicitis,” “appendix,” “appendectomy,” and “appendicectomy”. The top 100 websites of each search term were assessed using the validated Ensuring Quality Information for Patients (EQIP) tool (score 0-36). Results: A total of 119 websites met the eligibility criteria for evaluation. The overall median EQIP score for all websites was 20 (IQR 18-22). More than half the websites originated from the USA (65/119, 54.6%), and 45.4% (54/119) of all websites originated from hospitals, although 43% (23/54) of these did not mention qualitative risks from surgery. Incidence rates were only provided for complications and mortality in 12.6% (15/119) and 3.3% (4/119) of all websites, respectively. Conclusions: The assessment of the quality and readability of websites concerning appendicitis by the EQIP tool indicates that most sites online were of poor credibility, with minimal information regarding complication rates and mortality. To improve education and awareness of appendicitis, there is an immediate need for more informative and patient-centered websites that are more compatible with international quality standards. %M 33729160 %R 10.2196/22618 %U https://www.jmir.org/2021/3/e22618 %U https://doi.org/10.2196/22618 %U http://www.ncbi.nlm.nih.gov/pubmed/33729160 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e15443 %T Implementation of the Operating Room Black Box Research Program at the Ottawa Hospital Through Patient, Clinical, and Organizational Engagement: Case Study %A Boet,Sylvain %A Etherington,Cole %A Lam,Sandy %A Lê,Maxime %A Proulx,Laurie %A Britton,Meghan %A Kenna,Julie %A Przybylak-Brouillard,Antoine %A Grimshaw,Jeremy %A Grantcharov,Teodor %A Singh,Sukhbir %+ Department of Anesthesiology and Pain Medicine, University of Ottawa, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada, 1 613 798 5555 ext 78187, sboet@toh.ca %K patient safety %K implementation science %K quality improvement %K health personnel %K operating rooms %D 2021 %7 16.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: A large proportion of surgical patient harm is preventable; yet, our ability to systematically learn from these incidents and improve clinical practice remains limited. The Operating Room Black Box was developed to address the need for comprehensive assessments of clinical performance in the operating room. It captures synchronized audio, video, patient, and environmental clinical data in real time, which are subsequently analyzed by a combination of expert raters and software-based algorithms. Despite its significant potential to facilitate research and practice improvement, there are many potential implementation challenges at the institutional, clinician, and patient level. This paper summarizes our approach to implementation of the Operating Room Black Box at a large academic Canadian center. Objective: We aimed to contribute to the development of evidence-based best practices for implementing innovative technology in the operating room for direct observation of the clinical performance by using the case of the Operating Room Black Box. Specifically, we outline the systematic approach to the Operating Room Black Box implementation undertaken at our center. Methods: Our implementation approach included seeking support from hospital leadership; building frontline support and a team of champions among patients, nurses, anesthesiologists, and surgeons; accounting for stakeholder perceptions using theory-informed qualitative interviews; engaging patients; and documenting the implementation process, including barriers and facilitators, using the consolidated framework for implementation research. Results: During the 12-month implementation period, we conducted 23 stakeholder engagement activities with over 200 participants. We recruited 10 clinician champions representing nursing, anesthesia, and surgery. We formally interviewed 15 patients and 17 perioperative clinicians and identified key themes to include in an information campaign run as part of the implementation process. Two patient partners were engaged and advised on communications as well as grant and protocol development. Many anticipated and unanticipated challenges were encountered at all levels. Implementation was ultimately successful, with the Operating Room Black Box installed in August 2018, and data collection beginning shortly thereafter. Conclusions: This paper represents the first step toward evidence-guided implementation of technologies for direct observation of performance for research and quality improvement in surgery. With technology increasingly being used in health care settings, the health care community should aim to optimize implementation processes in the best interest of health care professionals and patients. %M 33724199 %R 10.2196/15443 %U https://www.jmir.org/2021/3/e15443 %U https://doi.org/10.2196/15443 %U http://www.ncbi.nlm.nih.gov/pubmed/33724199 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e18348 %T e-Mental Health Program Usage Patterns in Randomized Controlled Trials and in the General Public to Inform External Validity Considerations: Sample Groupings Using Cluster Analyses %A Sanatkar,Samineh %A Baldwin,Peter %A Huckvale,Kit %A Christensen,Helen %A Harvey,Samuel %+ Black Dog Institute, The University of New South Wales Sydney, Hospital Road, Randwick, 2031, Australia, 61 9382 4368, s.sanatkar@unsw.edu.au %K e-mental health %K engagement patterns %K external validity %K randomized controlled trial %K community sample %D 2021 %7 11.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Randomized controlled trials (RCTs) with vigorous study designs are vital for determining the efficacy of treatments. Despite the high internal validity attributed to RCTs, external validity concerns limit the generalizability of results to the general population. Bias can be introduced, for example, when study participants who self-select into a trial are more motivated to comply with study conditions than are other individuals. These external validity considerations extend to e-mental health (eMH) research, especially when eMH tools are designed for public access and provide minimal or no supervision. Objective: Clustering techniques were employed to identify engagement profiles of RCT participants and community users of a self-guided eMH program. This exploratory approach inspected actual, not theorized, RCT participant and community user engagement patterns. Both samples had access to the eMH program over the same time period and received identical usage recommendations on the eMH program website. The aim of this study is to help gauge expectations of similarities and differences in usage behaviors of an eMH tool across evaluation and naturalistic contexts. Methods: Australian adults signed up to myCompass, a self-guided online treatment program created to reduce mild to moderate symptoms of negative emotions. They did so either by being part of an RCT onboarding (160/231, 69.6% female) or by accessing the program freely on the internet (5563/8391, 66.30% female) between October 2011 and October 2012. During registration, RCT participants and community users provided basic demographic information. Usage metrics (number of logins, trackings, and learning activities) were recorded by the system. Results: Samples at sign-up differed significantly in age (P=.003), with community users being on average 3 years older (mean 41.78, SD 13.64) than RCT participants (mean 38.79, SD 10.73). Furthermore, frequency of program use was higher for RCT participants on all usage metrics compared to community users through the first 49 days after registration (all P values <.001). Two-step cluster analyses revealed 3 user groups in the RCT sample (Nonstarters, 10-Timers, and 30+-Timers) and 2 user groups in the community samples (2-Timers and 20-Timers). Groups seemed comparable in patterns of use but differed in magnitude, with RCT participant usage groups showing more frequent engagement than community usage groups. Only the high-usage group among RCT participants approached myCompass usage recommendations. Conclusions: Findings suggested that external validity concerns of RCT designs may arise with regards to the predicted magnitude of eMH program use rather than overall usage styles. Following up RCT nonstarters may help provide unique insights into why individuals choose not to engage with an eMH program despite generally being willing to participate in an eMH evaluation study. Overestimating frequency of engagement with eMH tools may have theoretical implications and potentially impact economic considerations for plans to disseminate these tools to the general public. %M 33704070 %R 10.2196/18348 %U https://www.jmir.org/2021/3/e18348 %U https://doi.org/10.2196/18348 %U http://www.ncbi.nlm.nih.gov/pubmed/33704070 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24590 %T Commencement of and Retention in Web-Based Interventions and Response to Prompts and Reminders: Longitudinal Observational Study Based on Two Randomized Controlled Trials %A Andriopoulos,Athanasios %A Olsson,Erik M G %A Hägg Sylvén,Ylva %A Sjöström,Jonas %A Johansson,Birgitta %A von Essen,Louise %A Grönqvist,Helena %+ Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, Uppsala, 75185, Sweden, 46 736236500, helena.gronqvist@kbh.uu.se %K log data analysis %K use pattern %K retention %K dropout %K attrition %K online intervention %K online data %D 2021 %7 12.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based interventions are effective for several psychological problems. However, recruitment, adherence, and missing data are challenges when evaluating these interventions. Objective: This study aimed to describe the use patterns during the commencement phase, possible retention patterns (continuation of data provision), and responses to prompts and reminders among participants in 2 randomized controlled trials (RCTs) evaluating web-based interventions. Methods: Data on use patterns logged in 2 RCTs aiming to reduce symptoms of anxiety and depression among adult patients recently diagnosed with cancer (AdultCan RCT) and patients with a recent myocardial infarction (Heart RCT) were analyzed. The web-based intervention in the AdultCan trial consisted of unguided self-help and psychoeducation and that in the Heart trial consisted of therapist-supported cognitive behavioral therapy. In total, 2360 participants’ use patterns at first log-in, including data collection at baseline (ie, commencement) and at 2 follow-ups, were analyzed. Both the intervention and comparison groups were analyzed. Results: At commencement, 70.85% (909/1283) and 86.82% (935/1077) of the participants in AdultCan and Heart RCTs, respectively, logged in and completed baseline data collection after receiving a welcome email with log-in credentials. The median duration of the first log-in was 44 minutes and 38 minutes in AdultCan and Heart RCTs, respectively. Slightly less than half of the participants’ first log-ins were completed outside standard office hours. More than 80% (92/114 and 103/111) of the participants in both trials explored the intervention within 2 weeks of being randomized to the treatment group, with a median duration of 7 minutes and 47 minutes in AdultCan and Heart RCTs, respectively. There was a significant association between intervention exploration time during the first 2 weeks and retention in the Heart trial but not in the AdultCan trial. However, the control group was most likely to retain and provide complete follow-up data. Across the 3 time points of data collection explored in this study, the proportion of participants responding to all questionnaires within 1 week from the prompt, without a reminder, varied between 35.45% (413/1165) and 66.3% (112/169). After 2 reminders, up to 97.6% (165/169) of the participants responded. Conclusions: Most participants in both RCTs completed the baseline questionnaires within 1 week of receiving the welcome email. Approximately half of them answered questions at baseline data collection outside office hours, suggesting that the time flexibility inherent in web-based interventions contributes to commencement and use. In contrast to what was expected, the intervention groups generally had lower completion rates than the comparison groups. About half of the participants completed the questionnaires without a reminder, but thereafter, reminders contributed to both baseline and follow-up retention, suggesting they were effective. Strategies to increase commencement of and retention in eHealth interventions are important for the future development of effective interventions and relevant research. %M 33709937 %R 10.2196/24590 %U https://www.jmir.org/2021/3/e24590 %U https://doi.org/10.2196/24590 %U http://www.ncbi.nlm.nih.gov/pubmed/33709937 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24373 %T Immersive Virtual Reality and Ocular Tracking for Brain Mapping During Awake Surgery: Prospective Evaluation Study %A Casanova,Morgane %A Clavreul,Anne %A Soulard,Gwénaëlle %A Delion,Matthieu %A Aubin,Ghislaine %A Ter Minassian,Aram %A Seguier,Renaud %A Menei,Philippe %+ Département de Neurochirurgie, CHU d'Angers, 4 rue Larrey, Angers , France, 33 241 354822, phmenei@chu-angers.fr %K virtual reality %K eye tracking %K brain mapping %K awake surgery %K visuospatial cognition %K nonverbal language %K mobile phone %D 2021 %7 24.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Language mapping during awake brain surgery is currently a standard procedure. However, mapping is rarely performed for other cognitive functions that are important for social interaction, such as visuospatial cognition and nonverbal language, including facial expressions and eye gaze. The main reason for this omission is the lack of tasks that are fully compatible with the restrictive environment of an operating room and awake brain surgery procedures. Objective: This study aims to evaluate the feasibility and safety of a virtual reality headset equipped with an eye-tracking device that is able to promote an immersive visuospatial and social virtual reality (VR) experience for patients undergoing awake craniotomy. Methods: We recruited 15 patients with brain tumors near language and/or motor areas. Language mapping was performed with a naming task, DO 80, presented on a computer tablet and then in 2D and 3D via the VRH. Patients were also immersed in a visuospatial and social VR experience. Results: None of the patients experienced VR sickness, whereas 2 patients had an intraoperative focal seizure without consequence; there was no reason to attribute these seizures to virtual reality headset use. The patients were able to perform the VR tasks. Eye tracking was functional, enabling the medical team to analyze the patients’ attention and exploration of the visual field of the virtual reality headset directly. Conclusions: We found that it is possible and safe to immerse the patient in an interactive virtual environment during awake brain surgery, paving the way for new VR-based brain mapping procedures. Trial Registration: ClinicalTrials.gov NCT03010943; https://clinicaltrials.gov/ct2/show/NCT03010943. %M 33759794 %R 10.2196/24373 %U https://www.jmir.org/2021/3/e24373 %U https://doi.org/10.2196/24373 %U http://www.ncbi.nlm.nih.gov/pubmed/33759794 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24945 %T Classification of the Use of Online Health Information Channels and Variation in Motivations for Channel Selection: Cross-sectional Survey %A Zhang,Di %A Shi,Zhen %A Hu,Hongchao %A Han,Gang (Kevin) %+ Greenlee School Journalism and Communication, Iowa State University, 119 Hamilton, 613 Wallace Rd, Ames, IA, 50011-4010, United States, 1 515 294 0482, ghan@iastate.edu %K search %K browse %K scan %K health information seeking %K channel selection %K health information %K health education %K health communication %K online media %D 2021 %7 9.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Existing health education and communication research routinely measures online channel use as a whole by, for example, evaluating how frequently people use the internet to search for health information. This approach fails to capture the complexity and diversity of online channel use in health information seeking. The measurement of generic online channel use may cause too much error, and it lends no support to media planning in public health promotion campaigns or scholarly research involving online channel use. Objective: This study intends to present a thorough picture of patterns of online health information channel use and classify the use of various types of online health information channels, including WeChat, microblogs, web portals, search engines, mobile apps, and online forums. Under the framework of the risk information seeking and processing model, this study also analyzes the differences in individuals’ motivations for channel selection to offer further evidence to validate the classification scheme. Methods: This study sampled 542 Chinese internet users in Beijing. The average age of the respondents was 33 years, female respondents accounted for 52.0% (282/542) of the sample, and the average monthly income ranged from US $900 to $1200. The study surveyed the use of 13 commonly used online health information channels and various sociopsychological factors associated with online health information seeking. Results: This study derived 3 categories of online health information channels: searching, browsing, and scanning channels. It was found that the use of online searching channels was affect driven (B=0.11; β=0.10; P=.02) and characterized by a stronger need for health knowledge (B=0.09; β=0.01; P<.001). The use of browsing channels was directly influenced by informational subjective norms (B=0.33; β=0.15; P=.004) and perceived current knowledge (B=0.007; β=0.09; P=.003). The use of scanning channels was mainly influenced by informational subjective norms (B=0.29; β=0.15; P=.007). Conclusions: The results of this study suggest that health communication practitioners and scholars may consider measuring the use of internet, new media, or online media more precisely instead of simply asking the public about the frequency of online channel use or internet use in the acquisition of health information. Scholars and practitioners may consider measuring the use of online health information channels by using the 3-category scheme described in this study. Future research is encouraged to further explore how people process health information when using different online channels. %M 33687342 %R 10.2196/24945 %U https://www.jmir.org/2021/3/e24945 %U https://doi.org/10.2196/24945 %U http://www.ncbi.nlm.nih.gov/pubmed/33687342 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e21642 %T Share to Seek: The Effects of Disease Complexity on Health Information–Seeking Behavior %A Alasmari,Ashwag %A Zhou,Lina %+ University of Maryland, Baltimore County, 1000 Hilltop Cir, Baltimore, MD, 21250, United States, 1 (410) 455 1000, ashwag1@umbc.edu %K health information consumers %K multimorbidity %K information searching %K information seeking %K disease development %D 2021 %7 24.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based question and answer (Q&A) sites have emerged as an alternative source for serving individuals’ health information needs. Although a number of studies have analyzed user-generated content in web-based Q&A sites, there is insufficient understanding of the effect of disease complexity on information-seeking needs and the types of information shared, and little research has been devoted to the questions concerning multimorbidity. Objective: This study aims to investigate seeking of health information in Q&A sites at different levels of disease complexity. Specifically, this study investigates the effects of disease complexity on information-seeking needs, types of information shared, and stages of disease development. Methods: First, we selected a random sample of 400 questions separately from each of the Q&A sites: Yahoo Answers and WebMD Answers. The data cleaning resulted in a final set of 624 questions from the two sites. We used a mixed methods approach, including qualitative content analysis and quantitative statistical analysis. Results: The one-way results of ANOVA showed significant effects of disease complexity (single vs multimorbid disease questions) on two information-seeking needs: diagnosis (F1,622=5.08; P=.02) and treatment (F1,622=4.82; P=.02). There were also significant differences between the two levels of disease complexity in two stages of disease development: the general health stage (F1,622=48.02; P<.001) and the chronic stage (F1,622=54.01; P<.001). In addition, our results showed significant effects of disease complexity across all types of shared information: demographic information (F1,622=32.24; P<.001), medical diagnosis (F1,622=11.04; P<.001), and treatment and prevention (F1,622=14.55; P<.001). Conclusions: Our findings present implications for the design of web-based Q&A sites to better support health information seeking. Future studies should be conducted to validate the generality of these findings and apply them to improve the effectiveness of health information in Q&A sites. %M 33759803 %R 10.2196/21642 %U https://www.jmir.org/2021/3/e21642 %U https://doi.org/10.2196/21642 %U http://www.ncbi.nlm.nih.gov/pubmed/33759803 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e20030 %T Internet-Specific Epistemic Beliefs in Medicine and Intention to Use Evidence-Based Online Medical Databases Among Health Care Professionals: Cross-sectional Survey %A Chiu,Yen-Lin %A Lee,Yu-Chen %A Tsai,Chin-Chung %+ Program of Learning Sciences, National Taiwan Normal University, No 162, Sec 1, He-Ping E Rd, Taipei, 10610, Taiwan, 886 2 7749 5179, tsaicc@ntnu.edu.tw %K evidence-based medicine (EBM) %K health care professionals %K internet-specific epistemic beliefs %K medical informatics %D 2021 %7 18.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Evidence-based medicine has been regarded as a prerequisite for ensuring health care quality. The increase in health care professionals’ adoption of web-based medical information and the lack of awareness of alternative access to evidence-based online resources suggest the need for an investigation of their information-searching behaviors of using evidence-based online medical databases. Objective: The main purposes of this study were to (1) modify and validate the internet-specific epistemic beliefs in medicine (ISEBM) questionnaire and (2) explore the associations between health care professionals’ demographics, ISEBM, and intention to use evidence-based online medical databases for clinical practice. Methods: Health care professionals in a university-affiliated teaching hospital were surveyed using the ISEBM questionnaire. The partial least squares-structural equation modeling was conducted to analyze the reliability and validity of ISEBM. Furthermore, the structural model was analyzed to examine the possible linkages between health professionals’ demographics, ISEBM, and intention to utilize the evidence-based online medical databases for clinical practice. Results: A total of 273 health care professionals with clinical working experience were surveyed. The results of the measurement model analysis indicated that all items had significant loadings ranging from 0.71 to 0.92 with satisfactory composite reliability values ranging from 0.87 to 0.94 and average variance explained values ranging from 0.70 to 0.84. The results of the structural relationship analysis revealed that the source of internet-based medical knowledge (path coefficient –0.26, P=.01) and justification of internet-based knowing in medicine (path coefficient 0.21, P=.001) were correlated with the intention to use evidence-based online medical databases. However, certainty and simplicity of internet-based medical knowledge were not. In addition, gender (path coefficient 0.12, P=.04) and academic degree (path coefficient 0.15, P=.004) were associated with intention to use evidence-based online medical databases for clinical practice. Conclusions: Advancing health care professionals’ ISEBM regarding source and justification may encourage them to retrieve valid medical information through evidence-based medical databases. Moreover, providing support for specific health care professionals (ie, females, without a master’s degree) may promote their intention to use certain databases for clinical practice. %M 33734092 %R 10.2196/20030 %U https://www.jmir.org/2021/3/e20030 %U https://doi.org/10.2196/20030 %U http://www.ncbi.nlm.nih.gov/pubmed/33734092 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e17856 %T Testing the Digital Health Literacy Instrument for Adolescents: Cognitive Interviews %A Park,Eunhee %A Kwon,Misol %+ School of Nursing, University at Buffalo, 201 E Wende Hall, 3435 Main St, Buffalo, NY, 14214-3079, United States, 1 716 829 3701, eunheepa@buffalo.edu %K adolescent %K digital health literacy %K ehealth literacy %K cognitive interview %D 2021 %7 15.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the increasing number of youth seeking health information on the internet, few studies have been conducted to measure digital health literacy in this population. The digital health literacy instrument (DHLI) is defined as a scale that measures the ability to operate digital devices and read and write in web-based modes, and it assesses seven subconstructs: operational skills, navigation skills, information searching, evaluating reliability, determining relevance, adding self-generated content to a web-based app, and protecting privacy. Currently, there is no validation process of this instrument among adolescents. Objective: This study aims to explore the usability and content validity of DHLI. Methods: Upon the approval of institutional review board protocol, cognitive interviews were conducted. A total of 34 adolescents aged 10-18 years (n=17, 50% female) participated in individual cognitive interviews. Two rounds of concurrent cognitive interviews were conducted to assess the content validity of DHLI using the thinking aloud method and probing questions. Results: Clarity related to unclear wording, undefined technical terms, vague terms, and difficult vocabularies was a major issue identified. Problems related to potentially inappropriate assumptions were also identified. In addition, concerns related to recall bias and socially sensitive phenomena were raised. No issues regarding response options or instrument instructions were noted. Conclusions: The initial round of interviews provided a potential resolution to the problems identified with comprehension and communication, whereas the second round prompted improvement in content validity. Dual rounds of cognitive interviews provided substantial insights into survey interpretation when introduced to US adolescents. This study examined the validity of the DHLI and suggests revision points for assessing adolescent digital health literacy. %M 33720031 %R 10.2196/17856 %U https://www.jmir.org/2021/3/e17856 %U https://doi.org/10.2196/17856 %U http://www.ncbi.nlm.nih.gov/pubmed/33720031 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24466 %T Arabic Version of the Electronic Health Literacy Scale in Arabic-Speaking Individuals in Sweden: Prospective Psychometric Evaluation Study %A Wångdahl,Josefin %A Dahlberg,Karuna %A Jaensson,Maria %A Nilsson,Ulrica %+ Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, 751 22, Sweden, 46 702034045, josefin.wangdahl@pubcare.uu.se %K eHealth %K digital health literacy %K eHEALS %K health literacy %K internet %K psychometrics %K evaluation, migrants, refugees, Arabic %D 2021 %7 22.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Health information is often communicated through the internet. It is vital for the end user to have a range of digital skills as well as understand the information to promote their health. There is a valid and reliable 8-item instrument, the Electronic Health Literacy Scale (eHEALS), that evaluates these skills. The number of Arabic-speaking people migrating to Sweden and to other parts of the world is increasing due to unstable military and political situations in their countries of origin. Poor health and limited health literacy have been described in this population in Sweden. Still, to our knowledge, an Arabic version of eHEALS has not been tested for validity or reliability. Thus, Arabic-speaking populations in Sweden cannot be included in studies measuring eHealth literacy, which does not support equal treatment in health care. Objective: The aim of this study was to translate and adapt the original English eHEALS version into Arabic and to evaluate its psychometric properties. Methods: The eHEALS was rigorously translated, adapted, and evaluated for content validity. We conducted prospective psychometric evaluation with natively Arabic-speaking participants living in Sweden. Construct validity, factor structure, internal consistency, and test-retest reliability were evaluated using Spearman correlation, principal component analysis, Cronbach α, and weighted quadratic Cohen κ, respectively. Results: The study population consisted of Arabic-speaking participants (n=298; age: mean 41.8 years, SD 10.5). Construct validity was supported with weak and moderate correlations. Principal component factor analysis revealed a one-factor structure. Internal consistency was high (Cronbach α=0.92); test-retest reliability was acceptable (weighted quadratic Cohen κ=0.76). Evaluation indicated that eHealth literacy threshold values should be dichotomized (limited and sufficient) rather than trichotomized (inadequate, problematic, and sufficient). Conclusions: The Arabic version of eHEALS, a unidimensional scale that is valid and reliable for measuring eHealth literacy among natively Arabic-speaking people in Sweden, was found to be acceptable and feasible in a general population. %M 33749614 %R 10.2196/24466 %U https://www.jmir.org/2021/3/e24466 %U https://doi.org/10.2196/24466 %U http://www.ncbi.nlm.nih.gov/pubmed/33749614 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e22806 %T Contribution of Free-Text Comments to the Burden of Documentation: Assessment and Analysis of Vital Sign Comments in Flowsheets %A Yin,Zhijun %A Liu,Yongtai %A McCoy,Allison B %A Malin,Bradley A %A Sengstack,Patricia R %+ Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Ave., Suite 1475, Nashville, TN, 37203, United States, 1 615 936 3690, zhijun.yin@vanderbilt.edu %K electronic health system %K documentation burden %K flowsheets %K content analysis %K vital sign comments %K free text %D 2021 %7 4.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Documentation burden is a common problem with modern electronic health record (EHR) systems. To reduce this burden, various recording methods (eg, voice recorders or motion sensors) have been proposed. However, these solutions are in an early prototype phase and are unlikely to transition into practice in the near future. A more pragmatic alternative is to directly modify the implementation of the existing functionalities of an EHR system. Objective: This study aims to assess the nature of free-text comments entered into EHR flowsheets that supplement quantitative vital sign values and examine opportunities to simplify functionality and reduce documentation burden. Methods: We evaluated 209,055 vital sign comments in flowsheets that were generated in the Epic EHR system at the Vanderbilt University Medical Center in 2018. We applied topic modeling, as well as the natural language processing Clinical Language Annotation, Modeling, and Processing software system, to extract generally discussed topics and detailed medical terms (expressed as probability distribution) to investigate the stories communicated in these comments. Results: Our analysis showed that 63.33% (6053/9557) of the users who entered vital signs made at least one free-text comment in vital sign flowsheet entries. The user roles that were most likely to compose comments were registered nurse, technician, and licensed nurse. The most frequently identified topics were the notification of a result to health care providers (0.347), the context of a measurement (0.307), and an inability to obtain a vital sign (0.224). There were 4187 unique medical terms that were extracted from 46,029 (0.220) comments, including many symptom-related terms such as “pain,” “upset,” “dizziness,” “coughing,” “anxiety,” “distress,” and “fever” and drug-related terms such as “tylenol,” “anesthesia,” “cannula,” “oxygen,” “motrin,” “rituxan,” and “labetalol.” Conclusions: Considering that flowsheet comments are generally not displayed or automatically pulled into any clinical notes, our findings suggest that the flowsheet comment functionality can be simplified (eg, via structured response fields instead of a text input dialog) to reduce health care provider effort. Moreover, rich and clinically important medical terms such as medications and symptoms should be explicitly recorded in clinical notes for better visibility. %M 33661128 %R 10.2196/22806 %U https://www.jmir.org/2021/3/e22806 %U https://doi.org/10.2196/22806 %U http://www.ncbi.nlm.nih.gov/pubmed/33661128 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24363 %T eHealth Applications to Support Independent Living of Older Persons: Scoping Review of Costs and Benefits Identified in Economic Evaluations %A Sülz,Sandra %A van Elten,Hilco J %A Askari,Marjan %A Weggelaar-Jansen,Anne Marie %A Huijsman,Robbert %+ Erasmus School of Health Policy & Management, PO Box 1738, Rotterdam, 3000 DR, Netherlands, 31 104088531, sulz@eshpm.eur.nl %K cost %K benefit %K eHealth %K aged %K economic evaluation %D 2021 %7 9.3.2021 %9 Review %J J Med Internet Res %G English %X Background: eHealth applications are constantly increasing and are frequently considered to constitute a promising strategy for cost containment in health care, particularly if the applications aim to support older persons. Older persons are, however, not the only major eHealth stakeholder. eHealth suppliers, caregivers, funding bodies, and health authorities are also likely to attribute value to eHealth applications, but they can differ in their value attribution because they are affected differently by eHealth costs and benefits. Therefore, any assessment of the value of eHealth applications requires the consideration of multiple stakeholders in a holistic and integrated manner. Such a holistic and reliable value assessment requires a profound understanding of the application’s costs and benefits. The first step in measuring costs and benefits is identifying the relevant costs and benefit categories that the eHealth application affects. Objective: The aim of this study is to support the conceptual phase of an economic evaluation by providing an overview of the relevant direct and indirect costs and benefits incorporated in economic evaluations so far. Methods: We conducted a systematic literature search covering papers published until December 2019 by using the Embase, Medline Ovid, Web of Science, and CINAHL EBSCOhost databases. We included papers on eHealth applications with web-based contact possibilities between clients and health care providers (mobile health apps) and applications for self-management, telehomecare, telemedicine, telemonitoring, telerehabilitation, and active healthy aging technologies for older persons. We included studies that focused on any type of economic evaluation, including costs and benefit measures. Results: We identified 55 papers with economic evaluations. These studies considered a range of different types of costs and benefits. Costs pertained to implementation activities and operational activities related to eHealth applications. Benefits (or consequences) could be categorized according to stakeholder groups, that is, older persons, caregivers, and health care providers. These benefits can further be divided into stakeholder-specific outcomes and resource usage. Some cost and benefit types have received more attention than others. For instance, patient outcomes have been predominantly captured via quality-of-life considerations and various types of physical health status indicators. From the perspective of resource usage, a strong emphasis has been placed on home care visits and hospital usage. Conclusions: Economic evaluations of eHealth applications are gaining momentum, and studies have shown considerable variation regarding the costs and benefits that they include. We contribute to the body of literature by providing a detailed and up-to-date framework of cost and benefit categories that any interested stakeholder can use as a starting point to conduct an economic evaluation in the context of independent living of older persons. %M 33687335 %R 10.2196/24363 %U https://www.jmir.org/2021/3/e24363 %U https://doi.org/10.2196/24363 %U http://www.ncbi.nlm.nih.gov/pubmed/33687335 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24905 %T Effort-Optimized Intervention Model: Framework for Building and Analyzing Digital Interventions That Require Minimal Effort for Health-Related Gains %A Baumel,Amit %A Muench,Frederick J %+ Partnership to End Addiction, 711 Third Avenue, New York, NY, 10017, United States, 1 9175320623, fmuench@toendaddiction.org %K behavior change %K digital health %K mental health %K addiction %K intervention %K behavioral health %K effort %K salience %K persuasive design %D 2021 %7 12.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X The majority of digital health interventions lean on the promise of bringing health and self-care into people’s homes and hands. However, these interventions are delivered while people are in their triggering environments, which places competing demands on their attention. Individuals struggling to change or learn a new behavior have to work hard to achieve even a minor change because of the automatic forces propelling them back to their habitual behaviors. We posit that effort and burden should be explored at the outset and throughout the digital intervention development process as a core therapeutic mechanism, beyond the context of design or user experience testing. In effort-focused conceptualization, it is assumed that, even though goals are rational and people want to achieve them, they are overtaken by competing cognitive, emotional, and environmental processes. We offer the term effort-optimized intervention to describe interventions that focus on user engagement in the face of competing demands. We describe design components based on a 3-step process for planning an effort-optimized intervention: (1) nurturing effortless cognitive and environmental salience to help people keep effort-related goals prominent despite competition; (2) making it as effortless as possible to complete therapeutic activities to avoid ego depletion and self-efficacy reduction; and (3) turning the necessary effortful activities into sustainable assets. We conclude by presenting an example of designing a digital health intervention based on the effort-optimized intervention model. %M 33709943 %R 10.2196/24905 %U https://www.jmir.org/2021/3/e24905 %U https://doi.org/10.2196/24905 %U http://www.ncbi.nlm.nih.gov/pubmed/33709943 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e20989 %T The Reliability of Remote Patient-Reported Outcome Measures via Mobile Apps to Replace Outpatient Visits After Rotator Cuff Repair Surgery: Repetitive Test-Retest Comparison Study for 1-Year Follow-up %A Hong,Taek Ho %A Kim,Myung Ku %A Ryu,Dong Jin %A Park,Jun Sung %A Bae,Gi Cheol %A Jeon,Yoon Sang %+ Department of Orthopedic Surgery, Inha University Hospital, 27 Inhang-ro, Jung-gu, Incheon, 22332, Republic of Korea, 82 010 8353 3695, ysjeon80@hanmail.net %K patient-reported outcome measures (PROMs) %K location %K remote PROMs using mobile application %K smartphone %K mobile phone %K follow-up loss %D 2021 %7 1.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: With the development of health care–related mobile apps, attempts have been made to implement remote patient-reported outcome measures (PROMs). In order for remote PROMs to be widely used by mobile apps, the results should not be different depending on the location; that is, remote PROM results performed in locations other than hospitals should be able to obtain reliable results equivalent to those performed in hospitals, and this is very important. However, to our knowledge, there are no studies that have assessed the reliability of PROMs using mobile apps according to the location by comparing the results performed remotely from the hospital and performed at the outpatient visits. Objective: The purpose of this study was to evaluate the reliability of remote PROMs using mobile apps compared to PROMs performed during outpatient follow-up visits after arthroscopic shoulder surgery. Methods: A total of 174 patients who underwent arthroscopic rotator cuff repair completed questionnaires 2 days before visiting the clinic for the 1-, 2-, 3-, 6-, and 12-month follow-ups (test A). The patients completed the questionnaires at the clinic (test B) using the same mobile app and device for the 1-, 2-, 3-, 6-, and 12-month follow-ups. Test-retest comparisons were performed to analyze the differences and reliability of the PROMs according to the period. Results: Comparisons of tests A and B showed statistically significant differences at 1, 2, and 3 months (all Ps<.05 except for the ASES function scale at 3-months) but not 6 or 12 months after surgery (all Ps>.05). The intraclass correlation values between the two groups were relatively low at the 1-, 2-, and 3-month follow-ups but were within the reliable range at 6 and 12 months after surgery. The rate of completion of tests A and B using the mobile app was significantly lower in the group older than 70 years than in the other groups for all postoperative periods (P<.001). Conclusions: PROMs using mobile apps with different locations differed soon after surgery but were reliably similar after 6 months. The remote PROMs using mobile apps could be used reliably for the patient more than 6 months after surgery. However, it is to be expected that the use of mobile app–based questionnaires is not as useful in the group older than 70 years as in other age groups. %M 33646133 %R 10.2196/20989 %U https://www.jmir.org/2021/3/e20989 %U https://doi.org/10.2196/20989 %U http://www.ncbi.nlm.nih.gov/pubmed/33646133 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26997 %T Preferences for Artificial Intelligence Clinicians Before and During the COVID-19 Pandemic: Discrete Choice Experiment and Propensity Score Matching Study %A Liu,Taoran %A Tsang,Winghei %A Xie,Yifei %A Tian,Kang %A Huang,Fengqiu %A Chen,Yanhui %A Lau,Oiying %A Feng,Guanrui %A Du,Jianhao %A Chu,Bojia %A Shi,Tingyu %A Zhao,Junjie %A Cai,Yiming %A Hu,Xueyan %A Akinwunmi,Babatunde %A Huang,Jian %A Zhang,Casper J P %A Ming,Wai-Kit %+ Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, 601 Huangpu W Ave, Tianhe District, Guangzhou, 510632, China, 86 85228852, wkming@connect.hku.hk %K propensity score matching %K discrete latent traits %K patients’ preferences %K artificial intelligence %K COVID-19 %K preference %K discrete choice %K choice %K traditional medicine %K public health %K resource %K patient %K diagnosis %K accuracy %D 2021 %7 2.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Artificial intelligence (AI) methods can potentially be used to relieve the pressure that the COVID-19 pandemic has exerted on public health. In cases of medical resource shortages caused by the pandemic, changes in people’s preferences for AI clinicians and traditional clinicians are worth exploring. Objective: We aimed to quantify and compare people’s preferences for AI clinicians and traditional clinicians before and during the COVID-19 pandemic, and to assess whether people’s preferences were affected by the pressure of pandemic. Methods: We used the propensity score matching method to match two different groups of respondents with similar demographic characteristics. Respondents were recruited in 2017 and 2020. A total of 2048 respondents (2017: n=1520; 2020: n=528) completed the questionnaire and were included in the analysis. Multinomial logit models and latent class models were used to assess people’s preferences for different diagnosis methods. Results: In total, 84.7% (1115/1317) of respondents in the 2017 group and 91.3% (482/528) of respondents in the 2020 group were confident that AI diagnosis methods would outperform human clinician diagnosis methods in the future. Both groups of matched respondents believed that the most important attribute of diagnosis was accuracy, and they preferred to receive combined diagnoses from both AI and human clinicians (2017: odds ratio [OR] 1.645, 95% CI 1.535-1.763; P<.001; 2020: OR 1.513, 95% CI 1.413-1.621; P<.001; reference: clinician diagnoses). The latent class model identified three classes with different attribute priorities. In class 1, preferences for combined diagnoses and accuracy remained constant in 2017 and 2020, and high accuracy (eg, 100% accuracy in 2017: OR 1.357, 95% CI 1.164-1.581) was preferred. In class 2, the matched data from 2017 were similar to those from 2020; combined diagnoses from both AI and human clinicians (2017: OR 1.204, 95% CI 1.039-1.394; P=.011; 2020: OR 2.009, 95% CI 1.826-2.211; P<.001; reference: clinician diagnoses) and an outpatient waiting time of 20 minutes (2017: OR 1.349, 95% CI 1.065-1.708; P<.001; 2020: OR 1.488, 95% CI 1.287-1.721; P<.001; reference: 0 minutes) were consistently preferred. In class 3, the respondents in the 2017 and 2020 groups preferred different diagnosis methods; respondents in the 2017 group preferred clinician diagnoses, whereas respondents in the 2020 group preferred AI diagnoses. In the latent class, which was stratified according to sex, all male and female respondents in the 2017 and 2020 groups believed that accuracy was the most important attribute of diagnosis. Conclusions: Individuals’ preferences for receiving clinical diagnoses from AI and human clinicians were generally unaffected by the pandemic. Respondents believed that accuracy and expense were the most important attributes of diagnosis. These findings can be used to guide policies that are relevant to the development of AI-based health care. %M 33556034 %R 10.2196/26997 %U https://www.jmir.org/2021/3/e26997 %U https://doi.org/10.2196/26997 %U http://www.ncbi.nlm.nih.gov/pubmed/33556034 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23483 %T Artificial Intelligence Techniques That May Be Applied to Primary Care Data to Facilitate Earlier Diagnosis of Cancer: Systematic Review %A Jones,Owain T %A Calanzani,Natalia %A Saji,Smiji %A Duffy,Stephen W %A Emery,Jon %A Hamilton,Willie %A Singh,Hardeep %A de Wit,Niek J %A Walter,Fiona M %+ Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, 2 Wort's Causeway, Cambridge, CB1 8RN, United Kingdom, 44 1223762554, otj24@medschl.cam.ac.uk %K artificial intelligence %K machine learning %K electronic health records %K primary health care %K early detection of cancer %D 2021 %7 3.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: More than 17 million people worldwide, including 360,000 people in the United Kingdom, were diagnosed with cancer in 2018. Cancer prognosis and disease burden are highly dependent on the disease stage at diagnosis. Most people diagnosed with cancer first present in primary care settings, where improved assessment of the (often vague) presenting symptoms of cancer could lead to earlier detection and improved outcomes for patients. There is accumulating evidence that artificial intelligence (AI) can assist clinicians in making better clinical decisions in some areas of health care. Objective: This study aimed to systematically review AI techniques that may facilitate earlier diagnosis of cancer and could be applied to primary care electronic health record (EHR) data. The quality of the evidence, the phase of development the AI techniques have reached, the gaps that exist in the evidence, and the potential for use in primary care were evaluated. Methods: We searched MEDLINE, Embase, SCOPUS, and Web of Science databases from January 01, 2000, to June 11, 2019, and included all studies providing evidence for the accuracy or effectiveness of applying AI techniques for the early detection of cancer, which may be applicable to primary care EHRs. We included all study designs in all settings and languages. These searches were extended through a scoping review of AI-based commercial technologies. The main outcomes assessed were measures of diagnostic accuracy for cancer. Results: We identified 10,456 studies; 16 studies met the inclusion criteria, representing the data of 3,862,910 patients. A total of 13 studies described the initial development and testing of AI algorithms, and 3 studies described the validation of an AI algorithm in independent data sets. One study was based on prospectively collected data; only 3 studies were based on primary care data. We found no data on implementation barriers or cost-effectiveness. Risk of bias assessment highlighted a wide range of study quality. The additional scoping review of commercial AI technologies identified 21 technologies, only 1 meeting our inclusion criteria. Meta-analysis was not undertaken because of the heterogeneity of AI modalities, data set characteristics, and outcome measures. Conclusions: AI techniques have been applied to EHR-type data to facilitate early diagnosis of cancer, but their use in primary care settings is still at an early stage of maturity. Further evidence is needed on their performance using primary care data, implementation barriers, and cost-effectiveness before widespread adoption into routine primary care clinical practice can be recommended. %M 33656443 %R 10.2196/23483 %U https://www.jmir.org/2021/3/e23483 %U https://doi.org/10.2196/23483 %U http://www.ncbi.nlm.nih.gov/pubmed/33656443 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26646 %T Future Medical Artificial Intelligence Application Requirements and Expectations of Physicians in German University Hospitals: Web-Based Survey %A Maassen,Oliver %A Fritsch,Sebastian %A Palm,Julia %A Deffge,Saskia %A Kunze,Julian %A Marx,Gernot %A Riedel,Morris %A Schuppert,Andreas %A Bickenbach,Johannes %+ Department of Intensive Care Medicine, University Hospital RWTH Aachen, Pauwelsstraße 30, Aachen, 52074, Germany, 49 2418080444, oliver.maassen@rwth-aachen.de %K artificial intelligence %K AI %K machine learning %K algorithms %K clinical decision support %K physician %K requirement %K expectation %K hospital care %D 2021 %7 5.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The increasing development of artificial intelligence (AI) systems in medicine driven by researchers and entrepreneurs goes along with enormous expectations for medical care advancement. AI might change the clinical practice of physicians from almost all medical disciplines and in most areas of health care. While expectations for AI in medicine are high, practical implementations of AI for clinical practice are still scarce in Germany. Moreover, physicians’ requirements and expectations of AI in medicine and their opinion on the usage of anonymized patient data for clinical and biomedical research have not been investigated widely in German university hospitals. Objective: This study aimed to evaluate physicians’ requirements and expectations of AI in medicine and their opinion on the secondary usage of patient data for (bio)medical research (eg, for the development of machine learning algorithms) in university hospitals in Germany. Methods: A web-based survey was conducted addressing physicians of all medical disciplines in 8 German university hospitals. Answers were given using Likert scales and general demographic responses. Physicians were asked to participate locally via email in the respective hospitals. Results: The online survey was completed by 303 physicians (female: 121/303, 39.9%; male: 173/303, 57.1%; no response: 9/303, 3.0%) from a wide range of medical disciplines and work experience levels. Most respondents either had a positive (130/303, 42.9%) or a very positive attitude (82/303, 27.1%) towards AI in medicine. There was a significant association between the personal rating of AI in medicine and the self-reported technical affinity level (H4=48.3, P<.001). A vast majority of physicians expected the future of medicine to be a mix of human and artificial intelligence (273/303, 90.1%) but also requested a scientific evaluation before the routine implementation of AI-based systems (276/303, 91.1%). Physicians were most optimistic that AI applications would identify drug interactions (280/303, 92.4%) to improve patient care substantially but were quite reserved regarding AI-supported diagnosis of psychiatric diseases (62/303, 20.5%). Of the respondents, 82.5% (250/303) agreed that there should be open access to anonymized patient databases for medical and biomedical research. Conclusions: Physicians in stationary patient care in German university hospitals show a generally positive attitude towards using most AI applications in medicine. Along with this optimism comes several expectations and hopes that AI will assist physicians in clinical decision making. Especially in fields of medicine where huge amounts of data are processed (eg, imaging procedures in radiology and pathology) or data are collected continuously (eg, cardiology and intensive care medicine), physicians’ expectations of AI to substantially improve future patient care are high. In the study, the greatest potential was seen in the application of AI for the identification of drug interactions, assumedly due to the rising complexity of drug administration to polymorbid, polypharmacy patients. However, for the practical usage of AI in health care, regulatory and organizational challenges still have to be mastered. %M 33666563 %R 10.2196/26646 %U https://www.jmir.org/2021/3/e26646 %U https://doi.org/10.2196/26646 %U http://www.ncbi.nlm.nih.gov/pubmed/33666563 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e22951 %T Natural Language Processing and Machine Learning for Identifying Incident Stroke From Electronic Health Records: Algorithm Development and Validation %A Zhao,Yiqing %A Fu,Sunyang %A Bielinski,Suzette J %A Decker,Paul A %A Chamberlain,Alanna M %A Roger,Veronique L %A Liu,Hongfang %A Larson,Nicholas B %+ Department of Health Sciences Research, Mayo Clinic, 205 3rd Ave SW, Rochester, MN, 55905, United States, 1 507 293 1700, Larson.Nicholas@mayo.edu %K stroke %K natural language processing %K electronic health records %K machine learning %D 2021 %7 8.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Stroke is an important clinical outcome in cardiovascular research. However, the ascertainment of incident stroke is typically accomplished via time-consuming manual chart abstraction. Current phenotyping efforts using electronic health records for stroke focus on case ascertainment rather than incident disease, which requires knowledge of the temporal sequence of events. Objective: The aim of this study was to develop a machine learning–based phenotyping algorithm for incident stroke ascertainment based on diagnosis codes, procedure codes, and clinical concepts extracted from clinical notes using natural language processing. Methods: The algorithm was trained and validated using an existing epidemiology cohort consisting of 4914 patients with atrial fibrillation (AF) with manually curated incident stroke events. Various combinations of feature sets and machine learning classifiers were compared. Using a heuristic rule based on the composition of concepts and codes, we further detected the stroke subtype (ischemic stroke/transient ischemic attack or hemorrhagic stroke) of each identified stroke. The algorithm was further validated using a cohort (n=150) stratified sampled from a population in Olmsted County, Minnesota (N=74,314). Results: Among the 4914 patients with AF, 740 had validated incident stroke events. The best-performing stroke phenotyping algorithm used clinical concepts, diagnosis codes, and procedure codes as features in a random forest classifier. Among patients with stroke codes in the general population sample, the best-performing model achieved a positive predictive value of 86% (43/50; 95% CI 0.74-0.93) and a negative predictive value of 96% (96/100). For subtype identification, we achieved an accuracy of 83% in the AF cohort and 80% in the general population sample. Conclusions: We developed and validated a machine learning–based algorithm that performed well for identifying incident stroke and for determining type of stroke. The algorithm also performed well on a sample from a general population, further demonstrating its generalizability and potential for adoption by other institutions. %M 33683212 %R 10.2196/22951 %U https://www.jmir.org/2021/3/e22951 %U https://doi.org/10.2196/22951 %U http://www.ncbi.nlm.nih.gov/pubmed/33683212 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24870 %T Machine Learning for Mental Health in Social Media: Bibliometric Study %A Kim,Jina %A Lee,Daeun %A Park,Eunil %+ Department of Applied Artificial Intelligence, Sungkyunkwan University, 312 International Hall, Sungkyunkwan-ro 25-2, Seoul, 03063, Republic of Korea, 82 2 740 1864, eunilpark@skku.edu %K bibliometric analysis %K machine learning %K mental health %K social media %D 2021 %7 8.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media platforms provide an easily accessible and time-saving communication approach for individuals with mental disorders compared to face-to-face meetings with medical providers. Recently, machine learning (ML)-based mental health exploration using large-scale social media data has attracted significant attention. Objective: We aimed to provide a bibliometric analysis and discussion on research trends of ML for mental health in social media. Methods: Publications addressing social media and ML in the field of mental health were retrieved from the Scopus and Web of Science databases. We analyzed the publication distribution to measure productivity on sources, countries, institutions, authors, and research subjects, and visualized the trends in this field using a keyword co-occurrence network. The research methodologies of previous studies with high citations are also thoroughly described. Results: We obtained a total of 565 relevant papers published from 2015 to 2020. In the last 5 years, the number of publications has demonstrated continuous growth with Lecture Notes in Computer Science and Journal of Medical Internet Research as the two most productive sources based on Scopus and Web of Science records. In addition, notable methodological approaches with data resources presented in high-ranking publications were investigated. Conclusions: The results of this study highlight continuous growth in this research area. Moreover, we retrieved three main discussion points from a comprehensive overview of highly cited publications that provide new in-depth directions for both researchers and practitioners. %M 33683209 %R 10.2196/24870 %U https://www.jmir.org/2021/3/e24870 %U https://doi.org/10.2196/24870 %U http://www.ncbi.nlm.nih.gov/pubmed/33683209 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e19461 %T Parents’ Perspectives on Using Artificial Intelligence to Reduce Technology Interference During Early Childhood: Cross-sectional Online Survey %A Glassman,Jill %A Humphreys,Kathryn %A Yeung,Serena %A Smith,Michelle %A Jauregui,Adam %A Milstein,Arnold %A Sanders,Lee %+ Clinical Excellence Research Center, School of Medicine, Stanford University, 365 Lasuen Street, #308, Stanford, CA, 94305, United States, 1 8314195302, jill.r.glassman@stanford.edu %K parenting %K digital technology %K mobile phone %K child development %K artificial intelligence %D 2021 %7 15.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Parents’ use of mobile technologies may interfere with important parent-child interactions that are critical to healthy child development. This phenomenon is known as technoference. However, little is known about the population-wide awareness of this problem and the acceptability of artificial intelligence (AI)–based tools that help with mitigating technoference. Objective: This study aims to assess parents’ awareness of technoference and its harms, the acceptability of AI tools for mitigating technoference, and how each of these constructs vary across sociodemographic factors. Methods: We administered a web-based survey to a nationally representative sample of parents of children aged ≤5 years. Parents’ perceptions that their own technology use had risen to potentially problematic levels in general, their perceptions of their own parenting technoference, and the degree to which they found AI tools for mitigating technoference acceptable were assessed by using adaptations of previously validated scales. Multiple regression and mediation analyses were used to assess the relationships between these scales and each of the 6 sociodemographic factors (parent age, sex, language, ethnicity, educational attainment, and family income). Results: Of the 305 respondents, 280 provided data that met the established standards for analysis. Parents reported that a mean of 3.03 devices (SD 2.07) interfered daily in their interactions with their child. Almost two-thirds of the parents agreed with the statements “I am worried about the impact of my mobile electronic device use on my child” and “Using a computer-assisted coach while caring for my child would help me notice more quickly when my device use is interfering with my caregiving” (187/281, 66.5% and 184/282, 65.1%, respectively). Younger age, Hispanic ethnicity, and Spanish language spoken at home were associated with increased technoference awareness. Compared to parents’ perceived technoference and sociodemographic factors, parents’ perceptions of their own problematic technology use was the factor that was most associated with the acceptance of AI tools. Conclusions: Parents reported high levels of mobile device use and technoference around their youngest children. Most parents across a wide sociodemographic spectrum, especially younger parents, found the use of AI tools to help mitigate technoference during parent-child daily interaction acceptable and useful. %M 33720026 %R 10.2196/19461 %U https://www.jmir.org/2021/3/e19461 %U https://doi.org/10.2196/19461 %U http://www.ncbi.nlm.nih.gov/pubmed/33720026 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e21695 %T Reducing the Impact of Confounding Factors on Skin Cancer Classification via Image Segmentation: Technical Model Study %A Maron,Roman C %A Hekler,Achim %A Krieghoff-Henning,Eva %A Schmitt,Max %A Schlager,Justin G %A Utikal,Jochen S %A Brinker,Titus J %+ Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, Heidelberg, 69120, Germany, 49 6221 3219304, titus.brinker@dkfz.de %K dermatology %K diagnosis %K artificial intelligence %K neural networks %K image segmentation %K confounding factors %K artifacts %K melanoma %K nevus %K deep learning %D 2021 %7 25.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Studies have shown that artificial intelligence achieves similar or better performance than dermatologists in specific dermoscopic image classification tasks. However, artificial intelligence is susceptible to the influence of confounding factors within images (eg, skin markings), which can lead to false diagnoses of cancerous skin lesions. Image segmentation can remove lesion-adjacent confounding factors but greatly change the image representation. Objective: The aim of this study was to compare the performance of 2 image classification workflows where images were either segmented or left unprocessed before the subsequent training and evaluation of a binary skin lesion classifier. Methods: Separate binary skin lesion classifiers (nevus vs melanoma) were trained and evaluated on segmented and unsegmented dermoscopic images. For a more informative result, separate classifiers were trained on 2 distinct training data sets (human against machine [HAM] and International Skin Imaging Collaboration [ISIC]). Each training run was repeated 5 times. The mean performance of the 5 runs was evaluated on a multi-source test set (n=688) consisting of a holdout and an external component. Results: Our findings showed that when trained on HAM, the segmented classifiers showed a higher overall balanced accuracy (75.6% [SD 1.1%]) than the unsegmented classifiers (66.7% [SD 3.2%]), which was significant in 4 out of 5 runs (P<.001). The overall balanced accuracy was numerically higher for the unsegmented ISIC classifiers (78.3% [SD 1.8%]) than for the segmented ISIC classifiers (77.4% [SD 1.5%]), which was significantly different in 1 out of 5 runs (P=.004). Conclusions: Image segmentation does not result in overall performance decrease but it causes the beneficial removal of lesion-adjacent confounding factors. Thus, it is a viable option to address the negative impact that confounding factors have on deep learning models in dermatology. However, the segmentation step might introduce new pitfalls, which require further investigations. %M 33764307 %R 10.2196/21695 %U https://www.jmir.org/2021/3/e21695 %U https://doi.org/10.2196/21695 %U http://www.ncbi.nlm.nih.gov/pubmed/33764307 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24850 %T A Therapeutic Relational Agent for Reducing Problematic Substance Use (Woebot): Development and Usability Study %A Prochaska,Judith J %A Vogel,Erin A %A Chieng,Amy %A Kendra,Matthew %A Baiocchi,Michael %A Pajarito,Sarah %A Robinson,Athena %+ Stanford Prevention Research Center, School of Medicine, Stanford University, Medical School Office Building, X316, 1265 Welch Road, Stanford, CA, 94305, United States, 1 650 724 3608, jpro@stanford.edu %K artificial intelligence %K conversational agent %K chatbot %K addiction %K substance misuse %K treatment %K acceptability %K feasibility %K craving %K psychoeducation %K psychotherapeutic %K mobile phone %D 2021 %7 23.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Misuse of substances is common, can be serious and costly to society, and often goes untreated due to barriers to accessing care. Woebot is a mental health digital solution informed by cognitive behavioral therapy and built upon an artificial intelligence–driven platform to deliver tailored content to users. In a previous 2-week randomized controlled trial, Woebot alleviated depressive symptoms. Objective: This study aims to adapt Woebot for the treatment of substance use disorders (W-SUDs) and examine its feasibility, acceptability, and preliminary efficacy. Methods: American adults (aged 18-65 years) who screened positive for substance misuse without major health contraindications were recruited from online sources and flyers and enrolled between March 27 and May 6, 2020. In a single-group pre/postdesign, all participants received W-SUDs for 8 weeks. W-SUDs provided mood, craving, and pain tracking and modules (psychoeducational lessons and psychotherapeutic tools) using elements of dialectical behavior therapy and motivational interviewing. Paired samples t tests and McNemar nonparametric tests were used to examine within-subject changes from pre- to posttreatment on measures of substance use, confidence, cravings, mood, and pain. Results: The sample (N=101) had a mean age of 36.8 years (SD 10.0), and 75.2% (76/101) of the participants were female, 78.2% (79/101) were non-Hispanic White, and 72.3% (73/101) were employed. Participants’ W-SUDs use averaged 15.7 (SD 14.2) days, 12.1 (SD 8.3) modules, and 600.7 (SD 556.5) sent messages. About 94% (562/598) of all completed psychoeducational lessons were rated positively. From treatment start to end, in-app craving ratings were reduced by half (87/101, 86.1% reporting cravings in the app; odds ratio 0.48, 95% CI 0.32-0.73). Posttreatment assessment completion was 50.5% (51/101), with better retention among those who initially screened higher on substance misuse. From pre- to posttreatment, confidence to resist urges to use substances significantly increased (mean score change +16.9, SD 21.4; P<.001), whereas past month substance use occasions (mean change −9.3, SD 14.1; P<.001) and scores on the Alcohol Use Disorders Identification Test-Concise (mean change −1.3, SD 2.6; P<.001), 10-item Drug Abuse Screening Test (mean change −1.2, SD 2.0; P<.001), Patient Health Questionnaire-8 item (mean change 2.1, SD 5.2; P=.005), Generalized Anxiety Disorder-7 (mean change −2.3, SD 4.7; P=.001), and cravings scale (68.6% vs 47.1% moderate to extreme; P=.01) significantly decreased. Most participants would recommend W-SUDs to a friend (39/51, 76%) and reported receiving the service they desired (41/51, 80%). Fewer felt W-SUDs met most or all of their needs (22/51, 43%). Conclusions: W-SUDs was feasible to deliver, engaging, and acceptable and was associated with significant improvements in substance use, confidence, cravings, depression, and anxiety. Study attrition was high. Future research will evaluate W-SUDs in a randomized controlled trial with a more diverse sample and with the use of greater study retention strategies. Trial Registration: ClinicalTrials.gov NCT04096001; http://clinicaltrials.gov/ct2/show/NCT04096001. %M 33755028 %R 10.2196/24850 %U https://www.jmir.org/2021/3/e24850 %U https://doi.org/10.2196/24850 %U http://www.ncbi.nlm.nih.gov/pubmed/33755028 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25107 %T Development and Evaluation of a Mobile App Designed to Increase HIV Testing and Pre-exposure Prophylaxis Use Among Young Men Who Have Sex With Men in the United States: Open Pilot Trial %A Biello,Katie B %A Hill-Rorie,Jonathan %A Valente,Pablo K %A Futterman,Donna %A Sullivan,Patrick S %A Hightow-Weidman,Lisa %A Muessig,Kathryn %A Dormitzer,Julian %A Mimiaga,Matthew J %A Mayer,Kenneth H %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main Street, 8th Floor, Providence, RI, 02912, United States, 1 (401)8633082, katie_biello@brown.edu %K HIV %K men who have sex with men %K pre-exposure prophylaxis %K pilot study %K mobile apps %K mobile phone %K mHealth %D 2021 %7 24.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: HIV disproportionately affects young men who have sex with men (YMSM) in the United States. Uptake of evidence-based prevention strategies, including routine HIV testing and use of pre-exposure prophylaxis (PrEP), is suboptimal in this population. Novel methods for reaching YMSM are required. Objective: The aim of this study is to describe the development and evaluate the feasibility and acceptability of the MyChoices app, a mobile app designed to increase HIV testing and PrEP use among YMSM in the United States. Methods: Informed by the social cognitive theory, the MyChoices app was developed using an iterative process to increase HIV testing and PrEP uptake among YMSM. In 2017, beta theater testing was conducted in two US cities to garner feedback (n=4 groups; n=28 YMSM). These findings were used to refine MyChoices, which was then tested for initial acceptability and usability in a technical pilot (N=11 YMSM). Baseline and 2-month postbaseline assessments and exit interviews were completed. Transcripts were coded using a deductive approach, and thematic analysis was used to synthesize data; app acceptability and use data were also reported. Results: The MyChoices app includes personalized recommendations for HIV testing frequency and PrEP use; information on types of HIV tests and PrEP; ability to search for nearby HIV testing and PrEP care sites; and ability to order free home HIV and sexually transmitted infection test kits, condoms, and lube. In theater testing, YMSM described that MyChoices appears useful and that they would recommend it to peers. Participants liked the look and feel of the app and believed that the ability to search for and be pinged when near an HIV testing site would be beneficial. Some suggested that portions of the app felt repetitive and preferred using casual language rather than formal or medicalized terms. Following theater testing, the MyChoices app was refined, and participants in the technical pilot used the app, on average, 8 (SD 5.0; range 2-18) times over 2 months, with an average duration of 28 (SD 38.9) minutes per session. At the 2-month follow-up, the mean System Usability Scale (0-100) score was 71 (ie, above average; SD 11.8). Over 80% (9/11) of the participants reported that MyChoices was useful and 91% (10/11) said that they would recommend it to a friend. In exit interviews, there was a high level of acceptability for the content, interface, and features. Conclusions: These data show the initial acceptability and user engagement of the MyChoices app. If future studies demonstrate efficacy in increasing HIV testing and PrEP uptake, the app is scalable to reach YMSM across the United States. Trial Registration: Clinicaltrials.gov NCT03179319; https://clinicaltrials.gov/ct2/show/NCT03179319 International Registered Report Identifier (IRRID): RR2-10.2196/10694 %M 33759792 %R 10.2196/25107 %U https://www.jmir.org/2021/3/e25107 %U https://doi.org/10.2196/25107 %U http://www.ncbi.nlm.nih.gov/pubmed/33759792 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e22219 %T What Every Reader Should Know About Studies Using Electronic Health Record Data but May Be Afraid to Ask %A Kohane,Isaac S %A Aronow,Bruce J %A Avillach,Paul %A Beaulieu-Jones,Brett K %A Bellazzi,Riccardo %A Bradford,Robert L %A Brat,Gabriel A %A Cannataro,Mario %A Cimino,James J %A García-Barrio,Noelia %A Gehlenborg,Nils %A Ghassemi,Marzyeh %A Gutiérrez-Sacristán,Alba %A Hanauer,David A %A Holmes,John H %A Hong,Chuan %A Klann,Jeffrey G %A Loh,Ne Hooi Will %A Luo,Yuan %A Mandl,Kenneth D %A Daniar,Mohamad %A Moore,Jason H %A Murphy,Shawn N %A Neuraz,Antoine %A Ngiam,Kee Yuan %A Omenn,Gilbert S %A Palmer,Nathan %A Patel,Lav P %A Pedrera-Jiménez,Miguel %A Sliz,Piotr %A South,Andrew M %A Tan,Amelia Li Min %A Taylor,Deanne M %A Taylor,Bradley W %A Torti,Carlo %A Vallejos,Andrew K %A Wagholikar,Kavishwar B %A , %A Weber,Griffin M %A Cai,Tianxi %+ Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck Street, Boston, MA, 02115, United States, 1 617 432 3226, isaac_kohane@harvard.edu %K COVID-19 %K electronic health records %K real-world data %K literature %K publishing %K quality %K data quality %K reporting standards %K reporting checklist %K review %K statistics %D 2021 %7 2.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X Coincident with the tsunami of COVID-19–related publications, there has been a surge of studies using real-world data, including those obtained from the electronic health record (EHR). Unfortunately, several of these high-profile publications were retracted because of concerns regarding the soundness and quality of the studies and the EHR data they purported to analyze. These retractions highlight that although a small community of EHR informatics experts can readily identify strengths and flaws in EHR-derived studies, many medical editorial teams and otherwise sophisticated medical readers lack the framework to fully critically appraise these studies. In addition, conventional statistical analyses cannot overcome the need for an understanding of the opportunities and limitations of EHR-derived studies. We distill here from the broader informatics literature six key considerations that are crucial for appraising studies utilizing EHR data: data completeness, data collection and handling (eg, transformation), data type (ie, codified, textual), robustness of methods against EHR variability (within and across institutions, countries, and time), transparency of data and analytic code, and the multidisciplinary approach. These considerations will inform researchers, clinicians, and other stakeholders as to the recommended best practices in reviewing manuscripts, grants, and other outputs from EHR-data derived studies, and thereby promote and foster rigor, quality, and reliability of this rapidly growing field. %M 33600347 %R 10.2196/22219 %U https://www.jmir.org/2021/3/e22219 %U https://doi.org/10.2196/22219 %U http://www.ncbi.nlm.nih.gov/pubmed/33600347 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e21023 %T Underrepresentation of Phenotypic Variability of 16p13.11 Microduplication Syndrome Assessed With an Online Self-Phenotyping Tool (Phenotypr): Cohort Study %A Li,Jianqiao %A Hojlo,Margaret A %A Chennuri,Sampath %A Gujral,Nitin %A Paterson,Heather L %A Shefchek,Kent A %A Genetti,Casie A %A Cohn,Emily L %A Sewalk,Kara C %A Garvey,Emily A %A Buttermore,Elizabeth D %A Anderson,Nickesha C %A Beggs,Alan H %A Agrawal,Pankaj B %A Brownstein,John S %A Haendel,Melissa A %A Holm,Ingrid A %A Gonzalez-Heydrich,Joseph %A Brownstein,Catherine A %+ Division of Genetics and Genomics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States, 1 6173554764, catherine.brownstein@childrens.harvard.edu %K self-phenotyping %K 16p13.11 microduplication syndrome %K copy number variation %K genetics %K incomplete penetrance %K phenotype %K variable presentation %K human phenotype ontology %K online survey %K digital health %D 2021 %7 16.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: 16p13.11 microduplication syndrome has a variable presentation and is characterized primarily by neurodevelopmental and physical phenotypes resulting from copy number variation at chromosome 16p13.11. Given its variability, there may be features that have not yet been reported. The goal of this study was to use a patient “self-phenotyping” survey to collect data directly from patients to further characterize the phenotypes of 16p13.11 microduplication syndrome. Objective: This study aimed to (1) discover self-identified phenotypes in 16p13.11 microduplication syndrome that have been underrepresented in the scientific literature and (2) demonstrate that self-phenotyping tools are valuable sources of data for the medical and scientific communities. Methods: As part of a large study to compare and evaluate patient self-phenotyping surveys, an online survey tool, Phenotypr, was developed for patients with rare disorders to self-report phenotypes. Participants with 16p13.11 microduplication syndrome were recruited through the Boston Children's Hospital 16p13.11 Registry. Either the caregiver, parent, or legal guardian of an affected child or the affected person (if aged 18 years or above) completed the survey. Results were securely transferred to a Research Electronic Data Capture database and aggregated for analysis. Results: A total of 19 participants enrolled in the study. Notably, among the 19 participants, aggression and anxiety were mentioned by 3 (16%) and 4 (21%) participants, respectively, which is an increase over the numbers in previously published literature. Additionally, among the 19 participants, 3 (16%) had asthma and 2 (11%) had other immunological disorders, both of which have not been previously described in the syndrome. Conclusions: Several phenotypes might be underrepresented in the previous 16p13.11 microduplication literature, and new possible phenotypes have been identified. Whenever possible, patients should continue to be referenced as a source of complete phenotyping data on their condition. Self-phenotyping may lead to a better understanding of the prevalence of phenotypes in genetic disorders and may identify previously unreported phenotypes. %M 33724192 %R 10.2196/21023 %U https://www.jmir.org/2021/3/e21023 %U https://doi.org/10.2196/21023 %U http://www.ncbi.nlm.nih.gov/pubmed/33724192 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e14042 %T Practical Considerations and Successful Implementation of Vital Signs Monitoring. Comment on “Continuous Versus Intermittent Vital Signs Monitoring Using a Wearable, Wireless Patch in Patients Admitted to Surgical Wards: Pilot Cluster Randomized Controlled Trial” %A Walsh,Caoimhe %A Zargaran,David %A Patel,Nikhil %A White,Amelia %A Koumpa,Foteini Stefania %A Tanna,Ravina %A Ashraf,Muhammad Arsalan %+ Epsom and St Helier University Hospitals NHS Trust, Wrythe Lane, Carshalton, Surrey, SM5 1AA, United Kingdom, 44 7584061131, caoimhemwalsh@gmail.com %K general surgery %K monitoring %K observations %K vital signs %D 2021 %7 11.3.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 33704079 %R 10.2196/14042 %U https://www.jmir.org/2021/3/e14042 %U https://doi.org/10.2196/14042 %U http://www.ncbi.nlm.nih.gov/pubmed/33704079 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e28358 %T Correction: Using the Patient Portal Sexual Health Instrument in Surveys and Patient Questionnaires Among Sexual Minority Men in the United States: Cross-sectional Psychometric Validation Study %A Jackman,Kevon-Mark P %A Kane,Jeremy %A Kharrazi,Hadi %A Johnson,Renee M %A Latkin,Carl %+ Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Hampton House 8th Floor, Baltimore, MD, 21205, United States, 1 410 955 3910, kjackma2@jhmi.edu %D 2021 %7 5.3.2021 %9 Corrigenda and Addenda %J J Med Internet Res %G English %X %M 33667179 %R 10.2196/28358 %U https://www.jmir.org/2021/3/e28358 %U https://doi.org/10.2196/28358 %U http://www.ncbi.nlm.nih.gov/pubmed/33667179 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e29042 %T Correction: Association Between Institutional Social Media Involvement and Gastroenterology Divisional Rankings: Cohort Study %A Chiang,Austin Lee %A Rabinowitz,Loren Galler %A Kumar,Akhil %A Chan,Walter Wai-Yip %+ Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, United States, 1 617 732 6389, wwchan@bwh.harvard.edu %D 2021 %7 29.3.2021 %9 Corrigenda and Addenda %J J Med Internet Res %G English %X %M 33780348 %R 10.2196/29042 %U https://www.jmir.org/2021/3/e29042 %U https://doi.org/10.2196/29042 %U http://www.ncbi.nlm.nih.gov/pubmed/33780348 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e29094 %T Correction: Associations Between Digital Health Intervention Engagement, Physical Activity, and Sedentary Behavior: Systematic Review and Meta-analysis %A Mclaughlin,Matthew %A Delaney,Tessa %A Hall,Alix %A Byaruhanga,Judith %A Mackie,Paul %A Grady,Alice %A Reilly,Kathryn %A Campbell,Elizabeth %A Sutherland,Rachel %A Wiggers,John %A Wolfenden,Luke %+ School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 02 4924 6477, Matthew.Mclaughlin1@health.nsw.gov.au %D 2021 %7 29.3.2021 %9 Corrigenda and Addenda %J J Med Internet Res %G English %X %M 33780346 %R 10.2196/29094 %U https://www.jmir.org/2021/3/e29094 %U https://doi.org/10.2196/29094 %U http://www.ncbi.nlm.nih.gov/pubmed/33780346 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e29041 %T Correction: Opportunities and Challenges for Digital Social Prescribing in Mental Health: Questionnaire Study %A Patel,Shivani %A Craigen,Gerry %A Pinto da Costa,Mariana %A Inkster,Becky %+ South London and Maudsley NHS Trust, Denmark Hill, London,, United Kingdom, 44 3228 6000 ext 1234, shivaninpatel183@gmail.com %D 2021 %7 29.3.2021 %9 Corrigenda and Addenda %J J Med Internet Res %G English %X %M 33780347 %R 10.2196/29041 %U https://www.jmir.org/2021/3/e29041 %U https://doi.org/10.2196/29041 %U http://www.ncbi.nlm.nih.gov/pubmed/33780347 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e28211 %T Correction: Measurement of Digital Literacy Among Older Adults: Systematic Review %A Oh,Sarah Soyeon %A Kim,Kyoung-A %A Kim,Minsu %A Oh,Jaeuk %A Chu,Sang Hui %A Choi,JiYeon %+ Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 3301, jychoi610@yuhs.ac %D 2021 %7 3.3.2021 %9 Corrigenda and Addenda %J J Med Internet Res %G English %X %M 33657006 %R 10.2196/28211 %U https://www.jmir.org/2021/3/e28211 %U https://doi.org/10.2196/28211 %U http://www.ncbi.nlm.nih.gov/pubmed/33657006 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e28660 %T Correction: Effects of COVID-19 Emergency Alert Text Messages on Practicing Preventive Behaviors: Cross-sectional Web-Based Survey in South Korea %A Lee,Minjung %A You,Myoungsoon %+ Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 880 2773, msyou@snu.ac.kr %D 2021 %7 18.3.2021 %9 Corrigenda and Addenda %J J Med Internet Res %G English %X %M 33735093 %R 10.2196/28660 %U https://www.jmir.org/2021/3/e28660 %U https://doi.org/10.2196/28660 %U http://www.ncbi.nlm.nih.gov/pubmed/33735093 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e28926 %T Correction: COVID-19 Discourse on Twitter in Four Asian Countries: Case Study of Risk Communication %A Park,Sungkyu %A Han,Sungwon %A Kim,Jeongwook %A Molaie,Mir Majid %A Vu,Hoang Dieu %A Singh,Karandeep %A Han,Jiyoung %A Lee,Wonjae %A Cha,Meeyoung %+ Data Science Group, Institute for Basic Science, 55, Expo-ro, Yuseong-gu, Daejeon, 34126, Republic of Korea, 82 428788114, meeyoung.cha@gmail.com %D 2021 %7 29.3.2021 %9 Corrigenda and Addenda %J J Med Internet Res %G English %X %M 33780345 %R 10.2196/28926 %U https://www.jmir.org/2021/3/e28926 %U https://doi.org/10.2196/28926 %U http://www.ncbi.nlm.nih.gov/pubmed/33780345 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26559 %T Exploring Usage of COVID Coach, a Public Mental Health App Designed for the COVID-19 Pandemic: Evaluation of Analytics Data %A Jaworski,Beth K %A Taylor,Katherine %A Ramsey,Kelly M %A Heinz,Adrienne %A Steinmetz,Sarah %A Pagano,Ian %A Moraja,Giovanni %A Owen,Jason E %+ National Center for PTSD, Dissemination & Training Division, US Department of Veterans Affairs, 795 Willow Road, Menlo Park, CA, 94025, United States, 1 650 308 9437, beth.jaworski@va.gov %K COVID-19 %K coronavirus %K mobile app %K mHealth %K digital health %K mental health %K public mental health %K stress %K coping %K public health %K app %D 2021 %7 1.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has significantly impacted mental health and well-being. Mobile mental health apps can be scalable and useful tools in large-scale disaster responses and are particularly promising for reaching vulnerable populations. COVID Coach is a free, evidence-informed mobile app designed specifically to provide tools and resources for addressing COVID-19–related stress. Objective: The purpose of this study was to characterize the overall usage of COVID Coach, explore retention and return usage, and assess whether the app was reaching individuals who may benefit from mental health resources. Methods: Anonymous usage data collected from COVID Coach between May 1, 2020, through October 31, 2020, were extracted and analyzed for this study. The sample included 49,287 unique user codes and 3,368,931 in-app events. Results: Usage of interactive tools for coping and stress management comprised the majority of key app events (n=325,691, 70.4%), and the majority of app users tried a tool for managing stress (n=28,009, 58.8%). COVID Coach was utilized for ≤3 days by 80.9% (n=34,611) of the sample whose first day of app use occurred within the 6-month observation window. Usage of the key content in COVID Coach predicted returning to the app for a second day. Among those who tried at least one coping tool on their first day of app use, 57.2% (n=11,444) returned for a second visit; whereas only 46.3% (n=10,546) of those who did not try a tool returned (P<.001). Symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) were prevalent among app users. For example, among app users who completed an anxiety assessment on their first day of app use (n=4870, 11.4% of users), 55.1% (n=2680) reported levels of anxiety that were moderate to severe, and 29.9% (n=1455) of scores fell into the severe symptom range. On average, those with moderate levels of depression on their first day of app use returned to the app for a greater number of days (mean 3.72 days) than those with minimal symptoms (mean 3.08 days; t1=3.01, P=.003). Individuals with significant PTSD symptoms on their first day of app use utilized the app for a significantly greater number of days (mean 3.79 days) than those with fewer symptoms (mean 3.13 days; t1=2.29, P=.02). Conclusions: As the mental health impacts of the pandemic continue to be widespread and increasing, digital health resources, such as apps like COVID Coach, are a scalable way to provide evidence-informed tools and resources. Future research is needed to better understand for whom and under what conditions the app is most helpful and how to increase and sustain engagement. %M 33606656 %R 10.2196/26559 %U https://www.jmir.org/2021/3/e26559 %U https://doi.org/10.2196/26559 %U http://www.ncbi.nlm.nih.gov/pubmed/33606656 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23362 %T Barriers to the Large-Scale Adoption of a COVID-19 Contact Tracing App in Germany: Survey Study %A Blom,Annelies G %A Wenz,Alexander %A Cornesse,Carina %A Rettig,Tobias %A Fikel,Marina %A Friedel,Sabine %A Möhring,Katja %A Naumann,Elias %A Reifenscheid,Maximiliane %A Krieger,Ulrich %+ School of Social Sciences, University of Mannheim, A5, 6, Mannheim, 68131, Germany, 49 621 181 2298, a.wenz@uni-mannheim.de %K digital health %K mobile health %K smartphone %K mobile phone %K app %K digital technology %K contact tracing %K coronavirus %K COVID-19 %K survey %D 2021 %7 2.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, one way to reduce further transmissions of SARS-CoV-2 is the widespread use of contact tracing apps. Such apps keep track of proximity contacts and warn contacts of persons who tested positive for an infection. Objective: In this study, we analyzed potential barriers to the large-scale adoption of the official contact tracing app that was introduced in Germany on June 16, 2020. Methods: Survey data were collected from 3276 adults during the week the app was introduced using an offline-recruited, probability-based online panel of the general adult population in Germany. Results: We estimate that 81% of the population aged 18 to 77 years possess the devices and ability to install the official app and that 35% are also willing to install and use it. Potential spreaders show high access to devices required to install the app (92%) and high ability to install the app (91%) but low willingness (31%) to correctly adopt the app, whereas for vulnerable groups, the main barrier is access (62%). Conclusions: The findings suggest a pessimistic view on the effectiveness of app-based contact tracing to contain the COVID-19 pandemic. We recommend targeting information campaigns at groups with a high potential to spread the virus but who are unwilling to install and correctly use the app, in particular men and those aged between 30 and 59 years. In addition, vulnerable groups, in particular older individuals and those in lower-income households, may be provided with equipment and support to overcome their barriers to app adoption. %M 33577466 %R 10.2196/23362 %U https://www.jmir.org/2021/3/e23362 %U https://doi.org/10.2196/23362 %U http://www.ncbi.nlm.nih.gov/pubmed/33577466 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25977 %T Social Media Engagement and Influenza Vaccination During the COVID-19 Pandemic: Cross-sectional Survey Study %A Benis,Arriel %A Khodos,Anna %A Ran,Sivan %A Levner,Eugene %A Ashkenazi,Shai %+ Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Golomb St. 52, Holon, 5810201, Israel, 972 3 5026892, arrielb@hit.ac.il %K influenza %K vaccines %K vaccination %K social media %K online social networking %K health literacy %K eHealth %K information dissemination %K access to information %K COVID-19 %D 2021 %7 16.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Vaccines are one of the most important achievements of modern medicine. However, their acceptance is only partial, with vaccine hesitancy and refusal representing a major health threat. Influenza vaccines have low compliance since repeated, annual vaccination is required. Influenza vaccines stimulate discussions both in the real world and online. Social media is currently a significant source of health and medical information. Elucidating the association between social media engagement and influenza vaccination is important and may be applicable to other vaccines, including ones against COVID-19. Objective: The goal of this study is to characterize profiles of social media engagement regarding the influenza vaccine and their association with knowledge and compliance in order to support improvement of future web-associated vaccination campaigns. Methods: A weblink to an online survey in Hebrew was disseminated over social media and messaging platforms. The survey answers were collected during April 2020. Anonymous and volunteer participants aged 21 years and over answered 30 questions related to sociodemographics; social media usage; influenza- and vaccine-related knowledge and behavior; health-related information searching, its reliability, and its influence; and COVID-19-related information searching. A univariate descriptive data analysis was performed, followed by multivariate analysis via building a decision tree to define the most important attributes associated with vaccination compliance. Results: A total of 213 subjects responded to the survey, of whom 207 were included in the analysis; the majority of the respondents were female, were aged 21 to 40 years, had 1 to 2 children, lived in central Israel, were secular Israeli natives, had higher education, and had a salary close to the national average. Most respondents (128/207, 61.8%) were not vaccinated against influenza in 2019 and used social media. Participants that used social media were younger, secular, and living in high-density agglomerations and had lower influenza vaccination rates. The perceived influence and reliability of the information on social media about COVID-19 were generally similar to those perceptions about influenza. Conclusions: Using social media is negatively linked to compliance with seasonal influenza vaccination in this study. A high proportion of noncompliant individuals can lead to increased consumption of health care services and can, therefore, overload these health services. This is particularly crucial with a concomitant outbreak, such as COVID-19. Health care professionals should use improved and targeted health communication campaigns with the aid of experts in social media. Targeted communication, based on sociodemographic factors and personalized social media usage, might increase influenza vaccination rates and compliance with other vaccines as well. %M 33651709 %R 10.2196/25977 %U https://www.jmir.org/2021/3/e25977 %U https://doi.org/10.2196/25977 %U http://www.ncbi.nlm.nih.gov/pubmed/33651709 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26799 %T Minimizing the Impact of the COVID-19 Epidemic on Oncology Clinical Trials: Retrospective Study of Beijing Cancer Hospital %A Fu,Zhiying %A Jiang,Min %A Wang,Kun %A Li,Jian %+ Beijing Institute for Cancer Research, Beijing Cancer Hospital, No 52 Fucheng Road, Haidian District, Beijing, China, 86 1088196949, LIJIAN8409@126.com %K COVID-19 %K clinical trials %K management strategy %K information technology %D 2021 %7 2.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In view of repeated COVID-19 outbreaks in most countries, clinical trials will continue to be conducted under outbreak prevention and control measures for the next few years. It is very significant to explore an optimal clinical trial management model during the outbreak period to provide reference and insight for other clinical trial centers worldwide. Objective: The aim of this study was to explore the management strategies used to minimize the impact of the COVID-19 epidemic on oncology clinical trials. Methods: We implemented a remote management model to maintain clinical trials conducted at Beijing Cancer Hospital, which realized remote project approval, remote initiation, remote visits, remote administration and remote monitoring to get through two COVID-19 outbreaks in the capital city from February to April and June to July 2020. The effectiveness of measures was evaluated as differences in rates of protocol compliance, participants lost to follow-up, participant withdrawal, disease progression, participant mortality, and detection of monitoring problems. Results: During the late of the first outbreak, modifications were made in trial processing, participant management and quality control, which allowed the hospital to ensure the smooth conduct of 572 trials, with a protocol compliance rate of 85.24% for 3718 participants across both outbreaks. No COVID-19 infections were recorded among participants or trial staff, and no major procedural errors occurred between February and July 2020. These measures led to significantly higher rates of protocol compliance and significantly lower rates of loss to follow-up or withdrawal after the second outbreak than after the first, without affecting rates of disease progression or mortality. The hospital provided trial sponsors with a remote monitoring system in a timely manner, and 3820 trial issues were identified. Conclusions: When public health emergencies occur, an optimal clinical trial model combining on-site and remote management could guarantee the health care and treatment needs of clinical trial participants, in which remote management plays a key role. %M 33591924 %R 10.2196/26799 %U https://www.jmir.org/2021/3/e26799 %U https://doi.org/10.2196/26799 %U http://www.ncbi.nlm.nih.gov/pubmed/33591924 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25726 %T Adoption of COVID-19 Contact Tracing Apps: A Balance Between Privacy and Effectiveness %A Seto,Emily %A Challa,Priyanka %A Ware,Patrick %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada, 1 416 669 9295, emily.seto@utoronto.ca %K mobile apps %K COVID-19 %K contact tracing %K exposure notification %K privacy %K effectiveness %K app %K surveillance %K tracing %K transmission %K security %K digital health %D 2021 %7 4.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X With the relative ubiquity of smartphones, contact tracing and exposure notification apps have been looked to as novel methods to help reduce the transmission of COVID-19. Many countries have created apps that lie across a spectrum from privacy-first approaches to those that have very few privacy measures. The level of privacy incorporated into an app is largely based on the societal norms and values of a particular country. Digital health technologies can be highly effective and preserve privacy at the same time, but in the case of contact tracing and exposure notification apps, there is a trade-off between increased privacy measures and the effectiveness of the app. In this article, examples from various countries are used to highlight how characteristics of contract tracing and exposure notification apps contribute to the perceived levels of privacy awarded to citizens and how this impacts an app’s effectiveness. We conclude that finding the right balance between privacy and effectiveness, while critical, is challenging because it is highly context-specific. %M 33617459 %R 10.2196/25726 %U https://www.jmir.org/2021/3/e25726 %U https://doi.org/10.2196/25726 %U http://www.ncbi.nlm.nih.gov/pubmed/33617459 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25696 %T Modeling Predictive Age-Dependent and Age-Independent Symptoms and Comorbidities of Patients Seeking Treatment for COVID-19: Model Development and Validation Study %A Huang,Yingxiang %A Radenkovic,Dina %A Perez,Kevin %A Nadeau,Kari %A Verdin,Eric %A Furman,David %+ Buck Institute for Research on Aging, 8001 Redwood Blvd, Novato, CA, 94945, United States, 1 (415) 209 2000, DFurman@buckinstitute.org %K clinical informatics %K predictive modeling %K COVID-19 %K app %K model %K prediction %K symptom %K informatics %K age %K morbidity %K hospital %D 2021 %7 25.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic continues to ravage and burden hospitals around the world. The epidemic started in Wuhan, China, and was subsequently recognized by the World Health Organization as an international public health emergency and declared a pandemic in March 2020. Since then, the disruptions caused by the COVID-19 pandemic have had an unparalleled effect on all aspects of life. Objective: With increasing total hospitalization and intensive care unit admissions, a better understanding of features related to patients with COVID-19 could help health care workers stratify patients based on the risk of developing a more severe case of COVID-19. Using predictive models, we strive to select the features that are most associated with more severe cases of COVID-19. Methods: Over 3 million participants reported their potential symptoms of COVID-19, along with their comorbidities and demographic information, on a smartphone-based app. Using data from the >10,000 individuals who indicated that they had tested positive for COVID-19 in the United Kingdom, we leveraged the Elastic Net regularized binary classifier to derive the predictors that are most correlated with users having a severe enough case of COVID-19 to seek treatment in a hospital setting. We then analyzed such features in relation to age and other demographics and their longitudinal trend. Results: The most predictive features found include fever, use of immunosuppressant medication, use of a mobility aid, shortness of breath, and severe fatigue. Such features are age-related, and some are disproportionally high in minority populations. Conclusions: Predictors selected from the predictive models can be used to stratify patients into groups based on how much medical attention they are expected to require. This could help health care workers devote valuable resources to prevent the escalation of the disease in vulnerable populations. %M 33621185 %R 10.2196/25696 %U https://www.jmir.org/2021/3/e25696 %U https://doi.org/10.2196/25696 %U http://www.ncbi.nlm.nih.gov/pubmed/33621185 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26482 %T Understanding Concerns, Sentiments, and Disparities Among Population Groups During the COVID-19 Pandemic Via Twitter Data Mining: Large-scale Cross-sectional Study %A Zhang,Chunyan %A Xu,Songhua %A Li,Zongfang %A Hu,Shunxu %+ Institute of Medical Artificial Intelligence, The Second Affiliate Hospital of Xi’an Jiaotong University, No.157 Xiwu Road, Xi'an, China, 86 18710823698, songhua_xu1@163.com %K COVID-19 %K Twitter mining %K infodemiology %K infoveillance %K pandemic %K concerns %K sentiments %K population groups %K disparities %D 2021 %7 5.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the beginning of the COVID-19 pandemic in late 2019, its far-reaching impacts have been witnessed globally across all aspects of human life, such as health, economy, politics, and education. Such widely penetrating impacts cast significant and profound burdens on all population groups, incurring varied concerns and sentiments among them. Objective: This study aims to identify the concerns, sentiments, and disparities of various population groups during the COVID-19 pandemic through a cross-sectional study conducted via large-scale Twitter data mining infoveillance. Methods: This study consisted of three steps: first, tweets posted during the pandemic were collected and preprocessed on a large scale; second, the key population attributes, concerns, sentiments, and emotions were extracted via a collection of natural language processing procedures; third, multiple analyses were conducted to reveal concerns, sentiments, and disparities among population groups during the pandemic. Overall, this study implemented a quick, effective, and economical approach for analyzing population-level disparities during a public health event. The source code developed in this study was released for free public use at GitHub. Results: A total of 1,015,655 original English tweets posted from August 7 to 12, 2020, were acquired and analyzed to obtain the following results. Organizations were significantly more concerned about COVID-19 (odds ratio [OR] 3.48, 95% CI 3.39-3.58) and expressed more fear and depression emotions than individuals. Females were less concerned about COVID-19 (OR 0.73, 95% CI 0.71-0.75) and expressed less fear and depression emotions than males. Among all age groups (ie, ≤18, 19-29, 30-39, and ≥40 years of age), the attention ORs of COVID-19 fear and depression increased significantly with age. It is worth noting that not all females paid less attention to COVID-19 than males. In the age group of 40 years or older, females were more concerned than males, especially regarding the economic and education topics. In addition, males 40 years or older and 18 years or younger were the least positive. Lastly, in all sentiment analyses, the sentiment polarities regarding political topics were always the lowest among the five topics of concern across all population groups. Conclusions: Through large-scale Twitter data mining, this study revealed that meaningful differences regarding concerns and sentiments about COVID-19-related topics existed among population groups during the study period. Therefore, specialized and varied attention and support are needed for different population groups. In addition, the efficient analysis method implemented by our publicly released code can be utilized to dynamically track the evolution of each population group during the pandemic or any other major event for better informed public health research and interventions. %M 33617460 %R 10.2196/26482 %U https://www.jmir.org/2021/3/e26482 %U https://doi.org/10.2196/26482 %U http://www.ncbi.nlm.nih.gov/pubmed/33617460 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23231 %T Comparing Public Perceptions and Preventive Behaviors During the Early Phase of the COVID-19 Pandemic in Hong Kong and the United Kingdom: Cross-sectional Survey Study %A Bowman,Leigh %A Kwok,Kin On %A Redd,Rozlyn %A Yi,Yuanyuan %A Ward,Helen %A Wei,Wan In %A Atchison,Christina %A Wong,Samuel Yeung-Shan %+ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 419, 4/F, JC School of Public Health and Primary Care Building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, Hong Kong, 852 22528405, kkokwok@cuhk.edu.hk %K COVID-19 %K novel coronavirus %K pandemic %K behavioural response %K risk perceptions %K anxiety %K comparative %K Hong Kong %K United Kingdom %D 2021 %7 8.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the public health responses to previous respiratory disease pandemics, and in the absence of treatments and vaccines, the mitigation of the COVID-19 pandemic relies on population engagement in nonpharmaceutical interventions. This engagement is largely driven by risk perception, anxiety levels, and knowledge, as well as by historical exposure to disease outbreaks, government responses, and cultural factors. Objective: The aim of this study is to compare psychobehavioral responses in Hong Kong and the United Kingdom during the early phase of the COVID-19 pandemic. Methods: Comparable cross-sectional surveys were administered to adults in Hong Kong and the United Kingdom during the early phase of the epidemic in each setting. Explanatory variables included demographics, risk perception, knowledge of COVID-19, anxiety level, and preventive behaviors. Responses were weighted according to census data. Logistic regression models, including effect modification to quantify setting differences, were used to assess the association between the explanatory variables and the adoption of social distancing measures. Results: Data from 3431 complete responses (Hong Kong, 1663; United Kingdom, 1768) were analyzed. Perceived severity of symptoms differed by setting, with weighted percentages of 96.8% for Hong Kong (1621/1663) and 19.9% for the United Kingdom (366/1768). A large proportion of respondents were abnormally or borderline anxious (Hong Kong: 1077/1603, 60.0%; United Kingdom: 812/1768, 46.5%) and regarded direct contact with infected individuals as the transmission route of COVID-19 (Hong Kong: 94.0%-98.5%; United Kingdom: 69.2%-93.5%; all percentages weighted), with Hong Kong identifying additional routes. Hong Kong reported high levels of adoption of various social distancing measures (Hong Kong: 32.6%-93.7%; United Kingdom: 17.6%-59.0%) and mask-wearing (Hong Kong: 98.8% (1647/1663); United Kingdom: 3.1% (53/1768)). The impact of perceived severity of symptoms and perceived ease of transmission of COVID-19 on the adoption of social distancing measures varied by setting. In Hong Kong, these factors had no impact, whereas in the United Kingdom, those who perceived their symptom severity as “high” were more likely to adopt social distancing (adjusted odds ratios [aORs] 1.58-3.01), and those who perceived transmission as “easy” were prone to adopt both general social distancing (aOR 2.00, 95% CI 1.57-2.55) and contact avoidance (aOR 1.80, 95% CI 1.41-2.30). The impact of anxiety on adopting social distancing did not vary by setting. Conclusions: Our results suggest that health officials should ascertain baseline levels of risk perception and knowledge in populations, as well as prior sensitization to infectious disease outbreaks, during the development of mitigation strategies. Risk should be communicated through suitable media channels—and trust should be maintained—while early intervention remains the cornerstone of effective outbreak response. %M 33539309 %R 10.2196/23231 %U https://www.jmir.org/2021/3/e23231 %U https://doi.org/10.2196/23231 %U http://www.ncbi.nlm.nih.gov/pubmed/33539309 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23703 %T A Comprehensive Overview of the COVID-19 Literature: Machine Learning–Based Bibliometric Analysis %A Abd-Alrazaq,Alaa %A Schneider,Jens %A Mifsud,Borbala %A Alam,Tanvir %A Househ,Mowafa %A Hamdi,Mounir %A Shah,Zubair %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, P.O. Box 5825, Doha Al Luqta St, Ar-Rayyan, Doha, 00000, Qatar, 974 55708549, zshah@hbku.edu.qa %K novel coronavirus disease %K COVID-19 %K SARS-CoV-2 %K 2019-nCoV %K bibliometric analysis %K literature %K machine learning %K research %K review %D 2021 %7 8.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Shortly after the emergence of COVID-19, researchers rapidly mobilized to study numerous aspects of the disease such as its evolution, clinical manifestations, effects, treatments, and vaccinations. This led to a rapid increase in the number of COVID-19–related publications. Identifying trends and areas of interest using traditional review methods (eg, scoping and systematic reviews) for such a large domain area is challenging. Objective: We aimed to conduct an extensive bibliometric analysis to provide a comprehensive overview of the COVID-19 literature. Methods: We used the COVID-19 Open Research Dataset (CORD-19) that consists of a large number of research articles related to all coronaviruses. We used a machine learning–based method to analyze the most relevant COVID-19–related articles and extracted the most prominent topics. Specifically, we used a clustering algorithm to group published articles based on the similarity of their abstracts to identify research hotspots and current research directions. We have made our software accessible to the community via GitHub. Results: Of the 196,630 publications retrieved from the database, we included 28,904 in our analysis. The mean number of weekly publications was 990 (SD 789.3). The country that published the highest number of COVID-19–related articles was China (2950/17,270, 17.08%). The highest number of articles were published in bioRxiv. Lei Liu affiliated with the Southern University of Science and Technology in China published the highest number of articles (n=46). Based on titles and abstracts alone, we were able to identify 1515 surveys, 733 systematic reviews, 512 cohort studies, 480 meta-analyses, and 362 randomized control trials. We identified 19 different topics covered among the publications reviewed. The most dominant topic was public health response, followed by clinical care practices during the COVID-19 pandemic, clinical characteristics and risk factors, and epidemic models for its spread. Conclusions: We provide an overview of the COVID-19 literature and have identified current hotspots and research directions. Our findings can be useful for the research community to help prioritize research needs and recognize leading COVID-19 researchers, institutes, countries, and publishers. Our study shows that an AI-based bibliometric analysis has the potential to rapidly explore a large corpus of academic publications during a public health crisis. We believe that this work can be used to analyze other eHealth-related literature to help clinicians, administrators, and policy makers to obtain a holistic view of the literature and be able to categorize different topics of the existing research for further analyses. It can be further scaled (for instance, in time) to clinical summary documentation. Publishers should avoid noise in the data by developing a way to trace the evolution of individual publications and unique authors. %M 33600346 %R 10.2196/23703 %U https://www.jmir.org/2021/3/e23703 %U https://doi.org/10.2196/23703 %U http://www.ncbi.nlm.nih.gov/pubmed/33600346 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e21064 %T Virtual Health Care for Community Management of Patients With COVID-19 in Australia: Observational Cohort Study %A Hutchings,Owen Rhys %A Dearing,Cassandra %A Jagers,Dianna %A Shaw,Miranda Jane %A Raffan,Freya %A Jones,Aaron %A Taggart,Richard %A Sinclair,Tim %A Anderson,Teresa %A Ritchie,Angus Graham %+ Sydney Local Health District, Missenden Road, Camperdown, 2050, Australia, 61 2 9767 6447, angus.ritchie@health.nsw.gov.au %K COVID-19 %K digital health %K health %K informatics %K remote monitoring %K telehealth %K virtual health care %D 2021 %7 9.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Australia has successfully controlled the COVID-19 pandemic. Similar to other high-income countries, Australia has extensively used telehealth services. Virtual health care, including telemedicine in combination with remote patient monitoring, has been implemented in certain settings as part of new models of care that are aimed at managing patients with COVID-19 outside the hospital setting. Objective: This study aimed to describe the implementation of and early experience with virtual health care for community management of patients with COVID-19. Methods: This observational cohort study was conducted with patients with COVID-19 who availed of a large Australian metropolitan health service with an established virtual health care program capable of monitoring patients remotely. We included patients with COVID-19 who received the health service, could self-isolate safely, did not require immediate admission to an in-patient setting, had no major active comorbid illness, and could be managed at home or at other suitable sites. Skin temperature, pulse rate, and blood oxygen saturation were remotely monitored. The primary outcome measures were care escalation rates, including emergency department presentation, and hospital admission. Results: During March 11-29, 2020, a total of 162 of 173 (93.6%) patients with COVID-19 (median age 38 years, range 11-79 years), who were diagnosed locally, were enrolled in the virtual health care program. For 62 of 162 (38.3%) patients discharged during this period, the median length of stay was 8 (range 1-17) days. The peak of 100 prevalent patients equated to approximately 25 patients per registered nurse per shift. Patients were contacted a median of 16 (range 1-30) times during this period. Video consultations (n=1902, 66.3%) comprised most of the patient contacts, and 132 (81.5%) patients were monitored remotely. Care escalation rates were low, with an ambulance attendance rate of 3% (n=5), emergency department attendance rate of 2.5% (n=4), and hospital admission rate of 1.9% (n=3). No deaths were recorded. Conclusions: Community-based virtual health care is safe for managing most patients with COVID-19 and can be rapidly implemented in an urban Australian setting for pandemic management. Health services implementing virtual health care should anticipate challenges associated with rapid technology deployments and provide adequate support to resolve them, including strategies to support the use of health information technologies among consumers. %M 33687341 %R 10.2196/21064 %U https://www.jmir.org/2021/3/e21064 %U https://doi.org/10.2196/21064 %U http://www.ncbi.nlm.nih.gov/pubmed/33687341 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24673 %T Behavioral Intention to Receive a COVID-19 Vaccination Among Chinese Factory Workers: Cross-sectional Online Survey %A Zhang,Ke Chun %A Fang,Yuan %A Cao,He %A Chen,Hongbiao %A Hu,Tian %A Chen,Yaqi %A Zhou,Xiaofeng %A Wang,Zixin %+ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Shatin, N.T., Hong Kong, 666888, China, 852 22528740, wangzx@cuhk.edu.hk %K COVID-19 %K vaccination %K behavioral intention %K perception %K social media influence %K personal preventive behaviors %K factory workers %K China %K social media %K vaccine %K behavior %K intention %K risk %D 2021 %7 9.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 vaccines will become available in China soon. Understanding communities’ responses to the forthcoming COVID-19 vaccines is important. We applied the theory of planned behavior as the theoretical framework. Objective: This study investigates the prevalence of and factors associated with behavioral intention to receive self-financed or free COVID-19 vaccinations among Chinese factory workers who resumed work during the pandemic. We examined the effects of factors including sociodemographics, perceptions related to COVID-19 vaccination, exposure to information about COVID-19 vaccination through social media, and COVID-19 preventive measures implemented by individuals and factories. Methods: Participants were full-time employees 18 years or older who worked in factories in Shenzhen. Factory workers in Shenzhen are required to receive a physical examination annually. Eligible workers attending six physical examination sites were invited to complete a survey on September 1-7, 2020. Out of 2653 eligible factory workers, 2053 (77.4%) completed the online survey. Multivariate two-level logistic regression models and ordinal logistic regression models were fitted. Results: The prevalence of behavioral intention to receive a COVID-19 vaccination was 66.6% (n=1368, conditional on 80% vaccine efficacy and market rate) and 80.6% (n=1655, conditional on 80% vaccine efficacy and free vaccines). After adjusting for significant background characteristics, positive attitudes toward COVID-19 vaccination (adjusted odds ratio [AOR] 1.20, 95% CI 1.15-1.25 and AOR 1.24, 95% CI 1.19-1.30), perceived support from significant others for getting a COVID-19 vaccination (AOR 1.43, 95% CI 1.32-1.55 and AOR 1.37, 95% CI 1.25-1.50), and perceived behavioral control to get a COVID-19 vaccination (AOR 1.51, 95% CI 1.32-1.73 and AOR 1.28, 95% CI 1.09-1.51) were positively associated with both dependent variables (conditional on 80% vaccine efficacy and market rate or free vaccines, respectively). Regarding social media influence, higher frequency of exposure to positive information related to COVID-19 vaccination was associated with a higher intention to receive a COVID-19 vaccination at market rate (AOR 1.53, 95% CI 1.39-1.70) or a free vaccination (AOR 1.52, 95% CI 1.35-1.71). Higher self-reported compliance with wearing a face mask in the workplace (AOR 1.27, 95% CI 1.02-1.58 and AOR 1.67, 95% CI 1.24-2.27) and other public spaces (AOR 1.80, 95% CI 1.42-2.29 and AOR 1.34, 95% CI 1.01-1.77), hand hygiene (AOR 1.21, 95% CI 1.00-1.47 and AOR 1.52, 95% CI 1.19-1.93), and avoiding social gatherings (AOR 1.22, 95% CI 1.01-1.47 and AOR 1.55, 95% CI 1.23-1.95) and crowded places (AOR 1.24, 95% CI 1.02-1.51 and AOR 1.73, 95% CI 1.37-2.18) were also positively associated with both dependent variables. The number of COVID-19 preventive measures implemented by the factory was positively associated with the intention to receive a COVID-19 vaccination under both scenarios (AOR 1.08, 95% CI 1.04-1.12 and AOR 1.06, 95% CI 1.01-1.11). Conclusions: Factory workers in China reported a high behavioral intention to receive a COVID-19 vaccination. The theory of planned behavior is a useful framework to guide the development of future campaigns promoting COVID-19 vaccination. %M 33646966 %R 10.2196/24673 %U https://www.jmir.org/2021/3/e24673 %U https://doi.org/10.2196/24673 %U http://www.ncbi.nlm.nih.gov/pubmed/33646966 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e19473 %T Digital Health Solutions to Control the COVID-19 Pandemic in Countries With High Disease Prevalence: Literature Review %A R Niakan Kalhori,Sharareh %A Bahaadinbeigy,Kambiz %A Deldar,Kolsoum %A Gholamzadeh,Marsa %A Hajesmaeel-Gohari,Sadrieh %A Ayyoubzadeh,Seyed Mohammad %+ Department of Health Information Management, Tehran University of Medical Sciences, 3rd Floor, School of Allied Medical Sciences, No #17, Farredanesh Alley, Ghods St, Enghelab Ave, Tehran, Iran, 98 2188983025, s.m.ayyoubzadeh@gmail.com %K COVID-19 %K digital health %K information technology %K telemedicine %K electronic health %D 2021 %7 10.3.2021 %9 Review %J J Med Internet Res %G English %X Background: COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, has become a global pandemic, affecting most countries worldwide. Digital health information technologies can be applied in three aspects, namely digital patients, digital devices, and digital clinics, and could be useful in fighting the COVID-19 pandemic. Objective: Recent reviews have examined the role of digital health in controlling COVID-19 to identify the potential of digital health interventions to fight the disease. However, this study aims to review and analyze the digital technology that is being applied to control the COVID-19 pandemic in the 10 countries with the highest prevalence of the disease. Methods: For this review, the Google Scholar, PubMed, Web of Science, and Scopus databases were searched in August 2020 to retrieve publications from December 2019 to March 15, 2020. Furthermore, the Google search engine was used to identify additional applications of digital health for COVID-19 pandemic control. Results: We included 32 papers in this review that reported 37 digital health applications for COVID-19 control. The most common digital health projects to address COVID-19 were telemedicine visits (11/37, 30%). Digital learning packages for informing people about the disease, geographic information systems and quick response code applications for real-time case tracking, and cloud- or mobile-based systems for self-care and patient tracking were in the second rank of digital tool applications (all 7/37, 19%). The projects were deployed in various European countries and in the United States, Australia, and China. Conclusions: Considering the potential of available information technologies worldwide in the 21st century, particularly in developed countries, it appears that more digital health products with a higher level of intelligence capability remain to be applied for the management of pandemics and health-related crises. %M 33600344 %R 10.2196/19473 %U https://www.jmir.org/2021/3/e19473 %U https://doi.org/10.2196/19473 %U http://www.ncbi.nlm.nih.gov/pubmed/33600344 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23365 %T Evidence Synthesis of Digital Interventions to Mitigate the Negative Impact of the COVID-19 Pandemic on Public Mental Health: Rapid Meta-review %A Rauschenberg,Christian %A Schick,Anita %A Hirjak,Dusan %A Seidler,Andreas %A Paetzold,Isabell %A Apfelbacher,Christian %A Riedel-Heller,Steffi G %A Reininghaus,Ulrich %+ Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, Mannheim, 68159, Germany, 49 62117031929, christian.rauschenberg@zi-mannheim.de %K COVID-19 %K mHealth %K eHealth %K telemedicine %K prevention %K mental health promotion %K intervention %K digital mental health %K digital intervention %K public mental health %D 2021 %7 10.3.2021 %9 Review %J J Med Internet Res %G English %X Background: Accumulating evidence suggests the COVID-19 pandemic has negative effects on public mental health. Digital interventions that have been developed and evaluated in recent years may be used to mitigate the negative consequences of the pandemic. However, evidence-based recommendations on the use of existing telemedicine and internet-based (eHealth) and app-based mobile health (mHealth) interventions are lacking. Objective: The aim of this study was to investigate the theoretical and empirical base, user perspective, safety, effectiveness, and cost-effectiveness of digital interventions related to public mental health provision (ie, mental health promotion, prevention, and treatment of mental disorders) that may help to reduce the consequences of the COVID-19 pandemic. Methods: A rapid meta-review was conducted. The MEDLINE, PsycINFO, and CENTRAL databases were searched on May 11, 2020. Study inclusion criteria were broad and considered systematic reviews and meta-analyses that investigated digital tools for health promotion, prevention, or treatment of mental health conditions and determinants likely affected by the COVID-19 pandemic. Results: Overall, 815 peer-reviewed systematic reviews and meta-analyses were identified, of which 83 met the inclusion criteria. Our findings suggest that there is good evidence on the usability, safety, acceptance/satisfaction, and effectiveness of eHealth interventions. Evidence on mHealth apps is promising, especially if social components (eg, blended care) and strategies to promote adherence are incorporated. Although most digital interventions focus on the prevention or treatment of mental disorders, there is some evidence on mental health promotion. However, evidence on process quality, cost-effectiveness, and long-term effects is very limited. Conclusions: There is evidence that digital interventions are particularly suited to mitigating psychosocial consequences at the population level. In times of physical distancing, quarantine, and restrictions on social contacts, decision makers should develop digital strategies for continued mental health care and invest time and efforts in the development and implementation of mental health promotion and prevention programs. %M 33606657 %R 10.2196/23365 %U https://www.jmir.org/2021/3/e23365 %U https://doi.org/10.2196/23365 %U http://www.ncbi.nlm.nih.gov/pubmed/33606657 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23097 %T Factors Affecting Public Adoption of COVID-19 Prevention and Treatment Information During an Infodemic: Cross-sectional Survey Study %A Han,Yangyang %A Jiang,Binshan %A Guo,Rui %+ School of Public Health, Capital Medical University, No.10 Youanmenwai, Xitoutiao, Beijing, China, 86 01083911573, guorui@ccmu.edu.cn %K information adoption %K infodemic %K China %K health information %K infodemiology %K COVID-19 %K public health %D 2021 %7 11.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: With the spread of COVID-19, an infodemic is also emerging. In public health emergencies, the use of information to enable disease prevention and treatment is incredibly important. Although both the information adoption model (IAM) and health belief model (HBM) have their own merits, they only focus on information or public influence factors, respectively, to explain the public’s intention to adopt online prevention and treatment information. Objective: The aim of this study was to fill this gap by using a combination of the IAM and the HBM as the framework for exploring the influencing factors and paths in public health events that affect the public’s adoption of online health information and health behaviors, focusing on both objective and subjective factors. Methods: We carried out an online survey to collect responses from participants in China (N=501). Structural equation modeling was used to evaluate items, and confirmatory factor analysis was used to calculate construct reliability and validity. The goodness of fit of the model and mediation effects were analyzed. Results: The overall fitness indices for the model developed in this study indicated an acceptable fit. Adoption intention was predicted by information characteristics (β=.266, P<.001) and perceived usefulness (β=.565, P<.001), which jointly explained nearly 67% of the adoption intention variance. Information characteristics (β=.244, P<.001), perceived drawbacks (β=–.097, P=.002), perceived benefits (β=.512, P<.001), and self-efficacy (β=.141, P<.001) jointly determined perceived usefulness and explained about 81% of the variance of perceived usefulness. However, social influence did not have a statistically significant impact on perceived usefulness, and self-efficacy did not significantly influence adoption intention directly. Conclusions: By integrating IAM and HBM, this study provided the insight and understanding that perceived usefulness and adoption intention of online health information could be influenced by information characteristics, people’s perceptions of information drawbacks and benefits, and self-efficacy. Moreover, people also exhibited proactive behavior rather than reactive behavior to adopt information. Thus, we should consider these factors when helping the informed public obtain useful information via two approaches: one is to improve the quality of government-based and other official information, and the other is to improve the public’s capacity to obtain information, in order to promote truth and fight rumors. This will, in turn, contribute to saving lives as the pandemic continues to unfold and run its course. %M 33600348 %R 10.2196/23097 %U https://www.jmir.org/2021/3/e23097 %U https://doi.org/10.2196/23097 %U http://www.ncbi.nlm.nih.gov/pubmed/33600348 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24804 %T Antecedents of Individuals’ Concerns Regarding Hospital Hygiene and Surgery Postponement During the COVID-19 Pandemic: Cross-sectional, Web-Based Survey Study %A Ostermann,Thomas %A Gampe,Julia %A Röer,Jan Philipp %A Radtke,Theda %+ Department of Psychology and Psychotherapy, Witten/Herdecke University, Alfred-Herrhausen-Str 50, Witten, 58448, Germany, 49 2302926707, thomas.ostermann@uni-wh.de %K COVID-19 %K public health %K medical investigations %K surgery %K hospitalization, medical practices %D 2021 %7 11.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic poses a major challenge to people’s everyday lives. In the context of hospitalization, the pandemic is expected to have a strong influence on affective reactions and preventive behaviors. Research is needed to develop evidence-driven strategies for coping with the challenges of the pandemic. Therefore, this survey study investigates the effects that personality traits, risk-taking behaviors, and anxiety have on medical service–related affective reactions and anticipated behaviors during the COVID-19 pandemic. Objective: The aim of this study was to identify key factors that are associated with individuals’ concerns about hygiene in hospitals and the postponement of surgeries. Methods: We conducted a cross-sectional, web-based survey of 929 residents in Germany (women: 792/929, 85.3%; age: mean 35.2 years, SD 12.9 years). Hypotheses were tested by conducting a saturated path analysis. Results: We found that anxiety had a direct effect on people’s concerns about safety (β=−.12, 95% CI −.20 to −.05) and hygiene in hospitals (β=.16, 95% CI .08 to .23). Risk-taking behaviors and personality traits were not associated with concerns about safety and hygiene in hospitals or anticipated behaviors. Conclusions: Our findings suggest that distinct interventions and information campaigns are not necessary for individuals with different personality traits or different levels of risk-taking behavior. However, we recommend that health care workers should carefully address anxiety when interacting with patients. %M 33617458 %R 10.2196/24804 %U https://www.jmir.org/2021/3/e24804 %U https://doi.org/10.2196/24804 %U http://www.ncbi.nlm.nih.gov/pubmed/33617458 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24883 %T Examining Tweet Content and Engagement of Canadian Public Health Agencies and Decision Makers During COVID-19: Mixed Methods Analysis %A Slavik,Catherine E %A Buttle,Charlotte %A Sturrock,Shelby L %A Darlington,J Connor %A Yiannakoulias,Niko %+ School of Earth, Environment and Society, McMaster University, General Science Building, 1280 Main Street West, Room 204, Hamilton, ON, L8S 4K1, Canada, 1 905 525 9140 ext 20118, yiannan@mcmaster.ca %K COVID-19 %K coronavirus %K pandemic %K public health %K Twitter %K social media %K engagement %K risk communication %K infodemiology %K content analysis %D 2021 %7 11.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective communication during a health crisis can ease public concerns and promote the adoption of important risk-mitigating behaviors. Public health agencies and leaders have served as the primary communicators of information related to COVID-19, and a key part of their public outreach has taken place on social media platforms. Objective: This study examined the content and engagement of COVID-19 tweets authored by Canadian public health agencies and decision makers. We propose ways for public health accounts to adjust their tweeting practices during public health crises to improve risk communication and maximize engagement. Methods: We retrieved data from tweets by Canadian public health agencies and decision makers from January 1, 2020, to June 30, 2020. The Twitter accounts were categorized as belonging to either a public health agency, regional or local health department, provincial health authority, medical health officer, or minister of health. We analyzed trends in COVID-19 tweet engagement and conducted a content analysis on a stratified random sample of 485 tweets to examine the message functions and risk communication strategies used by each account type. Results: We analyzed 32,737 tweets authored by 118 Canadian public health Twitter accounts, of which 6982 tweets were related to COVID-19. Medical health officers authored the largest percentage of COVID-19–related tweets (n=1337, 35%) relative to their total number of tweets and averaged the highest number of retweets per COVID-19 tweet (112 retweets per tweet). Public health agencies had the highest frequency of daily tweets about COVID-19 throughout the study period. Compared to tweets containing media and user mentions, hashtags and URLs were used in tweets more frequently by all account types, appearing in 69% (n=4798 tweets) and 68% (n=4781 tweets) of COVID-19–related tweets, respectively. Tweets containing hashtags also received the highest average retweets (47 retweets per tweet). Our content analysis revealed that of the three tweet message functions analyzed (information, action, community), tweets providing information were the most commonly used across most account types, constituting 39% (n=181) of all tweets; however, tweets promoting actions from users received higher than average retweets (55 retweets per tweet). When examining tweets that received one or more retweet (n=359), the difference between mean retweets across the message functions was statistically significant (P<.001). The risk communication strategies that we examined were not widely used by any account type, appearing in only 262 out of 485 tweets. However, when these strategies were used, these tweets received more retweets compared to tweets that did not use any risk communication strategies (P<.001) (61 retweets versus 13 retweets on average). Conclusions: Public health agencies and decision makers should examine what messaging best meets the needs of their Twitter audiences to maximize sharing of their communications. Public health accounts that do not currently employ risk communication strategies in their tweets may be missing an important opportunity to engage with users about the mitigation of health risks related to COVID-19. %M 33651705 %R 10.2196/24883 %U https://www.jmir.org/2021/3/e24883 %U https://doi.org/10.2196/24883 %U http://www.ncbi.nlm.nih.gov/pubmed/33651705 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26718 %T Clinical Trial Data Sharing for COVID-19–Related Research %A Dron,Louis %A Dillman,Alison %A Zoratti,Michael J %A Haggstrom,Jonas %A Mills,Edward J %A Park,Jay J H %+ Department of Experimental Medicine, University of British Columbia, 802-777 West Broadway, Vancouver, BC, V5Z 1J5, Canada, 1 (604) 294 3823, jayhpark1@alumni.ubc.ca %K COVID-19 %K data-sharing %K clinical trials %K data %K research %K privacy %K security %K registry %K feasibility %K challenge %K recruitment %K error %K bias %K assessment %K interoperability %K dataset %K intervention %K cooperation %D 2021 %7 12.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X This paper aims to provide a perspective on data sharing practices in the context of the COVID-19 pandemic. The scientific community has made several important inroads in the fight against COVID-19, and there are over 2500 clinical trials registered globally. Within the context of the rapidly changing pandemic, we are seeing a large number of trials conducted without results being made available. It is likely that a plethora of trials have stopped early, not for statistical reasons but due to lack of feasibility. Trials stopped early for feasibility are, by definition, statistically underpowered and thereby prone to inconclusive findings. Statistical power is not necessarily linear with the total sample size, and even small reductions in patient numbers or events can have a substantial impact on the research outcomes. Given the profusion of clinical trials investigating identical or similar treatments across different geographical and clinical contexts, one must also consider that the likelihood of a substantial number of false-positive and false-negative trials, emerging with the increasing overall number of trials, adds to public perceptions of uncertainty. This issue is complicated further by the evolving nature of the pandemic, wherein baseline assumptions on control group risk factors used to develop sample size calculations are far more challenging than those in the case of well-documented diseases. The standard answer to these challenges during nonpandemic settings is to assess each trial for statistical power and risk-of-bias and then pool the reported aggregated results using meta-analytic approaches. This solution simply will not suffice for COVID-19. Even with random-effects meta-analysis models, it will be difficult to adjust for the heterogeneity of different trials with aggregated reported data alone, especially given the absence of common data standards and outcome measures. To date, several groups have proposed structures and partnerships for data sharing. As COVID-19 has forced reconsideration of policies, processes, and interests, this is the time to advance scientific cooperation and shift the clinical research enterprise toward a data-sharing culture to maximize our response in the service of public health. %M 33684053 %R 10.2196/26718 %U https://www.jmir.org/2021/3/e26718 %U https://doi.org/10.2196/26718 %U http://www.ncbi.nlm.nih.gov/pubmed/33684053 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26182 %T A Self-Assessment Web-Based App to Assess Trends of the COVID-19 Pandemic in France: Observational Study %A Denis,Fabrice %A Fontanet,Arnaud %A Le Douarin,Yann-Mael %A Le Goff,Florian %A Jeanneau,Stephan %A Lescure,François-Xavier %+ Institut Inter-régional de Cancérologie Jean Bernard, 9 rue Beauverger, Le Mans, 72000, France, 33 684190480, f.denis@cjb72.org %K app %K big data %K COVID-19 %K diagnosis %K diagnostic test %K digital health %K France %K mobile phone %K observational %K participatory app %K self-assessment %K surveillance %K trend %K web-based app %D 2021 %7 12.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: We developed a self-assessment and participatory web-based triage app to assess the trends of the COVID-19 pandemic in France in March 2020. Objective: We compared daily large-scale RT–PCR test results to monitor recent reports of anosmia through a web-based app to assess the dynamics of emergency department visits, hospitalizations, and intensive care unit (ICU) admissions among individuals with COVID-19 in France. Methods: Between March 21 and November 18, 2020, users of the maladiecoronavirus.fr self-triage app were asked questions about COVID-19 symptoms. Data on daily hospitalizations, large-scale positive results on RT–PCR tests, emergency department visits, and ICU admission of individuals with COVID-19 were compared to data on daily reports of anosmia on the app. Results: As of November 18, 2020, recent anosmia was reported 575,214 times from among approximately 13,000,000 responses. Daily anosmia reports during peak engagement with the app on September 16, 2020, were spatially correlated with the peak in daily COVID-19–related hospitalizations in November 2020 (Spearman rank correlation coefficient [ρ]=0.77; P<.001). This peak in daily anosmia reports was observed primarily among young adults (age range 18-40 years), being observed 49 days before the peak of hospitalizations that corresponded to the first wave of infections among the young population, followed by a peak in hospitalizations among older individuals (aged ≥50 years) in November 2020. The reduction in the daily reports of anosmia associated with the peaks in the number of cases preceded the reduction in daily hospitalizations by 10 and 9 days during the first and the second waves of infection, respectively, although the reduction in the positivity rates on RT–PCR tests preceded the reduction in daily hospitalizations by only 2 days during the second wave of infections. Conclusions: Data on daily reports of anosmia collected through a nationwide, web-based self-assessment app can be a relevant tool to anticipate surges in outbreaks, hospitalizations, and ICU admission during the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04331171; https://clinicaltrials.gov/ct2/show/NCT04331171 %M 33709945 %R 10.2196/26182 %U https://www.jmir.org/2021/3/e26182 %U https://doi.org/10.2196/26182 %U http://www.ncbi.nlm.nih.gov/pubmed/33709945 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e21892 %T Effectiveness of Interactive Tools in Online Health Care Communities: Social Exchange Theory Perspective %A Ren,Dixuan %A Ma,Baolong %+ School of Management and Economics, Beijing Institute of Technology, Number 5, Zhongguancun Road, Haidian District, Beijing, China, 86 1068915602, dmmibb@163.com %K efforts %K income %K privacy disease %K platform %K social exchange %D 2021 %7 12.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Although the COVID-19 pandemic will have a negative effect on China’s economy in the short term, it also represents a major opportunity for internet-based medical treatment in the medium and long term. Compared with normal times, internet-based medical platforms including the Haodf website were visited by 1.11 billion people, the number of new registered users of all platforms increased by 10, and the number of new users’ daily consultations increased by 9 during the pandemic. The continuous participation of physicians is a major factor in the success of the platform, and economic return is an important reason for physicians to provide internet-based services. However, no study has provided the effectiveness of interactive tools in online health care communities to influence physicians’ returns. Objective: The effect of internet-based effort on the benefits and effectiveness of interactive effort tools in internet-based health care areas remains unclear. Thus, the goals of this study are to examine the effect of doctors’ internet-based service quality on their economic returns during COVID-19 social restrictions, to examine the effect of mutual help groups on doctors’ economic returns during COVID-19 social restrictions, and to explore the moderating effect of disease privacy on doctors’ efforts and economic returns during COVID-19 social restrictions. Methods: On the basis of the social exchange theory, this study establishes an internet-based effort exchange model for doctors. We used a crawler to download information automatically from Haodf website. From March 5 to 7, 2020, which occurred during the COVID-19 pandemic in China, cross-sectional information of 2530 doctors were collected. Results: Hierarchical linear regression showed that disease privacy (β=.481; P<.001), reputation (β=.584; P<.001), and service quality (β=.560; P<.001) had a significant positive effect on the economic returns of the physicians. The influence of mutual help groups on earnings increases with an increase in the degree of disease privacy (β=.189; P<.001), indicating that mutual help groups have a stronger effect on earnings when patients ask questions about diseases regarding which they desire privacy. Conclusions: For platform operators, the results of this study can help the platform understand how to improve doctors’ economic returns, especially regarding helping a specific doctor group improve its income to retain good doctors. For physicians on the platform, this study will help doctors spend their limited energy and time on tools that can improve internet-based consultation incomes. Patients who receive internet-based health care services extract information about a doctor based on the doctor’s internet-based efforts to understand the doctor’s level of professionalism and personality to choose the doctor they like the most. The data used in this study may be biased or not representative of all medical platforms, as they were collected from a single website. %M 33709940 %R 10.2196/21892 %U https://www.jmir.org/2021/3/e21892 %U https://doi.org/10.2196/21892 %U http://www.ncbi.nlm.nih.gov/pubmed/33709940 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e22453 %T Artificial Intelligence–Aided Precision Medicine for COVID-19: Strategic Areas of Research and Development %A Santus,Enrico %A Marino,Nicola %A Cirillo,Davide %A Chersoni,Emmanuele %A Montagud,Arnau %A Santuccione Chadha,Antonella %A Valencia,Alfonso %A Hughes,Kevin %A Lindvall,Charlotta %+ Barcelona Supercomputing Center, c/Jordi Girona, 29, Barcelona, Spain, 34 934137971, davide.cirillo@bsc.es %K COVID-19 %K SARS-CoV-2 %K artificial intelligence %K personalized medicine %K precision medicine %K prevention %K monitoring %K epidemic %K literature %K public health %K pandemic %D 2021 %7 12.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X Artificial intelligence (AI) technologies can play a key role in preventing, detecting, and monitoring epidemics. In this paper, we provide an overview of the recently published literature on the COVID-19 pandemic in four strategic areas: (1) triage, diagnosis, and risk prediction; (2) drug repurposing and development; (3) pharmacogenomics and vaccines; and (4) mining of the medical literature. We highlight how AI-powered health care can enable public health systems to efficiently handle future outbreaks and improve patient outcomes. %M 33560998 %R 10.2196/22453 %U https://www.jmir.org/2021/3/e22453 %U https://doi.org/10.2196/22453 %U http://www.ncbi.nlm.nih.gov/pubmed/33560998 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23272 %T COVID-19 Discourse on Twitter in Four Asian Countries: Case Study of Risk Communication %A Park,Sungkyu %A Han,Sungwon %A Kim,Jeongwook %A Molaie,Mir Majid %A Vu,Hoang Dieu %A Singh,Karandeep %A Han,Jiyoung %A Lee,Wonjae %A Cha,Meeyoung %+ Data Science Group, Institute for Basic Science, 55, Expo-ro, Yuseong-gu, Daejeon, 34126, Republic of Korea, 82 428788114, meeyoung.cha@gmail.com %K COVID-19 %K coronavirus %K infodemic %K infodemiology %K infoveillance %K Twitter %K topic phase detection %K topic modeling %K latent Dirichlet allocation %K risk communication %D 2021 %7 16.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19, caused by SARS-CoV-2, has led to a global pandemic. The World Health Organization has also declared an infodemic (ie, a plethora of information regarding COVID-19 containing both false and accurate information circulated on the internet). Hence, it has become critical to test the veracity of information shared online and analyze the evolution of discussed topics among citizens related to the pandemic. Objective: This research analyzes the public discourse on COVID-19. It characterizes risk communication patterns in four Asian countries with outbreaks at varying degrees of severity: South Korea, Iran, Vietnam, and India. Methods: We collected tweets on COVID-19 from four Asian countries in the early phase of the disease outbreak from January to March 2020. The data set was collected by relevant keywords in each language, as suggested by locals. We present a method to automatically extract a time–topic cohesive relationship in an unsupervised fashion based on natural language processing. The extracted topics were evaluated qualitatively based on their semantic meanings. Results: This research found that each government’s official phases of the epidemic were not well aligned with the degree of public attention represented by the daily tweet counts. Inspired by the issue-attention cycle theory, the presented natural language processing model can identify meaningful transition phases in the discussed topics among citizens. The analysis revealed an inverse relationship between the tweet count and topic diversity. Conclusions: This paper compares similarities and differences of pandemic-related social media discourse in Asian countries. We observed multiple prominent peaks in the daily tweet counts across all countries, indicating multiple issue-attention cycles. Our analysis identified which topics the public concentrated on; some of these topics were related to misinformation and hate speech. These findings and the ability to quickly identify key topics can empower global efforts to fight against an infodemic during a pandemic. %M 33684054 %R 10.2196/23272 %U https://www.jmir.org/2021/3/e23272 %U https://doi.org/10.2196/23272 %U http://www.ncbi.nlm.nih.gov/pubmed/33684054 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e27015 %T Social Media and Emotional Burnout Regulation During the COVID-19 Pandemic: Multilevel Approach %A Shao,Ruosi %A Shi,Zhen %A Zhang,Di %+ The Research Center for Journalism and Social Development, Renmin University of China, RM713 Mingde Journalism Building, 59 Zhongguancun Rd, Haidian Dist, Beijing, 100872, China, 86 13801247280, zhangdi204@gmail.com %K COVID-19 %K pandemic %K emotion regulation %K emotional exhaustion %K multilevel approach %K well-being %K emotion %K mental health %K social media %K perspective %K strategy %K effective %K modeling %K buffer %D 2021 %7 16.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In February 2020, the Chinese government imposed a complete lockdown of Wuhan and other cities in Hubei Province to contain a spike of COVID-19 cases. Although such measures are effective in preventing the spread of the virus, medical professionals strongly voiced a caveat concerning the pandemic emotional burnout at the individual level. Although the lockdown limited individuals’ interpersonal communication with people in their social networks, it is common that individuals turn to social media to seek and share health information, exchange social support, and express pandemic-generated feelings. Objective: Based on a holistic and multilevel perspective, this study examines how pandemic-related emotional exhaustion enacts intrapersonal, interpersonal, and hyperpersonal emotional regulation strategies, and then evaluates the effectiveness of these strategies, with a particular interest in understanding the role of hyperpersonal-level regulation or social media–based regulation. Methods: Using an online panel, this study sampled 538 Chinese internet users from Hubei Province, the epicenter of the COVID-19 outbreak in China. Survey data collection lasted for 12 days from February 7-18, 2020, two weeks after Hubei Province was placed under quarantine. The sample had an average age of 35 (SD 10.65, range 18-78) years, and a majority were married (n=369, 68.6%). Results: Using structural equation modeling, this study found that intrapersonal-level (B=0.22; β=.24; P<.001) and interpersonal-level (B=0.35; β=.49; P<.001) emotional regulation strategies were positively associated with individuals’ outcome reappraisal. In contrast with intrapersonal and interpersonal regulations, hyperpersonal (social media–based) regulation strategies, such as disclosing and retweeting negative emotions, were negatively related to the outcome reappraisal (B=–1.00; β=–.80; P<.001). Conclusions: Consistent with previous literature, intrapersonal-level regulation (eg, cognitive reappraisal, mindfulness, and self-kindness) and interpersonal-level supportive interaction may generate a buffering effect on emotional exhaustion and promote individuals’ reappraisal toward the stressful situation. However, hyperpersonal-level regulation may exacerbate the experienced negative emotions and impede reappraisal of the pandemic situation. It is speculated that retweeting content that contains pandemic-related stress and anxiety may cause a digital emotion contagion. Individuals who share other people’s negative emotional expressions on social media are likely to be affected by the negative affect contagion. More importantly, the possible benefits of intrapersonal and interpersonal emotion regulations may be counteracted by social media or hyperpersonal regulation. This suggests the necessity to conduct social media–based health communication interventions to mitigate the social media–wide negative affect contagion if lockdown policies related to highly infectious diseases are initiated. %M 33661753 %R 10.2196/27015 %U https://www.jmir.org/2021/3/e27015 %U https://doi.org/10.2196/27015 %U http://www.ncbi.nlm.nih.gov/pubmed/33661753 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23218 %T Improving Predictions of COVID-19 Preventive Behavior: Development of a Sequential Mediation Model %A Roberts,James A %A David,Meredith E %+ Marketing Department, Hankamer School of Business, Baylor University, 1 Bear Pl Unit 98007, Waco, TX, 76798-8007, United States, 1 2547104952, jim_roberts@baylor.edu %K pandemic %K COVID-19 %K preventive behavior %K self-efficacy %K prevention %K behavior %K modeling %K student %K communication %D 2021 %7 17.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the beginning of the COVID-19 pandemic, social distancing, self-quarantining, wearing masks, and washing hands have become part of the new norm for many, but not all. It appears that such preventive measures are critical to “flattening the curve” of the spread of COVID-19. The public’s adoption of such behaviors is an essential component in the battle against what has been referred to as the “invisible enemy.” Objective: The primary objective of this study was to develop a model for predicting COVID-19 preventive behaviors among US college students. The Health Belief Model has a long history of use and empirical support in predicting preventive health behaviors, but it is not without its purported shortcomings. This study identifies a more optimal and defensible combination of variables to explain preventive behaviors among college students. This segment of the US population is critical in helping slow the spread of COVID-19 because of the relative reluctance of college students to perform the needed behaviors given they do not feel susceptible to or fearful of COVID-19. Methods: For this study, 415 US college students were surveyed via Qualtrics and asked to answer questions regarding their fear of COVID-19, information receptivity (seeking relevant information), perceived knowledge of the disease, self-efficacy, and performance of preventive behaviors. The PROCESS macro (Model 6) was used to test our conceptual model, including predictions involving sequential mediation. Results: Sequential mediation results show that fear of COVID-19 leads individuals to seek out information regarding the disease, which increases their perceived knowledge and fosters self-efficacy; this is key to driving preventive behaviors. Conclusions: Self-imposed preventive measures can drastically impact the rate of infection among populations. Based on this study’s newly created sequential mediation model, communication strategies for encouraging COVID-19 preventive behaviors are offered. It is clear that college students, and very possibly adults of all ages, must have a healthy fear of COVID-19 to set in motion a process where concerned individuals seek out COVID-19–related information, increasing their store of knowledge concerning the disease, their self-efficacy, and ultimately their likelihood of performing the needed preventive behaviors. %M 33651707 %R 10.2196/23218 %U https://www.jmir.org/2021/3/e23218 %U https://doi.org/10.2196/23218 %U http://www.ncbi.nlm.nih.gov/pubmed/33651707 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e27078 %T Temporal Dynamics of Public Emotions During the COVID-19 Pandemic at the Epicenter of the Outbreak: Sentiment Analysis of Weibo Posts From Wuhan %A Yu,Shaobin %A Eisenman,David %A Han,Ziqiang %+ Department of Public Administration, School of Political Science and Public Administration, Shandong University, Binhai Road 72, Jimo, Qingdao, 266237, China, 86 13210178710, ziqiang.han@sdu.edu.cn %K public health emergencies %K emotion %K infodemiology %K temporal dynamics %K sentiment analysis %K COVID-19 %D 2021 %7 18.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The ongoing COVID-19 pandemic has led to an increase in anxiety, depression, posttraumatic stress disorder, and psychological stress experienced by the general public in various degrees worldwide. However, effective, tailored mental health services and interventions cannot be achieved until we understand the patterns of mental health issues emerging after a public health crisis, especially in the context of the rapid transmission of COVID-19. Understanding the public's emotions and needs and their distribution attributes are therefore critical for creating appropriate public policies and eventually responding to the health crisis effectively, efficiently, and equitably. Objective: This study aims to detect the temporal patterns in emotional fluctuation, significant events during the COVID-19 pandemic that affected emotional changes and variations, and hourly variations of emotions within a single day by analyzing data from the Chinese social media platform Weibo. Methods: Based on a longitudinal dataset of 816,556 posts published by 27,912 Weibo users in Wuhan, China, from December 31, 2019, to April 31, 2020, we processed general sentiment inclination rating and the type of sentiments of Weibo posts by using pandas and SnowNLP Python libraries. We also grouped the publication times into 5 time groups to measure changes in netizens’ sentiments during different periods in a single day. Results: Overall, negative emotions such as surprise, fear, and anger were the most salient emotions detected on Weibo. These emotions were triggered by certain milestone events such as the confirmation of human-to-human transmission of COVID-19. Emotions varied within a day. Although all emotions were more prevalent in the afternoon and night, fear and anger were more dominant in the morning and afternoon, whereas depression was more salient during the night. Conclusions: Various milestone events during the COVID-19 pandemic were the primary events that ignited netizens’ emotions. In addition, Weibo users’ emotions varied within a day. Our findings provide insights into providing better-tailored mental health services and interventions. %M 33661755 %R 10.2196/27078 %U https://www.jmir.org/2021/3/e27078 %U https://doi.org/10.2196/27078 %U http://www.ncbi.nlm.nih.gov/pubmed/33661755 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e22860 %T Revealing Opinions for COVID-19 Questions Using a Context Retriever, Opinion Aggregator, and Question-Answering Model: Model Development Study %A Lu,Zhao-Hua %A Wang,Jade Xiaoqing %A Li,Xintong %+ Department of Biostatistics, St. Jude Children’s Research Hospital, MS 768, Room R6006, 262 Danny Thomas Place, Memphis, TN, 38105-3678, United States, 1 901 595 2714, zhaohua.lu@stjude.org %K natural language processing %K question-answering systems %K language summarization %K machine learning %K life and medical sciences %K COVID-19 %K public health %K coronavirus literature %D 2021 %7 19.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has challenged global public health because it is highly contagious and can be lethal. Numerous ongoing and recently published studies about the disease have emerged. However, the research regarding COVID-19 is largely ongoing and inconclusive. Objective: A potential way to accelerate COVID-19 research is to use existing information gleaned from research into other viruses that belong to the coronavirus family. Our objective is to develop a natural language processing method for answering factoid questions related to COVID-19 using published articles as knowledge sources. Methods: Given a question, first, a BM25-based context retriever model is implemented to select the most relevant passages from previously published articles. Second, for each selected context passage, an answer is obtained using a pretrained bidirectional encoder representations from transformers (BERT) question-answering model. Third, an opinion aggregator, which is a combination of a biterm topic model and k-means clustering, is applied to the task of aggregating all answers into several opinions. Results: We applied the proposed pipeline to extract answers, opinions, and the most frequent words related to six questions from the COVID-19 Open Research Dataset Challenge. By showing the longitudinal distributions of the opinions, we uncovered the trends of opinions and popular words in the articles published in the five time periods assessed: before 1990, 1990-1999, 2000-2009, 2010-2018, and since 2019. The changes in opinions and popular words agree with several distinct characteristics and challenges of COVID-19, including a higher risk for senior people and people with pre-existing medical conditions; high contagion and rapid transmission; and a more urgent need for screening and testing. The opinions and popular words also provide additional insights for the COVID-19–related questions. Conclusions: Compared with other methods of literature retrieval and answer generation, opinion aggregation using our method leads to more interpretable, robust, and comprehensive question-specific literature reviews. The results demonstrate the usefulness of the proposed method in answering COVID-19–related questions with main opinions and capturing the trends of research about COVID-19 and other relevant strains of coronavirus in recent years. %M 33739287 %R 10.2196/22860 %U https://www.jmir.org/2021/3/e22860 %U https://doi.org/10.2196/22860 %U http://www.ncbi.nlm.nih.gov/pubmed/33739287 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24593 %T Insights From the SmokeFree.gov Initiative Regarding the Use of Smoking Cessation Digital Platforms During the COVID-19 Pandemic: Cross-sectional Trends Analysis Study %A El-Toukhy,Sherine %+ Division of Intramural Research, National Institute on Minority Health & Health Disparities, National Institutes of Health, 7201 Wisconsin Ave, Bethesda, MD, 20814, United States, 1 3015944743, sherine.el-toukhy@nih.gov %K COVID-19 %K smoking %K cessation %K mHealth %K risk %K digital platform %K social distancing %K lockdown %K trend %D 2021 %7 22.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Smoking is a plausible risk factor for COVID-19 progression and complications. Smoking cessation digital platforms transcend pandemic-driven social distancing and lockdown measures in terms of assisting smokers in their quit attempts. Objective: This study aims to examine trends in the number of visitors, followers, and subscribers on smoking cessation digital platforms from January to April 2020 and to compare these traffic data to those observed during the same 4-month period in 2019. The examination of prepandemic and postpandemic trends in smoking cessation digital platform traffic can reveal whether interest in smoking cessation among smokers is attributable to the COVID-19 pandemic. Methods: We obtained cross-sectional data from daily visitors on the SmokeFree website; the followers of six SmokeFree social media accounts; and subscribers to the SmokeFree SMS text messaging and mobile app interventions of the National Cancer Institute’s SmokeFree.gov initiative platforms, which are publicly available to US smokers. Average daily percentage changes (ADPCs) were used to measure trends for the entire 2020 and 2019 study periods, whereas daily percentage changes (DPCs) were used to measure trends for each time segment of change within each 4-month period. Data analysis was conducted in May and June 2020. Results: The number of new daily visitors on the SmokeFree website (between days 39 and 44: DPC=18.79%; 95% CI 5.16% to 34.19%) and subscribers to the adult-focused interventions QuitGuide (between days 11 and 62: DPC=1.11%; 95% CI 0.80% to 1.43%) and SmokeFreeTXT (between days 11 and 89: DPC=0.23%; 95% CI 0.004% to 0.47%) increased, but this was followed by declines in traffic. No comparable peaks were observed in 2019. The number of new daily subscribers to quitSTART (ie, the teen-focused intervention) trended downward in 2020 (ADPC=−1.02%; 95% CI −1.88% to −0.15%), whereas the overall trend in the number of subscribers in 2019 was insignificant (P=.07). The number of SmokeFree social media account followers steadily increased by <0.1% over the 4-month study periods in 2019 and 2020. Conclusions: Peaks in traffic on the SmokeFree website and adult-focused intervention platforms in 2020 could be attributed to an increased interest in smoking cessation among smokers during the COVID-19 pandemic. Coordinated campaigns, especially those for adolescents, should emphasize the importance of smoking cessation as a preventive measure against SARS-CoV-2 infection and raise awareness of digital smoking cessation platforms to capitalize on smokers’ heightened interest during the pandemic. %M 33646963 %R 10.2196/24593 %U https://www.jmir.org/2021/3/e24593 %U https://doi.org/10.2196/24593 %U http://www.ncbi.nlm.nih.gov/pubmed/33646963 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24925 %T Short-Range Forecasting of COVID-19 During Early Onset at County, Health District, and State Geographic Levels Using Seven Methods: Comparative Forecasting Study %A Lynch,Christopher J %A Gore,Ross %+ Virginia Modeling, Analysis, and Simulation Center, Old Dominion University, 1030 University Blvd, Suffolk, VA, 23435, United States, 1 7576866248, cjlynch@odu.edu %K coronavirus disease 2019 %K COVID-19 %K infectious disease %K emerging outbreak %K forecasting %K modeling and simulation %K public health %K modeling disease outbreaks %D 2021 %7 23.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Forecasting methods rely on trends and averages of prior observations to forecast COVID-19 case counts. COVID-19 forecasts have received much media attention, and numerous platforms have been created to inform the public. However, forecasting effectiveness varies by geographic scope and is affected by changing assumptions in behaviors and preventative measures in response to the pandemic. Due to time requirements for developing a COVID-19 vaccine, evidence is needed to inform short-term forecasting method selection at county, health district, and state levels. Objective: COVID-19 forecasts keep the public informed and contribute to public policy. As such, proper understanding of forecasting purposes and outcomes is needed to advance knowledge of health statistics for policy makers and the public. Using publicly available real-time data provided online, we aimed to evaluate the performance of seven forecasting methods utilized to forecast cumulative COVID-19 case counts. Forecasts were evaluated based on how well they forecast 1, 3, and 7 days forward when utilizing 1-, 3-, 7-, or all prior–day cumulative case counts during early virus onset. This study provides an objective evaluation of the forecasting methods to identify forecasting model assumptions that contribute to lower error in forecasting COVID-19 cumulative case growth. This information benefits professionals, decision makers, and the public relying on the data provided by short-term case count estimates at varied geographic levels. Methods: We created 1-, 3-, and 7-day forecasts at the county, health district, and state levels using (1) a naïve approach, (2) Holt-Winters (HW) exponential smoothing, (3) a growth rate approach, (4) a moving average (MA) approach, (5) an autoregressive (AR) approach, (6) an autoregressive moving average (ARMA) approach, and (7) an autoregressive integrated moving average (ARIMA) approach. Forecasts relied on Virginia’s 3464 historical county-level cumulative case counts from March 7 to April 22, 2020, as reported by The New York Times. Statistically significant results were identified using 95% CIs of median absolute error (MdAE) and median absolute percentage error (MdAPE) metrics of the resulting 216,698 forecasts. Results: The next-day MA forecast with 3-day look-back length obtained the lowest MdAE (median 0.67, 95% CI 0.49-0.84, P<.001) and statistically significantly differed from 39 out of 59 alternatives (66%) to 53 out of 59 alternatives (90%) at each geographic level at a significance level of .01. For short-range forecasting, methods assuming stationary means of prior days’ counts outperformed methods with assumptions of weak stationarity or nonstationarity means. MdAPE results revealed statistically significant differences across geographic levels. Conclusions: For short-range COVID-19 cumulative case count forecasting at the county, health district, and state levels during early onset, the following were found: (1) the MA method was effective for forecasting 1-, 3-, and 7-day cumulative case counts; (2) exponential growth was not the best representation of case growth during early virus onset when the public was aware of the virus; and (3) geographic resolution was a factor in the selection of forecasting methods. %M 33621186 %R 10.2196/24925 %U https://www.jmir.org/2021/3/e24925 %U https://doi.org/10.2196/24925 %U http://www.ncbi.nlm.nih.gov/pubmed/33621186 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e27009 %T Echo Chamber Effect in Rumor Rebuttal Discussions About COVID-19 in China: Social Media Content and Network Analysis Study %A Wang,Dandan %A Qian,Yuxing %+ School of Information Management, Wuhan University, No.483, Bayi Road, Hongshan District, Wuhan, 430072, China, 86 13871241431, dandanw@whu.edu.cn %K rumor rebuttal %K infodemiology %K infodemic %K infoveillance %K echo chamber effect %K attitude %K COVID-19 %K Weibo %D 2021 %7 25.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The dissemination of rumor rebuttal content on social media is vital for rumor control and disease containment during public health crises. Previous research on the effectiveness of rumor rebuttal, to a certain extent, ignored or simplified the structure of dissemination networks and users’ cognition as well as decision-making and interaction behaviors. Objective: This study aimed to roughly evaluate the effectiveness of rumor rebuttal; dig deeply into the attitude-based echo chamber effect on users’ responses to rumor rebuttal under multiple topics on Weibo, a Chinese social media platform, in the early stage of the COVID-19 epidemic; and evaluate the echo chamber’s impact on the information characteristics of user interaction content. Methods: We used Sina Weibo’s application programming interface to crawl rumor rebuttal content related to COVID-19 from 10 AM on January 23, 2020, to midnight on April 8, 2020. Using content analysis, sentiment analysis, social network analysis, and statistical analysis, we first analyzed whether and to what extent there was an echo chamber effect on the shaping of individuals’ attitudes when retweeting or commenting on others’ tweets. Then, we tested the heterogeneity of attitude distribution within communities and the homophily of interactions between communities. Based on the results at user and community levels, we made comprehensive judgments. Finally, we examined users’ interaction content from three dimensions—sentiment expression, information seeking and sharing, and civility—to test the impact of the echo chamber effect. Results: Our results indicated that the retweeting mechanism played an essential role in promoting polarization, and the commenting mechanism played a role in consensus building. Our results showed that there might not be a significant echo chamber effect on community interactions and verified that, compared to like-minded interactions, cross-cutting interactions contained significantly more negative sentiment, information seeking and sharing, and incivility. We found that online users’ information-seeking behavior was accompanied by incivility, and information-sharing behavior was accompanied by more negative sentiment, which was often accompanied by incivility. Conclusions: Our findings revealed the existence and degree of an echo chamber effect from multiple dimensions, such as topic, interaction mechanism, and interaction level, and its impact on interaction content. Based on these findings, we provide several suggestions for preventing or alleviating group polarization to achieve better rumor rebuttal. %M 33690145 %R 10.2196/27009 %U https://www.jmir.org/2021/3/e27009 %U https://doi.org/10.2196/27009 %U http://www.ncbi.nlm.nih.gov/pubmed/33690145 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e27443 %T Impact of a Serious Game (Escape COVID-19) on the Intention to Change COVID-19 Control Practices Among Employees of Long-term Care Facilities: Web-Based Randomized Controlled Trial %A Suppan,Mélanie %A Abbas,Mohamed %A Catho,Gaud %A Stuby,Loric %A Regard,Simon %A Achab,Sophia %A Harbarth,Stephan %A Suppan,Laurent %+ Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, Geneva, 1211, Switzerland, 41 223723311, melanie.suppan@hcuge.ch %K COVID-19 %K transmission %K serious game %K infection prevention %K health care worker %K SARS-CoV-2 %K nursing homes %K randomized controlled trial %K long-term care facilities %K impact %K game %K intention %K control %K elderly %D 2021 %7 25.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Most residents of long-term care facilities (LTCFs) are at high risk of complications and death following SARS-CoV-2 infection. In these facilities, viral transmission can be facilitated by shortages of human and material resources, which can lead to suboptimal application of infection prevention and control (IPC) procedures. To improve the dissemination of COVID-19 IPC guidelines, we developed a serious game called “Escape COVID-19” using Nicholson’s RECIPE for meaningful gamification, as engaging serious games have the potential to induce behavioral change. Objective: As the probability of executing an action is strongly linked to the intention of performing it, the objective of this study was to determine whether LTCF employees were willing to change their IPC practices after playing “Escape COVID-19.” Methods: This was a web-based, triple-blind, randomized controlled trial, which took place between November 5 and December 4, 2020. The health authorities of Geneva, Switzerland, asked the managers of all LTCFs under their jurisdiction to forward information regarding the study to all their employees, regardless of professional status. Participants were unaware that they would be randomly allocated to one of two different study paths upon registration. In the control group, participants filled in a first questionnaire designed to gather demographic data and assess baseline knowledge before accessing regular online IPC guidelines. They then answered a second questionnaire, which assessed their willingness to change their IPC practices and identified the reasons underlying their decision. They were then granted access to the serious game. Conversely, the serious game group played “Escape COVID-19” after answering the first questionnaire but before answering the second one. This group accessed the control material after answering the second set of questions. There was no time limit. The primary outcome was the proportion of LTCF employees willing to change their IPC practices. Secondary outcomes included the factors underlying participants’ decisions, the domains these changes would affect, changes in the use of protective equipment items, and attrition at each stage of the study. Results: A total of 295 answer sets were analyzed. Willingness to change behavior was higher in the serious game group (82% [119/145] versus 56% [84/150]; P<.001), with an odds ratio of 3.86 (95% CI 2.18-6.81; P<.001) after adjusting for professional category and baseline knowledge, using a mixed effects logistic regression model with LTCF as a random effect. For more than two-thirds (142/203) of the participants, the feeling of playing an important role against the epidemic was the most important factor explaining their willingness to change behavior. Most of the participants unwilling to change their behavior answered that they were already applying all the guidelines. Conclusions: The serious game “Escape COVID-19” was more successful than standard IPC material in convincing LTCF employees to adopt COVID-19–safe IPC behavior. International Registered Report Identifier (IRRID): RR2-10.2196/25595 %M 33685854 %R 10.2196/27443 %U https://www.jmir.org/2021/3/e27443 %U https://doi.org/10.2196/27443 %U http://www.ncbi.nlm.nih.gov/pubmed/33685854 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25042 %T Relationship Between Coronavirus-Related eHealth Literacy and COVID-19 Knowledge, Attitudes, and Practices among US Adults: Web-Based Survey Study %A An,Lawrence %A Bacon,Elizabeth %A Hawley,Sarah %A Yang,Penny %A Russell,Daniel %A Huffman,Scott %A Resnicow,Ken %+ Center for Health Communications Research, Rogel Cancer Center, University of Michigan, North Campus Research Complex, Building 16, 2800 Plymouth Rd, Ann Arbor, MI, 48109, United States, 1 734 763 6099, lcan@med.umich.edu %K internet %K digital health %K eHealth %K eHealth literacy %K coronavirus %K COVID-19 %K knowledge %K conspiracy beliefs %K protective behaviors %K social distancing %K survey %K health communication %K attitude %K behavior %D 2021 %7 29.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During a global pandemic, it is critical that the public is able to rapidly acquire new and accurate health information. The internet is a major source of health information. eHealth literacy is the ability of individuals to find, assess, and use health information available on the internet. Objective: The goals of this study were to assess coronavirus-related eHealth literacy and examine the relationship between eHealth literacy and COVID-19−related knowledge, attitudes, and practices (KAPs). Methods: We conducted a web-based survey of a representative sample of 1074 US adults. We adapted the 8-item eHealth Literacy Scale to develop the Coronavirus-Related eHealth Literacy Scale (CoV-eHEALS) to measure COVID-19−related knowledge, conspiracy beliefs, and adherence to protective behaviors (eg, wearing facial masks and social distancing). Our analyses identified sociodemographic associations with the participants’ CoV-eHEALS scores and an association between the CoV-eHEALS measure and COVID-19 KAPs. Results: The internal consistency of the adapted CoV-eHEALS measure was high (Cronbach α=.92). The mean score for the CoV-eHEALS was 29.0 (SD 6.1). A total of 29% (306/1074) of the survey participants were classified as having low coronavirus-related eHealth literacy (CoV-eHEALS score <26). Independent associations were found between CoV-eHEALS scores and ethnicity (standardized β=–.083, P=.016 for Black participants) and education level (standardized β=–.151, P=.001 for participants with high-school education or lower). Controlling for demographic characteristics, CoV-eHEALS scores demonstrated positive independent associations with knowledge (standardized β=.168, P<.001) and adherence to protective behaviors (standardized β=.241, P<.001) and a negative association with conspiracy beliefs (standardized β=–.082, P=.009). Conclusions: This study provides an estimate of coronavirus-related eHealth literacy among US adults. Our findings suggest that a substantial proportion of US adults have low coronavirus-related eHealth literacy and are thus at a greater risk of lower and less-protective COVID-19 KAPs. These findings highlight the need to assess and address eHealth literacy as part of COVID-19 control efforts. Potential strategies include improving the quality of health information about COVID-19 available on the internet, assisting or simplifying web-based search for information about COVID-19, and training to improve general or coronavirus-specific search skills. %M 33626015 %R 10.2196/25042 %U https://www.jmir.org/2021/3/e25042 %U https://doi.org/10.2196/25042 %U http://www.ncbi.nlm.nih.gov/pubmed/33626015 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e22613 %T Acceptance of Technologies for Aging in Place: A Conceptual Model %A Jaschinski,Christina %A Ben Allouch,Somaya %A Peters,Oscar %A Cachucho,Ricardo %A van Dijk,Jan A G M %+ Research Group Technology, Health & Care, Saxion University of Applied Sciences, M.H. Tromplaan 28, Enschede, 7513AB, Netherlands, 31 6 57 81 46 14, c.jaschinski@saxion.nl %K ambient assisted living %K assistive technology %K healthy aging %K technology adoption %K theory of planned behavior %K structural equation modeling %D 2021 %7 31.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Older adults want to preserve their health and autonomy and stay in their own home environment for as long as possible. This is also of interest to policy makers who try to cope with growing staff shortages and increasing health care expenses. Ambient assisted living (AAL) technologies can support the desire for independence and aging in place. However, the implementation of these technologies is much slower than expected. This has been attributed to the lack of focus on user acceptance and user needs. Objective: The aim of this study is to develop a theoretically grounded understanding of the acceptance of AAL technologies among older adults and to compare the relative importance of different acceptance factors. Methods: A conceptual model of AAL acceptance was developed using the theory of planned behavior as a theoretical starting point. A web-based survey of 1296 older adults was conducted in the Netherlands to validate the theoretical model. Structural equation modeling was used to analyze the hypothesized relationships. Results: Our conceptual model showed a good fit with the observed data (root mean square error of approximation 0.04; standardized root mean square residual 0.06; comparative fit index 0.93; Tucker-Lewis index 0.92) and explained 69% of the variance in intention to use. All but 2 of the hypothesized paths were significant at the P<.001 level. Overall, older adults were relatively open to the idea of using AAL technologies in the future (mean 3.34, SD 0.73). Conclusions: This study contributes to a more user-centered and theoretically grounded discourse in AAL research. Understanding the underlying behavioral, normative, and control beliefs that contribute to the decision to use or reject AAL technologies helps developers to make informed design decisions based on users’ needs and concerns. These insights on acceptance factors can be valuable for the broader field of eHealth development and implementation. %M 33787505 %R 10.2196/22613 %U https://www.jmir.org/2021/3/e22613 %U https://doi.org/10.2196/22613 %U http://www.ncbi.nlm.nih.gov/pubmed/33787505 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25933 %T Voice-Based Conversational Agents for the Prevention and Management of Chronic and Mental Health Conditions: Systematic Literature Review %A Bérubé,Caterina %A Schachner,Theresa %A Keller,Roman %A Fleisch,Elgar %A v Wangenheim,Florian %A Barata,Filipe %A Kowatsch,Tobias %+ Center for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, WEV G 214, Weinbergstrasse 56/58, Zurich, 8092, Switzerland, 41 44 633 8419, berubec@ethz.ch %K voice %K speech %K delivery of health care %K noncommunicable diseases %K conversational agents %K mobile phone %K smart speaker %K monitoring %K support %K chronic disease %K mental health %K systematic literature review %D 2021 %7 29.3.2021 %9 Review %J J Med Internet Res %G English %X Background: Chronic and mental health conditions are increasingly prevalent worldwide. As devices in our everyday lives offer more and more voice-based self-service, voice-based conversational agents (VCAs) have the potential to support the prevention and management of these conditions in a scalable manner. However, evidence on VCAs dedicated to the prevention and management of chronic and mental health conditions is unclear. Objective: This study provides a better understanding of the current methods used in the evaluation of health interventions for the prevention and management of chronic and mental health conditions delivered through VCAs. Methods: We conducted a systematic literature review using PubMed MEDLINE, Embase, PsycINFO, Scopus, and Web of Science databases. We included primary research involving the prevention or management of chronic or mental health conditions through a VCA and reporting an empirical evaluation of the system either in terms of system accuracy, technology acceptance, or both. A total of 2 independent reviewers conducted the screening and data extraction, and agreement between them was measured using Cohen kappa. A narrative approach was used to synthesize the selected records. Results: Of 7170 prescreened papers, 12 met the inclusion criteria. All studies were nonexperimental. The VCAs provided behavioral support (n=5), health monitoring services (n=3), or both (n=4). The interventions were delivered via smartphones (n=5), tablets (n=2), or smart speakers (n=3). In 2 cases, no device was specified. A total of 3 VCAs targeted cancer, whereas 2 VCAs targeted diabetes and heart failure. The other VCAs targeted hearing impairment, asthma, Parkinson disease, dementia, autism, intellectual disability, and depression. The majority of the studies (n=7) assessed technology acceptance, but only few studies (n=3) used validated instruments. Half of the studies (n=6) reported either performance measures on speech recognition or on the ability of VCAs to respond to health-related queries. Only a minority of the studies (n=2) reported behavioral measures or a measure of attitudes toward intervention-targeted health behavior. Moreover, only a minority of studies (n=4) reported controlling for participants’ previous experience with technology. Finally, risk bias varied markedly. Conclusions: The heterogeneity in the methods, the limited number of studies identified, and the high risk of bias show that research on VCAs for chronic and mental health conditions is still in its infancy. Although the results of system accuracy and technology acceptance are encouraging, there is still a need to establish more conclusive evidence on the efficacy of VCAs for the prevention and management of chronic and mental health conditions, both in absolute terms and in comparison with standard health care. %M 33658174 %R 10.2196/25933 %U https://www.jmir.org/2021/3/e25933 %U https://doi.org/10.2196/25933 %U http://www.ncbi.nlm.nih.gov/pubmed/33658174 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24475 %T Benchmarking Triage Capability of Symptom Checkers Against That of Medical Laypersons: Survey Study %A Schmieding,Malte L %A Mörgeli,Rudolf %A Schmieding,Maike A L %A Feufel,Markus A %A Balzer,Felix %+ Institute of Medical Informatics, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30 450 570425, felix.balzer@charite.de %K digital health %K triage %K symptom checker %K patient-centered care %K eHealth apps %K mobile phone %K decision support systems %K clinical %K consumer health information %K health literacy %D 2021 %7 10.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Symptom checkers (SCs) are tools developed to provide clinical decision support to laypersons. Apart from suggesting probable diagnoses, they commonly advise when users should seek care (triage advice). SCs have become increasingly popular despite prior studies rating their performance as mediocre. To date, it is unclear whether SCs can triage better than those who might choose to use them. Objective: This study aims to compare triage accuracy between SCs and their potential users (ie, laypersons). Methods: On Amazon Mechanical Turk, we recruited 91 adults from the United States who had no professional medical background. In a web-based survey, the participants evaluated 45 fictitious clinical case vignettes. Data for 15 SCs that had processed the same vignettes were obtained from a previous study. As main outcome measures, we assessed the accuracy of the triage assessments made by participants and SCs for each of the three triage levels (ie, emergency care, nonemergency care, self-care) and overall, the proportion of participants outperforming each SC in terms of accuracy, and the risk aversion of participants and SCs by comparing the proportion of cases that were overtriaged. Results: The mean overall triage accuracy was similar for participants (60.9%, SD 6.8%; 95% CI 59.5%-62.3%) and SCs (58%, SD 12.8%). Most participants outperformed all but 5 SCs. On average, SCs more reliably detected emergencies (80.6%, SD 17.9%) than laypersons did (67.5%, SD 16.4%; 95% CI 64.1%-70.8%). Although both SCs and participants struggled with cases requiring self-care (the least urgent triage category), SCs more often wrongly classified these cases as emergencies (43/174, 24.7%) compared with laypersons (56/1365, 4.10%). Conclusions: Most SCs had no greater triage capability than an average layperson, although the triage accuracy of the five best SCs was superior to the accuracy of most participants. SCs might improve early detection of emergencies but might also needlessly increase resource utilization in health care. Laypersons sometimes require support in deciding when to rely on self-care but it is in that very situation where SCs perform the worst. Further research is needed to determine how to best combine the strengths of humans and SCs. %M 33688845 %R 10.2196/24475 %U https://www.jmir.org/2021/3/e24475 %U https://doi.org/10.2196/24475 %U http://www.ncbi.nlm.nih.gov/pubmed/33688845